Approach Bias Retraining for Nicotine Addiction among Dual Combustible and Electronic Cigarette Users

项目摘要 电子烟（ECIG）的使用已成为尼古丁输送的一种流行方法。可燃卷烟（CC） 停止或减少是成年人摄取ECIG的主要原因。1 -3然而， 尽管打算完全退出CC，但ECIG的使用并未完全从CC过渡到ECIG。4 -9纵向工作 同时使用ECIG和CC的双重用户中，有89%的人在最初使用ECIG和CC一年后仍然是双重用户。 10理论和实证研究结果表明，针对自动化，冲动，内隐过程可能 11 -16具体而言，再培训方法的偏见，或方法 对与感兴趣的物质有关的刺激的动作倾向，在酒精使用障碍中是有效的（即， 复发率降低10%-13%）。16 -18当应用于CC相关刺激时， 发现减少方法偏差，这随后与更大的CC禁欲天数有关 在自我引导的戒烟计划之后。 父母补助金也将评估双CC/ECIG用户中接近偏差再培训的初步效果 作为治疗效果的假定机制。此外，目前的补充研究项目提出， 临床相关的社会人口学调节器（即，性别、种族和尼古丁依赖[CC依赖和 ECIG依赖分别]）的治疗效果和机制。我们将随机分配90个双CC/ECIG 使用成人进行三种情况之一：（1）CC+ECIG再培训;（2）仅CC再培训;（3）假培训 （对照）。参与者将使用各自的刺激完成4次接近偏差再训练，然后 进行自我引导的戒烟尝试，放弃所有尼古丁产品。每次会议将包括15分钟的 计算机化的方法偏见再培训和简短的评估。参与者将提供基线数据、生态 干预后前两周内的瞬时评估（EMA）数据，以及4周和 6-干预后几周。将在干预期间（第0-4周）、EMA期间、 在两次随访中。在完成数据收集后，我们将进行适度测试，探索性别，种族， 尼古丁依赖（分别为CC和ECIG依赖）作为治疗效应的独立调节剂， 点患病率禁欲，长期禁欲，和假定的中介途径。这项工作的关键是确定 个体差异可能会影响干预的有效性及其中介途径。 拟议的补充代表了翻译基础研究战略的关键和重要的“下一步” 用于治疗CC/ECIG双重使用者的尼古丁依赖。它将产生重要的发现，以帮助我们评估 对双重使用者进行的方法偏见再培训干预是否会对性别，种族， 可能还有尼古丁依赖这一知识对于了解是否需要调整干预措施至关重要 对于特定的子组。这份补充材料将提高我们检查干预措施在各个领域的有效性的能力。 分组人口和通知'下一步'在适应方法偏见再培训的双重用户。

PROJECT SUMMARY Electronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults.1-3 Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely.4-9 Longitudinal work has found that 89% of dual users—users of ECIG and CC concurrently--remain dual users a year after initial assessment.10 Theory and empirical findings suggest that targeting automated, impulsive, implicit processes may hold promise for substance use reduction and cessation.11-16 Specifically, retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol use disorders (i.e., reduction in relapse rates by 10%-13%).16-18 When applied to CC-related stimuli, approach bias retraining has been found to reduce approach bias, which is subsequently related to greater number of days abstinent from CC following a self-guided quit attempt.19 The parent grant will evaluate the initial efficacy of approach bias retraining among dual CC/ECIG users as well as putative mechanisms of treatment effects. In addition, the current supplement research project proposes to test clinically-relevant sociodemographic moderators (i.e., sex, race, and nicotine dependence [CC dependence and ECIG dependence separately]) of treatment effects and mechanisms. We will randomly assign 90 dual CC/ECIG using adults to one of three conditions: (1) CC+ECIG retraining; (2) CC only retraining; and (3) sham training (control). Participants will complete 4 sessions of approach bias retraining using the respective stimuli and then engage in a self-guided quit attempt to abstain from all nicotine products. Each session will consist of 15 minutes of computerized approach bias retraining and a brief assessment. Participants will provide baseline data, ecological momentary assessment (EMA) data during the first two weeks post-intervention, and complete follow-ups at 4- and 6-weeks post-intervention. Abstinence will be assessed during the intervention (weeks 0-4), during the EMA period, and at both follow-ups. Upon completion of data collection, we will run tests of moderation exploring sex, race, and nicotine dependence (CC and ECIG dependence separately) as independent moderators of treatment effects for point-prevalence abstinence, prolonged abstinence, and putative mediational pathways. This work is key to identify individual differences that may affect the efficacy of the intervention and its mediational pathways. The proposed supplement represents a crucial and important ‘next step’ in translating basic research strategies for treating nicotine dependence among dual CC/ECIG users. It will yield important findings to help us evaluate whether approach bias retraining interventions administered to dual users have a differential impact by sex, race, and perhaps nicotine dependence. This knowledge is critical to understand if the intervention needs to be adapted for specific subgroups. This supplement will enhance our ability to examine the efficacy of the intervention across subgroup populations and inform ‘next steps’ in adapting approach bias retraining for dual users.