DESCRIPTION (provided by investigator): African Americans (AA) have the highest
prevalence of hypertension in the world and smoking rates among urban AAs are
higher than among whites. Moreover, AA smokers experience a disproportionate
burden of the health consequences of smoking and AA hypertensives who smoke are
at exceedingly high risk of experiencing adverse health outcomes. Nevertheless,
little research has been aimed at developing effective smoking cessation
interventions for AAs, despite the fact that prominent publications (Treating
Tobacco Use and Dependence Clinical Practice Guideline; Surgeon General's
Report on Tobacco Use Among U.S. Racial/Ethnic Minority Groups) have decried
the paucity of research on treatments for AAs and have highlighted the need for
new treatments specifically targeted at minority smokers. Interactive,
computer-delivered interventions have the potential to produce significant
advances in the individualization, accessibility, and acceptability of
behavioral treatments for nicotine dependence. Unfortunately, there is a
"digital divide" with African Americans having less access to these resources.
The proposed study is a two-group randomized clinical trial (N=400) designed to
develop and evaluate a theoretically and technologically sophisticated,
culturally sensitive, smoking cessation intervention for African American
smokers with hypertension. Participants will be randomly assigned to either
standard care (SC) or standard care plus computer-delivered treatment (CDT). SC
consists of eight weeks of nicotine patch therapy, culturally sensitive
self-help materials, and four telephone counseling sessions based on the
Treating Tobacco Use and Dependence Clinical Practice Guideline. CDT will be
delivered by palmtop personal computers and will be individualized for each
smoker based on state-of-the-science ecological momentary assessment
techniques. Ambulatory assessment and treatment devices are becoming
increasingly common in today's medical care. The use of palmtop personal
computers can facilitate a bridging of the digital divide because of their low
cost and ease of use. Furthermore, this approach is congruent with the current
theoretical emphasis on high risk situations and an "episodic" model of smoking
motivation and relapse. CDT is able to directly intervene to influence relapse
precipitants in real-time during acute episodes of high risk, as well as
potentially strengthen adaptive predispositions through repeated exposure to
and repetition of coping behaviors. The latter may contribute to better
acquisition, retention, and use of coping skills over time. To ensure cultural
sensitivity, all treatment materials and study procedures will be developed and
evaluated in conjunction with a cultural and scientific advisory board.
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