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Schlam TR, Baker TB, Piper ME, Cook JW, Smith SS, Zwaga D, Jorenby DE, Almirall D, Bolt DM, Collins LM, Mermelstein R, Fiore MC. What to do after smoking relapse? A sequential multiple assignment randomized trial of chronic care smoking treatments. Addiction 2024; 119:898-914. [PMID: 38282258 PMCID: PMC11098029 DOI: 10.1111/add.16428] [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: 03/23/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
AIM To compare effects of three post-relapse interventions on smoking abstinence. DESIGN Sequential three-phase multiple assignment randomized trial (SMART). SETTING Eighteen Wisconsin, USA, primary care clinics. PARTICIPANTS A total of 1154 primary care patients (53.6% women, 81.2% White) interested in quitting smoking enrolled from 2015 to 2019; 582 relapsed and were randomized to relapse recovery treatment. INTERVENTIONS In phase 1, patients received cessation counseling and 8 weeks nicotine patch. Those who relapsed and agreed were randomized to a phase 2 relapse recovery group: (1) reduction counseling + nicotine mini-lozenges + encouragement to quit starting 1 month post-randomization (preparation); (2) repeated encouragement to quit starting immediately post-randomization (recycling); or (3) advice to call the tobacco quitline (control). The first two groups could opt into phase 3 new quit treatment [8 weeks nicotine patch + mini-lozenges plus randomization to two treatment factors (skill training and supportive counseling) in a 2 × 2 design]. Phase 2 and 3 interventions lasted ≤ 15 months. MEASUREMENTS The study was powered to compare each active phase 2 treatment with the control on the primary outcome: biochemically confirmed 7-day point-prevalence abstinence 14 months post initiating phase 2 relapse recovery treatment. Exploratory analyses tested for phase 3 counseling factor effects. FINDINGS Neither skill training nor supportive counseling (each on versus off) increased 14-month abstinence rates; skills on versus off 9.3% (14/151) versus 5.2% (8/153), P = 0.19; support on versus off 6.6% (10/152) versus 7.9% (12/152), P = 0.73. Phase 2 preparation did not produce higher 14-month abstinence rates than quitline referral; 3.6% (8/220) versus 2.1% [3/145; risk difference = 1.5%, 95% confidence interval (CI) = -1.8-5.0%, odds ratio (OR) = 1.8, 95% CI = 0.5-6.9]. Recycling, however, produced higher abstinence rates than quitline referral; 6.9% (15/217) versus 2.1% (three of 145; risk difference, 4.8%, 95% CI = 0.7-8.9%, OR = 3.5, 95% CI = 1.0-12.4). Recycling produced greater entry into new quit treatment than preparation: 83.4% (181/217) versus 55.9% (123/220), P < 0.0001. CONCLUSIONS Among people interested in quitting smoking, immediate encouragement post-relapse to enter a new round of smoking cessation treatment ('recycling') produced higher probability of abstinence than tobacco quitline referral. Recycling produced higher rates of cessation treatment re-engagement than did preparation/cutting down using more intensive counseling and pharmacotherapy.
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Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Kim HC, Kaplan CM, Islam S, Anderson AS, Piper ME, Bradford DE, Curtin JJ, DeYoung KA, Smith JF, Fox AS, Shackman AJ. Acute nicotine abstinence amplifies subjective withdrawal symptoms and threat-evoked fear and anxiety, but not extended amygdala reactivity. PLoS One 2023; 18:e0288544. [PMID: 37471317 PMCID: PMC10358993 DOI: 10.1371/journal.pone.0288544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
Tobacco smoking imposes a staggering burden on public health, underscoring the urgency of developing a deeper understanding of the processes that maintain addiction. Clinical and experience-sampling data highlight the importance of anxious withdrawal symptoms, but the underlying neurobiology has remained elusive. Mechanistic work in animals implicates the central extended amygdala (EAc)-including the central nucleus of the amygdala and the neighboring bed nucleus of the stria terminalis-but the translational relevance of these discoveries remains unexplored. Here we leveraged a randomized trial design, well-established threat-anticipation paradigm, and multidimensional battery of assessments to understand the consequences of 24-hour nicotine abstinence. The threat-anticipation paradigm had the expected consequences, amplifying subjective distress and arousal, and recruiting the canonical threat-anticipation network. Abstinence increased smoking urges and withdrawal symptoms, and potentiated threat-evoked distress, but had negligible consequences for EAc threat reactivity, raising questions about the translational relevance of prominent animal and human models of addiction. These observations provide a framework for conceptualizing nicotine abstinence and withdrawal, with implications for basic, translational, and clinical science.
