Full Project C: Cancer Risk Reduction through Combined Treatment for Tobacco and Alcohol Use
Co-Investigators
David Wetter, Ph.D., Professor and Chair, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
Elba Diaz, D.M.D., Associate Professor, Department of Restorative Sciences, University of Puerto Rico Comprehensive Cancer Center, Rio Piedras, Puerto Rico
The proposed study will evaluate a theoretically- and empirically-based “Motivation and Problem-Solving” (MAPS) approach to treating both smoking and at risk alcohol use, thereby reducing risk for numerous cancers. MAPS is a new treatment approach that combines attributes of both motivational interviewing (MI; Miller & Rollnick, 1991; 2002) and cognitive behavioral/ problem-solving/ relapse prevention theory-based treatment approaches (Fiore et al., 2000; Witkiewitz & Marlatt, 2004). The study is a randomized clinical trial among current smokers who call the Puerto Rico Quitline (PRQ) and who are also at risk drinkers. At risk drinking, as defined by the National Institute on Alcohol Abuse and Alcoholism, refers to a constellation of alcohol use behaviors that increase risk for physical and psychosocial problems. In our pilot study, 29% of smokers calling the PRQ were at risk drinkers who subsequently enrolled in the pilot study.
Participants (N=200) will be randomly assigned to either a MAPS treatment with a focus on smoking cessation, or a MAPS+ condition that focuses on smoking cessation and the reduction of at risk alcohol use. Treatment is telephone-based, and designed to be easily disseminated to health care systems and other population-based settings for tobacco and alcohol control. The primary outcome variable is at risk alcohol use. We hypothesize that MAPS+ will reduce at risk alcohol use relative to MAPS. Although we will also examine smoking cessation as an outcome, we believe that there will be no difference between MAPS and MAPS+ with respect to smoking cessation outcomes. Although MI and cognitive behavioral/problem-solving approaches have a relatively long history in the treatment of alcohol use and smoking cessation, to the best of our knowledge, this study would be the first to apply a motivational enhancement approach to concomitantly treating smoking and alcohol use. It is important to note that the goal of MAPS+ is not necessarily to promote abstinence from alcohol, but to modify at risk drinking behaviors. A major benefit of the study to the Puerto Rican population is that all participants in the study are provided with an empirically-based state-of-the-science treatment for smoking cessation.
Specific Aims
- Evaluate MAPS and MAPS+ effects on at risk alcohol use (and smoking cessation) among Puerto Rican smokers who are also at risk drinkers
- Assess MAPS and MAPS+ effects on treatment mechanisms and the role of those mechanisms in mediating treatment effects on at risk drinking (and smoking cessation)
- Evaluate the cost-effectiveness of MAPS and MAPS+ in the reduction of at risk drinking (and smoking cessation)