Personalized Smoking Relapse Prevention Delivered in Real-Time via Just-in-time Adaptive Interventions

通过及时的适应性干预措施实时提供个性化的吸烟复吸预防

• 批准号: 10319774
• 负责人: Bryan W. Heckman
• 金额: $ 18.9万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10319774
• 关键词: Abstinence; Adopted; Algorithms; Area; Attenuated; Award; Behavioral; Behavioral Sciences; Biochemical; Car Phone; Carbon Monoxide; Cellular Phone; Clinical Psychology; Clinical Research; Collaborations; Cotinine; Cues; Data; Development; Development Plans; Dose; Ecological momentary assessment; Educational workshop; Effectiveness; Ensure; Environment; Equipment; Evidence based practice; Evidence based treatment; Exposure to; Faculty; Feasibility Studies; Feedback; Funding; Global Positioning System; Goals; Grant; Health Technology; Hour; Instruction; Intervention; Journals; Knowledge; Laboratories; Location; Medical; Mentors; Mentorship; Methods; Motivation; National Institute of Drug Abuse; Nicotine; Outcome; Ownership; Participant; Patients; Peer Review; Pharmaceutical Preparations; Pharmacotherapy; Positioning Attribute; Precision Medicine Initiative; Predictive Analytics; Prevention approach; Psychiatry; Public Health; Publications; Randomized; Randomized Controlled Trials; Relapse; Research; Research Personnel; Research Training; Resources; SECTM1 gene; Schedule; Science; Self Efficacy; Self-control as a personality trait; Smoker; Smoking; Smoking Cessation Intervention; Smoking Status; South Carolina; Sterility; Strategic Planning; Structure; Technology; Testing; Therapeutic; Time; Tobacco Dependence; Tobacco smoking behavior; Training; Training Activity; Translating; United States National Institutes of Health; Universities; Visit; Withdrawal; Work; Writing; adaptive intervention; addiction; arm; base; behavioral pharmacology; career; career development; clinical efficacy; compliance behavior; coping; craving; disorder later incidence prevention; efficacy trial; evidence base; experience; follow-up; former smoker; high risk; improved; innovation; interest; intervention refinement; mHealth; member; nicotine replacement; novel; novel strategies; personalized approach; personalized intervention; personalized medicine; precision medicine; prevent; preventable death; prevention service; preventive intervention; professor; real time monitoring; recruit; relapse risk; skills; smartphone Application; smoking cessation; smoking intervention; smoking relapse; standard care; statistics; symposium; theories; therapy design; tobacco control; tool; usability

PROJECT SUMMARY/ABSTRACT Candidate: My research has been funded by the National Institute of Drug Abuse (NIDA) since 2012, first through a F31 to support my dissertation work that identified novel precipitants of smoking relapse, and then through a T32 [and K12] at the Medical University of South Carolina (MUSC) to support my work examining novel relapse prevention approaches. My research has been recognized through awards (locally and nationally) and publications in high-impact journals. I am excited to take the next step in my career development, and with K23 support I will be able to engage in the research and training experiences I need to become an expert in the emerging area of just-in-time-adaptive interventions (JITAIs) and pioneer their use in the addiction field. Career Development Plan: Career development activities build upon my clinical psychology training and twelve years of addiction-focused clinical research experience. K23 training objectives are to develop the knowledge, skills, and collaborations necessary to become a leader in the field of relapse prevention, with a focus on JITAIs. Training will be obtained through participation in scientific conferences, methods workshops, coursework, and [structured mentorship from Drs. Matthew Carpenter, Michael Cummings, David Gustafson, Andrew Lawson, Michael Saladin, and Thomas Kirchner, all of which will contribute towards the development of my expertise in]: 1) tobacco control, 2) precision medicine via mHealth technologies, 3) ecological momentary assessment (EMA), 4) geospatial