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Jones DR, Potter LN, Lam CY, Schlechter CR, Nahum-Shani I, Fagundes C, Wetter DW. Examining Links Between Distinct Affective States and Tobacco Lapse During a Cessation Attempt Among African Americans: A Cohort Study. Ann Behav Med 2024; 58:506-516. [PMID: 38740389 PMCID: PMC11185091 DOI: 10.1093/abm/kaae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Affect states are posited to play a pivotal role in addiction-related processes, including tobacco lapse (i.e., smoking during a quit attempt), and distinct affective states (e.g., joy vs. happiness) may differentially influence lapse likelihood. However, few studies have examined the influence of distinct affective states on tobacco lapse. PURPOSE This study examines the influence of 23 distinct affect states on tobacco lapse among a sample of tobacco users attempting to quit. METHODS Participants were 220 adults who identified as African American (50% female, ages 18-74). Ecological momentary assessment was used to assess affect and lapse in real-time. Between and within-person associations testing links between distinct affect states and lapse were examined with multilevel modeling for binary outcomes. RESULTS After adjusting for previous time's lapse and for all other positive or negative affect items, results suggested that at the between-person level, joy was associated with lower odds of lapse, and at the within-person level, attentiveness was associated with lower odds of lapse. Results also suggested that at the between-person level, guilt and nervous were associated with higher odds of lapse, and at the within-person level, shame was associated with higher odds of lapse. CONCLUSIONS The present study uses real-time, real-world data to demonstrate the role of distinct positive and negative affects on momentary tobacco lapse. This work helps elucidate specific affective experiences that facilitate or hinder the ability to abstain from tobacco use during a quit attempt.
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Affiliation(s)
- Dusti R Jones
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and the University of Utah, Salt Lake City, USA
| | - Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and the University of Utah, Salt Lake City, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and the University of Utah, Salt Lake City, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and the University of Utah, Salt Lake City, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, USA
- Center for Methodologies for Adapting and Personalizing Prevention, Treatment, and Recovery Services for SUD and HIV (MAPS Center), University of Michigan, Ann Arbor, USA
| | | | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and the University of Utah, Salt Lake City, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, USA
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Benson L, Chen M, De La Torre I, Hébert ET, Alexander A, Ra CK, Kendzor DE, Businelle MS. Associations between morning affect and later-day smoking urges and behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:277-295. [PMID: 38095939 PMCID: PMC11065619 DOI: 10.1037/adb0000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Affective experiences are associated with smoking urges and behavior. Few studies have examined the temporal nature of these associations within a day, such as whether positive and negative affect in the morning are associated with smoking urges and behavior later in the day. METHOD Participants (N = 63; MAge = 50 years, 48% female; 60% White) were randomized into one of three smoking cessation interventions and answered up to five daily ecological momentary assessments for 28 days during a quit attempt (M = 21.0 days, SD = 7.1). Before analysis, scores for morning positive and negative affect and later-day smoking urges and behavior were calculated. RESULTS On days when individuals' morning positive affect was higher than usual, later-day smoking urges tended to be lower than usual. In contrast, on days when individuals' morning negative affect was higher than usual, later-day smoking urges tended to be higher than usual, and smoking was more likely. Further, individuals who had higher characteristic morning positive affect tended to have less intense later-day smoking urges, whereas those who tended to have higher characteristic morning negative affect tended to have more intense later-day smoking urges. CONCLUSIONS Morning positive and negative affect were associated with later-day smoking urges, and morning negative affect was related to later-day smoking behavior. Future research should examine whether interventions that boost positive affect on mornings when it is lower than usual and attenuate negative affect on mornings when it is higher than usual, may reduce the intensity of smoking urges and the likelihood of smoking later in the day. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Lizbeth Benson
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Meng Chen
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center
| | - Irene De La Torre
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Emily T. Hébert
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, United States
| | - Adam Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Chaelin K. Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Rutgers Cancer Institute of New Jersey, RWJ Medical School, Rutgers University, New Brunswick, NJ
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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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
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4
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Ji L, Li Y, Potter LN, Lam CY, Nahum-Shani I, Wetter DW, Chow SM. Multiple imputation of missing data in multilevel ecological momentary assessments: an example using smoking cessation study data. Front Digit Health 2023; 5:1099517. [PMID: 38026834 PMCID: PMC10676222 DOI: 10.3389/fdgth.2023.1099517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/27/2023] [Indexed: 12/01/2023] Open
Abstract
Advances in digital technology have greatly increased the ease of collecting intensive longitudinal data (ILD) such as ecological momentary assessments (EMAs) in studies of behavior changes. Such data are typically multilevel (e.g., with repeated measures nested within individuals), and are inevitably characterized by some degrees of missingness. Previous studies have validated the utility of multiple imputation as a way to handle missing observations in ILD when the imputation model is properly specified to reflect time dependencies. In this study, we illustrate the importance of proper accommodation of multilevel ILD structures in performing multiple imputations, and compare the performance of a multilevel multiple imputation (multilevel MI) approach relative to other approaches that do not account for such structures in a Monte Carlo simulation study. Empirical EMA data from a tobacco cessation study are used to demonstrate the utility of the multilevel MI approach, and the implications of separating participant- and study-initiated EMAs in evaluating individuals' affective dynamics and urge.
