African Americans (AA) have the highest prevalence of hypertension in the world and smoking rates among urban AAs are higher than among whites. Moreover, AA smokers experience a disproportionate burden of the health consequences of smoking and AA hypertensives who smoke are at exceedingly high risk of experiencing adverse health outcomes. Nevertheless, little research has been aimed at developing effective smoking cessation interventions for AAs, despite the fact that prominent publications (Treating Tobacco Use and Dependence Clinical Practice Guideline; Surgeon General's Report on Tobacco Use Among U.S. Racial/Ethnic Minority Groups) have decried the paucity of research on treatments for AAs and have highlighted the need for new treatments specifically targeted at minority smokers. Interactive, computer-delivered interventions have the potential to produce significant advances in the individualization, accessibility, and acceptability of behavioral treatments for nicotine dependence. Unfortunately, there is a """"""""digital divide"""""""" with African Americans having less access to these resources. The proposed study is a two-group randomized clinical trial (N=400) designed to develop and evaluate a theoretically and technologically sophisticated, culturally sensitive, smoking cessation intervention for African American smokers with hypertension. Participants will be randomly assigned to either standard care (SC) or standard care plus computer-delivered treatment (CDT). SC consists of eight weeks of nicotine patch therapy, culturally sensitive self-help materials, and four telephone counseling sessions based on the Treating Tobacco Use and Dependence Clinical Practice Guideline. CDT will be delivered by palmtop personal computers and will be individualized for each smoker based on state-of-the-science ecological momentary assessment techniques. Ambulatory assessment and treatment devices are becoming increasingly common in today's medical care. The use of palmtop personal computers can facilitate a bridging of the digital divide because of their low cost and ease of use. Furthermore, this approach is congruent with the current theoretical emphasis on high risk situations and an """"""""episodic"""""""" model of smoking motivation and relapse. CDT is able to directly intervene to influence relapse precipitants in real-time during acute episodes of high risk, as well as potentially strengthen adaptive predispositions through repeated exposure to and repetition of coping behaviors. The latter may contribute to better acquisition, retention, and use of coping skills over time. To ensure cultural sensitivity, all treatment materials and study procedures will be developed and evaluated in conjunction with a cultural and scientific advisory board.
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