Reducing socioeconomic disparities in tobacco dependence treatment outcomes

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DESCRIPTION (provided by applicant): Tobacco use is a leading contributor to racial and socioeconomic health disparities in the US primarily due to an unequal burden of tobacco-related disease from a disproportionate share of smokers in lower socioeconomic (SES) groups in which minorities, particularly African Americans, are disproportionately represented.1-5 Although deemed effective for all smokers,6 the standard cognitive-behavioral treatment for tobacco dependence is significantly less effective for lower SES smokers.7-15 Tobacco dependence treatment, however, has the potential to reduce racial and socioeconomic disparities in achieving long-term abstinence by proactively providing our most at-risk smokers with the specific treatment components they need to achieve abstinence through the existing extensive treatment delivery system.16, 17 Our preliminary studies indicate that in addition to several socio-cultural barriers to engaging in treatment,18 there are several key factors associated with socioeconomic disparities in relapse rates and thus treatment outcomes. These factors include: stress, negative affect, smoking in response to negative affect, delay discounting, locus of control, impulsiveness, exposure to smokers in the environment, and treatment utilization (see Table 1).19, 20 Based on this and other evidence, our overall goal is to revise the standard treatment with specific, evidence-based, cognitive-behavioral strategies to address these key factors as well as target and tailor the approach to more fully meet the needs of lower SES and minority smokers, thereby reducing treatment outcome disparities. We expect: 1) The revised treatment (RT) to reduce socioeconomic disparities in treatment outcomes, and 2) Participants treated with the RT to demonstrate more improvement on each of the key factors associated with disparities than those treated with standard treatment (ST). The specific aims include: 1) Complete a revised draft of a widely utilized standard treatment manual that addresses each of the key factors with treatment components. This aim is partially accomplished (see Appendix for preliminary draft). 2) Using the PEN-3 Model,21-23 target and tailor the daft RT to more fully represent the experiences of smokers who are of lower SES and /or of minority status, particularly African American smokers. 3) Pilot test the targeted/tailored draft RT with three treatment groups (n=5-10 per group) to assess understandability and acceptability and to ensure that it can be delivered in the same timeframe as the ST. 4) Compare the effects of SES on treatment outcomes with socioeconomically and racially diverse participants treated with ST (n=110) and RT (n=110) in a randomized treatment design. 5) Compare the effects of treatment condition on each of the key factors. This innovative approach refines, improves upon, and applies theoretically derived and empirically supported concepts and strategies. If effective at reducing treatment outcome disparities, the manual-driven RT will be easily disseminable as a "new" standard, having a sustained and powerful impact on the field and contributing to a reduction in the magnitude of the present tobacco-related racial and socioeconomic health disparities.