Recent estimates indicate that both low income and educational attainment are among the strongest predictors of both smoking prevalence and continued smoking. Treatment development is limited by inadequate knowledge of the specific lapse/relapse-relevant vulnerabilities characteristic of these populations (i.e, the processes that underpin lapse/relapse). Recently, we published a comprehensive model of the way in which these cognitive and emotional vulnerabilities--lower WMC and elevated AS--represent separate liabilities for negative health behaviors and self-control lapses, particularly under conditions of stress. The interactive models we propose suggest that interventions targeting only some of these vulnerabilities will leave smokers at risk for cessation failure. Accordingly, interventions that can engage these multiple vulnerabilities have the potential to greatly benefit at-risk subsamples of smokers, such as low SES smokers. Accordingly, this project is devoted to using an experimental therapeutics approach to show: (1) that a standard mindfulness intervention, and a mindfulness intervention modified in accordance with crucial preliminary work (Mindfulness+IE), have the ability to differentially engage these triple risk mechanistic targets, and (2) that the degree to which these putative triple risk targets are engaged produces a desired change in a health behavior, using a laboratory model of smoking risk burden and lapse potential. An innovative approach for understanding risk for relapse in smokers undergoing a quit attempt is to examine candidate mechanistic targets assessed not only during nicotine use, but during the conditions smokers will face upon a cessation attempt ? during nicotine deprivation windows. In particular, we intend to show the incremental value of assessments during deprivation windows, in part due to the way in which triple vulnerabilities are modified by and interact with the heightened stress and withdrawal symptoms inherent to nicotine deprivation states in smokers. We also intent to show that a novel mindfulness intervention (Mindfulness+IE) can rescue limitations of standard mindfulness interventions, by extending therapeutic gains to the modification of mechanistic targets assessed in high-stress contexts. The overall goal is to validate mechanistic targets and associated interventions for the purpose of expanding treatment options for particularly at-risk smokers.
The purpose of this project is to show the relevance of specific vulnerability factors for smoking cessation failure, and to show that modification of these risk factors with intervention results in an improved ability to tolerate periods of nicotine withdrawal/craving without smoking. The vulnerability factors are specifically relevant to low socioeconomic status smokers, and include negative affectivity, low working memory capacity, and low distress tolerance. This research represents a first step toward trying to improve smoking cessation for these individuals by validating new treatment approaches.
