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， 负担据估计，美国13.7%的成年人目前是吸烟者。然而，烟草使用 在社会中并不是平均分布的。非裔美国人吸烟率升高（14.6%）， 更有可能使用薄荷醇香烟，这与一系列特定口味的负面影响有关。 健康成果。此外，非裔美国人吸烟者不太可能保持戒烟相比， 欧洲裔美国人和拉丁裔吸烟者尽管有更多的戒烟尝试。的一个主要因素 非裔美国人吸烟似乎是他们增加了内感受性压力症状的暴露。 因此，针对非裔美国人吸烟者的戒烟干预可能会受益于特定的 专注于增加适应性地响应内感受性应激的能力（例如，焦虑，身体感觉 在戒烟尝试期间及之后，由于种族主义或歧视造成的压力相关负担）。值得注意的是， 对于那些更敏感的人来说，吸烟是科普消极情绪状态的关键 为了强调（即，更高的焦虑敏感性[AS];一个建立良好的可塑性，transdiagnosis结构， 情绪症状和障碍以及维持吸烟）。过去的工作没有利用 AS的潜力，以更好地了解吸烟和内感受性压力之间的关系，这建立健康 差异组。目前的建议旨在完善和全面的文化适应初步测试 一种新的，移动的干预措施，针对非裔美国人吸烟者的AS（移动的焦虑敏感性 吸烟计划（MASP）。我们的干预是在内感受压力的文化背景下进行的 在非裔美国人吸烟者中，这得到了理论，经验证据和这种吸烟者的特征的支持。 组在第一阶段，我们将进一步在文化上调整我们的初步试验治疗（MASP 1.0）， 美国吸烟的内容和历史，以开发MASP 2.0，这将是试点测试在这一阶段。在 I期，25名具有升高的AS的非裔美国吸烟者将施用MASP 2.0持续6周。以下 在第一阶段完成后，我们将根据以下方面的定性和定量数据进一步完善MASP 2.0： 参与者和研究团队共同制作MASP 3.0。在第二阶段，200名非裔美国吸烟者， 将入选AS升高的患者，并随机分配至：（1）基于智能手机的国家癌症研究所（National Cancer 研究所（NCI）QuitGuide应用程序，用于标准移动的戒烟治疗（2）MASP 3.0。参与者 第一阶段和第二阶段将完成一个人的基线评估，戒烟前后的生态瞬间 评估、治疗结束定性访谈和第1、2（戒烟日期）、3、 4、5、6、28和54（戒烟后52周）通过应用程序以及接受尼古丁替代疗法。

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.