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Despite the large public health toll of smoking, genetic studies of smoking cessation have been limited with few discoveries of risk or protective loci. We investigated common and rare variant associations with success in quitting smoking using a cohort from 8 randomized controlled trials involving 2231 participants and a total of 10,020 common and 24,147 rare variants. We identified 14 novel markers including 6 mapping to genes previously related to psychiatric and substance use disorders, 4 of which were protective (CYP2B6 (rs1175607105), HTR3B (rs1413172952; rs1204720503), rs80210037 on chr15), and 2 of which were associated with reduced cessation (PARP15 (rs2173763), SCL18A2 (rs363222)). The others mapped to areas associated with cancer including FOXP1 (rs1288980) and ZEB1 (rs7349). Network analysis identified significant canonical pathways for the serotonin receptor signaling pathway, nicotine and bupropion metabolism, and several related to tumor suppression. Two novel markers (rs6749438; rs6718083) on chr2 are flanked by genes associated with regulation of bodyweight. The identification of novel loci in this study can provide new targets of pharmacotherapy and inform efforts to develop personalized treatments based on genetic profiles. [ABSTRACT FROM AUTHOR]

OBJECTIVES: SCALE-UP Counts tests population health management interventions to promote coronavirus disease 2019 (COVID-19) testing in kindergarten through 12th-grade schools that serve populations that have been historically marginalized. METHODS: Within 6 participating schools, we identified 3506 unique parents/guardians who served as the primary contact for at least 1 student. Participants were randomized to text messaging (TM), text messaging 1 health navigation (HN) (TM 1 HN), or usual care. Bidirectional texts provided COVID-19 symptom screening, along with guidance on obtaining and using tests as appropriate. If parents/guardians in the TM 1 HN group were advised to test their child but either did not test or did not respond to texts, they were called by a trained health navigator to address barriers. RESULTS: Participating schools served a student population that was 32.9% non-white and 15.4% Hispanic, with 49.6% of students eligible to receive free lunches. Overall, 98.8% of parents/guardians had a valid cell phone, of which 3.8% opted out. Among the 2323 parents/ guardians included in the intervention, 79.6% (n 5 1849) were randomized to receive TM, and 19.1% (n 5 354) engaged with TM (ie, responded to at least 1 message). Within the TM 1 HN group (40.1%, n 5 932), 1.3% (n 5 12) qualified for HN at least once, of which 41.7% (n 5 5) talked to a health navigator. CONCLUSIONS: TM and HN are feasible ways to reach parents/guardians of kindergarten through 12th-grade students to provide COVID-19 screening messages. Strategies to improve engagement may strengthen the impact of the intervention. [ABSTRACT FROM AUTHOR]

Objectives: One way to enhance the impact of smoking health risk messages may be to tailor their content to individual difference factors such as need for cognition (NFC). In this study, we examined how NFC influenced responses to different smoking risk messages. Outcomes included knowledge, risk perceptions, and behavioral expectations related to quitting smoking. Methods: We randomized 402 participants to one of 4 different risk message sets that were manipulated in terms of emotionality and framing in a 2x2 design: (1) factual gain-framed, (2) factual loss-framed, (3) emotional gain-framed, and (4) emotional loss-framed. Results: Statistically significant main effects emerged for NFC and emotionality. For certain risk perceptions, those with lower NFC reported greater perceived risk in response to emotional messages and lower risk in response to factual messages; those with higher NFC showed an opposite pattern. Similarly, those with lower NFC reported greater risk in response to gain-framed messages and lower risk in response to loss-framed messages; the opposite pattern emerged for those lower in NFC. Conclusions: Findings highlight the importance of an individual difference variable in influencing the impact of different types of smoking risk messages. [ABSTRACT FROM AUTHOR]

Background: Efforts are needed to ensure that smokers with lower health literacy are provided with understandable and impactful information about the health consequences of smoking and benefits of quitting.Purpose: To test the influence of health literacy on smokers' responses to health risk messages manipulated on framing (gain vs. loss) and emotionality (factual vs. emotional).Methods: Participants (N = 402) were randomized to evaluate one of four sets of smoking risk messages (factual gain-framed, factual loss-framed, emotional gain-framed, or emotional loss-framed). Multiple linear regressions examined main effects of health literacy, message emotionality, and message framing on: (a) risk perceptions, (b) behavioral expectations (i.e. cut down, limit, quit), and (c) risk knowledge. Two-way interactions of health literacy with emotionality and framing were examined for these outcomes. Analyses were based on theory-driven, a priori hypotheses.Results: As hypothesized, main effects emerged such that smokers with higher health literacy reported stronger risk perceptions and knowledge retention regardless of message type. Additionally, emotional (vs. factual) and gain- (vs. loss-) framed messages were associated with certain lower risk perceptions regardless of health literacy level. Consistent with hypotheses, two-way crossover interactions emerged between health literacy and emotionality. Among smokers with higher health literacy, factual messages produced higher perceived risk and stronger expectations for quitting. Among smokers with lower health literacy, emotional messages produced higher perceived risk and stronger expectations for quitting.Conclusions: Health literacy plays an important role in influencing how smokers respond to different risk messages. One's health literacy should be considered when determining whether risk communications emphasize factual or emotional content. [ABSTRACT FROM AUTHOR]

