Evaluating the role of panic disorder in emotional sensitivity processes involved with smoking

The Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping

Objective

Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping.

Method

College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used.

Results

Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC.

Conclusions

Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.

Associations between anxiety symptoms and barriers to smoking cessation among African Americans who smoke cigarettes daily

BACKGROUND

African Americans who smoke cigarettes and experience heightened anxiety symptoms may have low quit smoking rates. Identifying which particular barriers to cessation are associated with specific types of anxiety symptoms in African Americans could inform cessation treatments for this population. This cross-sectional, correlational study examined associations of anxiety-related symptoms and distinct barriers to cessation among non-treatment-seeking African Americans who smoke cigarettes daily.

METHODS

African Americans who smoke (N = 536) enrolled in a clinical research study on individual differences in tobacco addiction between 2013 and 2017 completed self-report measures of anxiety-related symptoms (i.e., social anxiety, panic, and posttraumatic intrusions) and types of barriers to cessation (i.e., addiction-related, social-related, and affect-related barriers). Linear regression models tested associations of anxiety symptoms with cessation barriers with and without adjusting for age, sex, depressive symptoms, and nicotine dependence.

RESULTS

All anxiety-related symptoms were associated with each cessation barrier (βs = 0.240-0.396). After covariate adjustment, panic and trauma-related symptoms were not associated with cessation barriers, and the strength of association of social anxiety with external barriers was reduced but remained significant (β = 0.254).

CONCLUSION

Symptoms of social anxiety, but not trauma or panic-related symptoms, may play a unique, but modest, role in certain barriers to cessation in non-treatment-seeking African Americans who smoke cigarettes over. Further research is needed to uncover why African Americans who smoke and have anxiety might experience these barriers, and how future interventions can mitigate these obstacles.

Latinx Individuals Who Smoke Daily with and without a Probable Anxiety Disorder: Differences in Smoking Behavior and Beliefs about Abstinence

There is a well-established relation between anxiety psychopathology and smoking in the general population. However, little work focuses on Latinx/Hispanic (hereafter Latinx) persons who smoke from this comorbidity perspective. The present investigation aimed to explore differences among English-speaking Latinx adults who live in the United States (US) and smoke cigarettes with and without a probable anxiety disorder in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) who identified as Latinx and were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with a probable anxiety disorder (compared to those without) were more likely to demonstrate higher levels of cigarette dependence, severity of problems when trying to quit, perceived barriers for quitting, and negative abstinence expectancies after adjusting for key variables linked to smoking and anxiety (e.g., hazardous drinking, education). The current findings are the first to document probable anxiety disorder status as a clinically relevant factor for a wide range of smoking variables and beliefs about abstinence among Latinx persons who smoke.

Smokers with and without Epilepsy show Similar Smoking Rate, Dependence Level, Cessation Attempts, and Motives

BACKGROUND

Individuals with epilepsy are up to twice as likely to be current cigarette smokers compared to those without. Moreover, one study showed current smoking is associated with an increased likelihood of seizures. However, outside of this one study, there is limited data on the presentation of specific smoking-related behaviors and cognitions in people with epilepsy, inhibiting our understanding of the severity of this behavior and our ability to formulate effective treatments for this population.

PURPOSE

The current study examined smoking-related behaviors and cognitions among smokers with epilepsy compared to smokers without epilepsy.

METHODS

Participants were 43 smokers with (Mage = 43.4, SD = 11.6) and 43 smokers without (Mage = 45.5, SD = 8.8) epilepsy recruited from an urban, academic setting within the U.S. Separate Analyses of Covariance (ANCOVAs) were conducted to evaluate differences between smokers with and without epilepsy in terms of smoking behavior (i.e., daily smoking rate, nicotine dependence, number of quit attempts, smoking duration, age of smoking onset) and smoking-related cognitive processes (i.e., smoking motives, perceived barriers to smoking cessation, cessation motives) after controlling for race and problematic alcohol use.

RESULTS

Smokers with epilepsy did not differ from smokers without epilepsy in terms of smoking rate (p = .51, ηp2 = .01), nicotine dependence (p = .12, ηp2 = .03), age of smoking onset (p = .42, ηp2 = .01), number of quit attempts (p = .43, ηp2 = .01), barriers to cessation (p = .30 to .80, ηp2 = .00 to .01), or cessation motives (p = .28 to .60, ηp2 = .00 to .02). Smokers without epilepsy reported higher levels of smoking for sensorimotor manipulation reasons (p = .03, ηp2 = .06) and longer smoking duration (p = .03, ηp2 = .06) than smokers with epilepsy.

CONCLUSIONS

Smokers with epilepsy do not appear to differ significantly from smokers without epilepsy in terms of smoking-related behaviors and cognitions, and may therefore benefit from current evidence-based treatments for smoking cessation that are not contraindicated for epilepsy (i.e., bupropion, varenicline).

Enhancing panic and smoking reduction treatment with D-Cycloserine: A pilot randomized clinical trial

In this placebo-controlled randomized clinical trial, we examined the efficacy of 250 mg d-cycloserine (DCS) for enhancing the effects of cognitive behavior therapy targeting anxiety sensitivity reduction in the context of smoking cessation treatment among adults with a history of panic attacks. We hypothesized that DCS would enhance treatment of our mechanistic targets-anxiety sensitivity and panic and related symptoms-and result in greater smoking abstinence. A total of 53 smokers were randomized to a 7-week integrated treatment and received study medication (DCS or placebo) prior to sessions 3-5; these sessions emphasized interoceptive exposure practice. Nicotine replacement therapy was initiated at session 5 (quit date). We found that DCS augmentation led to greater reductions of one (anxiety sensitivity) of two of our mechanistic targets at early but not late assessments, and that engaging that target predicted better smoking outcomes. However, there was no evidence of group (DCS vs. placebo) differences in smoking cessation success at treatment endpoint or follow-up evaluations. Hence, although we found that DCS can enhance treatment targeting a smoking maintaining factor, additional strategies appear to be needed to significantly affect smoking outcomes.

