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The present study investigated alcohol consumption and cigarettes per day in relation to smoking outcome expectancies among Spanish-speaking Latinx daily smokers (n = 371). There was a significant interaction between alcohol consumption and number of cigarettes per day on positive smoking expectancies. Specifically, alcohol consumption has a stronger association with positive expectancies for smoking at lower rates of cigarettes per day. No such interaction was evident for negative consequence smoking expectancies. The current study highlights the potential importance of alcohol consumption and smoking rate for better understanding smoking outcome expectancies among Latinx smokers.

Purpose Head and neck cancer (HNC) patients are at risk of long-term body image distress (BID). We aimed to investigate the severity of BID in long-term HNC survivors and to explore the associations between sociodemographic and clinical factors, patient-reported late effects, and cancer-related body image (BI) concerns. Methods This cross-sectional study included quality of life and BI assessment in an 8-year (SD = 1.58) follow-up after treatment among 258 HNC survivors. Multinomial logistic regression analysis was used to investigate the relationship between three groups of BI concerns (no concerns, mild to moderate concerns, and BID) and patient-reported late effects. Sociodemographic and clinical variables were included in the model as covariates. Results A total of 51.2% of participants had mild to moderate BI concerns, and 9.5% reported BID. Compared to those with no BI concerns, participants with BID were more likely to live without a partner, to have had radiotherapy and surgery, and to report worse emotional functioning and higher oral and throat pain. Compared to participants with no BI concerns, those with mild to moderate concerns reported higher oral and throat pain and speech problems. Conclusions Some level of cancer-related BI concerns persisted in the majority of HNC survivors many years after treatment, while a small proportion of survivors experienced BID. BI concerns were associated with treatment modality and patients’ daily functioning and symptoms. Implications for Cancer Survivors Insight into factors associated with BI problems may help to identify survivors at risk and may facilitate closer follow-up of survivors in need.

Background and aims: Polysubstance use represents a health risk for adolescents; however, large scale studies on this issue during COVID-19 pandemic are scarce. We aim to (i) characterise substance use profiles among adolescents, and (ii) identify predictors of such substance use profiles. Design: A Norwegian nationwide survey was analysed using Latent Profile Analysis in 2021.Participants: Adolescents (N = 97,429; ages 13 to 18 years). Measurements: We assessed current cigarettes, e-cigarettes and snus use, lifetime alcohol consumption, and cannabis and other illicit drugs use over a 12-month period. Predictors included psychosocial variables, health risk behaviours, and COVID-19 related problems. Findings: We identified three adolescent profiles; those who use no substances (n = 88,890; 92%); those who use snus and alcohol (n = 6,546; 6%); and those who use multiple substances (i.e., polysubstance users; n = 1,993; 2%). Boys, older adolescents, adolescents with lower socio-economic status, and those reporting low levels of parental control and higher parental alcohol use were most likely to be polysubstance users. Other significant predictors were to have easy access to cannabis, mental health problems, a high prevalence of pain, a low consumption of fruit, low levels of physical activity, and using over the counter painkillers. Adolescents with social and mental health issues related to COVID-19 were also more at risk of being in the polysubstance user profile. Adolescents who use snus and alcohol showed similar patterns of correlates compared to non-users, but associations were weaker than for polysubstance users. Conclusions: Adolescents who use multiple substances have an unhealthier lifestyle, are at a higher risk of experiencing psychosocial impairments, and report more negative problems related to the COVID-19 pandemic. Preventative strategies aimed at reducing polysubstance use might help to promote psychosocial wellbeing in adolescents in various life domains.

Despite findings from numerous cross-sectional studies suggesting a substantial association between loneliness and different types of disordered eating, much remains unknown about the impact of confounding, the order of cause and effect, and gender differences in the relationship. Thus, this study followed a large, population-based, mixed-gender sample through adolescence and young adulthood, applying a random intercept cross-lagged panel model (RI-CLPM) approach to examine the bidirectional prospective associations between loneliness and disordered eating while ruling out the effect of unmeasured time-invariant confounders.A Norwegian sample of N = 2933 adolescents (54.2% female) was examined across four time points (T1, MFor male participants, high levels of loneliness at T1 predicted more overall disordered eating and more dieting at T2. Meanwhile, among female participants, disordered eating and bulimic symptoms at T2 predicted more loneliness at T3, whereas loneliness at T3 predicted more disordered eating and bulimic symptoms at T4, and vice versa.The findings suggest a pattern of bidirectional associations between loneliness and disordered eating that varies by time points, gender, and type of eating problem. Preventive interventions and treatment should consider social factors involved in the onset and maintenance of eating problems in male adolescents and young adult women.This study contributes to the existing knowledge by examining for the first time the dynamic nature of the association between loneliness and disordered eating while accounting for all time-invariant confounding. Our findings reveal a pattern of bidirectional associations between loneliness and disordered eating that appears to vary by developmental period, gender, and type of eating problem. Our findings suggest that social factors have to be taken into account when designing prevention strategies aimed at disordered eating.

