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Zvolensky MJ, Clausen BK, Shepherd JM, Redmond BY, Robison JH, Santiago-Torres M, Bricker JB. Emotional dysregulation among English-speaking Hispanic persons who smoke living in the United states. Addict Behav 2024; 152:107959. [PMID: 38309241 PMCID: PMC11195297 DOI: 10.1016/j.addbeh.2024.107959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
Hispanic/Latinx (hereafter Hispanic) individuals in the United States (US) experience serious tobacco-related disparities and factors contributing to such disparities need to be adequately identified and clinically addressed. Emotion dysregulation is a key transdiagnostic relevant to smoking. The present cross-sectional investigation sought to test if emotion dysregulation was related to more severe problems during smoking quit attempts (e.g., irritability, weight gain), perceptions of difficulty about quitting, as well as negative and positive beliefs about smoking abstinence in a sample of English-speaking Hispanic adults residing in the US who smoke. Participants included 332 Hispanic adults who engaged in daily cigarette smoking (35.46 years old, 37 % identified as female). Emotion dysregulation was significantly related to more severe problems when quitting and perceived barriers for quitting, as well as negative beliefs about smoking abstinence. Additionally, emotion dysregulation was significantly and negatively related to positive outcomes about smoking abstinence. The amount of change in the various smoking criterion variables accounted for by emotion dysregulation was small (sr2 range: 0.028-0.085), but evident in adjusted models that accounted for a wide range of factors (e.g., depression, drug use severity). Overall, this investigation found consistent empirical evidence that individual differences in emotion dysregulation in Hispanic individuals were associated with several clinically significant smoking processes, suggesting this construct may represent an important factor involved in the maintenance and relapse of smoking among this ethnic population.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center; HEALTH Institute, University of Houston.
| | | | | | | | | | | | - Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences; Department of Psychology, University of Washington
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2
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Garey L, Smit T, Clausen BK, Redmond BY, Obasi EM, Businelle MS, Zvolensky MJ. Anxiety Sensitivity and Distress Tolerance in Relation to Smoking Abstinence Expectancies Among Black Individuals Who Smoke. J Stud Alcohol Drugs 2024; 85:244-253. [PMID: 38095261 PMCID: PMC10941823 DOI: 10.15288/jsad.23-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/19/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Black individuals who smoke in the United States experience significant tobacco-related disparities. Although prior work has established that smoking abstinence expectancies play an important role in smoking-related outcomes, few studies have examined potential individual difference factors that may be relevant to smoking abstinence expectancies among Black individuals who smoke. The present study investigated anxiety sensitivity and distress tolerance in relation to smoking abstinence expectancies among a sample of Black individuals who smoke. METHOD Participants were 86 Black adults who smoke cigarettes daily (M age = 46.07 years, SD = 10.37; 26.7% female). Four separate linear regression analyses were conducted to evaluate the relation between anxiety sensitivity, distress tolerance, and their interaction with each of the four smoking abstinence expectancies (i.e., somatic symptoms, positive consequences, harmful consequences, and negative mood). RESULTS Results indicated that higher anxiety sensitivity was related to higher somatic symptoms, harmful consequences, and negative mood abstinence expectancies, whereas distress tolerance was related to higher positive consequences. Further, anxiety sensitivity and distress tolerance interacted to confer greater expectancies for the positive consequences of quitting. CONCLUSIONS The current findings are among the first to document that anxiety sensitivity and distress tolerance are clinically relevant factors to consider when tailoring smoking cessation treatments for Black individuals who smoke. Future research is needed to examine distress tolerance and anxiety sensitivity as longitudinal predictors of smoking abstinence expectancies among Black individuals who smoke.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
- HEALTH Research Institute, University of Houston, Houston, Texas
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas
| | | | | | - Ezemenari M. Obasi
- HEALTH Research Institute, University of Houston, Houston, Texas
- Psychological, Health, & Learning Sciences, University of Houston, Houston, Texas
| | - Michael S. Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- HEALTH Research Institute, University of Houston, Houston, Texas
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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3
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Mayorga NA, Redmond BY, Salwa A, Shepherd JM, Garey L, Asfar T, Zvolensky MJ. Evaluating the role of smoking abstinence expectancies in the relation between perceived ethnic discrimination and cigarette dependence among Latinx individuals who smoke. Addict Behav 2024; 148:107864. [PMID: 37778236 PMCID: PMC11200200 DOI: 10.1016/j.addbeh.2023.107864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
The experience of perceived ethnic discrimination is prevalent and has harmful effects across various behavioral health processes among Latinx persons. Yet, there is limited work on the association between perceived ethnic discrimination and smoking among this health disparities group. Building from initial work that has demonstrated a relationship between perceived ethnic discrimination and smoking abstinence expectancies, the present study sought to explore mechanisms by which perceived ethnic discrimination may be related to cigarette dependence. Specifically, we tested the indirect effect of perceived ethnic discrimination on cigarette dependence through smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences) among Latinx persons who smoke (N = 338; Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that abstinence expectancies related to harmful consequences was a statistically significant underlying factor between the experience of perceived discrimination and cigarette dependence (b = 0.39, SE = 0.16, CI95% = 0.08, 0.71, CSE = 0.14). Overall, the present study suggests that smoking abstinence expectancies pertaining to harmful consequences may be a point of intervention for Latinx persons seeking to reduce or quit smoking. Future research is needed to extend the generalizability of these findings by corroborating the mediational role of abstinence expectancies related to harmful consequences across Latinx persons of varying cigarette use severity levels over time.
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Affiliation(s)
- Nubia A Mayorga
- Department of Psychology, University of Houston, United States
| | | | - Aniqua Salwa
- Department of Psychology, University of Houston, United States
| | | | - Lorra Garey
- Department of Psychology, University of Houston, United States; HEALTH Institute, University of Houston, United States
| | - Taghrid Asfar
- Department of Public Health Science, University of Miami Miller School of Medicine, and Sylvester Comprehensive Cancer Center, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, United States; HEALTH Institute, University of Houston, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, United States.