YMCA exercise intervention to augment smoking cessation treatment in adults with high anxiety sensitivity: Study protocol for a randomized controlled trial

Extant evidence suggests that exercise can reduce anxiety related vulnerability factors, such as anxiety sensitivity (AS), or fear of bodily sensations related to anxiety, that negatively impact smoking cessation outcomes. Building upon emerging evidence supporting the efficacy of exercise as an aid for smoking cessation in adults with high AS, we are conducting a trial to examine the efficacy and feasibility of this clinical application when implemented in a community setting. Partnering with the YMCA, this study aims to enroll 150 adults in a standard smoking cessation protocol (i.e. counseling and nicotine replacement therapy) and randomly assign them to either 15 weeks of programmed vigorous-intensity or low-intensity exercise. Smoking abstinence data will be collected up to 6 months following the quit attempt.

The role of anxiety sensitivity-physical concerns in terms of quit day withdrawal symptoms and cravings: A pilot test among smokers with asthma

OBJECTIVE

The aim of the current study was to conduct secondary analyses of data collected from a study examining a self-guided quit attempt of smokers with and without asthma in order to examine the unique predictive ability of precessation (i.e., baseline) anxiety sensitivity physical concerns in terms of quit day withdrawal symptoms and cravings among abstinent smokers with asthma.

METHODS

Participants were 24 regular cigarette smokers with asthma (50% female, M_age = 37.63 years, SD = 12.20) who participated in a self-guided-quit attempt and were able to maintain abstinence on their quit day.

RESULTS

After controlling for the effects of the cognitive and social concerns domains of anxiety sensitivity, anxiety sensitivity-physical concerns significantly predicted greater quit day withdrawal symptoms (20.8% unique variance) and urges to smoke (38.0% unique variance).

CONCLUSIONS

These findings suggest that smokers with asthma who fear anxiety-related sensations due to their feared physical consequences are more likely to experience intense withdrawal symptoms and desire to smoke at the beginning of a quit attempt. Clinically, smokers with higher levels of anxiety sensitivity physical concerns may benefit from smoking cessation interventions that specifically target anxiety sensitivity as well as prolonged use of nicotine replacement therapies to target withdrawal symptoms and cravings.

Nicotine deprivation attenuates panic reactivity in smokers: Findings from a placebo-controlled nicotine patch study

BACKGROUND

Prospective studies consistently find that smoking is a risk factor for the development of panic disorder (PD). A possible explanation is that nicotine deprivation promotes heightened sensitivity to bodily sensations and/or arterial carbon dioxide (CO₂ ). Abrams et al. (2011) previously found that, in response to a CO₂ rebreathing challenge, smokers experiencing more (vs. less) intense nicotine withdrawal had more severe panic symptoms and a stronger urge to escape. However, participants were aware of the last time they smoked, leaving unclear the extent to which fear reactivity was influenced by the pharmacologic effects of nicotine deprivation versus beliefs regarding when nicotine was most recently used. The present study aimed to ascertain whether nicotine deprivation, independent of beliefs regarding recent nicotine use, promotes fear reactivity among smokers.

METHODS

Moderate to heavy smokers without PD (N = 25) participated in a placebo-controlled, double-blind study consisting of two sessions spaced 1 week apart. Participants abstained from nicotine for 2 hr prior to sessions. During one session participants were given a 21 mg nicotine replacement patch and, during the other, a placebo patch, with the order counterbalanced. For both sessions, after a 3-hr absorption period, participants underwent a 10-min CO₂ rebreathing challenge.

RESULTS

Wearing a nicotine (vs. placebo) patch increased self-reported panic reactivity among participants, but did not significantly affect physiological and behavioral measures of reactivity.

CONCLUSIONS

In smokers without a history of PD, nicotine deprivation attenuates subjective panic reactivity. Possible explanations for the contrast between theory and laboratory findings as well as clinical implications are discussed.

The indirect effect of panic disorder on smoking cognitions via difficulties in emotion regulation

Panic disorder (PD) and cigarette smoking are highly comorbid and associated with worse panic and smoking outcomes. Smoking may become an overlearned automatized response to relieve panic-like withdrawal distress, leading to corresponding smoking cognitions, which contribute to its reinforcing properties and difficultly abstaining. Difficulties in emotion regulation (ER) may underlie this relation such that in the absence of adaptive emotion regulatory strategies, smokers with PD may more readily rely upon smoking to manage affective distress. In the current study, the indirect relation between PD status and smoking cognitions through ER difficulties was examined among daily smokers (N=74). We found evidence for an indirect relation between PD status and negative affect, addictive and habitual smoking motives, and anticipating smoking will result in negative reinforcement and personal harm, through self-reported difficulties with ER. Our findings are aligned with theoretical models on anxiety and smoking, and suggest that reports of greater smoking cognitions may be due to ER difficulties.

Is computerized psychoeducation sufficient to reduce anxiety sensitivity in an at-risk sample?: A randomized trial

BACKGROUND

Anxiety sensitivity (AS), or a fear of anxiety-related sensations, has become one of the most well researched risk factors for the development of psychopathology and comprises three subfactors: physical, cognitive, and social concerns. Fortunately, research has demonstrated brief protocols can successfully reduce AS, and in turn improve psychopathological symptoms. Computerized AS reduction protocols have combined psychoeducation with interoceptive exposure (IE), but they have not been dismantled to evaluate the effects of psychoeducation alone.

METHOD

The current study sought to determine the efficacy of a brief single-session psychoeducation intervention for AS, compared to a control intervention, in a sample of at-risk individuals (N=54) with elevated AS cognitive concerns.

