Crushing the craving to smoke is no easy feat—perhaps a herculean task for many who have key triggers to light up.
Addressing the specific triggers and the mental health aspect of the addiction equation among African American smokers is a complex issue that deeply interests University of Houston’s Dr. Michael Zvolensky who serves as the Director of RESTORE Laboratory: Research on Emotion, Substance Treatment Outcomes and Racial Equity and is a Distinguished Professor in UH’s Department of Psychology.
“In terms of health disparities, Black Americans tend to start smoking later in life,” Zvolensky said. “They end up making more failed quit attempts and have less success at quitting than some other groups. They are at risk for problems including throat cancer and lung cancer. Smoking increases the risk of more mental health problems, including depression.”
To shed light on the specific triggers, Zvolensky and his research team are developing a new smartphone app called MASP – a behavioral science research project funded by the NIH/NIMHD’s HEALTH Center for Addictions Research and Cancer Prevention (U54MD015946, PI: Ezemenari M. Obasi). Zvolensky is collaborating on the MASP app with Michael Businelle, Ph.D. who serves as the Co-Principal Investigator (Co-PI) of the research initiative. The app works by checking in with users throughout the day to pinpoint their mood and assess whether they’re experiencing cravings or withdrawal symptoms. The app ultimately gauges their overall mental health.
“Our project really centered on trying to develop and offer more accessible evidence- based smoking cessation interventions tailored to the population of Black smokers—who are often also suffering with concurrent mental health problems,” Zvolensky said. “We’re developing digital therapeutic that targets the risk factors for both smoking and mental health problems—and it’s tailored to this population in a variety of ways.”
The stark reality is that African American men have the highest rates of lung cancer in the U.S. according to the Centers for Disease Control and Prevention. African American men are 11 percent more likely to be diagnosed with lung cancer, and 9.8 percent more African American men die from the disease.
“The history of tobacco among Black smokers is that big tobacco targeted them and pushed menthol cigarettes to this group more than any other group,” Zvolensky said. “We’re hoping that this intervention, delivered on the app, will be a small step forward in increasing quality treatment access for this population.”
One of the key benefits of the MASP app is that when nicotine users are experiencing heightened cravings, the app selects and delivers an individually tailored message from an extensive library of hundreds of messages and videos. The app also features videos that teach relaxation techniques.
“What we came up with is that the app provides treatment on a schedule. Our treatment rolled out the process over time,” Zvolensky added. It walks them through that. All the information that’s presented is presented to Black Americans. The voices, the video pictures are from Black Americans--tailored to male or female. It uses ecological momentary assessment. Every day, we interact with the app--we track what they’re doing. It’s very personal information.”
Zvolensky has noted that the app has been successful in terms of study participant feedback and engagement in Phase I.
“I’m really surprised because we have people interacting with this app at a high level. It’s so surprising--the density of therapy and therapeutic activity was so much higher than what would be possible than traditional care,” Zvolensky said. “We have them interacting multiple times a day. The level of engagement has been super high. I’m so pleased about that because that’s one of the main barriers to behavior change.”
Currently in the process of finishing Phase I and tweaking the app, Zvolensky is now slated to launch Phase II of the MASP app study.
“There are two phases to this--one, we have this idea...first thing is to create the app...and then get feedback about how people use it. We are close to being finished with that phase,” Zvolensky said. “We’re starting to test in Phase II in a large-scale randomized clinical trial comparing it to the National Cancer Institute app that’s out there as a real-world best practice comparative. We’re seeing our culturally tailored integrated app for Black Americans smokers that we developed will outperform or do better than the National Cancer Institute app that’s not tailored or integrated.”
Perhaps one of the most striking advantages of the MASP app is that it allows for more therapeutic contact with Black American smokers which gives them continual feedback about their progress.
“What’s cool about it is that when you do traditional care, in-person care, you might see your provider at most once per week, like through an outpatient setting,” Zvolensky said. “It allows us to increase the density of our therapeutic contact with this group--through this monitoring of how they’re doing and an exchange of therapeutic information between them and us. If they’re doing well, they will get messages, like ‘you’re doing great.’ Or if they’re struggling, they will get messages, ‘remember this’ and ‘You can always call us.’”
Zvolensky added the overarching concept behind MASP app is that it will ultimately help boost smokers’ odds of quitting successfully.
“The idea, in short, is if we can increase the ability to be more psychologically healthy and adaptive, then we can increase the odds that can help them quit successfully,” Zvolensky said. “They all know that smoking is linked to problems with physical health, but they did not understand that it was also related to poor mental health. In fact, the effects are just as strong for mental health problems as for physical health. It’s a nice catalyst for change.”
Since 2011, Zvolensky has been running a smoking cessation program in Houston.
“Our team has treated thousands of smokers from this integrated treatment perspective,” Zvolensky said. “This work has continually been informed by its successes and failures of our clinical work with this population and related populations that are underserved, including the Latinx and Black American population. We’re trying to really integrate and think through with people how to develop interventions that are a good fit.”
Trained as a clinical psychologist who completed his clinical internship at Brown University, Zvolensky has been interested in the underpinnings of addiction throughout his entire career trajectory.
“The common theme is that addiction is intertwined with mental health,” Zvolensky added. “I’m hopeful we’ll be able to scale up these approaches, as we continue to learn, educate others and build strong alliances with community organizations with specific community organizations that are working with some of these populations.”
When Zvolensky came to Houston 11 years ago, he realized the path which focused on mental health addiction work hadn’t yet been forged.
“I came to Houston for that reason. My career really shifted to this kind of mental health addiction work, but more with a more health disparities prism,” Zvolensky said. “I personally think it is very important because there hasn’t been much light in these areas since there haven’t been many people doing much research.”
Zvolensky’s mentorship goal is to pass his knowledge about addiction and mental health on to others, with the greater intention of improving public health.
“My hope is that by continuing to do this work and to train others in this philosophy which is based on science and human experience--it will improve public health.” Zvolensky said.
"Smokers will recognize the importance of harm reduction, not just quitting, and this will require less stigmatization of both mental health and addiction. So many of our patients struggle with guilt, stigmatization, and shame, and there’s no reason for it because it’s learned behavior.”
Zvolensky said that recruitment of Phase II of the MASP app clinical trial is now underway and is designed for 200 people.
“In reality, smoking is very much a behavioral health problem that’s tied to mental health and physical health,” Zvolensky said. “If you don’t address the mental health piece of this in context of smoking, your chances of having much success of quitting are very low.”
By Alison Medley