Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial

Worldwide, more than eight million people die each year as a result of tobacco use. A large proportion of smokers who want to quit are interested in alternative smoking cessation methods, of which hypnotherapy is the most popular. However, the efficacy of hypnotherapy as a tobacco cessation intervention cannot be considered sufficiently proven due to significant methodological limitations in the studies available to date. The aim of the present study was to compare the efficacy of a hypnotherapeutic group program for smoking cessation with that of an established cognitive-behavioral group program in a randomized controlled trial. A total of 360 smokers who were willing to quit were randomly assigned to either hypnotherapy (HT) or cognitive-behavioral therapy (CBT) at two study sites, without regard to treatment preference. They each underwent a 6 weeks smoking cessation course (one 90 min group session per week) and were followed up at regular intervals over a 12 months period. The primary outcome variable was defined as continuous abstinence from smoking according to the Russell standard, verified by a carbon monoxide measurement at three measurement time points. Secondary outcome variables were 7 days point prevalence abstinence during the 12 months follow up and the number of cigarettes the non-quitters smoked per smoking day (smoking intensity). Generalized estimating equations were used to test treatment condition, hypnotic suggestibility, and treatment expectancy as predictors of abstinence. The two interventions did not differ significantly in the proportion of participants who remained continuously abstinent throughout the follow-up period (CBT: 15.6%, HT: 15.0%) and also regarding the 7 days abstinence rates during the 12 months follow-up (CBT: 21.2%, HT: 16.7%). However, when controlling for hypnotic suggestibility, CBT showed significantly higher 7 days abstinence rates. In terms of the continuous abstinence rates, it can be concluded that the efficacy of hypnotherapeutic methods for smoking cessation seem to be comparable to established programs such as CBT.

Clinical trial registration

ClinicalTrials.gov, identifier NCT01129999.

The Evidence Base for Interventions Targeting Individuals With Work-Related PTSD: A Systematic Review and Recommendations

The purpose of this study was to summarize the evidence base for interventions targeting individuals with work-related posttraumatic stress disorder (PTSD), to make recommendations for clinicians and administrative decision makers involved in their rehabilitation, and to guide future research in this area. Particular attention was given to studies that were conducted in naturalistic clinical settings or in a workers’ compensation claim context. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 11 articles. Study populations included railroad personnel, police officers, disaster workers, and individuals with industrial injuries. Interventions included trauma-focused cognitive-behavioral therapy and eye movement desensitization and reprocessing. Several studies specifically targeted workers who had failed to return to work (RTW) after standard PTSD treatment. The results suggest that psychotherapy interventions are beneficial for helping clients recover from PTSD symptoms and RTW. In studies that reported on work status, RTW rates increased over time and generally lay between 58% and 80% across follow-up time points. Narrative impressions were supplemented by calculation of Risk Differences for individuals working at pretreatment versus posttreatment. Clinical consideration, methodological issues limiting the current body of work, and recommendations for future research are discussed.

Recruitment and retention of homeless individuals with mental illness in a housing first intervention study

Background

Homeless individuals with mental illness are challenging to recruit and retain in longitudinal research studies. The present study uses information from the Vancouver site of a Canadian multi-city longitudinal randomized controlled trial on housing first interventions for homeless individuals. We were able to recruit 500 participants and retain large number of homeless individuals with mental illness; 92% of the participants completed the 6-month follow up interview, 84% the 24-month follow up, while 80% completed all follow-up visits of the study.

Purpose

In this article, we describe the strategies and practices that we considered as critical for successful recruitment and retention or participants in the study.

Methods

We discuss issues pertaining to research staff hiring and training, involvement of peers, relationship building with research participants, and the use of technology and social media, and managing challenging situations in the context of recruitment and retention of marginalized individuals.

Conclusions

Recruitment and retention of homeless participant with mental illness in longitudinal studies is feasible. It requires flexible, unconventional and culturally competent strategies. Longitudinal research projects with vulnerable and hidden populations may benefit from extensive outreach work and collaborative approaches that are based on attitudes of mutual respect, contextual knowledge and trust.

