A translational evaluation of depressive symptomology and smoking cessation treatment mechanisms for just-in-time-adaptive-interventions - PROJECT ABSTRACT Adults with current major depression are twice as likely to smoke cigarettes and less likely to quit versus those with no psychiatric diagnosis, even with evidence-based treatment. To improve smoking cessation treatment efficacy, it is critical to 1) identify how treatment mechanisms vary between adults with and without elevated depressive symptoms and 2) examine how transdiagnostic depressive and smoking abstinence symptoms interfere with treatment. However, smoking cessation trials typically exclude participants with psychopathology or rely exclusively on limited assessments of depression (e.g., binary status: current vs. never depressed, self- reported affect). Transdiagnostic processes implicated in depression, including atypical motivation to positive and aversive contexts (positive/negative valence systems; PVS/NVS), may be central to smoking behavior, but are typically not evaluated and their utility for predicting smoking behavior compared to categorical depression status has rarely been assessed. Just-in-time adaptive interventions (JITAIs) can enable examination of momentary treatment processes among individuals with depressive symptoms who may experience motivational deficits because they are low burden, highly accessible, and can harness ecological momentary assessments (EMA) to monitor and immediately intervene on key treatment and relapse processes across the quit attempt. The goals of this K23 proposal are 1) to evaluate JITAI treatment mechanisms for smoking cessation in adults with and without elevated depressive symptoms and 2) examine attenuation of treatment efficacy and mechanisms associated with disrupted PVS and NVS processes. Aim 1 of the project will evaluate the role of depressive symptoms on smoking cessation and treatment mechanisms using secondary data from a large JITAI randomized controlled trial (RCT). This aim will use moderated mediation models to evaluate group differences in treatment mechanisms. Aim 2 will collect original data to examine changes in PVS and NVS processes during a JITAI RCT using a translational, multimethod approach with EMA, behavioral, and psychophysiological data to identify the transdiagnostic processes that attenuate treatment effects and prevent cessation among adults with elevated depressive symptoms. This aim will collect PVS and NVS assessments across two laboratory visits and 13-weeks of EMA. The proposed research will identify the processes that contribute to reduced treatment efficacy for smoking cessation interventions among adults with elevated depressive symptoms. Long term, this work will allow for the development of novel and/or adjunct interventions to counteract biopsychosocial processes that reduce treatment efficacy among adults with psychopathology who smoke. Additionally, the expertise gained from the proposed training plan in multimethod, translational methodology can be extended to other high priority populations (e.g., low income, minoritized individuals) that experience the greatest health disparities from smoking and may benefit less from available interventions.
