Mobile App for Behavioral Activation in Smoking Cessation with Elevated Depressive Symptom Smokers

在美国，吸烟是导致死亡的主要原因，每年导致超过48万人死亡，并造成2780亿美元的生产力损失。吸烟也是癌症和癌症死亡的主要原因。吸烟会导致肺癌、喉癌、口腔癌、膀胱癌、肝癌、肾癌、结肠癌、直肠癌和其他癌症。尽管美国的吸烟率近年来有所下降，但持续吸烟与抑郁障碍和抑郁症状密切相关，抑郁障碍患者的吸烟率保持在30%-50%。抑郁症状也被证明可以预测戒烟失败。虽然尼古丁依赖治疗的临床实践指南建议需要解决抑郁症状增加等心理问题，但缺乏经验证的干预措施来解决这一重要的风险因素。戒烟热线是在美国提供戒烟服务的主要工具，在美国每个州都可以通过全国戒烟热线门户网站1-800-QUIT-NOW获得。然而，目前存在的烟草戒烟线提供标准的行为戒烟治疗，并没有很好的装备来有效地帮助患有共病抑郁症等疾病的吸烟者。事实上，最近的一项研究报告称，24%拨打国家烟草戒烟热线的吸烟者抑郁症状水平显著升高，这些有抑郁症状的吸烟者与没有抑郁症状的吸烟者相比，成功戒烟的可能性显著降低。烟草戒烟公司将从一种辅助的心理社会方法中获得显着好处，以解决他们的许多客户经历的抑郁症状。虽然可行性问题限制了这些方法在标准交付方法中的使用，但它们以移动应用程序(APP)的形式使用具有重要的前景。行为激活是一种有经验支持的治疗方法，简单明了，易于理解，因此特别适合移动平台和与烟草戒烟咨询的系统集成。通过研究，行为激活可以有效地减少阈值以下抑郁症患者和严重抑郁障碍患者(MDD)的抑郁症状，并符合作为经验性治疗的标准。这一第一阶段应用的目的是采用以用户为中心的设计流程来开发和测试移动健康应用Act2BSmokeFree的可接受性和有效性，该应用将在一项针对患有抑郁症状的吸烟者的小型随机对照试验中，将Brief Behaviative Activation与放松应用BREATHE2RELAX结合在一起。所有参与者都将接受戒烟咨询。该项目的预期结果是开发出Act2BSmokeFree的原型，它可以为未来与烟草戒烟咨询相结合的随机对照试验的临床疗效的第二阶段测试做好准备。

Cigarette smoking is the leading cause of mortality in the U.S., resulting in over 480,000 deaths every year and costing $278 billion in loss of productivity. Smoking is also the leading cause of cancer and of deaths from cancer. Smoking causes cancers of the lung, larynx, mouth, bladder, liver, kidney, colon, rectum and others. While smoking rates in the U.S. have declined over recent years, continued smoking is strongly associated with both depressive disorders and depressive symptoms, with smoking rates remaining at 30-50% among individuals with depressive disorders. Depressive symptoms have also been shown to predict smoking cessation failure. While clinical practice guidelines for nicotine dependence treatment suggest the need to address psychological issues such as elevated depressive symptoms, empirically validated interventions to address this important risk factor are lacking. Tobacco quitlines are the major vehicle through which smoking cessation services are delivered in the U.S and are available in every U.S. state via a national quitline portal, 1-800-QUIT-NOW. However tobacco quitlines, as they currently exist, deliver standard behavioral smoking cessation treatment and are not well equipped to effectively help smokers with conditions such as comorbid depression. Indeed, a recent study reported that 24% of smokers calling a state tobacco quitline had a significantly elevated level of depressive symptoms and that these smokers with depressive symptoms, compared to those without, were significantly less likely to successfully quit smoking. Tobacco quitlines would derive significant benefit from an adjunctive psychosocial approach to address the depressive symptoms experienced by many of their clients. While issues of feasibility limit the use of such approaches in a standard delivery method, their use in the form of a mobile application (app) holds significant promise. Behavioral Activation is an empirically supported treatment that is straightforward, easily understood, and as such is particularly amenable to a mobile platform and to systematic integration with tobacco quitline counseling. Across studies, Behavioral Activation is effective for reducing depressive symptoms among individuals with sub threshold depression as well as individuals with major depressive disorder (MDD) and it meets the criteria to be established as an empirically supported treatment. The aims of this Phase I application are to employ user centered design processes to develop and test the acceptability and efficacy of a mobile health app, Act2BSmokeFree, which will incorporate brief Behavioral Activation vs. a relaxation app, Breathe2Relax in a small randomized controlled trial of smokers with elevated depressive symptoms. All participants will receive tobacco quitline counseling. The expected outcome of this project is the development of a prototype of Act2BSmokeFree, which can readied for Phase II testing of clinical efficacy in a future randomized controlled trial in conjunction with tobacco quitline counseling.