The Dynamics of Smoking Cessation After Cancer Diagnosis: A Naturalisitic Study

The activities proposed in this NCI K07 application are designed to advance the career development of Dr. Jessica Burris, whose long-term career goal is to sustain an independent, innovative, and meaningful clinical research program that focuses on tobacco use and cessation in cancer patients. Most clinicians view cancer diagnosis as a teachable moment, and thus urge immediate smoking cessation whenever a cancer diagnosis is made. However, most quit attempts end in relapse and extant interventions for smoking cessation in cancer patients have limited success. A cancer diagnosis brings about many intra- and inter-personal changes (e.g., increase in emotional distress, greater need for social support, increase in saliency of personal risk), but there is very little understanding as to how such changes influence smoking cessation. With an eye toward intervention development, the independent research proposed in this application will examine the naturalistic course of smoking cessation after cancer diagnosis as well as the dynamics that underlie changes in smoking behavior. Specific aims are 1) to describe key events in the process of smoking cessation and 2) to uncover cognitive and affective variables that promote or undermine the occurrence of a quit attempt, lapse, and relapse among newly diagnosed cancer patients. After a baseline assessment (N=120 head and neck cancer patients), participants will initiate a 30-day period of daily assessment via interactive voice response technology, with a final assessment to occur three months after the baseline assessment. Biochemical verification of abstinence at the end of the 30-day daily IVR assessment and final assessment will be achieved through use of saliva cotinine samples. Statistical analysis will allow novel tests of how, and to what extent, day-to-day changes in cognitive and affective variables influence smoking cessation outcomes in newly diagnosed cancer patients. Innovation is achieved by: 1) a focus on the process of smoking cessation as opposed to the treatment of abstinence as a discrete outcome, 2) equal attention given to cognitive and affective predictors of smoking cessation outcomes, 3) use of mobile technology as the primary means of data collection among cancer patients, and 4) proper application of longitudinal data analysis techniques to rich within-subjects data. A training plan that complements the independent research includes coursework, seminars, workshops, mentored research, journal clubs, and conferences, the combination of which will cover these topics: nicotine dependence; individual-level and public health approaches to tobacco control; longitudinal research design, coordination, and execution; advanced statistical techniques; research dissemination; grantsmanship; and ethical conduct of research. The strong support of an excellent team of mentors, and the vast resources and outstanding scientific environment of the University of Kentucky, create an optimal training environment. Collectively, the integrated research and training plan proposed in this NCI K07 application are an ideal mechanism to promote the career development of Dr. Burris.