Fatigue severity and electronic cigarette beliefs and use behavior

Associations Between Self-Reported Sleep Quality, Fatigue Severity, Factors Associated With Successful Cessation, and Cessation Beliefs Among Regular Smokers

BACKGROUND

Smokers report poorer sleep than nonsmokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Better understanding of the relationship between sleep and relapse-related outcomes could inform novel approaches to smoking cessation support. The aim of this study was to investigate same-day associations of self-reported sleep quality and fatigue severity with factors associated with successful cessation and cessation beliefs, among regular smokers.

METHODS

This cross-sectional observational study (n = 412) collected self-reported sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs among regular smokers via an online survey (60% male).

RESULTS

There was evidence of an association between sleep quality (SQ) and reduced 24-hour (β = -0.12, p = .05) and lifetime (β = -0.09, p = .04) abstinence self-efficacy. In addition, poorer SQ and higher fatigue severity (FS) were associated with increased smoking urges (SQ: β = 0.27, p < .001; FS: β = 0.32, p < .001), increased barriers to cessation (SQ: β = 0.19, p < .001; FS: β = 0.32, p < .001), and increased perceived risks to cessation (SQ: β = 0.18, p < .001; FS: β = 0.26, p < .001). Fatigue severity was weakly associated with increased perceived benefits to cessation (β = 0.12, p = .017).

CONCLUSIONS

Self-reported sleep quality and fatigue severity were associated with multiple factors associated with successful cessation and cessation beliefs. Further research is needed to extend these findings by using different methods to identify the temporal direction of associations and causality.

IMPLICATIONS

This study is the first to examine associations between sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs. Findings show that both sleep quality and fatigue severity are associated with multiple factors associated with successful cessation and could be modifiable targets for future smoking cessation interventions. Furthermore, our data suggest that fatigue severity has an independent effect on multiple factors associated with successful cessation when accounting for sleep quality. This indicates that fatigue, independent of sleep quality, could be an important factor in a quit attempt.

The moderating role of anxiety sensitivity in terms of fatigue severity and e-cigarette use expectancies

Little is understood about individual difference factors related to e-cigarette expectancies about use. This study examined the interactive effects of fatigue severity and anxiety sensitivity in relation to e-cigarette expectancies among 525 e-cigarette users (51.0% female, Mage = 35.25 years, standard deviation = 10.10). Results indicated a significant interaction between fatigue severity and anxiety sensitivity in terms of positive expectancies (β = 0.57, p < 0.001, 95% confidence interval = (0.002, 0.01)), but not for negative expectancies (β = 0.25, p = 0.08, 95% confidence interval = (0, 0.005)) for e-cigarette use. These results support anxiety sensitivity as a moderator in the relation between fatigue severity and positive outcome expectancies for e-cigarette use.

The Role of Anxiety Sensitivity and Fatigue Severity in Predicting E-Cigarette Dependence, Barriers to Cessation, and Cravings among Young Adults

Background: Electronic cigarette (e-cigarette) use has risen dramatically in the United States among young adults; however, little is understood about potential factors that are related to e-cigarette use and maintenance among this population. Fatigue severity is one promising individual difference factor, as past work indicates that it is related to greater withdrawal symptoms and greater dependence on e-cigarettes, and more barriers to quitting. In addition, anxiety sensitivity and severe fatigue are both uniquely related to poor e-cigarette use outcomes; yet, no known studies have examined whether these individual difference factors are related to e-cigarette outcomes among young adults. Method: The current study sought to examine the unique and interactive effects of anxiety sensitivity and fatigue severity in predicting a variety of e-cigarette outcomes among 685 (69.1% female; Mage = 19.61 years, SD = 1.44) young adult e-cigarette users. Results: Results indicated that anxiety sensitivity was significantly associated with greater barriers for cessation (β = .63, p <.001) and e-cigarette cravings (β = .67, p =.001), but not dependence. Fatigue severity was significantly associated with greater e-cigarette dependence (β = .58, p <.001), barriers to cessation (β = 1.56, p <.001), and e-cigarette cravings (β = 3.34, p <.001). The interactive effects of anxiety sensitivity and fatigue severity did not significantly predict the outcomes. Discussion: Results suggest that anxiety sensitivity and fatigue severity independently predict greater e-cigarette maintenance factors among young adults. The current investigation highlights the importance of targeting anxiety sensitivity and fatigue severity among young adult e-cigarette users.

Fatigue Severity among Adults with Chronic Low Back Pain: Relations to Opioid Use and Hazardous Alcohol Use

BACKGROUND

Chronic low back pain is the second leading cause of disability in the United States and is related to greater risk of opioid misuse. Research suggests that severe fatigue may be a relevant factor for better understanding the greater rates of opioid and misuse among adults with chronic low back pain. Therefore, the current study sought to examine differences in opioid misuse, risk for opioid use disorder, and hazardous alcohol use in two different groups: one group with clinically significant fatigue, and one group without clinically significant fatigue.

METHODS

Participants were recruited utilizing a validated online survey management system that yielded 1,681 adults (70.0% female, 81.1% White, M _age = 44.5 years, SD = 11.88) with current mild to severe chronic low back pain. One-way analysis of covariance (ANCOVA) models were conducted to examine group differences.

RESULTS

Among adults with chronic low back pain, those with clinically significant fatigue reported significantly greater opioid misuse and risk for opioid use disorder compared to those without clinically significant fatigue. These results were evident after controlling for pain severity and interference. The results for hazardous alcohol use were not significantly different between groups.