RESULTS

Individuals in the active condition displayed greater reductions in self-reported AS (β=.198, 95% CI [.065, .331]) and less fear reactivity (β=.278, 95% CI [.069, .487]) to the induction of AS cognitive-relevant sensations through a behavioral challenge compared to those in the control condition. Further, fear reactivity to the challenge was mediated by reductions in self-reported AS cognitive concerns.

LIMITATIONS

Study limitations include use of an at-risk nonclinical student sample, lack of a long-term follow-up assessment, and inability to discern whether AS reductions due to CAST psychoeducation prevent future, or improve current, psychological symptoms.

CONCLUSIONS

These results suggest that psychoeducation alone can produce significant AS reduction.

Distress intolerance during smoking cessation treatment

Distress intolerance is a key vulnerability factor implicated in the maintenance and relapse of cigarette smoking. Yet, past work has not examined changes in these processes during smoking cessation treatment or their relation to smoking cessation outcomes. The aim of the present study was to examine the effect of two smoking cessation interventions on changes in self-report and behavioral distress intolerance indices during treatment, and whether these changes are associated with smoking cessation outcomes. Treatment-seeking smokers (N = 384) were randomly assigned to one of two 4-session smoking cessation treatment programs: Standard Cessation Program (SCP) or Smoking Treatment and Anxiety Management Program (STAMP). Quit dates were scheduled to coincide with the final treatment session. Physical domains of distress intolerance were assessed at baseline and at each weekly session, via the Discomfort Intolerance Scale (DIS; higher scores indicate more intolerance for discomfort) and Breath Holding Duration Task (shorter durations indicate more intolerance for respiratory distress). The STAMP condition produced a greater rate of reduction in DIS scores than did the SCP condition. Changes in DIS scores during treatment mediated the effect of STAMP treatment on 7-day point prevalence abstinence at Month 3 post-quit attempt. There were no treatment conditions differences in changes in Breath-Holding duration. Data suggest self-reported distress intolerance is malleable in the context of stress sensitivity reduction treatment, but not standard smoking cessation treatment, and such reductions may result in promotion of smoking abstinence.

Enhancing panic and smoking reduction treatment with d-cycloserine: Study protocol for a randomized controlled trial

There has been relatively little attention focused on treatment strategies for smokers with panic attacks despite their increased risk of relapse. Panic and Smoking Reduction Treatment (PSRT) integrates standard smoking cessation treatment with an exposure-based intervention targeting the mechanisms underlying panic-smoking relations. Building upon emerging evidence supporting the efficacy of d-cycloserine (DCS) for augmenting exposure-based therapy, we are conducting an initial test of the efficacy of DCS for enhancing PSRT outcomes. Utilizing a randomized, double-blind trial comparing PSRT+DCS to PSRT+placebo, we will obtain initial effect sizes for short-term and long-term smoking cessation outcomes and perform an initial test of putative mechanisms.

Influence of Psychiatric and Personality Disorders on Smoking Cessation Among Individuals in Opiate Dependence Treatment

OBJECTIVE

We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals.

METHODS

Participants (N = 116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory-III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked.

RESULTS

Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall, narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI [0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]).

CONCLUSIONS

Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.

Differences in panic psychopathology between smokers with and without asthma

Cigarette smoking is more common among individuals with asthma compared to those without, resulting in increased risk of morbidity and mortality. However, there has been little exploration of psychological factors that differ between smokers with and without asthma. Thus, the aim of the current study was to examine differences between smokers with and without asthma in terms of anxiety sensitivity, panic symptoms, lifetime history of panic attacks, and lifetime history of panic disorder. Participants were 115 smokers with asthma (55.3% male, M_age = 38.4 years, SD = 11.9) and 120 smokers without asthma (70.6% male, M_age = 37.0 years, SD = 12.8) who were administered a structured diagnostic interview and completed self-report measures. As hypothesized, after controlling for the effects of cigarettes per day, gender, race, and education, smokers with asthma reported higher levels of anxiety sensitivity and panic symptoms and were at an increased risk for having a lifetime history of panic attacks (OR = 3.01) and panic disorder (OR = 2.96) compared to smokers without asthma. Further, group differences in anxiety sensitivity and panic symptoms remained even after removing participants with a lifetime history of panic attacks or panic disorder. These findings suggest that smokers with asthma are a particularly 'at-risk' population for panic psychopathology and likely in need of specialized smoking-related prevention and intervention efforts.

Anxiety sensitivity risk reduction in smokers: A randomized control trial examining effects on panic

Empirical evidence has identified several risk factors for panic psychopathology, including smoking and anxiety sensitivity (AS; the fear of anxiety-related sensations). Smokers with elevated AS are therefore a particularly vulnerable population for panic. Yet, there is little knowledge about how to reduce risk of panic among high AS smokers. The present study prospectively evaluated panic outcomes within the context of a controlled randomized risk reduction program for smokers. Participants (N = 526) included current smokers who all received a state-of-the-art smoking cessation intervention with approximately half randomized to the AS reduction intervention termed Panic-smoking Program (PSP). The primary hypotheses focus on examining the effects of a PSP on panic symptoms in the context of this vulnerable population. Consistent with prediction, there was a significant effect of treatment condition on AS, such that individuals in the PSP condition, compared to those in the control condition, demonstrated greater decreases in AS throughout treatment and the follow-up period. In addition, PSP treatment resulted in lower rates of panic-related symptomatology. Moreover, mediation analyses indicated that reductions in AS resulted in lower panic symptoms. The present study provides the first empirical evidence that brief, targeted psychoeducational interventions can mitigate panic risk among smokers.

The indirect effect of emotion dysregulation in terms of negative affect and smoking-related cognitive processes

INTRODUCTION

Although negative affect is associated with a number of smoking-related cognitive processes, the mechanisms underlying these associations have yet to be examined. The current study sought to examine the indirect effect of emotion regulation difficulties in terms of the association between negative affect and smoking-related cognitive processes (internal barriers to cessation, negative affect reduction smoking motives, negative affect reduction smoking outcome expectancies).

