Developing a Smartphone App with Mindfulness Training for Teen Smoking Cessation

描述(由申请人提供)：新的卫生局局长报告(SGR)《预防青年和青年烟草使用》强调尼古丁的成瘾性质，并强调需要为超过360万吸烟的青年提供有效和可获得的戒烟治疗。本申请是对PA-13-078，行为和综合治疗发展计划(R34)的响应，该计划支持针对药物滥用的行为干预措施的开发和测试，包括侧重于干预措施的产生和完善(IA阶段)和试点或可行性(IB阶段)的研究，以及旨在“通过创造性地使用技术提高干预措施的可实施性”的研究。我们开发了戒烟渴望(C2Q)，这是一种针对成人戒烟的智能手机干预，将正念训练(MT)整合到戒烟课程中。虽然MT已被证明对成人戒烟有效，但尚未在青少年中进行测试。此外，MT的推广具有挑战性，因为需要有经验的MT治疗师，对时间的需求很高，安排会议的难度很大，以及面对面治疗的高成本。移动、智能手机技术为克服这些传播障碍提供了一个很有前途的媒介。我们建议调整和完善我们现有的戒烟渴望(C2Q)应用程序，以供青少年吸烟者使用(IA阶段)，并进行可行性和试点测试(IB阶段)，为R01应用程序进行最终测试做准备 MT的疗效及改变的心理机制探讨。在试点测试中，六所公立高中将被随机分配到三种条件之一，每种条件两所学校：(1)C2Q-Teen应用程序(通过MT通过智能手机应用程序提供戒烟服务)，(2)NCI为青少年吸烟者设计的QuitStart应用程序(NCI-QS)(通过智能手机应用程序提供戒烟服务，而不使用MT)，或(3)仅提供书面戒烟材料(MO)。144名有意戒烟的青少年吸烟者将被招募(24名/学校，48名/条件)。学校护士将在学校环境中介绍这三种干预措施。我们的首要目标是让C2Q应用程序适应青少年吸烟者(C2Q-Teen)的使用。我们的第二个主要目标是评估干预措施的可行性和可接受性，以确保每项干预措施对专门为比较有效率而设计的更大规模的随机对照试验具有充分性。次要目标是在3个月和6个月的随访中评估三种干预措施的相对有效性以及智能手机干预交付和正念在增加可替宁验证的7天点戒断发生率方面的独立贡献，以便为更大规模的试验提供足够的支持，并确定C2Q-Teen使用和禁欲之间的关系。如果最终被发现有效，C2Q-Teen为支持青少年戒烟努力提供了一种创新的、潜在的强大干预措施，相对容易广泛传播，并具有巨大的公共卫生意义，满足了SGR关于为想要戒烟的青少年吸烟者提供便捷治疗的呼吁。

DESCRIPTION (provided by applicant): The new Surgeon General's Report (SGR), Preventing Tobacco Use Among Youth and Young Adults, highlights the addictive nature of nicotine and emphasizes the need for effective and accessible cessation treatment for the more than 3.6 million youth who smoke. This application is in response to PA-13-078, Behavioral and Integrative Treatment Development Program (R34), which supports the development and testing of behavioral interventions targeting substance abuse, including studies focused on Intervention generation and refinement (Stage IA), and pilot or feasibility (Stage IB), and research designed to "increase implementability of interventions with creative use of technology". We have developed Craving to Quit (C2Q), a smartphone intervention for smoking cessation for adults that integrates mindfulness training (MT) into a smoking cessation curriculum. While MT has been shown to be efficacious for smoking cessation in adults, it has not been tested in adolescents. In addition, dissemination of MT is challenging due to the need for experienced MT therapists, high time demand, difficulties in scheduling sessions, and high costs of in-person treatment delivery. Mobile, smartphone technologies provide a promising medium for overcoming these barriers to dissemination. We propose to adapt and refine our existing Craving to Quit (C2Q) app for use by adolescent smokers (Stage IA), and to conduct feasibility and pilot testing (Stage IB) in preparation for an R01 application to definitively test efficacy and probe psychological mechanisms of change resulting from MT. In the pilot test, six public high schools will be randomly assigned to one of three conditions, two schools per condition: (1) C2Q-Teen app (smoking cessation delivered through a smartphone app via MT), (2) NCI's QuitSTART app designed for teen smokers (NCI-QS) (smoking cessation delivered through a smartphone app without MT), or (3) written smoking cessation materials only (MO). One hundred forty four adolescent smokers interested in quitting will be recruited (24/school, 48/condition). School nurses will introduce the three interventions in the school setting. Our firs primary aim is to adapt the C2Q app for use by adolescent smokers (C2Q-Teen). Our second primary aim is to evaluate the feasibility and acceptability of the interventions to ensure adequacy of each intervention for a larger RCT designed specifically to compare efficacy rates. Secondary aims are to assess relative efficacy of the three interventions and independent contributions of smartphone intervention delivery and mindfulness in increasing cotinine-validated 7-day point prevalence abstinence at 3- and 6-month follow-up in order to adequately power a larger trial, and to determine the relationship between C2Q-Teen usage and abstinence. If eventually found to be effective, C2Q-Teen offers an innovative and potentially powerful intervention for supporting teens in their efforts to quit that would be relatively easy t disseminate widely and have tremendous public health significance, addressing the SGR's call for readily available treatment for adolescent smokers wanting to quit.