An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial

BACKGROUND

Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV.

OBJECTIVE

This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management.

METHODS

This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date).

RESULTS

Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy.

CONCLUSIONS

The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52090.

Evaluating the indirect roles of anxiety and depressive symptoms in the relations between negative emotional reactivity to racial/ethnic stress and cigarette smoking among Hispanic adults who smoke

There has been increased recognition that Hispanic/Latinx (hereinafter Hispanic) persons are a tobacco disparities group in the United States. Although some past work has found greater exposure to racial/ethnic discrimination is associated with indices of smoking among Hispanic persons, research has not explored the degree of negative emotional reactivity to racial/ethnic stress in terms of smoking processes. The present cross-sectional study served to evaluate the indirect effects of depressive and anxiety symptoms in terms of relations between racial/ethnic stress reactivity and cigarette dependence, severity of problems when trying to quit, and perceived barriers for quitting among Hispanic persons who smoke in the United States. Participants included 329 Hispanic adults who smoked cigarettes daily (Mage = 35.5 years; SD = 8.67; 37.4% female). Results indicated that depressive symptoms exerted a statistically significant indirect effect in the association between negative emotional reactivity to racial/ethnic stress and cigarette dependence and severity of problems when trying to quit, whereas anxiety symptoms maintained an indirect effect for perceived barriers for smoking cessation. The current findings help characterize the intricacies by which negative emotional reactivity to racial/ethnic stress is related to smoking behavior and beliefs among Hispanic persons who smoke. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain interference among adult dual combustible and electronic tobacco users in terms of perceived barriers for quitting

Electronic cigarette (e-cigarette) use has become increasingly common among combustible cigarette users, and dual use may represent a more severe type of nicotine addiction. Experiencing pain is one prevalent domain that may be important to understand quit processes and behavior among dual users. Although most past research on pain and nicotine/tobacco has focused on combustible cigarette use, initial work on e-cigarette users has found that greater pain severity is associated with higher levels of dependence and negative thinking patterns about e-cigarette use. Yet, there has been no effort to explore the experience of pain among dual users in terms of perceived barriers for quitting combustibles or e-cigarettes. The present study sought to examine pain interference among dual combustible and e-cigarette users in terms of perceived barriers for quitting among 138 (45.9% female; Mage = 35.96 years, SD = 7.16) adult dual users (i.e., users of both combustible cigarette and e-cigarettes). Hierarchical linear regression models indicated that pain interference was significantly associated with both perceived barriers for cessation of combustible cigarettes and perceived barriers for cessation of e-cigarettes. Overall, the present investigation served as an initial evaluation of the role of pain interference in terms of perceived barriers for quitting combustible and e-cigarettes among adult daily dual users. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Latinx Individuals Who Smoke Daily with and without a Probable Anxiety Disorder: Differences in Smoking Behavior and Beliefs about Abstinence

There is a well-established relation between anxiety psychopathology and smoking in the general population. However, little work focuses on Latinx/Hispanic (hereafter Latinx) persons who smoke from this comorbidity perspective. The present investigation aimed to explore differences among English-speaking Latinx adults who live in the United States (US) and smoke cigarettes with and without a probable anxiety disorder in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) who identified as Latinx and were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with a probable anxiety disorder (compared to those without) were more likely to demonstrate higher levels of cigarette dependence, severity of problems when trying to quit, perceived barriers for quitting, and negative abstinence expectancies after adjusting for key variables linked to smoking and anxiety (e.g., hazardous drinking, education). The current findings are the first to document probable anxiety disorder status as a clinically relevant factor for a wide range of smoking variables and beliefs about abstinence among Latinx persons who smoke.

Perceived Racial/Ethnic Discrimination and Smoking Outcome Expectancies among Adult Latinx Smokers Living in the United States

Background: Smoking-related health disparities are prevalent in the Latinx community in the United States (US). Although Social Determinants of Health (SDoH) are known to contribute to a myriad of health problems among the Latinx population, there is relatively limited work expressly aimed at elucidating SDoH among Latinx smokers. Perceived racial/ethnic discrimination is one SDoH construct that may be especially relevant to understanding smoking-related cognition for Latinx smokers in the US. Smoking outcome expectancies, reflecting beliefs about the consequences of smoking, are established cognitive processes that have been linked to the maintenance and relapse of smoking. The purpose of the present work is to investigate perceived racial/ethnic discrimination in relation to smoking outcome expectancies amongst Latinx smokers in the US. Method: Participants included 338 English-speaking Latinx adult daily cigarette smokers from the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female). Results: Results indicated that perceived racial/ethnic discrimination was related to greater levels of negative reinforcement, positive reinforcement, and appetite-weight control expectancies, but not negative consequences expectancies. Discussion: Overall, the current findings provide novel insight into the relationship between perceived racial/ethnic discrimination and smoking outcome expectancies amongst English-speaking Latinx cigarette users in the US.

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%-3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%-3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.