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

摘要 电子烟（ECIG）的使用已成为尼古丁输送的一种流行方法。可燃卷烟（CC） 停止或减少是成年人摄取ECIG的主要原因。1 -3然而， 尽管打算完全退出CC，但ECIG的使用并未完全从CC过渡到ECIG。4 -9纵向工作 同时使用ECIG和CC的双重用户中，有89%的人在最初使用ECIG和CC一年后仍然是双重用户。 10持续的双重使用令人担忧，因为它与尼古丁使用的增加有关， 11因此，双重使用者暴露于氯化碳毒素和成分，包括致癌物， 12理论和实证研究结果表明，针对自动化， 冲动的、隐含的过程可能为减少和停止使用药物带来希望。13 -18具体而言， 再训练接近偏差，或接近行动倾向于刺激有关的物质的兴趣， 对酒精使用障碍有效（即，复发率降低10%-13%）。 相关的刺激，接近偏差再训练已被发现，以减少接近偏差，这是随后与 自我引导戒烟后，CC戒断天数增加。21 该R21应用程序将评估双CC/ECIG用户中接近偏差再训练的初始有效性。到 为了获得更大的R 01随访研究的初始效应量数据，我们将随机分配90名使用成人的双重CC/ECIG 三种情况之一：（1）CC+ECIG再训练;（2）仅CC再训练;和（3）假训练（对照）。 参与者将使用各自的刺激完成4次接近偏差再训练，然后进行一次 自我引导戒烟尝试放弃所有尼古丁产品。每次会议将包括15分钟的 计算机化的方法偏见再培训和简短的评估。参与者将提供基线数据、生态 干预后前两周内的瞬时评估（EMA）数据，以及4周和 6-干预后一周。将在干预期间（第0-4周）、EMA期间、 在两次随访中。 这项拟议中的研究代表了将基础研究转化为战略的关键和重要的“下一步”， 治疗CC/ECIG双重使用者的尼古丁依赖。调查涉及一个重要的公共卫生问题 通过测试一个简短的计算机干预问题-由基础研究提供信息-这可能会导致更有效的 治疗有风险的尼古丁使用者，同时隔离解释机制。预期结果 应该：（1）指导双重使用者尼古丁成瘾理论概念化和机制的进展 参与维持和放弃CC和ECIG;和（2）提供简短的初始效应量数据 干预，从而为大规模的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.