Background Several studies have investigated the intermediate variables or mediators through which attachment insecurity influence the development of depression. However, there has not been a systematic synthesis of this literature to date. The current meta-analytic review aimed at identifying such mediators and quantifying their effect size. Methods We systematically searched Medline, Pubmed, Psycinfo, Embase, Proceedings Web of Science and ProQuest Dissertations & Theses Global up until May 2019. 108 studies met inclusion criteria (i.e., investigated intermediate variables that explain the effect of attachment insecurity [exposure] on depressive symptoms [outcome]). Standardized regression coefficients of the indirect and total paths of mediation models of 80 studies were pooled using the inverse of their variance as a weight. Studies were coded and ranked for quality. Results Dysfunctional attitudes (β = 0.10, 95% CI = 0.01 to 0.20), self-criticism (β = 0.17, 95% CI = 0.04 to 0.28), low self-compassion (β = 0.16, 95% CI = 0.02 to 0.29), and cognitive hyperactivating regulation strategies (β = 0.13, 95% CI = 0.05 to 0.20), such as repetitive thinking (β = 0.17, 95% CI = 0.07 to 0.28), and particularly, brooding rumination β = 0.20, 95% CI = 0.07 to 0.32), mediated the association between insecure attachment and depressive symptoms. Indirect effects were only significant among adult populations. Limitations The methodological quality of studies was mostly moderate to low and analyses revealed considerable heterogeneity. Conclusion Our findings support the direct targeting of cognitive-emotional psychological mechanisms in prevention programs and treatment of depression. More longitudinal studies are needed to clarify the interplay of such mediators along with other interpersonal factors between insecure attachment and depression.

Numerous questionnaires are available on Knowledge, Attitudes, and Practices (KAP) towards antibiotics' use by adults, but none of these questionnaires is fully validated. We undertook an exhaustive literature review to design a comprehensive KAP questionnaire concerning the personal use of antibiotics in Galicia, North Spain. The Item Content Validity Index (I-CVI) and modified Kappa statistic (K*), confirmed the content validity of the questions (0.78 ≤ I-CVI ≤ 1.00 and 0.78 ≤ K* ≤ 1.00). The S-CVI statistic showed the content validity of the scale (S-CVI/Ave: 0.95). Following face validity and pilot testing, the Test–Retest Reliability in a sample of 145 adults confirmed the reliability of the questions. We carried out Confirmatory Factor Analysis using cross loadings and modification indices to choose the most adequate model in data collected from 844 adults. We estimated the indicators of model fit and demonstrated that the selected model has a good to excellent fit, thus establishing the construct validity. The final version of the questionnaire was highly accepted by the general adult population as reflected by the response rate (95.85%) and the low percentage of unanswered questions (0.4–2.7%). Our fully validated questionnaire could prove useful for research as it permits generating high quality data and reducing measurement error.

The COVID-19 pandemic has dramatically restricted adolescents’ lives. We used nationwide Norwegian survey data from 2014–2021 (N = 227,258; ages 13–18) to examine psychosocial outcomes in adolescents before and during the pandemic. Multilevel models revealed higher depressive symptoms and less optimistic future life expectations during the pandemic, even when accounting for the measures’ time trends. Moreover, alcohol and cannabis use decreased, and screen time increased. However, effect sizes of all observed changes during the pandemic were small. Overall, conduct problems and satisfaction with social relationships remained stable. Girls, younger adolescents, and adolescents from low socioeconomic backgrounds showed more adverse changes during the pandemic. Estimated changes in psychosocial outcomes varied little with municipality infection rates and restrictions. These findings can inform means and interventions to reduce negative psychological outcomes associated with the pandemic and identify groups that need particular attention during and after the pandemic. This research was funded by three grants from the Research Council of Norway: Grant 666 no. 288083 (T.v.S. and V.S.U.), grant no. 300816 (T.v.S., M.K., R.R.C. and E.F.H.) and 667 301010 (T.v.S., M.K., D.H.F. and L.C.G.).

Objectives: Validated knowledge–attitude–practice (KAP) questionnaires are essential to design and evaluate intervention programs on antibiotic use. Recently, we validated the first KAP questionnaire on antibiotics in Spain. Cross-cultural adaptation and validation of research tools increase their universal usefulness. Here, we aimed to validate the questionnaire in a developing country with different socioeconomic characteristics from that of Spain. Methods: We translated the previously developed KAP-questionnaire into Arabic and French, tailored it and then validated it in adult population in Lebanon. The item content validity index (I-CVI), scale content validity index (S-CVI/Ave) and modified Kappa (k*) were calculated. The construct validity of the questionnaire was evaluated using confirmatory factorial analysis (CFA, N = 1460) and its reliability was assessed using intraclass correlation coefficients (ICC, N = 100) and Cronbach’s alpha statistic. Results: ICV-I (>0.78), k* (equal to ICV-I for all items) and S-CVI/Ave (≥0.95) confirmed the questionnaire content validity. Pilot testing (N = 40) and face validity showed the understandability of the questionnaire by the population. Test–retest reliability analysis (N = 100) yielded ICC ≥ 0.59 for all knowledge and attitude items, showing the capacity of the questionnaire to generate reproducible results. CFA evidenced adequate fit of the chosen model, thus establishing the construct validity of the questionnaire (root mean squared error approximation = 0.053, standardized root mean square residual = 0.045, comparative fit index = 0.92 and Tucker–Lewis index = 0.90). The questionnaire showed an acceptable internal reliability (Cronbach’s alpha = 0.62) and was highly accepted in Lebanon (response rate = 96% and item response rates ≥ 94%). Conclusions: The validity of the KAP-questionnaire on antibiotics in Arabic and French was demonstrated in Lebanon.

