Adult smokers with a history of recurrent major depression (MDD) report higher levels of depressive symptoms when presenting for smoking cessation treatment and have poor smoking outcomes relative to other smokers. Carefully conducted clinical trials have supported the efficacy of cognitive-behavioral mood management treatment for depression in improving smoking cessation outcomes in this high-risk group. Although efficacious, these intensive group treatments require significant resources and thus may have limited impact outside of specialized smoking cessation programs. Proactive telephone counseling for smoking cessation has received strong recommendations from the US DHHS as a primary mechanism for increasing access to smoking cessation interventions. However, there are currently no established telephone counseling interventions for use with the more than 8 million smokers with a history of recurrent MDD who attempt to quit each year. Recent clinical studies directly observe that a significant proportion of smokers seeking cessation treatment have a history of MDD, with prevalence estimates ranging from 18-61%. Among individuals with a history of MDD, 64-74% will meet criteria for recurrent MDD. In the present application we propose to develop and obtain preliminary data on the efficacy of proactive telephone counseling for smoking cessation that integrates cognitive-behavioral mood management skills training for depression (MM). In the first phase of the project, we will complete the development of a proactive telephone counseling intervention that integrates mood management skills from a smoking cessation treatment that has been used successfully in improving outcomes among smokers with recurrent MDD. During this phase, 20 patients will complete the protocol and will provide ongoing feedback regarding their experiences and perceptions of the intervention. This feedback, along with the recommendations of the study staff, will be used to modify and refine the protocol, and intervention manuals for clinicians and patients will be developed. In the second phase of the project, we will recruit 60 smokers with a history of recurrent MDD who will be randomly assigned to the proactive telephone counseling for smoking cessation with mood management (MM) or a standard proactive telephone counseling (ST) comparison condition. We expect that as a result of this project, we will have developed a well-specified and novel telephone counseling intervention for smokers with a history of recurrent depression, the efficacy of which can be tested in future Stage II randomized clinical trials. From a longer-term perspective, we expect that this program of research will result in the development of a specialized, efficacious treatment with broad reach into a significant subpopulation of smokers at greatest risk for difficulties quitting, and will therefore have important clinical and public health significance in decreasing the overall prevalence of cigarette smoking.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Human Development Research Subcommittee (NIDA)
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Grossman, Debra
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Butler Hospital (Providence, RI)
United States
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Strong, David R; Cameron, Amy; Feuer, Shelley et al. (2010) Single versus recurrent depression history: differentiating risk factors among current US smokers. Drug Alcohol Depend 109:90-5
Ziedonis, Douglas; Hitsman, Brian; Beckham, Jean C et al. (2008) Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine Tob Res 10:1691-715