1
|
Naughton F, Hope A, Siegele-Brown C, Grant K, Notley C, Colles A, West C, Mascolo C, Coleman T, Barton G, Shepstone L, Prevost T, Sutton S, Crane D, Greaves F, High J. A smoking cessation smartphone app that delivers real-time 'context aware' behavioural support: the Quit Sense feasibility RCT. PUBLIC HEALTH RESEARCH 2024; 12:1-99. [PMID: 38676391 DOI: 10.3310/kqyt5412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background During a quit attempt, cues from a smoker's environment are a major cause of brief smoking lapses, which increase the risk of relapse. Quit Sense is a theory-guided Just-In-Time Adaptive Intervention smartphone app, providing smokers with the means to learn about their environmental smoking cues and provides 'in the moment' support to help them manage these during a quit attempt. Objective To undertake a feasibility randomised controlled trial to estimate key parameters to inform a definitive randomised controlled trial of Quit Sense. Design A parallel, two-arm randomised controlled trial with a qualitative process evaluation and a 'Study Within A Trial' evaluating incentives on attrition. The research team were blind to allocation except for the study statistician, database developers and lead researcher. Participants were not blind to allocation. Setting Online with recruitment, enrolment, randomisation and data collection (excluding manual telephone follow-up) automated through the study website. Participants Smokers (323 screened, 297 eligible, 209 enrolled) recruited via online adverts on Google search, Facebook and Instagram. Interventions Participants were allocated to 'usual care' arm (n = 105; text message referral to the National Health Service SmokeFree website) or 'usual care' plus Quit Sense (n = 104), via a text message invitation to install the Quit Sense app. Main outcome measures Follow-up at 6 weeks and 6 months post enrolment was undertaken by automated text messages with an online questionnaire link and, for non-responders, by telephone. Definitive trial progression criteria were met if a priori thresholds were included in or lower than the 95% confidence interval of the estimate. Measures included health economic and outcome data completion rates (progression criterion #1 threshold: ≥ 70%), including biochemical validation rates (progression criterion #2 threshold: ≥ 70%), recruitment costs, app installation (progression criterion #3 threshold: ≥ 70%) and engagement rates (progression criterion #4 threshold: ≥ 60%), biochemically verified 6-month abstinence and hypothesised mechanisms of action and participant views of the app (qualitative). Results Self-reported smoking outcome completion rates were 77% (95% confidence interval 71% to 82%) and health economic data (resource use and quality of life) 70% (95% CI 64% to 77%) at 6 months. Return rate of viable saliva samples for abstinence verification was 39% (95% CI 24% to 54%). The per-participant recruitment cost was £19.20, which included advert (£5.82) and running costs (£13.38). In the Quit Sense arm, 75% (95% CI 67% to 83%; 78/104) installed the app and, of these, 100% set a quit date within the app and 51% engaged with it for more than 1 week. The rate of 6-month biochemically verified sustained abstinence, which we anticipated would be used as a primary outcome in a future study, was 11.5% (12/104) in the Quit Sense arm and 2.9% (3/105) in the usual care arm (estimated effect size: adjusted odds ratio = 4.57, 95% CIs 1.23 to 16.94). There was no evidence of between-arm differences in hypothesised mechanisms of action. Three out of four progression criteria were met. The Study Within A Trial analysis found a £20 versus £10 incentive did not significantly increase follow-up rates though reduced the need for manual follow-up and increased response speed. The process evaluation identified several potential pathways to abstinence for Quit Sense, factors which led to disengagement with the app, and app improvement suggestions. Limitations Biochemical validation rates were lower than anticipated and imbalanced between arms. COVID-19-related restrictions likely limited opportunities for Quit Sense to provide location tailored support. Conclusions The trial design and procedures demonstrated feasibility and evidence was generated supporting the efficacy potential of Quit Sense. Future work Progression to a definitive trial is warranted providing improved biochemical validation rates. Trial registration This trial is registered as ISRCTN12326962. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/31) and is published in full in Public Health Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Aimie Hope
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Chloë Siegele-Brown
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Caitlin Notley
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Colles
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Claire West
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Cecilia Mascolo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Garry Barton
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, Kings College London, London, UK
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - David Crane
- Department of Behavioural Science and Health, University College London, London, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Juliet High
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| |
Collapse
|
2
|
Brevers D, Billieux J, de Timary P, Desmedt O, Maurage P, Perales JC, Suárez-Suárez S, Bechara A. Physical Exercise to Redynamize Interoception in Substance use Disorders. Curr Neuropharmacol 2024; 22:1047-1063. [PMID: 36918784 PMCID: PMC10964100 DOI: 10.2174/1570159x21666230314143803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 03/16/2023] Open
Abstract
Physical exercise is considered a promising medication-free and cost-effective adjunct treatment for substance use disorders (SUD). Nevertheless, evidence regarding the effectiveness of these interventions is currently limited, thereby signaling the need to better understand the mechanisms underlying their impact on SUD, in order to reframe and optimize them. Here we advance that physical exercise could be re-conceptualized as an "interoception booster", namely as a way to help people with SUD to better decode and interpret bodily-related signals associated with transient states of homeostatic imbalances that usually trigger consumption. We first discuss how mismatches between current and desired bodily states influence the formation of reward-seeking states in SUD, in light of the insular cortex brain networks. Next, we detail effort perception during physical exercise and discuss how it can be used as a relevant framework for re-dynamizing interoception in SUD. We conclude by providing perspectives and methodological considerations for applying the proposed approach to mixed-design neurocognitive research on SUD.
Collapse
Affiliation(s)
- Damien Brevers
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY), UCLouvain, Louvain-La-Neuve, Belgium
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Philippe de Timary
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY), UCLouvain, Louvain-La-Neuve, Belgium
- Department of Adult Psychiatry, Cliniques universitaires Saint-Luc and Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium
| | - Olivier Desmedt
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY), UCLouvain, Louvain-La-Neuve, Belgium
| | - José Cesar Perales
- Mind, Brain, and Behavior Research Center (CIMCYC), Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Samuel Suárez-Suárez
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY), UCLouvain, Louvain-La-Neuve, Belgium
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoine Bechara
- Department of Psychology, University of Southern California, Los Angeles, California, CA, USA
| |
Collapse
|
3
|
Zhang Z, Huang M, Chen T. Probability and predictors of long-term smoking relapse among Chinese adult smokers: A longitudinal study. Prev Med Rep 2023; 36:102482. [PMID: 37920593 PMCID: PMC10618515 DOI: 10.1016/j.pmedr.2023.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Numerous smokers attempt to quit smoking, but most cessation efforts prove unsuccessful. Scarce evidence exists regarding predictors of long-term relapse in China. This study aims to evaluate the probability of relapse and examine factors may contribute to relapse among Chinese adults. A dynamic cohort of 6,036 observations on 2,378 adult quitters was constructed from the China Family Panel Studies in 2010, 2012, 2014, 2016 and 2018. The life table method was employed to calculate the probability of relapse for long-term smoking abstinence. Multivariate complementary log-log survival models were developed to examine the predictors of smoking relapse. We found that the probability of relapse decreased as the duration of abstinence increased, with rates of 49.07 %, 20.05 %, 10.29 %, and 6.63 % at 2, 4, 6, and 8 years of abstinence, respectively. The cumulative probability of relapse within 8 years was 65.89 %. Age ≥65 years, higher educational attainment, respiratory disease, and a satisfying lifestyle were associated with a reduced likelihood of relapse. Conversely, higher occupational prestige, alcohol drinking, cohabitant smoking, and greater future confidence were associated with an increased risk of relapse. These findings demonstrated that the probability of relapse decreased progressively over time, with most relapses occurring in the initial two years following quit attempts. Predictors of Chinese quitters' relapse behavior in our study were similar to those in previous studies. Drinking and cohabitant smoking were identified as strong predictors of relapse in this population.
Collapse
Affiliation(s)
| | | | - Ting Chen
- School of Public Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
Potter LN, Nahum-Shani I, Wetter DW. Editorial: Digital technology for tobacco control: Novel data collection, study designs, and interventions. Front Digit Health 2023; 5:1341759. [PMID: 38107825 PMCID: PMC10725255 DOI: 10.3389/fdgth.2023.1341759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Lindsey N. Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - David W. Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
5
|
Niemiec CP, Ivarsson A, Weman K, Smit E, Williams GC. Self-determination theory and the smoking cessation process: Daily electronic self-reports can identify the initiation of quit attempts. PATIENT EDUCATION AND COUNSELING 2023; 115:107886. [PMID: 37567038 DOI: 10.1016/j.pec.2023.107886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES To examine the motivational predictors of the smoking cessation process at the between-persons and within-persons levels. METHODS Mediation analyses were conducted on self-report data (N = 236) that were collected using interval contingent sampling over a 39-day study period. RESULTS There was a high rate of attrition, as nearly 50% of participants were lost to follow-up. There were credible indirect effects of autonomous self-regulation on smoking behavior on the next day and seven-day abstinence through perceived competence and medication use. At the between-persons level, these models explained 17% of the variance in smoking behavior on the next day and 31% of the variance in seven-day abstinence; at the within-persons level, these estimates were 39% and 57%, respectively. CONCLUSIONS Day-to-day changes in autonomous self-regulation, perceived competence, and medication use are important initiators of the smoking cessation process. PRACTICE IMPLICATIONS Smokers might be more likely to make a quit attempt if practitioners "tune into" the day-to-day fluctuations of their patients' motivation for stopping smoking, perhaps using an electronic platform to assess and compare smokers' current reports to their previous experiences. Such "motivational attunement" can afford practitioners an opportunity to provide need support when patients are willing and able to initiate a quit attempt.