The Perceived Impact of Trauma-Focused Research on Forensic Psychiatric Patients With Lifetime Victimization Histories

This study examined the perceived costs, benefits, and motivations for participating in individual trauma-focused interviews among forensic psychiatric patients ( N = 74). The majority of our participants were male, and 100% endorsed adverse childhood experiences (e.g., abuse, neglect) or exposure to potentially traumatic events (e.g., assault). Levels of posttraumatic avoidance (41.9%), reexperiencing (59.5%), and increased arousal (51.3%) were high. In line with previous studies, our findings suggest an overall positive research experience in this sample. In spite of extensive histories of lifetime victimization we did not find an association between victimization, posttraumatic symptomatology, and a negative research experience. Our findings suggest that participation in trauma-focused research is not only possible with, but also potentially beneficial for forensic patients.

A Motivational, Gender-Sensitive Smoking Cessation Resource for Family Members of Patients With Lung Cancer

PURPOSE/OBJECTIVES

To gather feedback on an innovative gender-sensitive booklet that draws on emotional connections and relationship factors to motivate smoking cessation.

RESEARCH APPROACH

Qualitative, descriptive.

SETTING

Six provinces in Canada.

PARTICIPANTS

30 family members of patients with lung cancer who were currently smoking or had recently quit.

METHODOLOGIC APPROACH

Parallel booklets for women and men were developed using language and images to emphasize family relationships and gender considerations to motivate smoking cessation. Participants were provided with the women's and men's versions of the resource, and they were asked to review the gender-specific version of the booklet that was relevant to them. Semistructured telephone interviews were conducted, and transcriptions were analyzed for themes.

FINDINGS

Three themes were evident in the data, including "new perspectives.

CONCLUSIONS

A gender-sensitive approach that focuses on relationship factors represents an acceptable way to engage relatives of patients with lung cancer in discussions to support smoking cessation.

INTERPRETATION

Approaches to supporting smoking cessation among relatives of patients diagnosed with lung cancer should draw on positive relationship bonds and caring connections to motivate cessation.

"Like a lots happened with my whole childhood": violence, trauma, and addiction in pregnant and postpartum women from Vancouver's Downtown Eastside

Background

Women living in poor and vulnerable neighbourhoods like Vancouver’s Downtown Eastside (DTES) face multiple burdens related to the social determinants of health. Many of them struggle with addiction, are involved in the sex trade and experience homelessness and gender-based violence. Such evidence suggests that psychological trauma is also a common experience for these women.

Methods

The purpose of this qualitative study was to explore themes and subjective perspectives of trauma and gender-based violence in women who lived in an impoverished neighbourhood and struggled with substance use during pregnancy and early motherhood. We interviewed 27 individuals accessing harm reduction services for pregnant and postpartum women in Vancouver, Canada.

Results

Key themes that emerged from these women’s narratives highlighted the ubiquity of multiple and continuing forms of adversities and trauma from childhood to adulthood, in a variety of contexts, through a variety of offenders and on multiple levels. Both individual and environmental/structural conditions mutually intensified each other, interfering with a natural resolution of trauma-related symptoms and substance use. Women were also concerned that trauma could be passed on from one generation to the next, yet expressed hesitation when asked about their interest in trauma-specific counselling.

Conclusions

In offering harm reduction services for poor and marginalized women, it is clear that an understanding of trauma must be integrated. It is recommended that service providers integrate trauma-informed care into their programme in order to offer this service in a trusted environment. However, it is also necessary to shift the focus from the individual to include environmental, social, economic and policy interventions on multiple levels and from issues of drug use and reduction of drug-related harms to include issues of gendered vulnerabilities and human rights.

Gender, smoking and tobacco reduction and cessation: a scoping review

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our research team identified the need to clarify the current theoretical and methodological interpretations of gender within the context of tobacco research. To address this need a scoping review of the published literature was conducted focussing on tobacco reduction and cessation from the perspective of three aspects of gender: gender roles, gender identities, and gender relations. Findings of the review indicate that there is a need for greater clarity on how researchers define and conceptualize gender and its significance for tobacco control. Patterns and anomalies in the literature are described to guide the future development of interventions that are gender-sensitive and gender-specific. Three principles for including gender-related factors in tobacco reduction and cessation interventions were identified: a) the need to build upon solid conceptualizations of gender, b) the importance of including components that comprehensively address gender-related influences, and c) the importance of promoting gender equity and healthy gender norms, roles and relations.

