PROJECT SUMMARY/ABSTRACT Cigarette smoking is the leading cause of preventable death and disability in the United States. Among the various psychopathologies, anxiety and depression symptoms and syndromes are the most prevalent psychiatric conditions in the general population and are remarkably comorbid with smoking. Moreover, affective-vulnerable smokers often are more nicotine dependent, smoke more to manage negative mood states, and expect smoking to have greater positive effects on their mood compared to smokers without such affect vulnerability. An integrative approach to address negative affect symptoms and disorders associated with smoking is to focus on transdiagnostic processes that underpin both affective psychopathology and smoking. Anxiety sensitivity (AS), or the fear of anxiety and aversive internal sensations, is a transdiagnostic vulnerability factor for the etiology and maintenance of anxiety disorders and other emotional disorders. AS is associated with an increased risk of anxiety and mood psychopathology and implicated in several aspects of smoking maintenance and relapse, including nicotine withdrawal and craving and greater odds of early lapse and relapse. Our treatment development work (i.e., phases I and II) supports high-intensity exercise as an intervention strategy for smokers with high AS. High-intensity exercise reduces AS as well as nicotine withdrawal and craving, depression, and anxiety, all of which have shown to predict cessation failure. We have shown that a 15-week intervention that combines high-intensity exercise with standard smoking cessation treatment (Smoking Treatment Enhancement Program [STEP]) yields significantly higher abstinence rates relative an intervention that combines wellness education with standard smoking cessation treatment. We have also shown that STEP can be adapted for delivery in a community-based setting involving the YMCA and the Quitline; abstinence rates among participants receiving STEP were double those among participants assigned to the control intervention. The proposed study aims to build upon this research by conducting a phase III study. First, we will examine whether the efficacy of the community-based version of STEP will generalize across non-Latinx White, Black and Latinx smokers. This aim is informed by the observations that (1) racial/ethnic minorities are less apt to seek and receive (successful) evidenced-based care for smoking cessation and are underrepresented in efficacy research; and (2) Black and Latinx smokers might benefit from specific focus on increasing the ability to adaptively respond to interoceptive stress as targeted in STEP. Second, we will test putative mechanisms of actions and aim to identify moderators of efficacy. Third, we will aim to identify opportunities to improve the reach, effectiveness, adoption, implementation, and maintenance of STEP across YMCA’s using an implementation framework (RE-AIM) and qualitative process evaluation. These aims will be tested by conducting a large randomized clinical trial comparing STEP to a control intervention across several YMCA branches among a racially/ethnically diverse sample of smokers.

PUBLIC HEALTH NARRATIVE Anxiety sensitivity, reflecting the fear of bodily sensations, is a risk factor for the maintenance and relapse of smoking. This study is designed to address the question – is a smoking cessation intervention personalized to high anxiety sensitive smokers and adapted for implementation by the YMCA effective among racially/ethnically diverse samples? This protocol provides recommended treatment to achieve cessation and randomizes individuals to high-intensity exercise vs. low intensity exercise as a strategy to engage the mechanisms relevant to high anxiety sensitive smokers to improve smoking cessation outcomes.