Reducing socioeconomic disparities in tobacco dependence treatment outcomes

描述（申请人提供）：烟草使用是造成美国种族和社会经济健康差异的主要因素，主要是由于低社会经济（SES）群体中吸烟者比例不成比例，造成烟草相关疾病的不平等负担，其中少数民族，特别是非洲裔美国人，不成比例。6烟草依赖的标准认知行为治疗对于SES较低的吸烟者效果明显较差。7 -15然而，有可能减少种族和社会经济差异，实现长期禁欲，积极提供我们最-风险吸烟者通过现有的广泛治疗提供系统获得戒烟所需的特定治疗成分。16，17我们的初步研究表明，除了参与治疗的几个社会文化障碍外，18有几个关键因素与复发率和治疗结果的社会经济差异有关。这些因素包括：压力、负面影响、对负面影响的反应性吸烟、延迟折扣、控制点、冲动、环境中吸烟者的暴露和治疗利用（见表1）。19，20基于此和其他证据，我们的总体目标是 用具体的、基于证据的认知行为策略来修改标准治疗，以解决这些关键因素，并针对性地调整方法，以更充分地满足低SES和少数吸烟者的需求，从而减少治疗结果的差异。我们期望：1）修订的治疗（RT），以减少治疗结果的社会经济差异，2）与标准治疗（ST）相比，接受RT治疗的参与者在与差异相关的每个关键因素上都有更多的改善。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，该手册涉及治疗组成部分的每个关键因素。这一目标已部分实现（初稿见附录）。2)使用PEN-3模型，21-23针对并调整了愚蠢的RT，以更充分地代表社会经济地位较低和/或少数民族的吸烟者，特别是非裔美国人吸烟者的经历。3)用三个治疗组（每组n=5-10）对目标/定制的草案RT进行初步测试，以评估可理解性和可接受性，并确保其可以在与ST相同的时间范围内进行。4）在随机治疗设计中，将SES对用ST（n=110）和RT（n=110）治疗的社会经济和种族多样性参与者的治疗结果的影响进行比较。5)比较处理条件对各关键因素的影响。这种创新的方法提炼，改进，并应用理论推导和经验支持的概念和战略。如果能有效减少治疗结果的差异，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.