Clinical management of smoking cessation: patient factors affecting a reward-based approach

The effects of cardiorespiratory fitness on executive function and prefrontal oxygenation in older adults

Reviews on cardiovascular fitness and cognition in older adults suggest that a higher level of cardiorespiratory fitness may protect the brain against the effects of aging. Although studies reveal positive effects of cardiorespiratory fitness on executive function, more research is needed to clarify the underlying mechanisms of these effects in older adults. The aim of the current study was to assess the association between cardiorespiratory fitness level, cerebral oxygenation, and cognitive performance in older adults (OAs). Seventy-four OAs (68 ± 6.3 years) gave their written, informed consent to participate in the study. Complete data was collected from 66 participants. All participants underwent a cycle ergometer maximal continuous graded exercise test in order to assess their peak power output (PPO) and a neuropsychological paper and pencil tests (Trail Making Test A and B) while changes in left prefrontal cortex oxygenation were measured with functional near-infrared spectroscopy (fNIRS). The results reveal increased cardiorespiratory fitness was associated with decreased response time (i.e., better performance) on the Trail Making Test (B) (standardized β = - 0.42, p < 0.05). Cerebral oxygenation in higher fit older adults mediated the relationship with improved executive functioning (standardized β = - 0.08, p < 0.05). Specifically, in older adults with higher cardiorespiratory fitness (based on a median split), cerebral oxygenation was related to executive functioning but no such relationship existed in lower fit adults.

Clinical, sociodemographic and tobacco-use factors associated with smoking cessation rates at three years follow-up, Ankara, Turkey

INTRODUCTION

Smoking is a well-known major cause of early preventable mortality and morbidity. Maintenance of smoke-free status is important after a smoking cessation attempt. The present study aims to compare the sociodemographic and clinical characteristics of subjects participating in a smoking-cessation program, according to the duration of smoking cessation.

METHODS

A study was conducted in 261 smokers who had attended a smoking cessation clinic in a tertiary hospital, in Ankara, Turkey. The smoking status of the subjects at three years follow-up after participating in the smoking-cessation program was assessed. Sociodemographic, employment, environmental, smoking-related, health and clinical characteristics of subjects were compared according to the smoking cessation duration.

RESULTS

Marital status, having a child, absence of household smoking and lower levels of nicotine dependence were significantly higher in quitters, and anxiety was lower. Parameters that significantly differed between subjects that were and were not abstinent for >36 months were marital status (p<0.001), childbearing status (p=0.007), household smoking (p<0.001), age of smoking initiation (p=0.02), psychiatric illness history (p=0.01), and number of follow-up visits (p<0.001). The number of follow-up visits at the smoking cessation clinic was an important factor of quitting and maintenance of quit status.

CONCLUSIONS

Family and home environment as well as smoking-related and mental health characteristics influenced maintenance of long-term smoking cessation. Characteristics such as sociodemographic, clinical and smoking-related conditions should be considered in smoking cessation interventions. Personalized treatment strategies and follow-up visits at the smoking cessation clinic should be planned for maintenance of smoking cessation.

The phenotype of recovery III: Delay discounting predicts abstinence self-efficacy among individuals in recovery from substance use disorders

Abstinence self-efficacy (ASE) and delay discounting predict treatment outcomes and risk of relapse. Associations between delay discounting and ASE among individuals in recovery from substance use have not been investigated. Data from 216 individuals in recovery from substance abuse recruited from The International Quit & Recovery Registry, an ongoing online data collection program used to understand addiction and how people succeed in recovery, were included in the analysis. Discounting rates were assessed using an adjusting-delay task, and ASE was assessed using the Relapse Situation Efficacy Questionnaire (RSEQ). Delay discounting was a significant predictor of ASE, even after controlling for age, gender, race, ethnicity, annual income, education level, marital status, and primary addiction. Context-specific factors of relapse included Negative Affect, Positive Affect, Restrictive Situations (to drug use), Idle Time, Social-Food Situations, Low Arousal, and Craving. A principal component analysis of RSEQ factors in the current sample revealed that self-efficacy scores were primarily unidimensional and not situation specific. The current study expands the generality of delay discounting and indicates that discounting rates predict ASE among individuals in recovery from substance use disorders. This finding supports the recent characterizations of delay discounting as a candidate behavioral marker of addiction and may serve as a basis to better identify and target subgroups that need unique or more intensive interventions to address higher risks of relapse and increase their likelihood of abstinence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Behavioral Economic Research in Addiction as an Area of Growth for the Experimental Analysis of Behavior

Behavioral economics, a synthesis of the experimental analysis of behavior (EAB) and economics, seeks to determine the relative value of reinforcers as a function of various environmental constraints. Early animal and human studies often focused on drug reinforcement, and this has continued to the present. In particular, behavioral economic analyses of human and animal behavior in relation to nicotine and cigarette smoking have contributed to a greater understanding of this behavior, and to a greater reliance on these methods in the field of smoking cessation treatment, tobacco regulatory science and tobacco control. In this commentary, we briefly describe the history of behavioral economics in the context of EAB methods, the particular contribution of these methods to understanding cigarette smoking and the advance of tobacco regulation, as well as opportunities for growth and remaining challenges in this area. As behavioral economics continues to stimulate research and inform policy, we propose that the underlying elements of a rigorous analytic approach to understanding behavior are key contributors to the fruitfulness of this approach.

Increasing the Value of an Alternative Monetary Reinforcer Reduces Cigarette Choice in Adolescents

INTRODUCTION

Smoking can be conceptualized as an operant behavior maintained by the reinforcing effects of cigarettes. Changing the magnitude and availability of alternative reinforcers should shift behavior away from smoking. Adults' smoking behavior is sensitive to the magnitude and availability of alternative reinforcers; however, the extent to which the same is true for adolescents has not yet been shown in the laboratory.

METHODS

To test the sensitivity of adolescent smoking behavior to changes in the magnitude of alternative reinforcement, we gave adolescents who abstained overnight the opportunity to make 20 choices between receiving two puffs of their usual-brand cigarette or money. The magnitude of the monetary reinforcer was varied across sessions in counterbalanced order ($0.00, $0.10, and $0.50).

RESULTS

Results indicated that adolescents' choices for puffs decreased as a function of increasing monetary reinforcer magnitude, while money choices increased. This effect was moderated by baseline smoking level and by gender, such that heavier-smoking participants and males made more cigarette choices when the alternative monetary value was zero, and decreased their choices more steeply in response to increasing monetary value.

CONCLUSIONS

The current study validates a laboratory choice procedure for studying smoking in adolescents, and demonstrates that adolescent smoking behavior is sensitive to changes in the magnitude of concurrently available monetary reinforcers. The current paradigm can be adapted and applied to explore the effects of other variables that may affect cigarette choice in adolescents.