Dr. McClure is a [Research Instructor] in the Clinical Neuroscience Division of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina (MUSC). Dr. McClure seeks a Mentored Research Scientist Development Award (K01) through the National Institute on Drug Abuse. This award will provide the essential training to facilitate her transition to independence to pursue a research agenda focused on technological innovations to advance smoking cessation in adolescents. Candidate. Dr. McClure is a behavioral psychologist with extensive preclinical and clinical training in the areas of substance abuse research and treatment, with a specific focus on tobacco and cannabis dependence. Dr. McClure requires career development through the K01 award in order to realize her long-term goals focused in the multidisciplinary research of smoking and relapse and how that knowledge can inform personalized, patient-centered treatment interventions. Dr. McClure has carefully devised a structured career development plan for the 5-year K01 award period. Dr. McClure's objectives will be to: 1) obtain training in mobile health (mHealth), including extensive knowledge of methodology, analyses, engineering, and privacy/confidentiality concerns; [2) obtain biostatistical training in the analysis of longitudina data]; 3) broaden understanding of adolescent smoking cessation and addiction; 4) expand understanding in conducting randomized clinical trials; and [5) improve grant writing skills to successfully transition to research independence.] Environment. MUSC is a collaborative, productive environment that will provide the ideal setting for Dr. McClure to receive mentored career development through the K01 award. Research productivity is stellar, with 1,242 extramural grants awarded during FY2012, totaling more than $232 million. MUSC has a strong addictions focus, and ranks among the top 10 medical schools in the country for drug and alcohol abuse medical education. Over 30 faculty are engaged in training and research in addiction across departments and disciplines. The Department of Psychiatry and Behavioral Sciences ranks 7th in NIH research funding among domestic psychiatry departments, with faculty receiving 173 grant and contract awards, totaling $40.8 million in FY2012. All study procedures will take place through the Clinical Neuroscience Division (CND; Director, McRae-Clark), where the candidate, Primary Mentor (Gray) and Co-Mentor (Brady) hold appointments. The CND provides the infrastructure and dedicated space for successful execution of study procedures. Technological expertise, training, and software development will be provided by the Technology Applications Center for Healthful Lifestyles (TACHL) within the School of Nursing at MUSC, which is directed by Dr. Frank Treiber (Co-Mentor). [Biostatistical training and coursework will be provided through the Department of Public Health Sciences, where the candidate's Co-Mentor (Ramakrishnan) holds an appointment.] MUSC offers several resources to Early Career Investigators, such as pilot funds, seminars, grant writing courses and consultations, mock study sections, and research and recruitment services through the South Carolina Clinical and Translational Research Institute and the Offices of Research Development and Sponsored Programs Research. Cigarette smoking is the leading cause of preventable death in the US, with the vast majority of adult smokers starting prior to age 18. Understanding the process of relapse to smoking during a quit attempt is critical for the development of highly efficacious treatment interventions, yet little is known about the natural history of relapse among adolescent smokers. Technological innovations for the remote monitoring of smoking that do not primarily rely on self-report would allow for the fine-grained analysis of relapse and may be a highly fruitful avenue to explore. The studies in this K01 application propose to develop and evaluate a comprehensive remote monitoring system combining self-reports of smoking through ecological momentary assessment (EMA) with biochemical verification of smoking through breath carbon monoxide (CO) in adolescents (ages 14-21).
In Aim 1, feasibility, acceptability, and compliance of the EMA + CO system will be evaluated during 1 week of smoking through quantitative and qualitative methods (Experiment 1). Experiment 2 will then monitor relapse to smoking following a quit attempt and compare the EMA + CO system vs. traditional EMA alone plus weekly clinic visits to obtain biochemical verification of smoking.
In Aim 2, agreement between CO and self-reported smoking across groups will be compared. Participants in the EMA + CO group are expected to exhibit higher agreement between self-reported smoking and CO verification compared to the EMA alone group. Additionally, in Exploratory Aim 1, the trajectory of relapse following a quit attempt will be characterized across groups. Finally, in Exploratory Aim 2, EMA ratings of situational and momentary states will be compared during smoking and non-smoking occasions. The remote monitoring of smoking allows for the fine-grained characterization of behavioral processes, rather than outcomes that may not capture the complex process of relapse. The evaluation of this system is a critical first step in the eventual goal of facilitating its use for future studies to answer questions regarding relapse. Thi knowledge can then inform maximally effective, just-in-time interventions delivered at critical moments to promote long-term abstinence.
The majority of adult smokers start prior to age 18, yet little work has been done to understand smoking treatment failure and relapse in adolescents, despite considerable public health relevance. The proposed studies will develop and evaluate a remote monitoring technology system to more accurately characterize the process of relapse in adolescent smokers through technological integration. This knowledge can then be used to tailor highly effective treatment interventions to promote long-term abstinence in this underserved, understudied, and high-risk population.
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