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的滥用在感染艾滋病毒的老年人中都非常普遍。艾滋病毒携带者的吸烟率是普通人群的三倍，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，部分原因是复杂的尼古丁-阿片类药物相互作用。基于计算机的个性化反馈干预(PFI)作为一种增加戒烟动机和减少药物滥用的方法具有很大的前景，因为它们具有便携、适应性强、成本效益高的特点，并且可以由非专门护理提供者提供给大量患者。鉴于绝大多数携带艾滋病毒的吸烟者还没有准备好戒烟，旨在增加戒烟动力和信心的研究既新颖又符合目标人群的需求。这项拟议研究的目标是为患有艾滋病毒和慢性疼痛的老年人调整和试点测试一种简短的、集成的、基于计算机的PFI，旨在增加戒烟意图，减少滥用处方止痛药的意图。参与者将包括76名患有艾滋病毒和慢性疼痛的老年吸烟者，他们是从纽约州立大学北部医科大学指定的艾滋病中心招募的。参与者将被随机分为活动或对照PFI条件。主动PFI将包括与慢性疼痛、吸烟和在艾滋病毒和老龄化背景下使用/滥用止痛药之间的相互作用相关的内容。对照PFI将包括与锻炼、营养和在艾滋病毒和老龄化背景下坚持用药的重要性相关的内容。我们假设，被随机分配到主动PFI的参与者(相对于对照PFI)将表明：(1)戒烟动机、信心和戒烟意图有更大的提高；(2)对滥用处方止痛药的积极态度和意图有更大的下降；(3)在正常老龄化的背景下，关于疼痛、吸烟和止痛药使用/滥用之间相互关系的知识更多地增加；以及(4)对持续吸烟和滥用止痛药在慢性疼痛和HIV的背景和病程中的潜在益处的预期更大地降低。我们还假设，在慢性疼痛和HIV的背景和病程中，减少对持续吸烟和止痛药滥用的积极预期将中介拟议的干预对吸烟和处方止痛药滥用结果的影响。通过为患有艾滋病毒和慢性疼痛的老年吸烟者调整一种简短和便携的干预措施，我们的新型干预策略解决了迄今为止在研究中代表性不足的人群中的关键公共卫生需求。我们预计，以计算机为基础的PFI将在HIV护理环境中起到“第一道防线”的作用，拟议中的研究将第一次针对老年HIV+患者吸烟和滥用处方止痛药。

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.