Topic Modeling of Smoking- and Cessation-Related Posts to the American Cancer Society's Cancer Survivor Network (CSN): Implications for Cessation Treatment for Cancer Survivors Who Smoke

Introduction

Smoking is a risk factor in at least 18 cancers, and approximately two-thirds of cancer survivors continue smoking following diagnosis. Text mining of survivors' online posts related to smoking and quitting could inform strategies to reduce smoking in this vulnerable population.

Methods

We identified posts containing smoking/cessation-related keywords from the Cancer Survivors Network (CSN), an online cancer survivor community of 166 000 members and over 468 000 posts since inception. Unsupervised topic model analysis of posts since 2000 using Latent Dirichlet Allocation extracted 70 latent topics which two subject experts inspected for themes based on representative terms. Posterior analysis assessed the distribution of topics within posts, and the range of themes discussed across posts.

Results

Less than 1% of posts (n = 3998) contained smoking/cessation-related terms, and covered topics related to cancer diagnoses, treatments, and coping. The most frequent smoking-related topics were quit smoking methods (5.4% of posts), and the environment for quitters (2.9% of posts), such as the stigma associated with being a smoker diagnosed with cancer and lack of empathy experienced compared to nonsmokers. Smoking as a risk factor for one's diagnosis was a primary topic in only 1.7% of smoking/cessation-related posts.

Conclusions

The low frequency of smoking/cessation-related posts may be due to expected criticism/stigma for smoking but may also suggests a need for health care providers to address smoking and assist with quitting in the diagnostic and treatment process. Topic model analysis revealed potential barriers that should be addressed in devising clinical or population-level interventions for cancer survivors who smoke.

Implications

Although smoking is a major risk factor for cancer, little is known about cancer patients' or survivors' views or concerns about smoking and quitting. This study used text mining of posts to an online community of cancer patients and survivors to investigate contexts in which smoking or quitting is discussed. Results indicated that smoking and quitting discussions were relatively rare, but nevertheless provide insight into barriers that may need to be addressed in cessation interventions for survivors.

Randomised controlled trial of stand-alone tailored emails for smoking cessation

INTRODUCTION

Digital technology has created opportunities for delivering smoking cessation assistance at the population level. However, the efficacy of sending multiple, automated, tailored emails providing motivation, support and information for quitting is unknown.

METHODS

Smokers planning to quit (n=1070) were randomly assigned to (1) 27 tailored cessation emails (deluxe email group (DEG)), (2) 3 to 4 tailored emails with links to downloadable booklets (basic email group (BEG)) or (3) a single non-tailored email (single email group (SEG)). All emails included links to quitting resources. Self-reported 7-day point-prevalence abstinence was assessed at 1 month, 3 months and 6 months postenrolment.

RESULTS

Across follow-ups, abstinence was significantly greater for smokers in the DEG (34%) compared with the SEG (25.8%; OR=1.47, 95% CI 1.07 to 2.02, p=0.02) but there was no difference between the BEG (30.8%) and the SEG (p=0.13). Results were independent of baseline cigarettes per day, interest in quitting, smoker in household, use of nicotine replacement therapy (NRT) or varenicline and gender, themselves associated with abstinence (ps<0.05). Missing=smoking and multiple imputation analyses based on 25 data sets corroborated results. Participants in the DEG were also more likely to use non-medication aids (eg, quit smoking website, cessation class/clinic) compared with the SEG (OR=1.34, p=0.02, CI 1.06 to 1.71), but use of these or NRT by the 4-week follow-up (vs no use) increased abstinence across follow-ups primarily for those in the SEG.

CONCLUSIONS

Stand-alone tailored, multiple emails providing support, motivation and information during a quit attempt are an easily deployable, inexpensive mode of providing effective cessation assistance to large numbers of smokers planning to quit.