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Zvolensky MJ, Heggeness LF, Mayorga N, Garey L, Buckner JD, Businelle MS, Redmond BY. Financial Strain Among Black Smokers in Terms of Abstinence Expectancies. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01720-4. [PMID: 37488316 DOI: 10.1007/s40615-023-01720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, USA.
- HEALTH Institute, University of Houston, Houston, USA.
| | - Luke F Heggeness
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Nubia Mayorga
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
- HEALTH Institute, University of Houston, Houston, USA
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Michael S Businelle
- HEALTH Institute, University of Houston, Houston, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Brooke Y Redmond
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
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5
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Shevorykin A, Ruglass LM, Freitas-Lemos R, Bauer AG, Baez S, Sheffer CE. Attitudes about Cigarette Smoking, Perceived Consequences of Smoking, and Seeking Assistance with Cessation among Black and White Cigarette Smokers: A Qualitative Study. J Smok Cessat 2023; 2023:9298027. [PMID: 37250113 PMCID: PMC10224791 DOI: 10.1155/2023/9298027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Research has identified significant racial differences in cigarette smoking behavior, associated disease risk, likelihood of cessation, and mortality from smoking-related diseases. The current study assessed, via qualitative narrative analysis, racial differences in participants' motivations for smoking, perceived consequences of smoking, and how participants deal with cravings/withdrawal, as well as thoughts and feelings about quitting, seeking assistance with quitting, and the importance of social support in quitting. Methods Semistructured interviews were conducted with 11 Black and 11 White cigarette smokers. Data were analyzed using the Thematic Networks Analysis process, which entailed coding the data and constructing thematic networks by identifying basic and organizing themes. Results While there were no descriptive racial differences identified in participants' motivation for smoking or perceived consequences of smoking, differences existed between Blacks and Whites in terms of approaches in dealing with smoking cravings and withdrawal, perceived self-efficacy in controlling cravings, preferred methods of learning about and receiving smoking cessation assistance, and overall preference for receiving cessation-related support. Conclusions Further investigation is needed into racial differences in methods to deal with cigarette cravings and withdrawal, preferences for receiving cessation information, and social support for cessation. This research will further develop our understanding of and ability to address factors underlying racial disparities in smoking behavior and cessation, as well as inform the development of future smoking cessation interventions.
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Affiliation(s)
| | - Lesia M. Ruglass
- The City College of New York, City University of New York, USA
- Center for Alcohol and Substance Use Studies, Rutgers University, USA
| | | | | | - Shannyl Baez
- Fralin Biomedical Research Institute at Virginia Tech Carilion, USA
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6
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Zvolensky MJ, Shepherd JM, Clausen BK, Garey L, Redmond BY, Asfar T. Perceived racial/ethnic discrimination in relation to smoking abstinence expectancies among adult Latinx smokers in the United States. Addict Behav 2023; 140:107627. [PMID: 36701904 DOI: 10.1016/j.addbeh.2023.107627] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Hispanic/Latinx (hereafter Latinx) individuals in the United States (US) face unique smoking-related health disparities, including limited access to care and health insurance for smoking treatment. Social determinants of health (SDoH) have received increased recognition in their role of smoking behavior and cessation. However, research on SDoH in Latinx smoking populations has been limited. Past research on non-Latinx white individuals has found smoking abstinence expectancies to be an integral cognitive process related to multiple aspects of smoking behavior, and its role has also been understudied in Latinx individuals. Perceived racial/ethnic discrimination is one SDoH, but its role in relation to abstinence expectancies among Latinx smokers has not been explored. Therefore, the present investigation sought to evaluate perceived racial/ethnic discrimination in terms of smoking abstinence expectancies among Latinx smokers living in the US. METHODS Participants included 338 English-speaking Latinx adult daily cigarette smokers (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3 % female) recruited nationally throughout the US using Qualtrics Panels. RESULTS Results supported statistically significant main effects for perceived racial/ethnic discrimination in relation to increased smoking abstinence expectancies of negative mood, somatic symptoms, harmful consequences, and positive consequences (p's < 0.001). DISCUSSION Overall, the results of the present investigation build from a limited body of work on perceived racial/ethnic discrimination and smoking and provide novel evidence of consistent and moderate incremental associations between perceived racial/ethnic discrimination and negative and positive smoking abstinence expectancies among Latinx smokers.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, United States; HEALTH Institute, University of Houston, United States.
| | | | - Bryce K Clausen
- Department of Psychology, University of Houston, United States
| | - Lorra Garey
- Department of Psychology, University of Houston, United States
| | | | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, and Sylvester Comprehensive Cancer Center, United States
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7
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Smoking Abstinence Expectancies Among Latinx Smokers: An Initial Test and Evaluation of Individual Difference Factors. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Redmond BY, Salwa A, Smit T, Ditre JW, Garey L, Zvolensky MJ. Pain Severity and Smoking Abstinence Expectancies among Latinx Individuals Who Smoke Cigarettes: The Moderating Role of Perceived Discrimination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1079. [PMID: 36673835 PMCID: PMC9859392 DOI: 10.3390/ijerph20021079] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/16/2023]
Abstract
Latinx individuals experience significant health disparities related to smoking cessation in the United States (US). Although past works have consistently implicated pain in the maintenance of smoking behavior, limited research has examined the role of social determinants (e.g., perceived discrimination) in pain-smoking relations. The current study sought to examine the moderating role of perceived discrimination in the relation between pain severity and smoking abstinence expectancies (i.e., a cognitive factor related to poor smoking outcomes) among 226 Latinx individuals who currently smoke cigarettes (Mage = 34.95 years; SD = 8.62; 38.5% female). The results indicated a statistically significant interaction between pain severity and perceived discrimination with regard to smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences). Post-hoc analyses revealed the association of pain severity and negative mood, harmful consequences, and positive consequences smoking abstinence expectancies evident for individuals with higher perceived discrimination. Moreover, the association between pain severity and somatic symptoms smoking abstinence expectancies was stronger for individuals with higher perceived discrimination. Overall, these results suggest that clinical and community-based public health strategies may benefit from addressing the role of perceived discrimination among Latinx individuals who smoke cigarettes in the context of pain.
