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

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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.