Evaluation of a Novel Difficulty of Smoking Cessation Phenotype Based on Number of Quit Attempts

Background

Numerous studies have sought to identify genes that influence the ability to quit smoking, but none found any that are consistently associated with smoking cessation.

Methods

We developed a novel difficulty of quitting smoking phenotype based on the extremes of the number of quit attempts needed to achieve successful abstinence: Easy quitters were defined as having achieved long-term (>1 year) abstinence after their first quit attempt and difficult quitters as having reported 10 or more quit attempts. We conducted a two-stage study to determine if this phenotype could be useful for identifying single nucleotide polymorphisms (SNPs) that influence smoking cessation. In stage 1, 82 SNPs in 26 genes involved in nicotine signaling and metabolism were genotyped in 1357 easy quitters and 1321 difficult quitters from Cancer Prevention Study 3 (CPS-3). In stage 2, the 11 SNPs associated with difficult quitting in stage 1 (p < .1) were genotyped in an independent sample of 1300 easy quitters and 1299 difficult quitters from CPS-3.

Results

Three of 11 SNPs (HTR1B rs6298, NR4A2 rs834829, and CYP2A65 rs8192729) were significantly associated with the difficult quitting phenotype in stage 2 (p < .05). In addition, a polygenic risk score based on the 11 SNPs identified in stage 1 was significantly associated with the difficult quitting phenotype in stage 2 (odds ratio = 1.08, 95% confidence interval: 1.03-1.14 per quintile, p trend = 4.5×10-3).

Conclusions

Using a novel difficulty of quitting phenotype, three gene variants and a polygenic risk score based on 11 SNPs were found to be significantly associated with smoking cessation.

Implications

Our results provide evidence that a difficulty of quitting smoking phenotype based on the extremes of number of quit attempts could be a useful tool for identifying genetic variants that influence difficulty of smoking cessation. Knowledge of these genetic variants will indicate biological pathways that could be targeted for the development of novel smoking cessation aids and could be used to determine which smokers are most likely to benefit from such smoking cessation aids.

A Prospective Cohort Study of Cigarette Prices and Smoking Cessation in Older Smokers

Background: Cigarette price increases effectively prevent smoking initiation and reduce cigarette consumption among young smokers. However, the impact of cigarette prices on smoking cessation among older smokers is less clear, particularly for those aged 65 years and older, a group that is at highest risk of smoking-related disease and will almost double in the United States between 2012 and 2050.Methods: Biennial questionnaires administered between 1997 and 2013 assessed smoking status for 9,446 Cancer Prevention Study-II Nutrition Cohort participants who were ≥50 years old and lived in Washington, DC, and 48 states. For each interval between biennial questionnaires, change in price per pack and average price level per pack were calculated. The separate associations between these price variables and smoking cessation during the same time interval were determined.Results: In multivariable-adjusted models, each $1.00 price increase was associated with a 9% higher rate of quitting [rate ratio (RR) = 1.09; 95% confidence interval (CI), 1.04-1.14). Each $1.00 increase in average price was associated with a 6% higher rate of quitting (RR = 1.06; 95% CI, 1.02-1.10). The association with average price was strongest among smokers aged 65 years and older (RR = 1.07; 95% CI, 1.04-1.11) and, for price change, for smokers with no major prevalent disease (RR = 1.13; 95% CI, 1.07-1.19).Conclusions: These results suggest that increasing cigarette prices will promote quitting even among smokers aged 65 years and older.Impact: Increasing cigarette prices through higher taxes could reduce smoking rates among older adults and decrease risk of smoking-related cancers and diseases in this high-risk group. Cancer Epidemiol Biomarkers Prev; 26(7); 1071-7. ©2017 AACR.