Help-Seeking Experiences of Youth with Suicidal Ideations

Approximately 28 percent of Canadians begin to experience a mental health issue during their youth. In this article, we explore patients' perceptions of their mental healthcare experiences within a sample of youth who reported anxiety or depressive symptoms and past suicidal ideations. The study data is taken from in-depth interviews with 23 youth in British Columbia. Interview topics included support systems, help-seeking behavior and healthcare experiences. Our findings indicate that participant experiences were most positive when experiences were neither dismissive nor stigmatizing. Important factors for participants were respect, acknowledgement, information and choice. Our results generated the concept that treatment perceptions for youth with suicidal behaviours can be placed on a theoretical spectrum, which may be a useful tool for self reflection for those who support individuals with mental health conditions professionally or personally.

Religious participation and substance use behaviors in a Canadian sample of homeless people

This study examined religious behaviors in 380 homeless individuals. We hypothesized that higher frequency of religious attendance is associated with lower rates of use of all substances, lower rates of drug and alcohol dependence, and lower psychological distress. Individuals attending religious ceremonies at least weekly ("frequent attendees") were compared to infrequent attendees. Participants also provided qualitative information about their faith. In univariate analyses, frequent attendees had significantly lower rates of alcohol, cocaine, and opioid use than infrequent attendees. They also had lower rates of alcohol and drug dependence, lifetime suicide attempts, and psychological distress, but these differences were not significant. In multivariate analyses, religious attendance remained significantly associated with alcohol use and opioid use. Researchers need to examine how spiritual and religious practices can be effectively incorporated as a part of substance abuse treatment.

Are childhood abuse and neglect related to age of first homelessness episode among currently homeless adults?

This study investigates 500 homeless adults and the associations between childhood maltreatment types and the age of first reported homelessness episode. Those first experiencing homelessness in youth (age 24 years or younger; 46%) were compared with those first experiencing homelessness at a later age (older than age 24 years). In individual models, physical abuse, emotional abuse, and emotional neglect were associated with first experiencing homelessness during youth (p < .02 for all types of maltreatment). In the simultaneous model, only emotional abuse remained significantly associated (p = .002). In addition, increasing numbers of maltreatment were associated with becoming homeless during youth (p < .0001). These results highlight the unique associations between childhood maltreatment types and becoming homeless earlier in life and support the need for early interventions with at-risk families.

Gender differences in early trauma and high-risk behaviors among street-entrenched youth in British Columbia

OBJECTIVE

This work aimed to evaluate gender differences among the street-entrenched youth in British Columbia in terms of their demographics, experiences of childhood maltreatment, mental health issues, and substance use behaviors.

MATERIALS AND METHODS

Data were derived from the BC Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada. Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ), the Mini International Neuropsychiatric Interview (MINI) Plus and the National Survey of Homeless Assistance Providers and Clients (NSHAPC)-Health Chapter.

RESULTS

Youth constituted 16.5% (n=82) of the homeless population. Females (55%) outnumbered males and engaged in survival sex more frequently (17.8%; p=0.03). Males had greater substance abuse of alcohol (81.1%) and cannabis (89.2%). Depression (p=0.02) and psychosis (p=0.05) were more common among females, while panic disorder was more common among males (p=0.04). Rates of childhood trauma were similar across genders.

CONCLUSION

Our findings reflect trends among youth where illicit drug use may be similar among genders while males may report increased alcohol and cannabis use, possibly as a means to self medicate their panic-related symptoms. In any case, this population of street entrenched-youth frequently experiences several significant problems ranging from childhood abuse to high rates of substance abuse and mental illnesses.

