The goal of this renewal application is to enhance smoking cessation rates for homeless smokers by testing the effects of 1) intensive smoking intervention, and 2) integrating alcohol abuse treatment with smoking cessation. Despite progress in reducing cigarette smoking in the general US population, smoking rates and related heart disease and cancer morbidity remain strikingly high among the poor and underserved. One group generally unreached by smoking cessation interventions are those experiencing homelessness among whom cigarette smoking rate remains an alarming 70 percent or greater. The majority of homeless smokers also abuse alcohol and other drugs, which makes quitting more difficult and magnifies the health consequences of tobacco use. We recently completed the first NIH-funded (R01HL081522; Okuyemi, PI) smoking cessation clinical trial (n=430) targeting homeless smokers with 8-week treatment with nicotine patch and 6 sessions of motivational interviewing. This relatively low intensity study showed cotinine-verified 7-day quit rates of 9.3 percent for MI vs. 5.6 percent for Brief Advice at 26 weeks. We also found that quitting smoking was associated with reduced alcohol use. These smoking quit rates are low compared to the general population, demonstrating the challenge for tobacco interventions in this population and the need for more research. The goal of this renewal application is to evaluate interventions designed to enhance smoking cessation rates for homeless smokers by testing the effects of 1) intensive smoking intervention (i.e. higher dose and duration than our previous R01), and 2) integrating alcohol abuse treatment with smoking cessation. We will utilize a 3-group randomized design to test study hypotheses. The three study conditions are 1) Integrated Intensive Smoking intervention using cognitive behavioral therapy (CBT) plus Alcohol intervention -(IS+A); 2) Intensive Smoking Intervention using CBT- (IS); or 3) Usual Care (brief smoking cessation and brief alcohol counseling both based on the US Public Health Service's Guidelines)-(UC). In addition, all participants will receive 12-week treatment with combination nicotine patch plus gum or lozenge. Participants will be recruited from homeless shelters and facilities in the Minneapolis/St Paul area. Primary smoking outcome is cotinine-verified 7-day smoking abstinence at week 52 follow-up while Primary alcohol outcome will be breathalyzer-verified 90-day continuous alcohol abstinence at week 52. Recruitment and retention will be enhanced by use of debit cards, bus passes, other non-monetary incentives, attractive intervention materials, collaboration with homeless shelters, and advice from a Community Advisory Board. Findings from proposed research have a high potential to inform treatment of nicotine dependence and alcohol abuse in an underserved population that has been recalcitrant to treatments. Data from this study could influence policy and programs aimed at reducing tobacco- and alcohol- related disease burden in vulnerable populations.
Despite progress in reducing cigarette smoking in the general US population, smoking rates and related morbidity remain strikingly high among the poor and underserved. One group generally unreached by smoking cessation interventions are those experiencing homelessness among whom cigarette smoking rate remains an alarming 70 percent or greater. The majority of homeless smokers also abuse alcohol and other drugs, which makes quitting more difficult and magnifies the health consequences of tobacco use. The goal of this renewal application is to enhance smoking cessation rates for homeless smokers by testing the effects of 1) intensive smoking intervention, and 2) integrating alcohol abuse treatment with smoking cessation. We will utilize a 3- group randomized design to test study hypotheses. Findings from proposed research have a high potential to inform treatment of nicotine dependence and alcohol abuse in an underserved population that has been recalcitrant to treatments effective in the general population. Data from this study could influence policy and programs aimed at reducing tobacco- and alcohol-related disease burden in vulnerable populations.
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