|1R01CA273221-01A1 Interpret this number
|University Of Texas At Austin
|Efficacy and Implementation of Exercise-Based Smoking Cessation Treatment for Adults with High Anxiety Sensitivity
Cigarette smoking is the leading cause of preventable death and disability in the United States. Among the
various psychopathologies, anxiety and depression symptoms and syndromes are the most prevalent psychiatric
conditions in the general population and are remarkably comorbid with smoking. Moreover, affective-vulnerable
smokers often are more nicotine dependent, smoke more to manage negative mood states, and expect smoking
to have greater positive effects on their mood compared to smokers without such affect vulnerability.
An integrative approach to address negative affect symptoms and disorders associated with smoking is to
focus on transdiagnostic processes that underpin both affective psychopathology and smoking. Anxiety
sensitivity (AS), or the fear of anxiety and aversive internal sensations, is a transdiagnostic vulnerability factor
for the etiology and maintenance of anxiety disorders and other emotional disorders. AS is associated with an
increased risk of anxiety and mood psychopathology and implicated in several aspects of smoking maintenance
and relapse, including nicotine withdrawal and craving and greater odds of early lapse and relapse.
Our treatment development work (i.e., phases I and II) supports high-intensity exercise as an intervention
strategy for smokers with high AS. High-intensity exercise reduces AS as well as nicotine withdrawal and craving,
depression, and anxiety, all of which have shown to predict cessation failure. We have shown that a 15-week
intervention that combines high-intensity exercise with standard smoking cessation treatment (Smoking
Treatment Enhancement Program [STEP]) yields significantly higher abstinence rates relative an intervention
that combines wellness education with standard smoking cessation treatment. We have also shown that STEP
can be adapted for delivery in a community-based setting involving the YMCA and the Quitline; abstinence rates
among participants receiving STEP were double those among participants assigned to the control intervention.
The proposed study aims to build upon this research by conducting a phase III study. First, we will examine
whether the efficacy of the community-based version of STEP will generalize across non-Latinx White, Black
and Latinx smokers. This aim is informed by the observations that (1) racial/ethnic minorities are less apt to seek
and receive (successful) evidenced-based care for smoking cessation and are underrepresented in efficacy
research; and (2) Black and Latinx smokers might benefit from specific focus on increasing the ability to
adaptively respond to interoceptive stress as targeted in STEP. Second, we will test putative mechanisms of
actions and aim to identify moderators of efficacy. Third, we will aim to identify opportunities to improve the reach,
effectiveness, adoption, implementation, and maintenance of STEP across YMCA’s using an implementation
framework (RE-AIM) and qualitative process evaluation. These aims will be tested by conducting a large
randomized clinical trial comparing STEP to a control intervention across several YMCA branches among a
racially/ethnically diverse sample of smokers.