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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Zvolensky MJ, Shepherd JM, Clausen BK, Robison J, Cano MÁ, de Dios M, Correa-Fernández V. Posttraumatic stress and probable post traumatic stress disorder as it relates to smoking behavior and beliefs among trauma exposed hispanic persons who smoke. J Behav Med 2024:10.1007/s10865-024-00480-8. [PMID: 38409553 DOI: 10.1007/s10865-024-00480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Justin M Shepherd
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Jillian Robison
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Marcel de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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Jafarzadeh NS, Bello MS, Wong M, Cho J, Leventhal AM. Associations between anxiety symptoms and barriers to smoking cessation among African Americans who smoke cigarettes daily. Drug Alcohol Depend 2023; 245:109808. [PMID: 36857843 PMCID: PMC10108659 DOI: 10.1016/j.drugalcdep.2023.109808] [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: 09/08/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND African Americans who smoke cigarettes and experience heightened anxiety symptoms may have low quit smoking rates. Identifying which particular barriers to cessation are associated with specific types of anxiety symptoms in African Americans could inform cessation treatments for this population. This cross-sectional, correlational study examined associations of anxiety-related symptoms and distinct barriers to cessation among non-treatment-seeking African Americans who smoke cigarettes daily. METHODS African Americans who smoke (N = 536) enrolled in a clinical research study on individual differences in tobacco addiction between 2013 and 2017 completed self-report measures of anxiety-related symptoms (i.e., social anxiety, panic, and posttraumatic intrusions) and types of barriers to cessation (i.e., addiction-related, social-related, and affect-related barriers). Linear regression models tested associations of anxiety symptoms with cessation barriers with and without adjusting for age, sex, depressive symptoms, and nicotine dependence. RESULTS All anxiety-related symptoms were associated with each cessation barrier (βs = 0.240-0.396). After covariate adjustment, panic and trauma-related symptoms were not associated with cessation barriers, and the strength of association of social anxiety with external barriers was reduced but remained significant (β = 0.254). CONCLUSION Symptoms of social anxiety, but not trauma or panic-related symptoms, may play a unique, but modest, role in certain barriers to cessation in non-treatment-seeking African Americans who smoke cigarettes over. Further research is needed to uncover why African Americans who smoke and have anxiety might experience these barriers, and how future interventions can mitigate these obstacles.
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Affiliation(s)
- Nikki S Jafarzadeh
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA 90033, United States
| | - Mariel S Bello
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, United States
| | - Melissa Wong
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA 90033, United States
| | - Junhan Cho
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA 90033, United States
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA 90033, United States.
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Le Grande M, Balmford J, Borland R, McNeill A. Perceived Health and Capacity to Cope With Stress in Recent Ex-smokers: Impact of Vaping Versus Quitting All Nicotine. Nicotine Tob Res 2023; 25:553-562. [PMID: 36318814 PMCID: PMC9910145 DOI: 10.1093/ntr/ntac252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the continued use of nicotine following smoking cessation on perceived well-being in comparison to complete cessation of nicotine use. AIMS AND METHODS To explore aspects of perceived well-being and coping among recent ex-smokers as a function of vaping status. Ever-daily smokers in the International Tobacco Control 4 country smoking and vaping surveys in 2016 (w1 N = 883) and 2018 (w2 N = 1088). Cross-sectional associations and longitudinal samples for those who quit between waves and those who quit at w1 and maintained abstinence to w2. Main outcome measures were: Past 30 days of depression symptoms, perceived stress, stress management since quitting, and change in perceived day-to-day health. RESULTS In the cross-sectional analyses vapers were more likely to report both improved stress management (aOR = 1.71, 95% CI 1.23-2.36) and perceived day-to-day health (aOR = 1.65, 95% CI 1.26-2.16) than nicotine abstainers. In the longitudinal analyses, smokers who switched to vaping between waves (n = 372) were more likely to report depression symptoms at w2 (aOR = 2.00, 95% CI 1.09-3.65) but reported improved perceived health (aOR = 1.92, 95% CI 1.16-3.20). For the past daily smokers who remained quit between waves (n = 382), vapers were more likely to report improved stress management relative to abstainers (RRR = 5.05. 95% CI 1.19-21.40). There were no other significant differences between vapers and nicotine abstainers. CONCLUSIONS There is little evidence to support the view that perceptions of well-being deteriorate in vapers compared to complete nicotine abstainers in the immediate years after smoking cessation. IMPLICATIONS This study could find no conclusive evidence that the continued use of nicotine via e-cigarettes was detrimental to health compared to completely stopping nicotine intake altogether. Our results would suggest that continuing to use nicotine may even result in some benefits in the short term such as improved stress management, however further longitudinal studies are required to examine if these effects are restricted to the early post-quitting phase and whether other positive or negative effects on psychosocial health emerge in the future.
