Enhancing Tobacco Use Treatment for African American Light Smokers

描述（由申请人提供）：尽管非裔美国人每天吸烟少于普通人群，但他们与烟草相关的发病率和死亡率的风险增加。在这种竞争的延续中，我们经验丰富的多学科团队建议在城市非裔美国吸烟者戒烟干预研究的坚实基础上进行合作研究。我们之前的研究证明了安非他酮对中度至重度吸烟者的戒烟效果，健康教育咨询的效果以及轻度吸烟者使用尼古丁口香糖的局限性。我们计划扩展这些努力，以进一步评估吸烟行为和生物行为干预，并探索与药物活性和行为改变相关的因素，以提高戒烟结果。我们的具体目标是：1)评估缓释安非他酮联合健康教育（HE）咨询对城市非裔美国轻度吸烟者戒烟的疗效；2)通过评估表型（3HC/可替宁比率）和CYP2A6基因型来表征CYP2A6活性；3)通过评估表型和CYP2B6基因型来表征CYP2B6活性，以评估尼古丁和安非他酮代谢物水平。4)探讨这些表型和基因型变量与戒烟和安非他酮反应的关系。这项随机、安慰剂对照的研究将在密苏里州堪萨斯城的Swope Parkway健康中心的社区诊所进行。主要结局是在6个月时用唾液可替宁证实戒烟7天。540名非裔美国轻度吸烟者（每组270人）将被随机分配到积极的安非他酮和健康教育（HE）咨询（Tx）组或安慰剂和HE比较(C)组。安非他酮治疗（有效或安慰剂）将持续7周（戒烟前一周，戒烟后六周）。所有参与者将参加六次高等教育课程。拟议的研究提供了一个独特的机会来评估与药物使用和治疗结果相关的社会心理和生物学机制。确定治疗最有效的个体，相反，确定与复发风险相关的特征，对于推进针对非裔美国吸烟者的量身定制的烟草使用治疗和健康促进至关重要。

DESCRIPTION (provided by applicant): African Americans are at increased risk for tobacco related morbidity and mortality despite smoking fewer cigarettes per day than the general population. Within this competing continuation, our experienced, multidisciplinary team proposes to conduct collaborative research building upon a strong foundation of smoking cessation intervention studies among urban African American smokers. Our previous research demonstrated efficacy of bupropion for smoking cessation among moderate to heavy smokers, efficacy of health education counseling and limitations in nicotine gum use among light smokers. We plan to extend these efforts to further evaluate smoking behavior and biobehavioral interventions and to explore factors associated with drug activity and behavior change with the goal of enhancing abstinence outcomes. Our specific objectives are to 1) evaluate the efficacy of sustained release bupropion in combination with health education (HE) counseling for smoking cessation among urban African American light smokers, 2) characterize CYP2A6 activity by evaluating phenotype (3HC/cotinine ratio ) and CYP2A6 genotype, 3) characterize CYP2B6 activity by evaluating phenotype and CYP2B6 genotype to assess nicotine and bupropion metabolite levels, 4) explore associations of these phenotypic and genotypic variables with smoking cessation and response to bupropion. This randomized, placebo-controlled study will be conducted at a community-based clinic, Swope Parkway Health Center in Kansas City, Missouri. The primary outcome is 7-day point prevalence smoking abstinence at 6 months confirmed with salivary cotinine. Five hundred forty (270 in each arm) African American light smokers will be randomly assigned to an active bupropion and health education (HE) counseling (Tx) condition or to a placebo and HE comparison (C) condition. Bupropion treatment (active or placebo) will last for 7 weeks (one week prior to quit date, six weeks post quit date). All participants will be offered six HE sessions. The proposed research provides a unique opportunity to evaluate psychosocial and biological mechanisms related to drug use and treatment outcomes. Identifying individuals for whom treatments are most effective and, in contrast, identifying characteristics related to relapse risk will be critical to advancing tailored tobacco use treatment and health promotion for African American smokers.