Black smokers represent a vulnerable population given that they are underrepresented in tobacco-related research and the disproportionate burden they face regarding tobacco-related diseases. Black smokers demonstrate higher rates of lung cancer and lower rates of cigarette smoking cessation compared to their White peers. While effective treatments exist to reduce smoking behaviors in adults, they demonstrate limited effectiveness among Black smokers. This issue is exacerbated by the fact that Blacks live in communities with a disproportionately high number of tobacco cues and advertisements.] Studies suggest that exposure to smoking cues can promote smoking and undermine cessation attempts. While it is difficult to modify the number of smoking cues in the environment, it may be possible to reduce attention to those cues. Recent research has demonstrated that a cognitive task (e.g., the dot probe task) can be modified so as to reduce attention to smoking cues ("attentional bias"). This procedure is termed Attentional Retraining (AR). In AR, smokers are trained to automatically attend away from smoking cues. This training should reduce exposure to smoking cues, and therefore reduce craving. In this study we will investigate the efficacy of AR using a modified dot probe task. We will recruit sixty Black smokers from the Washington, D.C. area and randomly assign them to an AR condition or a Control (traditional dot probe) condition. Participants will receive a smartphone, which they will be requested to carry at all times for a two week period. We will utilize smartphone technology to send either AR or Control prompts to participants 3 times per day. Additionally, participants will be asked to complete one assessment per day of craving and attentional bias on the smartphone. We hypothesize that, over time, AR will 1) reduce attentional bias to smoking cues, 2) reduce craving in response to a stimulus containing both smoking and neutral cues, and 3) reduce self-reported exposure to smoking cues. We will also explore the effects of AR on smoking behavior. A team of experts in health disparities research, multi-level modeling, clinical trial design in minority populations, ad behavioral pharmacology has been assembled to assist with the study and research training process. The proposed study has the potential to provide a new resource for Black smokers wanting to reduce their smoking or quit smoking. Most traditional smoking cessation therapies target nicotine withdrawal or negative affect (e.g., Nicotine Replacement Therapy). By training smokers to attend away from smoking cues, AR targets a different aspect of dependence. It may therefore be used as an adjunctive treatment to enhance traditional treatments.
Black cigarette smokers have higher rates (compared to White smokers) of lung cancer, lower rates of smoking cessation, and live in communities that have a disproportionately high number of tobacco advertisements and other smoking cues. Greater exposure to smoking cues undermines smoking cessation. This proposal will investigate a Smartphone intervention to reduce exposure to smoking cues.