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Affiliation(s)
- Brooke Y. Redmond
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Aniqua Salwa
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX 77004, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Health Institute, University of Houston, Houston, TX 77004, USA
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9
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Mansueto G, Carrozzino D, Sparle Christensen K, Cardellicchio S, Pezzuto A, Abrams K, Zvolensky M, Cosci F. Clinimetric properties of the Smoking Abstinence Expectancies Questionnaire. Addict Behav 2021; 123:107061. [PMID: 34359015 DOI: 10.1016/j.addbeh.2021.107061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Smoking abstinence expectancies are beliefs about negative and positive short-term psychological and physiological consequences of not smoking. The Smoking Abstinence Expectancies Questionnaire (SAEQ) is a widely used Patient-Reported Outcome Measure (PROM) to assess smoking abstinence expectancies. It has four subscales: negative mood, somatic symptoms, harmful consequences, positive consequences. Although studied from a psychometric perspective, the SAEQ needs further evaluation. Clinimetrics, and its Clinimetric Criteria for Patient-Reported Outcome Measures (CLIPROM), offers a robust method to evaluate the SAEQ. We verified construct validity and sensitivity of the Italian version of the SAEQ applying CLIPROM criteria. A total of 293 adult Italian smokers were consecutively enrolled at two smoking cessation clinics and assessed via the SAEQ. Item Response Theory models (i.e., combining Rasch and Mokken analyses) were used to test construct validity and sensitivity. The total score of the SAEQ was not found to be unidimensional but each SAEQ subscale score was. PSI (0.90) indicated that the total score of the SAEQ could reliably discriminate between respondents with different levels of the trait under assessment, whereas SAEQ subscales on negative mood and harmful consequences could reliably distinguish between different groups but not between different subjects (PSI ranging from 0.77 and 0.78). Overall, the total score of the SAEQ is a sensitive screening PROM and can be used at smoking cessation clinics to discriminate between subjects with different levels of smoking abstinence expectancies. SAEQ subscales should be used to detect severity and subjective burden of a wide range of expected effects of nicotine abstinence.
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10
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Endrighi R, Rueras N, Dunsiger SI, Borrelli B. Perceived Pain and Smoking Interrelations and Expectancies Are Associated With Pain and Smoking Cessation in Individuals With Mobility Impairments. Nicotine Tob Res 2021; 23:179-185. [PMID: 31287549 DOI: 10.1093/ntr/ntz111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Smoking and pain are highly prevalent among individuals with mobility impairments (MIs; use assistive devices to ambulate). The role of pain-related smoking motives and expectancies in smoking cessation is unknown. We examined cross-sectional and prospective associations between a novel measure of pain-related smoking motives (how smokers with pain perceive their pain and smoking to be interrelated) and pain and smoking behavior in smokers with MI. METHODS This is a secondary data analysis of a smoking cessation induction trial (N = 263; 55% female) in smokers with MI. Participants did not have to want to quit to enroll. Pain-related smoking motives and expectancies were assessed at baseline with the pain and smoking inventory (PSI) which measures perceived pain and smoking interrelations in three distinct but related domains (smoking to cope with pain, pain as a motivator of smoking and as a barrier to cessation). Other measures included pain occurrence and interference, nicotine dependence, motivation and self-efficacy to quit smoking, and number of cigarettes per day. Biochemically verified smoking abstinence was assessed at 6 months. RESULTS PSI scores were significantly higher among smokers with chronic pain occurrence compared to occasional and to no occurrence (p < .002) and were associated with greater pain interference (ps < .01) and lower self-efficacy to quit smoking (ps < .01). In prospective analyses adjusted for age, treatment group, and chronic pain, only expectancies of smoking to help cope with pain predicted lower odds of abstinence. CONCLUSIONS Targeting expectancies of smoking as a mechanism to cope with pain may be useful in increasing smoking cessation in pain populations. IMPLICATIONS Individuals with MI have a high prevalence of smoking and pain, yet the extent to which this population perceives pain and smoking to be interrelated is unknown. This is the first article to examine prospective associations between a novel measure of perceived pain and smoking interrelations (PSI) and smoking outcomes. The PSI was associated with greater pain and lower self-efficacy for quitting. Prospectively, the PSI subscale tapping into expectancies that smoking help coping with pain predicted a lower probability of smoking abstinence. In smokers with MI, expectancies of smoking as pain-coping mechanism may be an important clinical target.
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Affiliation(s)
- Romano Endrighi
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Nicolle Rueras
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, RI.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Belinda Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
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11
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Klemperer EM, Hughes JR, Peasley-Miklus CE, Callas PW, Cook JW, Streck JM, Morley NE. Possible New Symptoms of Tobacco Withdrawal III: Reduced Positive Affect-A Review and Meta-analysis. Nicotine Tob Res 2021; 23:259-266. [PMID: 32188995 DOI: 10.1093/ntr/ntaa044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/26/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Most descriptions of tobacco withdrawal have not changed in >30 years despite new research. This meta-analysis tested whether abstinence leads to decreased positive affect (PA) because abstinence-induced symptom changes are a core feature of the tobacco withdrawal syndrome. In addition, we examined whether reduced PA was due to withdrawal (ie, temporary decrease in a "U-shaped" curve) or offset (ie, return to baseline) effect. METHODS Our main inclusion criterion was a prospective within-participant test of change in PA during abstinence conditions among people who smoke cigarettes daily who were not using a cessation medication. Our search of PubMed, PsycINFO, and personal libraries yielded a total of 32 tests with 2054 participants. RESULTS There was a medium effect size indicating an overall decrease in PA following abstinence from cigarettes (Cohen's d = -0.40, 95% CI = -0.30 to -0.49). There was large heterogeneity (I2 = 70.7%). Most (79%) of the 24 trials that conducted significance tests reported that reduction in PA was significant. Seven tests were adequately designed to detect a withdrawal versus offset effect. Over half (57%) displayed a U-shaped curve for abstinence-induced change in PA indicative of a withdrawal symptom rather than offset effect. CONCLUSIONS Abstinence from cigarettes is associated with a decrease in PA. Whether low PA should be added to withdrawal measures and diagnostic criteria requires replication of the time-course of change in PA and tests of whether abstinence-induced changes in PA and negative affect occur independently. IMPLICATIONS Though there was substantial heterogeneity among trials, our findings suggest that (1) abstinence from cigarettes decreases positive affect and (2) this decrease may represent a withdrawal effect (vs. an offset effect). However, it is unclear whether abstinence-induced losses in positive affect are independent from increased negative affect.
