The Process of Adapting the Evidence-Based Treatment for Tobacco Dependence for Smokers of Lower Socioeconomic Status

Abstract

Introduction Tobacco use is the leading cause of preventable death and disease and contributes significantly to socioeconomic health disparities. The prevalence of smoking among individuals of lower socioeconomic status (SES) in the US, many of whom are African American (AA), is three to four times greater than the prevalence of smoking among individuals of higher SES. The disparity in tobacco dependence treatment outcomes between lower and higher SES smokers contributes to tobacco-related health disparities and calls for adapting evidence-based treatment to more fully meet the needs of lower SES smokers. Aims We sought to adapt the evidence-based treatment for tobacco dependence using recommended frameworks for adapting evidence-based treatments. Methods We systematically applied the recommended steps for adapting evidence-based treatments described by Barrera and Castro and Lau. The steps included information gathering, preliminary adaptation design, preliminary adaptation tests, and adaptation refinement. We also applied the PEN-3 Model for incorporating AA values and experiences into treatment approaches and a community-engaged approach. Results/Findings Findings from each step in the process contributed to the results. The final results were incorporated into a revised treatment called the RITCh Study Tobacco Dependence Treatment Manual and Toolkit. Conclusions To our knowledge, this is the first adaptation of evidence-based treatment for tobacco dependence that has systematically applied these recommended frameworks. The efficacy of the treatment to reduce treatment outcome disparities is now being examined in a randomized controlled trial in which the revised treatment is being compared with a standard, individualized cognitive-behavioral approach.

Adapting evidence-informed population health interventions for new contexts: a scoping review of current practice

“…None of the studies provided explicit reflections on how relevant these cultural and structural factors are for intervention mechanisms and how they may interact with intervention mechanisms to affect implementation and outcomes in a new context. Other, less commonly mentioned reasons for adaptation included the need to ensure intervention attractiveness [ 40 ], reach [ 45 ], and salience [ 38 ].…”

“…Only six studies reported using existing guidance to inform their adaptation process (see Table 3 ). Nonetheless, most of the studies describing intervention adaptation (and not an evaluation) reported a structured process consisting of sequential phases and steps or key principles [ 27 , 28 , 30 – 36 , 38 , 39 , 41 , 43 , 45 , 48 ]. Four studies that did not report a phased process, still described well-demarcated procedures [ 24 – 26 , 44 ].…”

Cognitive, Behavioral, and Situational Influences on Relapse to Smoking After Group Treatment for Tobacco Dependence

“…Adaptation Refinement: Incorporate feedback from Step 3 into the final treatment manual (Barrera and Castro, 2006; Lau, 2006). See Evans et al (2015) for details.…”

“…Careful, systematic adaptation of standard, individualized CBT for tobacco dependence for lower SES and/or African American or Black smokers improves short-term failure rates for these groups (Sheffer et al, 2017; Webb Hooper et al, 2017). Sheffer et al (2017) adapted six sessions of standard CBT for lower SES smokers, most of whom identified as Black, using the Barrera and Castro systematic approach for adapting evidence-based behavioral treatments (Barrera and Castro, 2006; Evans et al, 2015). Perspectives from African American and Black smokers were then incorporated using the PEN-3 Model (Airhihenbuwa, 1990, 1992).…”

“…), common stressors (discrimination due to race, poverty, or other personal characteristics; economic hardship; financial anxiety; living situations, etc. ), and common barriers (menthol, views on medication use, smoking policies in the home) (Evans et al, 2015; Webb Hooper et al, 2017). While the rationale for tailoring supports the early treatment success findings in both studies, there is little understanding of why lower SES smokers relapse precipitously after making such remarkable early success with the adapted treatments.…”