Tranquilizer misuse is an emerging international public health concern. The psychosocial determinants of this misuse remain understudied. Instruments to measure the Knowledge, Attitudes and Practices (KAP) of tranquilizer misuse are unavailable, except for a recently published questionnaire validated in the Spanish language. We translated the KAP questionnaire into Arabic and French, adapted it and undertook a complete validation procedure in the general adult population in Lebanon. The content validity indicators were good: item content validity index ranged between 0.89 and 1.00, the content validity index scale average was ≥0.95 and the modified Kappa statistic for each of the KAP items was equal to I-CVI. The intra-class correlation coefficient values (n = 100) were ≥0.62 for all Knowledge and Attitudes items, demonstrating the item reliability. Confirmatory factorial analysis (n = 1450) showed that the selected model of Knowledge and Attitude constructs has adequate fit indicators and encompassed three factors that showed acceptable internal reliability: Knowledge (Cronbach’s alpha = 0.72), personal Attitudes towards tranquilizers (Cronbach’s alpha = 0.79) and Attitudes towards healthcare providers (Cronbach’s alpha = 0.65). The Arabic/French questionnaire was highly accepted, with a response rate of 95.72% and item non-response rate ≤3.6%. The availability of a cross-cultural adapted and multilingual validated questionnaire would stimulate research on tranquilizer misuse.

Loneliness is a subjective and emotionally unpleasant experience of perceiving insufficient social relationships. Previous research has revealed that loneliness constitutes a psychosocial risk factor for depression, and is also related to unhealthy behaviors such as smoking. This study aims to examine the relation between loneliness, depression, and cigarette dependence, and to explore the role of sex in this relationship. A total sample of 275 adult treatment-seeking daily smokers (Mage = 45.3; 61.5% females) was used. Our results showed a significant correlation between higher scores of loneliness, depressive symptoms, and cigarette dependence. In addition, mediation analysis showed a significant indirect effect of loneliness on cigarette dependence, via depressive symptoms. Regarding the effect of sex, we found that this variable significantly moderated the relationship between depressive symptoms and cigarette dependence. Results of this study extend previous literature by showing that, in treatment seeking smokers, loneliness is a significant predictor of depressive symptoms, and through this relation, it predicts cigarette dependence. Additionally, sex was a significant moderator of this relation. These findings have several clinical implications, and also contribute to the understanding of cigarette dependence, which is a well-known barrier for smoking cessation.

]The COVID-19 pandemic has dramatically restricted adolescents’ lives. We used nationwide Norwegian survey data collected from 2014–2021 (N = 227,258; ages 13–18) to address three essential questions: What are the psychosocial consequences of the pandemic? Are disadvantaged adolescents disproportionally affected by the pandemic? Do pandemic effects vary with geographical variations in infection rates and restrictions? Multilevel models revealed higher depressive symptoms and lower optimism during the pandemic than before the pandemic, even when accounting for the measures’ time trends. Further, alcohol and cannabis use decreased, and screen time increased. Social relationships and conduct problems remained stable. Girls, younger adolescents, and adolescents from low socioeconomic backgrounds were disproportionally affected by the pandemic. The pandemic’s effects varied little with municipality infection rates and restrictions. These findings can inform means and interventions to reduce negative pandemic effects and identify groups that need particular attention during and after the pandemic.

Background: Tranquilizer misuse is insufficiently acknowledged as a public health problem despite its alarming consequences. Instruments to measure psychosocial factors related to tranquilizer misuse are lacking. We aimed to develop and validate a Knowledge, Attitude and Practice questionnaire of tranquilizer misuse by adults in Spain. Methods: The questionnaire was designed after an extensive literature review and several meetings with experts. We assessed face and content validity, and pilot tested the questionnaire. We examined its reliability by test-retest analysis in a sample of 145 adults. We distributed the questionnaire to 879 individuals, tested the construct validity through Confirmatory Factor Analysis (CFA), measured its overall reliability and determined its acceptability. Results: The Item Content Validity Index (I-CVI from 0.78 to 1.00), the Scale Content Validity Index, using the averaging method (S-CVI/Ave = 0.95) and the fact that the modified Kappa statistic for each of the Knowledge, Attitude and Practice items was equal to I-CVI demonstrated the content validity of the questionnaire. The Intra-Class Correlation coefficients for Knowledge and Attitude items were > 0.5, establishing their reliability. The Knowledge and Attitude construct was modeled using CFA and the model showed a good fit, thus establishing its validity. The overall reliability of the construct was revealed by Cronbach՚s alpha values > 0.6. The questionnaire was highly accepted (response rate = 95 % and item non-response ≤ 4%). Conclusions: The validity of the developed questionnaire was established. Its availability will stimulate the initiation of research on tranquilizer misuse and will consequently help in designing related public health interventions.

