Do Pain-Related Anxiety and Difficulties With Emotion Regulation Impact Abstinence Expectancies or Motivation to Quit E-Cigarette Use?

Neighborhood Vigilance in Terms of Abstinence Expectancies for Smoking and Severity of Problems When Quitting

Background: Although social determinants of health (SDoH) have increasingly been understood as clinically important factors in the onset, maintenance, and relapse of substance use behavior, little research has evaluated neighborhood vigilance in terms of smoking. Objectives: The present investigation sought to evaluate the role of neighborhood vigilance in terms of smoking abstinence expectancies (i.e., perceived consequences of refraining from smoking, including negative mood, somatic symptoms, harmful consequences, and positive consequences) and severity of problems when trying to quit among adults who smoke. Results: Participants included 93 treatment-seeking people who smoke (45.2 years of age and 29% identified as female). Results: indicated that greater levels of neighborhood vigilance were associated with negative mood and harmful consequences abstinence expectancies. No effect was evident for somatic symptom abstinence expectancies after Bonferroni correction. Conclusions: As expected, neighborhood vigilance was not predictive of positive abstinence expectancies, offering explanatory specificity. Neighborhood vigilance was also associated with more severe problems when trying to quit smoking. The current findings suggest neighborhood vigilance represents an important contextual factor involved in certain negative beliefs about abstinence and challenges in quitting.

Effectiveness of the Brief Guided Self-Change Therapy Combined with Varenicline under "Real-Life" Conditions and Mediators for Smoking Cessation

Background: Brief therapies have proven to reduce tobacco cost-effectively, however, unsuccessful quit attempts remain notable in real-life conditions, and the underlying mechanisms of treatment success are still unclear. Objectives: We aimed to analyze the effectiveness of the Guided Self-Change (GSC) therapy combined with varenicline (VAR+T) in public health services against varenicline alone (VAR), and to identify mediators of treatment outcomes. We conducted a two-arm quasi-experimental study with 126 treatment-seeking smokers (age=57.3±9.1 years; 59.5% women). Before treatment, and at weeks 12 and 24, we assessed tobacco use and five potential mediators: withdrawal, craving, motivation to quit, anxiety, and depression. Results: Only 25% of participants adhered to varenicline prescription, and 54% to GSC therapy. VAR+T group showed a greater proportion of abstainers compared to VAR group at week 12 (75% vs 57.4%; φc=0.21) and week 24 (62.9% vs 52.5%; φc=0.10). When controlling for weeks taking varenicline, motivation showed a significant indirect effect over abstinence rates in VAR+T compared with VAR (a1b1=1.34; 95%CI=0.04, 5.03). Conclusions: The GSC effectiveness seems to increase motivation which in turn contributes to reducing tobacco use. The implementation of GSC therapy in public health services could minimize treatment duration and increase smoking abstinence in 'real-life' conditions where varenicline adherence remains low.

Longitudinal Associations Between Pain and Use of Cigarettes and E-cigarettes in the Population Assessment of Tobacco and Health (PATH) Study

INTRODUCTION

Pain has been implicated in the onset and maintenance of nicotine addiction, and there is initial cross-sectional evidence of covariation between pain and the use of cigarettes and e-cigarettes. The goals of the current study were to: (1)test pain severity as a predictor of initiating co-use of cigarettes and e-cigarettes, (2)examine longitudinal associations between pain and use/co-use of cigarettes and e-cigarettes, (3)generate the first prevalence rate data regarding cigarette and e-cigarette use as a function of pain, and (4)examine gender as a moderator of these associations.

AIMS AND METHODS

Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (2013-2018).

RESULTS

Among exclusive cigarette smokers at Wave 1 (n = 7719), pain severity was associated with a greater likelihood of and faster trajectory to initiating co-use of cigarettes and e-cigarettes (ps < .05). A significant pain × gender interaction (p < .05) revealed this prospective relationship was stronger among women. Among adult respondents who provided at least three waves of data (n = 24 255), greater Wave 1 pain severity was positively associated with e-cigarette use, cigarette smoking, and co-use of cigarettes and e-cigarettes at Waves 2, 3, and 4 (ps < .001). At Wave 4 (n = 33 822), adults with moderate or severe pain endorsed rates of e-cigarette and cigarette use almost two times greater versus no or low pain (ps < .001).

CONCLUSIONS

Collectively, these findings provide evidence that pain likely serves as an important candidate risk factor for the initiation and maintenance of cigarette and e-cigarette use.

IMPLICATIONS

This is the first prospective study to show that pain serves as an important risk factor for initiation and maintenance of cigarette and e-cigarette use over time. Weighted prevalence estimates further demonstrated that individuals with moderate or severe pain endorsed rates of cigarette and e-cigarette use and co-use approximately two times greater compared to those with no or low pain. These findings highlight a subpopulation of nicotine users more susceptible to greater healthcare burden, nicotine dependence, and physical impairment. Nicotine users with comorbid pain may benefit from integrated interventions that address pain in the context of cessation.