The Role of Perceived Similarity in Supportive Responses to Victims of Negative Life Events

The authors examined whether participants’ perceived similarity to an ostensible victim of a negative life event influenced their supportiveness during a live interaction. Two competing models were considered: (a) increased similarity would be associated with increased supportiveness through attraction to the target and (b) increased similarity would be associated with decreased supportiveness through anxiety (due to heightened vulnerability). Participants (N = 241) met individually with a confederate posing as a cancer patient. Reactions were assessed, including verbal and nonverbal behaviors, both before and after the interaction, by participants themselves and by observers of the interaction. Results supported a model based on the classic similarity/attraction paradigm: Perceived similarity indirectly predicted participant-reported supportiveness/warmth and smiling through its relationship to attraction. Results extend the literature on similarity and attraction to the stress and coping arena and suggest that emphasizing perceived similarities to victims would be beneficial.

Leveraging Big Data to Improve Health Awareness Campaigns: A Novel Evaluation of the Great American Smokeout

Background

Awareness campaigns are ubiquitous, but little is known about their potential effectiveness because traditional evaluations are often unfeasible. For 40 years, the “Great American Smokeout” (GASO) has encouraged media coverage and popular engagement with smoking cessation on the third Thursday of November as the nation’s longest running awareness campaign.

Objective

We proposed a novel evaluation framework for assessing awareness campaigns using the GASO as a case study by observing cessation-related news reports and Twitter postings, and cessation-related help seeking via Google, Wikipedia, and government-sponsored quitlines.

Methods

Time trends (2009-2014) were analyzed using a quasi-experimental design to isolate spikes during the GASO by comparing observed outcomes on the GASO day with the simulated counterfactual had the GASO not occurred.

Results

Cessation-related news typically increased by 61% (95% CI 35-87) and tweets by 13% (95% CI −21 to 48) during the GASO compared with what was expected had the GASO not occurred. Cessation-related Google searches increased by 25% (95% CI 10-40), Wikipedia page visits by 22% (95% CI −26 to 67), and quitline calls by 42% (95% CI 19-64). Cessation-related news media positively coincided with cessation tweets, Internet searches, and Wikipedia visits; for example, a 50% increase in news for any year predicted a 28% (95% CI −2 to 59) increase in tweets for the same year. Increases on the day of the GASO rivaled about two-thirds of a typical New Year’s Day—the day that is assumed to see the greatest increases in cessation-related activity. In practical terms, there were about 61,000 more instances of help seeking on Google, Wikipedia, or quitlines on GASO each year than would normally be expected.

Conclusions

These findings provide actionable intelligence to improve the GASO and model how to rapidly, cost-effectively, and efficiently evaluate hundreds of awareness campaigns, nearly all for the first time.

Does a Recent Cancer Diagnosis Predict Smoking Cessation? An Analysis From a Large Prospective US Cohort

PURPOSE

Quitting smoking provides important health benefits to patients with cancer. A cancer diagnosis may motivate quitting-potentially providing a teachable moment in which oncologists can encourage and assist patients to quit-but little is known about whether a recent cancer diagnosis (including diagnosis of a cancer that is less strongly linked to smoking) is associated with increased quitting.

METHODS

Cancer Prevention Study-II Nutrition Cohort participants reported smoking status at enrollment in 1992 to 1993 and approximately biennially through 2009. Quit rates of smokers diagnosed with cancer during 2- and 4-year intervals were compared with those of smokers not diagnosed with cancer (12,182 and 12,538 smokers in 2- and 4-year analyses, respectively). Cancers likely to cause physical limitations or symptoms that could influence smoking (cancers of the lung, head and neck, esophagus, or any metastatic cancer) were excluded. Logistic regressions calculated quit rates controlling for age, sex, survey year, cardiovascular disease, and chronic obstructive pulmonary disease.

RESULTS

The 2-year quit rate was higher among the 772 smokers who were diagnosed with cancer (31.3%; 95% CI, 28.0% to 34.5%) than among smokers not diagnosed with cancer (19.5%; 95% CI, 19.0% to 19.9%). A similar difference was observed for 4-year quit rates (43.0% v 33.8%). Results were similar by cancer site and stage.

