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Public Health Researchers to Study a Mindfulness-Based Smoking Cessation Smartphone Application For People Living With HIV

People living with HIV are at high risk of tobacco-related health disparities. Smoking prevalence in people with the virus is triple that of the general population – 68 percent compared to 17 percent, respectively. Compared to nonsmokers, people who live with HIV and smoke have a higher risk of HIV associated comorbidities, such as cancer and cardiovascular complications, a shorter lifespan, lower quality-of-life, and are less adherent to antiretroviral therapies (ART).

Taghrid Asfar, M.D., M.P.H., assistant professor in the Division of Epidemiology and Population Health Sciences at the Department of Public Health Sciences, is developing a mindfulness smartphone application for smoking cessation, specifically targeting people who live with HIV. The project, funded by the Center for AIDS Research, will adapt an existing mindfulness-based smoking cessation smartphone application – Craving to Quit – to people living with HIV and explore the acceptability and feasibility of adding a contingency management strategy and an assessment to ART adherence to the intervention in order to further increase its benefit for this population.

“This study will result in the creation of a new smartphone application that is tailored to this population and once in use, the application will hopefully be successful in helping this population to quit smoking,” said Dr. Asfar. “Along with the new application, recommendations can be made regarding smoking cessation smartphone apps that are already in use.”

Smartphone ownership in the United States is projected to reach at least 90 percent by 2020, and the growth in ownership is most pronounced in the ethnic minority groups and those with low incomes that make up the majority of the people living with HIV in the U.S. This suggests that smartphone interventions may have a broad reach among this population of smokers.

Smartphone-based smoking cessation applications are effective and significantly increase access to treatment. This technology allows an intervention to be integrated into a user’s daily life and delivered in multiple methods, such as through video and audio, as well as helps to track progress anywhere and anytime.

Mindfulness Training – the training of attention, body awareness, and emotional regulation – is an effective behavioral treatment for smoking by reducing stress and gaining a greater sense of control over a craving, which are major predictors of smoking relapse in people living with HIV. Contingency management provides financial incentives for confirming smoking abstinence and can improve cessation among socioeconomically disadvantaged and hard-to-treat smokers.

This study will consist of a multidisciplinary team of experts in smoking cessation. They will include experts in epidemiology, such as Dr. Asfar and David Lee, Ph.D., professor, director of graduate programs, and chair of the Office of Graduate Studies at the Miller School of Medicine. The study will also include experts in HIV prevention interventions, such as Adam Carrico, Ph.D., associate professor at the Miller School, in mindfulness training, such as Judson Brewer, M.D., Ph.D., who is an associate professor of medicine and psychiatry at Brown University, as well as in HIV management, such as Maria Alcaide, M.D., who is an associate professor of clinical medicine, director of the Miami CFAR Clinical Core, and mentor program in the Division of Infectious Diseases at the Miller School of Medicine. Josh Roman will serve as the developer of the application.

The team will adapt “Craving to Quit” – an existing mindfulness smoking cessation application – for people living with HIV and integrate contingency management and ART adherence assessment to maximize its value and effectiveness.

Dr. Lee and Dr. Carrico will be the mentors on the application. The Spiral Technology Action Research framework consists of a five-cycle operational model, which includes “Listen”, “Plan”, “Do”, “Act”, and “Study”. The framework will guide the development of the new application.

Given the scope of the CFAR Pilot Grant, this project will only “Listen” to people who live with HIV and who smoke to adapt the content and features of the “Craving to Quit” application. It will also “Plan” for the creation of the new adapted application – Mind2Quit – to be ready for the production of the “Do” component, to implement “Act”, as well as to test “Study” into a planned R34 feasibility clinical trial application.

“Once this information is gathered, improvements and recommendations can be made in order to personalize these applications for a more user-friendly and effective experience,” said Dr. Asfar. “Personalizing applications for this population may assist them in quitting smoking while reducing their stress and also improving ART adherence with the goal of helping those living with HIV to live healthier and fuller lives.”

Written by Amanda Torres
February 27, 2020