Although rates of smoking have declined, the decrease in prevalence has been much less pronounced in women than in men, and women are particularly vulnerable to ongoing smoking-related morbidity and mortality. One reason for gender differences in smoking cessation is concern about cessation-related weight gain among women. In the previous grant period, we tested the efficacy of two adjuncts to a standard cessation program for weight concerned women, behavioral weight control (WEIGHT) and cognitive behavior therapy to reduce weight concerns (CBT). Results of this trial have shown that CBT is a promising adjunctive treatment for weight concerned women. Specifically, 59.7% of known in the CBT condition were abstinent from smoking in post- treatment. Further, CBT yielded significantly higher abstinence rates in 3- month follow-up when compared to standard cessation only or the WEIGHT adjunct, with cessation rates of 39.4%, 23.6%, and 22.6% for the three groups, respectively. Nevertheless, abstinence rates decreased significantly during follow-up for all groups, and in the present study, we propose a randomized, double-blind, controlled trial to determine whether the addition of buproprion (Zyban) to CBT treatment for weight- concerned women will enhance longer-term abstinence. Four hundred fifty weight-concerned women smokers will be randomized to either cognitive behavioral treatment for weight concerns plus standard cessation (CBT) or standard smoking cessation only (STANDARD), and six months of either buproprion (Zyban) or placebo. Primary outcome will be rates of smoking abstinence and time to relapse across the four treatment conditions. In addition, we will determine the effects of these treatments on tobacco withdrawal, mood, and weight. Results of this investigation will provide information on the relative efficacy of CBT and buproprion alone and in combination, and the utility of drug and counseling strategies that are specifically tailored for a high- risk population. This is a competing continuation of 2-R01-DA04174-13.
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