Effects of anxiety sensitivity reduction on smoking abstinence: An analysis from a panic prevention program

Cannabidiol Reduces Nicotine Withdrawal Severity and State Anxiety During an Acute E-cigarette Abstinence Period: A Novel, Open-Label Study

Introduction: Despite efforts to curb nicotine use, 8.1 million adults in the United States use e-cigarettes. Notably, the majority of nicotine-containing e-cigarette users report wanting to quit in the near future, yet there is a dearth of research surrounding intervention efforts. Cannabidiol (CBD) has potential to facilitate e-cigarette quit attempts by decreasing withdrawal symptom intensity and anxiety during nicotine e-cigarette abstinence. Methods: This study employed an open-label, crossover design (n=20) to test the hypothesis that among daily nicotine-containing e-cigarette users, oral administration of 320 mg CBD would reduce self-reported nicotine withdrawal severity and state anxiety following a 4-h e-cigarette abstinence period compared to withdrawal and anxiety reported after abstinence in the absence of CBD. Results: After controlling for participants' positive CBD expectancies, results were consistent with hypotheses, suggesting CBD reduced both nicotine withdrawal symptom severity and state anxiety during e-cigarette abstinence. Conclusion: These preliminary findings suggest testing the impact of CBD on e-cigarette cessation attempts is warranted.

Understanding the role of cannabis use on cigarette dependence severity among individuals with e-cigarette and combustible tobacco dual use

BACKGROUND AND OBJECTIVES

The use of both electronic and combustible cigarettes is related to greater rates of cannabis use. Further, cannabis use is associated with worse combustible smoking-related outcomes, yet little research has identified mechanisms underlying such relations. It may be that negative-affect-related transdiagnostic factors such as emotion dysregulation, anxiety sensitivity, and/or distress intolerance play a mechanistic role in the cannabis-tobacco interrelations.

METHODS

The current study tested this hypothesis among 400 adults who endorsed dual use, 33% of whom endorsed current (past 3 months) cannabis use. We conducted analyses of variance and indirect effects model using the PROCESS v4.1 macro in SPSS version 29.

RESULTS

Results indicated that participants who use cannabis reported greater difficulty with emotion regulation, anxiety sensitivity, and cigarette dependence severity. Cannabis use was related to cigarette dependence severity indirectly via difficulty with emotion regulation and anxiety sensitivity.

DISCUSSION AND CONCLUSIONS

These results indicate that specific transdiagnostic negative-affect-related factors of difficulty with emotion regulation and anxiety sensitivity are associated with cannabis use among adults who smoke combustible and electronic cigarettes.

SCIENTIFIC SIGNIFICANCE

Given that these transdiagnostic factors are malleable, these findings suggest targeting and engaging such mechanisms may offer novel behavioral change strategies for this high-risk population.

Anxiety sensitivity in relation to smoking dependence motives among Latinx persons who smoke

Hispanic/Latinx (hereafter Latinx) persons are an established tobacco disparities population in the United States (US). Past work has suggested that individual differences in anxiety sensitivity, or the fear of arousal-based sensations, is one important cognitive construct for smoking maintenance and relapse among Latinx persons who smoke. However, previous research has not examined if anxiety sensitivity is associated with motivational facets of smoking dependence among this tobacco disparities population. In the current study, anxiety sensitivity was explored in terms of smoking motives for primary, secondary, and overall cigarette dependence. Participants included 336 English-speaking Latinx adults in the US who smoked cigarettes daily (Mage = 35.53, SD = 8.65, 37.3% Female). Results indicated that anxiety sensitivity was statistically significantly and positively related to higher primary and secondary dependence motives and marginally statistically significant to cigarette dependence; findings were evident after adjusting for numerous theoretically relevant variables (e.g., depression). Overall, the current study is the first to document linkages between anxiety sensitivity and numerous motivational bases of tobacco dependence among Latinx persons who smoke from the US.

Anxiety sensitivity and COVID-19 mental health, fatigue, and well-being: a longitudinal examination among adults from the United States during March-October 2020

There is widespread empirical evidence that the COVID-19 pandemic contributed to elevated risk of mental and physical health symptoms and decreased quality of life. The present investigation sought to examine if individual differences in anxiety sensitivity was associated with mental health, psychosomatic, and well-being among a sample of US adults during a 6-month period early in the COVID-19 pandemic. Employing longitudinal research methodology, we tested the hypothesis that the anxiety sensitivity global factor would be related to increased risk of anxiety, depression, fatigue, and lower well-being. Secondary analyses evaluated the lower order anxiety sensitivity factors for the same criterion variables. The sample consisted of 778 participants with an average age of 37.96 (SD = 11.81; range 18-73). Results indicated that, as hypothesized, anxiety sensitivity was associated with increased risk for more severe anxiety, depression, fatigue, and lesser well-being; the observed effects of anxiety sensitivity were relatively robust and evident in adjusted models that controlled for numerous theoretically and clinically relevant factors (e.g. perceived health status). Overall, these results suggest that pandemic functioning could likely be improved via interventions that target elevated anxiety sensitivity as a vulnerability factor for a broad range of aversive psychosomatic symptoms and personal well-being.

Anxiety sensitivity reduction-smoking cessation intervention among individuals who engage in dual cigarette and cannabis use: A secondary analysis

INTRODUCTION

Cannabis use among individuals who smoke is prevalent in the general population and related to adverse health effects, including higher levels of interoceptive perturbation (i.e., a disturbance in internal experiences). An important aspect of smoking cessation among individuals who co-use cannabis is to address behavioral associations between physiological sensations and habitual behaviors via integrated treatments focused on reducing reactivity to internal perturbations such as anxiety sensitivity (i.e., the belief that such symptoms produce personal harm).

METHODS

The current study involved a secondary analysis of a randomized clinical trial (RCT) of an integrated anxiety sensitivity-smoking cessation intervention compared to standard smoking cessation. The current study sought to extend findings from the initial trial to examine if the integrated intervention produced better smoking cessation outcomes than standard care among individuals who engage in dual cigarette and cannabis use. Participants were 149 adults who engage in dual cigarette and cannabis use (41.6 % female; Mage = 30.89, SD = 13.1).

