Enhancing Tobacco Use Treatment for African American Light Smokers

描述（由申请人提供）：尽管每天吸烟少于一般人群，但非裔美国人的烟草相关发病率和死亡率风险增加。在这一竞争的延续，我们经验丰富，多学科的团队建议进行合作研究的基础上建立在城市非裔美国人吸烟者戒烟干预研究的坚实基础。我们以前的研究证明了安非他酮对中度至重度吸烟者戒烟的疗效，健康教育咨询的疗效和轻度吸烟者使用尼古丁口香糖的限制。我们计划将这些努力扩展到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变化相关的因素，以提高戒烟效果。我们的具体目标是：1）评价缓释安非他酮联合健康教育（HE）咨询对城市非裔美国人轻度吸烟者戒烟的疗效，2）通过评估表型来表征CYP2A6活性，3）通过评价表型和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）探索这些表型和基因型变量与戒烟和对安非他酮反应的关联。这项随机、安慰剂对照研究将在密苏里州堪萨斯城的Swope百老汇健康中心的社区诊所进行。主要结果是在6个月时用唾液可替宁证实的7天点戒烟率。540名（每组270名）非裔美国轻度吸烟者将被随机分配至活性安非他酮和健康教育（HE）咨询（Tx）条件或安慰剂和HE比较（C）条件。安非他酮治疗（活性药物或安慰剂）将持续7周（戒烟日期前1周，戒烟日期后6周）。所有与会者将提供六个他的会议。拟议的研究提供了一个独特的机会，以评估与药物使用和治疗结果有关的心理社会和生物机制。确定治疗最有效的个体，与此相反，确定与复发风险相关的特征，对于推进针对非裔美国人吸烟者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.