Advances in the treatment of HIV disease have shown dramatic effects on improving immune function in a significant proportion of people infected with HIV in the US. For the first time since the beginning of the HIV epidemic, individuals with HIV are faced with the prospect of living longer, healthier lives. Cigarette smoking is highly prevalent among HIV+ individuals and, in addition to the negative health effects associated with smoking, poses unique health risks to those with HIV. Our research program is designed to improve the health and quality of life of HIV+ individuals and determine the most efficacious approaches to smoking cessation for diverse subpopulations of these patients. Latinos make up 13% of the population, yet account for 18.5% of all AIDS cases reported through December 2002, making the Latino AIDS rate 4 times higher than that of non-Hispanic Whites. The goal of this study is to develop and evaluate a clinic based culturally tailored smoking cessation treatment for a largely low-income, Latino, HIV+ population. We will compare this culturally sensitive intervention that incorporates a strong social support component to a standard care control condition, in a randomized controlled trial. This study will be the first to examine different smoking cessation treatments in a Latino HIV+ population and the results will have implications for importing culturally sensitive and cost effective cessation treatments into clinical care settings.

Principal Investigator: Raymond Niaura, PhD

Collaborators at other institutions: Cassandra Stanton, PhD (Brown University)

Funding agency: National Institute on Drug Abuse (R01 DA018079)

Project period: 09/2008 – 07/2013

Methadone-maintained smokers represent an important and large population of long- term, highly dependent smokers. This application compares, in the methadone setting, two forms of pharmacotherapy, combination nicotine-replacement-therapy versus non- nicotine-replacement therapy with varenicline tartrate, a recently approved nicotinic receptor partial agonist. With close to one million methadone treatment entries per year in the United States, this research can have a meaningful public health impact addressing a high-risk population that would otherwise be difficult to reach.

Principal Investigator: Michael Stein, MD (Brown University)

SI/Legacy Collaborators: Raymond Niaura, PhD

Funding agency: National Institute on Drug Abuse (R01 CA129226)

Project period: 08/2005 – 07/2011

Practical counseling, social support, and nicotine replacement therapy (NRT) are components of tobacco dependence treatment that increase the chances of cessation. Web-based interventions are a promising delivery channel for tobacco dependence treatment. Although millions of smokers use the Internet for cessation assistance each year, most users engage only minimally with even the best designed cessation websites, diminishing their impact due to limited exposure/use of effective treatment components (an insufficient “dose”). The goal of this study is to compare the effectiveness of two approaches to improve adherence to the elements of tobacco dependence treatment delivered via the Internet. Addressing adherence to Internet cessation programs is critical and timely to leverage the potential public health impact of this “broad reach” treatment modality. The proposed study is unconventional and innovative in its use of a social network intervention approach to improve both behavioral and pharmacological treatment adherence to enhance cessation outcomes.

Principal Investigator:  Amanda L. Graham, PhD

SI/Legacy Collaborators: Nathan Cobb, MD, David Abrams, PhD, Raymond Niaura, PhD

Collaborators at other institutions: George Papandonatos, PhD (Brown University), Larry An, PhD (University of Michigan), Dave Heilmann (SparkPeople.com)

Funding Agency: National Cancer Institute (1R01 CA155489-01A1)

Project Period:  7/2011 – 6/2016

Opportunities are available to conduct additional analyses and work on manuscripts from a rich and extensive dataset housed at the Schroeder Institute. The original study was conducted at The Brown University Transdisciplinary Tobacco Use Research Center (TTURC). It was a retrospective and prospective study of the parents and 2 generations of offspring of the National Collaborative Perinatal Cohort, first sampled from 1959 to 1964 for prospective examination of the effects of in-utero and early childhood environment on psychosocial and school adjustment up to age 7. The sample was re-contacted when offspring were aged about 40. Over 1600 probands were interviewed for retrospective and current behaviors and biological samples were collected for genetic studies. Measures are extensive and include tobacco use behavior, lifetime trajectories of patterns of tobacco use, mental illness/psychiatric and alcohol/substance abuse comorbidity, in-utero exposure during pregnancy, phenotypes. Data were also collected for methodological studies such as assessing reliability, validity and response bias to surveys and household interviews. Ongoing analyses pertain to: the natural history and patterns of smoking trajectories and transitions from uptake to regular use to relapse episodes; tobacco use and comorbid mental illness, alcohol and substance abuse; in-utero exposure to smoking during pregnancy and effects on offspring; and measures of dependence phenotypes to examine genotypes. Sample publications to date include:

• Abrams DB, Leslie F, Mermelstein R, Kobus K, Clayton RR. Transdisciplinary tobacco use research.  Nicotine Tob Res. 2003 Dec;5 Suppl 1:S5-10. PMID: 14668083. No abstract available.
• Gilman SE, Rende R, Boergers J, Abrams DB, Buka SL, Clark MA, Colby SM, Hitsman B, Kazura AN, Lipsitt LP, Lloyd-Richardson EE, Rogers ML, Stanton CA, Stroud LR, Niaura RS. Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control. Pediatrics. 2009 Feb;123(2):e274-81. PMID: 19171580. Full text.
• Kahler CW, Daughters SB, Leventhal AM, Rogers ML, Clark MA, Colby SM, Boergers J, Ramsey SE, Abrams DB, Niaura R, Buka SL. Personality, psychiatric disorders, and smoking in middle-aged adults. Nicotine Tob Res. 2009 Jul;11(7):833-41. Epub 2009 May 26. PMID: 19470795. Full text.
• Kahler CW, Leventhal AM, Daughters SB, Clark MA, Colby SM, Ramsey SE, Boergers J, Abrams DB, Niaura R, Buka SL. Relationships of personality and psychiatric disorders to multiple domains of smoking motives and dependence in middle-aged adults. Nicotine Tob Res. 2010 Apr;12(4):381-9. Epub 2010 Feb 18. PMID: 20167635. Full text.
• Graham AL, Papandonatos GD, DePue JD, Pinto BM, Borrelli B, Neighbors CJ, Niaura R, Buka SL, Abrams DB. Lifetime characteristics of participants and non-participants in a smoking cessation trial: implications for external validity and public health impact. Ann Behav Med. 2008 Jun;35(3):295-307. Epub 2008 Apr 15. PMID: 18414962. Abstract.

Principal Investigators:  David Abrams, PhD, and Raymond Niaura, PhD

SI/Legacy Collaborators: Amanda Graham, PhD

Collaborators at other institutions: Suzanne Colby, PhD (Brown University), Stephen Buka, ScD (Brown University), Christopher Kahler, PhD (Brown University), Melissa Clark PhD, (Brown University), George Papandonatos, PhD (Brown University), Belinda Borrelli, PhD (Brown University), and others.

Funding agency: National Cancer Institute (P50 CA084719)

Project Period:  09/30/2009 – 09/29/2011