RESULTS

Results indicated that the anxiety sensitivity intervention produced statistically significant differences in distal (long-term) smoking abstinence at 3-, 6-, and 12-month follow-up assessments but not proximal (short-term; quit-week to 2-weeks) smoking abstinence.

CONCLUSIONS

Overall, the potential of an integrated anxiety sensitivity smoking cessation intervention to yield better long-term smoking abstinence rates than standard cessation treatment among individuals who engage in dual cigarette and cannabis use is clinically significant.

Role of perceived discrimination and anxiety sensitivity in cigarette smoking among english-speaking latinx adults living in the United States

OBJECTIVE

The Latinx/Hispanic (hereafter, Latinx) population in the United States (US) experiences significant tobacco-related health disparities. Extant work suggests social determinants of health (SDoH) such as perceived discrimination is an individual differences factor for cigarette smoking behavior among Latinx individuals who smoke cigarettes. Other research has suggested sensitivity to internal cues, referred to as anxiety sensitivity, is related to smoking among Latinx adults, but this work has not explored whether anxiety sensitivity may moderate the association between perceived discrimination and smoking behavior.

METHOD

Therefore, the present investigation sought to explore the main and interactive association of perceived discrimination and anxiety sensitivity in relation to cigarettes smoked per day, severity of problems experienced when quitting, and perceived barriers for smoking cessation among 338 English-speaking Latinx individuals living in the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female) who smoke cigarettes.

RESULTS

Results supported statistically significant main effects for perceived discrimination and anxiety sensitivity in relation to increased severity of problems experienced when quitting and perceived barriers for smoking cessation. These associations were evident after adjusting for a sociodemographic covariates.

CONCLUSION

Overall, the present investigation suggests that both perceived discrimination and anxiety sensitivity are important constructs relevant to understanding smoking processes among Latinx adults who smoke cigarettes and should be integrated in theoretical models of smoking among this population.

Evaluating the long-term (Three Year) durability of brief interventions targeting risk factors for psychopathology

Despite their brevity, prior work indicates that computer-based interventions can substantially impact risk factors for psychopathology including anxiety sensitivity (AS), thwarted belongingness (TB), and perceived burdensomeness (PB). However, very few studies have assessed the long-term (> 1 year) effects of these interventions. The primary aim of the current study was to evaluate post-hoc, the long-term (3 year) durability of brief interventions targeting risk factors for anxiety and mood psychopathology using data from a pre-registered randomized clinical trial. Moreover, we were interested in evaluating whether mitigation in these risk factors mediated long-term symptom change. A sample determined to be at-risk for anxiety and mood pathology based on elevations on several risk factors (N = 303) was randomly assigned to one of four experimental conditions focused on: (1) reducing TB and PB; (2) reducing AS, (3) reducing TB,PB, and AS; or (4) a repeated contact control condition. Participants were assessed at post-intervention, one, three, six, 12, and 36 month follow-ups. Participants in the active treatment conditions showed sustained reductions in AS and PB through long-term follow-up. Mediation analyses suggested that reductions in AS mediated long-term reductions in anxiety and depression symptoms. These findings suggest that brief and scalable risk reduction protocols have long-term durability and efficacy both in terms of reducing risk factors for psychopathology.

Cumulative vulnerabilities and smoking abstinence: A test from a randomized clinical trial

Smoking cessation is often associated with socioeconomic and intrapersonal vulnerabilities such as psychopathology. Yet, most research that focuses on predicting smoking cessation outcomes tends focus on a small number of possible vulnerabilities. In a secondary data analysis, we developed and empirically evaluated a comprehensive, cumulative vulnerability risk composite reflecting psychologically based transdiagnostic processes, social determinants of health, and psychopathology. Participants were adult smokers who responded to study advertisements (e.g., flyers, newspaper ads, radio announcements) for an in-person delivered 4-session smoking cessation trial (N = 267; 47% female; Mage = 39.4, SD = 13.8). Results indicated that the decline in point prevalence abstinence (PPA) from quit week to 6-month post-quit was statistically significant (p < .001). There were statistically significant effects of cumulative risk score on the intercept (p < .001) and slope (p = .01). These findings were evident in unadjusted and adjusted (controlling for sex, treatment condition, and nicotine dependence) models. The present results indicate smokers with greater cumulative vulnerability demonstrated poorer smoking cessation outcomes. There may be clinical advantages to better understanding cumulative vulnerability among treatment-seeking smokers and other smoking populations to enhance the impact of public health efforts to reduce smoking.

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

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

Add-on exercise interventions for smoking cessation in people with mental illness: a systematic review and meta-analysis

BACKGROUND

Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness.

METHODS

Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel-Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up).

RESULTS

Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13-1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89-2.04).

CONCLUSIONS

Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).

An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial

BACKGROUND

Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation.

OBJECTIVE

This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation.

METHODS

In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones.

RESULTS

This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022.

CONCLUSIONS

If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/38905.

Evaluating the feasibility and acceptability of a mobile-based health technology for smoking cessation: Mobile Anxiety Sensitivity Program

OBJECTIVES

Cigarette smoking is the leading preventable cause of death and disability. Although most US smokers want to quit, more than 95% of cessation attempts end in relapse within 6 months. To improve cessation outcomes, research has turned to targetable mechanisms, such as anxiety sensitivity (AS), which maintain smoking behaviour, impede cessation success, and can be effectively targeted in the context of psychosocial interventions. Although integrated treatment programmes that address AS reduction in the context of smoking cessation have demonstrated promising results, presently, no mobile, technology-based integrated treatment exists to expressly address smoking and AS. The current study evaluated the initial feasibility and acceptability of a mobile smoking cessation intervention, Mobile Anxiety Sensitivity Program for smoking (MASP).

METHODS

Participants were 15 daily adult combustible cigarette smokers (females n = 6, M_age  = 46.5 years, SD = 13.3) who completed a 6-week total intervention period (baseline visit, 2 weeks pre-quit, 4 weeks post-quit, follow-up visit).

RESULTS

Most participants (N = 12) completed the full 6-week intervention, and participant engagement with MASP was high. Participants reported that MASP was acceptable. Biochemical verification of smoking abstinence indicated 25% of smokers were abstinent for at least 24 hr prior to the in-person 4 weeks post-quit follow-up visit.