METHOD

Participants were 126 daily cigarette smokers (70.4% male, Mage=36.5years, SD=13.0; 69.8% Caucasian) who smoked an average of 18.5 (SD=8.7) cigarettes per day and reported moderate nicotine dependence.

RESULTS

Formal mediation analyses were conducted using PROCESS to examine the indirect effect of negative affect on internal barriers to cessation and negative affect reduction smoking motives and outcome expectancies through emotion regulation difficulties. After accounting for the effects of gender, daily smoking rate, and anxiety sensitivity, negative affect was indirectly related to internal barriers to cessation and negative affect reduction smoking motives through emotion regulation difficulties. There was no significant indirect effect for negative affect reduction smoking outcome expectancies.

CONCLUSIONS

These findings suggest that greater negative affect is associated with a desire to smoke to reduce this negative affect and perceptions that quitting smoking will be difficult due to negative emotions because of greater difficulties managing these negative emotions. Thus, emotion regulation difficulties may be an important target for smoking cessation interventions.

Smoking cessation and reduction in people with chronic mental illness

The high prevalence of cigarette smoking and tobacco related morbidity and mortality in people with chronic mental illness is well documented. This review summarizes results from studies of smoking cessation treatments in people with schizophrenia, depression, anxiety disorders, and post-traumatic stress disorder. It also summarizes experimental studies aimed at identifying biopsychosocial mechanisms that underlie the high smoking rates seen in people with these disorders. Research indicates that smokers with chronic mental illness can quit with standard cessation approaches with minimal effects on psychiatric symptoms. Although some studies have noted high relapse rates, longer maintenance on pharmacotherapy reduces rates of relapse without untoward effects on psychiatric symptoms. Similar biopsychosocial mechanisms are thought to be involved in the initiation and persistence of smoking in patients with different disorders. An appreciation of these common factors may aid the development of novel tobacco treatments for people with chronic mental illness. Novel nicotine and tobacco products such as electronic cigarettes and very low nicotine content cigarettes may also be used to improve smoking cessation rates in people with chronic mental illness.

Smoking processes, panic, and depressive symptoms among treatment-seeking smokers

OBJECTIVES

The present study evaluated the relative contribution of panic and depressive symptoms in relation to past cessation difficulties and smoking motives among treatment-seeking daily smokers.

METHODS

The sample included 392 treatment-seeking daily smokers (47.07% female; Mage = 35.48; SD = 13.56), who reported smoking an average of 10 or more cigarettes daily for at least one year.

RESULTS

Findings indicated that panic and depressive symptoms were significantly associated with quit problems as well as addictive and negative affect motives for smoking. However, depressive symptoms were not associated with habitual smoking motives.

CONCLUSIONS

Differential patterns of associations with smoking-based processes imply that although panic and depression are related, there are important distinctions. Such data highlight the need for additional research to examine the putative role of panic and depressive symptoms in relation to smoking behaviors to further elucidate the mechanisms through which panic, depression, and smoking impact one another.

Emotional disorders and smoking: relations to quit attempts and cessation strategies among treatment-seeking smokers

The cross-sectional associations between lifetime emotional disorder status (anxiety/depressive disorders) among smokers in relation to historical quit processes were examined. Adult treatment-seeking daily cigarette smokers (n=472) received structured psychiatric interviews and completed a survey that included in-depth questions on cessation history. Having a lifetime emotional disorder was significantly associated with a greater number of prior quit attempts and cessation strategies used, including increased use of both non-pharmacological and pharmacological quit methods. These smokers may still require complimentary specialty care to address their specific affective vulnerabilities given that their use of commonly-applied strategies did not result in lifetime abstinence.

Anxiety sensitivity as a mediator of the association between asthma and smoking

OBJECTIVE

Despite its negative effects, smoking is more common among individuals with asthma compared to those without. Anxiety sensitivity (fear of arousal-related sensations) is associated with both smoking and asthma; however, no research, to date, has examined the interplay between these three factors. Thus, the purpose of the current study was to evaluate the mediating role of anxiety sensitivity in the association between asthma diagnosis and smoking status.

METHODS

The current study was a secondary analysis of data from three existing datasets of non-smokers and smokers with and without asthma (n = 433; 56.3% female, M(age) = 34.01 years, SD = 13.9). Participants provided information on their asthma diagnosis status and smoking status and completed self-report measures.

RESULTS

As hypothesized, after controlling for gender, race and age, there was a significant indirect effect of asthma diagnosis on smoking status through anxiety sensitivity (95% CI = 0.07-0.48).

CONCLUSIONS

These results indicate that the association between asthma diagnosis and smoking status appears to be driven, in part, by anxiety sensitivity and suggest that anxiety sensitivity may serve as an important target for prevention and intervention efforts for smokers with asthma.

Asthma and its relation to smoking behavior and cessation motives among adult daily smokers

Despite the negative effects of smoking on lung functioning and overall health, smoking is more prevalent among individuals with asthma compared to those without asthma. The purpose of this study was to examine the predictive ability of asthma diagnosis in terms of smoking behavior and reasons for quitting. Participants were 251 regular daily smokers: 125 smokers with self-reported, physician-diagnosed asthma and 126 smokers without asthma. Asthma diagnosis significantly predicted age of regular smoking onset, number of quit attempts, and reasons for quitting related to self-control suggesting that smokers with asthma may have more difficulty quitting and unique reasons for quitting.

Panic attack history and anxiety sensitivity in relation to cognitive-based smoking processes among treatment-seeking daily smokers

INTRODUCTION

Empirical research has found that panic attacks are related to increased risk of more severe nicotine withdrawal and poor cessation outcome. Anxiety sensitivity (AS; fear of anxiety and related sensations) has similarly been found to be related to an increased risk of acute nicotine withdrawal and poorer cessation outcome. However, research has yet to examine the relative contributions of panic attacks and AS in terms of cognitive-based smoking processes (e.g., negative reinforcement smoking expectancies, addictive and negative affect-based reduction smoking motives, barriers to cessation, problem symptoms experienced while quitting).

