Validation of the timeline follow-back in the assessment of adolescent smoking

Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study

Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18-25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.

Feasibility and acceptability of a timeline follow-back method to assess opioid use, non-fatal overdose, and substance use disorder treatment

BACKGROUND

Non-fatal overdoses are underreported and there is no accepted and feasible self-report research measure of non-fatal opioid overdose. Timeline follow-back (TLFB) calendar-based questionnaires assess self-reported risk behaviors. We assessed feasibility and acceptability of a new TLFB research measure for opioid use, non-fatal opioid overdose, and substance use disorder treatment among opioid overdose survivors.

METHODS

For the Repeated-dose Behavioral Intervention to Reduce Opioid Overdose Trial (REBOOT) study among opioid overdose survivors, we developed a TLFB questionnaire to assess daily non-prescribed opioid use, opioid overdose, facility stays, medications/behavioral treatment for opioid use disorder, and COVID-19 history during the previous 120 days. Staff assessors administered TLFB at four-monthly visits over the 16-month study participation period. To measure feasibility, we estimated TLFB completion time using an electronic timestamp tool. To measure acceptability, we administered a satisfaction survey to 103 participants who completed REBOOT.

RESULTS

Among 525 TLFB assessments conducted in 174 participants from January 2021-January 2023, opioid use was reported in 510 assessments, medication for opioid use disorder (MOUD) in 331 assessments, and ≥ 1 overdose in 107 assessments. Median TLFB completion time was 11 (IQR: 6-17) minutes for sections administered to all participants; detailed overdose questions administered to those reporting overdose took an additional 3 (IQR: 2-6) minutes. Report of ≥ 1 overdose and MOUD use were significantly associated with increased TLFB completion time. 88 % of participants reported that TLFB was very/somewhat acceptable.

CONCLUSIONS

Among opioid overdose survivors, REBOOT TLFB was a feasible and acceptable research measure, with similar completion time as other TLFB assessments of substance use.

Mobile health contingency management for smoking cessation among veterans experiencing homelessness: A comparative effectiveness trial

Tobacco cessation is reduced in U.S. military veterans experiencing homelessness. Mobile contingency management (mCM) is a promising treatment for tobacco use among populations experiencing homelessness, but past CM studies have largely been small, have relied on in-person follow-up, and/or lacked long-term biochemically verified abstinence measures. Veterans who smoked and were experiencing homelessness (N = 127) were randomly assigned to mCM treatment (4 weeks of mCM, 5 weeks of telehealth counseling, and the option of 12 weeks of pharmacotherapy) or VA standard care (3 biweekly group sessions and clinically appropriate pharmacotherapy), and all participants were randomly assigned to a $100 longer-term financial incentive for abstinence at 3-month follow-up. Participants were followed at 3-, 6-, and 12-months post-randomization, with the a priori main outcome designated as biochemically verified prolonged abstinence (with lapses) at 6-month follow-up. At 6-months, participants in the mCM group were significantly more likely to meet criteria for prolonged abstinence (OR = 3.1). Across time points, veterans in the mCM group had twice the odds of prolonged abstinence as those in the standard care group. However, by the 12-month follow-up, there was no statistically significant group difference in abstinence. Cost-effectiveness analysis indicated a modest increase in cost ($1,133) associated with an increase of one quality-adjusted life year saved for the intervention compared to standard care. mCM is a cost-effective approach to smoking cessation among veterans experiencing homelessness. Considering waning potency of this and other tobacco cessation interventions at 12-month follow-up, it is crucial to implement strategies to sustain abstinence for individuals experiencing homelessness.

Multimodal smoking cessation treatment combining transcranial magnetic stimulation, cognitive behavioral therapy, and nicotine replacement therapy in veterans with posttraumatic stress disorder: A feasibility randomized controlled trial protocol

Tobacco-related deaths exceed those resulting from homicides, suicides, motor vehicle accidence, alcohol consumption, illicit substance use, and acquired immunodeficiency syndrome (AIDS), combined. Amongst U.S. veterans, this trend is particularly concerning given that those suffering from posttraumatic stress disorder (PTSD)-about 11% of those receiving care from the Department of Veterans Affairs (VA)-have triple the risk of developing tobacco use disorder (TUD). The most efficacious strategies being used at the VA for smoking cessation only result in a 23% abstinence rate, and veterans with PTSD only achieve a 4.5% abstinence rate. Therefore, there is a critical need to develop more effective treatments for smoking cessation. Recent studies have revealed the insula as integrally involved in the neurocircuitry of TUD, specifically showing that individuals with brain lesions involving this region had drastically improved quit rates. Some of these studies show a probability of quitting up to 5 times greater compared to non-insula lesioned regions). Altered activity of the insula may be involved in the disruption of the salience network's (SN) connectivity to the executive control network (ECN), which compromises that patient's ability to switch between interoceptive states focused on cravings to executive and cognitive control. Thus, we propose a feasibility phase II randomized controlled trial (RCT) to study a patterned form of repetitive transcranial magnetic stimulation (rTMS), intermittent theta burst stimulation (iTBS), at 90% of the subject's resting motor threshold (rMT) applied over a region in the right post-central gyrus most functionally connected to the right posterior insula. We hypothesize that by increasing functional connectivity between the SN with the ECN to enhance executive control and by decreasing connectivity with the default mode network (DMN) to reduce interoceptive focus on withdrawal symptoms, we will improve smoking cessation outcomes. Fifty eligible veterans with comorbid TUD and PTSD will be randomly assigned to two conditions: active-iTBS + cognitive behavioral therapy (CBT) + nicotine replacement therapy (NRT) (n=25) or sham-iTBS + CBT + NRT (n=25). The primary outcome, feasibility, will be determined by achieving a recruitment of 50 participants and retention rate of 80%. The success of iTBS will be evaluated through self-reported nicotine use, cravings, withdrawal symptoms, and abstinence following quit date (confirmed by bioverification) along with evaluation for target engagement through neuroimaging changes, specifically connectivity differences between the insula and other regions of interest.

Intervention for marijuana using, court-involved non-incarcerated youth

INTRODUCTION

Justice-involved youth (JIY) are at elevated risk for substance use and for substance use-related harm compared to non-JIY. Marijuana use is of significant concern in this population, as it is tied to reoffending. Motivational enhancement therapy (MET) and electronic interventions show promise in reducing youth substance use; the degree to which these findings extend to JIY requires additional research attention. Thus, the purpose of this study was to test the preliminary feasibility and effectiveness of a combined brief electronic parenting intervention plus a brief MET-based electronic intervention for JIY adolescents, followed by feedback and development of a change plan with a court worker, on marijuana use.

METHODS

Participants were 83 parent-youth dyads recruited from a diversionary family court program who screened positive for past-year marijuana use. At baseline and 3- and 6-month follow-ups, youth self-reported on their substance use, parental monitoring, peer substance use, and dyads completed a discussion task querying parental monitoring, limit setting, and substance use. The study randomized dyads to psychoeducation or the experimental intervention condition post-baseline. The MET-based intervention involved the self-administered e-TOKE (an electronic, marijuana-specific assessment and feedback tool) and a brief follow-up meeting with court staff counselors to review feedback and create a marijuana use change plan. Caregivers completed a computer program aimed at improving parenting and communication with their adolescents. The study administered feasibility and acceptability measures for both conditions.

RESULTS

Feasibility of study procedures was demonstrated through recruitment and retention (∼75 % success). Acceptability ratings from youth, parents, and court staff were high and positive. While levels of parental monitoring, as assessed by an observational task, improved over the course of the study, the intervention did not result in a significant change in any of the outcomes tested.