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Affiliation(s)
- Elias M Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT
| | - John R Hughes
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT
| | | | - Peter W Callas
- Department of Biostatistics, University of Vermont, Burlington, VT
| | - Jessica W Cook
- Department of Medicine, William S. Middleton Memorial Veterans Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joanna M Streck
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT.,Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Nicolas E Morley
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT
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12
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Conti AA, Tolomeo S, Steele JD, Baldacchino AM. Severity of negative mood and anxiety symptoms occurring during acute abstinence from tobacco: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 115:48-63. [PMID: 32454051 DOI: 10.1016/j.neubiorev.2020.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 01/20/2023]
Abstract
This review was conducted with the following goals: To quantify the severity of mood and anxiety symptoms emerging during acute abstinence from tobacco (1). To explore sex differences related to the experience of specific symptoms (2). To investigate the early time course of symptoms (3). A meta-analysis was performed from 28 studies assessing mood and anxiety symptoms during the earliest phases of tobacco abstinence (up to 24 hrs post-quit) conducted from 1999 to 2019. Results revealed a significant (p < 0.0001) increase in 'anxiety', 'anger/irritability', 'depressed mood /sadness', and composite negative affect ('NA') in the 24 hours following smoking cessation. The largest effect size was detected for 'anxiety' (0.63). A qualitative analysis was performed to investigate sex differences and the time course of the specific symptoms. Results indicated that female smokers may experience worse mood symptoms compared to male smokers and that these symptoms may emerge within 3 hrs post-quit. Smoking cessation programs should implement sex-tailored interventions in order to improve their effectiveness, while future research should focus on alternative methods of nicotine administration.
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Affiliation(s)
- A A Conti
- University of St Andrews, School of Medicine, Division of Population and Behavioural Science, UK
| | - S Tolomeo
- National University of Singapore (NUS), Department of Psychology, Singapore
| | - J D Steele
- University of Dundee, School of Medicine, Division of Imaging Science and Technology, UK
| | - A M Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioural Science, UK.
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13
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Rosen RL, Borges AM, Kibbey MM, Steinberg ML, Leyro TM, Farris SG. Distress intolerance and withdrawal severity among daily smokers: The role of smoking abstinence expectancies. Addict Behav 2019; 99:106048. [PMID: 31421585 DOI: 10.1016/j.addbeh.2019.106048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/10/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Distress intolerance (DI), the perceived inability to withstand distress, is implicated in cigarette smoking maintenance. Greater DI may contribute to anticipation of negative outcomes from smoking abstinence, which in turn could contribute to withdrawal symptom severity. The current study aimed to evaluate (1) the association between DI and acute abstinence expectancies and (2) the potential mediating role of abstinence expectancies in the relationship between DI and withdrawal symptom severity. METHOD Participants (n = 444) were daily smokers who reported at least one prior quit attempt, participating in a larger online study on distress and smoking. DI, subjective nicotine withdrawal, and smoking abstinence expectancies were assessed using the Distress Tolerance Scale (DTS), Minnesota Nicotine Withdrawal Scale (MNWS), and Smoking Abstinence Expectancies Questionnaire (SAEQ). RESULTS DTS was significantly negatively associated with SAEQ, specifically Negative Mood (r = -0.37, p < .001), Somatic Symptoms (r = -0.47, p < .001), and Harmful Consequences (r = -0.59, p < .001) subscales, but was not associated with Positive Expectancies subscale (r = 0.05, p = .31). Results indicated a significant effect of DTS on withdrawal symptom severity via SAEQ. Follow-up analyses indicated that the indirect effects were driven specifically by SAEQ Negative Mood and Harmful Consequences subscales. DISCUSSION DI is related to more negative abstinence expectancies, particularly affective aspects of abstinence, which may contribute to the severity of nicotine withdrawal symptoms. This study provides initial evidence of a specific cognitive process that may explain why DI contributes to heightened subjective experience of nicotine withdrawal symptoms.
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Affiliation(s)
- Rachel L Rosen
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Allison M Borges
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Mindy M Kibbey
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, 317 George St, New Brunswick, NJ 08901, USA
| | - Teresa M Leyro
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Samantha G Farris
- Rutgers, the State University of New Jersey, Department of Psychology, 53 Avenue E, Piscataway, NJ 08854, USA.
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14
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Weinberger AH, Seng EK, Shuter J. Racial/ethnic differences in perceived risks and benefits of quitting smoking in a sample of African American and Hispanic adults living with HIV/AIDS: A preliminary study. J Ethn Subst Abuse 2019; 20:171-186. [PMID: 31010385 DOI: 10.1080/15332640.2019.1598906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Persons living with HIV/AIDS (PLWH) report very high prevalences of cigarette smoking, and there are racial/ethnic disparities in smoking consequences and quit outcomes. In this exploratory pilot study, we examined racial/ethnic differences in perceived risks and benefits of quitting cigarette smoking among 97 adult PLWH in the Bronx, New York (Hispanic, 53.6%; African American, 46.4%). Compared to African American PLWH, Hispanic PLWH reported greater endorsement of overall risks and benefits and risks of negative affect, difficulty concentrating, social ostracism, loss of enjoyment, and cravings. It may be useful to incorporate risks and benefits of quitting into smoking treatment for African American and Hispanic PLWH.
