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

改善非裔美国吸烟者获得戒烟治疗的机会：综合移动医疗应用程序的开发和评估

• 批准号: 10644994
• 负责人: MICHAEL J. ZVOLENSKY
• 金额: $ 61.55万
• 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/10644994
• 关键词: Abstinence; Acculturation; Address; Adult; African American; African American population; American; Anxiety; Asthma; Behavior; Biological; COVID-19 stress; Cardiovascular Diseases; Caring; Cellular Phone; Characteristics; Cigarette; Data; Development; Diagnostic; Diagnostic Factor; Discrimination; Distress; Ecological momentary assessment; Economic Burden; Emotional disorder; Enrollment; European; Evaluation; Exposure to; Feedback; Friends; Health; Improve Access; Intervention; Interview; Latinx; Maintenance; Malignant Neoplasms; Menthol; Methods; Mobile Health Application; National Cancer Institute; Nicotine Withdrawal; Outcome; Participant; Persons; Phase; Prevalence; Race; Randomized; Recording of previous events; Research; Resources; Smoker; Smoking; Smoking Cessation Intervention; Smoking treatment; Societies; Stress; Testing; Time; Tobacco; Tobacco use; Translating; United States; Withdrawal Symptom; Work; addiction; anxiety sensitivity; anxiety symptoms; bodily sensation; cancer prevention; cigarette smoking; comorbidity; coping; craving; depressive symptoms; design; disability; emotional symptom; ethnic discrimination; ethnic identity; experience; follow up assessment; health disparity; health disparity populations; improved; interest; intervention effect; mobile computing; mortality; negative mood; nicotine replacement; novel; pilot test; preventable death; programs; racial discrimination; racism; randomized, clinical trials; remote delivery; smoking cessation; smoking intervention; smoking relapse; stress symptom; success; theories; therapy design; willingness

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.

抽象的 烟草使用是可预防的死亡和残疾的主要原因，并导致巨大的经济损失 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 在社会中的分布并不均匀。非裔美国吸烟者的吸烟率较高（14.6%），并且 明显更有可能使用薄荷香烟，这与许多特定口味的负面影响有关 健康结果。此外，与其他吸烟者相比，非裔美国吸烟者维持戒烟的可能性较小。 尽管欧洲裔美国人和拉丁裔吸烟者做出了更多的戒烟尝试。一个主要促成因素 非裔美国人吸烟似乎是因为他们更容易遭受内感受应激症状。 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措施。 专注于提高对内感受压力（例如焦虑、身体感觉、 尝试戒烟期间及其后因种族主义或歧视而造成的与压力相关的负担）。值得注意的是，动机 对于那些敏感度较高的人来说，吸烟以应对负面情绪状态是吸烟的核心 对压力（即较高的焦虑敏感性 [AS]；一种成熟的可塑性、跨诊断结构 情绪症状和障碍以及吸烟的维持）。过去的工作没有利用 AS 更好地了解吸烟和内感受应激与这种既定健康之间关系的潜力 差异组。本提案旨在完善和全面文化适应经过初步测试的 针对非裔美国吸烟者的 AS 的新型移动干预（移动焦虑敏感性 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 在非洲裔美国吸烟者中，这一点得到了理论、经验证据和这一群体特征的支持。 团体。在第一阶段，我们将进一步根据非洲文化定制我们的初步测试治疗（MASP 1.0） 开发 MASP 2.0 的美国吸烟内容和历史，将在此阶段进行试点测试。在 第一阶段，25 名患有 AS 升高的非裔美国吸烟者将接受为期 6 周的 MASP 2.0。下列的 第一阶段完成后，我们将根据来自的定性和定量数据进一步完善 MASP 2.0 参与者和研究团队制作MASP 3.0。在第二阶段，200 名非裔美国吸烟者 升高的 AS 将被登记并随机分配至：(1) 基于智能手机的国家癌症中心 用于标准移动戒烟治疗的研究所 (NCI) QuitGuide 应用程序 (2) MASP 3.0。参加者 第一阶段和第二阶段将完成现场基线评估、戒烟前和戒烟后生态瞬时评估 评估、治疗结束定性访谈以及第 1、2（戒烟日）、3 周的后续评估 4、5、6、28 和 54（戒烟后 52 周）通过应用程序进行，并接受尼古丁替代疗法。