Collapse
Affiliation(s)
| | - Andreas Ivarsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Karin Weman
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Eline Smit
- School of Communication Research, University of Amsterdam, Amsterdam, the Netherlands
| | | |
Collapse
|
6
|
Perski O, Kwasnicka D, Kale D, Schneider V, Szinay D, ten Hoor G, Asare BY, Verboon P, Powell D, Naughton F, Keller J. Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to quit: A systematic review and meta-analysis of ecological momentary assessment studies. Addiction 2023; 118:1216-1231. [PMID: 36807443 PMCID: PMC10952786 DOI: 10.1111/add.16173] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
Abstract
AIMS When attempting to stop smoking, discrete smoking events ('lapses') are strongly associated with a return to regular smoking ('relapse'). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in ecological momentary assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesize within-person psychological and contextual predictor-lapse associations in smokers attempting to quit. METHODS We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science. A narrative synthesis and multi-level, random-effects meta-analyses were conducted, focusing on studies of adult, non-clinical populations attempting to stop smoking, with no restrictions on setting. Outcomes were the association between a psychological (e.g. stress, cravings) or contextual (e.g. cigarette availability) antecedent and smoking lapse incidence; definitions of 'lapse' and 'relapse'; the theoretical underpinning of EMA study designs; and the proportion of studies with pre-registered study protocols/analysis plans and open data. RESULTS We included 61 studies, with 19 studies contributing ≥ 1 effect size(s) to the meta-analyses. We found positive relationships between lapse incidence and 'environmental and social cues' [k = 12, odds ratio (OR) = 4.53, 95% confidence interval (CI) = 2.02, 10.16, P = 0.001] and 'cravings' (k = 10, OR = 1.71, 95% CI = 1.34, 2.18, P < 0.001). 'Negative feeling states' was not significantly associated with lapse incidence (k = 16, OR = 1.10, 95% CI = 0.98, 1.24, P = 0.12). In the narrative synthesis, negative relationships with lapse incidence were found for 'behavioural regulation', 'motivation not to smoke' and 'beliefs about capabilities'; positive relationships with lapse incidence were found for 'positive feeling states' and 'positive outcome expectancies'. Although lapse definitions were comparable, relapse definitions varied widely across studies. Few studies explicitly drew upon psychological theory to inform EMA study designs. One of the included studies drew upon Open Science principles. CONCLUSIONS In smokers attempting to stop, environmental and social cues and cravings appear to be key within-person antecedents of smoking lapse incidence. Due to low study quality, the confidence in these estimates is reduced.
Collapse
Affiliation(s)
- Olga Perski
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Dominika Kwasnicka
- Faculty of PsychologySWPS University of Social Sciences and HumanitiesWroclawPoland
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
| | - Dimitra Kale
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Verena Schneider
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Dorothy Szinay
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Gill ten Hoor
- Department of Work and Social Psychology, Faculty of Psychology and NeurosciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Bernard Yeboah‐Asiamah Asare
- Curtin School of Population HealthCurtin UniversityPerthAustralia
- Health Psychology, Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Peter Verboon
- Faculty of PsychologyOpen UniversityHeerlenthe Netherlands
| | - Daniel Powell
- Health Psychology, Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
- Rowett InstituteUniversity of AberdeenAberdeenUK
| | - Felix Naughton
- Behavioural and Implementation Science Research Group, School of Health SciencesUniversity of East AngliaNorwichUK
| | - Jan Keller
- Department of Education and PsychologyFreie Universität BerlinBerlinGermany
| |
Collapse
|
7
|
Tonkin S, Gass J, Wray J, Maguin E, Mahoney M, Colder C, Tiffany S, Hawk LW. Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial. J Med Internet Res 2023; 25:e43826. [PMID: 37347538 PMCID: PMC10337346 DOI: 10.2196/43826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/15/2023] [Accepted: 04/20/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is increasingly used to evaluate behavioral health processes over extended time periods. The validity of EMA for providing representative, real-world data with high temporal precision is threatened to the extent that EMA compliance drops over time. OBJECTIVE This research builds on prior short-term studies by evaluating the time course of EMA compliance over 9 weeks and examines predictors of weekly compliance rates among cigarette-using adults. METHODS A total of 257 daily cigarette-using adults participating in a randomized controlled trial for smoking cessation completed daily smartphone EMA assessments, including 1 scheduled morning assessment and 4 random assessments per day. Weekly EMA compliance was calculated and multilevel modeling assessed the rate of change in compliance over the 9-week assessment period. Participant and study characteristics were examined as predictors of overall compliance and changes in compliance rates over time. RESULTS Compliance was higher for scheduled morning assessments (86%) than for random assessments (58%) at the beginning of the EMA period (P<.001). EMA compliance declined linearly across weeks, and the rate of decline was greater for morning assessments (2% per week) than for random assessments (1% per week; P<.001). Declines in compliance were stronger for younger participants (P<.001), participants who were employed full-time (P=.03), and participants who subsequently dropped out of the study (P<.001). Overall compliance was higher among White participants compared to Black or African American participants (P=.001). CONCLUSIONS This study suggests that EMA compliance declines linearly but modestly across lengthy EMA protocols. In general, these data support the validity of EMA for tracking health behavior and hypothesized treatment mechanisms over the course of several months. Future work should target improving compliance among subgroups of participants and investigate the extent to which rapid declines in EMA compliance might prove useful for triggering interventions to prevent study dropout. TRIAL REGISTRATION ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/NCT03262662.
Collapse
Affiliation(s)
- Sarah Tonkin
- Stephenson Cancer Center, Tobacco Settlement Endowment Trust Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Julie Gass
- Department of Veterans Affairs Center for Integrated Healthcare, VA Western NY Healthcare System at Buffalo, Buffalo, NY, United States
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Jennifer Wray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Ralph H Johnson VA Healthcare System, Charleston, SC, United States
| | - Eugene Maguin
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Martin Mahoney
- Departments of Internal Medicine and Health Behavior, Roswell Park Cancer Comprehensive Cancer Center, Buffalo, NY, United States
| | - Craig Colder
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Stephen Tiffany
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Larry W Hawk
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| |
Collapse
|
8
|
Potter LN, Schlechter CR, Nahum-Shani I, Lam CY, Cinciripini PM, Wetter DW. Socio-economic status moderates within-person associations of risk factors and smoking lapse in daily life. Addiction 2023; 118:925-934. [PMID: 36564898 PMCID: PMC10073289 DOI: 10.1111/add.16116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Individuals of lower socio-economic status (SES) display a higher prevalence of smoking and have more diffxiculty quitting than higher SES groups. The current study investigates whether the within-person associations of key risk (e.g. stress) and protective (self-efficacy) factors with smoking lapse varies by facets of SES. DESIGN AND SETTING Observational study using ecological momentary assessment to collect data for a 28-day period following a smoking quit attempt. Multi-level mixed models (i.e. generalized linear mixed models) examined cross-level interactions between lapse risk and protective factors and indicators of SES on smoking lapse. PARTICIPANTS A diverse sample of 330 adult US smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation. MEASUREMENTS Risk factors included momentary urge, negative affect, stress; protective factors included positive affect, motivation, abstinence self-efficacy; SES measures: baseline measures of income and financial strain; the primary outcome was self-reported lapse. FINDINGS Participants provided 43 297 post-quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within-person association of negative [odds ratio (OR) = 0.967, 95% CI= 0.945, 0.990, P < 0.01] and positive affect (OR = 1.023, 95% CI = 1.003, 1.044, P < 0.05) and abstinence self-efficacy (OR = 1.020, 95% CI = 1.003, 1.038, P < 0.05) on lapse varied with financial strain. The within-person association of negative affect (OR = 1.005, 95% CI = 1.002, 1.008, P < 0.01), motivation (OR = 0.995, 95% CI = 0.991, 0.999, P < 0.05) and abstinence self-efficacy (OR = 0.996, 95% CI = 0.993, 0.999, P < 0.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self-efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self-efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse. CONCLUSION Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socio-economic status groups.
Collapse
Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1330, Houston, TX, 77230, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| |
Collapse
|
9
|
Smoking Abstinence Expectancies Among Latinx Smokers: An Initial Test and Evaluation of Individual Difference Factors. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
10
|
Modifying outcome expectancies and behavioral reinforcers to induce quit attempts among young adult smokers. Addict Behav 2023; 137:107542. [PMID: 36356395 DOI: 10.1016/j.addbeh.2022.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
Research has shown that outcome expectancies predict smoking behavior, and expectancy challenge interventions can reduce smoking. This study tested the hypothesis that supplementing expectancy challenge with a behavioral activation intervention promoting increased exposure to alternative reinforcers would help increase motivation to quit and induce actual quit attempts within the following month among young adult smokers. Smokers, aged 18-35 (N = 159, of whom 93 provided one-month follow-up data) and not required to be interested in quitting at the point of enrollment, were randomized to (a) the combined cognitive-behavioral intervention, (b) a cognitive-only expectancy challenge, or (c) a neutral reading (control) task. There were no significant between-group effects on motivation, but the conditions differed significantly in likelihood of leading to a quit attempt. Post hoc comparisons showed the combined condition participants (52 % of completers) to be significantly more likely than control group participants (25 %) to make a quit attempt, with the cognitive-only group (43 %) intermediate and not significantly different from the other conditions. These data provide preliminary evidence of utility for the brief cognitive-behavioral intervention in promoting smoking cessation attempts; more research is needed to test various possible explanations of how and for whom the intervention is effective, as well as whether it would significantly exceed expectancy challenge alone in larger samples.
Collapse
|
11
|
Wood EE, Liang Y, Moon TJ, Wasserman AM, Lamb RJ, Roache JD, Hill-Kapturczak N, Dougherty DM. Reduced alcohol use increases drink-refusal self-efficacy: Evidence from a contingency management study for DWI arrestees. Drug Alcohol Depend 2023; 242:109706. [PMID: 36493503 PMCID: PMC9784176 DOI: 10.1016/j.drugalcdep.2022.109706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several therapies and interventions to reduce drinking first target drink-refusal self-efficacy (DRSE) to influence drinking behavior. While higher self-efficacy scores are correlated with better outcomes, it is unclear that increased self-efficacy is the causative step leading to improved outcomes. Instead, this correlation may result from reduced drinking that increased self-efficacy. The current study sought to understand how changes in drinking behavior can influence DRSE. METHODS Data were from 211 driving while intoxicated (DWI) arrestees participating in an 8-week contingency management (CM) study to reduce drinking. Some of participants were mandated by the courts to wear transdermal alcohol monitoring devices (Mandated group) and some were not mandated (Non Mandated group). All wore a transdermal alcohol monitor during the 8-week study and were randomized to CM or a Control condition stratified by the mandate group. Participants completed weekly assessments of DRSE. Group-based trajectory-modeling identified three drinking behavior trajectory groups. RESULTS While there were no differences in baseline DRSE between the three trajectory groups, participants in the low- and moderate-frequency drinking behavior groups significantly increased DRSE across the study. CONCLUSION The present study indicates that being able to maintain abstinence or reduce heavy drinking may increase DRSE.