Alcohol use is associated with poorer smoking cessation-related outcomes, and smokers with elevated levels of worry experience greater smoking cessation problems. Yet, little is known about the explanatory mechanisms that may underlie the relationship between trait worry and hazardous drinking among smokers. Therefore, this study explored the explanatory roles of coping and conformity drinking motives in the relationship between trait worry and hazardous drinking outcomes including alcohol consumption, alcohol problems, maximum number of drinks, and the number of prior alcohol quit attempts among treatment-seeking smokers. Participants included 377 treatment-seeking smokers who consumed at least one alcoholic drink in the last year (48% female; 86.2% Caucasian

Among Latinx in the United States, alcohol is the most widely abused substance and is associated with a range of negative consequences. Acculturative stress is one factor that is relevant regarding Latinx substance use although more work is needed in this area. In theory, those with more adaptive emotion regulation capabilities may be better able to buffer against the adverse effects of acculturative stress on alcohol use because the person has more and better strategies to deal with life stress. Thus, the current study sought to examine the moderating role of dysregulation in the association of acculturative stress and alcohol use among Latinx in primary care. Latinx adults (N = 94; Mage = 38.5 years, SD = 10.8; 86.6% female) recruited from a Federally Qualified Health Center provided self-reported ratings of acculturative stress, emotion dysregulation, and alcohol use. All measures were in Spanish. Covariates included sex, marital status, age, years in the United States, negative affectivity, and clinic visit reason (patient vs. person accompanying patient). There was a statistically significant interaction of acculturative stress and emotion dysregulation (β = 1.65, t = 2.29, p = .025) on alcohol use, which accounted for 4.8% of additional variance over and above covariates and the nonsignificant main effects. Simple slope analyses revealed that acculturative stress was associated with alcohol use among those with high (β = 0.28, t = 2.04, p = .045), but not low (β = -0.28, t = -1.26, p = .210) levels of emotion dysregulation. The current results indicate that emotion dysregulation moderates the association between acculturative stress and alcohol use among Latinx in primary care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence.The sample included 275 adult treatment-seeking daily smokers (M age = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted.A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms.Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions.

OBJECTIVE: Suicidal ideation has increased among Latinx individuals in the last decade. Smoking increases the likelihood of suicidal ideation but work on Latinx smokers is minimal. Hazardous drinking and emotion dysregulation could be factors related to suicidal ideation among Latinx smokers, as has been evident in non-Latinx White samples. The current study sought to examine the main and interactive effects of emotion dysregulation and hazardous drinking in relation to suicidal ideation among Latinx daily-smokers. METHODS: Participants were 371 Spanish-speaking daily-smokers (58.8% female; M(age)=33.3; SD(age) = 9.8) recruited from the United States through Qualtrics. We used structural equation modeling (SEM) to test an interactive model of emotion dysregulation and hazardous alcohol consumption in relation to suicidal ideation; we also tested the effect of emotion dysregulation on suicidal ideation as a function of hazardous drinking status. RESULTS: Results indicated that latent emotional dysregulation was associated with greater suicidal ideation (p

Introduction Relapse is a common factor within the behavior change process. However, there is scarce and limited knowledge of smoking relapse situations in population-based samples. The aim of this study was to identify smoking relapse situations among a sample of Spanish relapsers from the general population. Methods A sample of 775 relapsers was recruited among the general population using a snowball method. Participants completed a survey including sociodemographic, smoking-related and psychopathology variables. Smoking relapse situations were identified through specific questions assessing different aspects related to the last relapse episode. Results The majority of smoking relapse situations were attributed to positive affect (36.6%) and negative affect (34.3%), followed by lack of control (10.1%), smoking habit (6.7%), craving or nicotine withdrawal (6.3%), and social pressure (5.9%). Being unemployed and having a mental disorder in the past increased the likelihood of relapse in situations of negative affect. Being single and having quit smoking to save money were associated with an increased likelihood of relapse in situations of positive affect. Conclusions Affect plays a significant role in smoking relapse among a community sample of unassisted Spanish smokers. Relapse may be much more of an affective and situational process than a habit, physiological or social pressure. Findings from this study may help develop tailored community smoking relapse prevention strategies or programs.

Purpose The current study examined whether the interaction of lower respiratory symptoms and anxiety sensitivity is related to smoking lapse in the context of smoking cessation. Method Participants were adult daily smokers (N = 60) exposed to the World Trade Center (WTC) disaster who were in a smoking cessation treatment program (75.0% male, 50.6 years old [SD = 9.2], and current smoking rate was 17.6 cigarettes per day (SD = 10.6). Results Results indicated that the interaction between lower respiratory symptoms and anxiety sensitivity was a significant predictor of greater risk for lapse (i.e., lower survival time; B = 0.005, OR = 1.01, p = 0.039). Follow-up analysis showed that greater respiratory symptoms were a significant predictor of lapse risk among those with high (B = 0.116, OR = 1.12, p = 0.025), but not those with low (B = − 0.048, OR = 0.95, p = 0.322), levels of anxiety sensitivity. Discussion The findings from the current study suggest that smokers with greater respiratory symptoms and higher levels of anxiety sensitivity may be associated with early lapse to smoking following smoking cessation treatment. Future work has the potential to inform the development of tailored cessation interventions for smokers who experience varying levels of lower respiratory symptoms and anxiety sensitivity.