METHOD

Participants (n = 242; 57.4% male; M (age) = 38.1) were daily smokers recruited as a part of a larger randomized control trial for smoking cessation. It was hypothesized that both panic attacks and AS would uniquely and independently predict the studied cognitive-based smoking processes.

RESULTS

As hypothesized, AS was uniquely and positively associated with all smoking processes after controlling for average number of cigarettes smoked per day, current Axis I diagnosis, and participant sex. However, panic attack history was only significantly related to problem symptoms experienced while quitting smoking.

CONCLUSIONS

Although past research has demonstrated significant associations between panic attacks and certain aspects of cigarette smoking (e.g., severity of nicotine withdrawal; lower abstinence rates, and negative affect reduction motives), the present findings suggest that AS may be more relevant to understanding beliefs about and motives for smoking behavior as well as perceptions of cessation-related difficulties.

Nicotine withdrawal exacerbates fear reactivity to CO₂-induced bodily sensations among smokers

INTRODUCTION

Independent lines of research suggest that smoking increases the prospective risk of panic disorder. Studies that have examined the hypothesized link between nicotine withdrawal and panic have typically employed light smokers or lacked optimal control groups. Our laboratory team previously found, for example, that smokers who abstained from cigarettes for 12 hr demonstrated greater fear reactivity to a CO(2) rebreathing challenge than nonsmokers. However, the absence of a smoking-as-usual group limited our ability to draw conclusions about the potential role of nicotine withdrawal.

METHODS

We exposed 27 heavy smokers who abstained from smoking for 12 hr and 27 heavy smokers who smoked as usual to a 5-min CO(2) rebreathing challenge.

RESULTS

More intense prechallenge nicotine withdrawal symptoms (regardless of group status) were associated with more severe panicky symptoms and a stronger urge to escape during the challenge, even after we controlled for prechallenge anxiety and daily cigarette use. Unexpectedly, group status did not predict challenge reactivity.

CONCLUSION

Smokers who regularly experience intense withdrawal symptoms, regardless of length of smoking abstinence, may be at heightened risk for experiencing panic attacks.

Anxiety sensitivity as a mediator of the relationship between moderate-intensity exercise and coping-oriented marijuana use motives

The present study examined the working hypothesis that moderate-intensity exercise is associated with coping-oriented marijuana use motives through its association with the fear of somatic arousal (ie, anxiety sensitivity). Using data from 146 young adult current marijuana users, we found evidence consistent with this hypothesis. Specifically, moderate-intensity exercise was associated with coping-oriented use motives, even after controlling for frequency of current marijuana use and other co-occurring marijuana use motives. This relationship became nonsignificant after entering anxiety sensitivity as an additional predictor variable, denoting a putative mediational role for this cognitive factor. These findings extend previous work and offer support for the potential utility of moderate-intensity aerobic exercise for the treatment of marijuana use problems.

Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment

AIMS

To understand the relations among anxiety disorders and tobacco dependence, withdrawal symptoms, response to smoking cessation pharmacotherapy and ability to quit smoking.

DESIGN

Randomized placebo-controlled clinical trial. Participants received six 10-minute individual counseling sessions and either: placebo, bupropion SR, nicotine patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge.

SETTING

Two urban research sites.

PARTICIPANTS

Data were collected from 1504 daily smokers (>9 cigarettes per day) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use.

MEASUREMENTS

Participants completed baseline assessments, the Composite International Diagnostic Interview and ecological momentary assessments for 2 weeks.

FINDINGS

A structured clinical interview identified participants who ever met criteria for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder (n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect. Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies.

CONCLUSIONS

Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy and impaired ability to quit smoking. These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses.

Panic-Relevant Cognitive Processes Among Smokers

To further understand the frequent co-occurrence of smoking and panic disorder (PD), we examined panic-relevant cognitive processes among heavy smokers, half of whom were in 12-hour withdrawal, and nonsmokers. All participants (N = 85) underwent a 5-minute carbon dioxide rebreathing challenge. Prior to the challenge, participants completed questionnaires on reasons for smoking, anxiety sensitivity, and suffocation fear. Results are consistent with a model in which smokers with predisposing risk factors (high anxiety sensitivity and high suffocation fear) misappraise bodily sensations and experience panicky symptoms. No evidence was found that being in acute withdrawal heightened this risk. Overall, findings highlight (a) cognitive vulnerabilities that may place smokers at elevated risk for developing PD and hence (b) potential targets for intervention.

Expectancies and marijuana use frequency and severity among young females

This study examined associations between the endorsement of drug use expectancies and the frequency and severity of marijuana use in a community sample of 332 women aged 18-24years who were not explicitly seeking treatment for their marijuana use. Participants were enrolled in a larger intervention study of motivational interviewing for various health behaviors and provided self-reports of their current and past marijuana use, marijuana abuse/dependence symptoms, and marijuana use expectancies. Marijuana use expectancies were measured using the six subscales of the Marijuana Effects Expectancy Questionnaire (MEEQ). Use frequency was defined as the number of use days in the past month, severity as the total number of DSM-IV marijuana abuse or dependence symptom criteria met. Replicating and extending prior research, expectations regarding Relaxation and Tension Reduction emerged as a robust belief in this cohort, predicting not only frequency (p<.01) but also severity (p<.01) of marijuana use in multivariate analyses. Severity of marijuana use was further predicted by expectations regarding loss of control, affective changes following marijuana use, and other aspects of emotion dysregulation (Global Negative Effects, p<.01). These findings document meaningful associations between substance-related cognitions and use behavior and suggest that marijuana users who hold certain beliefs regarding marijuana use may be particularly susceptible to clinically significant problems associated with their substance use. As such, marijuana use expectancies may represent a clinical target that could be incorporated into future interventions.

