Integrated Treatment for Smoking Cessation & Anxiety in People with HIV

戒烟综合治疗

• 批准号: 8470608
• 负责人: Conall Michael O'Cleirigh
• 金额: $ 24.53万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8470608
• 关键词: Abstinence; Address; Adult; Affect; Anxiety; Anxiety Disorders; Arousal; Attention; Bacterial Pneumonia; Basic Science; Behavior Therapy; Behavioral; Cause of Death; Cessation of life; Chronic Obstructive Airway Disease; Clinical; Cognitive Therapy; Collaborations; Depressed mood; Development; Disease; Feedback; Fright; Goals; Guidelines; HIV; Health; Individual; Interdisciplinary Study; Intervention; Lead; Life; Link; Literature; Maintenance; Manuals; Mediator of activation protein; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Nicotine Dependence; Outcome; Panic; Participant; Persons; Phase; Physicians; Population; Predisposition; Prevalence; Procedures; Professional counselor; Psychologist; Public Health; Randomized Controlled Trials; Relapse; Research; Research Personnel; Research Proposals; Risk; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Staging; Symptoms; Testing; Time; Translating; United States; United States National Institutes of Health; Vulnerable Populations; Withdrawal Symptom; Withholding Treatment; arm; base; cigarette smoking; clinically significant; depressive symptoms; design; disability; health related quality of life; high risk; improved; innovation; mortality; neglect; nicotine replacement; novel; primary outcome; programs; psychosocial; smoking cessation; smoking intervention; smoking relapse; standard care; success; therapy development; treatment effect

DESCRIPTION (provided by applicant): Cigarette smoking is the leading cause of death and disability in the United States (U.S.), contributing to over 440,000 deaths each year. Still, over 40 million adults in the U.S. currently smoke despite well-established links to morbidity and mortality. Studies suggest HIV+ adults are at a higher risk for being current smokers and that quitting smoking may be particularly difficult for individuals with anxiety problems. Although panic and related anxiety disorders frequently co-occur with smoking and are prevalent among persons living with HIV, there has been very little attention given to improving cessation outcome among this high-risk group of HIV+ smokers. This neglect sits on the backdrop of a larger issue in the smoking cessation literature: a general lack of innovation in efficacious psychosocial treatments for nicotine dependence, particularly among persons living with HIV. Researchers have frequently called attention to the links across smoking and anxiety-related states. Recent evidence suggests that anxiety disorders and related anxiety vulnerability factors, specifically anxiety sensitivity (or fear of somatic arousal), negatively impact cessation. These findings indicate that there is clinical and theoretical merit to targeting anxiety symptoms among HIV+ smokers to improve cessation outcomes. A growing body of work suggests that anxiety disorders can be effectively treated with transdiagnostic cognitive behavioral treatment (CBT). Accordingly, we are proposing a 3-year study to develop an integrated treatment for smoking cessation for anxiety-vulnerable HIV+ smokers. The intervention development approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions, with the proposed research representing a Stage IB study. Specifically, during the first year, startup activities will include piloting the integrated intervention on a subset of individuals (N = 12), soliciting internal and external expert consultant and participant feedback, and development of the final treatment manual and procedures. The goal during this phase will be to establish feasibility of treatment delivery, participant acceptability, and potential for an effect. During the following two years, a small two-arm efficacy study (N = 60) will be undertaken comparing the new intervention to a control intervention. This study represents an important step in the larger landscape of translating basic research to more efficacious strategies for treating nicotine dependence in HIV. This study addresses an important public health issue by assessing an intervention that may lead to a more effective application for the treatment of at-risk HIV+ smokers. The expected findings should: (1) Guide advances in the theoretical conceptualization of the mechanisms involved in HIV-anxiety-smoking relations. (2) Directly inform the development of a novel and psychosocial/behavioral and pharmacological smoking cessation intervention(s) for HIV+ smokers with anxiety disorders. This is an interdisciplinary research proposal that involves collaboration between clinical psychologists, physicians, and mental health/HIV counselors.