CONCLUSIONS

Findings indicated that MASP has the potential to provide effective assistance to those wanting to quit cigarettes.

PRACTITIONER POINTS

Mobile-based smoking cessation interventions may be a promising treatment option, particularly for those of lower socio-economic status. Targeting AS in the context of a mobile-based smoking cessation app may be a viable way to improve smoking cessation success and treatment outcome. Due to the pilot nature of this study, there was no control group. Thus, comparative conclusions and generalizability based on the current study must be made with caution.

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

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

Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions

Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.

Community-based smoking cessation treatment for adults with high anxiety sensitivity: a randomized clinical trial

BACKGROUND AND AIMS

People with anxiety disorders are more likely to smoke and less likely to succeed when they try to quit. Anxiety sensitivity may underlie both phenomena, such that people with high anxiety sensitivity react to interoceptive distress by avoidance. This study aimed to test the efficacy of an exercise program that induced interoceptive distress and thereby created tolerance to this distress in a safe environment.

DESIGN, SETTING AND PARTICIPANTS

Randomized clinical trial at four YMCA branches in Austin, Texas, USA. Participants [n = 150; 130 (86.7%) white; 101 (67.3%) female; mean_age  = 38.6, standard deviation (SD)_age  = 10.4] were adult, daily smokers with high anxiety sensitivity motivated to quit smoking, who reported no regular moderate-intensity exercise.

INTERVENTIONS

Participants were assigned a YMCA personal trainer who guided them through a 15-week intervention aerobic exercise program. Participants assigned to the personalized intervention trained at 60-85% of their heart rate reserve (HRR), whereas participants assigned to the control intervention trained at 20-40% of their HRR. Participants in both groups received standard behavioral support and nicotine replacement therapy.

MEASUREMENTS

The primary outcome was biologically verified 7-day point prevalence abstinence (PPA) at 6-month follow-up.

FINDINGS

Sixty-one per cent of participants were available at the 6-month follow-up. PPA at 6 months was higher in the personalized intervention than the control intervention [27.6 versus 14.8%; odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.28, 3.80, P = 0.005], assuming missing at random. Anxiety sensitivity declined in both groups with no evidence that this differed between groups.

CONCLUSIONS

An exercise program of high intensity increased abstinence from smoking in people with high anxiety sensitivity, but may not have done so by reducing anxiety sensitivity.

Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors-expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations-were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.

E-cigarettes use prior to smoking combustible cigarettes among dual users: The roles of social anxiety and E-cigarette outcome expectancies

E-cigarette use is prevalent, and rates of use continue to increase. Although e-cigarettes are often used to help combustible users quit or reduce smoking, some use e-cigarettes in the absence of combustible cigarettes, increasing risk for smoking combustible cigarettes. Yet, little research has examined individual vulnerability factors implicated in transitioning from exclusive e-cigarettes use to dual use of combustible cigarettes. Social anxiety may be one such factor given it is related to a variety of negative smoking-related outcomes. Thus, the current study tested whether social anxiety was related to using e-cigarettes before smoking combustibles among 226 current undergraduate dual users (use both e-cigarettes and combustible cigarettes). Most dual users reported initiating with e-cigarettes (67%). Those who initiated with e-cigarettes reported statistically significantly greater negative reinforcement (d = 0.59) and weight control expectancies (d = 0.37) and greater social anxiety (d = 0.37) than those who initiated with combustibles. Social anxiety was indirectly related to e-cigarette initiation via negative and weight control expectancies. Findings add to a growing literature that dual users initiated with e-cigarettes and extend understanding of this phenomenon by identifying that socially anxious persons may be especially vulnerable to doing so, at least partially due to expectations regarding e-cigarette's ability to manage negative affect and/or weight.

Anxiety sensitivity, pain severity and co-use of cigarettes and e-cigarettes among adults with chronic pain

Anxiety sensitivity (fear of potential negative consequences of anxiety-related symptoms/sensations) has been identified as a transdiagnostic factor in comorbid pain and nicotine dependence and evidence suggests that anxiety sensitivity may be indirectly associated with nicotine use via greater pain severity. Therefore, this study tested the hypothesis that anxiety sensitivity is associated with cigarette and e-cigarette use/co-use directly and indirectly via greater pain severity. Participants included 273 online survey respondents with chronic musculoskeletal pain (34% female; Mage = 32.9). Anxiety sensitivity was positively associated with cigarette smoking, e-cigarette use and cigarette/e-cigarette co-use (ps < .05). Furthermore, anxiety sensitivity was indirectly and positively associated with cigarette smoking, e-cigarette use and co-use via greater chronic pain severity. Pain severity may play an important role in associations between anxiety sensitivity and nicotine dependence and prospective research should examine temporal/causal effects of anxiety sensitivity in relation to pain severity and nicotine/tobacco use.

Anxiety sensitivity and substance use: Differential levels across individuals primarily using opioids, cannabis, or stimulants

BACKGROUND

The purpose of the current study was to compare levels of anxiety sensitivity (AS) across a treatment-seeking sample of individuals primarily using opioids, stimulants, or cannabis. Consistent with the idea that individuals high in AS may be motivated to use substances with real or perceived anxiolytic properties, it was hypothesized that individuals primarily using opioids or cannabis would evidence higher levels of AS compared to individuals primarily using stimulants.

METHODS

The sample consisted of 110 veterans (including 29 individuals primarily using opioids, 42 primarily using cannabis, and 39 primarily using stimulants) presenting for psychological services to a Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) specialty clinic at a large southeastern Veteran Affairs (VA) hospital.

RESULTS

AS levels varied by group with individuals primarily using stimulants evidencing the highest levels followed by those primarily using opioids and then those primarily using cannabis. Individuals primarily using stimulants had statistically significantly higher levels of AS physical concerns compared to individuals primarily using cannabis but not those primarily using opioids. Further, individuals who primarily use opioids did not differ from those primarily using cannabis.

CONCLUSIONS

Taken together, these findings call into question the notion that AS may be negatively related to the use of substances that have anxiogenic properties.

Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial

BACKGROUND

Interventions that target anxiety/depressive symptoms in the context of smoking treatment have shown promise irrespective of psychiatric diagnosis. Yet, these tailored treatments are largely absent for persons who smoke and are living with HIV (SLWH).

OBJECTIVE

To evaluate a novel, smoking cessation intervention that addresses anxiety/depression and HIV-related health (QUIT) against a time-matched control (TMC) and a standard of care (SOC) condition.

METHODS

SLWH (N = 180) will be recruited and enrolled from 3 medical clinics in Boston, MA, and Houston, TX. The trial will consist of a baseline assessment, a 10-week intervention/assessment period, and follow-up assessments, accounting for a total study duration of approximately 8 months. All participants will complete a baseline visit and a pre-randomization standardized psychoeducation visit, and will then be randomized to one of three conditions: QUIT, TMC, or SOC. QUIT and TMC will consist of nine 60-min, cognitive behavioral therapy-based, individual weekly counseling sessions using standard smoking cessation counseling; additionally, QUIT will target anxiety and depressive symptoms by addressing underlying mechanisms related to mood and quit difficulty. SOC participants will complete weekly self-report surveys for nine weeks. All participants will be encouraged to quit at Session 7 and will be offered nicotine replacement therapy to help.

CONCLUSIONS

QUIT is designed to improve smoking cessation in SLWH by addressing anxiety and depression and HIV-related health issues. If successful, the QUIT intervention would be ready for implementation and dissemination into "real-world" behavioral health and social service settings consistent with the four objectives outlined in NIDA's Strategic Plan.

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

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

Examining the moderating effect of anxiety sensitivity on past-month pain severity and heaviness of smoking among adult smokers experiencing homelessness

BACKGROUND

Pain and cigarette smoking are reciprocally related. Domiciled smokers with higher anxiety sensitivity (AS) - the fear of behaviors/sensations associated with the experience of anxiety - consume more cigarettes and report greater tobacco dependence than smokers with lower AS. AS treatment can reduce chronic pain and facilitate smoking cessation. Here, we examine the potentially moderating role of AS in the association between past-month pain (PMP) and heaviness of smoking (HS) among smokers experiencing homelessness.

METHODS

Participants (N = 461; 64.9% men, M_age = 43.1 ± 11.8) were smokers recruited from 6 homeless serving agencies in Oklahoma City, OK. Participants self-reported the presence and severity of PMP ("How much bodily pain have you had during the past four weeks?"), HS was measured via the heaviness of smoking index (HSI), and AS was measured via the Anxiety Sensitivity Index-III (ASI-III) and its 3 subscales: physical, cognitive, and social concerns. Linear regressions were used to examine potential ASI moderation controlling for age, sex, race, education, health insurance, perceived stress, and major depression.

RESULTS

ASI-III total, cognitive, and physical concerns each significantly moderated associations of PMP and HSI (ps < 0.05), whereas social concerns did not. Individuals with high AS had greater cigarette dependence as PMP values increased.

CONCLUSION

Similar to research with domiciled smokers, current results suggest that smokers experiencing homelessness who have high AS may benefit from AS-based interventions to reduce the association between PMP and HS, which may facilitate smoking cessation among this vulnerable group.

Main and Interactive Effects of Nicotine Product Type on Sleep Health Among Dual Combustible and E-Cigarette Users

BACKGROUND AND OBJECTIVES

E-cigarette use is associated with concurrent use of combustible cigarettes among adults and may increase the risk of future combustible cigarette use in adolescents and young adults. Detrimental effects of combustible cigarette use on sleep health are well documented, but little is known about the additive effects of concurrent e-cigarette use. The current study examined the main and interactive effects of daily nicotine product frequency on various components of sleep health.

METHODS

Two hundred and twenty-seven dual-product users (54.2% female, M_age  = 36.89, SD = 10.17) completed questionnaires regarding demographic information, average number of cigarettes smoked per day, average number of times e-cigarettes used per day, and sleep health.

RESULTS

Combustible cigarette frequency uniquely predicted shorter sleep duration, whereas e-cigarette frequency uniquely predicted increased daytime dysfunction due to sleepiness. Further, there was an interactive effect of combustible and electronic cigarettes on the use of sleeping medications.

DISCUSSION AND CONCLUSIONS

Findings may suggest differential adverse effects on sleep, depending on the type of nicotine product used, and highlight potential intervention targets for users. Future work should examine these associations prospectively and/or use objective measurements of sleep and nicotine use to further elucidate the nature of these relationships.

SCIENTIFIC SIGNIFICANCE

This is the first study to explore the main and interactive effects of dual-product use on various dimensions of subjective sleep quality. This is important to investigate, given that dual nicotine users are at greater risk for physical health problems as well as the adverse effects of nicotine on sleep health. (Am J Addict 2020;00:00-00).

Negative affect among daily smokers: A systematic review and meta-analysis

BACKGROUND

Negative Affect (NA), as a personality trait is a tendency towards experiencing a more negative emotion. The body of research suggests that NA encourages smoking relapse and smoking as a reason for NA reduction, though. The likelihood of this connection does not seem to be bright yet. The present study critically reviews researches to synthesize the existing literature to determine the strength of this linkage.

METHODS

Key-word related research was systematically searched in PubMed, PsychINFO, Science Direct and Google Scholar for studies conducted from 1980 to 2019, followed by, the assessment and selection of retrieved studies based on defined inclusion criteria. A random-effects meta-analysis model was used to examine the prospective relationship between NA and smoking. Meta-regression was also used to dig for possible explanations of heterogeneity. Furthermore a multi-moderators model and sub-group analyses examined the moderating factors.

RESULTS

Forty effect-sizes comprising 12 cross-sectional studies, 28 longitudinal studies and 24,913 participants were included in the meta-analysis. The forest plot of the pooled correlation effect size in the random model indicates a significant effect size of the relationship between NA and smoking (r = 0.11; 95%CI 0.071-0.15, P = 0.001) in the meta-analysis with high heterogeneity (Q = 473.916; df=39; P = 0.001; I²=91.77%). Also, the pooled effect size was obtained as 0.143 (95%CI 0.071-0.214) for light-to-moderate and 0.112 (95%CI 0.057-0.166) for moderate-to-heavy smokers, with the effect size ranging from 0.061 to 0.195 which was significant among all subtypes, though this trend seem higher among adolescents, males, and longitudinal studies than in adults, females, and cross-sectional studies.