Collapse
Affiliation(s)
- Erin E Wood
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, 660 W. Redwood Street, Baltimore, MD 21201, USA
| | - Tae-Joon Moon
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Alexander M Wasserman
- Department of Psychology, Ohio State University, Lazenby Hall 226, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - R J Lamb
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Donald M Dougherty
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| |
Collapse
|
12
|
Potter LN, Schlechter CR, Shono Y, Lam CY, Cinciripini PM, Wetter DW. An ecological momentary assessment study of outcome expectancies and smoking lapse in daily life. Drug Alcohol Depend 2022; 238:109587. [PMID: 35932749 DOI: 10.1016/j.drugalcdep.2022.109587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/30/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Outcome expectancies have been identified as key components of behavior change. Expectancies related to affect control are hypothesized to play an important role in smoking cessation, such that smokers may be more likely to lapse if they believe they can control their affect by smoking and less likely if they believe they can control their affect by means other than smoking. However, little is known about whether real-time, real-world changes in affect control expectancies influence smoking lapse during a quit attempt. METHODS A diverse sample (N = 369) of adult smokers completed ecological momentary assessment of smoking expectancies and lapse for 28 days following a quit attempt. Multilevel logistic regression was used to examine whether the difference score of positive smoking outcome expectancies (the belief that smoking would improve mood) minus positive coping outcome expectancies (the belief that something other than smoking would improve mood) was related to smoking lapse in daily life. RESULTS There was a significant within-person association between the expectancies difference score and lapse likelihood. When the difference score was 1 unit above a person's typical level, odds of lapse increased by 18.65 % (β = 0.174, SE = 0.024, p < .0001, OR = 1.189, 95 % CI [1.135, 1.247]). CONCLUSION Smokers undergoing a quit attempt were more likely to lapse in moments when the difference in the belief that smoking would improve their mood minus the belief that something other than smoking would improve their mood was larger. This work has relevance for tailoring interventions to both cultivate positive coping outcome expectancies and reduce smoking outcome expectancies, and informs theoretical models about the dynamic nature of outcome expectancies.
Collapse
Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Yusuke Shono
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL 60611, USA.
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1330, Houston, TX 77230, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| |
Collapse
|
13
|
Ullah MA, Chatterjee S, Fagundes CP, Lam C, Nahum-Shani I, Rehg JM, Wetter DW, Kumar S. mRisk: Continuous Risk Estimation for Smoking Lapse from Noisy Sensor Data with Incomplete and Positive-Only Labels. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2022; 6:143. [PMID: 36873428 PMCID: PMC9979627 DOI: 10.1145/3550308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Passive detection of risk factors (that may influence unhealthy or adverse behaviors) via wearable and mobile sensors has created new opportunities to improve the effectiveness of behavioral interventions. A key goal is to find opportune moments for intervention by passively detecting rising risk of an imminent adverse behavior. But, it has been difficult due to substantial noise in the data collected by sensors in the natural environment and a lack of reliable label assignment of low- and high-risk states to the continuous stream of sensor data. In this paper, we propose an event-based encoding of sensor data to reduce the effect of noises and then present an approach to efficiently model the historical influence of recent and past sensor-derived contexts on the likelihood of an adverse behavior. Next, to circumvent the lack of any confirmed negative labels (i.e., time periods with no high-risk moment), and only a few positive labels (i.e., detected adverse behavior), we propose a new loss function. We use 1,012 days of sensor and self-report data collected from 92 participants in a smoking cessation field study to train deep learning models to produce a continuous risk estimate for the likelihood of an impending smoking lapse. The risk dynamics produced by the model show that risk peaks an average of 44 minutes before a lapse. Simulations on field study data show that using our model can create intervention opportunities for 85% of lapses with 5.5 interventions per day.
Collapse
|
14
|
Dowling NA, Merkouris SS, Youssef GJ, Lubman DI, Bagot KL, Hawker CO, Portogallo HJ, Thomas AC, Rodda SN. GAMBLINGLESS IN-THE-MOMENT: Protocol for a micro-randomised trial of a gambling Just-In-Time Adaptive Intervention (Preprint). JMIR Res Protoc 2022; 11:e38958. [PMID: 35998018 PMCID: PMC9449828 DOI: 10.2196/38958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID) PRR1-10.2196/38958
Collapse
Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | | | - Dan I Lubman
- Turning Point and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Chloe O Hawker
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Anna C Thomas
- School of Psychology, Deakin University, Geelong, Australia
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
- School of Population Health, University of Auckland, Grafton, New Zealand
| |
Collapse
|
15
|
Do number of smoking friends and changes over time predict smoking relapse? Findings from the International Tobacco Control Four-Country Survey. J Subst Abuse Treat 2022; 138:108763. [DOI: 10.1016/j.jsat.2022.108763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 11/21/2022]
|
16
|
Coughlin LN, Bonar EE, Walton MA, Fernandez AC, Duguid I, Nahum-Shani I. New Directions for Motivational Incentive Interventions for Smoking Cessation. Front Digit Health 2022; 4:803301. [PMID: 35310552 PMCID: PMC8931767 DOI: 10.3389/fdgth.2022.803301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Motivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal intervention engagement, individual burden, and up-front costs. Purpose Technological advancements can mitigate some of these barriers. For example, mobile abstinence monitoring and digital, automated incentive delivery have the potential to lower the clinic burden associated with monitoring abstinence and administering incentives while also reducing the frequency of clinic visits. However, to fully realize the potential of digital technologies to deliver motivational incentives it is critical to develop strategies to mitigate longstanding concerns that reliance on extrinsic monetary reinforcement may hamper internal motivation for cessation, improve individual engagement with the intervention, and address scalability limitations due to the up-front cost of monetary incentives. Herein, we describe the state of digitally-delivered motivational incentives. We then build on existing principles for creating just-in-time adaptive interventions to highlight new directions in leveraging digital technology to improve the effectiveness and scalability of motivational incentive interventions. Conclusions Technological advancement in abstinence monitoring coupled with digital delivery of reinforcers has made the use of motivational incentives for smoking cessation increasingly feasible. We propose future directions for a new era of motivational incentive interventions that leverage technology to integrate monetary and non-monetary incentives in a way that addresses the changing needs of individuals as they unfold in real-time.
Collapse
Affiliation(s)
- Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Lara N. Coughlin
| | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Anne C. Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Isabelle Duguid
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
17
|
Manning K, Garey L, Viana AG, Smit T, Zvolensky MJ. The moderating role of anxiety sensitivity in terms of fatigue severity and e-cigarette use expectancies. J Health Psychol 2021; 26:2676-2687. [PMID: 32498566 PMCID: PMC7916988 DOI: 10.1177/1359105320926534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Little is understood about individual difference factors related to e-cigarette expectancies about use. This study examined the interactive effects of fatigue severity and anxiety sensitivity in relation to e-cigarette expectancies among 525 e-cigarette users (51.0% female, Mage = 35.25 years, standard deviation = 10.10). Results indicated a significant interaction between fatigue severity and anxiety sensitivity in terms of positive expectancies (β = 0.57, p < 0.001, 95% confidence interval = (0.002, 0.01)), but not for negative expectancies (β = 0.25, p = 0.08, 95% confidence interval = (0, 0.005)) for e-cigarette use. These results support anxiety sensitivity as a moderator in the relation between fatigue severity and positive outcome expectancies for e-cigarette use.
Collapse
Affiliation(s)
| | | | | | | | - Michael J Zvolensky
- University of Houston, USA
- The University of Texas MD Anderson Cancer Center, USA
| |
Collapse
|
18
|
Baker TB, Bolt DM, Smith SS. Barriers to Building More Effective Treatments: Negative Interactions Amongst Smoking Intervention Components. Clin Psychol Sci 2021; 9:995-1020. [PMID: 35003904 PMCID: PMC8740936 DOI: 10.1177/2167702621994551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Meaningfully improved mental and behavioral health treatment is an unrealized dream. Across three factorial experiments, inferential tests in prior studies showed a pattern of negative interactions suggesting that better clinical outcomes are obtained when participants receive fewer rather than more intervention components. Further, relatively few significant main effects were found in these experiments. Modeling suggested that negative interactions amongst components may account for these patterns. This paper evaluates factors that may contribute to such declining benefit: increased attentional or effort burden; components that produce their effects via the same capacity limited mechanisms, making their effects subadditive; and a tipping point phenomenon in which those near a hypothesized "tipping point" for change will benefit markedly from weak intervention while those far from the tipping point will benefit little from even strong intervention. New research should explore factors that cause negative interactions amongst components and constrain the development of more effective treatments.