Negative affect as a mediator of the relationship between vigorous-intensity exercise and smoking

The present cross-sectional study evaluated whether people who engage in vigorous-intensity exercise are better able to regulate negative affective states, thereby changing core maintenance factors of smoking. Participants were a community sample of adults (n = 270) who completed self-report measures of physical activity, cigarette smoking, anxiety sensitivity, and negative affect. Consistent with hypothesis, vigorous-intensity exercise was related to lower levels of cigarette smoking, accounting for 10% of the variance in smoking. Additionally, negative affect mediated the relationship between vigorous-intensity physical activity and cigarette smoking, accounting for about 12% of this relation. Furthermore, these relationships were stronger for individuals with high anxiety sensitivity than for those with low anxiety sensitivity; including anxiety sensitivity as a moderator of the mediated relationship increased the amount of variance accounted for by negative affect to 17%. The findings are discussed in relation to developing further scientific insight into the mechanisms and pathways relevant to understanding the association among vigorous-intensity exercise, smoking, and emotional vulnerability.

Premenstrual distress predicts panic-relevant responding to a CO2 challenge among young adult females

The current study examined the incremental validity of self-reported premenstrual distress in predicting panic responsivity (self-reported panic symptoms and skin conductance response frequency; SCR) following inhalation of 10% CO(2)-enriched air. A community sample of young adult women (n=46) completed questionnaires assessing substance use patterns, premenstrual symptoms and distress, and anxiety sensitivity and underwent a laboratory biological challenge procedure (4-min 10% CO(2)-enriched air inhalation). As hypothesized, higher premenstrual distress scores significantly predicted greater self-reported panic symptoms following the CO(2) challenge above and beyond other theoretically relevant variables (anxiety sensitivity, cigarette use, and alcohol consumption). In predicting SCR, premenstrual distress exhibited only a trend towards statistical significance. These findings provide preliminary evidence that premenstrual symptoms may serve as a potential risk factor to experience more intense panic symptoms in response to perturbations in bodily sensations.

Marijuana use, abuse, and dependence: evaluation of panic responsivity to biological challenge

The present investigation examined marijuana use, abuse, and dependence in relation to anxious and fearful responding to panic-relevant bodily sensations elicited by a biological challenge procedure among a sample of young adult marijuana users (n = 64; 46.9% women; M(age) = 20.97, SD = 6.01). Results indicated that those who were dependent on marijuana had greater self-reported panic attack symptoms post-challenge than those who abused marijuana. No differences were found between those who did not meet criteria for either abuse or dependence (users), and those who abused or were dependent on marijuana. No group differences were found for heart rate reactivity. Results are discussed in relation to better understanding the role of marijuana use and its disorders in terms of panic responsivity.

Psychiatric disorders in smokers seeking treatment for tobacco dependence: relations with tobacco dependence and cessation

OBJECTIVE

The present research examined the relation of psychiatric disorders to tobacco dependence and cessation outcomes.

METHOD

Data were collected from 1,504 smokers (58.2% women; 83.9% White; mean age = 44.67 years, SD = 11.08) making an aided smoking cessation attempt as part of a clinical trial. Psychiatric diagnoses were determined with the Composite International Diagnostic Interview structured clinical interview. Tobacco dependence was assessed with the Fagerström Test of Nicotine Dependence (FTND) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM).

RESULTS

Diagnostic groups included those who were never diagnosed, those who had ever been diagnosed (at any time, including in the past year), and those with past-year diagnoses (with or without prior diagnosis). Some diagnostic groups had lower follow-up abstinence rates than did the never diagnosed group (ps < .05). At 8 weeks after quitting, strong associations were found between cessation outcome and both past-year mood disorder and ever diagnosed anxiety disorder. At 6 months after quitting, those ever diagnosed with an anxiety disorder (OR = .72, p = .02) and those ever diagnosed with more than one psychiatric diagnosis (OR = .74, p = .03) had lower abstinence rates. The diagnostic categories did not differ in smoking heaviness or the FTND, but they did differ in dependence motives assessed with the WISDM.

CONCLUSION

Information on recent or lifetime psychiatric disorders may help clinicians gauge relapse risk and may suggest dependence motives that are particularly relevant to affected patients. These findings also illustrate the importance of using multidimensional tobacco dependence assessments.

Evaluating emotional sensitivity and tolerance factors in the prediction of panic-relevant responding to a biological challenge

The current study investigated anxiety sensitivity, distress tolerance (Simons & Gaher, 2005), and discomfort intolerance (Schmidt, Richey, Cromer, & Buckner, 2007) in relation to panic-relevant responding (i.e., panic attack symptoms and panic-relevant cognitions) to a 10% carbon dioxide enriched air challenge. Participants were 216 adults (52.6% female; M(age)=22.4, SD=9.0). A series of hierarchical multiple regressions was conducted with covariates of negative affectivity and past year panic attack history in step one of the model, and anxiety sensitivity, discomfort intolerance, and distress tolerance entered simultaneously into step two. Results indicated that anxiety sensitivity, but not distress tolerance or discomfort intolerance, was significantly incrementally predictive of physical panic attack symptoms and cognitive panic attack symptoms. Additionally, anxiety sensitivity was significantly predictive of variance in panic attack status during the challenge. These findings emphasize the important, unique role of anxiety sensitivity in predicting risk for panic psychopathology, even when considered in the context of other theoretically relevant emotion vulnerability variables.

