Sarah E. Linke, Ph.D. - US grants

DESCRIPTION (provided by applicant): Tobacco use and physical inactivity are the leading causes of preventable death in the United States, accounting for approximately one-third of annual deaths. They also tend to co-exist and apparently influence each other, as persistent smokers are more likely to remain inactive. Despite the widespread dangers associated with tobacco use, the seven-year decreasing trend in the U.S. smoking rate appears to have stalled: 20.8% of adults remained self-reported current smokers in 2006. Although 30-50% of smokers attempt to quit each year, most relapse within three months. These statistics suggest that mainstream cessation assistance options do not work well for many smokers, who may benefit from innovative, alternative cessation treatments. While smoking has been recognized as a leading behavioral risk factor for decades, inactivity has emerged relatively recently as an epidemic of Western society. In 2005, only 29.7% of the adult population reportedly engaged in regular leisure-time physical activity, and 10.3% obtained less than ten minutes of moderate or vigorous intensity physical activity per week. PUBLIC HEALTH RELEVANCE: The proposed study addresses both of these major public health problems, as it attempts to replace an unhealthy, addictive behavior (smoking) with a healthy, yet still rewarding activity (exercise). Inactive adult smokers who desire to quit and are otherwise generally healthy will be eligible to participate. The few previous studies attempting to replace smoking with exercise have resulted in modest, short-term smoking cessation success comparable to conventional cessation methods. The proposed study adds unique intervention strategies, including an exercise protocol that capitalizes on the frequent nicotine cravingsthat smokers experience during quit attempts and the craving reductions that occur during and after exercise;an Internet-based standard care control group;and other notable measurement components, to the methods employed in prior studies. The primary goal of the proposed study is to help smokers who desire to quit achieve both short- and long-term cessation, regardless of whether they are randomly assigned to the intervention or control group. Specific aims include examining the effectiveness of short bouts of exercise in response to cigarette cravings in terms of exercise compliance, smoking cessation success, prevention of weight gain, and improvements in fitness. Inactive smokers who desire to quit will have the opportunity to receive a free online smoking cessation program, and some will also receive an exercise training plan to follow in attempt to replace their unhealthy addiction with a healthy activity. This study is consistent with NIDA's recently identified goal of developing exercise interventions for substance abuse/addictions.

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This study intends to examine the immediate and long-term effects of initiating a novel type of exercise program among sedentary smokers, with the ultimate goal of replacing smoking with brief bouts of exercise.

Insufficient physical activity (PA) is a leading risk factor for most chronic health conditions. Identifying patients at higher risk of these conditions due to their insufficient levels of PA is one of the highest priorities given the evidence suggesting that insufficient PA poses as much of a risk to patients? health as other established risk factors that are routinely addressed within the primary care setting (e.g., smoking, hypertension, obesity) and creates a significant financial burden on the healthcare system. Exercise is Medicine (EIM) is a global health initiative managed by the American College of Sports Medicine and American Medical Association that is committed to the belief that PA is integral to the prevention and treatment of diseases and should be regularly assessed as a vital sign and ?treated? in the healthcare setting. The Physical Activity Vital Sign (PAVS) consists of two questions: ?On average, how many days per week do you engage in moderate to strenuous exercise like a brisk walk?? and ?On average, how many minutes do you engage in exercise at this level?? The PAVS tool is optimally used in the clinic setting when it is integrated into electronic medical records (EMR) systems such as UC San Diego Health System?s Epic. Although use of the PAVS in clinical practice has been linked to favorable changes, screening alone may be insufficient for many patients. Clinically significant gains are maximized when positive screening results lead to brief PA promotion interventions. Primary care providers (PCP) are uniquely positioned to provide PA ?prescriptions? to help prepare patients for change. Evidence suggests that PA counseling is more effective when delivered by behavioral health providers, who can use motivational interviewing and shared decision- making strategies to help patients build motivation, identify barriers and solutions, and set PA goals. This study examines the barriers and facilitators of integrating the PAVS and EIM prescription with referral to primary care behavioral health (PCBH) into routine PCP visits and evaluates the program from patient, provider, and healthcare systems perspectives. I am uniquely positioned to leverage the existing PCBH program within the UC San Diego Health System to investigate the practical aspects of implementing the EIM initiative into its six primary care clinics and refining it to fit within the existing infrastructure and cultural norms of each clinic. I propose to innovatively combine two health services research approaches to accomplish my goals of implementing and continuously adapting and evaluating this initiative to fit within the evolving needs and priorities of the healthcare system. I propose a training plan comprised of a strong and committed mentorship team, formal coursework, and experiential learning. I also have the institutional support and resources necessary to conduct this study. The training goals will build upon my background in behavioral medicine and expertise in PA intervention research and extend them to health services research with a focus on implementation science and quality improvement in the context of PA screening and promotion.