Collapse
Affiliation(s)
- Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin, Department of Educational Psychology, 1025 W. Johnson St., Madison, WI 53706
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| |
Collapse
|
19
|
Auster-Gussman LA, Gavin KL, Siddique J, Welch WA, Solk P, Whitaker M, Cullather E, Fanning J, Maria CS, Gradishar W, Khan S, Kulkarni S, Phillips SM. Social cognitive variables and physical activity during chemotherapy for breast cancer: An intensive longitudinal examination. Psychooncology 2021; 31:425-435. [PMID: 34546611 DOI: 10.1002/pon.5820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although physical activity is associated with better health outcomes in breast cancer survivors (BCS), activity often declines during cancer treatment. Social cognitive theory (SCT) constructs have been associated with physical activity in post-treatment BCS, but little is known about the relation between these constructs and physical activity during chemotherapy. METHODS BCS (n = 67; Mage = 48.6 [SD = 10.3]) undergoing chemotherapy wore accelerometers and completed prompts in the morning and at night assessing same-day and next-day exercise self-efficacy, physical and psychological outcome expectations, and goal-setting for 10 consecutive days (3 days pre-, day of, and 6 days post-chemotherapy dose) at three time points (beginning, middle, and end of chemotherapy). Separate mixed models assessed between- and within-person associations of each of the SCT constructs associations with same- and next-day moderate to vigorous physical activity (MVPA) and light physical activity (LPA), independently. RESULTS Within-person differences in all SCT variables were statistically significantly related to same-day MVPA (p's < 0.001) and LPA (p's < 0.001). Every one-point increase in SCT construct related to an increase in MVPA ranging from (a) 3.70 (self-efficacy) to 8.02 (physical outcome expectations) minute increase in MVPA and (b) 12.72 (self-efficacy) to 20.38 (physical outcome expectations) increase in LPA that day. No same-day between-person effects nor any next-day effects were significant. CONCLUSION MVPA and LPA were related to same-day within-person differences in SCT variables. Interventions targeted at increasing or mitigating chemotherapy-related declines in daily within-person changes in SCT constructs could help to increase physical activity among BCS during chemotherapy.
Collapse
Affiliation(s)
- Lisa A Auster-Gussman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kara L Gavin
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Whitney A Welch
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Payton Solk
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Madelyn Whitaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin Cullather
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Cesar Santa Maria
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William Gradishar
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Seema Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Swati Kulkarni
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
20
|
Park MJ, Seo YG, Noh HM, Kim Y, Yoon JL, Paek YJ. Effectiveness of National Residential Smoking Cessation Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9901. [PMID: 34574823 PMCID: PMC8466792 DOI: 10.3390/ijerph18189901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
We aimed to investigate the effectiveness of the Korean national five-day residential smoking cessation program and the factors affecting the long-term smoking cessation of participants. The residential smoking cessation program (2017-2018) recruited smokers with a smoking duration ≥ 20 years and who have attempted to quit smoking more than twice and/or smokers with chronic morbidities. Participants underwent an intensive intervention, including individual psychological therapy, group therapy, medical counseling, and pharmacotherapy. The 6-month continuous abstinence rate (CAR) was assessed via self-reports, the urine cotinine levels, and/or expired-air carbon monoxide levels. Logistic regression was used to analyze the adjusted odds ratio (aOR) to assess factors related to smoking cessation. Overall, 484 participants who completed the residential program and questionnaire were evaluated. The 3- and 6-month CAR were 81.82% and 63.22%, respectively. The aOR of 6-month continuous abstinence was lower among participants with severe nicotine dependence (aOR: 0.46, 95% confidence interval [CI]: 0.26-0.81) and higher among participants with combination therapy of varenicline with short-term nicotine replacement therapy (NRT) (aOR: 1.64, 95% CI: 1.07-2.51), with higher self-efficacy (aOR: 1.97, 95% CI: 1.15-3.37). The residential smoking cessation program was effective. High self-efficacy, combination therapy of varenicline with short-term NRT, and low nicotine dependence were associated with a high 6-month CAR.
Collapse
Affiliation(s)
- Mi-Jeong Park
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea; (M.-J.P.); (J.L.Y.)
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (Y.-G.S.); (H.-M.N.)
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (Y.-G.S.); (H.-M.N.)
| | - Yeol Kim
- National Cancer Center, Division of Center for Cancer Prevention and Detection, Goyang 10408, Korea;
- National Cancer Center, National Cancer Control Institute, Goyang 10408, Korea
| | - Jong Lull Yoon
- Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea; (M.-J.P.); (J.L.Y.)
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (Y.-G.S.); (H.-M.N.)
| |
Collapse
|
21
|
Vinci C, Cambron C, Lam C, Wetter DW. Perceived discrimination and smoking lapse among Mexican Americans: An ecological momentary assessment study. Health Psychol 2021; 40:388-397. [PMID: 34323541 PMCID: PMC8344071 DOI: 10.1037/hea0001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Racial/ethnic minorities face unique stressors, including perceived discrimination (PD), that may increase the difficulty of quitting smoking relative to the general population of smokers. The current study examines the impact of acute PD on smoking lapse during a quit attempt, as well as potential mechanisms linking PD to lapse among Spanish-speaking Mexican Americans. METHOD Participants (N = 169) were Spanish-speaking Mexican Americans living in the United States who completed ecological momentary assessments (EMAs) multiple times per day for 21 days postquit. A multilevel structural equation model decomposed the effect of PD on smoking lapse into indirect effects through negative affect, positive affect, smoking urge, motivation to quit, and self-efficacy. RESULTS Results indicated that PD operated indirectly through negative affect, positive affect, and urge to smoke, above and beyond other mechanisms, to increase risk for smoking lapse. CONCLUSIONS Findings have direct implications for intervention development among this population, including the potential for developing strategies to buffer the impact of PD, as well as skills to directly manage increased negative affect and urge to smoke. Just-in-time adaptive interventions (JITAIs) might be particularly useful, given they are designed to deliver treatment in real-time (e.g., delivery of strategies to build resilience and implement coping strategies) that could counter the impact of PD on smoking lapse. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
22
|
Naughton F, Brown C, High J, Notley C, Mascolo C, Coleman T, Barton G, Shepstone L, Sutton S, Prevost AT, Crane D, Greaves F, Hope A. Randomised controlled trial of a just-in-time adaptive intervention (JITAI) smoking cessation smartphone app: the Quit Sense feasibility trial protocol. BMJ Open 2021; 11:e048204. [PMID: 33903144 PMCID: PMC8076923 DOI: 10.1136/bmjopen-2020-048204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A lapse (any smoking) early in a smoking cessation attempt is strongly associated with reduced success. A substantial proportion of lapses are due to urges to smoke triggered by situational cues. Currently, no available interventions proactively respond to such cues in real time. Quit Sense is a theory-guided just-in-time adaptive intervention smartphone app that uses a learning tool and smartphone sensing to provide in-the-moment tailored support to help smokers manage cue-induced urges to smoke. The primary aim of this randomised controlled trial (RCT) is to assess the feasibility of delivering a definitive online efficacy trial of Quit Sense. METHODS AND ANALYSES A two-arm parallel-group RCT allocating smokers willing to make a quit attempt, recruited via online adverts, to usual care (referral to the NHS SmokeFree website) or usual care plus Quit Sense. Randomisation will be stratified by smoking rate (<16 vs ≥16 cigarettes/day) and socioeconomic status (low vs high). Recruitment, enrolment, baseline data collection, allocation and intervention delivery will be automated through the study website. Outcomes will be collected at 6 weeks and 6 months follow-up via the study website or telephone, and during app usage. The study aims to recruit 200 smokers to estimate key feasibility outcomes, the preliminary impact of Quit Sense and potential cost-effectiveness, in addition to gaining insights on user views of the app through qualitative interviews. ETHICS AND DISSEMINATION Ethics approval has been granted by the Wales NHS Research Ethics Committee 7 (19/WA/0361). The findings will be disseminated to the public, the funders, relevant practice and policy representatives and other researchers. TRIAL REGISTRATION NUMBER ISRCTN12326962.
Collapse
Affiliation(s)
- Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Chloë Brown
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Juliet High
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Cecilia Mascolo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Tim Coleman
- Division of General Practice, University of Nottingham, Nottingham, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - A Toby Prevost
- Nightingale-Saunders Clinical Trials & Epidemiology Unit, King's College London, London, UK
| | - David Crane
- Department of Behavioural Science and Health, University College London, London, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Aimie Hope
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
23
|
Dowling NA, Merkouris SS, Spence K. Ecological Momentary Assessment of the Relationship between Positive Outcome Expectancies and Gambling Behaviour. J Clin Med 2021; 10:1709. [PMID: 33921069 PMCID: PMC8071390 DOI: 10.3390/jcm10081709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/04/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
Relapse prevention models suggest that positive outcome expectancies can constitute situational determinants of relapse episodes that interact with other factors to determine the likelihood of relapse. The primary aims were to examine reciprocal relationships between situational positive gambling outcome expectancies and gambling behaviour and moderators of these relationships. An online survey and a 28 day Ecological Momentary Assessment (EMA) were administered to 109 past-month gamblers (84% with gambling problems). EMA measures included outcome expectancies (enjoyment/arousal, self-enhancement, money), self-efficacy, craving, negative emotional state, interpersonal conflict, social pressure, positive emotional state, financial pressures, and gambling behaviour (episodes, expenditure). Pre-EMA measures included problem gambling severity, motives, psychological distress, coping strategies, and outcome expectancies. No reciprocal relationships between EMA outcome expectancies and gambling behaviour (episodes, expenditure) were identified. Moderations predicting gambling episodes revealed: (1) cravings and problem gambling exacerbated effects of enjoyment/arousal expectancies; (2) positive emotional state and positive reframing coping exacerbated effects of self-enhancement expectancies; and (3) instrumental social support buffered effects of money expectancies. Positive outcome expectancies therefore constitute situational determinants of gambling behaviour, but only when they interact with other factors. All pre-EMA expectancies predicted problem gambling severity (OR = 1.61-3.25). Real-time interventions addressing gambling outcome expectancies tailored to vulnerable gamblers are required.
Collapse
Affiliation(s)
- Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (K.S.)
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC 3053, Australia
- School of Psychology, Faculty of Health, Melbourne Burwood Campus, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | | | - Kimberley Spence
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (K.S.)
| |
Collapse
|
24
|
Maladaptive Personality Traits and Their Interaction with Outcome Expectancies in Gaming Disorder and Internet-Related Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083967. [PMID: 33918737 PMCID: PMC8070224 DOI: 10.3390/ijerph18083967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022]
Abstract
Gambling disorder and gaming disorder have recently been recognized as behavioral addictions in the ICD-11 (International Classification of Diseases, 11th edition). The association between behavioral addictions and personality has been examined before, yet there is a lack of studies on maladaptive traits and their relationship to specific outcome expectancies. In study 1, we recruited a community sample (n = 365); in study 2 a sample of treatment-seekers was enrolled (n = 208). Maladaptive personality traits were assessed by the brief form of the Personality Inventory for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Internet-related outcome expectancies were measured by the Virtual Expectancy Questionnaire. In the clinical sample, the Global Assessment of Functioning was additionally administered. Behavioral Addictions were closely associated with maladaptive traits that in turn were related to a poorer level of psychosocial functioning. There is evidence for an exacerbated risk of internet-related disorders when specific outcome expectancies and maladaptive traits interact. Implications for phenomenology and treatment are discussed.
