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

 描述(由申请者提供)：戒烟后体重增加(PCWG)可以阻止戒烟尝试，促使吸烟复发，并导致与超重相关的健康问题。大部分体重增加发生在戒烟后3-6个月内，平均体重增加9.3磅(5-30磅)。PCWG的主要原因是由于两餐之间吃了高脂肪和高糖的食物而增加了卡路里摄入量。二十年来预防PCWG的治疗研究充其量也只是取得了不大的成功。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，对PCWG的接受度最低，这突显了确定预防PCWG的有效方法的重要性。考虑到戒烟后食物摄入量增加的潜在机制的新型理论驱动的行为干预可能会减少PCWG并促进戒烟。为了促进减少PCWG的干预措施的科学性和实践性，我们建议针对吸烟和美味食物摄入常见的与奖励相关的机制。通过将行为激活干预应用于戒烟和戒烟后体重增加(BAS+)，我们将增加强化的机会，并增强从这些强化剂中获得的快感。BAS+加经皮尼古丁(TN)与标准戒烟咨询(SC)加TN的疗效将在426名寻求治疗的吸烟者(年龄为18-65岁)的随机临床试验中进行评估。参与者将在10周内获得8个BAS+或SC课程以及TN。主要结果将是PCWG和生化证实的点流行率，在目标戒烟日期26周后戒烟。食物摄入量(次要结果)将通过在治疗前、治疗中期、治疗结束和随访时连续3天进行24小时食品召回来衡量。BAS+减少PCWG和促进戒烟的机制(例如，替代增强剂、食物的相对强化价值、食物奖励和食物提示诱导的渴望)将在治疗前、治疗期间和治疗结束时(第8周)进行评估。主持人将在治疗前接受评估(例如，性别、抑郁症状和体重问题)。这项拟议的研究开拓了新的概念和经验基础，通过以下方式：(1)首次评估BAS+戒烟的有效性，并将PCWG作为最广泛使用的戒烟药物疗法的辅助药物；(2)研究BAS+减少食物摄入量和体重增加的机制；以及(3)确定是否存在可能影响干预效果的个体差异。如果假设得到支持，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，同时将PCWG降至最低；以及(2)是同时解决两种奖励行为的可行方法，而不会冒着其中一种行为补偿性增加的风险。

 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.