Sexual health, vulnerabilities and risk behaviours among homeless adults

It is well known that homeless individuals are at risk for a variety of health problems, including sexually transmissible infections. Optimisation of health services for the homeless requires knowledge of their sexual health. The sexual health and sexual vulnerability factors of 500 homeless adults (196 women) were assessed in a cross-sectional survey in three Canadian cities. Our data indicate that a significant proportion of individuals and more women than men reported multiple experiences that compromise their sexual health exponentially. These findings may inform health policies related to sexuality to foster positive sexual health outcomes for all people, including marginalised populations.

Posttraumatic stress disorder and substance use disorder comorbidity in homeless adults: Prevalence, correlates, and sex differences

Substance use disorders (SUDs) are highly prevalent in homeless populations, and rates are typically greater among males. Posttraumatic stress disorder (PTSD) is a common co-occurring condition among individuals with SUDs; however, little attention has been directed to examining this comorbidity in homeless populations. Although some studies indicate considerable sex differences among individuals with PTSD, it has also been suggested that sex differences in PTSD rates diminish in populations with severe SUDs. This cross-sectional study investigated SUD-PTSD comorbidity and its associations with indicators of psychosocial functioning in a sample of 500 homeless individuals from Canada. Sex-related patterns of SUD, PTSD, and their comorbidity were also examined. Males and females had similar SUD prevalence rates, but the rates of PTSD and PTSD-SUD comorbidity were higher in females. PTSD and sex were found to have significant main effects on suicidality, psychological distress, somatic symptoms, and incarceration among individuals with SUD. Sex also moderated the association of PTSD with suicide risk and psychological distress. Our results contradict assumptions that sex differences in PTSD rates attenuate in samples with severe SUDs. Organizations providing SUD treatment for homeless people should address PTSD as an integrated part of their services. SUD and integrated treatment programs may benefit from sex-specific components.

Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings

OBJECTIVE

To determine the standardized rates of mental disorder, health service use and barriers to care in a representatively diverse sample of homeless adults in three different sized urban centers in British Columbia, Canada.

METHOD

Five hundred homeless adults from Vancouver, Victoria and Prince George were recruited. The MINI-International Neuropsychiatric Interview PLUS was used to determine current and lifetime rates of mental disorder, mental disorder episodes and suicidality. Health service use and barriers to care were recorded.

RESULTS

Overall, 92.8 % of participants met criteria for a current mental disorder: 82.6 % for alcohol or drug dependence, 57.3 % anxiety disorder, 31.5 % mood disorder. Over half (53.4 %) met criteria for a concurrent disorder. Only 14.9 % had seen a psychiatrist and 12.7 % a mental health team in the year prior to the survey. Most common barriers included being poorly connected to the system of care and issues related to homelessness. Mental disorder rates across sites were high, however, differences were found that reflected the composition of the samples.

CONCLUSION

Improving the mental health state of the homeless will require significant capacity for mental health and concurrent disorder programming that is tailored to the community it intends to serve. Demographic features of the population may help in directing assessments of need.

The Burnaby treatment center for mental health and addiction, a novel integrated treatment program for patients with addiction and concurrent disorders: results from a program evaluation

Background

Patients with addictions and concurrent disorders constitute the most underserved population in the system of care. There are numerous reasons why this population has so much difficulty accessing services, including behavioural issues, criminal engagement, and non-compliance with outpatient services. To improve services to this population which is marked by multiple morbidities, high mortality and insufficient access to health care, the government of British Columbia, Canada developed a program for people with both substance use disorder and one or more mental disorders who have not benefited from previous therapies.

Method

In July 2008, the Burnaby Treatment Centre for Mental Health and Addiction (BCMHA), a specialized and integrated tertiary care facility, was opened. The current article provides a description of the treatment program and a clinical profile of the population.

Results

The target population is being served, at intake clients present with high rates of psychopathology, childhood and adult trauma, and substance use.

Conclusion

While preliminary, these results indicate, that the novel approach of the Burnaby Centre may constitute a new path towards providing effective recovery for this population.