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Affiliation(s)
- Michael Le Grande
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, Vic 3010, Australia
| | - James Balmford
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, Vic 3010, Australia
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Izadpanah M, Najafi M, Khosravani V. Anxiety in social interactions and nicotine dependence in nicotine-dependent men: The role of metacognitions about smoking. Addict Behav 2021; 112:106656. [PMID: 32977272 DOI: 10.1016/j.addbeh.2020.106656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 01/10/2023]
Abstract
Anxiety in social interactions is an important factor in cigarette use and nicotine dependence. Metacognitions about smoking have been found to predict smoking behavior and may help understand the relationship between anxiety in social interactions and nicotine dependence. In the current study, we evaluated the direct effect of anxiety in social interactions on nicotine dependence and its indirect effect through metacognitions (controlling for anhedonia and depression) in nicotine-dependent men (n = 388). Participants completed measures of anxiety in social interactions [the Social Interaction Anxiety Scale (SIAS)], anhedonia [the Snaith HamiltonPleasure Scale (SHAPS)], metacognitions about smoking [e.g., theMetacognitions aboutSmoking Questionnaire (MSQ)] nicotine dependence [the Fagerström Test for Nicotine Dependence (FTND)], and clinical factors related to smoking including depressive symptoms [e.g., the Beck Depression Inventory-II (BDI-II)]. As expected, after controlling for depressive symptoms and anhedonia, anxiety in social interactions indirectly affected nicotine dependence through negative metacognitions about smoking, but not positive metacognitions. These findings are discussed in relation to the metacognitive model of addictive behaviors.
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Estey D, Platt J, Goodwin RD, Weinberger AH. Relationship of trauma exposure and PTSD to cigarette smoking prevalence, frequency, and quantity: Data from a nationally representative sample of U.S. adults. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2020; 13:231-239. [PMID: 33252969 DOI: 10.1037/tra0000991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Individuals with Post-Traumatic Stress Disorder (PTSD) smoke cigarettes at much higher prevalences than the general population. Less is known about PTSD and other smoking behaviors (e.g., smoking quantity and frequency) or about smoking among individuals who experience trauma. OBJECTIVE To examine differences in cigarette smoking behaviors among adults in the United States (a) with no exposure to trauma or PTSD, (b) with trauma but no PTSD, and (c) with PTSD. METHODS Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions-II (NESARC-II, 2004-2005) and included demographics, PTSD diagnoses, traumatic events, and smoking behaviors. Odds ratios and group differences in smoking prevalence and behaviors based on PTSD diagnoses and exposure to traumatic experiences were calculated. RESULTS Traumatic events and PTSD diagnoses were both associated with greater smoking prevalences than persons without trauma or PTSD. Individuals with PTSD who smoke were more likely to report daily smoking than those without PTSD who smoke (Cohen's d = 0.19). Cigarette users with either trauma or PTSD smoked more cigarettes per day than cigarette users without trauma or PTSD (Cohen's d = 0.35). US adults with trauma exposure or PTSD have higher smoking prevalences and more intense smoking behaviors than those without PTSD or trauma. CONCLUSION Trauma or PTSD may each serve as a clinical indicator of increased risk of cigarette smoking-related health problems and prompt the implementation of targeted interventions to reduce the harms of smoking. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- David Estey
- Ferkauf Graduate School of Psychology, Yeshiva University
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Mu W, Narine K, Farris S, Lieblich S, Zang Y, Bredemeier K, Brown L, Foa E. Trauma-related cognitions predict treatment response in smokers with PTSD: Evidence from cross-lagged panel analyses. Addict Behav 2020; 108:106376. [PMID: 32413581 DOI: 10.1016/j.addbeh.2020.106376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Compared to smokers without posttraumatic stress disorders (PTSD), smokers with PTSD smoke more heavily and are less successful in quitting smoking. However, limited research has examined the cognitive pathways underlying this heightened comorbidity. The current study is the first to simultaneously model the cross-sectional and lagged relationships between trauma-related cognitions and cigarette smoking, as well as between trauma-related cognitions and PTSD severity, in smokers with comorbid PTSD receiving treatment. METHOD Participants (n = 142) were seeking treatment for smoking cessation and PTSD as part of a randomized controlled trial of varenicline and smoking cessation counseling with or without adjunctive Prolonged Exposure (varenicline + PE vs. varenicline only) (Foa et al., 2017). Data were available for both baseline and end-of-treatment