描述（由申请人提供）：吸烟是美国 (U.S.) 死亡和残疾的主要原因，每年导致超过 440,000 人死亡。尽管如此，尽管吸烟与发病率和死亡率之间存在明确的联系，但目前美国仍有超过 4000 万成年人吸烟。研究表明，艾滋病病毒感染者目前吸烟的风险更高，对于有焦虑问题的人来说，戒烟可能尤其困难。尽管恐慌和相关的焦虑症经常与吸烟同时发生，并且在艾滋病毒感染者中普遍存在，但人们很少关注改善这一高危艾滋病毒+吸烟者群体的戒烟结果。这种忽视是戒烟文献中一个更大问题的背景：针对尼古丁依赖的有效心理社会治疗普遍缺乏创新，特别是在艾滋病毒感染者中。研究人员经常呼吁人们关注吸烟与焦虑相关状态之间的联系。最近的证据表明，焦虑症和相关的焦虑脆弱因素，特别是焦虑敏感性（或对躯体唤醒的恐惧），会对戒烟产生负面影响。这些发现表明，针对艾滋病病毒感染者吸烟者的焦虑症状以改善戒烟结果具有临床和理论价值。越来越多的研究表明，跨诊断认知行为治疗（CBT）可以有效治疗焦虑症。 因此，我们提议开展一项为期 3 年的研究，为易患焦虑症的 HIV+ 吸烟者开发一种综合戒烟治疗方法。干预开发方法将遵循与 NIH 指导方针一致的分阶段模型，用于开发和标准化行为干预，拟议的研究代表 IB 阶段研究。具体来说，第一年的启动活动将包括对一小部分人（N = 12）进行综合干预试点，征求内部和外部专家顾问和参与者的反馈，以及制定最终的治疗手册和程序。此阶段的目标是确定治疗实施的可行性、参与者的可接受性以及效果的潜力。在接下来的两年中，将进行一项小型双臂疗效研究（N = 60），将新干预措施与对照干预措施进行比较。这项研究代表了将基础研究转化为治疗艾滋病毒尼古丁依赖的更有效策略的重要一步。 这项研究通过评估可能导致更有效地治疗高危艾滋病毒+吸烟者的干预措施来解决一个重要的公共卫生问题。预期的结果应该：（1）指导艾滋病毒-焦虑-吸烟关系机制的理论概念化进展。 (2) 直接为针对患有焦虑症的 HIV + 吸烟者制定新型心理社会/行为和药物戒烟干预措施提供信息。这是一项跨学科研究计划，涉及临床心理学家、医生和心理健康/艾滋病毒咨询师之间的合作。

项目成果

Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: a longitudinal analysis of data from six sites involved in a "prevention for positives" study.

• DOI: 10.1007/s10461-013-0462-8
• 发表时间: 2013-06
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: O'Cleirigh, Conall;Newcomb, Michael E.;Mayer, Kenneth H.;Skeer, Margie;Traeger, Lara;Safren, Steven A.
• 通讯作者: Safren, Steven A.

Characteristics and Correlates of Tobacco Use in a Community Sample of Sexual Minority Men and Women: Implications for Smoking Cessation Program Development.

性少数群体男性和女性社区样本中烟草使用的特征和相关性：对戒烟计划制定的影响。

• DOI: 10.1089/lgbt.2016.0157
• 发表时间: 2018
• 期刊: LGBT health
• 影响因子: 4.8
• 作者: O'Cleirigh,Conall;Elsesser,StevenA;King,Dana;Ehlinger,PeterP;Bradford,JudithB;Grasso,Chris;Mayer,KennethH
• 通讯作者: Mayer,KennethH

A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation.

• DOI: 10.1080/09540121.2018.1533225
• 发表时间: 2019-05
• 期刊: AIDS care
• 影响因子: 1.7
• 作者: Labbe AK;Wilner JG;Coleman JN;Marquez SM;Kosiba JD;Zvolensky MJ;Smits JAJ;Norton PJ;Rosenfield D;O'Cleirigh C
• 通讯作者: O'Cleirigh C