Marc L. Steinberg, Ph.D. - US grants

DESCRIPTION (provided by applicant): Nicotine Dependence is a substantial problem for individuals with serious unique mental illness. The biopsychosocial problems of individuals with schizophrenia and the realities of the current mental health system have somehow shielded this population from the benefits of tobacco control efforts to better engage these heavy smokers into nicotine dependence treatment. This K23 Award is necessary to provide the candidate with the required time, resources, and additional training to further his patient oriented research interests in better understanding how to engage and treat nicotine dependence in smokers with schizophrenia. The proposed Primary Mentor (Douglas Ziedonis) and the UMDNJ/Rutgers environment offers much to help the applicant achieve his goal of becoming an independent researcher. The research plan includes two studies that seek to further evaluate why so few smokers with schizophrenia quit compared to the general population and to develop interventions to engage this population into tobacco dependence treatment. The first study is a Patient-Oriented Laboratory Study that will a) Compare levels of task persistence, cognition, and motivation in smokers with and without schizophrenia, and b) Evaluate task persistence as a partial mediator of psychiatric status and nicotine dependence treatment outcome. An additional reason smokers with schizophrenia may be less likely to quit smoking may be related to their motivation to make a quit attempt. The second study is a Stage 1 a/b Behavioral Therapy Development Study that will build on the candidate's prior research on enhancing motivation to seek nicotine dependence treatment. The primary aims include a) Further develop a computerized personal feedback assessment, b) Further develop an impact scale of feedback items, c) Create a therapy manual, adherence scale, training program, and randomized study to determine the appropriate effect size with which to power a future Stage II study. The training plan aims to complement the research plan and advance the candidate's professional skills. The plan will include important hands-on learning experiences, workshops, class work, attendance at national scientific conferences, and strong mentoring relationships.

DESCRIPTION (provided by applicant): Tobacco use is the leading preventable cause of death in the United States1, and unfortunately, even in empirically supported multi-component tobacco dependence treatment2 trials, most smokers relapse within days of their quit attempt.3 One potentially modifiable relapse risk factor is "task persistence"-the tendency to persist in a difficult task. Because greater task persistence is associated with better smoking cessation treatment outcomes,4-7 an intervention which increases task persistence should result in higher quit rates. Cognitive theory8 indicates that automatic thoughts-such as those which may contribute to low task persistence (e.g., "This stress is unbearable without a cigarette!")-are modifiable. If we can train smokers to modify behaviors and dispute automatic thoughts that contribute to their lack of persistence during a quit attempt, we may be able to improve cessation rates. In this Stage I Behavioral and Integrative Treatment Development (R34) project, we propose to develop a theory-based smoking cessation intervention (called Persistence-targeted smoking cessation;PTSC), including a treatment manual, preliminary training materials, and preliminary therapy integrity scales. After writing a first draft of the PTSC manual, we will use a successive cohort design 9,10 that allows for a structured approach to therapy development. We will recruit two successive cohorts of 5 smokers each to participate in an 8-session, weekly, individual, smoking cessation treatment (PTSC) plus nicotine patch. After treating patients 1-5, we will analyze data and feasibility, and will modify the treatment manual and protocol accordingly before then treating patients 6-10. We will again revise the manual based on data and clinical experience in treating the second cohort before beginning a Stage Ib pilot RCT. In the RCT, we will randomize participants (N=50) to Persistence-Targeted Smoking Cessation + patch (PTSC) or to a manualized version of the National Cancer Institute's "Clearing the Air" + patch (CTA), and assess outcomes at 1- and 3-months after the target quit date. We will test the feasibility and preliminary efficacy of the intervention (i.e., cigarettes per day and prolonged abstinence) and evaluate the relationship between changes in task persistence and smoking cessation success - including testing a mediational model as an experimental hypothesis. Our research team is particularly qualified to successfully conduct the proposed study. We have conducted multiple therapy development studies (including those of CBT) resulting in treatment manuals, developed and used therapy integrity scales, and treated hundreds of smokers in cessation clinics and in NIH clinical trials. This project has strong potential significance because if we can train smokers to dispute automatic thoughts contributing to their lack of persistence during a quit attempt, we may be able to improve cessation rates. PUBLIC HEALTH RELEVANCE: Tobacco use is the leading preventable cause of death in the United States,1 and unfortunately, most smokers relapse within days of their quit attempt.3 Because smokers demonstrating a greater tendency to persist in difficult tasks have better smoking cessation treatment outcomes,4-7 we will design an intervention that increases abstinence-related persistence with the goal of increasing smoking cessation success rates.