assessments of trauma cognitions severity of cigarette smoking and PTSD symptoms. We conducted both cross-sectional and lagged analysis to simultaneously examine the bidirectional relationship from trauma cognitions and 1) cigarette smoking and 2) PTSD symptoms. RESULTS Trauma cognitions (specifically, negative beliefs about the self and the world) were significantly associated with cigarette/day at the end of treatment for participants who received varenicline only. However, baseline trauma cognitions did not predict post-treatment cigarettes/day. Baseline trauma cognitions (specifically negative beliefs about the self and world) were associated with PTSD severity at both baseline and end of treatment; furthermore, these negative cognitions at baseline positively and prospectively predicted end-of-treatment PTSD severity, but not vice versa. Wald tests revealed that there were no treatment effects on these cross-lagged relationships. Conclusions These findings provide novel empirical support for the importance of addressing trauma-related cognitions in the smoking cessation treatment efforts for patients with comorbid PTSD and cigarette smoking.
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Garey L, Olofsson H, Garza T, Shepherd JM, Smit T, Zvolensky MJ. The Role of Anxiety in Smoking Onset, Severity, and Cessation-Related Outcomes: a Review of Recent Literature. Curr Psychiatry Rep 2020; 22:38. [PMID: 32506166 DOI: 10.1007/s11920-020-01160-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Anxiety is one of the most common mental health conditions globally and co-occurs with smoking at a markedly high rate. The present review offers a narrative overview of the most recent research on the role of anxiety in smoking onset, maintenance, and cessation-related outcomes. Additionally, given the rise in electronic cigarette use, we review the emerging literature on the influence of anxiety on e-cigarette use. RECENT FINDINGS Evidence across studies varied as to the role of anxiety or anxiety symptoms in smoking behavior. The most consistent findings suggested that those with anxiety are more likely to be a smoker, supporting a high rate of co-occurrence across these conditions. Less consistent evidence was observed for the association between anxiety and onset, indicators of severity, and cessation outcomes. Although there is robust evidence for an association between smoking and anxiety, there were considerable discrepancies for the precise role of anxiety in smoking onset, severity, and cessation outcomes. Future work utilizing more sophisticated methodologies is needed to identify causal relations as well as putative moderators and mediators of the anxiety-smoking relation.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA.
| | - Hannah Olofsson
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Tatyana Garza
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Justin M Shepherd
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,HEALTH Institute, University of Houston, Houston, TX, 77204, USA
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Miller S, Pike J, Shono Y, Beleva Y, Xie B, Stacy AW. The role of negative affect in the persistence of nicotine dependence among alternative high school students: A latent growth curve analysis. Drug Alcohol Depend 2020; 209:107883. [PMID: 32065940 PMCID: PMC7127931 DOI: 10.1016/j.drugalcdep.2020.107883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/23/2019] [Accepted: 01/23/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous research has demonstrated how negative affect (i.e., depression, anxiety, stress) is often a correlate of and precursor to nicotine dependence. Although recent evidence shows a gradual decline in tobacco use in the United States, subgroups that report higher levels of negative affect may continue to be at risk of becoming dependent on nicotine. One high-risk subgroup is students who attend alternative high schools. The current longitudinal investigation examined the effect of negative affect on nicotine dependence in this youth population. METHODS 1060 students from 29 alternative high schools in Southern California completed a series of attitudinal and behavioral measures once per year over a three-year period. The main outcome was nicotine dependence i.e., feeling a strong urge to use nicotine products or experiencing withdrawal symptoms after a period of abstinence, measured using a version of the Fagerstrom Tolerance Questionnaire designed for adolescents. A latent growth curve model was utilized to examine the effect of negative affect on nicotine dependence during this timeframe. RESULTS The analysis revealed that negative affect had both a concurrent and prospective relationship with nicotine dependence. Moreover, the association between negative affect and nicotine dependence in the present was not statistically significant once the influence of negative affect reported one year earlier was accounted for. CONCLUSIONS Negative affect may play a critical role in the persistence of nicotine dependence among high-risk youth. Providing resources to help manage negative affect may be critical to curtailing nicotine dependence in this population.