Collapse
|
25
|
Alexander AC, Waring JJC, Hébert ET, Ra CK, Rangu N, Kendzor DE, Businelle MS. Identifying mechanisms that link pain to smoking relapse during a quit attempt. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:52-61. [PMID: 33719473 DOI: 10.1037/adb0000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Emerging evidence suggests that adults with chronic pain have poor smoking cessation outcomes, but the exact mechanisms are less understood. This study examined whether depression, anxiety, stress, and then, positive outcome expectancy for smoking mediated the association between pain and smoking relapse during a quit attempt. METHODS This study is a secondary data analysis of a three-armed randomized clinical trial that compared in-person and smartphone-based smoking cessation interventions. Participants (N = 81) self-reported the amount of bodily pain they experienced in the past 4 weeks at baseline. Depression, anxiety, stress, and positive outcome expectancy for smoking were measured daily, via a smartphone app, throughout the first week of the quit attempt, and were aggregated to the week level for analyses. Biochemically verified smoking abstinence was assessed 4 weeks postquit date. RESULTS Sequential mediation analyses showed that pain was indirectly associated with smoking relapse through greater feelings of stress and then higher expectations that smoking would improve mood (B = 0.22 [95% CI = 0.03, 0.65]). The pathways for depression and anxiety were not significant mediators of pain and smoking relapse. CONCLUSION Findings from this study indicate that pain is indirectly associated with smoking relapse through feelings of stress and then positive outcome expectancy for smoking. Smoking cessation treatment for adults who experience high levels of bodily pain should include psychoeducation that teaches adaptive coping responses, such as mindfulness, to manage stress, and challenge expectations about the ability of smoking to improve mood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Adam C Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Joseph J C Waring
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Chaelin Karen Ra
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Neal Rangu
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Darla E Kendzor
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| |
Collapse
|
26
|
Zvolensky MJ, Manning K, Garey L, Alfano CA, Mayorga NA, Peraza N. Emotion dysregulation, fatigue, and electronic cigarette expectancies. Cogn Behav Ther 2021; 50:138-153. [PMID: 33006499 PMCID: PMC7916989 DOI: 10.1080/16506073.2020.1819868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Emotion dysregulation and the experience of fatigue have both been linked to the maintenance of substance use. However, limited empirical data has evaluated individual differences in these constructs in terms of e-cigarette use expectancies. The present study examined a theoretically relevant model focused on whether the experience of more severe fatigue explains, in part, the relation between individual differences in emotion dysregulation and positive and negative e-cigarette expectancies among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). It was hypothesized that emotion dysregulation, via fatigue severity, would significantly predict greater positive and negative e-cigarette expectancies, which was examined in two separate mediation models. Fatigue severity significantly explained, in part, the relation between emotion dysregulation and positive (b = 0.02, CI [0.01, 0.02]) and negative expectancies of e-cigarette use (b = 0.02, 95% CI [0.02, 0.03]). The current findings suggest that the experience of fatigue helps explain the relation between emotion dysregulation and positive and negative e-cigarette expectancies among adult e-cigarette users. Future work is needed to explicate how reducing fatigue severity in the context of emotion dysregulation may change expectancies about e-cigarette expectancies.
Collapse
Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Psychology, HEALTH Institute, University of Houston, Houston, TX, USA
| | - Kara Manning
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Natalia Peraza
- Department of Psychology, University of Houston, Houston, TX, USA
| |
Collapse
|
27
|
Van Dessel P, Tibboel H. Assessing the influence of warnings with testimonies from former smokers on smoking and quitting behaviour. Br J Health Psychol 2021; 26:917-934. [PMID: 33554386 DOI: 10.1111/bjhp.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cigarette pack warnings are widely used internationally for reducing smoking behaviour. Current warnings typically consist of a textual or graphic warning that smoking can lead to negative (health) outcomes. Though these warnings have proven benefits, they also have important limitations. Most notably, they do not produce beneficial changes in important cognitive determinants of smoking cessation such as self-efficacy to refrain from smoking and they do not reduce smoking for specific subsets of the target population. Recent studies provide evidence for the effectiveness of health warnings that include health-related testimonies from former smokers. METHODS We designed cigarette pack warnings that consist of more general testimonial statements from former smokers, selected in a pilot study for their potential impact on two important cognitive determinants of smoking (i.e., self-efficacy beliefs and outcome expectancies). In the main study, online participants were either exposed to the new testimonial warnings, to graphic health warnings, or to text-only health warnings on four separate occasions during a 24-h window. RESULTS In a sample of 416 daily smokers, we observed beneficial changes in self-reported cigarette smoking, craving, quit intentions, evaluations of smoking, self-efficacy, and outcome expectancies, immediately after viewing the warnings a first time and after multiple exposures. These effects were comparable for participants in the three warning type groups, with some (small) differences for changes in outcome expectancies and craving. CONCLUSIONS Warnings with general testimonies from former smokers might provide a useful evidence-based addition to currently used cigarette pack health warnings.
Collapse
Affiliation(s)
- Pieter Van Dessel
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Helen Tibboel
- Erasmus School of Social and Behavior Sciences, Erasmus University Rotterdam, The Netherlands
| |
Collapse
|
28
|
Navarro MA, Hoffman L, Ganz O, Guillory J, Crankshaw EC. Those who believe they can, do: The relationship between smoking avoidance beliefs, perceived risks of smoking, and behavior in a sexual and gender minority young adult sample. Addict Behav 2021; 113:106733. [PMID: 33223360 PMCID: PMC8284558 DOI: 10.1016/j.addbeh.2020.106733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/06/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
An individual’s beliefs in their perceived risk and ability to resist smoking have been found to be associated with smoking behavior. The current study explores the effects of confidence in one’s ability to avoid smoking, measured by avoidance beliefs, on the relationship between perceived risks of smoking and behavior. This analysis was done using 2016 baseline data collected among 4057 participants aged 18–24 for the evaluation of a large-scale public education campaign in the U.S. aimed at reducing tobacco use among sexual and gender minority young adults. The analytic sample included roughly 3493 participants per analysis. Analyses used the following measures: (1) perceived risks of smoking (e.g., smoking cigarettes will shorten my life); (2) confidence to avoid smoking in various situations (i.e., avoidance beliefs), and (3) past 30-day cigarette smoking. Binary logistic regression models with interaction analyses assessed the relationship between perceived risks of smoking and past 30-day smoking behavior using the interaction term of avoidance beliefs. An interaction between perceived risks of smoking and avoidance behaviors interaction emerged, such that the negative relationship between perceived risks of smoking and smoking behavior was stronger for those who believed that they could avoid smoking in various situations. This suggests that the relationship between perceived risk and smoking behavior can be bolstered if one’s beliefs about their ability to avoid smoking are strong. Campaigns that build smoking avoidance confidence may enhance the effects of tobacco outcome expectations-related messaging on smoking.
Collapse
|
29
|
Potter LN, Haaland BA, Lam CY, Cambron C, Schlechter CR, Cinciripini PM, Wetter DW. A time-varying model of the dynamics of smoking lapse. Health Psychol 2020; 40:40-50. [PMID: 33370151 DOI: 10.1037/hea0001036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The majority of smokers who make a quit attempt experience their first lapse within the first week of quitting, yet limited research to date has examined how the strength and direction of the relationship between smoking risk factors and lapse may change over longer periods of time. Time-varying effect modeling (TVEM) was used to address this gap. METHOD A diverse sample (N = 325) of adult smokers completed ecological momentary assessments of risk factors for lapse for 28 days after quitting. TVEM was used to examine the relationship between risk factors (abstinence self-efficacy, positive affect, positive coping expectancies, smoking expectancies, motivation, negative affect, stress, and urge) and lapse for 28 days postquit. RESULTS Some associations were stable (e.g., negative affect, motivation), whereas others varied over time. Abstinence self-efficacy, positive affect, and positive coping expectancies were most strongly associated with lapse between Days 3 and 8 postquit. The association of urge with lapse was strongest between Days 4 and 10, as well as near the end of the quit attempt. Stress was also most strongly associated with lapse near the beginning and end of the postquit period and was the only predictor associated with lapse on quit date. The strength of the association between smoking expectancies and lapse increased over time. CONCLUSION There may be periods during a quit attempt when certain risk factors are more strongly related to lapse. This work has relevance for tailoring interventions designed to deliver intervention components in particular contexts or times of need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| | - Benjamin A Haaland
- Cancer Biostatistics Shared Resource at Huntsman Cancer Institute, University of Utah
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| | | | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, University of Texas
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| |
Collapse
|
30
|
Muench C, Malloy EJ, Juliano LM. Lower self-efficacy and greater depressive symptoms predict greater failure to recover from a single lapse cigarette. J Consult Clin Psychol 2020; 88:965-970. [PMID: 33048572 DOI: 10.1037/ccp0000605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Smoking reexposure after a quit attempt (i.e., lapse) increases relapse risk, but lapse recovery is possible. Using a 6-day analogue model of smoking cessation and lapse, this study tested the effect of a single lapse cigarette on the risk of subsequent smoking. Abstinence self-efficacy (ASE) and depressive symptoms (using the Center for Epidemiological Studies Depression Scale, CES-D) were also examined as hypothesized moderators of lapse recovery. METHOD After receiving cessation counseling and achieving 2 days of incentivized abstinence, 54 daily smokers (mean age: 41 years, 61% African American, 63% male) were randomly assigned to smoke 1 cigarette or to a no-lapse control condition. Participants were then offered monetary incentives to abstain for 3 more days and smoking was monitored. RESULTS Compared to the control condition, participants who experienced a lapse had a 2.5 times greater risk of smoking in the first 24 hours Furthermore, a lapse resulted in much greater risk of subsequent smoking compared to the control condition among individuals with lower postquit ASE scores (p = .044) and greater CES-D scores (p = .040). CONCLUSIONS These findings provide preliminary evidence that a single lapse cigarette after quitting plays a causal role in subsequent smoking and suggest that individuals with lower postquit ASE and greater depressive symptoms are less likely to recover from a lapse. Future research should investigate factors associated with lapse recovery and failure so that effective lapse-responsive strategies can be developed. Laboratory models provide an efficient and controlled method to examine such processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
31
|
Rodriguez-Cano R, Garey L, Bakhshaie J, Shepherd JM, Zvolensky MJ. The synergetic effect of alcohol consumption and cigarettes per day on smoking outcomes expectancies among Latinx adult smokers. J Ethn Subst Abuse 2020; 21:975-996. [PMID: 32915108 DOI: 10.1080/15332640.2020.1815114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study investigated alcohol consumption and cigarettes per day in relation to smoking outcome expectancies among Spanish-speaking Latinx daily smokers (N = 371). There was a significant interaction between alcohol consumption and number of cigarettes per day on positive smoking expectancies. Specifically, alcohol consumption has a stronger association with positive expectancies for smoking at lower rates of cigarettes per day. No such interaction was evident for negative consequence smoking expectancies. The current study highlights the potential importance of alcohol consumption and smoking rate for better understanding smoking outcome expectancies among Latinx smokers.