CONCLUSIONS

Despite high acceptability and feasibility ratings for the use of an electronic plus in-person MET intervention, reduction of marijuana and other substances was limited for most youth. This suggests that a more intensive intervention, such as stepped care, may be necessary for JIY who are not specifically referred for court proceedings due to marijuana use or those with already well-established use patterns.

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study

BACKGROUND

Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments.

OBJECTIVE

The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase.

METHODS

Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study.

RESULTS

No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group.

CONCLUSIONS

Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report.

The Role of Emotion Differentiation in the Association Between Momentary Affect and Tobacco/Nicotine Craving in Young Adults

INTRODUCTION

Tobacco/nicotine use is commonly initiated during adolescence or young adulthood, which increases the likelihood of continued use into adulthood and related adverse health outcomes. Despite interest in cessation, achieving and maintaining abstinence is difficult among this population. Cravings are often a barrier to abstinence, which have been associated with intensity of affect at the moment level. Emotion differentiation involves the ability to distinguish between discrete emotion states, and previous work suggests it may moderate the effect of momentary affect on craving, which has never been explored among young adults who are smoking or vaping nicotine.

AIMS AND METHODS

In a sample of young adults (N = 37, observations = 2020, ages 18-25, 51% female, and 78% white) interested in quitting smoking or vaping, we used real-time, naturalistic data capture via mobile phones to examine the interaction of momentary affect and trait emotion differentiation on nicotine craving. Participants were prompted with four surveys per day for 35 days and asked to make a 48-h quit attempt on day 7.

RESULTS

Multilevel models showed moments of higher-than-average momentary negative affect (NA; b = 0.39, p < .001), and positive affect (PA; b = 0.26, p = .001) were associated with greater levels of craving. NA emotion differentiation significantly moderated the associations between PA and craving (b = -0.63, p = .031) and NA and craving (b = -0.67, p = .003).

CONCLUSIONS

Findings from this exploratory analysis suggest that for young adults engaging in a nicotine quit attempt, greater ability to differentiate NA weakens the momentary association between intense affect and craving.

IMPLICATIONS

Results of this study show that the ability to differentiate between discrete emotional experiences may protect young adults against nicotine craving during moments of intense affective experience. These preliminary findings suggest that emotion differentiation, a modifiable construct, could be an important treatment target for individuals engaged in treatment for nicotine dependence.

Agreement between momentary and retrospective reports of cannabis use and alcohol use: Comparison of ecological momentary assessment and timeline followback indices

OBJECTIVE

This study compares three methods of cannabis and of alcohol use assessment in a sample of regular cannabis users: (a) ecological momentary assessment (EMA) repeated momentary surveys aggregated to the daily level, (b) EMA morning reports (MR) where participants reported on their total use from the previous day, and (c) retrospective timeline followback (TLFB) interviews covering the same period of time as the EMA portion of the study. We assessed the overall correspondence between these methods in terms of cannabis and alcohol use occasions and also investigated predictors of agreement between methods.

METHOD

Forty-nine individuals aged 18-50 (Mage = 24.49, 49% female, 84% White) who reported regular cannabis use completed a 14-day EMA study. At the end of the EMA period, participants returned to the laboratory to complete a TLFB (administered via computer) corresponding to the same dates of the EMA period.

RESULTS

Daily aggregated EMA and TLFB reports showed a low to modest agreement for both alcohol and cannabis use. Overall, agreement between EMA and MR was better than agreement between EMA and TLFB, likely because less retrospection is required when only reporting on behavior from the previous day. Quantity and frequency of use differentially predicted agreement across reporting methods when assessing alcohol compared to cannabis. When reporting cannabis use, but not alcohol use, individuals who used more demonstrated higher agreement between EMA and TLFB.

CONCLUSIONS

Results suggest that retrospective reporting methods assessing alcohol and cannabis should not be considered a direct "substitute" for momentary or daily assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cigarette and e-cigarette use as a function of psychological distress following COVID-19 related university campus closures

Background: Individuals experienced increased social isolation resulting from the COVID-19 pandemic. Studies have found social isolation and loneliness to be strongly associated with anxiety and depression, which have been associated with increased smoking and vaping rates among young adults, including college students.Objectives: To examine relationships between psychological distress and nicotine use within the context of the COVID-19 pandemic.Methods: A cross-sectional online survey (n = 4634; 77.9% female) was used to collect nicotine use and psychological measures from students enrolled at a large Midwestern university. Timeline follow-back data were collected from students reporting current cigarette or electronic cigarette (e-cigarette) use in the week before and immediately following the closure of campus due to the pandemic. Generalized estimating equations were used to examine the interaction between nicotine use and psychological symptoms across the 2-week period.Results: Both cigarette (Rate ratio (RR) = 1.115, 95% CI = 1.061, 1.171, p < .0001) and e-cigarette (β = 0.258, 95% CI = 0.166, 0.351, p < .0001) use increased significantly following campus closure. Students experiencing higher levels of depression reported greater increases in e-cigarette use frequency over time as compared to students reporting fewer symptoms of depression (β = 0.018, 95% CI = 0.006, 0.030, p = .004).Conclusions: Increases in nicotine use were found immediately following the implementation of public health safety measures that closed most university campuses. Additional and/or increased stressors have potentially impacted young adults who are college students as a result of campus closures resulting from the pandemic, which may have contributed to further increases in nicotine use.

Resources for the Assessment and Treatment of Substance Use Disorder in Adolescents

Substance Use Disorder (SUD) is understood as the persistent use of substances to the detriment of the individual's livelihood and wellness. SUD can have serious mental, physical, and social ramifications if not properly addressed. Though SUD can develop at any age, it is especially important to address in adolescents, given rising prevalence of certain substances (e.g. cannabis) in that age group and poor prognosis associated with early-onset SUD.[1][2] Data from the National Survey on Drug Use and Health show the lifetime use of illicit drugs in people ages 12-17 is 20.9%.[3] The same survey found the rate of Substance Use Disorder in the past year for people ages 12-17 who used illicit drugs or alcohol to be 6.3% in 2020.[3] This paper is intended for clinicians and lay people to gain a deeper understanding of SUD in adolescents, particularly relating to alcohol, cannabis, nicotine, and opioids. Though alcohol, cannabis, and nicotine are the substances most commonly used by this age demographic nationally,[4] opioid use – and resulting deaths – have been on the rise. According to the Centers for Disease Control and Prevention (CDC), opioids were connected to about 75% of the nearly 92,000 drug deaths in 2020.[5] Beyond significant death rates in the general population, recent spikes in adolescent death rate tied to the synthetic opioid fentanyl – which held a relatively stable death rate from 2010 to 2019 until seeing a 94% increase from 2019 to 2020 and additional 20% increase to 2021 - warrants inquiry into opioids for this population.[6] Each of these substances can have adverse, long-lasting effects on health if not managed properly, resulting in seriously compromised lifelong wellbeing.[7] This article explores SUD prevalence and reviews diagnostic criteria in relation to adolescence, including a synopsis of changes in SUD classification between the DSM-IV and DSM-5 and discussion of ICD-11 and the Research Domain Criteria (RDoC) as a basis for research related to substance use. Effective assessment and consideration of co-occurring disorders are covered as well. Although the prognosis of SUD varies by an individual's environment and circumstances, a modal developmental course for SUD is discussed. Finally, a curated list of nationally recognized resources including hotlines, treatment locators, informational sites, and support groups is provided, along with tools to compile local resources. By addressing these aspects of adolescent SUD, the research team offers a broader view of its prevalence in the United States, key warning signs and comorbidities, and possible assessments and treatments for adolescents with SUD.