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Affiliation(s)
- Stephen Miller
- Department of Research and Evaluation, Didi Hirsch Mental Health Services, 323 N. Prairie Ave, Suite 325, Inglewood, CA 90301, USA.
| | - James Pike
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
| | - Yusuke Shono
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th Street, Suite 300, Box 354944, Seattle, WA 98195-4944, USA
| | - Yuliyana Beleva
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
| | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA
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Asnaani A, Kaczkurkin AN, Fitzgerald HE, Jerud A, Foa EB. The association between cognitive coping strategies and treatment outcomes in smokers with PTSD. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2020; 12:92-100. [PMID: 31120265 PMCID: PMC6874709 DOI: 10.1037/tra0000473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Numerous researchers have suggested that certain coping styles (e.g., maladaptive cognitive coping strategies) interfere with recovery from traumatic experiences and contribute to the onset/maintenance of posttraumatic stress disorder (PTSD). Further, given that individuals with PTSD have a high rate of smoking (e.g., Mahaffey et al., 2016) and that maladaptive coping strategies in general are associated with lower smoking quit rates, it is possible that use of maladaptive cognitive coping strategies are particularly problematic for the recovery of smokers with PTSD. The present study examined whether specific cognitive coping strategies are associated with poorer outcome among smokers with PTSD following an integrated treatment for both disorders. METHOD Patients with chronic PTSD and nicotine dependence (N = 142) received up to 12 sessions of smoking cessation counseling combined with varenicline or integrated prolonged exposure therapy and cessation counseling combined with varenicline. We hypothesized that greater maladaptive, and lower adaptive, cognitive coping strategies at baseline would moderate degree of improvement in smoking and PTSD outcomes through to follow-up. RESULTS Multilevel modeling revealed that neither maladaptive nor adaptive cognitive coping strategies moderated smoking abstinence outcomes over the course of the study (ps ≥ .271). However, greater use of catastrophizing and lower use of positive reappraisal at baseline were associated with less improvement in the hyperarousal PTSD symptom cluster over the course of the study (ps ≤ .01). CONCLUSIONS These findings suggest that maladaptive cognitive coping strategies are not necessarily a contraindication for overall outcomes in integrated PTSD and smoking treatment, although they may influence improvement in hyperarousal symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Associations between child maltreatment, cigarette smoking, and nicotine dependence in young adults with a history of regular smoking. Ann Epidemiol 2019; 40:13-20.e4. [PMID: 31711840 DOI: 10.1016/j.annepidem.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/31/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether childhood maltreatment is associated with smoking behaviors and lifetime nicotine dependence and if associations are moderated by sex. We examined these associations among individuals who ever reported being regular smokers. METHODS Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined relationships between retrospectively self-reported child maltreatment (parent/caregiver-perpetrated emotional, physical, sexual abuse, and neglect; and non-parent/caregiver-perpetrated sexual abuse) and self-reported smoking behaviors among individuals with a history of regular smoking. Outcomes were any current smoking in early adulthood (mean age = 28 years), current smoking in adolescent study waves only, adulthood only, and adolescence and adulthood (n = 3581); and lifetime history of nicotine dependence (n = 3594) per the Fagerstrom scale. RESULTS Poly-maltreatment (aRR for 2+ vs. 0 exposures = 1.20, 95% CI: 1.08, 1.34) was associated with lifetime nicotine dependence; associations between nicotine dependence and neglect and non-parent/caregiver sexual abuse by force were only present in women. Neglect and non-parent/caregiver sexual abuse by nonphysical threat were associated with continued smoking, and an association between non-parent/caregiver sexual abuse by physical force and continued smoking was also noted in women only. Women who experienced poly-maltreatment were less likely to report current smoking in adolescence but not adulthood. CONCLUSIONS These data suggest in a nationally representative sample of ever regular smokers, child maltreatment is associated with outcomes that suggest an inability to quit smoking and some associations may vary by sex.
