Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity

项目总结/摘要 吸烟是美国可预防的死亡和残疾的主要原因。中 各种精神病理学、焦虑和抑郁症状和综合征是最普遍的精神疾病 在一般人群中的条件，并与吸烟显着共病。此外，情感脆弱 吸烟者通常更依赖尼古丁，吸烟更多是为了控制负面情绪状态， 与没有这种情绪脆弱性的吸烟者相比，对他们的情绪有更大的积极影响。 解决与吸烟相关的负面影响症状和障碍的综合方法是 专注于支持情感精神病理学和吸烟的transdiagnosis过程。焦虑 敏感性（AS），或对焦虑和厌恶的内部感觉的恐惧，是一个跨诊断的脆弱性因素 焦虑症和其他情绪障碍的病因和维持。AS与 增加焦虑和情绪精神病理学的风险，并涉及吸烟维持的几个方面 和复发，包括尼古丁戒断和渴望，以及早期失效和复发的更大几率。 我们的治疗开发工作（即，第一阶段和第二阶段）支持高强度运动作为干预措施 高AS吸烟者的策略。高强度运动减少AS以及尼古丁戒断和渴望， 抑郁和焦虑，所有这些都被证明可以预测戒烟失败。我们已经证明了一个15周的 高强度运动与标准戒烟治疗相结合的干预措施（吸烟 治疗增强计划[STEP]）的戒烟率显著高于干预措施 将健康教育与标准戒烟治疗相结合。我们还表明，STEP 可在基督教青年会和戒烟热线参与的社区环境中进行调整; 在接受STEP的参与者中，是分配到控制干预的参与者的两倍。 拟议的研究旨在通过进行第三阶段研究来加强这项研究。首先，我们将研究 STEP社区版的有效性是否适用于非拉丁裔白色、黑人 拉丁裔吸烟者这一目标是根据以下意见实现的：（1）种族/族裔少数群体不太容易寻求 并接受（成功的）循证戒烟护理，但在有效性方面代表性不足 研究;（2）黑人和拉丁裔吸烟者可能会受益于特别关注提高吸烟能力， 自适应地响应STEP中的内感受性应激。第二，我们将测试假设的机制， 行动和目的是确定有效性的调节者。第三，我们将致力于确定扩大覆盖面的机会， 跨基督教青年会STEP的有效性、采用、实施和维护 框架（RE-AIM）和定性过程评估。这些目标将通过进行一次大规模的 一项随机临床试验，比较STEP与几个YMCA分支的对照干预措施， 不同种族/民族的吸烟者样本。

PROJECT SUMMARY/ABSTRACT Cigarette smoking is the leading cause of preventable death and disability in the United States. Among the various psychopathologies, anxiety and depression symptoms and syndromes are the most prevalent psychiatric conditions in the general population and are remarkably comorbid with smoking. Moreover, affective-vulnerable smokers often are more nicotine dependent, smoke more to manage negative mood states, and expect smoking to have greater positive effects on their mood compared to smokers without such affect vulnerability. An integrative approach to address negative affect symptoms and disorders associated with smoking is to focus on transdiagnostic processes that underpin both affective psychopathology and smoking. Anxiety sensitivity (AS), or the fear of anxiety and aversive internal sensations, is a transdiagnostic vulnerability factor for the etiology and maintenance of anxiety disorders and other emotional disorders. AS is associated with an increased risk of anxiety and mood psychopathology and implicated in several aspects of smoking maintenance and relapse, including nicotine withdrawal and craving and greater odds of early lapse and relapse. Our treatment development work (i.e., phases I and II) supports high-intensity exercise as an intervention strategy for smokers with high AS. High-intensity exercise reduces AS as well as nicotine withdrawal and craving, depression, and anxiety, all of which have shown to predict cessation failure. We have shown that a 15-week intervention that combines high-intensity exercise with standard smoking cessation treatment (Smoking Treatment Enhancement Program [STEP]) yields significantly higher abstinence rates relative an intervention that combines wellness education with standard smoking cessation treatment. We have also shown that STEP can be adapted for delivery in a community-based setting involving the YMCA and the Quitline; abstinence rates among participants receiving STEP were double those among participants assigned to the control intervention. The proposed study aims to build upon this research by conducting a phase III study. First, we will examine whether the efficacy of the community-based version of STEP will generalize across non-Latinx White, Black and Latinx smokers. This aim is informed by the observations that (1) racial/ethnic minorities are less apt to seek and receive (successful) evidenced-based care for smoking cessation and are underrepresented in efficacy research; and (2) Black and Latinx smokers might benefit from specific focus on increasing the ability to adaptively respond to interoceptive stress as targeted in STEP. Second, we will test putative mechanisms of actions and aim to identify moderators of efficacy. Third, we will aim to identify opportunities to improve the reach, effectiveness, adoption, implementation, and maintenance of STEP across YMCA’s using an implementation framework (RE-AIM) and qualitative process evaluation. These aims will be tested by conducting a large randomized clinical trial comparing STEP to a control intervention across several YMCA branches among a racially/ethnically diverse sample of smokers.