Behavioral Activation for Smoking Cessation and the Prevention of Post-Cessation Weight Gain

 描述（由申请人提供）：戒烟后体重增加（PCWG）可以阻止戒烟尝试，促使吸烟复发，并导致与体重超重相关的健康问题。大多数体重增加发生在戒烟后的3-6个月内，平均体重增加9.3磅（5-30磅范围）。PCWG主要归因于高脂肪和高糖食物的餐间零食导致的热量摄入增加。二十年来预防PCWG的治疗研究取得了适度的成功。研究表明，70%寻求治疗的吸烟者超重或肥胖;他们在戒烟后体重增加最多，最不接受PCWG。新的理论驱动的行为干预，考虑的机制，戒烟后增加食物摄入量可能会减少PCWG和促进戒烟。为了推进科学和实践的干预措施，以减少PCWG，我们建议针对奖励相关的机制共同吸烟和可口的食物摄入。通过将行为激活干预应用于戒烟和戒烟后体重增加（BAS+）的新应用，我们将增加强化的机会，并增强从这些戒烟者中获得的快乐。将在一项随机临床试验中评估BAS++透皮尼古丁（TN）与标准戒烟咨询（SC）+TN的疗效，该试验纳入了426名寻求治疗的吸烟者（年龄18-65岁）。参与者将在10周内获得8个BAS+或SC课程以及TN。主要结局将是PCWG和目标戒烟日期后26周经生化验证的点患病率戒烟率。将通过在治疗前、治疗中、治疗结束和随访时连续3天进行的24小时食物回忆来测量摄食量（次要结局）。BAS+减少PCWG和促进戒烟的机制（例如，在治疗前、治疗期间和治疗结束时（第8周），评估可选择的强化剂、食物的相对强化值、食物奖励和食物线索诱导的渴望）。将在治疗前对调节剂进行评估（例如，性别、抑郁症状和体重问题）。这项拟议的研究通过以下方式打破了新的概念和经验基础：（1）首次评估BAS+戒烟和PCWG作为最广泛使用的戒烟药物疗法的辅助治疗的疗效;（2）检查BAS+减少食物摄入和体重增加的机制;（3）确定个体差异是否可能影响干预疗效。如果这些假设得到支持，研究结果将表明，针对吸烟和饮食共同的奖励相关机制是：（1）促进戒烟的有效方法，同时最大限度地减少PCWG;（2）是同时解决两种奖励行为的可行方法，而不会导致其中一种行为的代偿性增加。

 DESCRIPTION (provided by applicant): Post-cessation weight gain (PCWG) can deter a quit attempt, precipitate smoking relapse, and contribute to health issues related to excess body weight. The majority of weight gain occurs within 3-6 months of quitting smoking, with weight gains averaging 9.3 pounds (5-30 pound range). PCWG has been attributed primarily to increased caloric intake due to between-meal snacking on foods high in fat and sugar. Two decades of treatment research to prevent PCWG has yielded modest success at best. The importance of identifying efficacious treatments for the prevention of PCWG is highlighted by research showing that 70 percent of treatment- seeking smokers are overweight or obese; they gain the most weight upon quitting smoking, and are least accepting of PCWG. Novel theory-driven behavioral interventions that consider the mechanisms that underlie post-cessation increases in food intake may reduce PCWG and promote smoking abstinence. To advance the science and practice of interventions to reduce PCWG, we propose to target reward-related mechanisms common to smoking and palatable food intake. Through a novel application of a behavioral activation intervention to smoking cessation and to post-cessation weight gain (BAS+), we will increase opportunities for reinforcement and enhance the pleasure obtained from these reinforcers. The efficacy of BAS+ plus transdermal nicotine (TN) vs. Standard Smoking Cessation Counseling (SC) plus TN will be evaluated in a randomized clinical trial of 426 treatment seeking smokers (ages 18-65). Participants will receive 8 BAS+ or SC sessions plus TN over a 10-week period. The primary outcomes will be PCWG and biochemically verified point prevalence smoking abstinence 26-weeks after the target quit date. Food intake (secondary outcome) will be measured via 24-hour food recall conducted over 3 consecutive days at pre- treatment, mid-treatment, end of treatment, and follow-up. Mechanisms by which BAS+ reduces PCWG and promotes smoking cessation (e.g., alternative reinforcers, relative reinforcing value of food, food reward, and food cue-induced craving) will be assessed prior to, during and at the end of treatment (week 8). Moderators will be assessed pre-treatment (e.g., gender, depression symptoms, and weight concerns). The proposed study breaks new conceptual and empirical ground by: (1) providing the first evaluation of the efficacy of BAS+ for smoking cessation and PCWG as an adjunct to the most widely used pharmacotherapy for smoking cessation; (2) examining the mechanisms by which BAS+ reduces food intake and weight gain; and (3) identifying whether individual differences that may impact intervention efficacy. If the hypotheses are supported, the findings would suggest that targeting reward-related mechanisms common to both smoking and eating is: (1) an effective approach to promoting smoking cessation, while minimizing PCWG; and (2) is a viable approach for addressing two rewarding behaviors concurrently, without risking compensatory increases in one of those behaviors.