Understanding treatment-seeking smokers' motivation to change: content analysis of the decisional balance worksheet

The Decisional Balance Worksheet (DBW), an open-ended measure of motivation to change, may be used to record the pros and cons of smoking versus abstinence among treatment-seeking smokers. Recent findings indicated that the open-ended DBW could be quantified to validly reflect people's level of motivation to stop smoking (Collins, Eck, Torchalla, Schröter, & Batra, 2010). The goal of the current study was to enhance our understanding of these participants' motivation to change by examining the qualitative content of their decisional balance. Participants were treatment-seeking smokers (N=268) who had participated in a larger randomized controlled trial of tailored smoking cessation interventions (Batra et al., 2010). Using the DBW, participants recorded their pros and cons of smoking versus abstinence, and content analysis methods were used to extract common themes. Findings indicated that the physical and psychological effects/functions of smoking and abstinence were most commonly mentioned as both pros and cons. Although the decisional balance categories were substantively similar over time, their relative frequency shifted from pre- to posttreatment. For the sample as a whole, the number of pros of smoking generally decreased, whereas the pros of abstinence increased from pre- to posttreatment. Findings suggest that clinicians can expect certain perceived pros and cons to characterize their clients' decision-making process about smoking and abstinence. At the same time, the use of the decisional balance allows for assessment of individuals' unique motivational set.

Sex differences in nicotine dependence among addictions clients accessing a smoking cessation programme in Vancouver, British Columbia, Canada

Most individuals in drug treatment programmes use tobacco and are dependent on nicotine. For 323 participants (65% men, mean age = 49.3 years) with a history of substance use disorder (SUD) and/or psychiatric disorders (PD) enrolled in a tobacco dependence clinic programme, we compared baseline characteristics among women and men and examined factors associated with nicotine dependence (ND). Individuals with mood, anxiety and psychotic disorders were more likely to be female, whereas men were more likely to be characterized by alcohol, cocaine and marijuana use, older age, older age at smoking initiation and higher confidence in quitting smoking scores. In stratified multivariate analyses, among women, history of an anxiety disorder and a greater number of cigarettes smoked per day were associated with higher ND scores; among men, a greater number of cigarettes smoked per day and higher confidence in quitting scores were associated with higher ND scores. Given the differences in smoking, SUD and PD histories between women and men accessing addiction treatment, and differential associations with ND, it is important to further explore factors that may enhance tailored treatments and inform future studies examining biological and psychosocial factors for tobacco use in SUD and PD treatment populations.

The association between childhood maltreatment subtypes and current suicide risk among homeless men and women

This study explored self-reports of five childhood maltreatment (CM) subtypes and their associations with current suicide risk in a sample of 500 homeless persons. Participants completed the Childhood Trauma Questionnaire and the Mini-International Neuropsychiatric Interview. Individual, unique, and cumulative associations of CM subtypes and subtype combinations with suicide risk (no vs. low vs. moderate/high) were examined. In multivariate analyses, four of the five CM subtypes were associated with suicide risk in individual models, but not in a model that included all CM subtypes. The strongest associations were found for reports of multitype CM involving all five subtypes. Mental disorders and female sex were independently associated with suicide risk. Clinicians working with CM victims should be aware that homeless clients are likely to report multitype maltreatment and should assess a variety of CM experiences. Future studies need to further examine multitype maltreatment and suicidal behaviors in homeless populations with complex conditions.

Gender Differences in Smoking Behaviour and Cessation

This article reviews the literature to compare differential outcomes among men and women after smoking cessation, assess barriers they may face during cessation and provide recommendation to address gender-specific challenges in smoking cessation interventions. There is some evidence that women achieve lower abstinence rates than men after a quit attempt with nicotine replacement therapy, as well as without pharmacotherapy, and several underlying mechanisms were discussed to account for these findings. These include: (a) women have specific genetic variants that affect pharmacokinetics and pharmacodynamics of the medication, (b) hormonal influences increase nicotine metabolism and withdrawal symptoms, (c) women are more responsive to nonpharmacological aspects of smoking than men, (d) women are more vulnerable to depression and negative mood than men, (e) weight concerns are greater barriers for women than for men and (g) women receive less effective social support than men during a quit attempt. Gender-specific counselling that accounts for these factors and addresses the different needs of men and women may be a promising approach to improve long-term abstinence rates. However, more research is required to identify gender-related underlying mechanisms of differential smoking cessation outcomes, develop tailored interventions that account for gender differences and study the implementation and outcomes of gender-responsive treatment approaches.