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Latkin CA, Kennedy RD, Davey-Rothwell MA, Tseng TY, Czaplicki L, Baddela A, Edwards C, Chander G, Moran MB, Knowlton AR. The Relationship Between Neighborhood Disorder and Barriers to Cessation in a Sample of Impoverished Inner-City Smokers in Baltimore, Maryland, United States. Nicotine Tob Res 2019; 20:1451-1456. [PMID: 29126121 DOI: 10.1093/ntr/ntx252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022]
Abstract
Introduction Economic disparities in rates of smoking have been well documented in many countries. These disparities exist on an individual and geographic or neighborhood level. This cross-sectional study examined the relationship between neighborhood physical and social disorder and barriers to smoking cessation among an impoverished urban sample. Methods A sample of current smokers were recruited through street outreach, posted advertisements, and word of mouth from impoverished neighborhoods in Baltimore, Maryland, USA for a study of psychosocial factors and smoking behaviors. Neighborhood disorder was assessed with a 10-item scale from the Block Environmental Inventory and barriers to cessation with a 9-item scale. Results In the multiple logistic regression model, perceived stress (aOR = 1.60, 95% CI = 1.32 to 1.95), neighborhood disorder (aOR= 1.34, 95% CI = 1.11 to 1.63), and level of nicotine dependence (aOR = 1.97), 95% CI = 1.62 to 2.40) were all strongly associated with barriers to cessation. Conclusion The results of this study suggest that neighborhood disorder may lead to barriers to cessation among low-income populations. The findings also indicate that tobacco control interventions should examine and address social and physical aspects of impoverished neighborhoods. Implications In many countries, tobacco control programs and policies have been less effective among low-income populations as compared to more affluent populations. Little is known about how neighborhood factors influence smoking cessation. This study examined the relationship between neighborhood disorder and barriers to cessation among a low-income population. We recruited a convenience sample of hard-to-reach cigarette smokers from low-income neighborhoods. Even after controlling for level of nicotine dependence and stress, neighborhood disorder was found to be associated with barriers to cessation. The findings suggest the important role of neighborhood disorder as a barrier to smoking cessation.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan D Kennedy
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa A Davey-Rothwell
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tuo-Yen Tseng
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren Czaplicki
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anirudh Baddela
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catie Edwards
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Geetanjali Chander
- Division of Infectious diseases, Johns Hopkins School of Medicine, Baltimore, MD
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amy R Knowlton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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13
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Bilsky SA, Cloutier RM, Guillot CR, Bynion TM, Lewis SF. Relations Between Parental Distress Intolerance, Adolescent Motives for Cigarette Use, and Adolescent Cigarette Smoking Levels. Subst Use Misuse 2019; 54:2207-2217. [PMID: 31299868 PMCID: PMC6849207 DOI: 10.1080/10826084.2019.1638937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A relatively large body of evidence indicates that coping motives for cigarette smoking are associated with a number of problematic outcomes (e.g., greater smoking frequency) among adolescents. Evidence also indicates that lower distress tolerance (or higher distress intolerance) is related to higher levels of coping motives for cigarette smoking among adults and adolescents. Therefore, it is critical to improve our understanding of factors that may increase the likelihood of smoking to cope among adolescents. In addition, evidence suggests that a number of parenting behaviors may affect adolescent smoking behavior. No work to date, however, has examined the relation between parental distress intolerance and adolescent smoking motives, or adolescent smoking behavior. Objective/methods: The current study involving adolescents (n = 46) and one of their parents aimed to address this gap in the literature by examining the association between parent-reported parental distress intolerance, self-reported adolescent motives for cigarette use, and self-reported adolescent cigarette smoking levels. Results: Results indicated that parental distress intolerance was related to greater adolescent coping motives for cigarette smoking, but not to other motives for adolescent cigarette use. Furthermore, results indicated that parental distress intolerance was indirectly associated with higher adolescent cigarette smoking levels through adolescent coping motives for cigarette smoking. Conclusions: Parental distress intolerance is associated with coping motives for adolescent cigarette smoking. This suggests parental emotional factors may be associated with adolescent cigarette use.