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Affiliation(s)
- Linying Ji
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
- Department of Psychology, Montana State University, Bozeman, MT, United States
| | - Yanling Li
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Lindsey N. Potter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, and Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Cho Y. Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, and Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Inbal Nahum-Shani
- Data-Science for Dynamic Decision-Making Center (d3c), Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - David W. Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, and Intermountain Healthcare Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Sy-Miin Chow
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
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5
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Sobolev M, Anand A, Dziak JJ, Potter LN, Lam CY, Wetter DW, Nahum-Shani I. Time-varying model of engagement with digital self reporting: Evidence from smoking cessation longitudinal studies. Front Digit Health 2023; 5:1144081. [PMID: 37122813 PMCID: PMC10134394 DOI: 10.3389/fdgth.2023.1144081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Objective Insufficient engagement is a critical barrier impacting the utility of digital interventions and mobile health assessments. As a result, engagement itself is increasingly becoming a target of studies and interventions. The purpose of this study is to investigate the dynamics of engagement in mobile health data collection by exploring whether, how, and why response to digital self-report prompts change over time in smoking cessation studies. Method Data from two ecological momentary assessment (EMA) studies of smoking cessation among diverse smokers attempting to quit (N = 573) with a total of 65,974 digital self-report prompts. We operationalize engagement with self-reporting in term of prompts delivered and prompt response to capture both broad and more granular engagement in self-reporting, respectively. The data were analyzed to describe trends in prompt delivered and prompt response over time. Time-varying effect modeling (TVEM) was employed to investigate the time-varying effects of response to previous prompt and the average response rate on the likelihood of current prompt response. Results Although prompt response rates were relatively stable over days in both studies, the proportion of participants with prompts delivered declined steadily over time in one of the studies, indicating that over time, fewer participants charged the device and kept it turned on (necessary to receive at least one prompt per day). Among those who did receive prompts, response rates were relatively stable. In both studies, there is a significant, positive and stable relationship between response to previous prompt and the likelihood of response to current prompt throughout all days of the study. The relationship between the average response rate prior to current prompt and the likelihood of responding to the current prompt was also positive, and increasing with time. Conclusion Our study highlights the importance of integrating various indicators to measure engagement in digital self-reporting. Both average response rate and response to previous prompt were highly predictive of response to the next prompt across days in the study. Dynamic patterns of engagement in digital self-reporting can inform the design of new strategies to promote and optimize engagement in digital interventions and mobile health studies.