Substance use and predictors of substance dependence in homeless women

OBJECTIVE

To examine lifetime and current prevalence rates of substance use disorders and the demographic and clinical correlates of current drug dependence in a sample of homeless women.

METHODS

A cross-sectional study of 196 homeless women in three Canadian cities was done. Each subject was assessed using structured clinical interviews. A multivariate regression model was applied to determine predictors of substance use.

RESULTS

The mean age of the sample was 35.3 years, 54.4% identified as Aboriginal, 46.4% lived on the street Crack cocaine (58%) was the most common substance used, followed by alcohol (53%), cannabis (41%), and heroin (30%). Overall, 82.4% of the sample had at least one type of current substance use disorder, of which 70.5% had drug dependence and 37.8% had alcohol dependence. 58.3% had concurrent substance use and mental health disorders. 76.7% of those individuals with current alcohol dependence had concurrent drug dependence. Only 24.6% of those who had recovered from alcohol dependence had no current substance use disorder. Multivariate analyses showed that younger age, living on the street, engaging in sex work, and having ever attempted suicide were associated with current drug dependence.

CONCLUSION

Prevalence rates for alcohol and especially drug dependence were exceptionally high in this sample. Innovative programs need to be developed which are accessible and tailored to meet the needs of this specific population, accounting for high problem severity, polysubstance dependence, and high rates of psychiatric comorbidity.

Smoking and predictors of nicotine dependence in a homeless population

OBJECTIVE

To assess prevalence rates of tobacco use and dependence in a sample of homeless individuals and to investigate trends for demographic and clinical characteristics across different levels of nicotine dependence (nonsmokers vs. lowly dependent smokers vs. highly dependent smokers).

METHODS

A cross-sectional study of 489 homeless men and women in 3 Canadian cities. Each subject was assessed using structured clinical interviews and the Fagerström Test for Nicotine Dependence (FTND). Cochran-Armitage trend tests were applied to determine unadjusted trends in sociodemographic and clinical variables across levels of nicotine dependence. A generalized logit model was computed to adjust for potential confounding.

RESULTS

The mean age was 37.9 years; 39.2% of the participants were women. About 80.8% were current smokers; the mean FTND score was 5.0. Although no significant differences were found between nonsmokers and smokers with low nicotine dependence, smokers with high nicotine dependence were only half as likely as nonsmokers to be Aboriginal, were 2.39 times more likely to have ever been incarcerated, and 2.44 times more likely to have current drug dependence. There were significant trends for the use of cocaine, opioids, and alcohol, with nonsmokers having the lowest and highly dependent smokers having the highest rates of using these substances.

CONCLUSIONS

Available public health smoking cessation treatment opportunities should be made available within health care services for the homeless. There is also a need for developing and implementing tobacco dependence treatment programs, which are accessible and tailored to meet the needs of this specific population, accounting for polysubstance use and concurrent substance dependence and mental health disorders.

Nicotine dependence and gender differences in smokers accessing community mental health services

Despite evidence of differences in smoking behaviour between women and men, few studies have assessed these differences in individuals with mental illnesses. In this cross-sectional study, we explored gender differences in smoking behaviour among 298 individuals (60% male) accessing community mental health services. Individuals with a psychotic disorder as compared with a non-psychotic disorder, and individuals using a greater number of substances were more likely to be male. Readiness to change, daily cigarette consumption and level of nicotine dependence did not differ between men and women; however, subjective ratings of tobacco addiction were higher in women than in men. Among women, only scores on the subjective tobacco addiction scale were associated with nicotine dependence, while among men, a variety of variables were associated with nicotine dependence. These factors are important for understanding individual differences in tobacco dependence among clients with mental illnesses, and are expected to inform future studies examining tobacco use in mental health treatment populations.

