Mobile App for Behavioral Activation in Smoking Cessation with Elevated Depressive Symptom Smokers

在美国，吸烟是导致死亡的主要原因，每年造成超过48万人死亡，生产力损失达2780亿美元。吸烟也是导致癌症和癌症死亡的主要原因。吸烟导致肺癌、喉癌、口腔癌、膀胱癌、肝癌、肾癌、结肠癌、直肠癌和其他癌症。虽然近年来美国的吸烟率有所下降，但持续吸烟与抑郁症和抑郁症状密切相关，抑郁症患者的吸烟率保持在30-50%。抑郁症状也被证明可以预测戒烟失败。虽然尼古丁依赖治疗的临床实践指南建议需要解决心理问题，如抑郁症状升高，但缺乏经验验证的干预措施来解决这一重要的风险因素。戒烟热线是在美国提供戒烟服务的主要工具，在美国每个州都可以通过国家戒烟热线门户网站1-800-QUIT-NOW获得。然而，戒烟热线，因为他们目前存在，提供标准的行为戒烟治疗，并没有很好地装备，以有效地帮助吸烟者与条件，如共病抑郁症。事实上，最近的一项研究报告称，24%的吸烟者致电州烟草戒烟热线，抑郁症状水平显着升高，与没有抑郁症状的吸烟者相比，这些吸烟者成功戒烟的可能性显着降低。戒烟热线将从一种积极的心理社会方法中获得巨大的好处，以解决许多客户所经历的抑郁症状。虽然可行性问题限制了这些方法在标准交付方法中的使用，但它们以移动的应用程序（app）的形式的使用具有重要的前景。行为激活是一种经验支持的治疗方法，简单明了，易于理解，因此特别适合移动的平台，并与戒烟咨询系统整合。在所有研究中，行为激活对于减少阈下抑郁症患者以及重度抑郁症（MDD）患者的抑郁症状是有效的，并且它符合作为经验支持治疗的标准。本阶段I应用的目的是采用以用户为中心的设计过程，开发和测试移动的健康应用程序Act 2BSmokeFree的可接受性和有效性，该应用程序将在抑郁症状加重的吸烟者的小型随机对照试验中结合短暂的行为激活与放松应用程序Breathe 2 Relax。所有参与者都将接受戒烟咨询。该项目的预期成果是开发Act 2BSmokeFree的原型，可以在未来的随机对照试验中结合戒烟咨询进行临床疗效的II期测试。

Cigarette smoking is the leading cause of mortality in the U.S., resulting in over 480,000 deaths every year and costing $278 billion in loss of productivity. Smoking is also the leading cause of cancer and of deaths from cancer. Smoking causes cancers of the lung, larynx, mouth, bladder, liver, kidney, colon, rectum and others. While smoking rates in the U.S. have declined over recent years, continued smoking is strongly associated with both depressive disorders and depressive symptoms, with smoking rates remaining at 30-50% among individuals with depressive disorders. Depressive symptoms have also been shown to predict smoking cessation failure. While clinical practice guidelines for nicotine dependence treatment suggest the need to address psychological issues such as elevated depressive symptoms, empirically validated interventions to address this important risk factor are lacking. Tobacco quitlines are the major vehicle through which smoking cessation services are delivered in the U.S and are available in every U.S. state via a national quitline portal, 1-800-QUIT-NOW. However tobacco quitlines, as they currently exist, deliver standard behavioral smoking cessation treatment and are not well equipped to effectively help smokers with conditions such as comorbid depression. Indeed, a recent study reported that 24% of smokers calling a state tobacco quitline had a significantly elevated level of depressive symptoms and that these smokers with depressive symptoms, compared to those without, were significantly less likely to successfully quit smoking. Tobacco quitlines would derive significant benefit from an adjunctive psychosocial approach to address the depressive symptoms experienced by many of their clients. While issues of feasibility limit the use of such approaches in a standard delivery method, their use in the form of a mobile application (app) holds significant promise. Behavioral Activation is an empirically supported treatment that is straightforward, easily understood, and as such is particularly amenable to a mobile platform and to systematic integration with tobacco quitline counseling. Across studies, Behavioral Activation is effective for reducing depressive symptoms among individuals with sub threshold depression as well as individuals with major depressive disorder (MDD) and it meets the criteria to be established as an empirically supported treatment. The aims of this Phase I application are to employ user centered design processes to develop and test the acceptability and efficacy of a mobile health app, Act2BSmokeFree, which will incorporate brief Behavioral Activation vs. a relaxation app, Breathe2Relax in a small randomized controlled trial of smokers with elevated depressive symptoms. All participants will receive tobacco quitline counseling. The expected outcome of this project is the development of a prototype of Act2BSmokeFree, which can readied for Phase II testing of clinical efficacy in a future randomized controlled trial in conjunction with tobacco quitline counseling.