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Affiliation(s)
- Sarah A. Bilsky
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Renee M. Cloutier
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Casey R. Guillot
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Teah M. Bynion
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Sarah F. Lewis
- Center for Research, Assessment, and Treatment Efficacy (CReATE), Asheville, NC, USA
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14
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Erwin MC, Dennis PA, Coughlin LN, Calhoun PS, Beckham JC. Examining the relationship between negative affect and posttraumatic stress disorder symptoms among smokers using ecological momentary assessment. J Affect Disord 2019; 253:285-291. [PMID: 31077971 PMCID: PMC6620145 DOI: 10.1016/j.jad.2019.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/12/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and negative affect (e.g., anger, depression, anxiety), are highly co-occurring. It remains unclear whether changes in PTSD symptoms subsequently impact negative affect, or vice versa. This study assessed associations between moment-to-moment PTSD symptoms and negative affect in a sample of smokers with PTSD to determine directionality of this relationship. METHODS Participants (N = 125) enrolled in two smoking cessation studies with co-occurring PTSD and cigarette use completed measures of PTSD and negative affect. Ecological momentary assessment (EMA) methodology was used to record symptoms during a one-week baseline period, during which participants smoked ad lib. Cross-lagged path analyses assessed PTSD symptoms and negative affect for directionality of their relationship, controlling for whether an EMA reading was smoking or non-smoking. Path analyses examined the lagged associations between PTSD symptoms and negative affect. RESULTS Results found PTSD symptom severity at T-1 was significantly related to negative affect levels at time T, but negative affect at time T-1 was not associated with PTSD symptom severity at time T. Results indicated the model retaining the cross-lagged effect of PTSD symptom severity on negative affect provided better fit to the data than other models. LIMITATIONS Limitations included use of self-report data, brief measures of symptoms, participants already had PTSD and/or MDD, participants were recruited from a specific clinical population, and use of DSM-IV data. CONCLUSIONS Results suggest PTSD symptoms drive day-to-day fluctuations in negative affect, and highlight the importance of evaluating negative affect in the treatment of PTSD.
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Affiliation(s)
- Meredith C. Erwin
- Durham VA Health Care System, Durham, NC,University of Toledo, Department of Psychology, Toledo, OH
| | - Paul A. Dennis
- Durham VA Health Care System, Durham, NC,Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Lara N. Coughlin
- Durham VA Health Care System, Durham, NC,Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA
| | - Patrick S. Calhoun
- Durham VA Health Care System, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC,VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC,Health Science Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC,VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC
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15
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Payne TJ, Sheffer CE, Gaughf NW, Sutton MJ, Peeples HH, Elci OU, Ma JZ, Penman A, Crews KM. Enrollee Characteristics in an Intensive Tobacco Dependence Treatment Program: The Relationship of Race and Sex to Demographic Factors and Tobacco Use Patterns. Front Psychiatry 2019; 10:112. [PMID: 30949071 PMCID: PMC6437063 DOI: 10.3389/fpsyt.2019.00112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/14/2019] [Indexed: 11/20/2022] Open
Abstract
Intensive tobacco treatment programs offer many advantages relative to other treatment options, particularly for more complex patients, e.g., highly nicotine dependent, or those with medical and psychiatric symptoms and disorders. Efforts to better understand those who choose to enroll in these programs, particularly regarding the characteristics they possess known to mediate outcomes, are important considerations in tailoring available services. In this study, we examined how participants differed on key descriptive and tobacco use variables within race (i.e., African-American, Caucasian) and sex subgroups. Baseline characteristics from a large group of consecutive program enrollees were examined across targeted subgroups. Strong racial effects and some sex effects were noted for marital status, education, employment and health insurance status, alcohol consumption, presence of medical and psychiatric disorders, as well as participant tobacco use patterns and tobacco use rates of family, friends and coworkers. The differences in participant tobacco use measures across race and sex factors remained significant after adjusting for the confounding effects of all other covariates. These findings have implications for characterizing key patient subgroups who present at tobacco treatment clinics. Such information may contribute to options for tailoring treatment regimens.