Sex differences in smoking cessation outcomes of a tailored program for individuals with substance use disorders and mental illness

Tobacco use is highly prevalent among individuals with a history of substance use disorders (SUD) and/or mental illness (MI). Despite evidence of differences in smoking cessation (SC) outcomes between women and men, few studies have formally evaluated sex differences among SUD and/or MI populations. For 258 participants (62% male, mean age=48.6 years) with an SUD and/or MI enrolled in a tobacco dependence clinic (TDC) program, we examined SC outcomes and compared men's and women's predictors of end-of-treatment abstinence. Individuals with an MI, social support for quitting, and a greater number of visits to the TDC program were more likely to be female; whereas males were characterized by having an SUD, older age, smoking a greater number of cigarettes per day, and having higher confidence in quitting smoking. In the intent-to-treat analysis, end-of-treatment smoking cessation was 32.2% (females=35.4% vs males=30.2, χ(2)=0.74, df=1, p=.390). Among females, baseline expired carbon monoxide (CO) level and a greater number of visits to the program were significantly predictive of SC; among males, having a history of alcohol, heroin and other opioids, and marijuana use were predictive of unsuccessful SC, whereas baseline expired CO level and a greater number of visits to the program were predictive of SC. These factors may be important in the design of enhanced tailored treatments and development of future SC programs for individuals with SUD and MI.

Differences in the smoking identities of adolescent boys and girls

OBJECTIVE

To assess sex-disaggregated differences in youths' characterizations of their own smoking behavior.

METHOD

Cross-sectional data including demographics (sex, age, and grade level), perceived addiction to tobacco, Dimensions of Tobacco Dependence Scale (DTDS) scores, the Modified Fagerström Tolerance Questionnaire (M-FTQ) scores, smoking history, and self-reported smoking identity were collected from questionnaires administered to 7246 students in British Columbia, Canada. Differences in tobacco dependence by sex and by smoking identity were examined.

RESULTS

Girls were more likely to report being ex-, social, irregular, or regular smokers than were boys; and were more likely to select more than one smoking identity to describe their smoking behavior. Among the current smokers, the boys smoked more cigarettes each day, on average, and had significantly higher scores on the social and sensation dependence dimensions of the DTDS, and the M-FTQ, compared with the girls. Girls in each smoking identity group had lower scores on every tobacco dependence measure, except the emotional dependence dimension of the DTDS.

CONCLUSION

Adolescent boys and girls appear to understand and subscribe to 'smoking identity' groups in similar patterns. However, there may be differences in the ways boys and girls conceptualize, describe, and endorse smoking identities. Researchers should examine the consistency between adolescents' smoking identities and researcher-derived categorizations of their smoking in planning and selecting appropriate interventions. Future research should explore qualitative gender differences in the smoking identities of adolescents.

Decisional balance proportion: quantifying qualitative data to represent motivation to change among treatment-seeking smokers

This study tested a new measure of motivation to change as a predictor of smoking behavior following smoking cessation treatment. Participants were adult, regular smokers (N=191) who took part in a randomized smoking cessation trial in southwestern Germany (Batra et al., 2010). Participants completed smoking and psychological self-report measures before and after a 6-week smoking cessation treatment. Among these measures, the open-ended decisional balance worksheet elicited participant-generated pros and cons of smoking versus abstinence. Counts of the pros and cons were combined into the decisional balance proportion (DBP), which reflected participants' current balance towards smoking behavior change. Additional smoking assessments were conducted up to the 12-month follow-up. After controlling for group effects and baseline smoking, DBP change scores (posttreatment-pretreatment) reflecting greater movement towards change during treatment predicted time to first smoking lapse as well as abstinence up to the 12-month follow-up. Higher DBP change scores also predicted lower frequency and intensity of smoking lapses during the 12-month follow-up. Findings indicated that participant-generated, qualitative data from a decisional balance worksheet can be quantified to produce a valid measure of motivation to change among smokers. This measure can inform intervention content and may potentially be used to match smokers to appropriate treatments.

