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

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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.