Working Memory Training Reduces Cigarette Smoking Among Low-Income Individuals With Elevated Delay Discounting

INTRODUCTION

The competing neurobehavioral decision systems theory conceptualizes addictive behavior, such as cigarette smoking, as arising from the imbalance between stronger impulsive relative to weaker executive decision processes. Working memory trainings may enhance executive decision processes, yet few studies have evaluated its efficacy on substance misuse, with mixed evidence. The current study is the first to evaluate the efficacy of a working memory training on cigarette smoking. We consider the moderating role of delay discounting (DD), or the preference for smaller, immediately available rewards relative to larger, delayed rewards, which has been associated with smoking onset, progression, and resumption. The investigation focuses on individuals living in high-poverty, low-resource environments due high burden of tobacco-related disease they experience.

AIMS AND METHODS

The study utilized a subset of data (N = 177 individuals who smoke) generated from a randomized clinical trial that is evaluating the efficacy of working memory training for improving health-related outcomes. Participants were randomized to complete up to 15 sessions of the active, working memory training or a control training.

RESULTS

Findings showed that among participants who were randomized to the working memory condition, those with higher rates of baseline DD demonstrated decreases in cigarette smoking (p = .05). Conversely, individuals randomized to the control condition, who had higher rates of baseline DD exhibited increases in cigarette smoking (p = .025).

CONCLUSIONS

Results suggest that DD may be an important indicator of working memory training outcomes and a possible approach for effectively targeting treatments in the future.

IMPLICATIONS

DD is important indicator of working memory training outcomes on cigarette smoking. The findings suggest the possibility to effectively target treatments considering the impact of DD. Given that rates of DD tend to be higher among individuals from low-resource communities, and that computer-based working memory training programs are relatively low-cost and scalable, these findings suggest this approach may have specific utility for adults at heightened risk for cigarette use.This study was registered with ClinicalTrials.gov (Identifier NCT03501706).

Methodological review of caffeine assessment strategies with a focus on adolescents

Adolescent caffeine use and its implications for developmental changes in sleep and circadian rhythms is under-researched. A majority of adolescents report consuming caffeine and yet the United States has not established federal guidelines for this age group. This widely used stimulant is primarily studied using self-report methodologies; however, there is no standardized method for collecting self-report caffeine data and past studies' findings have limited generalizability and comparability, making it challenging to examine the effects of caffeine use on adolescents' sleep. This review discusses methods and measures used for assessing caffeine in the field with adolescents: questionnaires, interviews, and diaries. Based on the review, recommendations for future methodologies and approaches are discussed.

Validation of a single question for the assessment of past three-month alcohol consumption among adolescents

BACKGROUND

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use is increasingly used in clinical care. Despite its endorsement by several professional societies, the U.S. Preventive Services Task Force has found the evidence base for adolescent SBIRT to be insufficient. A measure of substance use that is brief enough to embed in the electronic medical record could be used in pragmatic trials that enroll large numbers of primary care patients, facilitating research in this area.

METHODS

Participants aged 14-18 years (N = 492) completed an electronic survey that included a 90-day Timeline Follow Back (TLFB) Calendar, considered the criterion standard, along with three survey questions about the frequency of their alcohol use: days of use in the past three months, average days of use per week in the past three months, and average days of use per month in the past year. We calculated the correlation between the number of days reported on each of the three questions and the total number of days of use reported on the TLFB.

RESULTS

The question on number of days of use in the past three months was highly correlated with alcohol consumption frequency on the 90-day TLFB assessment (rho = 0.903). Other items displayed lower but satisfactory correlation with the TLFB (rho = 0.719-0.830).

CONCLUSIONS

A single question about past 3-month frequency of alcohol use was highly correlated with alcohol use frequency on the criterion standard TLFB among adolescents presenting for routine primary care.

Daily cannabis use in adolescents who smoke tobacco is associated with altered late-stage feedback processing: A high-density electrical mapping study

Impairments in feedback processing, often associated with risk-taking behavior, may have implications for development of substance abuse in adolescents. The most commonly used substances by adolescents include tobacco and cannabis, with some individuals using both substances, potentially heightening risk. Our objective was to examine feedback processing and impulsivity in adolescents who smoke cigarettes and use cannabis daily (N = 21), comparing them with adolescents who smoke cigarettes daily and use cannabis occasionally (N = 18) and non-smoking (N = 27) adolescents. To do this, the Balloon Analog Risk Task (BART) with concurrent EEG was used to measure risk-related feedback processing, and impulsivity was measured using the Barratt's impulsiveness scale (BIS-11). It was found that adolescent daily tobacco/cannabis smoking was associated with higher BIS-11 scores, shortened feedback-related-negativity (FRN) latencies and reduced P300 amplitudes. In addition, FRN latencies during win conditions were inversely associated with tobacco-use severity, indicated by scores on the Fagerstrom Test for Nicotine Dependence (FTND), and with BIS-11 scores. Adolescents with concurrent tobacco and cannabis use show altered feedback processing and higher impulsivity. Future work should disentangle whether the effect reflects risk, consequences of use or both.

Methods to Optimize Recruitment, Participation, and Retention Among Vulnerable Individuals Participating in a Longitudinal Clinical Trial

Low-income and ethnic/racial minority adults do not often participate in research or may face unique barriers when participating in research, which delays and impedes medical advances for this vulnerable population. This article describes in detail the evidenced-based methods used to enhance recruitment, participation, and retention in a clinical trial at a center serving ethnic/racial minorities and low-income individuals. The article details the partnership with a community outreach center and describes the duties and impact of a community liaison to enhance recruitment, participation, and retention in a randomized controlled trial with a 6-month follow-up. Of the 246 individuals initially recruited for screening, 80 did not meet inclusion criteria with the most common reason for disqualification being meeting criteria for substance use disorder (n = 44). One hundred sixty-six participants qualified for participation. The majority of participants identified as African American (n = 127, 77.1%) and reported an annual individual income under $10,000 (n = 121 (74.2%). Forty-five percent of the sample completed the requested number of sessions (i.e., 12). Sixty-three percent of participants completed post intervention assessments and 42% completed 6-month follow-up data collection. The participation and retention numbers in this study appear higher than typical participation and retention rates in longitudinal studies with similar populations. The methods and lessons learned may be useful for other clinical trials that recruit vulnerable populations and wish to enhance participation, engagement, and retention.

Decídetexto: Mobile cessation support for Latino smokers. Study protocol for a randomized clinical trial

INTRODUCTION

Latinos, the largest minority group in the U.S., experience tobacco-related disparities, including limited access to cessation resources. Evidence supports the efficacy of mobile interventions for smoking cessation, which may be greater among Latinos, the highest users of text messaging.

OBJECTIVES

To describe the methodology of a randomized clinical trial to evaluate the impact of Decídetexto, a culturally appropriate mobile smoking cessation intervention versus standard care on smoking abstinence (cotinine-verified 7-day point prevalence abstinence) at Month 6 among Latino smokers.

METHODS

Latino smokers (N = 618) will be randomized to one of two conditions: 1) Decídetexto or 2) standard of care. Decídetexto is a mobile smoking cessation intervention (available in English and Spanish) that incorporates three integrated components: 1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, 2) a 24-week text messaging counseling program with interactive capabilities, and 3) pharmacotherapy support. Decídetexto follows the Social Cognitive Theory as theoretical framework. Standard of care consists of printed smoking cessation materials along with referral to telephone quitline. Participants in both groups are given access to free pharmacotherapy (nicotine patches or gum) by calling study phone number. Promotores de Salud will rely on community-based approaches and clinical settings to recruit smokers into the study. All participants will complete follow-up assessments at Week 12 and Month 6.

