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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. [ABSTRACT FROM AUTHOR]

Aims: To understand dual users' cigarette and e‐cigarette use patterns, including the contexts in which they vape versus smoke and to understand how environmental and internal contexts and smoking patterns differ between dual users and exclusive smokers. Design Longitudinal observational trial. Setting: Research center in Wisconsin, USA. Participants: Adult dual users (n = 162) and adults who exclusively smoked (n = 143), with no plans to quit smoking or vaping in the next 30 days. Measurements Participants carried smartphones for 2 weeks at baseline to record each use event for the two products and report on the context of their product use. The percentage of mornings where participants vaped first versus smoked were used to compute e‐cigarette dependence. Findings Hierarchical linear regression models with random slopes and intercepts examined the within‐ and between‐subject effects of context on the likelihood of vaping (versus smoking); significant fixed effects were tested for moderation by e‐cigarette dependence. Dual users reported significantly more puffs/cigarette [mean = 13.1, standard deviation (SD) = 10.2] than puffs/vape event (mean = 11.7, SD = 11.5; P = 0.01). E‐cigarette dependence moderated the influence of social cues (t‐ratio = 2.4, P = 0.02) and smoking restrictions (t‐ratio = 3.1, P = 0.003) on the likelihood of vaping versus smoking [odds ratio (OR) = 2.30, P = 0.02]. Context was more related to which product was used in those of low versus higher e‐cigarette dependence. Reports of strong cravings to smoke and positive expectancies for cigarettes were associated with a reduced likelihood of vaping, whereas strong cravings to vape and positive vaping expectancies were related to increased likelihood of vaping. Conclusions: Among dual users of cigarettes and e‐cigarettes with no motivation to quit, vaping appears to be related to internal cues and more highly linked with social contexts and smoking restrictions (i.e. under stronger external stimulus control) among those with low to moderate e‐cigarette dependence compared with high e‐cigarette dependence. These findings illustrate the importance of contextual factors in tobacco product use among dual users with the influence of context being reduced at high levels of e‐cigarette dependence. [ABSTRACT FROM AUTHOR]

Background and aims: The phase‐based model of smoking cessation treatment suggests that treatment needs may vary across phases (e.g. pre‐cessation, cessation). This study tested the comparative effects of varenicline and combination nicotine replacement therapy (C‐NRT) relative to nicotine patch monotherapy on pre‐cessation and cessation phase candidate withdrawal, expectancy and motivation mediators; relations between mediators and abstinence; and indirect effects of enhanced treatments on abstinence via candidate mediators. Design Secondary mediation analysis of data from the open‐label, randomized Wisconsin Smokers' Health Study 2, a comparative effectiveness trial of varenicline or C‐NRT, versus patch monotherapy, in adults who smoked, recruited via media and community outreach. Setting: Research clinics in Madison and Milwaukee, Wisconsin, USA. Participants: A total of 1051 daily smokers motivated to quit smoking (52.5% female; mean age = 48.1, standard deviation = 11.6). Interventions: Twelve weeks of varenicline (n = 407) or 12 weeks of combination nicotine patch and nicotine lozenge therapy (n = 421), both compared with 12 weeks of patch control condition (n = 230), with individual smoking cessation counseling. Measurements The primary abstinence outcome was biochemically verified 7‐day point‐prevalence abstinence 4 weeks post‐target quit day (TQD). Candidate mediators (craving, positive smoking expectancies, withdrawal symptoms, and quitting motivation) were assessed via ecological momentary assessment from 1 week prior (pre‐cessation phase) to 4 weeks after (cessation phase) the TQD. Findings Pre‐cessation and cessation mean levels and slopes of craving [adjusted odds ratio (aOR) = 0.34–0.79], smoking expectancies (aOR = 0.46–0.79) and quitting motivation (aOR = 1.35–7.21) significantly predicted 4‐week post‐TQD abstinence (P < 0.05). Significant varenicline mediation occurred via greater suppression in pre‐cessation craving [mediated effect (ab) = 0.09, standard error (SE) = 0.03, 95% confidence interval (CI) = 0.04–0.14] and smoking expectancies (ab = 0.06, SE = 0.02, 95% CI = 0.02–0.12). C‐NRT mediation occurred via greater reduction in pre–post‐TQD changes in craving (ab = 0.04, SE = 0.02, 95% CI = 0.01–0.08) and expectancies (ab = 0.03, SE = 0.02, 95% CI = 0.001–0.07), relative to patch monotherapy. Conclusion: Among adult smokers seeking to quit, varenicline seems to work through its effects on suppression of craving and smoking expectancies pre‐cessation while combination nicotine replacement therapy mediation seems to work through cessation‐related reduction in craving and smoking expectancies changes. [ABSTRACT FROM AUTHOR]

Aims: To identify when smoking cessation treatments affect craving, negative affect and anhedonia, and how these symptoms relate to abstinence, to help evaluate the effects of particular intervention components in multi‐component treatments and accelerate treatment refinement. Design Secondary analysis of data from a two‐arm randomized controlled trial. Setting: Seven primary care clinics in Wisconsin, United States. Participants: Adult primary care patients who smoked daily (n = 574). Intervention and comparator: Intervention was abstinence‐optimized treatment (A‐OT, n = 276) comprising 3 weeks of nicotine mini‐lozenges pre‐target quit day (TQD), 26 weeks of combination nicotine patch and mini‐lozenges post‐TQD and extensive psychosocial support. The comparator was recommended usual care (RUC, n = 298), comprising brief counseling and 8 weeks of nicotine patch post‐TQD. Measurements Time‐varying effect models examined dynamic effects of A‐OT (versus RUC) on the primary outcomes of nightly cigarette craving, negative affect and anhedonia from 1 week pre‐ to 2 weeks post‐TQD. Exploratory models examined within‐person relations between nicotine medication use and same‐day symptom ratings. Secondary logistic regression analyses examined associations between post‐TQD craving, negative affect and anhedonia and 1‐month post‐TQD abstinence. Findings A‐OT significantly suppressed pre‐ and post‐TQD craving (β = −0.27 to −0.46 across days) and post‐TQD anhedonia (β = −0.24 to −0.38 across days), relative to RUC. Within individuals, using patches was associated with lower negative affect in RUC (β = −0.42 to −0.52), but not in A‐OT. Using more mini‐lozenges was associated with greater craving (β = 0.04–0.07) and negative affect (β = 0.03–0.05) early, and with lower anhedonia (β = −0.06 to −0.12) later. Greater post‐TQD craving (OR = 0.68) and anhedonia (OR = 0.85) predicted lower odds of abstinence 1 month post‐TQD. Conclusion: Time‐varying effect models showed that a multi‐component treatment intervention for smoking cessation suppressed significant withdrawal symptoms more effectively than recommended usual care among daily adult smokers motivated to quit. The intervention reduced craving pre‐ and post‐target quit day (TQD) and anhedonia post‐TQD. [ABSTRACT FROM AUTHOR]

Presents several commentaries on the research `Meta-analysis of cue-reactivity in addiction research,' by Brian L. Carter and Stephen T. Tiffany published in the same issue of the `Addiction.'