Although there is an interconnection between history of major depressive disorder and smoking, there has been relatively limited scientific attention oriented on the interplay between history of major depressive disorder and smoking maintenance processes. The current study sought to address whether history of major depressive disorder and post-cessation craving interact in the prediction of relapse among treatment-seeking smokers. Separate models were evaluated as a function of sex. Participants (n = 319, Mage = 41.7, 62.1% female) were treatment-seeking smokers who were abstinent at the end of six weekly 1-hour sessions involving psychosocial treatment for cessation. Participants completed a baseline assessment and reported post-cessation craving. Smoking status was assessed at 1-, 2-, 3-, 6-, and 12-month follow-up after the end of treatment. There was a significant interactive effect evident for females (B = 0.05, OR = 1.05, p = 0.013), but not males. The form of the interaction indicated females with history of major depressive disorder and greater post-treatment craving evinced the highest rate of relapse. Findings suggest that history of major depressive disorder and post-treatment craving are related to increased risk of relapse for female, but not male, smokers. Sex differences play a fundamental role in the explanation of the interaction of history of major depressive disorder and craving post-treatment in smoking relapse. Considering sex differences related to smoking relapse may help to tailor smoking cessation treatments.

Introduction Behavioral Activation is a behavioral-based treatment that has been proposed as suitable for smoking cessation, as it simultaneously addresses reinforcement-related variables and also mood management. The aim of this study was to compare the effects of a cognitive-behavioral smoking cessation treatment with components of behavioral activation (SCBSCT-BA) with a standard cognitive-behavioral treatment (SCBSCT), and a wait-list control group (WL). Method The sample was comprised of 275 adults smokers (61.4% females, mean age = 45.36, SD = 10.96). After baseline assessment sessions, participants were randomized (ratio: 2.2.1.) to SCBSCT-BA, SCBSCT, or WL. Active groups received 8 weekly 1-hour face-to-face group sessions. Biochemically verified smoking abstinence and depressive symptoms were assessed at the end of treatment, and at 3-, 6-, and 12-month follow-ups. Results Significant treatment effects in 7-dayspoint prevalence abstinence rates were found for both active groups at the end of treatment. Abstinence rates at 12-months follow-up were 30% for SCBSCT-BA, and 18% for SCBSCT. Using Multiple Imputation for missing data, regression analysis showed significantly greater ORs for the SCBSCT-BA condition (vs. SCBSCT) at the end of treatment and at 3-months follow-up. At 6-, and 12-months follow-ups, ORs for the SCBSCT-BA condition, although greater, did not reach statistical significance. Multilevel analysis showed that abstinence was related to reductions in depressive symptoms. Conclusions SCBSCT-BA obtained positive results at short and medium term. Participants who quit smoking experienced a significant reduction in depressive symptoms. Findings support the benefit of adding BA to a cognitive-behavioral smoking cessation treatment This research was supported by the Spanish Ministry of Economy and Competiveness (Project reference: PSI2015-66755-R) and co-financed by FEDER (European Regional Development Fund; pluri-annual plan 2014-2020) SI

Despite advances in smoking cessation treatments, smoking relapse remains common. Experiencing positive or negative affect and cigarette dependence are the most common causes of relapse; however, little is known about the characteristics that increase the risk of relapse from these causes among current treatment-seeking smokers. Thus, this study aimed to identify the most frequent causes of relapse and the individual characteristics that increase the risk of relapse from these causes during a 12-month period after smoking cessation. Participants included 121 treatment-seeking smokers who quit smoking at the end of treatment and relapsed during a 12-month follow-up period (60.3% female; Mage = 42.57, SD = 11.07). Results indicated that the most frequent smoking relapse situations occurred when smokers experienced positive (e.g., being relaxed; 43.0%) or negative (e.g., being angry; 37.2%) affect or cigarette dependence–related situations (e.g., craving; 19.8%). At an individual level, males with a higher level of education and without a psychopharmaceutical prescription had a higher risk of relapsing in positive-affect situations. Smoking the first cigarette at an older age increased the risk of relapse in negative-affect situations. Finally, being younger and less motivated to quit at pretreatment increased the likelihood of relapse in cigarette dependence–related situations. These findings provide detailed information about smoking relapse situations and identify a set of characteristics that might help to improve current relapse-prevention interventions.

Introduction: Treatment completion is associated with abstinence outcomes in smoking cessation interventions. Previous research has stated that anxiety sensitivity (AS) is associated with smoking-related variables and smoking-cessation outcomes. To date, research has not examined the interaction between AS and treatment completion on smoking-cessation outcomes over time. This study aims to examine the main and the interactive effects of treatment completion and AS (total score and specific dimensions) on smoking-cessation outcomes at 3- , 6-, and 12-month follow-ups. Method: The sample consisted of 210 smokers enrolled in an eight-session smoking-cessation cognitivebehavioral treatment (62.1% women; Mage = 45.2, SD = 11.0). Participants were classified as completers (attended the eight treatment sessions) and non-completers (attended ≤ 7 sessions). Abstinence was biochemically confirmed. Results: Main effects indicated that completers had a higher likelihood of being abstinent over time when compared to non-completers. Regarding AS, those with greater AS-Physical Concerns had lower abstinence rates. Besides, a significant interaction between treatment completion, time and AS-Physical Concerns was found. Particularly, completers with greater AS-Physical Concerns had a higher likelihood of being abstainers than noncompleters over time, while no significant differences were found for those with lower AS-Physical Concerns. Conclusion: These data highlight the relevance of AS-Physical levels and smoking-cessation treatment completion on abstinence outcomes over time among treatment-seeking smokers Ruben Rodriguez-Cano is supported by the Cancer Prevention and Research Institute of Texas (CPRIT) Postdoctoral Fellowship in Cancer Prevention (RP 170259, Drs. Chang and Shete, PIs) and by MD Anderson’s Cancer Center Support Grant (CA016672) funded by the National Cancer Institute SI

