Predicting electronic cigarette dependence and perceived barriers for electronic cigarette cessation: examining the roles of fatigue severity and emotion dysregulation

Emotion Dysregulation and E-Cigarette Expectancies among College Student E-Cigarette Users

Background: E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods: Participants were 116 college student e-cigarette users (Mage = 19.72, SD = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results: Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion: These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.

Attentional Bias in Non-Smoking Electronic Cigarette Users: An Eye-Tracking Study

INTRODUCTION

This study examined attentional bias (AB) to e-cigarette cues among a sample of non-smoking daily e-cigarette users (n = 27), non-smoking occasional e-cigarette users (n = 32), and control participants (n = 61) who did not smoke or use e-cigarettes. The possibility that e-cigarette users develop a transference of cues to traditional cigarettes was also examined.

METHODS

AB was assessed using a free-viewing eye-gaze tracking methodology, in which participants viewed 180 pairs of images for 4 seconds (e-cigarette and neutral image, e-cigarette and smoking image, smoking and neutral image).

RESULTS

Daily and occasional e-cigarette users attended to pairs of e-cigarette and neutral images equally, whereas non-users attended to neutral images significantly more than e-cigarette images. All three groups attended to e-cigarette images significantly more than smoking images, with significantly larger biases for e-cigarette users. There were no between-group differences in attention to pairs of smoking and neutral images. A moderation analysis indicated that for occasional users but not daily users, years of vaping reduced the bias toward neutral images over smoking images.

CONCLUSIONS

Taken together, the results indicate that e-cigarette users exhibit heighted attention to e-cigarettes relative to non-users, which may have implications as to how they react to e-cigarette cues in real-world settings. AB for e-cigarettes did not transfer to traditional cigarette cues, which indicates that further research is required to identify the mechanisms involved in the migration of e-cigarettes to traditional cigarettes.

IMPLICATIONS

This study is the first attempt to examine attentional biases for e-cigarette cues among non-smoking current e-cigarette users using eye-gaze tracking. The results contribute to the growing literature on the correlates of problematic e-cigarette use and indicate that daily and occasional e-cigarette use is associated with attentional biases for e-cigarettes. The existence of attentional biases in e-cigarette users may help to explain the high rate of failure to quit e-cigarettes and provides support for the utility of attentional bias modification in the treatment of problematic e-cigarette use.

The explanatory role of fatigue severity in the relation between COVID-19 perceived stress and depression, anxiety, and panic severity

The COVID-19 pandemic has had an adverse effect on anxiety and depression symptoms and disorders in the United States and worldwide. As such, there is considerable interest in better understanding the relationship between COVID-19 and anxiety and depressive disorders. Although individual differences in perceived stress have shown to be related to anxiety and depression in non-COVID-19 work, research has not examined potential factors underlying this relation in the context of COVID-19. Fatigue severity may be a promising mechanistic construct for perceived stress and anxiety and depression relations, as some work has found that perceived stress may predict elevated fatigue symptoms. As such, the current study sought to examine the potential explanatory role of fatigue severity in the relation between COVID-19 specific perceived stress and depression, anxiety, and panic symptoms among 563 adults (41.9% female, Mage = 38.26 years, SD = 12.15). Results suggested that COVID-19 perceived stress, via fatigue severity, significantly predicted depression, anxiety, and panic symptoms. These results provide initial empirical support for the role of fatigue severity in the relation between COVID-19 perceived stress and depression, anxiety, and panic symptoms. Future work would benefit from using longitudinal data to evaluate the current model.

Anxiety Sensitivity and Emotion Dysregulation in Dual and Exclusive E-Cigarette Users

Background: E-cigarette use has increased exponentially over the past decade, particularly among current combustible cigarette users. Preliminary evidence has demonstrated differences across exclusive and dual e-cigarette/combustible cigarette users, such that dual users represent a more clinically severe group. Yet, the extent to which these groups differ on critical transdiagnostic risk factors that may promote and maintain nicotine dependence, such as anxiety sensitivity and emotional dysregulation has yet to be systematically studied. The purpose of the current study was to examine differences between exclusive e-cigarette users and dual e-cigarette and combustible cigarette users in anxiety sensitivity and both global emotion regulation difficulties as well as within specific emotion regulation difficulty domains. Methods: Participants were 192 exclusive e-cigarette users and 315 dual e-cigarette and combustible cigarette users (52.1% female, Mage = 34.8 years, SD = 11.42). Results: Compared to exclusive e-cigarette users, dual users reported higher anxiety sensitivity, overall emotion regulation difficulties, and specific emotion regulation difficulties related to impulse control and lack of access to effective emotion regulation strategies. There were no group differences in emotion regulation difficulties related to emotional clarity, ability to engage in goal-directed behavior when upset, and emotional non-acceptance. Conclusion: The current data suggest that dual users are an at-risk group in terms of emotional processes. Dual users would likely benefit from targeted intervention efforts focused on reducing anxiety sensitivity and improving emotion regulation in order to reduce nicotine consumption and/or promote cessation.

Pain intensity, e-cigarette dependence, and cessation-related outcomes: The moderating role of pain-related anxiety

Pain and nicotine dependence are prevalent, co-occurring conditions posited to interact in the manner of a positive feedback loop; however, most research to date has been conducted among tobacco cigarette smokers. Initial evidence suggests that pain is a risk factor for greater e-cigarette dependence, and additional research is needed to examine covariation between pain and e-cigarette use. There is reason to suspect that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with greater e-cigarette dependence and difficulty quitting, and that pain intensity and pain-related anxiety may interact to confer greater risk for e-cigarette use. The current study represents the first examination of cross-sectional associations between pain intensity, pain-related anxiety, and e-cigarette dependence, motivation to quit, history of lifetime e-cigarette quit attempts, perceived barriers to cessation, and negative expectancies during abstinence from e-cigarettes. Participants (N = 520 e-cigarette users, 52.1% female, Mage = 34.85) completed an online survey assessing health behaviors. Results indicated that pain-related anxiety was positively associated with e-cigarette dependence and perceived barriers to cessation (ps < 0.05). Pain-related anxiety was found to moderate relations between pain intensity and primary outcomes, such that pain intensity was positively associated with motivation to quit, likelihood of past failed quit attempt, and negative abstinence expectancies among participants who endorsed high (but not moderate or low) levels of pain-related anxiety. Future research would benefit from examining prospective associations between pain-related anxiety, pain intensity, and e-cigarette use/cessation trajectories among individuals with chronic pain.