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。吸烟也是导致癌症和癌症致死的主要原因。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。虽然近年来美国的吸烟率有所下降，但持续吸烟与抑郁症和抑郁症状密切相关，抑郁症患者的吸烟率仍保持在30-50%。抑郁症状也被证明预示着戒烟失败。虽然尼古丁依赖治疗的临床实践指南建议需要解决心理问题，如抑郁症状加剧，但缺乏经验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途径，在美国每个州都可以通过全国戒烟热线门户网站1-800-现在戒烟。然而，目前存在的戒烟热线提供了标准的行为戒烟治疗，并没有很好地有效帮助患有合并症抑郁症等疾病的吸烟者。事实上，最近的一项研究报告称，在一个州戒烟热线的吸烟者中，有24%的人抑郁症状明显升高，而这些有抑郁症状的吸烟者与没有抑郁症状的吸烟者相比，成功戒烟的可能性要小得多。戒烟热线将从辅助的社会心理方法中获得重大利益，以解决许多客户所经历的抑郁症状。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。行为激活是一种经验支持的治疗方法，简单易懂，因此特别适合移动平台，并与戒烟热线咨询系统整合。在所有研究中，行为激活对亚阈值抑郁症个体以及重度抑郁症（MDD）个体的抑郁症状都是有效的，并且它符合作为一种经验支持的治疗方法建立的标准。这个第一阶段的应用程序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程序Act2BSmokeFree的可接受性和有效性，该应用程序将在一项小型随机对照试验中结合简短的行为激活和放松应用程序Breathe2Relax，这些试验对象是患有抑郁症状升高的吸烟者。所有参与者将接受戒烟热线咨询。该项目的预期结果是开发Act2BSmokeFree的原型，可以准备在未来的随机对照试验中进行临床疗效的II期测试，并结合戒烟咨询。

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.