Exploring the Role of Traumatic Event Exposure in Tobacco Dependence Treatment Outcomes Among African Americans

African Americans are more likely to die from tobacco-related diseases and less likely to quit smoking than their white counterparts. Evidence of greater prevalence of posttraumatic stress disorder (PTSD) among African Americans underscores the importance of studying the effects of traumatic event exposure on tobacco dependence treatment outcomes in this group. In this secondary analysis of data from a previously completed randomized control trial, we examined the effects of traumatic event exposure (e.g., serious accident) on tobacco dependence treatment outcomes, as well its moderating effects on the effectiveness of an adapted smoking cessation treatment, in a sample (n = 169) of African American smokers in New York City. Traumatic event exposure did not have a significant impact on tobacco treatment outcomes and did not moderate the relationship between treatment type and outcomes in this sample. While results may be driven by unique sample characteristics, they may also indicate that an average level of traumatic event exposure does not significantly impact tobacco treatment outcomes among African Americans. Future research should examine the effects of higher levels of traumatic event exposure on treatment outcomes, as well as investigating the factors underlying trauma-exposed individuals' difficulties with reducing/quitting smoking in a larger, more diverse African American sample.

A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparities

We propose that executive dysfunction is an important component relating to the socio-economic status gradient of select health behaviors. We review and find evidence supporting an SES gradient associated with (1) negative health behaviors (e.g., obesity, excessive use of alcohol, tobacco and other substances), and (2) executive dysfunction. Moreover, the evidence supports that stress and insufficient cognitive resources contribute to executive dysfunction and that executive dysfunction is evident among individuals who smoke cigarettes, are obese, abuse alcohol, and use illicit drugs. Collectively these data support the dual system model of cognitive control, referred to here as the Competing Neurobehavioral Decision Systems hypothesis. The implications of these relationships for intervention and social justice considerations are discussed.

The impact of brief tobacco treatment training on practice behaviours, self-efficacy and attitudes among healthcare providers

INTRODUCTION AND PURPOSE

The need for aggressive efforts to help tobacco users quit remains a healthcare priority. Brief interventions delivered in the healthcare environment continue to be a valuable component of a comprehensive tobacco control policy. Unfortunately, such treatments are offered less often than desired, and quality is variable. Previous research has demonstrated the value of training experiences in increasing treatment availability, quality, as well as improving clinical outcomes. Less is known about how specific clinical activities and other features are impacted as a function of training. These issues were explored within the context of a standardised 5A's (ASK, ADVISE, ASSESS, ASSIST, ARRANGE) brief intervention training program.

METHODS

A variety of healthcare providers participated in this study. Survey methodology was employed to collect Practice Behaviour, Self-Efficacy and Attitude ratings at pretraining, post training and 6-month follow-up. Linear mixed effects models were used to evaluate primary outcomes, and linear regression to explore the relationships among clinical variables.

RESULTS

Pretraining data suggested overall modest levels of tobacco treatment activity, with limited direct intervention (ASSIST) or follow-up (ARRANGE) efforts. The training experience was shown to have a substantial and sustained impact on 5A's Practice Behaviour ratings, and other clinical indicators (all Pre vs. Post and Pre vs. Follow-up comparisons p < 0.001). Self-Efficacy at post training predicted practice behaviours at follow-up (for ADVISE, ASSESS, ASSIST and ARRANGE: all p's < 0.05).

CONCLUSIONS

The value of a structured training experience was confirmed, and findings served to clarify the specific nature of training program impact.

The effects of impression management demands on heart rate, self-reported social anxiety, and social competence in undergraduate males

The effects of self-presentation demands were evaluated through conversational probe (CP) role-play tasks. Participants (N = 29) were required to manage their self-presentations (i.e., the impression they made, in each of two conditions). During high impression management (IM) demand, participants were evaluated on their performance. During Low IM demand, participants evaluated a confederate's performance. The High IM demand condition produced significantly higher heart rate (HR) and self-reported anxiety. HR and self-reported anxiety accounted for a significant amount of the variance in criterion measures of social competence. Greater social competence during High IM was associated with higher HR. Greater social competence during Low IM was associated with lower HR and lower self-reported anxiety. Although preliminary, these results suggest that uncontrolled IM demands contributed to mixed results found within and between social anxiety studies in the literature. Implications for the treatment of social anxiety are discussed.