Collapse
Affiliation(s)
- Ruben Rodriguez-Cano
- The University of Texas MD Anderson Cancer Center, Houston, Texas.,University of Houston, Houston, Texas
| | | | | | | | - Michael J Zvolensky
- The University of Texas MD Anderson Cancer Center, Houston, Texas.,University of Houston, Houston, Texas.,HEALTH Institute, University of Houston, Houston, Texas
| |
Collapse
|
32
|
Carpenter SM, Menictas M, Nahum-Shani I, Wetter DW, Murphy SA. Developments in Mobile Health Just-in-Time Adaptive Interventions for Addiction Science. CURRENT ADDICTION REPORTS 2020; 7:280-290. [PMID: 33747711 PMCID: PMC7968352 DOI: 10.1007/s40429-020-00322-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Addiction is a serious and prevalent problem across the globe. An important challenge facing intervention science is how to support addiction treatment and recovery while mitigating the associated cost and stigma. A promising solution is the use of mobile health (mHealth) just-in-time adaptive interventions (JITAIs), in which intervention options are delivered in situ via a mobile device when individuals are most in need. RECENT FINDINGS The present review describes the use of mHealth JITAIs to support addiction treatment and recovery, and provides guidance on when and how the micro-randomized trial (MRT) can be used to optimize a JITAI. We describe the design of five mHealth JITAIs in addiction and three MRT studies, and discuss challenges and future directions. SUMMARY This review aims to provide guidance for constructing effective JITAIs to support addiction treatment and recovery.
Collapse
Affiliation(s)
| | | | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - David W. Wetter
- Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT
| | | |
Collapse
|
33
|
Kaufmann A, Malloy EJ, Haaga DAF. Examining outcome expectancies for smoking vs. abstinence among adult daily smokers. Addict Behav 2020; 102:106140. [PMID: 31706142 PMCID: PMC7135904 DOI: 10.1016/j.addbeh.2019.106140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022]
Abstract
In a motivational interviewing (MI) framework of decision-making, we consider potential outcomes for both a primary choice and an alternative choice (DiClemente & Velazquez, 2002). Thus, we would expect that motivation to quit smoking is related to expectancies for quitting smoking and expectancies for continuing to smoke. While smoking expectancies have been frequently studied, less attention has been paid to abstinence expectancies. The present study sought to clarify the predictive utility of smoking and abstinence expectancies together for smoking motivation and behavior, versus measuring smoking expectancies alone. Expectancies were measured at baseline; outcomes were measured at baseline and one-month follow-up. Smoking expectancies were assessed via the Smoking Consequences Questionnaire-Adult (Copeland, Brandon, & Quinn, 1995), and abstinence expectancies were assessed via the Perceived Risks and Benefits of Quitting scale (McKee, O'Malley, Salovey, Krishnan-Sarin, & Mazure, 2005). Outcomes included motivation to quit (Contemplation Ladder, Biener & Abrams, 1991; Stage of Change, DiClemente et al., 1991), and average daily smoking rate. Data was analyzed for 183 smokers at baseline and 166 at follow-up. Baseline smoking expectancies and abstinence expectancies were each uniquely associated with concurrent motivation to quit, but not concurrent smoking rate. Abstinence expectancies uniquely predicted changes in smoking rate over time. Smoking and abstinence outcome expectancies may relate differently to smoking behavior, motivation to quit, and changes in these constructs over time.
Collapse
|
34
|
Chatterjee S, Moreno A, Lizotte SL, Akther S, Ertin E, Fagundes CP, Lam C, Rehg JM, Wan N, Wetter DW, Kumar S. SmokingOpp: Detecting the Smoking 'Opportunity' Context Using Mobile Sensors. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2020; 4. [PMID: 34651096 DOI: 10.1145/3380987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Context plays a key role in impulsive adverse behaviors such as fights, suicide attempts, binge-drinking, and smoking lapse. Several contexts dissuade such behaviors, but some may trigger adverse impulsive behaviors. We define these latter contexts as 'opportunity' contexts, as their passive detection from sensors can be used to deliver context-sensitive interventions. In this paper, we define the general concept of 'opportunity' contexts and apply it to the case of smoking cessation. We operationalize the smoking 'opportunity' context, using self-reported smoking allowance and cigarette availability. We show its clinical utility by establishing its association with smoking occurrences using Granger causality. Next, we mine several informative features from GPS traces, including the novel location context of smoking spots, to develop the SmokingOpp model for automatically detecting the smoking 'opportunity' context. Finally, we train and evaluate the SmokingOpp model using 15 million GPS points and 3,432 self-reports from 90 newly abstinent smokers in a smoking cessation study.
Collapse
Affiliation(s)
| | | | | | | | - Emre Ertin
- The Ohio State University, Columbus, OH, 43210, USA
| | | | - Cho Lam
- University of Utah, Salt Lake City, UT, 84112, USA
| | - James M Rehg
- Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Neng Wan
- University of Utah, Salt Lake City, UT, 84112, USA
| | | | | |
Collapse
|
35
|
Nahum-Shani I, Smith SN, Spring BJ, Collins LM, Witkiewitz K, Tewari A, Murphy SA. Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support. Ann Behav Med 2019; 52:446-462. [PMID: 27663578 PMCID: PMC5364076 DOI: 10.1007/s12160-016-9830-8] [Citation(s) in RCA: 849] [Impact Index Per Article: 169.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual's state can change rapidly, unexpectedly, and in his/her natural environment. Purpose Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap. Methods Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration. Conclusions As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.
Collapse
Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N Smith
- Division of General Medicine, Department of Internal Medicine and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Bonnie J Spring
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Linda M Collins
- TheMethodology Center andDepartment ofHuman Development & Family Studies, Penn State, State College, PA, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Ambuj Tewari
- Department of Statistics and Department of EECS, University of Michigan, Ann Arbor, MI, USA
| | - Susan A Murphy
- Department of Statistics, and Institute for Social Research,University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
36
|
Li M, Okamoto R, Shirai F. Factors associated with smoking cessation and relapse in the Japanese smoking cessation treatment program: A prospective cohort study based on financial support in Suita City, Japan. Tob Induc Dis 2019; 17:71. [PMID: 31636526 PMCID: PMC6786003 DOI: 10.18332/tid/112154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The purpose of this study is to clarify the effect of providing financial support and factors associated with smoking cessation and relapse in the Japanese smoking cessation treatment (SCT) program based on financial support. METHODS A prospective cohort study was conducted at the smoking cessation outpatients of hospitals or clinics in Suita City, Japan from May 2017 to September 2018. In all, 153 participants were recruited and received standardized treatment based on the SCT program. Participants were required to answer four questionnaires and register for the financial support program. Chi-squared test, Fisher’s exact test, non-paired t-test and log-binomial regression analysis were used to analyze the data. RESULTS Of the 153 participants, 140 participants completed a 12-week treatment and the completion rate was 91.5%. There were no factors significantly associated with smoking cessation and relapse (p<0.05). However, male, cigarettes smoked per day, having present diseases, having previous abstinence, living with family, cohabitation with smokers, desire to smoke at the start of treatment, self-efficacy at the start of treatment, desire to smoke at 4 weeks and self-efficacy at 4 weeks showed statistically significant odds ratio for success of smoking cessation. Similarly at 12 weeks, male, age at smoking initiation, cigarettes smoked per day, having previous abstinence, living with family, cohabitation with smokers, desire to smoke, self-efficacy and depression disorders showed statistically significant odds ratio for smoking relapse. In addition, the rate of abstainers using varenicline was 68.60%, which was higher than abstainers using nicotine patch (55.60%) and the relapse rate of participants using nicotine patch was 100.00%, significantly higher than for relapsers using varenicline (45.80%). CONCLUSIONS Further study is expected to clarify the effect of providing financial support and the factors associated with smoking cessation and relapse in the SCT program based on financial support.