LIMITATIONS

The review was limited to English articles, and the heterogeneity of the studies were high.

CONCLUSION

These results support the notion that NA was positively and weakly linked to smoking and this linkage is stronger in light-to-moderate smokers, males, and adolescents. Theoretical and clinical implications are discussed with the aim of extending future directions on NA and smoking.

Anxiety Sensitivity and Distress Tolerance in Smokers: Relations With Tobacco Dependence, Withdrawal, and Quitting Success†

INTRODUCTION

This study examined relations of two affective vulnerabilities, high anxiety sensitivity (AS) and low distress tolerance (DT), with tobacco dependence, withdrawal, smoking cessation, and pharmacotherapy response.

METHODS

Smokers interested in quitting (N = 1067; 52.2% female, 28.1% African American) were randomized to 12 weeks of nicotine patch, nicotine patch plus nicotine lozenge, or varenicline. Baseline questionnaires assessed AS, DT, negative affect, anxiety, and dependence. Withdrawal was assessed the first-week post-quit via ecological momentary assessment.

RESULTS

DT, but not AS, predicted biochemically confirmed point-prevalence abstinence at multiple endpoints: weeks 4, 12, 26, and 52 post-quit (ps < .05); relations remained after controlling for pharmacotherapy treatment, AS, baseline negative affect, anxiety, and anxiety disorder history (ps < .05). Additional exploratory analyses examining week 4 abstinence showed DT predicted abstinence (p = .004) even after controlling for baseline dependence, post-quit withdrawal (craving and negative affect), and treatment. DT moderated treatment effects on abstinence in exploratory analyses (interaction p = .025); those with high DT were especially likely to be abstinent at week 4 with patch plus lozenge versus patch alone.

CONCLUSIONS

DT, but not AS, predicted abstinence over 1 year post-quit (higher DT was associated with higher quit rates), with little overlap with other affective measures. DT also predicted early abstinence independent of dependence and withdrawal symptoms. Results suggest low DT may play a meaningful role in motivation to use tobacco and constitute an additional affective risk factor for tobacco cessation failure beyond negative affect or clinical affective disorders.

IMPLICATIONS

People in a stop-smoking study who reported a greater ability to tolerate distress were more likely to quit smoking and remain smoke-free 1 year later. Smokers with high DT were more likely to be smoke-free 4 weeks after their target quit day if they received nicotine patch plus nicotine lozenge rather than nicotine patch alone.

TRIAL REGISTRATION

NCT01553084.

Positive Expectancies for E-Cigarette Use and Anxiety Sensitivity Among Adults

INTRODUCTION

Although e-cigarette use is on the rise among youth and adults, there is little understanding of the individual difference factors at a cognitive level of analysis for e-cigarette beliefs and quit behavior.

METHOD

The present investigation sought to test a theoretically driven interactive model of positive expectancies for e-cigarettes and anxiety sensitivity (fear of the consequences of anxiety) among 551 adult e-cigarette users (50.6% female, Mage = 35.2 years, SD = 10.1).

RESULTS

Results indicated a significant interaction between positive expectancies for e-cigarette use and AS was significantly related to greater perceived benefits of e-cigarette use, greater perceived risk of e-cigarette use, and more serious attempts for trying to quit e-cigarettes. The significant interaction effect for each dependent variable was evident over and above the main effects as well as the covariates of sex, income, education, and concurrent combustible cigarette use. The form of this interaction indicated that e-cigarette users higher in AS who also maintained more positive outcome expectancies for e-cigarette use reported more perceived benefits as well as more perceived risk of e-cigarette use and engaged in more (failed) attempts to quit e-cigarettes.

CONCLUSIONS

Overall, the current data suggest that individual differences in AS and positive expectancies may represent two important factors to consider in e-cigarette beliefs and quit attempts.

IMPLICATIONS

This study provides the first empirical evidence of a transdiagnostic construct (anxiety sensitivity) in relation to e-cigarette use and how it interplays with positive expectancies for e-cigarette use beliefs and behavior. These novel data suggest that future clinical research may benefit by understanding the potential therapeutic role of anxiety sensitivity and expectancies for e-cigarette use behavior.

A computerized anxiety sensitivity intervention for opioid use disorders: A pilot investigation among veterans

The opioid epidemic is having a disproportionate impact on veterans. Indeed, veterans are twice as likely to die from an accidental overdose than members of the general population, even after accounting for gender and age distribution. Although many veterans seek treatment, a large proportion drop out prematurely and/or relapse highlighting the need to identify malleable factors that may contribute to the recovery process. One such variable is anxiety sensitivity (AS; i.e., fear of anxious arousal). AS is elevated in opioid use populations and is a predictor of treatment dropout among opioid users. Importantly, research suggests that AS is highly malleable; although, no studies have systematically examined such protocols among opioid users. To this end, the purpose of the proposed study was to test the acceptability, feasibility, and utility of a brief, one-session Computerized Anxiety Sensitivity Treatment (termed CAST) delivered to veterans seeking services for an opioid use disorder (OUD). Veterans (n = 16) were assessed at baseline and also at one-week and one-month following CAST. All veterans completed the protocol and reported being interested and engaged during the intervention. Further, small to medium reductions in psychopathology and substance use outcomes were found. Although more work is needed, the current study provides preliminary support for the effectiveness of a brief AS-focused intervention among veterans seeking treatment for an OUD.