DISCUSSION

If successful, Decídetexto will be ready to be implemented in different community- and clinic-based settings to reduce tobacco-related disparities.

Cannabis and Alcohol Co-Use in a Smoking Cessation Pharmacotherapy Trial for Adolescents and Emerging Adults

INTRODUCTION

The co-use of cannabis and alcohol among tobacco-using youth is common. Alcohol co-use is associated with worse tobacco cessation outcomes, but results are mixed regarding the impact of cannabis on tobacco outcomes and if co-use leads to increased use of non-treated substances. This secondary analysis from a youth smoking cessation trial aimed to (1) evaluate the impact of cannabis or alcohol co-use on smoking cessation, (2) examine changes in co-use during the trial, and (3) explore secondary effects of varenicline on co-use.

METHODS

The parent study was a 12-week, randomized clinical trial of varenicline for smoking cessation among youth (ages 14-21, N = 157; Mage = 19, 40% female; 76% White). Daily cigarette, cannabis, and alcohol use data were collected via daily diaries during treatment and Timeline Follow-back for 14 weeks post-treatment.

RESULTS

Baseline cannabis co-users (68%) had double the odds of continued cigarette smoking throughout the trial compared with noncannabis users, which was pronounced in males and frequent cannabis users. Continued smoking during treatment was associated with higher probability of concurrent cannabis use. Baseline alcohol co-users (80%) did not have worse smoking outcomes compared with nonalcohol users, but continued smoking was associated with higher probability of concurrent drinking. Varenicline did not affect co-use.

CONCLUSIONS

Inconsistent with prior literature, results showed that alcohol co-users did not differ in smoking cessation, whereas cannabis co-users had poorer cessation outcomes. Youth tobacco treatment would benefit from added focus on substance co-use, particularly cannabis, but may need to be tailored appropriately to promote cessation.

IMPLICATIONS

Among youth cigarette smokers enrolled in a pharmacotherapy evaluation clinical trial, alcohol and/or cannabis co-use was prevalent. The co-use of cannabis affected smoking cessation outcomes, but more so for males and frequent cannabis users, whereas alcohol co-use did not affect smoking cessation. Reductions in smoking were accompanied by concurrent reductions in alcohol or cannabis use. Substance co-use does not appear to affect all youth smokers in the same manner and treatment strategies may need to be tailored appropriately for those with lower odds of smoking cessation.

A Habit-Based Randomised Controlled Trial to Reduce Sugar-Sweetened Beverage Consumption: the Impact of the Substituted Beverage on Behaviour and Habit Strength

BACKGROUND

Excess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention-based intervention.

METHOD

An online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (M_age = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months.

RESULTS

There was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit.

CONCLUSION

This study demonstrates that an implementation intention-based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.

Maximum likelihood function for fuzzy count data models (using heaped data as fuzzy)

Count data models are based on definite counts of events as dependent variables. But there are practical situations in which these counts may fail to be specific and are seen as imprecise. In this paper, an assumption that heaped data points are fuzzy is used as a way of identifying counts that are not definite since heaping can result from imprecisely reported counts. Because it is practically unlikely to report all counts in an entire dataset as imprecise, this paper proposes a likelihood function that not only considers both precise and imprecisely reported counts but also incorporates α - cuts of fuzzy numbers with the aim of varying impreciseness of fuzzy reported counts. The proposed model is then illustrated through a smoking cessation study data that attempts to identify factors associated with the number of cigarettes smoked in a month. Through the real data illustration and a simulation study, it is shown that the proposed model performs better in predicting the outcome counts especially when the imprecision of the fuzzy points in a dataset are increased. The results also show that inclusion of α - cuts makes it possible to identify better models, a feature that was not previously possible.

Web-Based Contingency Management for Adolescent Tobacco Smokers: A Clinical Trial

INTRODUCTION

Adolescence is a critical time when the majority of tobacco users initiate smoking. Contingency management for adolescent smoking cessation has shown promise in previous studies, but efficacy following removal of contingencies is not well understood. This study examined a remote form of contingency management among non-treatment-seeking adolescent smokers.

METHODS

Participants (N = 127) submitted breath carbon monoxide (CO) three times daily throughout a 42-day program. For this randomized trial, participants in the active condition (n = 63) were reinforced for providing CO measurements on schedule and below a set criterion, whereas those in the control condition (n = 64) were reinforced for providing CO measurements on schedule. Self-reported smoking and urinary cotinine levels were collected at several timepoints.

RESULTS

Active condition showed greater within-group reductions in CO levels relative to control condition, but not at 3- or 6-month follow-up. Active condition reported significantly less smoking during treatment compared to control condition, but not at follow-up. There were no significant differences for urinary cotinine. Overall treatment adherence was low, with only 37% and 51% of possible CO samples being submitted among active and control, respectively. Poor treatment adherence may explain the disparity between CO and cotinine results, and poor follow-up treatment efficacy.

CONCLUSIONS

This study replicates feasibility of a remote form of contingency management for adolescent smoking. CO results suggest active condition reduced smoking within group, but treatment adherence and posttreatment efficacy was poor. Future research should focus on increasing adherence for this type of program among adolescent smokers.

IMPLICATIONS

This study demonstrates feasibility of a remote form of contingency management therapy for smoking cessation among adolescents, while providing posttreatment efficacy data. Within-group efficacy of this form of treatment is suggested, but treatment adherence and follow-up efficacy were poor. This study underscores the need for further development of contingency management therapy for adolescent smoking cessation, which emphasizes better treatment adherence and posttreatment efficacy.

Targeting cognitive and emotional regulatory skills for smoking prevention in low-SES youth: A randomized trial of mindfulness and working memory interventions

Research to date provides striking evidence that youth from low socio-economic status (SES) households are at an increased risk for smoking. Converging evidence from developmental studies, psychopathology studies, intervention studies, and basic research on self-control abilities have identified working memory and distress tolerance as potential crucial modifiable risk factors to prevent smoking onset in this cohort. To confirm the value of these mechanistic targets, this randomized trial was designed to evaluate the influence of working memory and distress tolerance interventions on risk of smoking initiation. Recruiting primarily from low-income community afternoon programs, we randomized 93 adolescents to one of three intervention conditions, all of which were a prelude to a smoking-prevention informational intervention: (1) a working memory intervention, (2) a mindfulness training intervention to target distress tolerance, and (3) a wellness-focused control condition. Despite a number of adherence efforts, engagement in treatment was limited, and under these conditions no significant evidence was found either for differential efficacy for smoking prevention or for intervention effects on mechanistic targets. However, working memory capacity and distress tolerance were found to be negatively related to smoking propensity. As such, our mechanistic targets-working memory and distress tolerance--may well be processes undergirding smoking, despite the fact that our interventions did not adequately engage these targets.

Affective and Situational Precipitants of Smoking Lapses Among Adolescents

INTRODUCTION

Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants.

METHODS

Adolescent daily smokers (n = 166; ages 14-18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6).

RESULTS

Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states-regardless of valence-were associated with 12%-13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen's mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences.

CONCLUSIONS

This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group.

IMPLICATIONS

This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens' daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.

Behavioral economic demand and delay discounting are differentially associated with cigarette dependence and use in adolescents

INTRODUCTION

The Reinforcer Pathology Model describes how two behavioral economic processes, increased sensitivity to immediate rewards (delay discounting) and excessive reward derived from a substance (demand), both contribute to problematic patterns of substance use. In a novel application of this model, the current cross-sectional study examined how these distinct processes relate to different facets of cigarette use in adolescents.