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Affiliation(s)
- Thomas J Payne
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, United States
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Natalie W Gaughf
- Academic Counseling, University of Mississippi Medical Center, Jackson, MS, United States
| | - Monica J Sutton
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Holly H Peeples
- Department of Family Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Okan U Elci
- Center for Biostatistics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Alan Penman
- Center for Biostatistics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Karen M Crews
- Professor Emeritus, University of Mississippi Medical Center, Jackson, MS, United States
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16
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Pericot-Valverde I, Elliott RJ, Miller ME, Tidey JW, Gaalema DE. Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis. Addict Behav 2018; 84:238-247. [PMID: 29753221 PMCID: PMC7285418 DOI: 10.1016/j.addbeh.2018.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/18/2018] [Accepted: 04/30/2018] [Indexed: 12/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) and tobacco use are prevalent conditions that co-occur at striking rates in the US. Previous reviews examined prevalence and factors associated with cigarette smoking among individuals with PTSD but have not been summarized since 2007. Moreover, none explored rates and factors associated with the use of other tobacco products. This study aimed to systematically review the most recent literature examining the comorbidity of PTSD and tobacco use to provide prevalence rates, as well as summarize the literature exploring other factors associated with tobacco use among individuals with PTSD. Studies were identified using a systematic search of keywords related to tobacco use and PTSD within the following databases: PubMed, PsycINFO, Web of Knowledge, CINAHL, PsycARTICLES, and Cochrane Clinical Trials Library. The studies included in this review (N = 66) showed that the prevalence of current use of tobacco products in individuals with PTSD was 24.0% and the rate of PTSD among users of tobacco products was 20.2%. Additionally, results demonstrated that individuals with PTSD present with high levels of nicotine dependence and heavy use of tobacco products, as well as underscore the importance of negative emotional states as a contributing factor to tobacco use among individuals with PTSD. It is imperative that future studies continue monitoring tobacco use among individuals with PTSD while also assessing factors identified as having a prominent role in tobacco use among individuals with PTSD. These findings also demonstrate the need for more innovative approaches to reduce the pervasive tobacco use among individuals with PTSD.
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Affiliation(s)
- Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States
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17
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Bakhshaie J, Kulesz PA, Garey L, Langdon KJ, Businelle MS, Leventhal AM, Gallagher MW, Schmidt NB, Manning K, Goodwin R, Zvolensky MJ. A prospective investigation of the synergistic effect of change in anxiety sensitivity and dysphoria on tobacco withdrawal. J Consult Clin Psychol 2017; 86:69-80. [PMID: 29172591 DOI: 10.1037/ccp0000256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Prevailing theory and research suggests the psychological and physiological discomfort associated with tobacco withdrawal may play a formative role in the risk of cessation failure. Yet, research elucidating cognitive-affective vulnerability characteristics that contribute to increased tobacco withdrawal severity during periods of planned abstinence is highly limited. In the current study, we explored whether smokers with greater reductions of Anxiety Sensitivity (AS) and dysphoria during a smoking cessation intervention would experience less severe postquit tobacco withdrawal. METHOD Specifically, the interactive effect of change (from preintervention baseline to quit day) in AS and dysphoria in relation to postquit withdrawal severity (quit day through 12 weeks postquit) was examined among treatment-seeking adult smokers enrolled in a smoking cessation trial (N = 198; 55.3% female; 86.8% Caucasian; Mage = 38.8, SD = 14.0). RESULTS Results indicated that the interactive effect of change in AS and dysphoria was related to linear change in postquit withdrawal symptoms. Specifically, larger reductions in AS were associated with a faster decline in the severity of withdrawal symptoms across the 12-week postquit period only for individuals with lower (but not higher) reductions in dysphoria. Additionally, the findings indicated that reducing levels of AS and dysphoria prequit is broadly related to the degree of change in postquit withdrawal symptoms. CONCLUSION Collectively, these data suggest there is apt to be clinical merit to employing strategies to address AS and/or dysphoria to more effectively manage emergent withdrawal symptoms following smoking cessation treatment. (PsycINFO Database Record
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Affiliation(s)
| | | | - Lorra Garey
- Department of Psychology, University of Houston
| | | | - Michael S Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California
| | | | | | | | - Renee Goodwin
- Department of Psychology, Queens College, City University of New York
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18