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Affiliation(s)
- Andrea H Weinberger
- Yeshiva University, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Elizabeth K Seng
- Yeshiva University, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Shuter
- Yeshiva University, Bronx, New York.,Montefiore Medical Center, Bronx, New York
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15
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Juliano LM, Kardel PG, Harrell PT, Muench C, Edwards KC. Investigating the role of expectancy in caffeine withdrawal using the balanced placebo design. Hum Psychopharmacol 2019; 34:e2692. [PMID: 30861208 DOI: 10.1002/hup.2692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/20/2018] [Accepted: 01/18/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study investigated psychological influences on drug withdrawal symptomatology using a caffeine-based model. METHODS Using the 2 × 2 balanced placebo design caffeine dose (given caffeinated vs decaffeinated coffee) was crossed with dose expectancy (told caffeine vs. decaf) among 87 (16-hr abstinent) regular coffee consumers in a 2-day study. RESULTS There were effects of expectancy and pharmacology that differed depending on the measure. Those told decaf reported greater caffeine cravings than those told caffeine 45 min and 8 hr postmanipulation. There were no expectancy effects on withdrawal symptoms or cognitive performance. There were pharmacological effects on all measures. Those given decaf reported greater withdrawal symptoms and showed poorer cognitive performance 45 min and 8 hr postmanipulation, with effects for headache and flu-like symptoms first emerging 8 hr postmanipulation (i.e., 24 hr abstinence in given decaf conditions). Caffeine readministration alleviated all withdrawal symptoms and cognitive decrements within 45 min. No drug by expectancy interactions were observed. CONCLUSIONS These findings confirm a strong pharmacological basis for caffeine withdrawal and an important role of cognition in drug craving. Future research should investigate the role of expectancy in drug withdrawal and craving and the potential use of expectancy manipulations in symptom prevention and management.
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Affiliation(s)
- Laura M Juliano
- Department of Psychology, American University, Washington, DC, USA
| | - Peter G Kardel
- Department of Psychology, American University, Washington, DC, USA.,Moran Company, Arlington, Virginia, USA
| | - Paul T Harrell
- Department of Psychology, American University, Washington, DC, USA.,Division of Community Health & Research, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Christine Muench
- Department of Psychology, American University, Washington, DC, USA.,Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Kathryn C Edwards
- Department of Psychology, American University, Washington, DC, USA.,Behavioral Health Group, Westat, Rockville, Maryland, USA
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16
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Abstract
Many smokers are aware that smoking is a dangerous health behavior and eventually try to quit smoking. Unfortunately, most quit attempts end in failure. Traditionally, the addictive nature of smoking has been attributed to the pharmacologic effects of nicotine. In an effort to offer a more comprehensive, biobehavioral analysis of smoking behavior and motivation, some researchers have begun to consider the role of social factors in smoking. In line with recent recommendations to integrate social and pharmacological analyses of smoking, we reviewed the experimental literature examining the effects of nicotine and nicotine withdrawal on social functioning. The review identified 13 studies that experimentally manipulated nicotine and assessed social functioning, 12 of which found support for nicotine's enhancement of social functioning. Although few experiments have investigated social functioning, they nevertheless offer compelling evidence that nicotine enhances social functioning in smokers and suggest that nicotine deprivation may hamper social functioning in those dependent on nicotine. Future directions for investigating social outcomes and context in those who use nicotine products are discussed with a focus on leveraging advances in social and developmental psychology, animal research, sociology, and neuroimaging to more comprehensively understand smoking behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Lea M Martin
- Department of Psychology, University of Pittsburgh
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17
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Postcessation weight gain concern as a barrier to smoking cessation: Assessment considerations and future directions. Addict Behav 2018; 76:250-257. [PMID: 28865363 DOI: 10.1016/j.addbeh.2017.08.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/01/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Concern about postcessation weight gain may be one potential barrier to quitting smoking. In this 'mini-review' of recent literature, we summarize findings on the relationship between postcessation weight gain concern and smoking cessation, and evaluate varied use of postcessation weight gain concern assessments and potential moderators of the postcessation weight gain concern-cessation association. METHODS We conducted a search using the terms "smoking" OR "smoking cessation" AND "weight concern" for articles published between January 1, 2011 and December 31, 2016. We identified 17 studies assessing postcessation weight gain concern, seven of which evaluated the postcessation weight gain concern-cessation association. RESULTS The relationship between postcessation weight gain concern and smoking cessation was mixed. Recent studies varied in their assessments of postcessation weight gain concern, many of which were not validated and assessed correlates of this construct. Studies varied in their adjustment of demographic (e.g., sex), smoking-specific (e.g., smoking level), and weight-specific (e.g., body mass index) variables. CONCLUSIONS The use of non-validated assessments and variability in testing covariates/moderators may contribute to conflicting results regarding the postcessation weight gain concern-cessation relationship. We recommend validating an assessment of postcessation weight gain concern, maintaining vigilance in testing and reporting covariates/moderators, and investigating trajectories of this construct over time and by smoking status to inform future assessment and intervention efforts.
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Weinberger AH, Seng EK, Esan H, Shuter J. Perceived risks and benefits of quitting smoking in a sample of adults living with HIV/AIDS. AIDS Care 2017; 30:564-568. [PMID: 28975812 DOI: 10.1080/09540121.2017.1382678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Persons living with HIV/AIDS (PLWH) smoke at high prevalences and experience significant smoking-related consequences. In community samples, perceived risks and benefits of quitting smoking are related to quit motivation and outcomes and are more strongly endorsed by women. This study examined perceived risks and benefits of quitting smoking and the relationship between risks and benefits and quit motivation and confidence in male and female PLWH. One hundred seven PLWH who reported current cigarette smoking completed measures of demographics, smoking, perceived risks and benefits of quitting smoking, motivation to quit smoking, and confidence in ability to quit smoking. The highest endorsed risks of quitting smoking were cravings and weight gain and higher endorsement of craving risks was associated with lower confidence in the ability to quit smoking. Women endorsed overall risks and risks related to negative affect more highly than men. Women and men did not differ in their endorsement of the other risks, the benefits of quitting, or the relationship between risks and benefits and quit motivation or confidence. It may be useful for health care professionals to incorporate information about perceived risks and benefits of quitting smoking into treatment when working with PLWH who want to stop smoking.