METHODS

Adolescent daily cigarette smokers ages 15 to 19 (Mean age 17.7, N = 50) completed a laboratory assessment of demand using a Cigarette Purchase Task for their usual brand cigarettes and an adjusting-amount delay discounting task. Demand was conceptualized as two factors (Amplitude and Persistence) and delay discounting was calculated as Area Under the Curve (log AUC). The two factors of demand and discounting AUC were included as statistical predictors of level of cigarette dependence and average number of cigarettes smoked per day in linear regression models.

RESULTS

Amplitude of demand was marginally significant predictor (p = .06) of cigarettes smoked per day whereas neither Persistence of demand nor delay discounting significantly predicted this outcome. Both Amplitude of demand and delay discounting, but not Persistence, were associated with level of cigarette dependence. The effects of amplitude of demand and delay discounting on cigarette dependence or use did not significantly interact.

CONCLUSIONS

Results of this study suggest that amplitude of cigarette demand may be a risk factor for both cigarette consumption and dependence, while discounting - a known risk factor for cigarette initiation - may relate specifically to level of dependence.

PhenX: Host: Biobehavioral measures for tobacco regulatory research

A working group (WG) of experts from diverse fields related to nicotine and tobacco addiction was constituted to identify constructs and measures for the PhenX (Phenotypes and eXposures) Tobacco Regulatory Research (TRR) Host: Biobehavioral Collection with potential relevance to users of both conventional and newer tobacco products. This paper describes the methods and results the WG used to identify, select, approve and place measures in the PhenX TRR Collection. The WG recognised 13 constructs of importance to guide their categorisation of measures already in the PhenX Toolkit ('complementary measures') and to identify novel or improved measures of special relevance to tobacco regulatory science. In addition to the 22 complementary measures of relevance to tobacco use already in the PhenX Toolkit, the WG identified and recommended nine additional Host: Biobehavioral measures characterising the use, exposure and health outcomes of tobacco products for application to TRR. Of these, five were self-administered or interviewer-administered measures: amount, type and frequency of recent tobacco use; flavor preference in e-cigarette users (adult and youth); pregnancy status and tobacco use; pregnancy status-mother and baby health and withdrawal from tobacco use. The remaining four measures were laboratory-based: cotinine in serum, expired carbon monoxide, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in urine and cue reactivity. Although a number of validated tools are now available in the Host: Biobehavioral Collection, several gaps were identified, including a need to develop and test the identified measures in adolescent samples and to develop or identify measures of nicotine dependence, tolerance and withdrawal associated with newer non-combusted tobacco products.

An electronic, smart lighter to measure cigarette smoking: A pilot study to assess feasibility and initial validity

Understanding variability in smoking patterns may inform smoking cessation interventions. Retrospective reports of cigarettes smoked per day may be biased and typically do not provide temporal precision regarding when cigarettes are smoked. However, real-time, user-initiated tracking, such as logging each time a cigarette is smoked, can be burdensome over long time frames. In this study, adult, non-treatment seeking daily smokers (N = 22) used an electronic, smart lighter to light and timestamp cigarettes for 14 days. Participants reported number of cigarettes smoked per day (CPD) via a mobile device (daily diary) and retrospectively reported CPD at the end of the study using the Timeline Followback (TLFB). Self-reported lighter satisfaction and adherence varied with 68% of participants reporting that they liked using the lighter and participants reporting using the lighter for 92% of cigarettes smoked, on average. Lighter-estimated CPD did not differ from daily diary-estimated CPD, but was significantly lower than TLFB estimates. The lighter resulted in greater day-to-day variability relative to other methods and fewer rounded cigarette counts (digit bias) relative to the TLFB. The lighter appears to be feasible for capturing data on smoking patterns in daily smokers. Though false positive cigarettes are likely low, additional technologies that augment data captured from the lighter may be necessary to reduce false negatives (missed cigarettes) and alternative lighter designs may appeal more to certain smokers.

Adolescent smokers' response to reducing the nicotine content of cigarettes: Acute effects on withdrawal symptoms and subjective evaluations

BACKGROUND

Mandating a reduction in the nicotine content of cigarettes to a minimally addictive level could dramatically reduce smoking rates in the US. However, little is known about the effects of reduced nicotine content cigarettes in adolescents.

METHODS

Following overnight abstinence, adolescent daily smokers (ages 15-19, n = 50) reported on their craving, withdrawal, and positive and negative affect pre- and post- ad lib smoking of one cigarette containing varying nicotine content (15.8, 5.2, 1.3 and 0.4 mg/g of tobacco) in the laboratory and reported their subjective evaluations of each cigarette. Carbon monoxide (CO) boost from pre- to post-cigarette was calculated to determine if lower-nicotine cigarettes led to differential acute changes in toxicant exposure.

RESULTS

All four nicotine cigarette types significantly reduced abstinence-induced craving, withdrawal, and negative affect (all p's < .05). Mixed models evaluating the effect of nicotine content, with nicotine dependence level and gender included as covariates, revealed a significant effect of nicotine content on craving and subjective evaluations: higher nicotine content resulted in greater reductions in craving and increases in both positive and negative subjective evaluations. There were no significant effects of nicotine dose on withdrawal symptoms, negative affect, or CO boost.

CONCLUSIONS

These results suggest that lower nicotine cigarettes might result in reduced abuse liability compared to higher nicotine content cigarettes due to reduced positive subjective effects, while still reducing withdrawal, in adolescents. These results highlight the potential feasibility of this policy approach and support continued research on how a nicotine reduction policy may affect adolescent smoking patterns.

Implicit Alcohol and Smoking Associations among Young Adult Heavy Drinkers: Associations with Smoking Status and Alcohol-Cigarette Co-Use

Implicit memory associations may play a role in motivation to use alcohol and cigarettes, but the relationship between implicit associations and co-use of alcohol and cigarettes is currently unknown. This study provided an initial examination of alcohol and smoking implicit associations among young adult drinkers who were either nonsmokers or relatively light smokers (i.e., 10 or fewer cigarettes per day) as a function of smoking frequency and daily-level alcohol-cigarette co-use. Drinkers (N = 129) completed alcohol-arousal and smoking-valence variants of the Implicit Association Test as well as a daily-level assessment of past 90-day alcohol and cigarette use. Smokers were grouped according to whether they reported daily or nondaily smoking frequency. Results showed that although implicit alcohol-arousal associations did not differ between smokers and nonsmokers, stronger implicit alcohol-arousal associations were observed for nondaily smokers relative to daily smokers after controlling for drinking frequency. Further, implicit positive-smoking associations were stronger for smokers relative to nonsmokers. Within the subgroup of nondaily smokers, more frequent co-use of alcohol and cigarettes was associated with stronger implicit positive-smoking associations when controlling for total drinking and smoking frequency. The findings suggest that implicit alcohol and smoking associations may be linked with smoking patterns (daily vs. nondaily) and co-use of alcohol and cigarettes among young adult drinkers who are not heavy smokers, highlighting the need for more research on the role of implicit associations in the co-use of cigarettes and alcohol.

Acceptability and compliance with a remote monitoring system to track smoking and abstinence among young smokers

BACKGROUND

Similar to adult smokers, quit attempts among younger smokers almost inevitably result in relapse. Unlike adults, less is known about the process of relapse in this younger age group. A technology-based remote monitoring system may allow for detailed and accurate characterization of smoking and abstinence and would help to improve cessation strategies.

OBJECTIVES

This study describes a mobile system that captures smoking using breath carbon monoxide (CO) and real-time self-reports of smoking behavior. Compliance, feasibility, acceptability, and accuracy of the system were measured during a quit attempt and subsequent monitoring period.