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Affiliation(s)
| | - Aditi Anand
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - John J. Dziak
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Lindsey N. Potter
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Cho Y. Lam
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - David W. Wetter
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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Santiago-Torres M, Mull KE, Sullivan BM, Rigotti NA, Bricker JB. Acceptance and Commitment Therapy-Based Smartphone Applications for Cessation of Tobacco Use among Adults with High Nicotine Dependence: Results from the iCanQuit Randomized Trial. Subst Use Misuse 2023; 58:354-364. [PMID: 36683573 PMCID: PMC9901262 DOI: 10.1080/10826084.2022.2161317] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: With 1 in 2 adult tobacco users being highly dependent on nicotine, population-based interventions specifically designed for this group are urgently needed. This study used data from a randomized trial to evaluate whether (1) Acceptance and Commitment Therapy (ACT) delivered via a smartphone application (iCanQuit) would be more efficacious for cessation of nicotine-containing tobacco products than the US Clinical Practice Guidelines (USCPG)-based application (QuitGuide) among highly nicotine-dependent adults, (2) the effect of treatment on cessation was mediated by increases in acceptance of cravings to smoke, and (3) treatment utilization and satisfaction differed by arm. Methods: A total of 1452 highly nicotine-dependent adults received the iCanQuit or QuitGuide application for 12-months. Cessation outcomes were self-reported complete-case 30-day abstinence of nicotine-containing tobacco products (e.g., combustible cigarettes, e-cigarettes, chewing tobacco, snus, hookahs, cigars, cigarillos, tobacco pipes, and kreteks) at 3, 6, and 12-month post-randomization timepoints, missing-as-smoking, and multiple imputation analyses. Acceptance of cues to smoke and satisfaction with the applications was also reported. Results: Participants who received iCanQuit were significantly more likely to report 30-day abstinence of nicotine-containing tobacco products than those who received QuitGuide at 12-months (24% vs. 17%; OR = 1.47 95% CI: 1.11, 1.95). iCanQuit participants utilized their application more frequently and reported greater satisfaction than those who received QuitGuide. Increases in participants' acceptance of cues to smoke mediated the intervention effect on cessation of nicotine-containing tobacco products. Conclusions: Among nicotine-dependent adults, an application-delivered ACT-based intervention was more engaging and efficacious than a USCPG-based intervention for cessation of nicotine-containing tobacco products.
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Affiliation(s)
- Margarita Santiago-Torres
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
| | - Kristin E. Mull
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
| | - Brianna M. Sullivan
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Division of General
Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, Massachusetts, USA
| | - Jonathan B. Bricker
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
- University of Washington, Department of Psychology,
Seattle, Washington, USA
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7
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Yang MJ, Sutton SK, Hernandez LM, Jones SR, Wetter DW, Kumar S, Vinci C. A Just-In-Time Adaptive intervention (JITAI) for smoking cessation: Feasibility and acceptability findings. Addict Behav 2023; 136:107467. [PMID: 36037610 PMCID: PMC10246550 DOI: 10.1016/j.addbeh.2022.107467] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 02/03/2023]
Abstract
Smoking cessation treatments that are easily accessible and deliver intervention content at vulnerable moments (e.g., high negative affect) have great potential to impact tobacco abstinence. The current study examined the feasibility and acceptability of a multi-component Just-In-Time Adaptive Intervention (JITAI) for smoking cessation. Daily smokers interested in quitting were consented to participate in a 6-week cessation study. Visit 1 occurred 4 days pre-quit, Visit 2 was on the quit day, Visit 3 occurred 3 days post-quit, Visit 4 was 10 days post-quit, and Visit 5 was 28 days post-quit. During the first 2 weeks (Visits 1-4), the JITAI delivered brief mindfulness/motivational strategies via smartphone in real-time based on negative affect or smoking behavior detected by wearable sensors. Participants also attended 5 in-person visits, where brief cessation counseling (Visits 1-4) and nicotine replacement therapy (Visits 2-5) were provided. Outcomes were feasibility and acceptability; biochemically-confirmed abstinence was also measured. Participants (N = 43) were 58.1 % female (AgeMean = 49.1, mean cigarettes per day = 15.4). Retention through follow-up was high (83.7 %). For participants with available data (n = 38), 24 (63 %) met the benchmark for sensor wearing, among whom 16 (67 %) completed at least 60 % of strategies. Perceived ease of wearing sensors (Mean = 5.1 out of 6) and treatment satisfaction (Mean = 3.6 out of 4) were high. Biochemically-confirmed abstinence was 34 % at Visit 4 and 21 % at Visit 5. Overall, the feasibility of this novel multi-component intervention for smoking cessation was mixed but acceptability was high. Future studies with improved technology will decrease participant burden and better detect key intervention moments.
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Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Steven K Sutton
- Department of Psychology, University of South Florida, Tampa, FL, United States; Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States; Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Laura M Hernandez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Sarah R Jones
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Santosh Kumar
- Department of Computer Science, University of Memphis, Memphis, TN, United States
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States; Department of Psychology, University of South Florida, Tampa, FL, United States; Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States.
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8
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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.