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Affiliation(s)
- Andrea H Weinberger
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,b Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Elizabeth K Seng
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,c The Saul R. Korey Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Hannah Esan
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA
| | - Jonathan Shuter
- b Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA.,d AIDS Center and Division of Infectious Diseases , Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx , NY , USA
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19
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Metrik J, Farris SG, Aston ER, Kahler CW. Development and initial validation of a marijuana cessation expectancies questionnaire. Drug Alcohol Depend 2017; 177:163-170. [PMID: 28600928 PMCID: PMC5567860 DOI: 10.1016/j.drugalcdep.2017.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 03/06/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The present research examines anticipated consequences of ceasing or reducing marijuana use with initial development and psychometric validation of a measure of marijuana cessation expectancies. METHODS The 46-item Marijuana Cessation Expectancies Questionnaire (MCEQ) was initially developed from the content validity analysis of free responses about expected outcomes of stopping and decreasing marijuana use generated by 94 participants. The closed-ended MCEQ was subsequently administered to 151 non-treatment seeking regular marijuana users (used on M=64.7% of the prior 60days, SD=25.1%;Mage=21.4, SD=3.96; 38.4% female). RESULTS Exploratory factor analyses identified six MCEQ factors that accounted for 61% of variance, which were related to expected improvement in: 1) performance/motivation, 2) problems with authority, and 3) interpersonal functioning, and expected worsening of 4) mood states and 5) fun experiences, and 6) changes in appetite/weight from cessation/reduction of marijuana use. Internal consistency of full scale items was good (α=0.86) and moderate to high for all factors (α's=0.60-0.89). The MCEQ items showed good concurrent validity with key measures and incremental associations with change indices (prior history of cessation/reduction attempt, benefits of reduction, importance of change), beyond the effects of marijuana use expectancies. CONCLUSIONS These data provide initial support for the MCEQ and suggest it is closely linked to reduction/cessation decisions in marijuana users. MCEQ may be used clinically to enhance existing behavioral treatments and motivational interventions for problem marijuana use.
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Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA; Providence Veterans Affairs Medical Center, Providence, RI, 02908, USA; The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02906, USA.
| | - Samantha G. Farris
- The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02906,The Miriam Hospital, Centers for Behavioral and Preventative Medicine, Providence, RI, 02906,Butler Hospital, Providence, RI, 02906
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
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20
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Hughes JR, Naud S. Abstinence expectancies and quit attempts. Addict Behav 2016; 63:93-6. [PMID: 27450906 DOI: 10.1016/j.addbeh.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Several scales have been developed to measure expectancies about smoking cessation. This secondary analysis tested the reliability and validity of one of the most commonly used expectancy measures - the Perceived Risks and Benefits of Quitting Scale (PRBQ). METHODS Smokers (n=143) who planned to quit at some point in the next 3months entered an observational study in which they called an Interactive Voice Response system nightly for 3months to report quit attempts and abstinence. They completed the PRBQ at baseline and the end of 1, 2 and 3months. No treatment was provided. RESULTS The Risks scores and Benefit scores of the PRBQ had high internal reliability (alpha=0.88-0.96 across administrations) and high test-retest stability (ICC=0.67-0.80), but poor to moderate concurrent validity (correlation with other cessation measures=0.09-0.52), and poor predictive validity (no significant prediction of quit attempts or duration of abstinence). Results were similar for men and women. CONCLUSIONS The PRBQ appears to be reliable but, similar to other scales of cessation expectancies, its validity appears to be poor. The face valid notion that expectations influence quitting requires further testing.
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Affiliation(s)
- John R Hughes
- Vermont Center for Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, United States; University of Vermont, Burlington, VT 05401, United States.
| | - Shelly Naud
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT 05401, United States
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21
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Ditre JW, Zale EL, Heckman BW, Hendricks PS. A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory. Cogn Behav Ther 2016; 46:339-351. [PMID: 27871214 DOI: 10.1080/16506073.2016.1256347] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e. pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The nine-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.
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Affiliation(s)
- Joseph W Ditre
- a Department of Psychology , Syracuse University , 430 Huntington Hall, Syracuse , NY , USA
| | - Emily L Zale
- a Department of Psychology , Syracuse University , 430 Huntington Hall, Syracuse , NY , USA
| | - Bryan W Heckman
- b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Peter S Hendricks
- c Department of Health Behavior, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA
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22
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Svicher A, Zvolensky MJ, Cosci F. The Smoking Abstinence Expectancies Questionnaire—Italian Version: Analysis of psychometric properties. J Addict Dis 2016; 36:80-87. [DOI: 10.1080/10550887.2016.1251732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Michael J. Zvolensky
- University of Houston, Houston, Texas, USA
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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Weinberger AH, Platt J, Shuter J, Goodwin RD. Gender differences in self-reported withdrawal symptoms and reducing or quitting smoking three years later: A prospective, longitudinal examination of U.S. adults. Drug Alcohol Depend 2016; 165:253-9. [PMID: 27350655 PMCID: PMC4966547 DOI: 10.1016/j.drugalcdep.2016.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known about gender differences in withdrawal symptoms among smokers in the community. This study used longitudinal epidemiologic data to examine gender differences in current smokers' report of withdrawal symptoms during past quit attempts and the relationship between withdrawal symptoms and the odds of reducing or quitting smoking three years later. METHODS Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2001, n=43,093; Wave 2, 2004-2005, n=34,653). Analyses were conducted on respondents who reported current daily cigarette smoking at Wave 1 (n=6911). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Current smoking status was assessed at Wave 2. RESULTS Wave 1 current smoking women, compared to men, were more likely to endorse any withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related relapse (ps<0.0001). Women endorsed a greater number of withdrawal symptoms than men (M=2.37, SE=0.05 versus M=1.78, SE=0.04; p<0.0001). The odds of reducing and quitting smoking were significantly lower for respondents who reported any Wave 1 withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related relapse. These relationships did not differ for women versus men. Among men, the odds of reducing smoking at Wave 2 decreased significantly with each cumulative withdrawal symptom compared to women (β interaction=0.87; p=0.01). CONCLUSIONS Women were more likely to report withdrawal while the relationship between withdrawal symptoms and decreased likelihood of reducing smoking was stronger in men. Identifying gender differences in withdrawal can help develop strategies to help reduce withdrawal for both men and women.
