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

以运动为基础的戒烟治疗对高焦虑敏感性成人的疗效和实施

• 批准号: 10660767
• 负责人: MARSHALL CHENEY
• 金额: $ 64.8万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-03 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10660767
• 关键词: Abstinence; Address; Adult; Affect; Affective; Anxiety; Anxiety Disorders; Black race; Caring; Cessation of life; Communities; Control Groups; Counseling; Diagnostic; Discrimination; Disease; Distress; Education; Emotional disorder; Esthesia; Ethnic Origin; Ethnic Population; Etiology; Exercise; Exposure to; Failure; Fright; General Population; Heart Rate; Individual; Intervention; Interview; Investigational Therapies; Latinx; Literature; Maintenance; Mediating; Mediator; Mental Depression; Minority; Modeling; Moods; Nicotine Dependence; Nicotine Withdrawal; Outcome; Participant; Phase; Prevalence; Process; Protocols documentation; Provider; Psychopathology; Public Health; Race; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Relapse; Reporting; Research; Risk; Risk Factors; Sampling; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Smoking treatment; Social support; Societies; Stress; Symptoms; Syndrome; Testing; Tobacco; United States; Work; anxiety reduction; anxiety sensitivity; anxiety symptoms; bodily sensation; burden of illness; cigarette smoking; community based evaluation; community based treatment; comorbidity; demographics; depressive symptoms; design; disability; dysphoria; efficacy evaluation; efficacy research; efficacy study; efficacy trial; ethnic diversity; ethnic minority; evidence base; exercise intensity; exercise prescription; follow-up; implementation framework; improved; instructor; intervention effect; long term abstinence; low socioeconomic status; negative affect; negative mood; nicotine craving; nicotine replacement; perceived discrimination; personalized intervention; phase 3 study; phase III trial; prevent; preventable death; process evaluation; programs; quality assurance; quitline; racial diversity; racial minority; racial population; racism; randomized, clinical trials; smoking cessation; smoking prevalence; smoking relapse; stress symptom; therapy development; trial comparing

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.

项目摘要/摘要 吸烟是美国可预防死亡和残疾的主要原因。在 各种心理病理学，焦虑和抑郁症状和综合症是最普遍的精神病学 普通人群的条件，并与吸烟非常合并。此外，情感掩盖 吸烟者通常更依赖尼古丁，吸烟更多以管理负面情绪状态，并期望吸烟 与没有这种影响脆弱性的吸烟者相比，对他们的情绪产生更大的积极影响。 解决与吸烟相关的负面影响症状和疾病的综合方法是 专注于经过情感心理病理学和吸烟的基础的转诊过程。焦虑 敏感性（AS），或者对动画和厌恶性内部感觉的恐惧是经诊断的脆弱因素 用于焦虑症和其他情绪障碍的病因和维持。与 动画和情绪心理病理学的风险增加，并在吸烟的几个方面暗示 和救济，包括尼古丁的戒断和渴望以及早期和救济的更大几率。 我们的治疗开发工作（即I和II阶段）支持高强度运动作为干预 较高的吸烟者的策略。高强度锻炼会减少尼古丁的戒断和渴望， 抑郁和动画，所有这些都证明可以预测停止失败。我们已经证明了为期15周 将高强度运动与标准戒烟治疗（吸烟）结合起来的干预措施 治疗增强程序[步骤]）相对于干预措施产生的节制率明显更高 将健康教育与标准的戒烟治疗相结合。我们还显示了这一步骤 可以在涉及基督教青年会和Quitline的基于社区的环境中进行调整；节制率 在接收步骤的参与者中，分配给控制干预措施的参与者中有两倍。 拟议的研究旨在通过进行III期研究来建立这项研究。首先，我们将检查 基于社区版本的步骤的效率是否会推广到非Latinx White，黑色 和拉丁吸烟者。 （1）种族/族裔少数群体不太容易寻求这个目标，这一目标是为了告知这一目标。 并获得（成功）基于证据的戒烟的护理，效率不足 研究; （2）黑人和拉丁裔吸烟者可能会受益于提高能力的特定关注 对逐步的针对性应对互感应力的自适应响应。第二，我们将测试假定的机制 行动和旨在确定效率的主持人。第三，我们将旨在确定改善覆盖范围的机会 使用实施 框架（RE-AIM）和定性过程评估。这些目标将通过进行大型 随机临床试验将步骤与跨YMCA分支的对照干预进行比较 种族/种族多样的吸烟者样本。