A Fully Automated and Culturally-Adapted mHealth Intervention for Smoking Cessation Among Black Smokers with HIV

针对感染艾滋病毒的黑人吸烟者戒烟的全自动且适应文化的移动健康干预措施

• 批准号: 10675133
• 负责人: Ezemenari M Obasi
• 金额: $ 67.39万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-08 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675133
• 关键词: AIDS/HIV problem; Acute; Adherence; Adult; Affective; African American; Anti-Anxiety Agents; Anti-Retroviral Agents; Anxiety; Applications Grants; Behavioral; Biochemical; Black American; Black Populations; Black race; Cellular Phone; Chronic Disease; Clinical; Communities; Complex; Data; Development; Discrimination; Disease Management; Disease Outcome; Distress; Ecological momentary assessment; Education; Enrollment; Ethnic Origin; Expert Opinion; Exposure to; Feedback; Foundations; Future; General Population; Grant; HIV; HIV diagnosis; Health; Health Promotion; Individual; Intervention; Interview; Knowledge; Literature; Mediating; Mental Depression; Methods; Modeling; Morbidity - disease rate; National Cancer Institute; Nicotine; Outcome; Participant; Persons; Pharmaceutical Preparations; Pilot Projects; Play; Population Intervention; Prejudice; Process; Psychopathology; Public Health; Publishing; Quality of life; Race; Randomized; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Stress; Target Populations; Telephone; Testing; Work; addiction; anxiety sensitivity; barrier to care; base; behavioral health; behavioral health intervention; bodily sensation; cigarette smoke; cigarette smoking; community based participatory research; community clinic; contextual factors; coping; emotion regulation; evidence base; experience; follow up assessment; follow-up; health care availability; health care quality; health disparity; health inequalities; improved; low socioeconomic status; mHealth; member; mobile application; mortality; nicotine replacement; novel; novel strategies; pilot test; psychoeducation; racial discrimination; racial minority; racism; recruit; side effect; skills; smoking abstinence; smoking cessation; social health determinants; social stigma; stress symptom; stressor

ABSTRACT People with HIV/AIDS (PWH) are twice as likely to smoke cigarettes compared with the general population. Furthermore, PWH are less likely to quit smoking, likely due to the complex inter-play among co-occurring behavioral risk factors, stigma, limited resources, experiences of racism and discrimination, and diminished access to health care. Importantly, cigarette smoking is a significant risk factor for both HIV-related and non-HIV-related morbidity and mortality among PWH. Health disparities observed among smokers with HIV are compounded by the tendency for PWH to have lower socioeconomic status, lower education attainment, and lower access to healthcare. A major contributing barrier to smoking cessation and HIV disease management among Black adults with HIV appears to be their increased exposure to interoceptive-stress symptoms (e.g., anxiety, bodily sensations, stress-related burden due to racism or HIV diagnosis discrimination or stigma). Consequently, smoking cessation interventions and HIV disease management directed toward Black smokers with HIV might benefit from specific focus on increasing the ability to cope with interoceptive stress. Within this context, anxiety sensitivity (AS) is a core affective vulnerability factor that is implicated in internal distress that has emerged as a leading mechanistic target for behavioral health change. Yet, past work has not leveraged the potential of AS to better understand smoking, HIV disease management outcomes, and interoceptive stress relations among this health disparities group. The present proposal aims to refine and extend our novel, culturally adapted, and initially tested mHealth intervention that targets AS among Black smokers (MASP) to Black smokers with HIV. A total of 72 Black smokers with HIV and elevated AS will be enrolled and randomly assigned to either: (1) the smartphone-based National Cancer Institute (NCI) QuitGuide app for standard mobile smoking cessation treatment or (2) the individually tailored and automated MASP smoking cessation app for Black smokers with HIV. Participants will complete a baseline assessment, pre- and post-quit ecological momentary assessments, and follow-up assessments at weeks 1, 2 (quit date), 3, 4, 5, 6, and 28 (26 weeks post-quit) via the app as well as receive nicotine replacement therapy. A portion of participants will also complete a qualitative interview via phone at the 6-week post-baseline follow-up. This pivotal work will lay the foundation for a new approach to integrated treatment among Black smokers with HIV that has the potential to overcome barriers to treatment, reduce practitioner burden, and provide a readily available resource to support this vulnerable and underserved health disparities group.

摘要 艾滋病毒/艾滋病患者（PWH）吸烟的可能性是普通人群的两倍。 此外，PWH不太可能戒烟，可能是由于共同发生的行为之间复杂的相互作用， 风险因素、耻辱感、资源有限、种族主义和歧视经历以及获得医疗保健的机会减少。 重要的是，吸烟是艾滋病毒相关和非艾滋病毒相关发病率的一个重要危险因素， 威尔斯亲王医院的死亡率。在感染艾滋病毒的吸烟者中观察到的健康差距因以下趋势而加剧： 威尔斯亲王医院的社会经济地位较低，教育程度较低，获得医疗服务的机会较少。一个主要 在感染艾滋病毒的黑人成年人中，戒烟和艾滋病毒疾病管理的障碍似乎是 他们对内感受性应激症状的暴露增加（例如，焦虑，身体感觉，压力相关的负担， 种族主义或艾滋病毒诊断歧视或污名化）。因此，戒烟干预和艾滋病毒疾病 针对感染艾滋病毒的黑人吸烟者的管理可能会受益于特别关注提高以下能力： 科普内感受性压力在这种情况下，焦虑敏感性（AS）是一个核心的情感脆弱性因素， 与内在痛苦有关，已经成为行为健康改变的主要机制目标。然而，过去 工作没有利用AS的潜力来更好地了解吸烟，艾滋病毒疾病管理结果， 内感受性压力关系。目前的建议旨在完善和扩大我们的 一种新颖的、适应文化的、经过初步测试的移动健康干预措施，针对黑人吸烟者中的AS（MASP）， 黑人吸烟者携带艾滋病毒总共将随机招募72名患有艾滋病毒和AS升高的黑人吸烟者 分配给：（1）基于智能手机的国家癌症研究所（NCI）QuitGuide应用程序，用于标准移动的 戒烟治疗或（2）针对黑人的个性化定制和自动化MASP戒烟应用程序 吸烟者携带艾滋病毒参与者将完成基线评估，戒烟前后的生态瞬时 通过应用程序在第1、2（戒烟日期）、3、4、5、6和28周（戒烟后26周）进行评估和随访评估 以及接受尼古丁替代疗法。部分参与者还将通过以下方式完成定性访谈： 在基线后6周随访时进行电话随访。这一关键工作将为采取新的综合办法奠定基础， 艾滋病毒感染的黑人吸烟者的治疗有可能克服治疗障碍，减少医生 负担，并提供随时可用的资源，以支持这一脆弱和服务不足的健康差距群体。