METHODS

The mobile application (My Mobile Monitor, M3) combined breath CO with ecological momentary assessment, delivered via smartphone. Participants (N = 16; 75% female) were daily smokers between the ages of 19 and 25, who used the app for 11 days during which they agreed to make a quit attempt. Acceptability, compliance, and abstinence were measured.

RESULTS

Participants averaged 22.3 ± 2.0 years old and smoked an average of 13.0 ± 6.1 cigarettes per day. Overall session compliance was 69% and during the quit attempt, 56% of participants abstained from smoking for at least 24 hours. Agreement between self-reported smoking compared to breath CO was generally high, when available for comparison, though underreporting of cigarettes was likely.

CONCLUSION

This study demonstrates feasibility of a remote monitoring app with younger smokers, though improvements to promote compliance are needed. Remote monitoring to detect smoking and abstinence represents a step forward in the improvement of cessation strategies, but user experience and personalization are vital.

Validation of a contextualized assessment of smoking behaviour in students

AIMS

The aim of this study was to validate an audio simulation of culture-specific social contexts associated with smoking to provide a medium for researchers to investigate social-contextual influences on tobacco use in the laboratory.

METHODS

Eighty-one students (34.6% men; n = 28) listened to five audio simulations of peer social contexts where offers to smoke tobacco were made [Smoking Simulated Intoxication Digital Elicitation (S-SIDE)]. For each social scenario, participants answered questions about their willingness to accept the offer to smoke and completed measures of smoking cognitions and tobacco use. Thirty days later, participants completed online assessments of smoking behaviour.

RESULTS

Willingness to accept smoking offers in the S-SIDE procedure was related to smoking at both time-points (T1: r₍₈₁₎  = 0.37, P < 0.001;T2: r₍₈₁₎  = 0.36, P = 0.001). Performance on the simulation improved prediction of smoking at 1 month follow-up over and above smoking expectancies, F_(2,74)  = 4.27, P = 0.02; R²  = 0.21; ΔR²  = 0.09, as well as other indices of smoking willingness, F_(2,75)  = 4.22, P = 0.02; R²  = 0.22: ΔR²  = 0.09, while neither expectancies nor willingness was related to smoking above and beyond the simulation.

CONCLUSIONS

Social context plays an important role in smoking-related decision-making and simulated social contexts have potential for the study of context-related decision-making in addiction.

Rescuing cognitive and emotional regulatory skills to aid smoking prevention in at-risk youth: A randomized trial

Adolescence is a vulnerable period for smoking initiation, with disadvantaged teens particularly at risk. In addition, emotional and cognitive dysregulation is associated with an increased risk of smoking and makes it particularly challenging to benefit from standard substance use prevention interventions. The goal of the current study is to investigate the extent to which interventions designed to improve cognitive (working memory) and emotional (distress tolerance) regulatory processes enhance the effectiveness of a standard smoking prevention informational intervention. We will study adolescents (12-16 years of age) predominantly from racial/ethnic-minority and low-income households. Proximal smoking-risk outcome measures are used to allow testing of prevention models outside a full longitudinal study. We hope to generate new insights and approaches to smoking prevention among adolescents from lower socio-economic status (SES) by documenting the influence of working memory training and distress tolerance (mindfulness) interventions on cognitive/affective targets that place individuals at risk for smoking initiation and maintenance.

CLINICAL TRIALS REGISTRATION

NCT03148652.

Mobile contingency management as an adjunctive treatment for co-morbid cannabis use disorder and cigarette smoking

INTRODUCTION

Cannabis is the most widely used illicit drug in the U.S. with 19.8 million current users. Population-based data indicate that almost all cannabis users (90%) have a lifetime history of tobacco smoking and the majority (74%) currently smoke tobacco. Among cannabis users, smoking tobacco is associated with increased frequency of cannabis use, increased morbidity, and poorer cannabis cessation outcomes. There is a lack of research, however, focused on addressing cessation of both substances simultaneously. The purpose of the current pilot study was to evaluate the feasibility and acceptability of a multi-component tobacco/cannabis abstinence treatment.

METHODS

Five participants completed Abstinence Reinforcement Therapy, an intervention that included five sessions of cognitive-behavioral telephone counseling for tobacco/cannabis, pharmacotherapy for smoking cessation, and five weeks of mobile contingency management to remain abstinent from tobacco and cannabis.

RESULTS

Feasibility of recruitment, retention and treatment completion was high. Satisfaction with the treatment was also high.

CONCLUSION

Results support the feasibility and acceptability of this approach with dual cannabis and tobacco users and suggest that further research examining the efficacy of this approach is warranted.

Abstinence-induced withdrawal severity among adolescent smokers with and without ADHD: disentangling effects of nicotine and smoking reinstatement

RATIONALE

Individuals with attention deficit hyperactivity disorder (ADHD) start smoking earlier, are more likely to progress to nicotine dependence, and have a more difficult time quitting smoking compared to their non-ADHD peers. Little is known about the underlying behavioral mechanisms associated with this increased risk, particularly at the adolescent stage.

OBJECTIVE

This study aimed to assess the effects of overnight nicotine abstinence and smoking reinstatement on subjective withdrawal states in adolescent smokers with and without ADHD.

METHODS

Adolescent daily smokers (27 with ADHD and 17 without ADHD) completed three experimental sessions: (1) a placebo patch followed by smoking a nicotine cigarette, (2) placebo patch followed by smoking a nicotine-free cigarette, and (3) nicotine patch followed by smoking a nicotine-free cigarette. Subjects abstained overnight before each session, and patches were administered 45 min before smoking. The primary outcome measure was a smoking withdrawal symptom questionnaire.

RESULTS

ADHD smokers experienced greater difficulty concentrating and impatience/restlessness during abstinence than non-ADHD smokers. Smoking a cigarette improved abstinence-induced difficulty concentrating and restlessness, regardless of its nicotine content, and regardless of whether transdermal nicotine was received or not.

CONCLUSIONS

Thus, sensorimotor aspects of smoking, rather than nicotine itself, appeared to relieve withdrawal. Although ADHD smokers report greater withdrawal symptoms than non-ADHD smokers, they responded strongly to the sensorimotor aspects of smoking during withdrawal. These findings suggest that even lighter, adolescent smokers with ADHD are vulnerable to smoking progression through altered smoking abstinence and withdrawal relief processes.

Financial Incentives Alone Versus Incentivized Partner Support for Promoting Smoking Cessation During Pregnancy and Postpartum: Protocol for a Non-Randomized Single-Blinded Study

Background

Smoking tobacco remains the most significant modifiable cause of adverse pregnancy outcomes and contributor to ongoing maternal and infant ill-health. Pregnancy for many is a time of heightened health focus, with the primary motivation being the well-being of the unborn child. Yet, many women continue to smoke throughout their pregnancy. Despite this heightened motivation and known health risks, interventions to date have not effectively curbed the rate of smoking during pregnancy and they remain as high as rates among the general population. One promising strategy has been to incentivize these women to quit. However, incentives-based studies have not shown or reported long-term efficacy. Here, we present the protocol of a trial exploring the effect of incentivized partner support on pre- and postpartum smoking cessation.

Objective

The aim of this study is to determine whether providing incentives to both the expectant mother and her support person in promoting short- and long-term smoking cessation during pregnancy is more effective than incentives to the expectant mother alone.

Methods

This protocol is designed as a non-randomized, single-blinded trial to determine the efficacy of incentivized partner support, compared to participant incentive only, in promoting smoking cessation during pregnancy and postpartum. All eligible pregnant women receiving antenatal care via the Tasmanian Health Service (Australia) will be invited to participate. Participants will be eligible for monthly quit-contingent shopping vouchers if they verify, via carbon monoxide breath sample, as being abstinent from smoking. Participating women will be eligible for vouchers until 6-months postpartum and will be followed up at 12-months postpartum.