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Affiliation(s)
- Hyung Cho Kim
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, Maryland, United States of America
| | - Claire M Kaplan
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Samiha Islam
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Allegra S Anderson
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Megan E Piper
- Center for Tobacco Research and Intervention and Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Daniel E Bradford
- School of Psychological Sciences, Oregon State University, Corvallis, Oregon, United States of America
| | - John J Curtin
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kathryn A DeYoung
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Jason F Smith
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Andrew S Fox
- Department of Psychology, University of California, Davis, California, United States of America
- California National Primate Research Center, University of California, Davis, California, United States of America
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, Maryland, United States of America
- Maryland Neuroimaging Center, University of Maryland, College Park, Maryland, United States of America
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Paz Castro R, Henninger M, Schaub MP, Salis Gross C. Changes in attitudes towards smoking during smoking cessation courses for Turkish- and Albanian-speaking migrants in Switzerland and its association with smoking behavior: A latent change score approach. Front Psychol 2022; 13:1032091. [PMID: 36619056 PMCID: PMC9813416 DOI: 10.3389/fpsyg.2022.1032091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Migrant populations usually report higher smoking rates than locals. At the same time, people with a migration background have little or no access to regular smoking cessation treatment. In the last two decades, regular smoking cessation courses were adapted to reach out to Turkish- and Albanian-speaking migrants living in Switzerland. The main aims of the current study were (1) to analyze the effects of an adapted smoking cessation course for Turkish- and Albanian-speaking migrants in Switzerland on attitudes toward smoking and smoking behavior; and (2) to elucidate whether changes in attitudes toward smoking were associated to changes in smoking behavior in the short- and in the long-term. Methods A total of 59 smoking cessation courses (Turkish: 37; Albanian: 22) with 436 participants (T: 268; A: 168) held between 2014 and 2019 were evaluated. Attitudes toward smoking and cigarettes smoked per day were assessed at baseline and 3-months follow-up. One-year follow-up calls included assessment of cigarettes smoked per day. Data were analyzed by means of structural equation modeling with latent change scores. Results Participation in an adapted smoking cessation course led to a decrease of positive attitudes toward smoking (T: β = -0.65, p < 0.001; A: β = -0.68, p < 0.001) and a decrease of cigarettes smoked per day in the short-term (T: β = -0.58, p < 0.001; A: β = -0.43, p < 0.001) with only Turkish-speaking migrants further reducing their smoking in the long-term (T: β = -0.59, p < 0.001; A: β = -0.14, p = 0.57). Greater decreases in positive attitudes were associated with greater reductions of smoking in the short-term (T: r = 0.39, p < 0.001; A: r = 0.32, p = 0.03), but not in the long-term (T: r = -0.01, p = 0.88; A: r = -0.001, p = 0.99). Conclusion The adapted smoking cessation courses fostered changes in positive attitudes toward smoking that were associated with intended behavior change in the short-term. The importance of socio-cognitive characteristics related to behavior change maintenance to further increase treatment effectiveness in the long-term is discussed.
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Affiliation(s)
- Raquel Paz Castro
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland,Marie Meierhofer Institut für das Kind, Zurich, Switzerland,*Correspondence: Raquel Paz Castro,
| | - Mirka Henninger
- Psychological Methods, Evaluation and Statistics, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland
| | - Corina Salis Gross
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland
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Schiess-Jokanovic J, Knefel M, Kantor V, Weindl D, Schäfer I, Lueger-Schuster B. The boundaries between complex posttraumatic stress disorder symptom clusters and post-migration living difficulties in traumatised Afghan refugees: a network analysis. Confl Health 2022; 16:19. [PMID: 35477465 PMCID: PMC9043511 DOI: 10.1186/s13031-022-00455-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological distress due to the ongoing war, violence, and persecution is particularly common among Afghan asylum seekers and refugees. In addition, individuals face a variety of post-migration living difficulties (PMLDs). Complex posttraumatic stress symptoms are among the most common mental health problems in this population, and were associated with the overall burden of PMLDs. The complex interplay of posttraumatic symptoms has been investigated from a network perspective in previous studies. However, individuals are embedded in and constantly react to the environment, which makes it important to include external factors in network models to better understand the etiology and maintaining factors of posttraumatic mental health problems. PMLDs are a major risk factor for posttraumatic distress and considering their impact in interventions might improve response rates. However, the interaction of these external factors with posttraumatic psychopathological distress is not yet fully understood. Thus, we aimed to illuminate the complex interaction between PMLDs and CPTSD symptom clusters. OBJECTIVE The main objective is the exploration of the network structure and the complex interplay of ICD-11 CPTSD symptom clusters and distinct forms of PMLDs. METHOD The symptom clusters of CPTSD and PMLDs were collected within a randomised controlled trial among 93 treatment-seeking Afghan asylum seekers and refugees via a fully structured face-to-face and interpreter assisted interview. Using a network analytical approach, we explored the complex associations and network centrality of the CPTSD symptom clusters and the PMLD factors: discrimination & socio-economical living conditions, language acquisition & barriers, family concerns, and residence insecurity. RESULTS The results suggest direct links within and between the constructs (CPTSD, PMLD). Almost all PMLD factors were interrelated and associated to CPTSD, family concerns was the only isolated variable. The CPTSD symptom cluster re-experiencing and the PMLD factor language acquisition & barriers connected the two constructs. Affective dysregulation had the highest and avoidance the lowest centrality. CONCLUSIONS Re-experiencing and affective dysregulation have the strongest ties to PMLDs. Thus, these domains might explain the strong association of posttraumatic psychopathology with PLMDs and, consequently, prioritization of these domains in treatment approaches might both facilitate treatment response and reduce burden caused by PMLDs.
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Affiliation(s)
- Jennifer Schiess-Jokanovic
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010, Vienna, Austria.
| | - Matthias Knefel
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010, Vienna, Austria
| | - Viktoria Kantor
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010, Vienna, Austria
| | - Dina Weindl
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010, Vienna, Austria
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Lueger-Schuster
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010, Vienna, Austria
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