Improving Access to Cigarette Cessation Treatment Among African American Smokers: Development and Evaluation of an Integrated mHealth Application

摘要 烟草使用是可预防的死亡和残疾的主要原因，并导致大量的经济 负担。据估计，美国13.7%的成年人是目前的吸烟者。然而，烟草的使用 在社会上分配不均。非洲裔美国吸烟者吸烟率较高(14.6%)， 明显更有可能使用薄荷醇香烟，这与一系列特定味道的负面影响有关 健康结果。此外，与非裔美国人吸烟者相比，非裔美国吸烟者保持戒烟的可能性较小 欧洲、美国和拉丁裔吸烟者，尽管戒烟尝试更多。一个主要的促成因素 非裔美国人吸烟似乎是他们暴露在内感压力症状下的增加。 因此，针对非裔美国吸烟者的戒烟干预措施可能会受益于特定的 专注于提高对内感压力(如焦虑、身体感觉、 在戒烟尝试期间及之后因种族主义或歧视造成的压力相关负担)。值得注意的是，动机 对于那些对吸烟比较敏感的人来说，吸烟是应对负面情绪状态的核心 应激(即较高的焦虑敏感度[AS]；一种公认的可延展性、跨诊断性的结构 情绪症状和障碍以及吸烟的维持)。过去的工作并没有利用 AS在更好地了解吸烟和内感应激关系方面的潜力 差异组。本提案旨在完善和全面调整一个经过初步测试的 针对非裔美国吸烟者的新型移动干预(移动焦虑敏感症 吸烟计划：MASP)。我们的干预是在内感压力的文化背景下进行的 在非裔美国人吸烟者中，这是由理论、经验证据和特征支持的 一群人。在第一阶段，我们将进一步从文化上定制我们与非洲人的初步测试治疗(MASP1.0) 美国吸烟内容和历史，以开发MASP2.0，它将在这个阶段进行试点测试。在……里面 第一阶段，25名AS升高的非裔美国吸烟者将接受为期6周的MASP2.0治疗。跟随 第一阶段完成后，我们将根据以下定性和定量数据进一步完善MASP2.0 参与者和研究团队共同制作MASP3.0。在第二阶段，200名非裔美国人吸烟者 提升的AS将被登记并随机分配给以下任一项：(1)基于智能手机的国家癌症 学会(NCI)QuitGuide应用程序用于标准的移动戒烟治疗(2)MASP3.0。参与者： 第一阶段和第二阶段将完成面对面的基线评估，在退出前和退出后的瞬间 评估，治疗结束定性访谈，以及在第1、2周(戒烟日期)、3周、 4、5、6、28和54(戒烟后52周)，并接受尼古丁替代治疗。

ABSTRACT Tobacco use is the leading cause of preventable death and disability and results in substantial economic burden. Estimates suggest that 13.7% of adults in the United States (US) are current smokers. Yet, tobacco use is not equally distributed in society. African American smokers evince elevated smoking rates (14.6%) and are significantly more likely to use menthol cigarettes, which are associated with a host of flavor-specific negative health outcomes. Additionally, African American smokers are less likely to maintain cessation compared to European American and Latinx smokers despite making more quit attempts. A major contributing factor to smoking among African Americans appears to be their increased exposure to interoceptive-stress symptoms. Consequently, cessation interventions directed toward African American smokers might benefit from specific focus on increasing the ability to adaptively respond to interoceptive stress (e.g., anxiety, bodily sensations, stress-related burden due to racism or discrimination during a quit attempt and thereafter). Notably, motives for smoking to cope with negative mood states are central to cigarette use among those with greater sensitivity to stress (i.e., higher anxiety sensitivity [AS]; a well-established malleable, transdiagnostic construct for emotional symptoms and disorders and the maintenance of smoking). Past work has not leveraged the potential of AS to better understand smoking and interoceptive stress relations among this established health disparities group. The present proposal aims to refine and comprehensively culturally adapt an initially tested novel, mobile intervention that targets AS among African American smokers (Mobile Anxiety Sensitivity Program for Smoking: MASP). Our intervention is framed within the cultural context of interoceptive stress among African American smokers, which is supported by theory, empirical evidence, and characteristics of this group. In Phase I, we will further culturally tailor our preliminarily test treatment (MASP 1.0) with African American-smoking content and history to develop MASP 2.0, which will be pilot tested during this phase. In Phase I, 25 African American smokers with elevated AS will be administered MASP 2.0 for 6 weeks. Following completion of Phase I, we will further refine MASP 2.0 based on qualitative and quantitative data from participants and the research team to produce MASP 3.0. In Phase II, 200 African American smokers with 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 (2) MASP 3.0. Participants in Phase I and Phase II will complete an in-person baseline assessment, pre- and post-quit ecological momentary assessments, an end-of-treatment qualitative interview, and follow-up assessments at weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (52 weeks post-quit) via the app as well as receive nicotine replacement therapy.