Results

The recruitment phase of this study has concluded. Results are expected to be published by the end of 2018.

Conclusions

This study protocol extends the current literature on incentivized smoking cessation interventions for pregnant women by assessing the influence of incentivizing a support partner on short- and long-term abstinence. Key ethical considerations are discussed including potential for receipt (or not) of quit-contingent vouchers impacting negatively on the participant’s relationship with their partner. The findings of the study may have important implications for the role support partners are assigned in smoking cessation programs targeting pregnant women.

Trial Registration

Australian New Zealand Clinical Trials Registry (ACTRN): 12615001158550; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367981 (Archived by WebCite at http://www.webcitation.org/6tGKO28uh)

An open-label pilot study of an intervention using mobile phones to deliver contingency management of tobacco abstinence to high school students

This pilot study assessed the feasibility, acceptability, and preliminary efficacy of a smoking cessation intervention that used mobile phones to remotely deliver reinforcements contingent on tobacco abstinence (contingency management [CM]) and weekly in-person cognitive-behavioral therapy to adolescent smokers. Daily adolescent smokers (N = 15; 12 completed study procedures, 3 dropped out) were recruited to participate in a 4-week study. During the first 2 weeks, daily text messages sent at random times prompted participants to transmit a video of themselves providing a carbon monoxide (CO) sample. During the last 2 weeks, text messages sent on 3 randomly chosen days each week prompted participants to transmit a video of themselves providing a saliva sample. Negative samples (CO ≤8 ppm; cotinine ≤100 ng/ml) were reinforced with monetary incentives. Feasibility was assessed using the number of on-time, valid videos, and acceptability was determined using participant perceptions of the intervention. Seven-day point-prevalence (PP) abstinence (self-reported abstinence, cotinine <100 ng/ml) was assessed at end of treatment (EOT) and at a 1-month follow-up. The study findings indicate that remote delivery of CM using mobile phones was feasible (85.8% of the CO videos and 67% of the saliva cotinine videos were on time) and acceptable (positive perceptions of the CM procedures). Seven-day PP was 60% at EOT and 46.7% at the follow-up. Although larger randomized controlled trials are needed to evaluate efficacy, this pilot study suggests that the use of mobile phones to deliver CM for smoking cessation among adolescent smokers was acceptable and feasible. (PsycINFO Database Record

Impulsivity and approach tendencies towards cigarette stimuli: Implications for cigarette smoking and cessation behaviors among youth

Impulsivity is associated with smoking, difficulties quitting smoking, and approach tendencies toward cigarette stimuli among adolescents. We examined the effects of impulsivity on (a) the association between approach tendencies and adolescents' smoking status and (b) the effectiveness of Cognitive Bias Modification (CBM), a smoking cessation intervention focused on changing approach tendencies, among adolescent smokers. We conducted a secondary analysis of evidence from 2 previous published studies: Study 1: a cross-sectional study comparing impulsivity and approach tendencies between adolescent smokers (n = 67) and nonsmokers (n = 58); Study 2: a treatment study that randomized 60 adolescent smokers to receive either CBM or sham training. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS) and the Experiential Discounting Task (EDT). We found higher impulsivity, as determined by the BIS but not the EDT, increased adolescents' odds of being smokers. We observed that the interaction between EDT and approach tendencies also significantly predicted smoking status, however post hoc comparisons were not significant. Adolescents with higher BIS scores receiving CBM had increased odds of being abstinent at the end of treatment, but we found no association between EDT and treatment outcome. Our findings suggest that approach-bias modification (a form of CBM) may be more effective in impulsive adolescent smokers. Differences in findings for BIS and EDT highlight the complexity of the construct of impulsivity. Future studies with larger samples are needed to further disentangle the effects of different aspects of impulsivity on smoking behaviors and cessation outcomes among youth. (PsycINFO Database Record

The effect of varenicline and nicotine patch on smoking rate and satisfaction with smoking: an examination of the mechanism of action of two pre-quit pharmacotherapies

OBJECTIVES

In recent years, there has been growing research interest in using nicotine replacement medications to aid smoking reduction prior to a quit attempt. Gaining a better understanding of how treatments influence smoking reduction may allow for better tailoring of treatments and, ultimately, better cessation outcomes. The objective of the current study was to test the effects of the pre-quit use of varenicline and nicotine patch on smoking rate and satisfaction with smoking.

METHODS

All participants were required to attend up to five study visit sections. Participants (n = 213) who were interested in quitting were randomised (open-label) to receive either pre-quit patch or varenicline (both treatments started 2 weeks prior to an assigned quit day, followed by 10 weeks post-quit) or standard patch (10 weeks starting from an assigned quit day). Participants used modified smartphones to monitor their smoking in real time for 4 weeks.

RESULTS

Participants in the two pre-quit treatment groups reported significant reductions in both their satisfaction with smoking (p < 0.001) and smoking rate (p < 0.001) from baseline to the end of pre-quit period; participants in the standard patch group did not. The observed reduction of smoking rate was associated with the satisfaction with smoking (p < 0.01), although the mediation effect of satisfaction was small.

CONCLUSIONS

Pre-quit treatment caused reductions in satisfaction with smoking and smoking rate. Satisfaction was associated with changes in smoking rate, but the relationship was weak. As such, monitoring reductions in satisfaction do not appear to be a viable method of evaluating responsiveness to treatment.

The Importance of Filter Collection for Accurate Measurement of Cigarette Smoking

OBJECTIVES

We examined the impact of cigarette filter collection on reports of cigarettes per day (CPD) versus self-reported CPD and to assess the utility of a pre-intervention baseline period in smoking studies.

METHODS

Using baseline data from 522 non-treatment seeking smokers, we assessed differences in self-reported CPD via phone screen (CPD PS) and during baseline (CPD BL). We analyzed self-reported cigarette measures to predict carbon monoxide (CO), a measure of smoke exposure.

RESULTS

On average, CPD PS was 2.8 CPD more than CPD BL, and reporting multiples of 10 were more often found in CPD PS compared with CPD BL (54.7% vs17.2%, respectively). CPD BL was more strongly associated with CO than self-report CPD. Number of cigarettes smoked today, time since last cigarette, and nicotine dependence were significantly associated with CO.

CONCLUSIONS

CPD BL using filter collection is a more accurate measure of cigarette consumption than self-report, which may have implications for assessment of nicotine dependence. When feasible, studies should include a pre-intervention baseline period for comparison data with study outcomes. In addition to CPD BL, studies should assess time since last cigarette and the number of cigarettes smoked today when using CO as a biological measure of smoke exposure.

Attitudes and interest in technology-based treatment and the remote monitoring of smoking among adolescents and emerging adults

INTRODUCTION

Despite the public health relevance of smoking in adolescents and emerging adults, this group remains understudied and underserved. High technology utilization among this group may be harnessed as a tool for better understanding of smoking, yet little is known regarding the acceptability of mobile health (mHealth) integration.

METHODS

Participants (ages 14-21) enrolled in a smoking cessation clinical trial provided feedback on their technology utilization, perceptions, and attitudes; and interest in remote monitoring for smoking. Characteristics that predicted greater technology acceptability for smoking treatment were also explored.

RESULTS

Participants (N=87) averaged 19 years old and were mostly male (67%). Technology utilization was high for smart phone ownership (93%), Internet use (98%), and social media use (94%). Despite this, only one-third of participants had ever searched the Internet for cessation tips or counseling (33%). Participants showed interest in mHealth-enabled treatment (48%) and felt that it could be somewhat helpful (83%). Heavier smokers had more favorable attitudes toward technology-based treatment, as did those with smartphones and unlimited data.

