This application will serve as the foundation on which the Principal Investigator will build a major line of research dedicated to the area of improving smoking abstinence rates in weight-concerned smokers. Many individuals smoke to manage their weight. This subpopulation of smokers has been classified as having weight concerns. Weight concerned smokers have lower smoking abstinence rates compared to non-weight concerned smokers, and women have higher rates of weight concern than men. Behavioral weight management interventions added to nicotine dependence treatment have not been found to be effective and pharmacological interventions have delayed rather than prevented weight gain. New avenues need to be explored for this difficult-to-treat subpopulation. A novel approach is to focus on changing the weight concerns themselves by implementing a body image intervention. Negative body image has been found to predict reduced rates of smoking abstinence. The primary aim of this study is to evaluate the efficacy of body image treatment compared to weight management intervention on improving the smoking abstinence rates in weight concerned smokers after 12 weeks of treatment and at 6-month (week 24) follow-up. A further aim is to examine the effect of body image treatment on improving body image satisfaction, and reducing weight concerns in weight concerned smokers. We hypothesize that the body image treatment will be associated with higher 7-day point-prevalence smoking abstinence rates, greater improvements in body image satisfaction scores, and decreased weight concerns at end of treatment (week 12) and at 6-month follow-up as compared to the weight management intervention. The ultimate goal is to develop effective interventions that will reduce tobacco-related morbidity and mortality in this population. This is consistent with the objectives of the National Cancer Institute to develop and test new behavioral, pharmacological, and combination therapies to treat nicotine dependence, with special emphasis on populations at high risk. Subjects will be randomly assigned to either a 12-week group cognitive-behavioral treatment for body image improvement (experimental group) (N=20) or to a 12-week group behavioral weight management treatment (contact control group) (N=20). Subjects in both conditions will receive bupropion and prescription for home-based exercise. The major assessments will occur at end-of-treatment (week 12) and at 6-month (week 24) follow-up. Dependent measures include 7-day point prevalence smoking abstinence confirmed with expired air carbon monoxide, and self-report measures of body image satisfaction and weight concerns.