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461 USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - Jonathan Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Jonathan Shuter
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10467, USA.
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), 65-30 Kissena Boulevard, Queens, NY 11367 USA
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Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting. Int J Public Health 2016; 61:701-708. [PMID: 27083449 DOI: 10.1007/s00038-016-0818-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To identify predictors of nicotine withdrawal symptoms among smokers who participated in a randomized cessation trial in a low-income country. METHODS We analyzed data from 269 smokers who participated in a randomized, placebo-controlled smoking cessation trial conducted in primary healthcare in Aleppo, Syria. All participants received behavioral counseling and were randomized to receive either 6 weeks of nicotine or placebo patch and were followed for one year. RESULTS Throughout the study, lower total withdrawal score was associated with greater education (p = 0.044), older age of smoking initiation (p = 0.017), lower nicotine dependence (p = 0.024), higher confidence in ability to quit (p = 0.020), lower reported depression (p < 0.001), higher adherence to patch (p = 0.026), belief of receiving nicotine patches rather than placebo (p = 0.011), and waterpipe use (p = 0.047). CONCLUSIONS Lower nicotine dependence, greater educational attainment, higher confidence in ability to quit and waterpipe use predict lower withdrawal severity. Waterpipe smoking may serve as a barrier to smoking cessation efforts in countries where its use is highly prevalent. Further, expectancies about the effects of pharmacotherapy appear to mediate the experience of nicotine withdrawal.
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25
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Past-month Pain and Cognitive-affective Smoking Processes Among Daily Smokers. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Anxiety sensitivity mediates the association between post-traumatic stress symptom severity and interoceptive threat-related smoking abstinence expectancies among World Trade Center disaster-exposed smokers. Addict Behav 2015; 51:204-10. [PMID: 26298644 DOI: 10.1016/j.addbeh.2015.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anxiety sensitivity (fear of internal anxiety-relevant bodily sensations) is an individual difference variable that is associated with the development and maintenance of posttraumatic stress disorder (PTSD) and is also involved in the maintenance/relapse of smoking. Abstinence expectancies are crucial to smoking maintenance, yet, past work has not explored how PTSD symptom severity and anxiety sensitivity contribute to them. METHOD Participants were 122 treatment-seeking daily smokers (36.1% female; Mage=49.2, SD=9.7; cigarettes per day: M=18.3, SD=15.2) who were exposed to the World Trade Center disaster on September 11, 2001 and responded to an advertisement for a clinical smoking cessation trial. The indirect effect of anxiety sensitivity was tested in terms of the effect of PTSD symptom severity on smoking abstinence expectancies (i.e., anxiety sensitivity as a statistical mediator). RESULTS PTSD symptom severity was positively associated with interoceptive threat-related smoking abstinence expectancies: expecting harmful consequences (β=.33, p<.001) and somatic symptoms (β=.26, p=.007). PTSD symptom severity was also significantly associated with anxiety sensitivity (β=.27, p=.003). Anxiety sensitivity mediated the association between PTSD symptom severity and expectancies about the harmful consequences (β=.09, CI95%=.02-.21; ΔR(2)=.076) and somatic symptoms (β=.11, CI95%=.02-.24; ΔR(2)=.123) from smoking abstinence, with medium effect sizes (Κ(2)=.08 and .10, respectively). CONCLUSIONS These data document the role of PTSD symptoms in threat-based expectancies about smoking abstinence and suggest anxiety sensitivity may underlie the associations between PTSD symptom severity and abstinence expectancies.
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Reese ED, Veilleux JC. Relationships Between Craving Beliefs and Abstinence Self-Efficacy are Mediated by Smoking Motives and Moderated by Nicotine Dependence. Nicotine Tob Res 2015; 18:48-55. [PMID: 25744968 DOI: 10.1093/ntr/ntv054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Decreased abstinence self-efficacy is linked to increased craving and negative affect, as well as poorer smoking outcomes, such as lapse, relapse, and withdrawal symptom severity. Research suggests that beliefs and cognitions concerning ourselves and the world orient us toward specific goals and thus impact our judgments and behavior. This study serves to investigate whether motives for smoking mediate the relationship between beliefs about craving and abstinence self-efficacy judgments and whether this may differ by nicotine dependence. METHODS In a sample of 198 smokers (M age = 34.96, 51.8% female, 81.8% Caucasian), self-report measures of craving beliefs, situational abstinence self-efficacy, and smoking motives were measured. We examined the effect of beliefs on abstinence self-efficacy in both craving and negative affect situations, with craving and negative reinforcement smoking motives as mediators, and nicotine dependence as a moderator. RESULTS Results indicate that craving beliefs predict lower abstinence self-efficacy judgments in craving situations indirectly through increased craving motives. However, this relationship was only significant for less dependent smokers. Additionally, regardless of nicotine dependence, craving beliefs predicted lower abstinence self-efficacy in negative affect situations via increased negative reinforcement smoking motives. CONCLUSIONS These findings suggest that beliefs concerning the specific nature of craving correlate with smoking motives (ie, smoking goals) and thus abstinence self-efficacy judgments. Furthermore, these associations are stronger for less dependent smokers. Such findings suggest the importance of addressing craving beliefs during smoking cessation treatment, especially for less dependent smokers whose craving beliefs are associated with abstinence self-efficacy across multiple situations.
