Reducing socioeconomic disparities in tobacco dependence treatment outcomes

说明(申请人提供)：烟草使用是美国种族和社会经济健康差距的主要因素，主要是由于较低社会经济(SES)群体中吸烟者所占比例不成比例造成的与烟草相关的疾病负担不成比例。1-5尽管认为对所有吸烟者有效，6烟草依赖的标准认知行为疗法对较低的SES吸烟者有效。7-15然而，烟草依赖治疗，16、17我们的初步研究表明，除了在进行治疗方面存在若干社会文化障碍外，18在复发率和治疗结果方面存在若干与社会经济差异有关的关键因素。这些因素包括：压力，负面情绪，吸烟对负面情绪的反应，延迟折扣，控制点，冲动，暴露在环境中的吸烟者，以及治疗利用(见表1)。19，20基于这一证据和其他证据，我们的总体目标是 用具体的、以证据为基础的认知-行为策略修订标准治疗，以解决这些关键因素，并针对和定制方法，以更充分地满足较低SES和少数吸烟者的需求，从而减少治疗结果差异。我们期望：1)修订的治疗(RT)将减少治疗结果中的社会经济差异，2)接受RT治疗的参与者在与差异相关的每个关键因素上比标准治疗(ST)治疗的参与者表现出更多的改善。具体目标包括：1)完成一份广泛使用的标准治疗手册的修订草案，该手册涉及治疗组件的每一个关键因素。这一目标已部分实现(初稿见附录)。2)使用PEN-3模型，21-23目标和定制愚蠢的RT，以更全面地代表较低SES和/或少数族裔地位的吸烟者，特别是非裔美国吸烟者的经历。3)与三个处理组(每组n=5-10)试行有针对性的/量身定制的RT草案，以评估可理解性和可接受性，并确保其能够在与ST相同的时间框架内交付。4)在随机试验设计中，比较社会经济和种族不同的参与者接受ST(n=110)和RT(n=110)治疗的SES对治疗结果的影响。5)比较治疗条件对各关键因素的影响。这一创新方法完善、改进并应用了理论推导和经验支持的概念和策略。如果在减少治疗结果差异方面有效，人工驱动的RT将很容易作为一种“新”标准传播，对该领域产生持续和强大的影响，并有助于减少目前与烟草有关的种族和社会经济健康差异的严重程度。

DESCRIPTION (provided by applicant): Tobacco use is a leading contributor to racial and socioeconomic health disparities in the US primarily due to an unequal burden of tobacco-related disease from a disproportionate share of smokers in lower socioeconomic (SES) groups in which minorities, particularly African Americans, are disproportionately represented.1-5 Although deemed effective for all smokers,6 the standard cognitive-behavioral treatment for tobacco dependence is significantly less effective for lower SES smokers.7-15 Tobacco dependence treatment, however, has the potential to reduce racial and socioeconomic disparities in achieving long-term abstinence by proactively providing our most at-risk smokers with the specific treatment components they need to achieve abstinence through the existing extensive treatment delivery system.16, 17 Our preliminary studies indicate that in addition to several socio-cultural barriers to engaging in treatment,18 there are several key factors associated with socioeconomic disparities in relapse rates and thus treatment outcomes. These factors include: stress, negative affect, smoking in response to negative affect, delay discounting, locus of control, impulsiveness, exposure to smokers in the environment, and treatment utilization (see Table 1).19, 20 Based on this and other evidence, our overall goal is to revise the standard treatment with specific, evidence-based, cognitive-behavioral strategies to address these key factors as well as target and tailor the approach to more fully meet the needs of lower SES and minority smokers, thereby reducing treatment outcome disparities. We expect: 1) The revised treatment (RT) to reduce socioeconomic disparities in treatment outcomes, and 2) Participants treated with the RT to demonstrate more improvement on each of the key factors associated with disparities than those treated with standard treatment (ST). The specific aims include: 1) Complete a revised draft of a widely utilized standard treatment manual that addresses each of the key factors with treatment components. This aim is partially accomplished (see Appendix for preliminary draft). 2) Using the PEN-3 Model,21-23 target and tailor the daft RT to more fully represent the experiences of smokers who are of lower SES and /or of minority status, particularly African American smokers. 3) Pilot test the targeted/tailored draft RT with three treatment groups (n=5-10 per group) to assess understandability and acceptability and to ensure that it can be delivered in the same timeframe as the ST. 4) Compare the effects of SES on treatment outcomes with socioeconomically and racially diverse participants treated with ST (n=110) and RT (n=110) in a randomized treatment design. 5) Compare the effects of treatment condition on each of the key factors. This innovative approach refines, improves upon, and applies theoretically derived and empirically supported concepts and strategies. If effective at reducing treatment outcome disparities, the manual-driven RT will be easily disseminable as a "new" standard, having a sustained and powerful impact on the field and contributing to a reduction in the magnitude of the present tobacco-related racial and socioeconomic health disparities.