Collapse
Affiliation(s)
- Meng Li
- Public Health Nursing Laboratory, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Reiko Okamoto
- Public Health Nursing Laboratory, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Fumie Shirai
- Community Health-Care System Science Laboratory, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
37
|
Cambron C, Haslam AK, Baucom BRW, Lam C, Vinci C, Cinciripini P, Li L, Wetter DW. Momentary precipitants connecting stress and smoking lapse during a quit attempt. Health Psychol 2019; 38:1049-1058. [PMID: 31556660 DOI: 10.1037/hea0000797] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Most attempts at smoking cessation are unsuccessful, and stress is frequently characterized both as a momentary precipitant of smoking lapse and a predictor of subsequent changes in other key precipitants of lapse. The current study examined longitudinal associations among stress, multiple precipitants of lapse, and lapse among smokers attempting to quit. METHOD Ecological momentary assessments (EMAs) were gathered from a multiethnic, gender-balanced sample of 370 adults enrolled in a smoking cessation program. EMAs (N = 32,563) assessed smoking lapse and precipitants of lapse, including stress, negative affect, smoking urge, abstinence self-efficacy, motivation to quit, difficulty concentrating, coping outcome expectancies, and smoking outcome expectancies. A multilevel structural equation model simultaneously estimated within-subject paths from stress to multiple precipitants and subsequent smoking lapse. Indirect effects of stress to smoking lapse through precipitants were computed. RESULTS Results indicated that increased stress was significantly associated with all precipitants of lapse, consistent with a greater risk for lapse (i.e., increased negative affect, smoking urge, difficulty concentrating, and smoking outcome expectancies and reduced abstinence self-efficacy, motivation to quit, and coping outcome expectancies). All precipitants were significantly associated with subsequent lapse. Indirect effects indicated that stress was uniquely connected to lapse through negative affect, smoking urge, abstinence self-efficacy, coping outcome expectancies, and smoking outcome expectancies. CONCLUSIONS Results of this study highlight the broad importance of stress for smoking lapse during a quit attempt. Smoking cessation programs should pay close attention to the role of stress in exacerbating key precipitants of lapse to improve cessation success rates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | - Cho Lam
- Huntsman Cancer Institute, University of Utah
| | | | - Paul Cinciripini
- Department of Behavioral Science, M. D. Anderson Cancer Center, The University of Texas
| | - Liang Li
- Department of Biostatistics, M. D. Anderson Cancer Center, The University of Texas
| | | |
Collapse
|
38
|
Clyde M, Pipe A, Reid R, Els C, Tulloch H. A bidirectional path analysis model of smoking cessation self-efficacy and concurrent smoking status: impact on abstinence outcomes. Addict Biol 2019; 24:1034-1043. [PMID: 30088695 DOI: 10.1111/adb.12647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/04/2018] [Accepted: 05/27/2018] [Indexed: 11/28/2022]
Abstract
Self-efficacy is routinely associated with abstinence in the addictions literature, and is a major component relapse-prevention models. The magnitude of this relationship has been brought into question following equivocal results in studies controlling for concurrent smoking status. The aim of our study was to clarify the relationship between cessation self-efficacy, smoking status, and cessation outcomes in a cohort of treatment-seeking smokers. Smokers participating in the FLEX trial, a randomized trial investigating the efficacy of three pharmacologic treatments for smoking cessation, completed questionnaires assessing cessation self-efficacy at baseline and at weeks 1, 3, 5 and 10 post-target quit date; smoking status was verified using expired carbon monoxide. Structural models were fit in order to ascertain the relationship between cessation self-efficacy and concurrent smoking at each time-point, and to assess the association between cessation self-efficacy, smoking and seven-day point prevalence smoking status at week 10. A total of 737 treatment-seeking smokers participated. In our path model, self-efficacy and smoking status at all time points were associated with week 10 abstinence (except week 3 self-efficacy), after controlling these values' previous time-points. All direct pathways between cessation self-efficacy and smoking were also significant, supporting a bidirectional relationship. Our results support a bidirectional and reciprocal relationship between cessation self-efficacy and concurrent smoking behavior; participants with higher confidence were more likely to be smoke-free, and concurrent smoking status predicted levels of confidence over the ensuing weeks. Both measures were associated with week 10 abstinence. Our results indicate that while correlated, both cessation self-efficacy and current smoking behavior during a cessation attempt are important independent markers of ultimate cessation success.
Collapse
Affiliation(s)
- Matthew Clyde
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Psychology; University of Ottawa; Ottawa Ontario Canada
| | - Andrew Pipe
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Robert Reid
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Charl Els
- Department of Psychiatry; University of Alberta; Edmonton Alberta Canada
| | - Heather Tulloch
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Psychology; University of Ottawa; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| |
Collapse
|
39
|
Veilleux JC. Shifts in momentary motivation to quit smoking based on experimental context and perceptions of motivational instability. Addict Behav 2019; 96:62-67. [PMID: 31035080 DOI: 10.1016/j.addbeh.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Smoking quit intentions (i.e., plans or commitments to reduce smoking) are distinct from quit motivation (i.e., desire to quit). Motivation to quit is a dynamic avoidance motivational state, likely subject to frequent fluctuations and shifts based on environmental context, similar to craving (an approach motivational state). Moreover, people's perceptions of motivational instability may influence their momentary quit motivation and beliefs surrounding their abilities to manage the quit process successfully. METHODS In the current study, smokers were recruited online. Baseline motivation to quit was examined along with perceptions of motivational instability. Participants who reported some interest in eventually quitting (n = 174; Mage = 45.29, SD = 14.81, 74.1% women) were randomly assigned to negative affect, cigarette or neutral cue conditions and then momentary motivation to quit was assessed, followed by a validated index of quit intentions. RESULTS Participants in the negative affect and cigarette cue conditions reported greater momentary motivation to quit than participants in the neutral condition (F = 3.73, p = .03), particularly for people who reported upfront that their motivation did not change from day-to-day (F = 3.97, p = .02). In addition, greater momentary quit motivation predicted stronger quit intentions (B = 0.66, p < .001). CONCLUSION Findings from this study suggest that motivation to quit is likely dynamic and influenced by context as well as by self-perceptions. Implications suggest that further efforts to separate motivation from intention may be useful in understanding smokers' desires and plans to quit smoking.
Collapse
Affiliation(s)
- Jennifer C Veilleux
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, United States.
| |
Collapse
|
40
|
When Should We Measure Self-Efficacy as an Aid to Smoking Cessation? Arch Bronconeumol 2019; 55:654-656. [PMID: 31171413 DOI: 10.1016/j.arbres.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022]
|
41
|
An Interpretative Phenomenological Analysis of Discontinued Use of the E-Cigarette. J Smok Cessat 2019. [DOI: 10.1017/jsc.2018.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Many UK smokers use e-cigarettes as a quitting aid; however, a substantial number discontinue use of the e-cigarette and revert to smoking. Understanding why this may happen is important both for individuals and for stop smoking services.Aims: To explore young adult smokers’ experiences of use and discontinued use of the e-cigarette.Methods: Semi-structured interviews were conducted with six participants who tried e-cigarettes for at least seven days and returned to smoking. Data was transcribed and analysed using interpretative phenomenological analysis.Results: Findings suggested participants held conflicting attitudes about using e-cigarettes, which undermined attempts to quit smoking, and led to the discontinuation of the e-cigarette. These conflicts centred on participants’ discomfort with the e-cigarette or vaping identity, lack of abstinence self-efficacy and navigation of barriers to e-cigarette use. The complex interplay of these factors may have led to an underestimation of the individual effort required to continue vaping and reinforced participants’ perception of the e-cigarette as an inferior product to the cigarette.Conclusions: Future research should focus on the role of identity, self-efficacy, control and smokers’ expectations of e-cigarettes on smoking cessation as these may be important factors to consider for a more tailored service for e-cigarette users.
Collapse
|
42
|
Abstract
Objectives: This study focused on lapse shortly after an attempt to quit smoking. Ecological momentary assessment (EMA) studies have mapped real-time situational factors that induce lapses in everyday life. However, the possible role of nonsmoking intention is disregarded in the dynamic context of daily life, whereas intention plays a key role in behavior change and shifts during smoking cessation. This study therefore aimed to capture the influence of intention on lapse, next to the known risk factors of negative affect, low self-efficacy, craving, positive outcome expectations towards smoking (POEs), being around smokers, and stress. It is hypothesized that scores on these factors shift during the day, especially shortly after quitting, which may induce lapse. Based on behavioral explanation models, intention is hypothesized to mediate the influence of the mentioned factors on lapse. Methods: An EMA study was conducted among 49 self-quitters in the first week of smoking cessation. Results: Generalized Linear Mixed Model regression analyses revealed that low nonsmoking intentions, low self-efficacy, and being around smokers (estimates were, respectively, −0.303, −0.331, and 2.083) predicted lapse. Nonsmoking intention partially mediated the influence of self-efficacy on lapse. Nonsmoking intention was predicted by not being around smokers, high self-efficacy, and low POEs (estimates were, respectively, −0.353, 0.293, and −0.072). Conclusions: This small-scale EMA study confirms the importance of nonsmoking intention on lapse, next to self-efficacy and being around smokers. It adds insights into the mediating role of intention on the relationship between self-efficacy and lapse, and into the predictors of nonsmoking intention.
