Study of the relationship between anxiety sensitivity, smoking abstinence expectancies, nicotine withdrawal, and cigarette dependence among daily smokers

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.

Evaluating the role of smoking abstinence expectancies in the relation between perceived ethnic discrimination and cigarette dependence among Latinx individuals who smoke

The experience of perceived ethnic discrimination is prevalent and has harmful effects across various behavioral health processes among Latinx persons. Yet, there is limited work on the association between perceived ethnic discrimination and smoking among this health disparities group. Building from initial work that has demonstrated a relationship between perceived ethnic discrimination and smoking abstinence expectancies, the present study sought to explore mechanisms by which perceived ethnic discrimination may be related to cigarette dependence. Specifically, we tested the indirect effect of perceived ethnic discrimination on cigarette dependence through smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences) among Latinx persons who smoke (N = 338; Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that abstinence expectancies related to harmful consequences was a statistically significant underlying factor between the experience of perceived discrimination and cigarette dependence (b = 0.39, SE = 0.16, CI95% = 0.08, 0.71, CSE = 0.14). Overall, the present study suggests that smoking abstinence expectancies pertaining to harmful consequences may be a point of intervention for Latinx persons seeking to reduce or quit smoking. Future research is needed to extend the generalizability of these findings by corroborating the mediational role of abstinence expectancies related to harmful consequences across Latinx persons of varying cigarette use severity levels over time.

Perceived racial/ethnic discrimination in relation to smoking abstinence expectancies among adult Latinx smokers in the United States

INTRODUCTION

Hispanic/Latinx (hereafter Latinx) individuals in the United States (US) face unique smoking-related health disparities, including limited access to care and health insurance for smoking treatment. Social determinants of health (SDoH) have received increased recognition in their role of smoking behavior and cessation. However, research on SDoH in Latinx smoking populations has been limited. Past research on non-Latinx white individuals has found smoking abstinence expectancies to be an integral cognitive process related to multiple aspects of smoking behavior, and its role has also been understudied in Latinx individuals. Perceived racial/ethnic discrimination is one SDoH, but its role in relation to abstinence expectancies among Latinx smokers has not been explored. Therefore, the present investigation sought to evaluate perceived racial/ethnic discrimination in terms of smoking abstinence expectancies among Latinx smokers living in the US.

METHODS

Participants included 338 English-speaking Latinx adult daily cigarette smokers (M_age = 35.5 years; SD = 8.65; age range 18-61; 37.3 % female) recruited nationally throughout the US using Qualtrics Panels.

RESULTS

Results supported statistically significant main effects for perceived racial/ethnic discrimination in relation to increased smoking abstinence expectancies of negative mood, somatic symptoms, harmful consequences, and positive consequences (p's < 0.001).

DISCUSSION

Overall, the results of the present investigation build from a limited body of work on perceived racial/ethnic discrimination and smoking and provide novel evidence of consistent and moderate incremental associations between perceived racial/ethnic discrimination and negative and positive smoking abstinence expectancies among Latinx smokers.

Pain Severity and Smoking Abstinence Expectancies among Latinx Individuals Who Smoke Cigarettes: The Moderating Role of Perceived Discrimination

Latinx individuals experience significant health disparities related to smoking cessation in the United States (US). Although past works have consistently implicated pain in the maintenance of smoking behavior, limited research has examined the role of social determinants (e.g., perceived discrimination) in pain-smoking relations. The current study sought to examine the moderating role of perceived discrimination in the relation between pain severity and smoking abstinence expectancies (i.e., a cognitive factor related to poor smoking outcomes) among 226 Latinx individuals who currently smoke cigarettes (Mage = 34.95 years; SD = 8.62; 38.5% female). The results indicated a statistically significant interaction between pain severity and perceived discrimination with regard to smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences). Post-hoc analyses revealed the association of pain severity and negative mood, harmful consequences, and positive consequences smoking abstinence expectancies evident for individuals with higher perceived discrimination. Moreover, the association between pain severity and somatic symptoms smoking abstinence expectancies was stronger for individuals with higher perceived discrimination. Overall, these results suggest that clinical and community-based public health strategies may benefit from addressing the role of perceived discrimination among Latinx individuals who smoke cigarettes in the context of pain.

