Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity

项目摘要/摘要 在美国，吸烟是可预防的死亡和残疾的主要原因。在这些人中 各种精神病理、焦虑和抑郁症状和证候是最常见的精神疾病 在普通人群中的情况，并与吸烟显著共病。此外，情感脆弱 吸烟者通常更依赖尼古丁，吸烟更多是为了管理负面情绪状态，并期待吸烟 与没有这种影响的吸烟者相比，对他们的情绪有更大的积极影响。 解决与吸烟相关的负面情绪症状和障碍的综合方法是 专注于情感精神病和吸烟的跨诊断过程。焦虑感 敏感度(AS)，或对焦虑和令人厌恶的内在感觉的恐惧，是一个跨诊断易感性因素 用于焦虑症和其他情绪障碍的病因和维持。因为它与 增加焦虑和情绪心理病理的风险，并与吸烟维持的几个方面有关 和复发，包括尼古丁戒断和渴求，以及更大的早期失误和复发的几率。 我们的治疗开发工作(即第一阶段和第二阶段)支持高强度运动作为干预 针对高AS吸烟者的策略。高强度运动可以减少尼古丁的戒断和渴求， 抑郁和焦虑，所有这些都被证明可以预测戒烟失败。我们已经证明了一个15周的 将高强度运动与标准戒烟治疗(吸烟)相结合的干预 强化治疗计划[STEP])与干预相比，产生显著更高的戒断率 将健康教育与标准戒烟治疗相结合。我们还展示了这一步骤 可调整为在社区环境中提供，涉及基督教青年会和Quitline；禁酒率 在接受STEP的参与者中，是被分配到对照干预的参与者中的两倍。 拟议的研究旨在通过进行第三阶段研究，在这项研究的基础上再接再厉。首先，我们将研究 基于社区的STEP版本的疗效是否会在非Latinx White、Black 以及拉丁裔吸烟者。这一目标是由以下观察得到的：(1)少数族裔不太倾向于寻求 和接受(成功的)循证戒烟护理，且在有效性方面表现不足 研究；以及(2)黑人和拉丁裔吸烟者可能受益于特别关注提高 根据STEP中的目标，对内感压力做出适应性反应。第二，我们将测试假设的机制 行动和目标是确定功效的调节因素。第三，我们将致力于寻找机会来扩大覆盖范围， 跨基督教青年会使用实现步骤的有效性、采用、实施和维护 框架(RE-AIM)和定性过程评估。这些目标将通过开展一项大型 一项比较多个基督教青年会分支机构干预的随机临床试验 不同种族/民族的吸烟者样本。

PROJECT SUMMARY/ABSTRACT Cigarette smoking is the leading cause of preventable death and disability in the United States. Among the various psychopathologies, anxiety and depression symptoms and syndromes are the most prevalent psychiatric conditions in the general population and are remarkably comorbid with smoking. Moreover, affective-vulnerable smokers often are more nicotine dependent, smoke more to manage negative mood states, and expect smoking to have greater positive effects on their mood compared to smokers without such affect vulnerability. An integrative approach to address negative affect symptoms and disorders associated with smoking is to focus on transdiagnostic processes that underpin both affective psychopathology and smoking. Anxiety sensitivity (AS), or the fear of anxiety and aversive internal sensations, is a transdiagnostic vulnerability factor for the etiology and maintenance of anxiety disorders and other emotional disorders. AS is associated with an increased risk of anxiety and mood psychopathology and implicated in several aspects of smoking maintenance and relapse, including nicotine withdrawal and craving and greater odds of early lapse and relapse. Our treatment development work (i.e., phases I and II) supports high-intensity exercise as an intervention strategy for smokers with high AS. High-intensity exercise reduces AS as well as nicotine withdrawal and craving, depression, and anxiety, all of which have shown to predict cessation failure. We have shown that a 15-week intervention that combines high-intensity exercise with standard smoking cessation treatment (Smoking Treatment Enhancement Program [STEP]) yields significantly higher abstinence rates relative an intervention that combines wellness education with standard smoking cessation treatment. We have also shown that STEP can be adapted for delivery in a community-based setting involving the YMCA and the Quitline; abstinence rates among participants receiving STEP were double those among participants assigned to the control intervention. The proposed study aims to build upon this research by conducting a phase III study. First, we will examine whether the efficacy of the community-based version of STEP will generalize across non-Latinx White, Black and Latinx smokers. This aim is informed by the observations that (1) racial/ethnic minorities are less apt to seek and receive (successful) evidenced-based care for smoking cessation and are underrepresented in efficacy research; and (2) Black and Latinx smokers might benefit from specific focus on increasing the ability to adaptively respond to interoceptive stress as targeted in STEP. Second, we will test putative mechanisms of actions and aim to identify moderators of efficacy. Third, we will aim to identify opportunities to improve the reach, effectiveness, adoption, implementation, and maintenance of STEP across YMCA’s using an implementation framework (RE-AIM) and qualitative process evaluation. These aims will be tested by conducting a large randomized clinical trial comparing STEP to a control intervention across several YMCA branches among a racially/ethnically diverse sample of smokers.