Obsessive-compulsive symptoms and cigarette smoking: an initial cross-sectional test of mechanisms of co-occurrence

Tobacco addiction and obsessive-compulsive symptoms (OCS; intrusive thoughts or impulses that cause distress and rituals) are both mediated by compulsivity and negative reinforcement. Little evidence exists to guide theory, research, treatment, and population-based prevention of this co-occurrence. We propose a conceptual model of OCS-smoking co-occurrence in which smokers with elevated OCS capitalize on smoking to assuage OCS. This secondary analysis examined associations between OCS levels and self-reported smoking motives that are model-concordant: i) negative reinforcement-smoking for relief; ii) sensorimotor-benefits of behaviors and sensations of the tobacco self-administration ritual; and iii) habitual-smoking without conscious control. A community sample of cigarette smokers enrolled in a cessation trial (N = 458; 47.2% female; M _age = 36.9; SD = 13.6) completed pre-quit self-report measures of OCS levels and smoking motives. Regression models adjusted for sociodemographic covariates and non-OCS psychopathologies indicated that OCS level was positively associated with each model-concordant motive. OCS level was also correlated with tobacco dependence severity and greater withdrawal symptom severity experienced during previous quit attempts. Those with higher OCS report greater motivation to smoke for negative reinforcement, sensorimotor behavioral-ritualistic, habit/automaticity, and stimulation reasons. Further examination of the proposed model of OCS-smoking co-occurrence is warranted to guide theory and intervention for this population.

Current cannabis use and smoking cessation among treatment seeking combustible smokers

INTRODUCTION

Combustible tobacco smoking and cannabis use frequently occur together, and the use of both substances is associated with overall greater severity of tobacco and cannabis related problems. Observational work has found that cannabis use is associated with tobacco cessation failure, but research directly testing the longitudinal associations of cannabis use on tobacco cessation during smoking cessation treatment is lacking. The current study examined the impact of current cannabis use on combustible tobacco cessation outcomes.

METHODS

207 daily combustible tobacco smokers (M_age = 38.24 years, SD = 14.84, 48.1 % male) were enrolled in a randomized controlled smoking cessation trial. Survival analyses and multi-level modeling were used to assess lapse and relapse behavior through 12-week follow up. The current study is a secondary data analysis.

RESULTS

Results of the current study suggest that cannabis use is associated with faster time to lapse (OR = 0.644, se = .188, p =  .019), but not relapse (OR = -0.218, se = .403, p =  .525), compared to combustible tobacco-only smokers. Additionally, cannabis use was associated with lower likelihood of achieving any 7-day point prevalence abstinence during the 12 week follow up (b = 0.93, se = 0 0.24, p =  0.0001).

CONCLUSIONS

The current study provides novel evidence that cannabis use may be related to combustible tobacco use in terms of faster time to lapse and lower likelihood of any 7-day point prevalence abstinence following smoking cessation treatment. Developing integrated cannabis-tobacco cessation treatments is an important next step in research focused on tobacco-cannabis use.

Distress Intolerance and Smoking Topography in the Context of a Biological Challenge

INTRODUCTION

Distress intolerance (DI), one's perceived or behavioral incapacity to withstand distress, is implicated in psychopathology and smoking. This study evaluated the effect of DI on smoking reinforcement in the context of a carbon dioxide (CO2) biological challenge.

METHODS

Adult daily smokers (n = 90; 48.9% female) were randomized to receive a single inhalation/breath of 35% CO2-enriched air (n = 45) or compressed room air (n = 45). Perceived DI was assessed before the challenge. Smoking reinforcement was examined via average post-challenge puff volume across puffs and at the puff-to-puff level.

RESULTS

Higher DI was associated with an increased average puff volume (b = -4.7, p = .031). CO2 produced decreased average puff volume compared with room air (b = -7.7, p = .018). There was a DI* condition interaction (ƒ2 = 0.02), such that CO2 decreased average puff volume compared with room air in smokers with higher DI (b = -13.9, t = -3.06, p = .003), but not lower DI. At the puff-to-puff level, there was a significant interaction between DI, condition, and cubic time (b = 0.0003, p =. 037). Specifically, room air produced large initial puff volumes that decreased from puff to puff over the cigarette for high- and low-DI smokers. CO2 produced persistent flat volumes from puff to puff over the cigarette for higher DI smokers, whereas CO2 produced puff volumes like that of room air in lower DI smokers.

DISCUSSION

Findings suggest DI heightens smoking reinforcement generally, and in the context of intense cardiorespiratory distress, is associated with stable and persistent smoking. DI is a promising therapeutic target that, if addressed through psychological intervention, may improve cessation outcomes by decreasing smoking reinforcement.

IMPLICATIONS

This study contributes to our understanding of the relationship between DI and smoking reinforcement, via examining these processes in response to acute cardiorespiratory distress. Specifically, we found that smokers who are less tolerant of distress, as opposed to those who are more tolerant, evince a decrease in average puff volume, and consistently low puff-to-puff volume, in response to a biological stressor. These findings suggest that smokers high in DI alter smoking behavior following acute cardiorespiratory distress, perhaps to reduce overstimulation, yet also persist in smoking in a manner that suggests an inability to achieve satiation.

Subjective social status is indirectly associated with short-term smoking cessation through nicotine withdrawal symptoms

This study used data collected from a smoking cessation program (N = 146) to evaluate whether subjective social status was indirectly associated with smoking cessation through nicotine withdrawal symptoms. Findings indicated that subjective social status was indirectly associated with smoking cessation through withdrawal symptoms, specifically through anger and anxiety symptoms. People with lower subjective social status reported more withdrawal symptoms, particularly symptoms related to anger and anxiety, shortly after a quit attempt, and as such, were less likely to achieve smoking abstinence. Findings from this study provide insight into why socioeconomically disadvantaged adults are less likely to remain abstinent after a quit attempt.

The Effect of Positive and Negative Affect on Early Treatment Milestones in the Context of Integrated Smoking Treatment

: Smoking is the leading cause of preventable death in the United States. Efforts have been made to develop effective, integrated smoking-cessation treatments for individuals with greater difficulty quitting, including individuals with elevated anxiety sensitivity (AS). Despite initial evidence for the efficacy of these treatments, little is understood about pretreatment predictors of early treatment milestones, including treatment initiation and response. Positive affectivity (PA) and negative affectivity (NA) are unique mood traits that may be related to early treatment milestones. Indeed, PA and NA are related to smoking and mood outcomes generally. Yet, it is presently unknown if pretreatment PA or NA predict early treatment milestones within the context of an integrated smoking-cessation treatment. The current study sought to evaluate the independent effect of PA and NA on early treatment milestones within the context of an integrated smoking-AS treatment protocol. Smoking and AS outcomes were evaluated independently. Participants included 288 (50% female; Mage = 38.66, SD = 13.67) treatment-seeking adult daily cigarette users. Results indicated that higher pretreatment NA was associated with an increased likelihood of early dropout versus responding to treatment across both outcomes (smoking: odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88-0.99; AS: OR 0.92, 95% CI 0.88-0.98). Pretreatment PA did not significantly differentiate any of the groups. Overall, the present study serves as an initial investigation of the role of pretreatment NA in identifying those at greatest risk for dropping out of treatment (cf. responding to treatment).

