Cigarette smoking is the leading cause of death and disability in the United States. Moreover, depression- related vulnerabilities are highly comorbid with smoking behavior and dramatically reduce cessation rates among both community and clinical samples. Previous research has examined the efficacy of integrating cognitive-behavioral treatment for depression into standard smoking cessation treatment focusing on individuals who have a past history of major depressive disorder (MDD). However, success has been limited in focusing on MDD history. A broader health impact can be achieved by targeting individuals with current elevated depressive symptoms given their association with cessation failure. Furthermore, the complexity of cognitive behavioral approaches for depression may impair their effective integration into smoking cessation protocols. As a result, new approaches to smoking cessation are needed for smokers with currently elevated depressive symptoms. We have recently completed an initial randomized controlled trial comparing an integrated novel behavioral activation smoking cessation treatment (BATS) versus standard smoking cessation treatment (ST) [with both conditions receiving 8 weeks of transdermal nicotine patch (TNP)] among smokers with elevated depressive symptoms. Preliminary findings indicate that in the first week post quit date, participants receiving BATS (n = 26) were 2.7 times more likely to be abstinent (p <.05) than ST (n = 16) participants. BATS participants also evidenced significantly higher (p = .02) abstinence rates than ST participants throughout the 26 week post-quit follow-up period. Preliminary results are encouraging and support a larger Stage II randomized controlled trial in order to better establish BATS as an efficacious treatment for smokers with depression-relevant vulnerabilities. Of further relevance, participants in this study were predominantly low income, minority individuals. This is important given considerable documented barriers to cessation and lower cessation rates for this at-risk group. Thus, the objective of the present proposal is to follow-up on our previous Stage I treatment development efforts and small scale randomized controlled trial (RCT) with a Stage II RCT comparing BATS to ST among a similar sample of 200 predominantly low income and minority smokers with elevated depressive symptoms. Treatments will be equated for participant and therapist contact time. Participants will be followed over 52 weeks post-quit date and the larger sample size will allow for more complex analyses of the mechanisms underlying cessation outcomes. We expect that as a result of this project, we will have provided evidence for the efficacy of a well-specified, novel behavioral activation smoking treatment that works well with smokers at significant risk for relapse.
Smokers with depression-relevant vulnerabilities smoke at high rates and have poor cessation outcomes, yet smoking treatments specifically meeting the needs of these individuals have typically been limited to MDD history rather than current symptomatology. The objective of the current proposal is to continue our program of NIDA-funded research starting with a Behavioral Therapy Development Grant (R01DA18730) by conducting a Stage II RCT comparing behavioral activation therapy for smoking (BATS) to standard smoking cessation treatment (ST) for smokers with elevated depressive symptoms.
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