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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
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Cruvinel E, Richter KP, Pollak KI, Ellerbeck E, Nollen NL, Gajewski B, Sullivan-Blum Z, Zhang C, Shergina E, Scheuermann TS. Quitting Smoking before and after Pregnancy: Study Methods and Baseline Data from a Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10170. [PMID: 36011811 PMCID: PMC9408087 DOI: 10.3390/ijerph191610170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Smoking during pregnancy and postpartum remains an important public health problem. No known prior study has prospectively examined mutual changes in risk factors and women's smoking trajectory across pregnancy and postpartum. The objective of this study was to report methods used to implement a prospective cohort (Msgs4Moms), present participant baseline characteristics, and compare our sample characteristics to pregnant women from national birth record data. The cohort study was designed to investigate smoking patterns, variables related to tobacco use and abstinence, and tobacco treatment quality across pregnancy through 1-year postpartum. Current smokers or recent quitters were recruited from obstetrics clinics. Analyses included Chi-square and independent sample t-tests using Cohen's d. A total of 62 participants (41 smokers and 21 quitters) were enrolled. Participants were Black (45.2%), White (35.5%), and multiracial (19.3%); 46.8% had post-secondary education; and most were Medicaid-insured (64.5%). Compared with quitters, fewer smokers were employed (65.9 vs 90.5%, Cohen's d = 0.88) and more reported financial strain (61.1% vs 28.6%; Cohen's d = 0.75). Women who continue to smoke during pregnancy cope with multiple social determinants of health. Longitudinal data from this cohort provide intensive data to identify treatment gaps, critical time points, and potential psychosocial variables warranting intervention.
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Affiliation(s)
- Erica Cruvinel
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kimber P. Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, and Cancer Prevention and Control Program, Duke Cancer Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Nicole L. Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Zoe Sullivan-Blum
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Chuanwu Zhang
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Elena Shergina
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Taneisha S. Scheuermann
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
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10
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Nahum-Shani I, Potter LN, Lam CY, Yap J, Moreno A, Stoffel R, Wu Z, Wan N, Dempsey W, Kumar S, Ertin E, Murphy SA, Rehg JM, Wetter DW. The mobile assistance for regulating smoking (MARS) micro-randomized trial design protocol. Contemp Clin Trials 2021; 110:106513. [PMID: 34314855 PMCID: PMC8824313 DOI: 10.1016/j.cct.2021.106513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
Smoking is the leading preventable cause of death and disability in the U.S. Empirical evidence suggests that engaging in evidence-based self-regulatory strategies (e.g., behavioral substitution, mindful attention) can improve smokers' ability to resist craving and build self-regulatory skills. However, poor engagement represents a major barrier to maximizing the impact of self-regulatory strategies. This paper describes the protocol for Mobile Assistance for Regulating Smoking (MARS) - a research study designed to inform the development of a mobile health (mHealth) intervention for promoting real-time, real-world engagement in evidence-based self-regulatory strategies. The study will employ a 10-day Micro-Randomized Trial (MRT) enrolling 112 smokers attempting to quit. Utilizing a mobile smoking cessation app, the MRT will randomize each individual multiple times per day to either: (a) no intervention prompt; (b) a prompt recommending brief (low effort) cognitive and/or behavioral self-regulatory strategies; or (c) a prompt recommending more effortful cognitive or mindfulness-based strategies. Prompts will be delivered via push notifications from the MARS mobile app. The goal is to investigate whether, what type of, and under what conditions prompting the individual to engage in self-regulatory strategies increases engagement. The results will build the empirical foundation necessary to develop a mHealth intervention that effectively utilizes intensive longitudinal self-report and sensor-based assessments of emotions, context and other factors to engage an individual in the type of self-regulatory activity that would be most beneficial given their real-time, real-world circumstances. This type of mHealth intervention holds enormous potential to expand the reach and impact of smoking cessation treatments.
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Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America.
| | - Lindsey N Potter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Cho Y Lam
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Jamie Yap
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America
| | - Alexander Moreno
- College of Computing, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - Rebecca Stoffel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Zhenke Wu
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, UT, United States of America
| | - Walter Dempsey
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Santosh Kumar
- Department of Computer Science, University of Memphis, Memphis, TN, United States of America
| | - Emre Ertin
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Susan A Murphy
- Departments of Statistics & Computer Science, Harvard University, Cambridge, MA, United States of America
| | - James M Rehg
- College of Computing, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - David W Wetter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
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