Collapse
|
43
|
Poggiolini C. High self-efficacy regarding smoking cessation may weaken the intention to quit smoking. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1574096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Claudia Poggiolini
- IKMZ – Department of Communication and Media Research, University of Zurich, Andreasstrasse 15, Zürich 8050, Switzerland
| |
Collapse
|
44
|
Garey L, Peraza N, Smit T, Mayorga NA, Neighbors C, Raines AM, Schmidt NB, Zvolensky MJ. Sex differences in smoking constructs and abstinence: The explanatory role of smoking outcome expectancies. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:660-669. [PMID: 30211586 PMCID: PMC6137813 DOI: 10.1037/adb0000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Scientific evidence suggests women experience more severe problems when attempting to quit smoking relative to men. Yet, little work has examined potential explanatory variables that maintain sex differences in clinically relevant smoking processes. Smoking outcome expectancies have demonstrated sex differences and associative relations with the smoking processes and behavior, including problems when attempting to quit, smoking-specific experiential avoidance, perceived barriers to quitting, and smoking abstinence. Thus, expectancies about the consequences of smoking may explain sex differences across these variables. Accordingly, the current study examined the explanatory role of smoking-outcome expectancies (e.g., long-term negative consequences, immediate negative consequences, sensory satisfaction, negative affect reduction, and appetite weight control) in models of sex differences across cessation-related problems, smoking-specific experiential avoidance, perceived barriers to quitting, and smoking abstinence. Participants included 450 (48.4% female; Mage = 37.45, SD = 13.50) treatment-seeking adult smokers. Results indicated that sex had an indirect effect on problems when attempting to quit smoking through immediate negative consequences and negative affect reduction expectancies; on smoking-specific experiential avoidance through long-term negative consequences, immediate negative consequences, and negative affect reduction expectancies; on barriers to quitting through negative affect reduction expectancies; and on abstinence through appetite weight control expectancies. The current findings suggest that sex differences in negative affect reduction expectancies and negative consequences expectancies may serve to maintain maladaptive smoking processes, whereas appetite weight control expectancies may promote short-term abstinence. These findings provide initial evidence for the conceptual role of smoking expectancies as potential "linking variables" for sex differences in smoking variables. (PsycINFO Database Record
Collapse
Affiliation(s)
- Lorra Garey
- University of Houston, Houston, TX, United Sates
| | | | - Tanya Smit
- University of Houston, Houston, TX, United Sates
| | | | | | | | | | - Michael J. Zvolensky
- University of Houston, Houston, TX, United Sates
- The University of Texas MD Anderson Cancer Center, Houston, TX, United Sates
| |
Collapse
|
45
|
Nohlert E, Öhrvik J, Helgason ÁR. Self-perceived ability to cope with stress and depressive mood without smoking predicts successful smoking cessation 12 months later in a quitline setting: a secondary analysis of a randomized trial. BMC Public Health 2018; 18:1066. [PMID: 30153814 PMCID: PMC6114486 DOI: 10.1186/s12889-018-5973-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Telephone-based smoking cessation services (‘quitlines’) are both effective and cost-effective. Knowledge of modifiable baseline factors in real-life settings with heterogeneous participants is essential for the development and improvement of treatment protocols to assist in telephone-based smoking cessation. The aim was to assess if self-perceived abilities to cope measured at baseline, would predict abstinence at the 12-month follow-up at the Swedish National Tobacco Quitline (SNTQ). Methods The data were retrieved from a previous randomized controlled trial comparing the effectiveness of proactive and reactive service at the SNTQ. Included were 612 clients calling the SNTQ between February 2009 and September 2010. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Plausible predictors of smoking cessation were assessed at the first call and in a baseline questionnaire. Self-perceived abilities at baseline were measured by two questions: (1) How likely is it that you will be smoke-free in one year? and (2) How likely are you to be able to handle stress and depressive mood without smoking? The associations between potential predictors and outcome (smoke-free at 12-month follow-up) were assessed by logistic regression analysis. Results Of the two potential predictors for abstinence at 12-month follow-up, only the perceived ability to handle stress and depressive mood without smoking remained significant in the adjusted analyses (Odds Ratio, OR 1.13, 95% CI 1.00–1.27 for point prevalence and OR 1.16, 95% CI 1.01–1.33 for 6-month continuous abstinence according to intention-to-treat). The overall strongest predictor in the adjusted analyses was smoking status in the week before baseline (OR 3.30, 95% CI 1.79–6.09 for point prevalence and OR 3.97, 95% CI 2.01–7.83 for 6-month continuous abstinence). Conclusions The perceived ability to handle stress and depressive mood without smoking at baseline predicted the subjects’ abstinence at the 12-month follow-up. An assessment of/adjustment for stress and depressive mood coping skills may be appropriate in future smoking cessation treatment and research. The treatment protocol can be tailored to individual differences and needs for optimal support. Trial registration ClinicalTrials.gov: NCT02085616. Registered March 10, 2014, ‘retrospectively registered’.
Collapse
Affiliation(s)
- Eva Nohlert
- Centre for Clinical Research, Uppsala University, Hospital of Vastmanland Vasteras, 721 89, Vasteras, Sweden.
| | - John Öhrvik
- Centre for Clinical Research, Uppsala University, Hospital of Vastmanland Vasteras, 721 89, Vasteras, Sweden
| | - Ásgeir R Helgason
- Department of Public Health Sciences, Social Medicine, Karolinska Institutet, Stockholm, Sweden.,Reykjavik University and Icelandic Cancer Society, Reykjavik, Iceland
| |
Collapse
|
46
|
Murphy CM, Martin RA, Tidey JW, Colby SM, Rohsenow DJ. Smoking outcome expectancies predict smoking during voucher-based treatment for smokers with substance use disorders. J Subst Abuse Treat 2018; 90:73-78. [PMID: 29866386 DOI: 10.1016/j.jsat.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/03/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Strong expectations regarding positive effects of smoking may reduce the likelihood of successfully quitting. The Smoking Effects Questionnaire (SEQ) assesses the importance of seven expected positive and negative effects of smoking. SEQ was used to predict responses to contingent monetary rewards for smoking abstinence among smokers with substance use disorders (SUD). METHODS Smokers (N = 184) in residential (i.e., 24 h/day) treatment for SUD received 19 consecutive days of either contingent vouchers (CV) for smoking abstinence (twice-daily carbon monoxide [CO] readings) or non-contingent vouchers (NV) plus counseling to motivate smoking cessation. Analyses investigated effects of smoking expectancies on days of smoking within-treatment and number of cigarettes/day at 1 month post-treatment. RESULTS Higher positive expectancies for reduced negative affect, weight control, stimulation and positive social effects from smoking were related to more days of smoking during treatment only for participants in the CV condition. Post-treatment, expecting positive social and stimulating effects from smoking were related to more smoking only among CV participants. In both conditions, negative expectancies were largely unrelated to smoking outcomes. CONCLUSIONS The moderation of CV by positive smoking expectancies suggests that those who rate positive expectancies as more important may require a complementary treatment or different incentives to reduce smoking. The SEQ was probably unassociated with smoking in NV due to little reduction in smoking behavior. Helping smokers with SUD develop alternative ways to produce positive effects sought from smoking may be important to improve initial smoking outcomes.
Collapse
Affiliation(s)
- Cara M Murphy
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Damaris J Rohsenow
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA; Providence Veterans Affairs Medical Center, Providence, RI, USA.
| |
Collapse
|
47
|
Vosper J, Evangeli M, Porter JB, Shah F. Psychological Factors Associated with Episodic Chelation Adherence in Thalassemia. Hemoglobin 2018. [PMID: 29521137 DOI: 10.1080/03630269.2018.1433686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
β-Thalassemia major (β-TM) is a life-long genetic hemoglobin (Hb) disorder requiring intensive treatment regimens, including frequent blood transfusions and daily chelation therapy. Understanding psychosocial correlates of chelation adherence is important for developing interventions to improve adherence. This study investigated within-participant correlates of oral chelation adherence on a daily (episodic) basis. Thirty-seven adult participants with β-TM were recruited from clinics at two hospitals (22 males, 9 females, mean age 34.5 years, range 19-54 years). A structured interview was used to assess behavioral and psychological situational variables related to an adherent and a nonadherent episode for each participant. Positive outcome expectancies and higher self-efficacy were both significantly associated with adherent episodes. Behavioral variables, including difficulty in accessing medication, location, and whether alone or with others, were also associated with nonadherent episodes. Findings suggested that situational psychological factors are important for chelation adherence. Adherence interventions should consider focusing on potentially modifiable situational variables (psychological and behavioral).
Collapse
Affiliation(s)
- Jane Vosper
- a Department of Clinical Psychology , Royal Holloway University of London , Egham , UK
| | - Michael Evangeli
- a Department of Clinical Psychology , Royal Holloway University of London , Egham , UK
| | - John B Porter
- b Clinical Haematology, Joint Red Cell Unit , University College London Hospitals , London , UK
| | - Farrukh Shah
- c Clinical Haematology, Joint Red Cell Unit, Department of Haematology , The Whittington Hospital , London , UK
| |
Collapse
|
48
|
Pinsker EA, Hennrikus DJ, Erickson DJ, Call KT, Forster JL, Okuyemi KS. Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT. Addict Behav 2018; 78:43-50. [PMID: 29125976 DOI: 10.1016/j.addbeh.2017.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics. METHODS Homeless smokers (n=430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group. RESULTS Among the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites. CONCLUSIONS White participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.
Collapse
|
49
|
Schumacher LM, Martin GJ, Goldstein SP, Manasse SM, Crosby RD, Butryn ML, Lillis J, Forman EM. Ecological momentary assessment of self-attitudes in response to dietary lapses. Health Psychol 2017; 37:148-152. [PMID: 29172606 DOI: 10.1037/hea0000565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether self-attitudes and self-efficacy after dietary lapses relate to lapse frequency or predict risk for lapsing again on the same day. METHOD Adults with overweight/obesity (n = 91) completed ecological momentary assessment for 14 days at the start of a lifestyle modification program. At each survey, participants reported whether they had experienced a dietary lapse, and, if so, reported their self-attitudes (i.e., self-criticism, self-forgiveness, self-regard) and self-efficacy. The relationships between participants' typical (i.e., average level for each participant across lapses) self-attitudes/self-efficacy after lapsing and lapse frequency were examined using correlations. Generalized estimating equations examined whether participants' typical (average across lapses; between-person effect) self-attitudes/self-efficacy or momentary (i.e., level of each variable at a particular lapse relative to one's typical level; within-person effect) self-attitudes/self-efficacy predicted same-day lapse occurrence. RESULTS Lower typical self-efficacy and more negative typical self-regard related to greater lapse frequency. Additionally, lower momentary self-criticism predicted greater likelihood of same-day lapse occurrence. There also was a quadratic relationship between typical self-regard and risk of same-day lapse occurrence, such that individuals with either more negative or more positive typical self-regard were more likely to lapse on the same day. CONCLUSION Findings provide preliminary support for the relevance of self-attitudes and self-efficacy to lapses during early lifestyle modification. While greater typical self-efficacy and more positive typical self-regard are associated with fewer lapses, lower momentary self-criticism and very positive or negative typical self-regard may confer risk for same-day lapses. (PsycINFO Database Record
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Alpert Medical School
| | | |
Collapse
|
50
|
Caponnetto P, Polosa R. Are we addressing relevant determinants of smoking cessation? Eur Respir J 2017; 50:50/5/1701615. [PMID: 29167305 DOI: 10.1183/13993003.01615-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Pasquale Caponnetto
- Smoking Prevention/Cessation Center (CPCT), Institute of Internal Medicine, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Riccardo Polosa
- Smoking Prevention/Cessation Center (CPCT), Institute of Internal Medicine, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| |
Collapse
|