CONCLUSION

A diagnosis of cancer, even a cancer not strongly related to smoking and with a relatively good prognosis, may be associated with increased quitting that is sustained well after diagnosis. Results support the hypothesis that a cancer diagnosis presents a teachable moment that can be capitalized on to promote cessation.

Prevalence and correlates of smoking and cessation-related behavior among survivors of ten cancers: findings from a nationwide survey nine years after diagnosis

BACKGROUND

Smoking is detrimental to recovery and survival from cancer, but many cancer survivors continue to smoke. Information is lacking on smoking patterns of survivors many years after diagnosis and correlates of smoking status and patterns, likelihood of quitting, and intentions to quit.

METHODS

Cross-sectional analyses were conducted among survivors of 10 cancers recruited by stratified random sampling from cancer registries in a nationwide, longitudinal, quality-of-life study (n = 2,938).

RESULTS

Approximately 9 years after diagnosis, 9.3% of all survivors were current (past 30-day) smokers. Smoking prevalence was highest among survivors of bladder (17.2%), lung (14.9%), and ovarian (11.6%) cancers. Most current smokers (83%) smoked daily, averaging 14.7 cigarettes per day (cpd). Forty percent of daily smokers smoked more than 15 cpd. Nondaily smokers smoked a mean of 10.9 days in the last 30 days and averaged 5.7 cpd on smoking days. Current smoking was associated with younger age, lower education and income, and greater alcohol consumption. Quitting after diagnosis was associated with having a smoking-related cancer. Roughly, a third of current smokers intended to quit, 40% within the next month. The odds of intending to quit were lower if survivors were married, older, or smoked more.

CONCLUSIONS

This population-based study indicated that smoking can persist long after initial diagnosis and at high levels and identified characteristics associated with quitting and intentions to quit.

IMPACT

Findings can be used to identify survivors most at risk for continued smoking and to inform tailoring of cessation treatments for survivors.

An fMRI study of nicotine-deprived smokers' reactivity to smoking cues during novel/exciting activity

Engaging in novel/exciting (“self-expanding”) activities activates the mesolimbic dopamine pathway, a brain reward pathway also associated with the rewarding effects of nicotine. This suggests that self-expanding activities can potentially substitute for the reward from nicotine. We tested this model among nicotine-deprived smokers who, during fMRI scanning, played a series of two-player cooperative games with a relationship partner. Games were randomized in a 2 (self-expanding vs. not) x 2 (cigarette cue present vs. absent) design. Self-expansion conditions yielded significantly greater activation in a reward region (caudate) than did non-self-expansion conditions. Moreover, when exposed to smoking cues during the self-expanding versus the non-self-expanding cooperative games, smokers showed less activation in a cigarette cue-reactivity region, a priori defined [temporo-parietal junction (TPJ)] from a recent meta-analysis of cue-reactivity. In smoking cue conditions, increases in excitement associated with the self-expanding condition (versus the non-self-expanding condition) were also negatively correlated with TPJ activation. These results support the idea that a self-expanding activity promoting reward activation attenuates cigarette cue-reactivity among nicotine-deprived smokers. Future research could focus on the parameters of self-expanding activities that produce this effect, as well as test the utility of self-expansion in clinical interventions for smoking cessation.

Smoking abstinence-related expectancies among American Indians, African Americans, and women: potential mechanisms of tobacco-related disparities

Research has documented tobacco-related health disparities by race and gender. Prior research, however, has not examined expectancies about the smoking cessation process (i.e., abstinence-related expectancies) as potential contributors to tobacco-related disparities in special populations. This cross-sectional study compared abstinence-related expectancies between American Indian (n = 87), African American (n = 151), and White (n = 185) smokers, and between women (n = 231) and men (n = 270) smokers. Abstinence-related expectancies also were examined as mediators of race and gender relationships with motivation to quit and abstinence self efficacy. Results indicated that American Indians and African Americans were less likely than Whites to expect withdrawal effects, and more likely to expect that quitting would be unproblematic. African Americans also were less likely than Whites to expect smoking cessation interventions to be effective. Compared with men, women were more likely to expect withdrawal effects and weight gain. These expectancy differences mediated race and gender relationships with motivation to quit and abstinence self-efficacy. Findings emphasize potential mechanisms underlying tobacco-related health disparities among American Indians, African Americans, and women and suggest a number of specific approaches for targeting tobacco dependence interventions to these populations.

