Smoking remains the leading cause of death and disability in the United States, resulting in death for 1 out of every 2 smokers. While smoking rates have declined to about 18% among the general population, smoking rates still remain disproportionately high among individuals in the criminal justice system (i.e., 70-80%). Despite this high rate of smoking, few interventions have been tested in this population. We were the first to investigate providing 12 weeks of bupropion to a sample of community corrections smokers and then randomizing them to either four sessions of smoking cessation counseling or no counseling to quit. No significant differences were found between our two groups, indicating no additional benefit from more intensive smoking cessation counseling. However, while only 5.8% were abstinent at the 6 month follow-up, abstinence rates were quadrupled among the minority of those who were adherent to medication. Developing interventions to increase medication adherence has been cited as the most important means to reducing disparities; however, the few interventions that have investigated increasing adherence have been psychoeducational only and have yielded poor results. But evidence from our previous work demonstrated that smokers who had previous experience using bupropion had higher subsequent cessation rates and this relationship was mediated by improved medication adherence. Thus, exposure to medication is very likely the critical factor in improving subsequent adherence. The current application proposes a randomized controlled trial to maximize medication adherence with this population of smokers by testing an In Vivo NRT experiential intervention. Participants randomized to the In Vivo intervention will try a nicotine patch in Session 1, try nicotine gum in Session 2, try combination nicotine replacement therapy (cNRT) in Session 3, and discuss any problems with use of cNRT for a quit attempt in Session 4. During each 30-minute session they will discuss their expectations for the medication as well as the In Vivo session effects of these medications on withdrawal symptomatology, including urge to smoke. Between sessions, participants will be given medication to use during that week to make practice quit attempts and to become familiar with the medication. Participants randomized to the control group will receive four 30-minute sessions of standard behavioral counseling. All participants will receive cNRT for 10 weeks. Follow-ups will occur up to six months post-intervention. Primary outcomes include 6 month point prevalence abstinence and abstinence across time as well as medication adherence. If successful, this intervention could provide an easily transportable, novel, and tailored intervention to increase medication adherence and improve smoking cessation rates among smokers in the criminal justice system to reduce health disparities and save lives.
Smoking is now concentrated in high risk and disadvantaged populations such as individuals in the criminal justice system. Novel intervention strategies have the potential to reduce the smoking rates and health disparities in a population with high rates of smoking but little access to traditional smoking cessation interventions.
