Approach Bias Retraining for Nicotine Addiction among Dual Combustible and Electronic Cigarette Users

摘要 电子烟(ECIG)的使用已经成为一种流行的尼古丁输送方式。可燃香烟(CC) 停止或减少是成年人摄取ECIG的主要原因。1-3然而，大多数CC吸烟者开始 ECig的使用没有完全从CC过渡到ECIG，尽管打算完全退出CC。4-9纵向工作 发现89%的双重用户-ECIG和CC同时使用-在初始一年后仍然是双重用户 评估。10持续的双重使用令人担忧，因为它与尼古丁使用量的增加和 11因此，双重使用者暴露在CC毒素和成分中，包括致癌物质。 与独家CC吸烟者相当的水平。12理论和经验研究结果表明， 冲动的、隐含的过程可能为物质使用的减少和停止带来希望。 再培训方法偏差，或对与兴趣实质相关的刺激的方法行动倾向，具有 对酒精使用障碍有效(即，将复发率降低10%-13%)。18-20当应用于CC- 在相关的刺激中，方法偏差再培训被发现可以减少方法偏差，这随后与 自我指导戒烟尝试后戒断CC的天数增加21 此R21应用程序将评估双重CC/ECIG用户中方法偏见再培训的初步效果。至 获得更大规模的R01后续研究的初始效应量数据，我们将使用成人随机分配90个双CC/ECIG 三种情况之一：(1)CC+ECIG再培训；(2)仅CC再培训；(3)假培训(对照)。 参与者将使用各自的刺激完成4个阶段的方法偏见再培训，然后进行 自我引导戒烟尝试戒除所有尼古丁产品。每节课由15分钟组成 电脑化方法偏见再培训和简要评估。参与者将提供基线数据、生态 干预后前两周的瞬时评估(EMA)数据，并在4-和 干预后6周。禁欲将在干预期间(0-4周)、EMA期间进行评估， 在两个后续行动中。 拟议的研究代表着将基础研究转化为战略的关键和重要的下一步 治疗双重CC/ECIG使用者的尼古丁依赖。这项调查涉及一个重要的公共卫生问题 通过测试简短的计算机化干预来解决这个问题--基础研究提供了信息--这可能会导致更有效的 对高危尼古丁使用者的治疗，同时隔离解释机制。预期的调查结果 应：(1)指导双重使用者尼古丁成瘾理论概念化和机制方面的进展 参与维护和戒除CC和ECIG；以及(2)提供简要的初始效果大小数据 干预，从而为大规模后续试验提供必要的数据。

ABSTRACT Electronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults.1-3 Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely.4-9 Longitudinal work has found that 89% of dual users—users of ECIG and CC concurrently--remain dual users a year after initial assessment.10 Continued dual use is alarming because it is associated with increased nicotine use and dependence.11 Consequently, dual users are exposed to CC toxins and constituents, including carcinogens, at levels comparable to exclusive CC smokers.12 Theory and empirical findings suggest that targeting automated, impulsive, implicit processes may hold promise for substance use reduction and cessation.13-18 Specifically, retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol use disorders (i.e., reduction in relapse rates by 10%-13%).18-20 When applied to CC- related stimuli, approach bias retraining has been found to reduce approach bias, which is subsequently related to greater number of days abstinent from CC following a self-guided quit attempt.21 This R21 application will evaluate the initial efficacy of approach bias retraining among dual CC/ECIG users. To obtain initial effect size data for a larger R01 follow-up study, we will randomly assign 90 dual CC/ECIG using adults to one of three conditions: (1) CC+ECIG retraining; (2) CC only retraining; and (3) sham training (control). Participants will complete 4 sessions of approach bias retraining using the respective stimuli and then engage in a self-guided quit attempt to abstain from all nicotine products. Each session will consist of 15 minutes of computerized approach bias retraining and a brief assessment. Participants will provide baseline data, ecological momentary assessment (EMA) data during the first two weeks post-intervention, and complete follow-ups at 4- and 6-week post-intervention. Abstinence will be assessed during the intervention (weeks 0-4), during the EMA period, and at both follow-ups. The proposed study represents a crucial and important ‘next step’ in translating basic research to strategies for treating nicotine dependence among dual CC/ECIG users. The investigation addresses an important public health issue by testing a brief computerized intervention - informed by basic research - that may lead to a more effective treatment for at-risk nicotine users while simultaneously isolating explanatory mechanisms. The expected findings should: (1) guide advances in the theoretical conceptualization of nicotine addiction for dual users and mechanisms involved in maintaining and abstaining from CC and ECIG; and (2) provide initial effect size data for a brief intervention, and thus provide the necessary data for a large-scale follow-up trial.