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A Pilot SMART Testing an Integrative Smoking Cessation Intervention for HIV Patients

This study is a pilot Sequential Multiple Assignment randomized clinical trial incorporating nicotine replacement treatment (NRT), contingency management (CM), and mindfulness training (MT) to help people living with HIV quit cigarette smoking.

Mindfulness training (MT) is an evidence-based approach that has become popularly used for smoking cessation. MT can be divided into two components: 1) focusing attention on the present moment, and 2) cultivating an acceptance attitude toward that experience. Both components can improve individuals’ capacity to refrain from getting absorbed in maladaptive mental patterns, behaviors, and emotional reactions that lead to depression.1, 2 It can help smokers control cravings by being less emotionally reactive and less prone to relapse related to avoidance of distressing symptoms.3 Further research is warranted to explore the effectiveness of mindfulness training as a smoking cessation intervention specifically tailored for individuals living with HIV who smoke. Additionally, this study uses contingency management to promote smoking cessation among this population. Contingency management is an evidence-based behavioral intervention where individuals are provided increasing tangible rewards for biologically confirmed substance abstinence. CM has been deemed effected in promoting stable periods of abstinence in substance use behavioral research, including tobacco.4, 5, 6

We aim to identify the optimal dynamic strategy to promote biomarker-confirmed smoking abstinence among this population. The criteria for our participants are the following:

  • 18 and older
  • Diagnosed with HIV
  • Participants who speak either English or Spanish
  • Regular smokers (smoke 5 or more cigarettes a day in the past year)
  • Interested in making a quit attempt within the next 30 days
  • Own a smartphone

If you are interested in participating, please apply.

References
  1. Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette Books; 2009.
  2. Malinowski P. (2013). Neural mechanisms of attentional control in mindfulness meditation. Frontiers in neuroscience, 7, 8. https://doi.org/10.3389/fnins.2013.00008
  3. Elwafi, H. M., Witkiewitz, K., Mallik, S., Thornhill, T. A., 4th, & Brewer, J. A. (2013). Mindfulness training for smoking cessation: moderation of the relationship between craving and cigarette use. Drug and alcohol dependence, 130(1-3), 222–229. https://doi.org/10.1016/j.drugalcdep.2012.11.015
  4. Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes, and they will come: contingency management for treatment of alcohol dependence. Journal of consulting and clinical psychology, 68(2), 250–257. https://doi.org/10.1037//0022-006x.68.2.250
  5. Shoptaw, S., Jarvik, M. E., Ling, W., & Rawson, R. A. (1996). Contingency management for tobacco smoking in methadone-maintained opiate addicts. Addictive behaviors, 21(3), 409–412. https://doi.org/10.1016/0306-4603(95)00066-6
  6. Sigmon, S. C., & Patrick, M. E. (2012). The use of financial incentives in promoting smoking cessation. Preventive medicine, 55 Suppl(Suppl), S24–S32. https://doi.org/10.1016/j.ypmed.2012.04.007

This study is an investigator-initiated study funded by a Sylvester Cancer Comprehensive Center (SCCC) Pilot Award Dr. Asfar received in 2019 to conduct another study, a pilot randomized clinical trial among young cancer survivors to evaluate the feasibility, acceptability, and potential efficacy of a smartphone application versus an in-person mindfulness smoking cessation intervention.

Collaborators

Portrait of Taghrid Asfar

Taghrid Asfar, M.D., M.S.P.H.

Principal Investigator
Assistant Professor, Department of Public Health Sciences
Member, Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine

tasfar@miami.edu

(305) 243-3826

Dr. Asfar has extensive experience in tobacco control research nationally and internationally. Since 2001, her tobacco control work has been funded continuously by the NIH and conducted both in the United States and the Eastern Mediterranean Region, including Syria, Lebanon, and Tunisia. This work involves epidemiological and qualitative studies of tobacco use, randomized clinical trials of smoking cessation interventions, and tobacco regulatory research in health communication approaches targeting emerging tobacco products such as e-cigarettes and hookahs. She has two overarching aims in her research: (1) improving smoking cessation treatment among socially disadvantaged and high-risk populations (i.e., low-income adults, ethnic minorities, HIV patients, cancer survivors); and (2) preventing tobacco use among youth and young adults by advancing health communication strategies, such as health warning labels. She has more than 60 peer-reviewed publications (Asfar T - Search Results - PubMed) and many of these are in leading, high impact journals in this field (i.e., Tobacco Control; Nicotine and Tobacco Research; Addiction; and the Cochrane Tobacco Addiction Group). Dr. Asfar has currently five active grants as PI including:

  • 1R01DA051836: Developing and testing health warning labels on the ENDS (electronic cigarette) device
  • 20K10 James and Esther King Biomedical Research Program: Developing and testing waterpipe-specific health warning labels targeting young people in Florida
  • R01TW010654-01: Translating Evidence and Building Capacity to Support Waterpipe Control in the Eastern Mediterranean
  • CFAR Pilot Award P30AI07396: “Mind2Quit” Developing A Mindfulness Smartphone App for Smoking Cessation for People Living with HIV
  • Sylvester Cancer Center Pilot Award P30CA240139: Smartphone Application versus In-Person Mindfulness-Based Smoking Cessation Intervention for Young Cancer Survivors: Reach versus Effectiveness
Portrait of Judson Brewer

Judson Brewer, M.D., Ph.D.