CONCLUSIONS

Our results demonstrate high technology utilization, favorable attitudes towards technology, and minimal concerns. Technology integration among this population should be pursued, though in a tailored fashion, to accomplish the goal of providing maximally effective, just-in-time interventions.

Effects of a brief, parent-focused intervention for substance using adolescents and their sibling

The purpose of this study was to evaluate the efficacy of the Family Check-up (FCU), a parent-focused brief motivational intervention, in families where parents were concerned about one adolescent's alcohol or marijuana use and the referred adolescent also had a sibling close in age. The primary goal of the FCU was to provide individualized feedback on specific parenting skills, including monitoring and supervision, limit setting, and alcohol-related communication. A total of 92 adolescents (37 female) between the ages of 12-19years of age along with a sibling (48 female) between the ages of 11-21years old, were randomized to the FCU or a psychoeducation (PE) comparison condition. Findings indicated that the FCU did not produce better effects on alcohol and other drug use outcomes than the PE condition, in either the adolescent or sibling. Brief interventions addressing parenting behaviors may not be sufficient to reduce alcohol use in adolescent drinkers not referred due to an alcohol-related incident. Future research might be conducted to explore whether brief parent interventions, such as those in the present study, could be useful as a preventive intervention for parents whose teens report low levels of substance use.

Late smoking relapse among adolescent quitters

Whereas some data are available about late smoking relapse among adult quitters, there are none for teen quitters. This study is a 6-year follow-up of teen quitters (n=253) for whom we collected (retrospectively) data on the extent and timing of relapse. We found that even after a strictly defined quit (six-months prolonged abstinence) at one year, substantial relapse occurred both early and late: the majority (55%) of relapses occurred after the 0-1year interval after having quit. These findings have implication for the need for research into the relapse process for teen quitters, and for the need to develop interventions for teens (as for adults) to prevent (early and) late relapse.

Examination of the Extent to which Employment Factors are Associated with Reduced Child Maltreatment Potential and Drug Use

Job assistance programs are commonly recommended for parents of children who have been victimized by child maltreatment, particularly when illicit drugs are indicated. However, the relationship between employment factors, substance abuse and risk of child maltreatment has received limited empirical attention. Therefore, the current study examines employment factors in a sample of 72 mothers who were referred by Child Protective Services (CPS) for treatment of substance abuse and child neglect. Child maltreatment potential was found to be negatively associated with number of hours employed and self-reported happiness with employment. The association between child abuse potential and personal income of participants approached significance (p = .057), and the results were not influenced by social desirability. Employment satisfaction significantly contributed to the prediction of child maltreatment potential over and above other employment factors and control variables. These findings suggest that when mothers are involved in CPS their risk of perpetrating child maltreatment may be reduced when they are assisted in gainful employment that is personally satisfying. Happiness with employment was the only employment factor correlated (inversely) with substance use (biological testing, self-report of participants). Future directions are discussed in light of the results, including the importance of considering employment satisfaction when conducting vocational assistance programs in this population.

Measurement of smoking behavior: Comparison of self-reports, returned cigarette butts, and toxicant levels

A basic tenet of empirical research on cigarette smoking behavior is the systematic assessment of patterns of use. However, the large majority of extant research relies on smokers' retrospective reports of their average number of cigarettes per day (CPD), a measure that may be variable in terms of reliability and validity. Using data from 3 previously published studies of non-treatment-seeking daily smokers (combined N = 89), this analysis examined the reliability of self-reported CPD, the consistency of returned cigarette butts each day over 4 consecutive 24-hr periods, the validity of self-reported CPD compared with returned cigarette butts, and the relationship of CPD and returned cigarette butts to toxicant exposure. Results showed that self-reported CPD was reliable across telephone and in-person screening interviews (r = .87, p < .01). Although average self-reported CPD and returned cigarette butt counts did not differ significantly, t(87) = -1.5 to 0.3, all ns, butt counts revealed a wider range of variability in daily smoking behavior. In addition, self-reported cigarette use exhibited substantial digit bias (Whipple's index = 413.8), meaning that participants tended to round their estimates to values ending in 0 or 5. Cigarette butt counts, but not self-reported CPD, were significantly associated with exposure to smoke toxicants. However, this former relationship was revealed to be linear, but not curvilinear, in nature. These findings have implications for both research and treatment efforts, as researchers often rely on accurate assessment of CPD to predict a variety of smoking-related outcomes. (PsycINFO Database Record

Anxiety sensitivity and smoking variability among treatment seeking smokers

OBJECTIVES

Anxiety sensitivity (AS) is associated with poor smoking cessation outcomes. One reason may be that smokers with high AS smoke differently (i.e., to manage negative affect and uncomfortable bodily sensations) than other smokers, leading to stronger addiction (due to an affect/sensation based and thereby highly variable rather than a regular smoking routine). Thus, we examined the relationship between AS and smoking variability in a group of treatment-seeking smokers.

METHODS

Participants (N = 136; 52.2% female; Mage = 44.19 years, SD = 11.29) were daily smokers with elevated AS (AS≥20 on the Anxiety Sensitivity Index 16-item at prescreen) recruited as part of a larger randomized controlled trial for smoking cessation. Most participants were Caucasian (73%), educated (with 76% attending some college), unmarried (73%), and employed full-time (56%). They smoked, on average, 17 cigarettes per day.

RESULTS

Consistent with prediction, a regression analysis of baseline assessments and a longitudinal analysis with multilevel modeling (MLM) both showed higher AS was associated with greater variability in cigarettes smoked per day while controlling for gender, age, ethnicity, and income.

CONCLUSIONS

This finding encourages investigation of how AS might interact with clinical strategies using a fixed smoking taper as part of quit attempts.

Abstinence Reinforcement Therapy (ART) for rural veterans: Methodology for an mHealth smoking cessation intervention

INTRODUCTION

Smoking is the most preventable cause of morbidity and mortality in U.S. veterans. Rural veterans in particular have elevated risk for smoking and smoking-related illness. However, these veterans underutilize smoking cessation treatment, which suggests that interventions for rural veterans should optimize efficacy and reach.

OBJECTIVE

The primary goal of the current study is to evaluate the effectiveness of an intervention that combines evidenced based treatment for smoking cessation with smart-phone based, portable contingency management on smoking rates compared to a contact control intervention in a randomized controlled trial among rural Veteran smokers. Specifically, Veterans will be randomized to receive Abstinence Reinforcement Therapy (ART) which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mobile contingency management (mCM) or a control condition (i.e., TC and NRT alone) that will provide controls for therapist, medication, time and attention effects.

METHODS

Smokers were identified using VHA electronic medical records and recruited proactively via telephone. Participants (N=310) are randomized to either ART or a best practice control consisting of telephone counseling and telemedicine. Participating patients will be surveyed at 3-months, 6-months and 12-months post-randomization. The primary outcome measure is self-reported and biochemically validated prolonged abstinence at 6-month follow-up.

DISCUSSION

This trial is designed to test the relative effectiveness of ART compared to a telehealth-only comparison group. Dissemination of this mHealth intervention for veterans in a variety of settings would be warranted if ART improves smoking outcomes for rural veterans and is cost-effective.

Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial

INTRODUCTION

Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return).

METHODS

We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum.

RESULTS

Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences (

CONTROL

36% [95% confidence interval [CI]: 29-43] vs.

INTERVENTION

35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%).

CONCLUSIONS

Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking.

IMPLICATIONS

Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.