Validity of the timeline followback among treatment-seeking smokers in Germany

Few studies have assessed the convergent validity of the timeline followback for smoking (TLFB-S) among treatment-seeking smokers, and there are no studies assessing its discriminant validity. Further, no studies to date have documented the psychometric properties of the TLFB in the German population. The aim of this study was therefore to test the convergent and discriminant validity of the TLFB-S among adult, treatment-seeking smokers in Germany. In the context of a smoking cessation trial, participants (N=268) completed sociodemographic, TLFB-S and other, self-aggregated, single-item (SA) smoking measures at pretreatment. During the 12-month posttreatment period, participants completed TLFB-S and biochemically validated SA measures of smoking intensity and abstinence at regular intervals. Discriminant validity analyses showed no significant associations for substance-use and sociodemographic variables and measurement discrepancy between TLFB-S and SA measures of pretreatment smoking intensity. Convergent validity analyses indicated that TLFB-S and SA measures of smoking intensity were in high agreement at both pretreatment and posttreatment. Finally, there was high concordance between TLFB-S and SA measures of abstinence at both 1- and 12-month posttreatment. This study replicated and extended the current literature on the TLFB and showed that, even across cultures, it can be a valid measure of various smoking-related variables.

Implementation of a smoking cessation treatment integrity protocol: treatment discriminability, potency and manual adherence

Testing manual adherence and treatment discriminability and potency have become increasingly important to ensuring the internal validity of treatment studies [Moncher, F.J., & Prinz, R.J., (1991). Treatment fidelity in outcome studies. Clinical Psychology Review, 11, 247-266.]. The objective of this study was therefore to implement the treatment integrity protocol based on the standardized framework proposed by Waltz, Addis, Koerner and Jacobson [Waltz, J., Addis, M.E., Koerner, K., & Jacobson, N.S., (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61, 620-630.] to assess manual adherence and treatment discriminability and potency in a smoking cessation trial. Audio recordings of 15, 6-week smoking cessation groups were randomly selected from a sample of 31 groups and were rated for treatment integrity. Findings offered partial evidence for manual adherence which did not differ according to treatment condition. Analyses also indicated that the treatments were potent yet not highly discriminable across conditions. Despite some challenges, this preliminary application of the Waltz et al. [Waltz, J., Addis, M.E., Koerner, K., & Jacobson, N.S., (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61, 620-630.] protocol indicated that it is a promising and flexible tool that may be used to examine different aspects of treatment integrity.

Development and validation of a cluster-based classification system to facilitate treatment tailoring

AIMS

The objectives of this study were to replicate smoker profiles identified in Batra et al. (in press) and to develop a cluster-based classification system to categorize new cases into smoker profiles so that an appropriate tailored intervention could be applied.

METHODS

Participants were smokers in southwest Germany who sought treatment for smoking cessation. In the first sample, discriminant analysis was used to create classification formulas for a future study (classification sample: n = 165). The second sample served to replicate the smoker profiles, which included participants reporting symptoms of hyperactivity/novelty-seeking, depressivity or high nicotine dependence as well as participants scoring low across smoking and psychological variables (replication sample: N = 134).

RESULTS

Part 1 was focused on the development of formulas, using Fisher's coefficients, with which new cases could be classified. Part 2 adequately replicated previous findings concerning the smoker profiles, such that 70% of participants in the second sample were classified identically using cluster analysis and classification formulas.

CONCLUSIONS

The smoker profiles found in a previous study were replicated, and a classification system was developed for a future study which will test the efficacy of tailored treatments for the different smoker profiles.

[Homeless women with psychiatric disorders -- a field study]

AIM

The aim of the study was to investigate the psychosocial situation of all homeless women in a southern German university town.

METHOD

The scope, structure and whereabouts of the target group were initially unknown. 17 of 22 homeless women identified agreed to participate in an extensive study including the Structured Clinical Interview for DSM-IV (SKID-I).

RESULTS

The prevalence of diagnosed psychiatric disorders was 71 %; the leading disorder was substance abuse/dependence (43 %), followed by anxiety disorders (35 %) and schizophrenia (12 %). Multiple diagnoses were made in 35 % of the women.

DISCUSSION

Striking features were the often early onset of homelessness and the reticence in seeking help. The flight from violence was a crucial precipitant of the loss of the home and should also be discussed in the context of the development of the psychiatric disorders. This study is the first involving women outside major cities. Precipitant situation, need for help and help-seeking pattern appear to deviate markedly from those of homeless men. The results should be verified in further gender-specific studies.