statistics, 5) predictive analytics relevant to JITAIs and relapse, and 6) grant writing. These experiences will ensure research aims are met, and I will be prepared to transition to research independence. [Research Plan: We will beta test, refine (Aim 1), and pilot test (Aim 2) a personalized JITAI designed to guide delivery of fast acting nicotine replacement therapy (NRT; lozenge) in real-time, to prevent smoking relapse. Feedback from three rounds of beta testing (10 participants per round) will guide intervention refinement before it is tested in a small-scale randomized controlled trial (RCT), thereby ensuring usability, functionality, acceptability, and technical feasibility]. Specifically, a smartphone application (app), will integrate pre-quit smoking data with objective location data captured via global positioning system (GPS) to establish relapse risk (hotspot) algorithms. During a quit attempt, the GPS-enabled app (MyQuit) will detect proximity to hotspots and deliver NRT prompts, all of which will occur automatically and prior to exposure. Thus, MyQuit will optimize NRT use to prevent cue-provoked cravings known to undermine sustained abstinence, thereby repurposing this evidence-based cessation medication to promote relapse prevention. MyQuit will be tested against standard care (NRT with brief instructions). Two versions of MyQuit will be tested, which will differ only in how hotspot algorithms are derived: retrospectively from locations recalled at the onset of a quit attempt (MyQuit-Recall) or based on real-time EMA completed pre-quit (MyQuit+). We are not powered to examine clinical efficacy [(N=75)], but results will provide preliminary data to estimate effect sizes, and support a R01 submission, for a fully powered Stage II efficacy trial of these innovative approaches. We hypothesize effect sizes will suggest better outcomes (1 week, 1 month, 3 month abstinence) in both MyQuit conditions relative to standard care. We also expect MyQuit+ will outperform MyQuit-Recall, but test both because they each offer unique reach potential. MyQuit-Recall will advance the limited evidence-base for relapse prevention tools available to former smokers. Mentorship Team: All 5 mentors have external funding (3 with center grants), and collectively have over 900 publications and mentored 3 K awardees. Collaborations will result in 3-4 peer-reviewed publications per year. Environment and Institutional Commitment: The research environment, facilities, and resources at the MUSC are ideally suited for mentored career development in addiction research. An abundance of training activities are available across campus (workshops/seminars), and over 30 faculty are involved with addiction research training. I will carry out K23 activities as an Assistant Professor in the Addiction Sciences Division, within the Department of Psychiatry and Behavioral Sciences. Many of the nation's preeminent addiction researchers are members of the department, including NIH's highest funded psychiatric researcher. In FY2014 the department was ranked 8th in NIH research funding among domestic psychiatry departments. Conclusions: The need to accelerate advances in relapse prevention through technology is paramount. Smoking remains the leading cause of preventable death worldwide, and 95% of cessation attempts fail. High relapse rates are, in part, due to environmental triggers and improper NRT use. MyQuit minimizes both by guiding NRT use in anticipation of triggers. Compared to traditional interventions, tailored (idiographic) and dynamic (in- the-moment) interventions may improve effectiveness. Personalized JITAIs offer great promise for benefiting public health, and could be adopted to treat a wide range of addictive problems. The use of mHealth technology to provide idiographic and real-time treatment is consistent with NIDA's Strategic Plan and the NIH-supported Precision Medicine Initiative. K23 mentored career development will support my transition to independence, and position me to become an expert in emerging and novel approaches to addiction treatment (i.e., JITAIs).