Clinimetric properties of the Smoking Abstinence Expectancies Questionnaire

Smoking abstinence expectancies are beliefs about negative and positive short-term psychological and physiological consequences of not smoking. The Smoking Abstinence Expectancies Questionnaire (SAEQ) is a widely used Patient-Reported Outcome Measure (PROM) to assess smoking abstinence expectancies. It has four subscales: negative mood, somatic symptoms, harmful consequences, positive consequences. Although studied from a psychometric perspective, the SAEQ needs further evaluation. Clinimetrics, and its Clinimetric Criteria for Patient-Reported Outcome Measures (CLIPROM), offers a robust method to evaluate the SAEQ. We verified construct validity and sensitivity of the Italian version of the SAEQ applying CLIPROM criteria. A total of 293 adult Italian smokers were consecutively enrolled at two smoking cessation clinics and assessed via the SAEQ. Item Response Theory models (i.e., combining Rasch and Mokken analyses) were used to test construct validity and sensitivity. The total score of the SAEQ was not found to be unidimensional but each SAEQ subscale score was. PSI (0.90) indicated that the total score of the SAEQ could reliably discriminate between respondents with different levels of the trait under assessment, whereas SAEQ subscales on negative mood and harmful consequences could reliably distinguish between different groups but not between different subjects (PSI ranging from 0.77 and 0.78). Overall, the total score of the SAEQ is a sensitive screening PROM and can be used at smoking cessation clinics to discriminate between subjects with different levels of smoking abstinence expectancies. SAEQ subscales should be used to detect severity and subjective burden of a wide range of expected effects of nicotine abstinence.

Personality-targeted prevention for adolescent tobacco use: Three-year outcomes for a randomised trial in Australia

This is the first study to investigate the effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of tobacco smoking over a three-year period in adolescence. A cluster randomised controlled trial was conducted to assess the effectiveness of Preventure. Schools were block randomised to either the Preventure group (n = 7 schools) or the Control group (n = 7 schools) and students were assessed at five time points (baseline, 6-, 12-, 24- and 36-months post-baseline) on measures of tobacco use, intentions to use and self-efficacy to resist peer pressure to smoke tobacco. Intervention effects were estimated using mixed models to account for the hierarchical data structure. Exploratory analyses assessed intervention effects among internalising and externalising personality traits. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820; www.anzctr.org.au). A total of 1005 adolescents (mean age: 13.4 years, SD = 0.47) attending 14 Australian schools in February 2012 were recruited to the study. Relative to students in Control schools, students in Preventure schools were less likely to report recent tobacco use (OR = 0.66 95% CI = 0.50, 0.87) and intentions to use tobacco in the future (OR = 0.77 95% CI = 0.60, 0.97) over the three-year follow-up. Students in Preventure schools with internalising personality traits had a greater increase in their likelihood to report high self-efficacy to resist peer pressure to smoke sustained three-years post program delivery (OR = 1.85 95% CI = 1.0, 3.4). Findings from this study support the use of selective personality-targeted preventive interventions in reducing tobacco smoking during adolescence.

Treatment completion and anxiety sensitivity effects on smoking cessation outcomes

INTRODUCTION

Treatment completion is associated with abstinence outcomes in smoking cessation interventions. Previous research has stated that anxiety sensitivity (AS) is associated with smoking-related variables and smoking-cessation outcomes. To date, research has not examined the interaction between AS and treatment completion on smoking-cessation outcomes over time. This study aims to examine the main and the interactive effects of treatment completion and AS (total score and specific dimensions) on smoking-cessation outcomes at 3-, 6-, and 12-month follow-ups.

METHOD

The sample consisted of 210 smokers enrolled in an eight-session smoking-cessation cognitive-behavioral treatment (62.1% women; M_age = 45.2, SD = 11.0). Participants were classified as completers (attended the eight treatment sessions) and non-completers (attended ≤ 7 sessions). Abstinence was biochemically confirmed.

RESULTS

Main effects indicated that completers had a higher likelihood of being abstinent over time when compared to non-completers. Regarding AS, those with greater AS-Physical Concerns had lower abstinence rates. Besides, a significant interaction between treatment completion, time and AS-Physical Concerns was found. Particularly, completers with greater AS-Physical Concerns had a higher likelihood of being abstainers than non-completers over time, while no significant differences were found for those with lower AS-Physical Concerns.

CONCLUSION

These data highlight the relevance of AS-Physical levels and smoking-cessation treatment completion on abstinence outcomes over time among treatment-seeking smokers.