Introduction The associations between depression and cigarette dependence had been established through a large amount of studies. Nevertheless, mechanisms underlying such association are not clearly recognized. The main aim of this study was to explore whether the perception of environmental reinforcement mediates the effect of cigarette dependence on depressive symptoms in smokers seeking smoking cessation treatment. Methods The sample consisted of 275 smokers (61.5% women, average age 45.36 years, SD = 10.96), seeking smoking cessation treatment in the Smoking Cessation and Addictive Disorders Unit of the University of Santiago de Compostela. The following questionnaires were applied: Fagerström Test of Cigarette Dependence (FTCD), Beck Depression Inventory - II (BDI-II) and Environmental Reward Observation Scale (EROS) that evaluates the degree of reward / reinforcement provided by the environment. To examine the associations between study variables bivariate correlations were tested. Mediation analyses were conducted through the statistical macro PROCESS. Results The total sample obtained an average score in the EROS of 27.92 (SD = 4.51), in the FTCD of 4.78 (SD = 2.16); and in the BDI-II of 10.57 (SD = 9.17). Bivariate correlations were statistically significant between depressive symptoms, perceived environmental reinforcement and cigarette dependence. There was a significant direct effect of cigarette dependence on depressive symptoms (b = 0.63; p = .004), and a significant indirect effect of cigarette dependence on depressive symptoms via perceived environmental reinforcement (a*b = 0.36, 95% CI [0.140 − 0.612]). Conclusions Findings show significant associations between cigarette dependence and depressive symptoms through perceived environmental reward in smokers seeking smoking cessation treatment. This support previous research suggesting that smoking cessation interventions including components aimed at increasing reward probability and access to reward stimuli or activities others than tobacco, could be useful in order to improve depressive symptoms, as these could be a barrier to achieve smoking abstinence. Funding This research was supported by the Spanish Ministry of Economy and Competitiveness (Project reference: PSI2015-66755-R) and co-financed by FEDER (European Regional Development Fund; pluri-annual plan 2014-2020).

Knowing more about the personality of smokers may help to increase the effectiveness of smoking cessation treatments and can contribute to relapse prevention. The aim of the present study was to analyze the influence of 30 specific facets of the Five-Factor Model of personality on the outcomes at the end of treatment and at 12-month follow-up, in a sample of 281 smokers seeking psychological treatment to stop smoking. Personality facets were assessed with the Revised NEO Personality Inventory (NEO-PI-R). Results showed that nicotine dependence and several facets of personality (Self-discipline, Depression, Aesthetics, Trust, and Modesty) contribute to explain short- and long-term outcomes after smoking cessation. These findings support the need of integrate information about individual smoker’s personality facets into smoking cessation programs.

Background: Depressive symptoms and craving are related to smoking maintenance; however, little is known about the association between trajectories of depressive symptoms and smoking craving after quitting. Objectives: We examined if depressive symptom change relates to change in craving following smoking cessation treatment. Methods: Participants were 362 (64.1% female; 35.9% male) adult treatment seeking smokers who quit smoking after treatment. Depressive symptoms and craving trajectories were evaluated during smoking cessation treatment until 6 months follow-up. A latent growth curve model was used to study the correlation between trajectories. Results: Depressive symptoms and smoking craving reduced significantly after quitting. Change in depressive symptoms was significantly related to change in craving symptoms over time. Conclusions: Quitting smoking was related to a reduction in depressive symptoms and craving. Clinically, the reduction of depressive symptoms is associated with reduce craving. The data suggest depression plays an important role in craving change following treatment.

Previous studies have shown that smoking is associated with health-related quality of life (HRQoL) impairment. In order to evaluate HRQoL in a sample of Spanish relapsers, a cross-sectional study was conducted.The sample was made up of 775 smokers who had relapsed after a period of abstinence. HRQoL was evaluated using the Euro-Qol questionnaire (EQ-5D); through the descriptive profile, the EQ-5D index and the visual analogue scale (EQ-VAS).Higher nicotine dependence was related to worse HRQL. According to the EQ-VAS, higher daily cigarette consumption and more years smoking were related to worse perceived health. In the EQ-5D those who had quit smoking in the previous year perceived worse health. Mobility and anxiety / depression are the dimensions affected by smoking. Those who are more nicotine dependent (OR = 2.29) and have been smoking for longer (OR = 4.12) are more likely to have mobility problems; and those who are nicotine dependent (OR = 1.85) and relapsed more than a year ago (OR = 0.63), are more likely to experience anxiety / depression.Nicotine dependence demonstrated a determining effect on HRQOL deterioration in smokers who have relapsed.