Anxiety sensitivity in relation to cigarette smoking and other substance use in African American smokers

Anxiety sensitivity (AS)-fearfulness of anxiety symptoms-has been implicated in the etiology of emotional disorders (e.g., depressive and anxiety disorders) and linked to cigarette smoking and other substance use (SU). However, studies examining AS in relation to SU primarily have been conducted with racially/ethnically heterogeneous or mostly European American samples. Hence, this cross-sectional study involving secondary analysis of baseline data focused on investigating associations of AS with cigarette smoking and other SU in a sample of 630 non-treatment-seeking African American smokers (37.3% female; M age = 49.6 years; M cigarettes smoked per day = 15.4). After screening out individuals with non-nicotine substance dependence, participants reported their demographics, AS, dysphoria symptoms (i.e., depression and anxiety symptoms), and SU. In regression analyses controlling for dysphoria symptoms, age, education level, income level, and years of regular smoking, AS was positively associated with tobacco withdrawal severity (β = .12, p = .007), overall smoking motives (β = .17, p < .001), alcohol use problems (β = .12, p = .005), and other (non-nicotine, nonalcohol) SU problems (β = .16, p < .001). Though lacking the passage of time between assessments needed to provide strong evidence of mediation, unplanned analyses further revealed indirect associations of AS with several SU variables through dysphoria symptoms. Current findings are consistent with those found in prior samples and suggest that AS is similarly related to SU in African Americans, who may benefit from interventions that have been helpful in improving AS, dysphoria symptoms, and SU in other groups. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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

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

Effects of smoking cessation treatment attendance on abstinence: The moderating role of psychologically based behavioral health conditions

Available smoking cessation treatments have shown only modest quit success. Presence of a psychologically based behavioral health condition (PBHC), such as depression, anxiety, or addiction, can impact smoking cessation treatment engagement and quit success; however, the differential effect of treatment engagement on smoking cessation outcomes across smokers with and without a PBHC is unknown. The current study examined the moderating effect presence (versus absence) of a PBHC on the relation between treatment attendance and early smoking abstinence following a 4-session smoking cessation treatment. Participants included 529 (45.9% male; Mage = 38.23 years, SD = 13.56; 75.4% White) smokers enrolled in a large randomized controlled trial evaluating the efficacy of a transdiagnostic smoking cessation treatment. A repeated-measures latent class analysis (RMLCA) was conducted to examine treatment attendance. The effects of treatment attendance, PBHC (present/absent), and their interaction were modeled on biochemically-verified point prevalence abstinence using a latent growth curve from 1-week to 1-month post-quit. The RMLCA provided evidence for three classes: Drop-outs (n = 197), Titrators (n = 89), and Completers (n = 243). A significant interaction emerged such that Completers without a PBHC were significantly more likely to be abstinent relative to Completers with a PBHC (b = 2.69, SE = 0.67, p < .001) and Titrators without a PBHC (b = 3.36, SE = 0.80, p < .001). These results provide novel data that implicate the clinical importance of treatment attendance and PBHC status on smoking abstinence.

Acculturative Stress, Anxiety Sensitivity, and Smoking among Spanish-Speaking Latinx Adult Smokers

Objectives: Although acculturative stress is a known individual difference factor related to poor health, little is understood about its relationship to smoking among Latinx adults. One transdiagnostic factor that may serve a mediational role in the relation between acculturative stress and smoking is anxiety sensitivity. The current study evaluated whether anxiety sensitivity mediated the relations between acculturative stress and smoking among a large sample of adult Spanish-speaking Latinx smokers. Method: Participants were 359 Spanish-speaking Latinx daily smokers (58.8% female, M_age= 33.2 years, SD = 9.7) who provided self-report data on acculturative stress, anxiety sensitivity, and smoking outcomes of cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Independent mediation models were conducted for each smoking outcome, with acculturative stress entered as the predictor and anxiety sensitivity entered as the proposed explanatory factor. Results: There were statistically significant indirect effects of acculturative stress via anxiety sensitivity in relation to cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Conclusions: The present findings provide novel evidence that anxiety sensitivity serves a mediational role in relations between acculturative stress and smoking outcomes among Latinx adult smokers.

Understanding quit patterns from a randomized clinical trial: Latent classes, predictors, and long-term abstinence

OBJECTIVE

Tobacco dependence treatment is recognized as a dynamic, chronic process comprised of several specific phases. Of these phases, the Cessation phase is the most critical as it has demonstrated the strongest relation to quit success. Yet, little is understood about smoking trajectories during this period. The current study aimed to address gaps in the smoking research literature and advance understanding of the dynamic quit process unique to completing an integrated smoking treatment by evaluating quit behavior during the Cessation phase.

METHOD

Two hundred and sixty-seven treatment seeking smokers enrolled in a clinical trial to evaluate the efficacy of a novel, integrated smoking cessation treatment (46.1% male; Mage = 39.25, SD = 13.70) were included in the present study. Repeated-measure latent class analysis was employed to evaluate quit patterns from quit day through day 14 post-quit.

RESULTS

Results supported a four-class solution: Consistent Quitters, Non-Quitters, Relapsers, and Delayed Quitters. Predictors of class membership included age, number of prior quit attempts, motivation to quit smoking, and quit day smoking urges. Moreover, class membership was significantly associated with 6-month abstinence.

CONCLUSION

Results suggest that there are four relevant classes of quit behavior, each with specific predictor variables including age, motivation to quit, smoking urges, and number of quit attempts, and that these classes relate to long-term abstinence. These results have the potential to inform manualized smoking cessation treatment interventions based on relevant subgroups of quit behavior.

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.