A content analysis of popular smartphone apps for smoking cessation

BACKGROUND

Smartphone applications (apps) are increasingly available for smoking cessation.

PURPOSE

This study examined the content of popular apps for smoking cessation for both iPhone and Android operating systems in February 2012.

METHODS

A total of 252 smoking-cessation apps were identified for the iPhone and 148 for the Android. Across both operating systems, the most popular apps were identified (n=47 for the iPhone and n=51 for the Android) and analyzed for their (1) approach to smoking cessation and (2) adherence to an index based on the U.S. Public Health Service's Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Where available, apps were coded for frequency of downloads. The analysis took place in 2012.

RESULTS

Overall, popular apps have low levels of adherence, with an average score of 12.9 of a possible 42 on the Adherence Index. No apps recommended calling a quitline, and only a handful of apps recommended using approved medications (4.1%). Android apps in the sample were downloaded worldwide between 310,800 and 1,248,000 times per month. For both the iPhone and Android, user ratings were positively associated with scores on the Adherence Index. For the iPhone, display order was also positively associated with scores on the Adherence Index.

CONCLUSIONS

Apps could be improved by better integration with the Clinical Practice Guidelines and other evidence-based practices.

Abstract B54: A candidate gene study of smoking cessation

Background: Efforts to identify genes that influence smoking cessation have been largely unsuccessful to date. However, SNPs in the chromosome 15q25 region that encodes the nicotinic receptor subunits CHRNA5, CHRNA3, and CHRNB4 have been consistently and strongly associated with nicotine dependence as measured directly through dependence surveys or indirectly with smoking quantity (cigarettes per day, cpd). These SNPs have been found to either be modestly or not at all associated with smoking cessation as defined by a variety of different phenotypes. Despite the fact that nicotine dependence influences smoking cessation, these results suggest that cessation may be influenced by a wider range of genetic variants than just those that influence measures of nicotine dependence.

Methods: To identify genes important for smoking cessation, we defined a smoking cessation phenotype based on number of quit attempts; easy quitters achieved successful, long-term (&gt; 1 year) abstinence after their first quit attempt and difficult quitters reported ≥10 attempts before either continuing to smoke or quitting. We identified 1,500 easy quitters and 1,500 difficult quitters who were participants in the Cancer Prevention Study-3 (CPS-3), a large prospective study of cancer incidence and mortality conducted by the American Cancer Society. The association of 83 SNPs from 25 nicotine signaling and metabolism genes that had previously been associated with some aspect of smoking behavior with difficulty quitting was determined using logistic regression.

Results: Three SNPs in three separate genes were significantly associated with difficult quitting (p&lt;0.05). These were SLC6A3 rs2652511 [per allele odds ratio (OR)=0.89, 95% confidence intervals (CI): 0.80-0.99, p-trend=0.040], HTR1B rs6298 (per allele OR=0.88, 95% CI: 0.80-0.99, p-trend=0.034), and CHRNA5 rs16969968 (per allele OR=1.12, 95% CI: 1.00-1.22, p-trend=0.045). A genetic risk score based on number of risk alleles from these three SNPs was also associated with difficult quitting (OR=1.62, 95% CI:1.26-2.08, p=1.9 x 10-4 for score of 5-6 versus 0-2). None of the associations remained statistically significant after correction for multiple comparisons.

