Smoking is a major cause of morbidity and mortality in the United States, leading to substantial health care costs and productivity losses each year. Current relapse prevention programs are associated with underutilization and poor response rates, necessitating new interventions that offer effective, accessible support for abstinence from smoking. The proposed research builds upon Dr. Magee's existing background by translating a well-established model of intrusive thoughts in anxiety disorders to better understand and intervene upon nicotine cravings during attempts to quit smoking. This model suggests that cravings are nearly universal during quit attempts, but are not closely linked to relapse. Instead, the way individuals think about their cravings predicts relapse. Aligning with recent recommendations in the literature, the proposed intervention will teach smokers to rethink and effectively manage responses to unpleasant cravings. This project will serve as the vehicle for Dr. Magee's long term career goal of building a research program focused on trials addressing novel mechanisms driving relapse in nicotine dependence. Achieving this goal will require new mentored experiences, as well as the requisite data for applying for an R01. As part of this award, Dr. Magee will receive needed training regarding 1) nicotine cravings and smoking cessation; 2) clinical research in community treatment settings, including primary care and substance use disorder community treatment programs; and 3) advanced qualitative and methodological skills. Dr. Magee will also benefit from professional development activities including publishing, grant-writing, and specialized ethics training. The research plan consists of three phases leading to a pilot text messaging intervention to teach adults healthier styles of thinking about their nicotine cravings. Phases include 1) characterizing the ways smokers think about their nicotine cravings via a) semi-structured individual interviews with adult smokers (N=16-20), b) the development of the new Thinking Styles about Cravings Scale (N=150), and c) an ecological momentary assessment study testing how changes within individuals in thinking styles about nicotine cravings relate to and potentially account for changes in smoking behavior and distress (N=20); 2) adaptation of techniques from successful anxiety treatments to alter thinking about nicotine cravings; and 3) pilot testing of a text messaging intervention to alter thinking about nicotine cravings and reduce the risk of relapse (N=40). Text messaging will be used to overcome known barriers to treatment access, making the intervention inexpensive, appealing, accessible at any time or location, and easily integrated into common community treatment settings. The primary mentor, Dr. Winhusen, and the mentorship team possess a range of expertise that is ideally matched to the training goals. Dr. Magee will acquire new skills and knowledge that will facilitate his transition to an independent scientist conducting large community-based interventions for nicotine dependence.
Smokers often view nicotine cravings as major obstacles to quitting that can arise at any time or place. The proposed project will develop a text messaging intervention that alters the way smokers think about their nicotine cravings in everyday life, in order to increase abstinence from smoking. As relapse rates are extremely high for the millions of adult smokers, this project could have a significant public health impact.
| Magee, Joshua C; Adut, Sarah; Brazill, Kevin et al. (2018) Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care. Curr Treat Options Psychiatry 5:345-362 |