Marijuana coping motives interact with marijuana use frequency to predict anxious arousal, panic related catastrophic thinking, and worry among current marijuana users

The present investigation evaluated whether coping motives for marijuana use interacted with past 30-day frequency of marijuana use in relation to anxiety-relevant variables among community-recruited young adult marijuana users (n=149). As expected, after covarying cigarettes per day, alcohol use, and total years of marijuana use, the interaction between frequency of past 30-day marijuana use and coping motives predicted anxious arousal symptoms, agoraphobic cognitions, and worry. Marijuana users who demonstrated high use frequency and high coping motives demonstrated the highest levels of anxiety across these anxiety-relevant criterion variables. No such effects were evident, as expected, for depressive symptoms, offering explanatory specificity for anxiety relative to depressive factors. These results are discussed in relation to better understanding the role of marijuana use and coping motives in regard to anxiety vulnerability.

Negative affectivity as a moderator of the association between smoking status and anxiety sensitivity, anxiety symptoms, and perceived health among young adults

The present investigation evaluated the moderational role of negative affectivity in the relation between smoking status and panic-relevant symptoms in a young adult sample (n = 222; 123 females; mean age = 22.45 years, SD = 8.08). Consistent with the prediction, negative affectivity moderated the association of smoking status with anxious arousal symptoms, anxiety sensitivity, and perceived health. Specifically, greater negative affectivity was associated with higher levels of anxious arousal and anxiety sensitivity and lower levels of perceived health among smokers compared to nonsmokers. The effects were evident after controlling for the variance accounted for by alcohol use problems and gender. Findings are discussed with regard to the role of negative affectivity in the relation between smoking and panic-related processes.

A further investigation of the relations of anxiety sensitivity to smoking motives

Prior research has shown that anxiety sensitivity (AS) is associated with smoking to reduce negative affect (e.g., [Comeau, N., Stewart, S.H., & Loba, P., (2001). The relations of trait anxiety, anxiety sensitivity and sensation seeking to adolescents' motivations for alcohol, cigarette, and marijuana use. Addictive Behaviors, 26, 803-825.]). However, given limitations in the measurement of smoking motives in previous AS studies, it has yet to be definitively established that AS is specifically related to negative reinforcement smoking motives. Moreover, the overall AS construct is comprised of three lower-order components: physical, psychological, and social concerns (e.g., [Stewart, S.H., Taylor, S., & Baker, J.M., (1997). Gender differences in dimensions of anxiety sensitivity. Journal of Anxiety Disorders, 11, 179-200.]). Previous investigations generally have not examined the relative contributions of each of these three AS components to smoking for negative reinforcement motives. The present study attempted to address each of these gaps in the literature. A sample of 119 smokers attending a tobacco intervention program (see [Mullane, J.C., Stewart, S.H., Rhyno, E., Steeves, D., Watt, M., & Eisner, A., (2008). Anxiety sensitivity and difficulties with smoking cessation. In A.M. Columbus (Ed.), Advances in Psychological Research (vol. 54A, pp. 141-155). Hauppauge, NY: Nova Science Publishers.]) completed the Anxiety Sensitivity Index (ASI; [Peterson, R.A., & Reiss, S., (1992). The Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Services.]) and the Reasons For Smoking scale (RFS; [Ikard, F.F., Green, D.E., & Horn, D., (1969). A scale to differentiate between types of smoking as related to the management of affect. International Journal of the Addictions, 4, 649-659.]) at pre-treatment. In a principal components analysis (PCA) of the RFS items, stringent parallel analysis supported a two-factor solution (negative and positive reinforcement smoking motives) as opposed to the intended six factors ([Ikard, F.F., Green, D.E., & Horn, D., (1969). A scale to differentiate between types of smoking as related to the management of affect. International Journal of the Addictions, 4, 649-659.]). ASI total scores were significantly positively correlated with both RFS factors in bivariate correlational analyses. In partial correlations, the relation between the ASI and the RFS negative reinforcement factor remained significant when controlling for RFS positive reinforcement smoking motives, but the correlation of ASI with RFS positive reinforcement motives was not significant after controlling for RFS negative reinforcement motives. At the level of AS components, AS psychological concerns were related to both negative and positive reinforcement motives, while AS physical concerns were more strongly related to negative reinforcement motives. Implications for designing targeted tobacco interventions for high AS smokers are discussed.

Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology

The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; C) in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.

Anxiety sensitivity: a unique predictor of dropout among inner-city heroin and crack/cocaine users in residential substance use treatment

The present study examined the extent to which anxiety sensitivity (AS) at treatment entry was related to prospective treatment dropout among 182 crack/cocaine and/or heroin-dependent patients in a substance use residential treatment facility in Northeast Washington, DC. Results indicated that AS incrementally and prospectively predicted treatment dropout after controlling for the variance accounted for by demographics and other drug use variables, legal obligation to treatment (i.e., court-ordered vs. self-referred), alcohol use frequency, and depressive symptoms. Findings are discussed in relation to the role of AS in treatment dropout and substance use problems more generally.

Anxiety sensitivity as a moderator of the association between smoking status and anxiety symptoms and bodily vigilance: replication and extension in a young adult sample

The present investigation evaluated the moderational role of the physical concerns dimension of anxiety sensitivity (fear of anxiety and anxiety-related states) in the relation between smoking status and panic-relevant symptoms in a young adult sample (n=222; 123 females; M(age)=22.45 years, SD=8.08). Consistent with prediction, anxiety sensitivity physical concerns moderated the association of smoking status with body vigilance and anxious arousal symptoms, such that greater anxiety sensitivity physical concerns was associated with greater panic symptoms among smokers. The observed effects were evident even after controlling for the variance accounted for by alcohol use problems and gender. Also consistent with prediction, there was no interactive effect apparent for depressive symptoms, providing evidence of explanatory specificity with respect to the anxiety variables examined. Findings are discussed with regard to the role of anxiety sensitivity in the relation between smoking and panic processes.

Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users

The present study examines the relation between posttraumatic stress symptom severity and motives for marijuana use among 103 (55 women) young adult marijuana users (current) who reported experiencing at least one traumatic event in their lifetime. As expected, after covarying for the theoretically relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, and volume of alcohol consumed, posttraumatic stress symptom severity was significantly related to marijuana use coping motives, but no other motives for marijuana use. Results are discussed in relation to better understanding the role of coping-motivated marijuana use among young adults experiencing posttraumatic stress.

Concurrent associations between anxiety sensitivity and perceived health and health disability among young adult daily smokers

The aim of this investigation was to evaluate the incremental validity of anxiety sensitivity (fear of arousal-related physical and psychological sensations) relative to health factors (smoking variables, alcohol use and exercise level), in predicting perceived health and disability among a sample of 225 young adult daily smokers (102 females; M(age) = 23.9 years, SD = 8.8). Consistent with prediction, anxiety sensitivity, relative to smoking-relevant variables, alcohol consumption (a single frequency by quantity composite) and exercise activity, predicted lower perceived general health and impairments in mental health and social functioning; no incremental effects were evident for anxiety sensitivity for predicting impairments in physical functioning, role functioning, or increased healthcare usage. These findings are discussed with respect to better understanding cognitive factors that affect perceptions of health status and functioning among daily smokers.

Perceived health moderates the association between smoking rate and panic vulnerability variables among daily smokers

Our aim in this investigation was to evaluate the moderating role of perceived health in the relation between smoking rate and panic variables in a community-based sample of 220 daily smokers (98 females; M(age)=23.76 years, SD=8.76). As hypothesized, the interaction between smoking and perceived health incrementally predicted anxiety sensitivity (fear of anxiety) and anxious arousal symptoms, but not depressive symptoms. Individuals who had higher smoking rates and lower perceived health reported higher levels of anxiety sensitivity and anxious arousal, but not depressive symptoms. The primary implication of these findings is that there may be segments of the cigarette smoking population who are at relatively greater risk for anxiety symptoms and fear of bodily sensations by virtue of individual differences in perceived health. The identification of such moderating effects is clinically important, because it helps to refine our understanding of complex associations between drug behavior and panic vulnerability.

Smoking motives in the prediction of affective vulnerability among young adult daily smokers

The primary aim of this study was to examine whether smoking to reduce negative affect was uniquely related to a range of affective vulnerability factors (e.g., anxiety sensitivity, anxious arousal, and negative affectivity) among daily smokers. Participants were 276 young adult daily smokers (124 females; M(age)=25.12, SD=10.37). Partially consistent with prediction, the motivation to smoke to reduce negative affect was significantly related to anxiety sensitivity and negative affectivity, but not anxious arousal; the observed significant effects were above and beyond other theoretically relevant factors (e.g., smoking rate, years smoked, age, gender). In contrast to prediction, habitual smoking motives demonstrated significant incremental associations with anxiety sensitivity and anxious arousal symptoms. These results suggest that there are important associations between certain smoking motives and negative affective states and that such relations are not attributable to other smoking factors (e.g., smoking rate).

Perceived Health: A Test of Incremental Validity in Relation to Smoking Outcome Expectancies, Motivation to Smoke and Desire to Quit Smoking

This study examined the role of perceived health in predicting theoretically-relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.

Posttraumatic stress symptoms and smoking to reduce negative affect: an investigation of trauma-exposed daily smokers

The present investigation examined the relations among posttraumatic stress symptoms and smoking motives. Participants included 100 daily smokers recruited from the community and university settings who reported exposure to at least one traumatic event that met criterion A for posttraumatic stress disorder. Consistent with prediction, higher levels of posttraumatic stress symptoms were associated with smoking to reduce negative affect; this relation was observed after controlling for variance accounted for by number of cigarettes smoked per day and gender. Results are discussed in terms of the implications of smoking to regulate affect among daily smokers who have been exposed to traumatic events.

Marijuana use motives: concurrent relations to frequency of past 30-day use and anxiety sensitivity among young adult marijuana smokers

The present investigation examined two theoretically relevant aspects of marijuana motives using the Marijuana Motives Measure (MMM) [Simons, J., Correia, C. J., Carey, K. B., & Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology 45, 265-273] among 141 (78 female) young adults (M(age)=20.17, S.D.=3.34). The first objective was to evaluate the incremental validity of marijuana motives in relation to frequency of past 30-day use after controlling for the theoretically relevant factors of the number of years using marijuana (lifetime), current levels of alcohol, as well as tobacco smoking use. As expected, coping, enhancement, social, and expansion motives each were uniquely and significantly associated with past 30-day marijuana use over and above the covariates; conformity motives were not a significant predictor. A second aim was to explore whether coping, but no other marijuana motive, was related to the emotional vulnerability individual difference factor of anxiety sensitivity (fear of anxiety). As hypothesized, after controlling for number of years using marijuana (lifetime), past 30-day marijuana use, current levels of alcohol consumption, and cigarettes smoked per day, anxiety sensitivity was incrementally and uniquely related to coping motives for marijuana use, but not other motives. These results are discussed in relation to the clinical implications of better understanding the role of motivation for marijuana use among emotionally vulnerable young adults.

Anxiety sensitivity interacts with marijuana use in the prediction of anxiety symptoms and panic-related catastrophic thinking among daily tobacco users

The present investigation evaluated whether anxiety sensitivity interacted with marijuana use in relation to the prediction of panic-relevant variables among young adult tobacco smokers (n=265). Approximately 73% of the sample was composed of current marijuana smokers, with 78.5% of this sub-sample using marijuana more than once per week. As expected, after covarying cigarettes per day, alcohol use, and negative affectivity, the interaction between marijuana use and anxiety sensitivity predicted anxiety symptoms and agoraphobic cognitions. Partially consistent with prediction, the interaction between frequency of marijuana use and anxiety sensitivity predicted only anxiety symptoms. These results are discussed in relation to better understanding the potential role of regular marijuana use and anxiety sensitivity for panic-relevant emotional vulnerability among regular tobacco smokers.