Conclusions: Although none of the SNPs investigated were statistically significantly associated with the number of quit attempts, these results suggest that examining this phenotype in future genome-wide association studies would be useful for the discovery of genes that could be targeted for the development of novel smoking cessation aids.

Citation Format: Victoria L. Stevens, Susan M. Gapstur, Juzhong Sun, Eric J. Jacobs, Mia M. Gaudet, J. Lee Westmaas, Alpa V. Patel. A candidate gene study of smoking cessation. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B54.

Intense passionate love attenuates cigarette cue-reactivity in nicotine-deprived smokers: an FMRI study

Self-expanding experiences like falling in love or engaging in novel, exciting and interesting activities activate the same brain reward mechanism (mesolimbic dopamine pathway) that reinforces drug use and abuse, including tobacco smoking. This suggests the possibility that reward from smoking is substitutable by self-expansion (through competition with the same neural system), potentially aiding cessation efforts. Using a model of self-expansion in the context of romantic love, the present fMRI experiment examined whether, among nicotine-deprived smokers, relationship self-expansion is associated with deactivation of cigarette cue-reactivity regions. Results indicated that among participants who were experiencing moderate levels of craving, cigarette cue-reactivity regions (e.g., cuneus and posterior cingulate cortex) showed significantly less activation during self-expansion conditions compared with control conditions. These results provide evidence that rewards from one domain (self-expansion) can act as a substitute for reward from another domain (nicotine) to attenuate cigarette cue reactivity.

College student reactions to health warning labels: sociodemographic and psychosocial factors related to perceived effectiveness of different approaches

OBJECTIVE

To examine factors associated with perceiving different types of pictorial cigarette health warning labels as most effective in motivating smokers to quit or preventing smoking initiation among college students.

METHOD

We administered an online survey to 24,055 students attending six Southeast colleges in Fall, 2010. We obtained complete data for the current analyses from 2600.

RESULTS

Current smoking prevalence was 23.5%. The largest majority (78.6%) consistently rated gruesome images as most effective, 19.5% rated testimonial images as most effective, and only a small proportion rated either standard (1.6%) or human suffering images (0.3%) as most effective. Subsequent analyses focused on differences between those endorsing gruesome images or testimonials as most effective. Factors related to ranking testimonials versus gruesome images as most effective included being female (p<0.01), White (p<0.01), and nonsmokers (p=0.04), lower perceived smoking prevalence (p<0.01), and greater receptivity to laws/restrictions around smoking (p<0.01) and tobacco marketing (p=0.01). Among smokers, factors related to ranking testimonials as most effective versus gruesome images included being female (p=0.03), being White (p=0.03), higher autonomous motivation (p=0.03), and greater extrinsic self-efficacy (p=0.02).

CONCLUSIONS

Understanding factors related to perceived effectiveness of different pictorial warnings among subpopulations should inform health warning labels released by the FDA.

Using the internet to understand smokers' treatment preferences: informing strategies to increase demand

BACKGROUND

Most smokers attempt to quit on their own even though cessation aids can substantially increase their chances of success. Millions of smokers seek cessation advice on the Internet, so using it to promote cessation products and services is one strategy for increasing demand for treatments. Little is known, however, about what cessation aids these smokers would find most appealing or what predicts their preferences (eg, age, level of dependence, or timing of quit date).

OBJECTIVE

The objective of our study was to gain insight into how Internet seekers of cessation information make judgments about their preferences for treatments, and to identify sociodemographic and other predictors of preferences.

METHODS

An online survey assessing interest in 9 evidence-based cessation products and services was voluntarily completed by 1196 smokers who visited the American Cancer Society's Great American Smokeout (GASO) webpage. Cluster analysis was conducted on ratings of interest.