CONCLUSIONS

Clinically significant fatigue is a distinguishing characteristic among adults with chronic low back pain in terms of opioid misuse and risk for opioid use disorder. Potential clinical implications of such findings suggest that it may be important for clinicians to assess fatigue levels to better manage opioid misuse potential among adults with chronic low back pain.

Evaluating the psychometric properties of the e-cigarette barriers to cessation scale

Evidence suggests that electronic cigarette (e-cigarette) users have difficulty quitting e-cigarettes. The Electronic Cigarette Barriers to Cessation Scale (E-BCS) was developed to assess barriers to cessation among e-cigarette users. Yet, no work has evaluated the psychometric properties of the E-BCS. The current study utilized data from two independent samples of adult e-cigarette users to evaluate the psychometric properties and structure of the E-BCS. In Study 1, competing models of the E-BCS were evaluated, and initial construct validity and reliability were explored using data from 599 adult e-cigarettes users (52.3% female, M_age = 35.16 years, SD = 10.30). Results supported a unidimensional structure for the E-BCS comprised of 18 items. In Study 2, the unidimensional structure of the 18-item E-BCS and construct validity were evaluated among a sample of 516 current e-cigarette using adults (52.3% female; M_age = 34.74, SD = 11.37). Results confirmed the unidimensional structure, measurement invariance across sex, and construct validity across related e-cigarette behavior constructs and psychopathology for the E-BCS. These findings suggest that the E-BCS is a potentially useful clinical instrument for measuring barriers that may interfere with e-cigarette cessation.

Emotion dysregulation, fatigue, and electronic cigarette expectancies

Emotion dysregulation and the experience of fatigue have both been linked to the maintenance of substance use. However, limited empirical data has evaluated individual differences in these constructs in terms of e-cigarette use expectancies. The present study examined a theoretically relevant model focused on whether the experience of more severe fatigue explains, in part, the relation between individual differences in emotion dysregulation and positive and negative e-cigarette expectancies among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). It was hypothesized that emotion dysregulation, via fatigue severity, would significantly predict greater positive and negative e-cigarette expectancies, which was examined in two separate mediation models. Fatigue severity significantly explained, in part, the relation between emotion dysregulation and positive (b = 0.02, CI [0.01, 0.02]) and negative expectancies of e-cigarette use (b = 0.02, 95% CI [0.02, 0.03]). The current findings suggest that the experience of fatigue helps explain the relation between emotion dysregulation and positive and negative e-cigarette expectancies among adult e-cigarette users. Future work is needed to explicate how reducing fatigue severity in the context of emotion dysregulation may change expectancies about e-cigarette expectancies.

The Role of Anxiety Sensitivity in the Relation Between Pain Intensity with Substance Use and Anxiety and Depressive Symptoms Among Smokers with Chronic Pain

BACKGROUND

The additive effect of experiencing chronic pain in the context of nicotine addiction places smokers with chronic pain at elevated risk for experiencing physical and mental health problems. Isolating factors that explain linkages between pain and health-related outcomes among smokers with chronic pain is an important next step. Therefore, the current study examined the explanatory role of anxiety sensitivity in relations between pain intensity and current opioid misuse, severity of opioid dependence, tobacco-related problems, and anxiety/depressive symptoms.

METHOD

Participants were 187 (M_age = 39.02, SD = 9.94, 74.9% female) daily smokers with chronic pain who completed a battery of self-report measures on pain experience, anxiety sensitivity, tobacco and opioid use, and anxiety/depression symptoms. Indirect effect analyses were conducted to examine anxiety sensitivity as a mediator of the relations between pain intensity and health-related outcomes.

RESULTS

A significant indirect effect emerged for pain intensity, through anxiety sensitivity, on opioid misuse (ab = 0.83, SE = 0.24, 95% CI [0.39, 1.34], CSE = 0.17), severity of opioid dependence (ab = 0.17, SE = 0.05, 95% CI [0.08, 0.26], CSE = 0.16), tobacco use problems (ab = 0.16, SE = 0.06, 95% CI [0.07, 0.28], CSE = 0.11), and anxiety/depressive symptoms (ab = 0.20, SE = 0.06, 95% CI [0.10, 0.31], CSE = 0.19).

CONCLUSION

The current investigation highlights the potential importance of anxiety sensitivity in terms of the experience of pain with severity of substance use and anxiety/depressive symptoms among smokers with chronic pain.

The Positive and Negative Experiences of 342 Antidepressant Users

Most efficacy and safety studies about medications adopt a quantitative approach, testing specific hypotheses with restricted samples. This online survey provides additional insights by directly asking people open questions. Thematic analysis was used to explore the responses of 342 antidepressant users to "Is there anything else you would like to tell us about your experience of taking medication". 59 (17.3%) made exclusively positive comments, 146 (42.7%) purely negative comments and 137 (40.0%) offered a mixture of positive and negative. Positive themes included: daily coping, life-changing/saving and stepping stone. Negative themes included: physical adverse effects, emotional and cognitive blunting, and withdrawal effects. Many participants also commented on relationships with prescribers. Collaboration was particularly valued. Negative sub-themes included failings in relation to information (especially about adverse effects and withdrawal), support, and alternatives. Clinicians have a duty to inform potential antidepressant users about positive and adverse effects, including withdrawal effects.