PFI for Smoking and Analgesic Misuse among Older Adults with HIV and Chronic Pain

描述（由申请人提供）：吸烟、慢性疼痛和处方止痛药滥用在老年艾滋病毒感染者中都非常普遍。艾滋病毒感染者的吸烟率是一般人群的三倍，老年艾滋病毒+吸烟者特别容易遭受慢性疼痛和阿片类药物滥用，部分原因是尼古丁-阿片类药物相互作用复杂。基于计算机的个性化反馈干预（PFI）作为一种提高戒烟动机和减少药物滥用的方法提供了巨大的希望，因为它们是便携式的，适应性强的，具有成本效益的，并且可以由非专业护理提供者提供给大量患者。鉴于绝大多数感染艾滋病毒的吸烟者尚未准备好戒烟，旨在增加戒烟动机和信心的研究既新颖又符合目标人群的需求。拟议研究的目标是适应和试点测试一个简短的、综合的、基于计算机的PFI，用于合并HIV和慢性疼痛的老年人，旨在增加戒烟的意图，减少滥用处方镇痛药物的意图。参与者将从纽约州立大学上州医科大学指定的艾滋病中心招募76名患有合并艾滋病毒和慢性疼痛的老年吸烟者。参与者将被随机分为主动或控制PFI状态。主动PFI将包括在HIV和衰老背景下慢性疼痛、吸烟和镇痛药物使用/滥用之间相互作用的相关内容。对照PFI将包括在艾滋病毒和衰老背景下运动、营养和药物依从性的重要性相关内容。我们假设随机分配到主动PFI的参与者（相对于控制PFI）将表现出：(1)戒烟的动机、信心和意图更大的增加；(2);对滥用处方镇痛药物的积极态度和意图有较大的下降；(3)在规范老龄化的背景下，对疼痛、吸烟和镇痛药物使用/滥用之间的相互关系的认识有了更大的提高；(4)在慢性疼痛和艾滋病毒感染的背景和过程中，对继续吸烟和滥用止痛药的潜在益处的期望大大降低。我们还假设，在慢性疼痛和艾滋病毒的背景和过程中，对继续吸烟和滥用止痛药的积极预期的降低将介导所提出的干预措施对各自吸烟和处方止痛药滥用结果的影响。通过对携带艾滋病毒和慢性疼痛的老年吸烟者进行简短和便携的干预，我们的新干预策略解决了迄今为止在研究中代表性不足的人群的关键公共卫生需求。我们预计，基于计算机的PFI将作为艾滋病毒护理环境中的“第一道防线”，并且拟议的研究将是第一个针对老年艾滋病毒+个体中吸烟和处方止痛药滥用的研究。

DESCRIPTION (provided by applicant): Tobacco smoking, chronic pain, and prescription analgesic misuse are all highly prevalent among older adults with HIV. The prevalence of smoking among persons with HIV is three times that observed in the general population, and older HIV+ smokers are particularly vulnerable to chronic pain and opioid misuse, in part due to complex nicotine-opioid interactions. Computer-based personalized feedback interventions (PFI) offer great promise as an approach to increasing motivation to quit smoking and reducing medication misuse because they are portable, adaptable, cost-effective, and can be delivered to a large number of patients by non- specialized care providers. Given that the vast majority of all smokers with HIV are not yet ready to quit smoking, research designed to increase motivation and confidence to quit smoking is both novel and consistent with the needs of the target population. The goal of the proposed study is to adapt and pilot test a brief, integrated, computer-based PFI for older adults with comorbid HIV and chronic pain aimed at increasing intentions to quit smoking and decreasing intentions to misuse prescription analgesic medications. Participants will include 76 older tobacco smokers with comorbid HIV and chronic pain, recruited from the Designated AIDS Center at SUNY Upstate Medical University. Participants will be randomized to either Active or Control PFI conditions. The Active PFI will include content relevant to interactions between chronic pain, tobacco smoking, and analgesic medication use/misuse in the context of HIV and aging. The Control PFI will include content relevant to the importance of exercise, nutrition, and medication adherence in the context of HIV and aging. We hypothesize that participants randomized to the Active PFI (relative to Control PFI) will evince: (1) a greater increase in motivation, confidence, and intention to quit smoking; (2); a greater decrease in positive attitudes and intentions toward the misuse of prescription analgesic medications; (3) a greater increase in knowledge regarding interrelations between pain, smoking, and analgesic medication use/misuse in the context of normative aging; and (4) a greater decrease in expectancies regarding the potential benefits of continued smoking and analgesic misuse in the context and course of both chronic pain and HIV. We also hypothesize that decreased positive expectancies for continued smoking and analgesic misuse in the context and course of both chronic pain and HIV will mediate the effects of the proposed intervention on respective smoking and prescription analgesic misuse outcomes. By adapting a brief and portable intervention for older smokers with HIV and chronic pain, our novel intervention strategy addresses a critical public health need in a population that has, to date, been underrepresented in research. We anticipate that a computer-based PFI will function as a "first line of defense" in HIV care settings, and the proposed study will be the first to target boh smoking and prescription analgesic misuse among older HIV+ individuals.