RESULTS

In total, 48% (572/1196) of respondents were "quite a bit" or "very much" interested in nicotine replacement therapy (NRT), 45% (534/1196) in a website that provides customized quitting advice, and 37% (447/1196) in prescription medications. Only 11.5% (138/1196) indicated similar interest in quitlines, and 17% (208/1196) in receiving customized text messages. Hierarchical agglomerative cluster analysis revealed that interest in treatments formed 3 clusters: interpersonal-supportive methods (eg, telephone counseling, Web-based peer support, and in-person group programs), nonsocial-informational methods (eg, Internet programs, tailored emails, and informational booklets), and pharmacotherapy (NRT, bupropion, and varenicline). Only 5% (60/1196) of smokers were "quite a bit" or "very much" interested in interpersonal-supportive methods compared with 25% (298/1196) for nonsocial-informational methods and 33% (399/1196) for pharmacotherapy. Multivariate analyses and follow-up comparisons indicated that level of interest in pharmacotherapy ("quite a bit or "very much" vs. "not at all") varied as a function of education (n = 575, χ(2) (3) =16.6, P = .001), age (n = 528, χ(2) (3) = 8.2, P = .04), smoking level (n = 514, χ(2) (3) = 9.5, P = .02), and when smokers were planning to quit (n = 607, χ(2) (4) = 34.0, P < .001). Surprisingly, greater age was associated with stronger interest in nonsocial-informational methods (n = 367, χ(2) (3) = 10.8, P = .01). Interest in interpersonal-supportive methods was greater if smokers had used a quitline before (n = 259, χ(2) (1) = 18.3, P < .001), or were planning to quit earlier rather than later (n = 148, χ(2) (1) = 4.9, P = .03).

CONCLUSIONS

Smokers accessing the Internet for information on quitting appear to differentiate cessation treatments by how much interpersonal interaction or support the treatment entails. Quitting date, smoking level, and sociodemographic variables can identify smokers with varying levels of interest in the 3 classes of cessation methods identified. These results can potentially be used to more effectively target and increase demand for these treatments among smokers searching the Internet for cessation information.

The influence of sexual orientation and masculinity on young men's tobacco smoking

OBJECTIVE

The prevalence of smoking among gay men is considerably higher than in the general population. To investigate possible causes of this health risk disparity, this study used multilevel modeling of daily diary data to examine the temporal relationship between smoking and both sexual orientation concealment and masculine gender role variables.

METHOD

Gay (n = 136) and heterosexual (n = 56) university students (mean age = 20.56, SD = 2.13) completed measures of boyhood and current gender nonconformity, as well as daily measures of smoking, negative affect, and masculinity self-consciousness across 9 days. Gay participants additionally indicated the extent to which they concealed their sexual orientation each day.

RESULTS

The same percentage of gay (17.7%; n = 24) and heterosexual (17.9% n = 10) participants smoked over the course of the study. Gay men who smoked, however, smoked on more days across the study, t = 2.20, p < .05. Boyhood gender nonconformity and current masculinity significantly predicted the average odds of smoking for all participants. Daily masculinity self-consciousness also predicted the odds of smoking for all participants, although it predicted those odds more strongly for heterosexual men (b = 1.00, p < .001) than for gay men (b = .31, p = .06). Gay participants' attempts to conceal their sexual orientation on a given day positively predicted their likelihood of smoking that day.

CONCLUSIONS

Results suggest the need to consider the role of gender nonconformity, masculinity self-consciousness, and sexual orientation stress in future investigations of smoking among young men.

Self-expansion and smoking abstinence

Helping smokers quit is important as smoking is the number one preventable cause of death in the U.S. Smoking activates the mesolimbic dopamine reward system which is also responsible for pleasure associated with other behaviors, including engaging in novel, exciting and/or challenging (i.e., self-expanding) events. We hypothesized that the reward activation achieved by experiencing self-expanding events can supplant the reinforcement normally provided by smoking and can thus facilitate quitting. We investigated this hypothesis among 74 current and 66 former smokers who reported the self-expanding events they experienced for the 2 months prior to their most successful or final, quit attempt, respectively. Former smokers, compared to current smokers, reported significantly more self-expanding events and that the events were more helpful to their quitting. For current smokers, there was a significant moderate-to-large positive correlation between number of self-expanding events and number of days subsequently abstained from smoking. The results support the proposition that experiencing self-expanding activities or events can be beneficial for smoking abstinence.