Director of Research and Innovation
Brown University

judson_brewer@brown.edu

Dr. Judson Brewer is the Director of Research and Innovation at the Mindfulness Center and associate professor in Behavioral and Social Sciences at the School of Public Health and Psychiatry at the Medical School at Brown University. He also is a research affiliate at MIT. Brewer has conducted research on the neurobiology of habits and mindfulness techniques to help individuals overcome various forms of addiction, including smoking and emotional eating. He has also written books on mindfulness, such as "The Craving Mind: From Cigarettes to Smartphones to Love – Why We Get Hooked and How We Can Break Bad Habits.". Dr. Brewer is the founder and moderater of the Craving to Quit application, where smokers can receive support, weekly tips, can track their progress of their quit journey.

Portrait of Maria Alcaide

Maria Alcaide, M.D.

Professor
Director, Infectious Diseases Research Unit
Research and Center for AIDS Research (CFAR) Clinical Core
Director, Clinical Research with the office of the Executive Dean for Research
Leader, Miami Clinical Translational Science Institute (CTSI) and Center for AIDS Research
(CFAR) Mentoring Programs
University of Miami Miller School of Medicine

malcaide@med.miami.edu

Dr. Alcaide holds various roles, including being an Infectious Diseases specialist, Professor of Medicine, OB/GYN, and Public Health Sciences at the University of Miami Miller School of Medicine. Additionally, she serves as the Director of Clinical Research for the Infectious Diseases Research Unit and the Clinical Core of the Miami Center for AIDS Research (CFAR). In these capacities, she offers scientific and administrative guidance for numerous multidisciplinary research studies concentrating on HIV and other emerging infections, including SARS-CoV-2.

Portrait of Adam W. Carrico

Adam W. Carrico, Ph.D.

Professor
Health Promotion and Disease Prevention
Robert Stempel College of Public Health

acarrico@fiu.edu

Dr. Carrico earned his doctorate in clinical health psychology, specializing in psychoneuroimmunology at the University of Miami. Following a clinical internship at the Veterans Affairs Palo Alto Health System, he joined the University of California, San Francisco (UCSF) for postdoctoral fellowships in Health Psychology and Reproductive Infectious Disease. Over a decade at UCSF, Dr. Carrico conducted research on the intersection of methamphetamine and HIV epidemics in sexual minority men. He led pioneering studies on substance use disorder treatment from a harm reduction perspective, addressing amphetamine-type stimulant use in low- and middle-income countries. Currently, he is involved in four randomized controlled trials funded by the National Institute on Drug Abuse (NIDA) focusing on optimizing biomedical approaches to HIV prevention in sexual minority men using stimulants. Dr. Carrico is also a principal investigator for two large national cohorts exploring the biological and behavioral pathways linking methamphetamine use to increased HIV risk among sexual minority men.

Portrait of Deborah L. Jones

Deborah L. Jones, Ph.D.

Professor
Co-Director of the Center for HIV Research on Mental Health (CHARM)
Co-Director of the HIV & Women Program of the UM Center for AIDS Research (CFAR)
PI/MPI of the MACS/WIHS Combined Cohort Study (MWCCS)
Department of Psychiatry and Behavioral Sciences
Division of Psychology
University of Miami Miller School of Medicine

malcaide@med.miami.edu

Dr. Deborah L. Jones is a clinical psychologist and professor in the Department of Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine co-Director of the Center for HIV Research on Mental Health (CHARM), co-Director of the HIV & Women Program of the UM Center for AIDS Research (CFAR), and PI/MPI of the MACS/WIHS Combined Cohort Study (MWCCS). Dr. Jones has worked on HIV/AID for over two decades and has worked with community based recruitment and underrepresented minority men and women at risk for HIV. Additionally, she has been PI and collaborator on large biobehavioral cohort studies in Miami FL on HIV and COVID, and HIV, mental health, substance use, and sex/gender-based disparities (e.g., PI Jones/Kumar, R01DA034589; PI: Jones; K18DA031463; R01MH110242-S1).

Portrait of Michael J Zvolensky

Michael J Zvolensky, Ph.D.

Director of the RESTORE Laboratory
University of Houston

mjzvolen@central.uh.edu

Dr. Zvolensky Dr. Zvolensky is a Distinguished Professor at the University of Houston, leading the RESTORE Laboratory focused on researching the intersection of anxiety, stress-related psychopathology, and substance use disorders. With over 400 scholarly works, his expertise lies in understanding the co-occurrence of these issues and their impact on physical health, including conditions like HIV/AIDS, asthma, cardiac disease, and chronic pain. Committed to global health equity, Dr. Zvolensky employs various research methodologies, such as community-based participatory research and clinical trials and has played a significant role in over 45 NIH grants. His impactful research has earned recognition from organizations like the American Psychological Association and the Anxiety and Depression Association of America.

  • Asfar, T., Alcaide, M. L., Jones, D. L., McClure, L. A., Brewer, J., Lee, D. J., & Carrico, A. (2022). HIV patients' perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention. PloS one, 17(8), e0271946. https://doi.org/10.1371/journal.pone.0271946
  • Asfar, T., Perez, A., Shipman, P., Carrico, A. W., Lee, D. J., Alcaide, M. L., Jones, D. L., Brewer, J., & Koru-Sengul, T. (2021). National Estimates of Prevalence, Time-Trend, and Correlates of Smoking in US People Living with HIV (NHANES 1999-2016). Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 23(8), 1308–1317. https://doi.org/10.1093/ntr/ntaa277
  • Abbamonte, J. M., Sawhney, M., Alcaide, M. L., Weiss, S. M., Kumar, M., Asfar, T., & Jones, D. L. (2020). The association of HIV and cocaine use to cigarette smoking in the context of depression and perceived stress. AIDS care, 32(10), 1229–1237. https://doi.org/10.1080/09540121.2020.1778627

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