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Affiliation(s)
- Elizabeth D Reese
- Department of Psychological Science, University of Arkansas, Fayetteville, AR
| | - Jennifer C Veilleux
- Department of Psychological Science, University of Arkansas, Fayetteville, AR
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28
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Piper ME. Withdrawal: Expanding a Key Addiction Construct. Nicotine Tob Res 2015; 17:1405-15. [PMID: 25744958 DOI: 10.1093/ntr/ntv048] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/16/2015] [Indexed: 02/03/2023]
Abstract
Withdrawal is an essential component of classical addiction theory; it is a vital manifestation of dependence and motivates relapse. However, the traditional conceptualization of withdrawal as a cohesive collection of symptoms that emerge during drug deprivation and decline with either the passage of time or reinstatement of drug use, may be inadequate to explain scientific findings or fit with modern theories of addiction. This article expands the current understanding of tobacco withdrawal by examining: (1) withdrawal variability; (2) underlying causes of withdrawal variability, including biological and person factors, environmental influences, and the influence of highly routinized behavioral patterns; (3) new withdrawal symptoms that allow for enhanced characterization of the withdrawal experience; and (4) withdrawal-related cognitive processes. These topics provide guidance regarding the optimal assessment of withdrawal and illustrate the potential impact modern withdrawal conceptualization and assessment could have on identifying treatment targets.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
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29
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Hospitalized smokers' expectancies for electronic cigarettes versus tobacco cigarettes. Addict Behav 2015; 41:106-11. [PMID: 25452052 DOI: 10.1016/j.addbeh.2014.09.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The objectives of the current study were to compare hospitalized smokers' expectancies for electronic cigarettes (e-cigarettes) against their expectancies for tobacco cigarettes and evaluate relationships between e-cigarette expectancies and intention to use e-cigarettes. METHODS Analysis of baseline data from a one-year longitudinal observational study. The setting was a tertiary care academic center hospital in the Southeastern U.S. Participants were 958 hospitalized tobacco cigarette smokers. A questionnaire of e-cigarette expectancies based on the Brief Smoking Consequences Questionnaire-Adult (BSCQ-A) was developed and administered along with the original, tobacco-specific, BSCQ-A. Intention to use e-cigarettes was assessed with a single 10-point Likert scale item. RESULTS Participants reported significantly weaker expectancies for e-cigarettes relative to tobacco cigarettes on all 10 BSCQ-A scales. Participants held sizably weaker expectancies that e-cigarettes pose health risks (p<.001, Cohen's d=-2.07), relieve negative affect (p<.001, Cohen's d=-1.01), satisfy the desire for nicotine (p<.001, Cohen's d=-.83), and taste pleasant (p<.001, Cohen's d=-.73). Among the strongest predictors of intention to use e-cigarettes were greater expectancies that e-cigarettes taste pleasant (p<.001, adjusted β=.34), relieve negative affect (p<.001, adjusted β=.32), and satisfy the desire for nicotine (p<.001, adjusted β=.31). CONCLUSIONS Hospitalized tobacco smokers expect fewer negative and positive outcomes from e-cigarettes versus tobacco cigarettes. This suggests that e-cigarettes might be viable though imperfect substitutes for tobacco cigarettes.
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Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull 2015; 141:176-212. [PMID: 25365764 PMCID: PMC4293352 DOI: 10.1037/bul0000003] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.
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Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
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Hendricks PS, Delucchi KL, Benowitz NL, Hall SM. Clinical significance of early smoking withdrawal effects and their relationships with nicotine metabolism: preliminary results from a pilot study. Nicotine Tob Res 2013; 16:615-20. [PMID: 24353342 DOI: 10.1093/ntr/ntt204] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although the early time course of smoking withdrawal effects has been characterized, the clinical significance of early withdrawal symptoms and their predictors are unknown. This study evaluated the relationships of early smoking withdrawal effects with quit attempt outcomes and the rate of nicotine metabolism. METHODS Eleven treatment-seeking smokers abstained from smoking for 4 hr in the laboratory before a quit attempt. Withdrawal measures included heart rate, sustained attention, and self-report. Following baseline assessment, withdrawal measures were administered every 30 min. At the conclusion of the 4-hr early withdrawal session, participants received a brief smoking cessation intervention and then returned 1 week and 12 weeks later for outcome assessments that included biochemically confirmed smoking abstinence, cigarettes smoked in the past 24hr, and self-reported withdrawal symptoms. The rate of nicotine metabolism was estimated at intake with the nicotine metabolite ratio (trans-3'-hydroxycotinine/cotinine) measured in saliva. RESULTS Greater self-reported negative affect and concentration difficulty during early withdrawal, most notably anxiety, were related with poorer quit attempt outcomes. There was some indication that although a faster increase in craving and greater hunger during early withdrawal were associated with more favorable outcomes, a greater decrease in heart rate during this time was associated with poorer outcomes. Faster nicotine metabolism was related to a faster increase in anxiety but a slower increase in craving during early withdrawal. CONCLUSIONS These findings lend support to the clinical significance of early smoking withdrawal effects. The rate of nicotine metabolism may be a useful predictor of early withdrawal symptoms.
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Affiliation(s)
- Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Expectancies for smoking cessation among drug-involved smokers: implications for clinical practice. J Subst Abuse Treat 2013; 46:320-4. [PMID: 24314605 DOI: 10.1016/j.jsat.2013.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/22/2022]
Abstract
Drug-involved smokers may be less motivated to quit smoking because they expect smoking cessation to occasion adverse outcomes (e.g., exacerbation of drug use). Non-treatment-seeking adult smokers from the community (N=507) reported drug involvement, expectancies for smoking abstinence via the Smoking Abstinence Questionnaire (SAQ), and motivation to quit smoking (desire to quit and abstinence goal). Mediation analyses evaluated the indirect effects of binge drinking, marijuana, cocaine, other stimulant, opiate, and barbiturate/other sedative involvement on motivation to quit smoking through the SAQ Adverse Outcomes scale. Adverse outcomes expectancies accounted for a reduced desire to quit smoking and a lower likelihood of endorsing a goal of complete smoking abstinence among those involved with binge drinking, marijuana, cocaine, other stimulants, opiates, and barbiturates/other sedatives. Drug-involved smokers' greater expectancies for adverse outcomes upon quitting smoking may deter smoking quit attempts. Interventions are encouraged to counteract the notion that smoking cessation jeopardizes sobriety.
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