项目摘要/摘要 候选人： 自2012年以来，我的研究一直由国家药物滥用研究所（NIDA）资助，首先， 通过F31来支持我的论文工作，确定吸烟复吸的新诱因，然后 通过南卡罗来纳州医科大学（MUSC）的T32 [和K12]来支持我的工作， 新的复发预防方法。我的研究已通过奖项（当地和国家）的认可 并在高影响力期刊上发表文章。我很高兴能在我的职业发展中迈出下一步， K23支持我将能够从事研究和培训的经验，我需要成为一个专家， 及时适应性干预（JITAIs）的新兴领域，并率先在成瘾领域使用。 职业发展计划：职业发展活动建立在我的临床心理学培训和十二 多年的成瘾临床研究经验。K23培训目标是发展知识， 技能和合作，成为复发预防领域的领导者，重点是JITAIs。 培训将通过参加科学会议、方法讲习班、课程作业和 [来自Matthew Carpenter博士，Michael Cummings，大卫古斯塔夫森，Andrew Lawson， 迈克尔·萨拉丁和托马斯·基什内尔，所有这些都将有助于我在以下方面的专业知识的发展： 1)烟草控制，2）通过移动医疗技术的精准医疗，3）生态瞬时评估（EMA）， 4)地理空间统计，5）与JITAI和复发相关的预测分析，以及6）赠款写作。这些 经验将确保研究目标得到满足，我将准备过渡到研究独立。 [研究计划：我们将测试，完善（目标1）和试点测试（目标2）个性化JITAI旨在指导 实时递送速效尼古丁替代疗法（NRT;锭剂），以防止吸烟复发。 三轮Beta测试（每轮10名参与者）的反馈将指导干预措施的改进，然后 它在小规模随机对照试验（RCT）中进行了测试，从而确保了可用性，功能性， 技术可行性和可接受性]。具体来说，一个智能手机应用程序（应用程序），将集成预退出 通过全球定位系统（GPS）获取的吸烟数据和客观位置数据，以确定复发风险 （热点）算法。在尝试退出期间，启用GPS的应用程序（MyQuit）将检测到热点的接近程度， 提供NRT提示，所有这些都将在暴露前自动发生。因此，MyQuit将优化NRT 用于防止已知会破坏持续禁欲的线索引发的渴望，从而重新利用这一点， 循证戒烟药物，以促进预防复发。MyQuit将根据标准测试 护理（NRT和简要说明）。两个版本的MyQuit将被测试，这将是唯一的不同，在如何热点 算法是：回顾性地从戒烟尝试开始时回忆的位置（MyQuit-Recall）或 基于完成退出前的实时EMA（MyQuit+）。我们没有能力检查临床疗效[（N=75）]， 但结果将提供初步数据，以估计效应量，并支持R 01提交， 这些创新方法的第二阶段有效性试验。我们假设效应量会更好地表明 结果（1周，1个月，3个月禁欲）在两个MyQuit条件相对于标准护理。我们也 我预计MyQuit+的表现会优于MyQuit-Recall，但对两者都进行了测试，因为它们都提供了独特的覆盖潜力。 MyQuit-Recall将推进前吸烟者可用的复发预防工具的有限证据基础。 导师团队：所有5名导师都有外部资金（3名获得中心赠款），总共有900多名导师。 出版物和指导3 K获奖者。合作将导致每年3-4篇同行评审的出版物。 环境和机构承诺：MUSC的研究环境，设施和资源 非常适合成瘾研究中的指导职业发展。丰富的培训活动， 整个校园提供（讲习班/研讨会），超过30名教师参与成瘾研究 训练我将在成瘾科学部担任助理教授，开展K23活动， 精神病学和行为科学系。美国许多杰出的成瘾研究人员 该部门的成员，包括国家卫生研究院最高资助的精神病研究人员。2014财年， 在美国国立卫生研究院的研究经费中，在国内精神病学部门中排名第八。 结论：通过技术加速预防复发的必要性至关重要。 吸烟仍然是全球可预防死亡的主要原因，95%的戒烟尝试失败。高 复发率部分是由于环境触发因素和NRT使用不当。MyQuit通过引导 预期触发时使用NRT。与传统的干预措施相比，定制的（具体的）和动态的（在 干预措施可以提高效率。个性化的JITAIs为受益者提供了巨大的希望 公共卫生，并可用于治疗广泛的成瘾问题。使用mHealth技术 提供具体和实时治疗是符合NIDA的战略计划和NIH支持的 精准医疗倡议。K23指导的职业发展将支持我向独立的过渡， 使我成为一名新兴和新颖的成瘾治疗方法的专家（即，JITAIs）。