Effect of Metformin on Cigarette Withdrawal Syndrome and Abstinence in Lung Cancer Patients; A Double-blind Placebo-controlled Trial

Background: Lung cancer (LC) is a leading cause of cancer morbidity and mortality worldwide. One of the predisposing factors for LC is smoking. Metformin is the first line for diabetes treatment and is shown that it can be used for nicotine withdrawal syndrome reduction. Objectives: This study was conducted to evaluate the effects of metformin on reducing the nicotine withdrawal syndrome and increasing nicotine abstinence in patients with LC. Methods: In a randomized double-blind placebo-controlled trial from February 2018 to May 2019, 53 patients with LC were selected by respondent-driven sampling (RDS), and were assigned into two experimental and wait-list control (WLC) group through block randomization (BR). After 3 weeks of baseline assessment, metformin or placebo was prescribed in the form of escalating doses. Cigarette Withdrawal Scale (CWS-21), urinary cotinine levels, and exhaled carbon monoxide (eCO) levels were evaluated in 16 steps by the repeated measures. The primary outcomes include metformin efficacy on cigarette withdrawal syndrome and secondary outcomes include urinary cotinine levels and eCO level. The data were analyzed by generalized estimation equation (GEE), chi-square, and Atlas-Ti5. Results: The primary outcomes showed that the metformin group had significant effects on the improvement of depression, anxiety, craving, irritability, and appetite, difficulty in concentrating, appetite-weight, and insomnia during the 12-weeks treatment period (all P's < 0.05). In addition, only cravings scores remained constant until the 6-month follow-up (P < 0.05). Secondary outcomes demonstrated that urinary cotinine levels and eCO level significantly decreased in the metformin group (all P's < 0.05). However, this decrease did not remain constant at both levels until the 6-month follow-up (P > 0.05). Conclusions: Metformin had a clinical potential for reducing nicotine withdrawal. However, more studies are needed.

Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors

BACKGROUND

Preoperative anxiety comprising anesthesia and surgery related anxiety is common and perceived by many patients as the worst aspect of the surgical episode. The aim of this study was to identify independent predictors of these three anxieties dimensions and to quantify the relevance of specific fears particularly associated with anesthesia.

METHODS

This study was part of a cross-sectional survey in patients scheduled to undergo elective surgery. Anxiety levels were measured with the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Modified numeric rating scales (mNRS, range 0-10) were used to assess the severity of eight selected specific fears which were predominantly analyzed descriptively. Multivariate stepwise linear regression was applied to determine independent predictors of all three anxiety dimensions (APAIS anxiety subscales).

RESULTS

3087 of the 3200 enrolled patients were analyzed. Mean (SD) total preoperative anxiety (APAIS-A-T, range 4-20) was 9.9 (3.6). High anxiety (APAIS-A-T > 10) was reported by 40.5% of subjects. Mean (SD) levels of concern regarding the eight studied specific fears ranged from 3.9 (3.08) concerning "Anesthesiologist error" to 2.4 (2.29) concerning "Fatigue and drowsiness" with an average of 3.2 (2.84) concerning all specific fears. Ranking of all specific fears according to mean mNRS scores was almost identical in patients with high versus those with low anxiety. Among nine independent predictors of anxiety, only 3 variables (female gender, negative and positive anesthetic experience) independently predicted all three APAIS anxiety subscales. Other variables had a selective impact on one or two APAIS anxiety subscales only. Female gender had the strongest impact on all three APAIS anxiety subscales. Adjusted r² values of the three models were all below 13%.

CONCLUSIONS

The high variability of importance assigned to all specific fears suggests an individualized approach is advisable when support of anxious patients is intended. Considering independent predictors of anxiety to estimate each patient's anxiety level is of limited use given the very low predictive capacity of all three models. The clinical benefit of dividing patients into those with high and low anxiety is questionable.

TRIAL REGISTRATION

German Registry of Clinical Trials (DRKS00016725), retrospectively registered.

Associations between personality and uptake of tobacco smoking: Do they differ across adolescence?

INTRODUCTION AND AIMS

Tobacco use is one of the leading causes of death globally, yet it is entirely preventable. Tobacco smoking typically begins in adolescence, and thus efforts to intervene early are vital. Personality has been identified as a risk factor for smoking in adolescence. The current study aimed to examine whether associations between personality traits (impulsivity, sensation-seeking, anxiety sensitivity and hopelessness) and new onset tobacco smoking differ across adolescence.

DESIGN AND METHODS

At baseline, 527 secondary-school students (mean age 13 years) completed a validated personality questionnaire and were surveyed on recent tobacco smoking. Participants were followed-up at 12-, 24- and 36-months. Logistic regression was conducted to examine prospective associations between the four personality types and tobacco smoking at each follow-up.

RESULTS

Results revealed age-related differences in the associations between personality and smoking in adolescence. Baseline sensation-seeking was significantly associated with new onset tobacco smoking at age 14; baseline impulsivity was significantly associated with new onset tobacco smoking at age 15; and baseline hopelessness was significantly associated with new onset tobacco smoking at age 16.

DISCUSSION AND CONCLUSIONS

This study extends knowledge by demonstrating age-specific effects on the association between personality and smoking. This has important implications for prevention and could inform the development of tailored smoking interventions to be delivered at different ages. Future research will examine personality-targeted intervention in reducing tobacco smoking in Australian adolescents across different ages.