Objectives: The present study sought to address whether there is sex effect in the interactive effect between depressive symptoms and hazardous drinking in the prediction of smoking craving after cognitive-behavioral smoking cessation treatment among those with at least mild depression. Methods: Participants (n=114, mean age 42.0, SD=9.73, 64% women) were treatment-seeking smokers who attended 6 weekly 1-hour sessions involving psychological treatment for cessation. Participants reported depressive symptoms and alcohol use at baseline and reported craving at baseline and after treatment. Results: Results indicated that there was a statistically significant 3-way interaction (depression by alcohol use by sex) for smoking craving (B=-0.30, standard error [SE]=0.14, P=0.042) and appetitive craving (B=-.21, SE=0.09, P=0.031), but not negative reinforcement craving. The form of the significant interactions indicted that higher levels of depressive symptoms and alcohol use were related to greater levels of craving at the end of treatment only among men. Conclusions: The current findings provide novel empirical evidence suggesting that there is a clinically relevant interplay between depressive symptoms and alcohol use regarding general craving and appetitive craving among male treatment-seeking smokers. Although the present results should be replicated in larger samples, this type of research can inform the development of sex-specific interventions for smoking cessation.

Introduction Depressive symptoms are related to smoking cessation outcomes. We examined the effects of behavioral activation (BA), as part of a cognitive behavioral intervention to quit smoking, in terms of abstinence rates according to depressive symptom level. We also analyzed whether BA could differentially benefit participants with higher versus lower anhedonia. Methods The sample was composed of 183 smokers (Mage = 45.3; 62.8% female) who participated in a randomized clinical trial assessing the effects of a BA intervention compared to a standard intervention. Smoking outcomes were biochemically confirmed point prevalence abstinence, and abstinence days after treatment during one year follow-up. The intensity of depressive symptomatology and anhedonic symptoms were assessed using the Beck Depression Inventory-II. Results No differences in abstinence rates were found in relation to depressive symptom level. The BA condition (vs. standard condition) predicted greater abstinence rates (OR = 1.91) in participants with lower scores on depressive symptoms, whereas in participants with higher scores, it did not (OR = 1.17). Moreover, the BA condition predicted greater abstinence rates in participants with lower scores on anhedonia. When examining days of abstinence during the one-year follow-up period, a significant interaction was found between depressive symptoms and treatment condition, favoring the BA condition. Conclusion BA implemented as part of a cognitive behavioral intervention to quit smoking improves long-term abstinence rates, especially among those with fewer depressive symptoms.

Little work has focused on the underlying mechanisms that may link financial strain and smoking processes. The current study tested the hypothesis that financial strain would exert an indirect effect on cognitive-based smoking processes via depressive symptoms. Three clinically significant dependent variables linked to the maintenance of smoking were evaluated: negative affect reduction motives, negative mood abstinence expectancies, and perceived barriers for quitting. Participants included 102 adult daily smokers (Mage = 33.0 years, SD = 13.60; 35.3% female) recruited from the community to participate in a self-guided (unaided; no psychological or pharmacological intervention) smoking cessation study. Results indicated that depressive symptoms explain, in part, the relation between financial strain and smoking motives for negative affect reduction, negative mood abstinence expectancies, and perceived barriers for quitting. Results indicate that smoking interventions for individuals with high levels of financial strain may potentially benefit from the addition of therapeutic tactics aimed at reducing depression.

There is limited understanding of pain and its relationship to mental health in Latinos, and limited knowledge about the biobehavioral mechanisms that underlie pain-mental health interrelations. To address these gaps, the present investigation sought to address whether anxiety sensitivity explained relations between pain intensity and anxious arousal, depressive symptoms, social anxiety, and depressive and anxiety disorders among an economically disadvantaged Latino sample. Participants included 349 adult Latinos (88% women; Mage = 38.8) who attended a community-based primary health care. In the multiple mediation model, anxiety sensitivity physical concerns accounted for the association between pain intensity and anxious arousal symptoms, cognitive concerns accounted for the association between pain intensity and depressive symptoms, and social concerns accounted for the association between pain intensity and social anxiety symptoms. This is the first study to demonstrate the explanatory role of anxiety sensitivity in pain-affective associations among disadvantaged Latinos.

Smoking is an important risk factor for mental health-related problems. Numerous studies have supported a bi-directional association between cigarette smoking and depression. Despite the advances in understanding the comorbidity between both problems, the most effective psychological treatment that simultaneously targets smoking and depressive symptomatology remains unclear. The objective of this study is to assess the effectiveness of a cognitive-behavioral intervention for smoking cessation with components of behavioral activation for managing depressed mood. A single blind, three-arm, superiority randomized controlled trial is proposed. Participants will be smokers over 18 years old, who smoke at least 8 cigarettes per day. Participants will be randomized to one of three conditions, using a 2:2:1 allocation ratio: 1) standard cognitive-behavioral smoking cessation treatment; 2) standard cognitive-behavioral smoking cessation treatment plus behavioral activation; or 3) a three-month delayed treatment control group. The primary outcome measures will be biochemically verified point-prevalence abstinence (carbon monoxide in expired air) and significant change from baseline in depressive symptoms to the end of treatment, and at the 3-, 6-, and 12-month follow-up. This study aims to assess the efficacy of a cognitive-behavioral intervention with behavioral activation components for smoking cessation and depressive symptoms, compared to a standard cognitive-behavioral intervention to quit smoking. As the relation between depressive symptoms, even at subclinical levels, and quitting smoking difficulties is well known, we expect that such intervention will allow obtaining higher abstinence rates, lower relapse rates, and mood improvement. ClinicalTrials.gov : NCT02844595 . Retrospectively registered 19th July, 2016. The study started in January 2016, and the recruitment is ongoing.

