A Multiple Health Behavior Change Intervention for Overweight and Obese Smokers

Brown University, Providence RI

Investigators

Linked publications & trials

Abstract

Project Summary/Abstract This K23 award provides the PI with mentored research career development training necessary to become an independent researcher capable of developing and testing innovative interventions targeting problematic use of addictive substances and other maladaptive patterns of behavior associated with obesity or other comorbidities. Overweight and obese smokers are disproportionately at risk for disease, disability, and premature death but may be reluctant to give up smoking due to the fear of subsequent weight gain and trouble managing their weight without cigarettes. Applying weight gain prevention as part of a multiple health behavior change (MHBC) program prior to smoking cessation, can help overweight and obese individuals lose weight and buffer against post-cessation weight gain. Achieving some degree of success with behavioral weight loss may result in decreased negative affect, increased future-oriented decision-making, and increased self-efficacy to manage weight and change smoking with great potential impact on subsequent smoking cessation outcomes. The K23 research developed this MHBC intervention for treatment-seeking overweight and obese smokers and used qualitative focus group data (completed Year 1) and data from an open series of patients (completed Year 3) to refine treatment. In Year 4, a small 2-group randomized controlled clinical trial (RCT) began aiming for 60 overweight or obese smokers (BMI ≥ 25) to be assigned to either weight gain prevention (an intervention based on self-regulation approaches to produce and maintain weight loss as a way to effectively prevent weight gain) or healthy lifestyle education (an attention- placebo comparison condition matched for contact time) before smoking cessation treatment. Participants are randomized to 8 weeks of weight gain prevention or lifestyle education followed by 8 weeks of cognitive behavioral therapy for smoking cessation with combination nicotine replacement therapy. Smoking cessation counseling sessions include brief maintenance information according to assigned condition. Intervention feasibility and acceptability are assessed and preliminary data regarding efficacy of the intervention on weight and smoking outcomes will be analyzed. The PI works with an experienced and knowledgeable team of mentors (Drs. Damaris Rohsenow, Rena Wing, Rosemarie Martin, Suzanne Colby, and Jennifer Tidey) to continue to pursue training relevant to this proposal including: (1) conducting randomized controlled trials for health behavior change interventions for smokers with comorbid conditions, with an initial primary focus on obesity, (2) implementing the stage model of treatment development for clinical behavioral therapy research including qualitative methodology for therapy development, (3) learning advanced statistical techniques for analyzing longitudinal data in clinical trials, and (4) strengthening professional research career development skills. Preliminary efficacy data obtained in the proposed study represents an important first step in creating an innovative, empirically-supported, MHBC intervention with high significance to public health and will be used to pursue a fully- powered R01 grant and transition to research independence. Supplemental research funds will provide continuity of research by supporting research personnel to sustain progress on the RCT phase of the research during a period in which the PI will experience a significant life event that would otherwise impact research progress and productivity.