Randomized controlled trial of an interactive internet smoking cessation program with long-term follow-up

BACKGROUND

Internet programs for smoking cessation are widely available but few controlled studies demonstrate long-term efficacy.

PURPOSE

To determine the 13-month effectiveness of an Internet program presenting a set sequence of interactive steps, and the role of depressed affect.

METHODS

In a randomized controlled trial sponsored by the American Cancer Society, a treatment condition (n = 1,106) was compared to a control site (n = 1,047).

RESULTS

More treatment condition participants were abstinent (30-day point prevalence) than control site participants (12.9% vs. 10.1%, p < .05) at 13 months. This effect was greater among participants not reporting depressed affect (15.0% vs. 10.1%, p < .01). Among smokers who reported depressed affect, there was no difference in abstinence between the treatment and control conditions.

CONCLUSIONS

Data support the long-term efficacy of an Internet intervention for cessation modeled on a structured, in-person treatment approach, especially for participants not experiencing daily depressed affect.

Depressive symptoms and smokers' perceptions of lung cancer risk: moderating effects of tobacco dependence

Smokers who acknowledge the personal health risks of smoking are more likely to attempt quitting. Unfortunately, many smokers are unrealistically optimistic about their health risks. Depressed smokers, however, may be more realistic about their risks. These studies examined the relationship between depressive symptoms and risk perceptions among two groups: college-age smokers (N = 128) and smokers from the nationally representative HINTS database (N = 1,246). In the college sample, among highly tobacco dependent smokers, more depressed smokers believed more strongly that quitting eliminates lung cancer risk (b = - .27, p = .01), and they estimated a faster reversal of risk after quitting (b = - .70, p = .03). In the HINTS sample, among highly tobacco dependent women, the more depressed they were, the higher their perceived risk of developing lung cancer (b = .23, p = .05). In sum, depressive symptoms among some smokers may lead to heightened risk perceptions. However the belief that quitting can reduce risk quickly might encourage smokers to postpone quitting. Cessation programs could benefit from tailoring their programs accordingly.

Parental communication not to smoke and adolescent cigarette smokers' readiness to quit: differences by age

There is limited information on the relationship between parental practices that specifically discourage current cigarette smoking and adolescent cessation, and how this relationship varies by age. Among 1629 adolescent smokers, self-reported receipt of parental communication not to smoke was significantly and positively associated with readiness to quit. The strength and significance of this association decreased from early to middle adolescence and was not significant in late adolescence.

Paradoxical effects of social support on blood pressure reactivity among defensive individuals

BACKGROUND

Social support can reduce cardiovascular responses to an acute stressor. However, prior clinical research suggests that defensive individuals may react negatively to social support.

PURPOSE

This experiment examined whether emotional support provided during a speech stressor would escalate rather than decrease blood pressure (BP) reactivity among defensive individuals.

METHODS

After completing personality measures, 176 female undergraduates were randomly assigned to give a speech in 1 of 3 social conditions: alone, or with a neutral or supportive confederate present. Mean arterial BP was assessed at baseline, immediately before, and during and after the stressor.

RESULTS

In the supportive condition, defensiveness predicted higher BP reactivity during anticipation (beta = .35, p = .04) and delivery of the speech (beta = .32, p = .03), and longer recovery to baseline BP levels (beta = .35, p = .01). In the absence of support (i.e., alone and neutral conditions), defensiveness was not associated with BP reactivity. Defensiveness also predicted greater dissociation between subjective stress and BP responses (beta = .35, p = .05), but only in the supportive condition.

CONCLUSIONS

According to results, the provision of social support during stressors does not benefit defensive individuals' BP reactivity but has the opposite effect.