Diverse studies have found a relation between alcohol consumption and smoking relapse. Few studies have analyzed the relation of smoking relapse with pretreatment alcohol consumption and gender differences. The main purpose of this study is to analyze the influence of alcohol consumption in smoking relapse over 12 months (3-, 6-, and 12-months follow-up) and to determine possible gender differences. The sample included 374 smokers who quit smoking by participating in a psychological smoking cessation treatment. We assessed hazardous pretreatment alcohol drinking (AUDIT), cigarette consumption (FTND; number of cigarettes) and sociodemographic variables. Higher scores on hazardous pretreatment alcohol drinking predict smoking relapse at 3-, 6-, and 12-months after smoking cessation. In males, higher scores on hazardous pretreatment alcohol drinking predict relapse at 6 and at 12 months. In females, higher scores on hazardous pretreatment alcohol drinking predict tobacco relapse at 3 months. Hazardous pretreatment alcohol drinking predicts relapse at all intervals after smoking cessation (3-, 6-, and 12-months follow-up). However, the influence of hazardous pretreatment alcohol drinking on smoking relapse differs as a function of gender, as it is a short-term predictor in women (3 months) and a long-term predictor in men (6 and 12 months).

Aunque contamos con tratamientos eficaces para la dependencia del tabaco, la recaída continúa siendo un fenómeno frecuente en aquellos que consiguen dejar de fumar. El objetivo del presente estudio fue analizar si existían diferencias en función del sexo en la curva de recaída en hombres y mujeres que participaron en un tratamiento psicológico cognitivo-conductual para dejar de fumar. La muestra estuvo formada por 266 personas (59.8 % mujeres) que dejaron de fumar al finalizar el tratamiento. Los resultados indicaron que a medida que se incrementaba el tiempo transcurrido tras la intervención, disminuía el porcentaje de participantes abstinentes. No obstante, no se encuentraron diferencias significativas entre hombres y mujeres en la curva de recaída, lo cual podría explicarse por la inclusión en el tratamiento de técnicas psicológicas eficaces para el afrontamiento de algunas de las principales causas de la recaída (e.g., estado de ánimo negativo). Dada la importancia que tiene la recaída en el proceso de dejar de fumar, es necesario profundizar en los distintos determinantes que la desencadenan. Although we have effective treatments for tobacco dependence, relapse is a frequent phenomenon in those who quit. The aim of this study was to analyze whether there were differences by gender in the relapse curve in men and women who participated in a cognitive-behavioral smoking cessation treatment. The sample was composed of 266 individuals (59.8 % women) who were abstinent at the end of treatment. The results indicate that as time after the intervention increases, the percentage of abstinent participants decreases. However, no significant differences between men and women in the relapse curve were found, which could be explained by the inclusion of effective psychological tools to cope with some of the main causes of relapse (e.g., negative affect) in the treatment. Given the importance of relapse in the smoking cessation process, it is necessary to deepen in its triggers.

Background The relationship between tobacco and depressive symptoms has been examined. However, there is little information on the evolution of these symptoms when an individual quits. The aim of this study was to analyze the evolution of depressive symptoms over time (pre-, post-treatment, 1-, 3-, 6-, and 12-months follow-up) in relation to smoking status 12 months after having received a psychological treatment for smoking cessation. Method The sample was made up of 242 adults who received cognitive-behavioral treatment for smoking cessation (64.4% women; mean age=41.71 years). The BDI-II was used to assess depressive symptomatology. Participants were classified into three groups according to smoking status at 12-months follow-up (abstainers, relapsers, and smokers). Results There were no significant differences in depressive symptoms among the three groups at pretreatment. At the end of treatment, abstainers and relapsers presented less depressive symptomatology than smokers. At follow-up, abstainers continued to present less depressive symptomatology than smokers, whereas in relapsers, symptoms began to increase as the relapses occurred. Regarding the evolution of depressive symptomatology, the abstainer and relapser groups showed a significant reduction at the end of treatment. Only in the group of abstainers did the decrease continue during 12 months follow-up. Limitations The decrease of the initial sample size from 562 to 242 participants. Variables such as self-esteem and self-efficacy were not assessed. Conclusions Smoking cessation is associated with a decrease in depressive symptomatology, that is maintained over time. In contrast, relapse is associated with an increase of such symptoms. These findings signify the potential importance of addressing depressive symptomatology in smoking cessation treatment.

Although we have effective treatments for tobacco dependence, relapse is a frequent phenomenon in those who quit. The aim of this study was to analyze whether there were differences by gender in the relapse curve in men and women who participated in a cognitive-behavioral smoking cessation treatment. The sample was composed of 266 individuals (59.8 % women) who were abstinent at the end of treatment. The results indicate that as time after the intervention increases, the percentage of abstinent participants decreases. However, no significant differences between men and women in the relapse curve were found, which could be explained by the inclusion of effective psychological tools to cope with some of the main causes of relapse (e.g., negative affect) in the treatment. Given the importance of relapse in the smoking cessation process, it is necessary to deepen in its triggers.