Anxiety sensitivity and smoking among Spanish-speaking Latinx smokers

Despite the documented health disparities for smoking among the Latinx population, there is limited understanding of transdiagnostic constructs that may help explain smoking among Spanish-speaking Latinx smokers. The present study examined one promising transdiagnostic factor, anxiety sensitivity (fear of anxiety and related sensations), in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced when trying to quit among a large sample of Latinx smokers. Participants were 367 Spanish-speaking Latinx daily smokers (59.1% female, M_age = 33.20 years, SD = 11.81). As hypothesized, anxiety sensitivity was significantly related to the severity of cigarette dependence, perceived barriers for quitting, and problems when trying to quit. Inspection of the lower-order dimensions of anxiety sensitivity indicated that Physical Concerns was significantly related to cigarette dependence whereas Cognitive Concerns was associated with greater perceived barriers for quitting and severity of problems experienced during past quit attempts. The present study provides novel empirical evidence that anxiety sensitivity is related to a moderate, yet clinically meaningful, proportion of the variance in cigarette dependence, perceived barriers for quitting, and problems experienced during quit attempts. These findings underscore the value of examining anxiety sensitivity among Latinx smokers and focusing greater attention on this construct in efforts to reduce or quit smoking among this population.

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

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

Intraindividual change in anxiety sensitivity and alcohol use severity 12-months following smoking cessation treatment

Although past work has documented reduction in alcohol use severity among smokers following smoking cessation treatment, little is known regarding factors associated with this reduction. The current study sought to examine relations between trajectories of change in anxiety sensitivity and non-targeted alcohol use severity from baseline to one year following smoking cessation treatment. Individuals (n = 386) were adult daily smokers engaged in a smoking cessation treatment study. Measures of alcohol use severity and anxiety sensitivity were collected at baseline as well as 1-, 3-, 6-, and 12-months post-treatment. Latent growth curve modelling was used to estimate intercepts and slopes. Anxiety sensitivity (M = -0.87 95% CI [-1.19, -0.54], p < 0.001) and alcohol use severity (M = -0.22 95% CI [-0.38, -0.06], p = 0.006) each significantly reduced over time. Reductions in anxiety sensitivity were strongly associated with reductions in alcohol use over time (r = 0.63, 95% CI [0.18, 1.09], p = 0.006). Changes in anxiety sensitivity positively correlated with changes in alcohol use severity. Examinations of means suggest that anxiety sensitivity reduced earlier whereas alcohol use severity reduced later in the follow-up period. If replicated establishing temporal precedence of change, these results could implicate anxiety sensitivity reduction as one avenue towards reduced alcohol use severity, among smokers.

The effects of exercise on transdiagnostic treatment targets: A meta-analytic review

BACKGROUND

The present study meta-analytically reviewed the effects of exercise on four transdiagnostic treatment targets: anxiety sensitivity (AS), distress tolerance (DT), stress reactivity (SR), and general self-efficacy (GSE).

METHODS

We conducted systematic searches of peer-reviewed studies in bibliographical databases (Cochrane Library, psychINFO, PubMed) before April 1, 2018. Only randomized controlled trials (RCT) evaluating the effect of exercise on AS, DT, SR, or GSE using at least one validated outcome instrument in a sample of adolescents (≥13 years old) or adults were selected. We employed a meta-analysis of effects using random-effects pooling modeling for each treatment target.

RESULTS

The systematic search yielded 28 RCTs meeting eligibility criteria. Exercise interventions had a large effect on reducing AS (six studies, Hedges's g = 0.72, p = .001), a medium effect on increasing GSE (eight studies, Hedges's g = 0.59, p < .001), and a small effect on reducing SR (ten studies, Hedges's g = 0.32, p < .001). Evidence from four studies suggested that exercise interventions had a small but non-significant effect on increasing DT (Hedges's g = 0.21, p = .26).

CONCLUSIONS

This meta-analysis provides preliminary evidence exercise can engage certain transdiagnostic targets. Further research is required to optimize exercise intervention parameters to achieve the strongest effects on these important mechanistic variables.

Sex-Specific Link Between Emotional Vulnerability and Poor Weight Control in Cigarette Smokers

BACKGROUND

Cigarette smoking and poor weight control independently and synergistically increase risk for morbidity and mortality. However, few studies have examined the etiological role of emotion-regulatory dysfunction in the link between smoking and poor weight control, as well as the possible moderating role of sex.

METHOD

Participants (n = 577; M_age = 44.42; SD = 13.80; 52.7% female) were daily smokers who completed a single survey online through Qualtrics. Emotional vulnerability was indexed by a latent construct comprised of the subscales from the Distress Tolerance Scale (DTS) and the Anxiety Sensitivity Index-3 (ASI-3). A regression model was constructed to examine the relation between emotional vulnerability and poor weight control, measured via body mass index (BMI).

RESULTS

Emotional vulnerability was significantly and positively associated with BMI (b = .08, p = .020). The effect was moderated by sex, such that emotional vulnerability was significantly related to BMI in female smokers (b = .15, p = .002), but not in male smokers (b = .01, p = .806).

CONCLUSIONS

Emotional vulnerability appears to be a novel female-specific psychological mechanism related to poor weight control in smokers. Possible limitations are discussed.

Worry, anxiety sensitivity, and electronic cigarettes among adults

Although electronic cigarette (e-cigarette) use is now a common substance use behavior, there is little understanding of the individual difference factors related to e-cigarette use beliefs and dependence. The present investigation sought to test a theoretically-driven model of anxiety sensitivity as an explanatory element in a worry-e-cigarette beliefs and dependence model. Participants included 558 adult e-cigarette users (51.4% female; 35.2 years, SD = 10.1) who were nationally recruited via an online survey system. Participants completed a single survey that assessed their mood and e-cigarette behavior and beliefs. Results supported a statistically significant indirect pathway for worry in relation to perceived benefits of e-cigarettes, e-cigarette positive outcome expectancies, and e-cigarette dependence via anxiety sensitivity; effect sizes were small. The indirect effects were evident when accounting for several theoretically relevant covariates (sex, income, education, concurrent cigarette use, and neuroticism). This study provides the first empirical evidence of the role of anxiety sensitivity in the relation between worry and e-cigarette use beliefs and behavior, which may represent a novel intervention target.