Cigarette smoking is the leading cause of death and disability in the United States. Moreover, depression-related vulnerabilities are highly comorbid with smoking behavior and dramatically reduce cessation ratesamong both community and clinical samples. Previous research has examined the efficacy of integratingcognitive-behavioral treatment for depression into standard smoking cessation treatment focusing onindividuals who have a past history of major depressive disorder (MDD). However, success has been limited infocusing on MDD history. A broader health impact can be achieved by targeting individuals with currentelevated depressive symptoms given their association with cessation failure. Furthermore, the complexity ofcognitive behavioral approaches for depression may impair their effective integration into smoking cessationprotocols. As a result, new approaches to smoking cessation are needed for smokers with currently elevateddepressive symptoms. We have recently completed an initial randomized controlled trial comparing anintegrated novel behavioral activation smoking cessation treatment (BATS) versus standard smoking cessationtreatment (ST) [with both conditions receiving 8 weeks of transdermal nicotine patch (TNP)] among smokerswith elevated depressive symptoms. Preliminary findings indicate that in the first week post quit date,participants receiving BATS (n = 26) were 2.7 times more likely to be abstinent (p < .05) than ST (n = 16)participants. BATS participants also evidenced significantly higher (p = .02) abstinence rates than STparticipants throughout the 26 week post-quit follow-up period. Preliminary results are encouraging andsupport a larger Stage II randomized controlled trial in order to better establish BATS as an efficacioustreatment for smokers with depression-relevant vulnerabilities. Of further relevance, participants in this studywere predominantly low income, minority individuals. This is important given considerable documented barriersto cessation and lower cessation rates for this at-risk group. Thus, the objective of the present proposal is tofollow-up on our previous Stage I treatment development efforts and small scale randomized controlled trial(RCT) with a Stage II RCT comparing BATS to ST among a similar sample of 200 predominantly low incomeand minority smokers with elevated depressive symptoms. Treatments will be equated for participant andtherapist contact time. Participants will be followed over 52 weeks post-quit date and the larger sample size willallow for more complex analyses of the mechanisms underlying cessation outcomes. We expect that as aresult of this project, we will have provided evidence for the efficacy of a well-specified, novel behavioralactivation smoking treatment that works well with smokers at significant risk for relapse.
Smokers with depression-relevant vulnerabilities smoke at high rates and have poor cessation outcomes, yet smoking treatments specifically meeting the needs of these individuals have typically been limited to MDD history rather than current symptomatology. The objective of the current proposal is to continue our program of NIDA-funded research starting with a Behavioral Therapy Development Grant (R01DA18730) by conducting a Stage II RCT comparing behavioral activation therapy for smoking (BATS) to standard smoking cessation treatment (ST) for smokers with elevated depressive symptoms.
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