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Garey L, Jardin C, Kauffman BY, Sharp C, Neighbors C, Schmidt NB, Zvolensky MJ. Psychometric evaluation of the Barriers to Cessation Scale. Psychol Assess 2017; 29:844-856. [PMID: 27736128 PMCID: PMC5311030 DOI: 10.1037/pas0000379] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Barriers to Cessation Scale (BCS; Macnee & Talsma, 1995a) was developed to assess global and specific perceived barriers that may interfere with the quit process. Although the BCS is widely used in the literature, little scientific work has been devoted to examining the psychometric properties of the measure. Thus, the present study sought to address this gap by evaluating the BCS in a sample of 497 treatment-seeking smokers. The current study examined the factor structure of the BCS, measurement invariance of the BCS subscales across sex and over 2 time points, and evaluated construct validity. Results indicated that the BCS was best modeled by a higher order factor structure wherein the originally proposed 3-factor solution (Addiction, External, and Internal) constituted the lower order and a global factor constituted the higher order factor. The higher order BCS structure demonstrated partial measurement invariance across sex and full measurement invariance from baseline to quit day among treatment seeking smokers. Additionally, expected relations were observed between the BCS subscales and similar and divergent constructs, and predictive validity was partially supported. The current findings provide novel empirical evidence that the BCS is a reliable measure of perceived barriers to smoking cessation across multiple domains and is related to several affective and smoking processes the may interfere with the process of quitting. (PsycINFO Database Record
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston
| | | | | | - Carla Sharp
- Department of Psychology, University of Houston
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19
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Foa EB, Asnaani A, Rosenfield D, Zandberg LJ, Gariti P, Imms P. Concurrent varenicline and prolonged exposure for patients with nicotine dependence and PTSD: A randomized controlled trial. J Consult Clin Psychol 2017; 85:862-872. [PMID: 28569519 DOI: 10.1037/ccp0000213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prevalence of smoking among individuals with posttraumatic stress disorder (PTSD) is disproportionately high, and PTSD is associated with especially poor response to smoking cessation treatment. OBJECTIVE The current study examined whether integrating treatments for smoking cessation (varenicline plus smoking cessation counseling; VARCC) and PTSD (prolonged exposure therapy; PE) enhances smoking outcomes among smokers diagnosed with PTSD. METHOD 142 adults with nicotine dependence (ND) and PTSD were randomized to a treatment program consisting of varenicline, smoking cessation counseling, and PE (VARCC + PE) or to VARCC only. Seven-day point prevalence abstinence (PPA) at posttreatment (3-months postquit day) and follow-up (6-months postquit day), verified by serum cotinine levels and exhaled carbon monoxide, was the primary smoking outcome. Psychological outcomes were PTSD and depression severity. Mixed effects models included baseline PTSD severity as a moderator of treatment condition effects. RESULTS Overall, VARCC + PE participants did not show greater PPA than VARCC participants. However, treatment effects were moderated by baseline PTSD severity. For participants with moderate and high PTSD severity, VARCC + PE led to significantly higher PPA than VARCC alone (ps<.05). No differences between treatment conditions emerged for participants with low baseline PTSD severity. Participants who received PE showed significantly greater reduction of PTSD and depression symptoms than those who did not receive PE. CONCLUSIONS Integrating psychological treatment for PTSD and smoking cessation treatment enhances smoking cessation for participants with moderate or severe PTSD symptom severity, but does not enhance smoking cessation for participants with low baseline PTSD severity. (PsycINFO Database Record
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Affiliation(s)
- Edna B Foa
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | - Anu Asnaani
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | | | - Laurie J Zandberg
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | - Peter Gariti
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | - Patricia Imms
- Department of Psychiatry Center for the Treatment and Study of Anxiety
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20
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Treatment attrition: Associations with negative affect smoking motives and barriers to quitting among treatment-seeking smokers. Addict Behav 2016; 63:165-71. [PMID: 27518764 DOI: 10.1016/j.addbeh.2016.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/19/2016] [Accepted: 07/30/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Pre-treatment attrition and perceived barriers for quitting are clinically important processes involved in early phases of quitting smoking. However, less is known about the constructs that may contribute to these processes such as negative affect reduction smoking motives. METHOD The current study sought to evaluate the relation between negative affect reduction smoking motives and pre-treatment attrition and perceived barriers for quitting in a sample of 425 treatment-seeking smokers (48.5% female; Mage=37.69 years; SD=13.61) enrolled in a smoking cessation study examining the efficacy of a transdiagnostic panic-smoking cessation treatment relative to a standard smoking cessation treatment. RESULTS Results indicated that greater negative affect reduction smoking motives was associated with an increased likelihood of treatment initiation (odds ratio=1.49, CI: 1.09, 2.04). Additionally, negative affect reduction smoking motives was associated with greater perceived barriers for cessation among pre-treatment drop-outs and treatment initiators. CONCLUSIONS This initial investigation provides evidence for the possible clinical utility in addressing negative affect reduction smoking motives during early stages of quitting. Additionally, such findings could potentially inform the development of personalized, early stages of quitting interventions for smoking cessation.
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