Although the prevalence of smoking is lower among Hispanics than among the general population, smoking still levies a heavy public health burden on this underserved group. The current study, Adiós al Fumar (Goodbye to Smoking), was designed to increase the reach of the Spanish-language smoking cessation counseling service provided by the National Cancer Institute's Cancer Information Service (CIS) and to evaluate the efficacy of a culturally sensitive, proactive, behavioral treatment program among Spanish-speaking smokers. Adiós was a 2-group randomized clinical trial evaluating a telephone-based smoking cessation intervention. Spanish-speaking smokers (N = 297) were randomized to receive either standard counseling or enhanced counseling (EC). Paid media was used to increase the reach of the Spanish-language smoking cessation services offered by the CIS. The Adiós sample was of very low socioeconomic status (SES), and more than 90% were immigrants. Calls to the CIS requesting smoking cessation help in Spanish increased from 0.39 calls to 17.8 calls per month. The unadjusted effect of EC only approached significance (OR = 2.4, P = .077), but became significant after controlling for demographic and tobacco-related variables (OR = 3.8, P = .048). Adiós al Fumar demonstrated that it is possible to reach, retain, and deliver an adequate dose of treatment to a very low SES population that has traditionally been viewed as difficult to reach and hard to follow. Moreover, the findings suggest that a proactive, telephone-counseling program, based on the Treating Tobacco Use and Dependence Clinical Practice Guideline and adapted to be culturally appropriate for Hispanics, is effective. Cancer 2007. (c) 2006 American Cancer Society. [ABSTRACT FROM AUTHOR]

The current study examined the association between education level and smoking status in a community-based sample of working adults. Participants were enrolled at the University of Texas M.D. Anderson Cancer Center site of a cancer risk behavior reduction intervention delivered at the worksite. There was a strong educational gradient in smoking status. The prevalence of current smoking was almost threefold higher among individuals with

Education has been identified as a potent sociodemographic predictor of smoking cessation and the Healthy People 2010 goals include the elimination of health disparities attributable to education.The current study prospectively examined the association of education with smoking cessation as well variables that might account for that association among employed adults residing in the southeastern United States.A strong educational gradient in cessation was evident. Only 6% of smokers with less than a high school (HS) degree quit smoking during the 4-year study period, whereas 17% of smokers with a HS degree but no college degree and 28% of smokers with at least a college degree quit smoking.Education appeared to uniquely contribute to the prediction of smoking abstinence over and above the effects of demographic, environmental, tobacco dependence, transtheoretical model, and job-related variables. Obtaining a better understanding of how or why education influences smoking cessation could contribute to reducing the educational gradient in abstinence and warrants further research attention. [Copyright &y& Elsevier]

Experimental and occasional cigarette use among college students is widespread. Little is known about what differentiates the occasional college smoker who becomes a regular smoker from the one who does not. Possible risk factors include peer smoking, lifestyle factors, such as lack of exercise, and health/addiction concerns. The current study investigated the progression of smoking in a cohort of 321 low-level/occasional smokers. Over the course of 4 years, 45% of low-level/occasional users had become nonsmokers, 35% became occasional smokers, and 20% became daily smokers. Baseline exercise patterns, addiction beliefs, and smoking pervasiveness were modestly related to distal smoking outcome. The level of baseline smoking was strongly related to smoking outcome. These results support the wisdom of limiting access and exposure to cigarettes among the college population. [Copyright &y& Elsevier]

Background. Relapse remains the most refractory aspect of nicotine dependence, but little is known about relapse that occurs after a period of prolonged abstinence (i.e., “late relapse”).Method. The current study examined the prevalence and predictors of late relapse/sustained abstinence in a community-based, longitudinal cohort of former smokers surveyed at baseline and again 4 years later (n = 1143).Results. Late relapse rates declined precipitously and sustained abstinence increased as the duration of abstinence at baseline increased. Although the risk for late relapse appeared to be small when using a point prevalence definition of smoking, that risk increased substantially if fluctuations in smoking behavior over time were considered (i.e., many former smokers relapsed and then regained abstinence during the 4-year study period). Although there were a number of significant prospective predictors of late relapse/sustained abstinence, they did not retain their predictive ability after controlling for baseline duration of abstinence.Conclusion. Although late relapse rates in the general population of former smokers appear low, and particularly so for individuals who have been abstinent for long periods of time, fluctuations between abstinence and smoking over time are not uncommon. How these fluctuations influence health or sustained abstinence over time is unclear. Because late relapse rates are generally low, interventions are likely to require careful targeting of at-risk individuals if they are to be efficacious and cost-effective. [Copyright &y& Elsevier]

This study evaluated the relationship between smoking cessation treatment outcome and the DRD2 polymorphism. Participants were 134 smokers who took part in a larger clinical trial evaluating the effects of an antidepressant medication (venlafaxine or placebo) plus standard care (brief counseling and nicotine replacement therapy). Venlafaxine is an antidepressant that inhibits the reuptake of serotonin and norepinephrine. A1 smokers were expected to quit significantly less often on placebo, although the abstinence rates between A1s and A2s on active drug were not expected to differ (i.e., an interaction between genotype and drug was hypothesized). In addition, antidepressant therapy was expected to have a similar genotype x treatment interaction on negative affect reduction. The results showed that smokers carrying the DRD2 Al allele (A1/A1/A2) quit significantly less often than the homozygous A2s (OR = 1.54, 95% (1= 1.01-2.36). No interaction with treatment was observed. A significant pharmacogenetic effect of the drug on negative mood while quitting also was noted. Smokers absent the Al allele (A21A2) responded to the drug with a substantial reduction in negative affect, whereas those with the Al allele showed no significant reduction in negative mood, F(1, 130) = 5.95, p = .01. These results are contrary to expectations and suggest that although A1s may have more difficulty quitting, adding venlafaxine does not improve abstinence or mood. However, the results for the A2s provide evidence for a genotype-specific response to a pharmacological intervention, which could have implications for the development of future treatments. [ABSTRACT FROM AUTHOR]

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the nicotine patch. The results showed that precessation depressed mood was inversely related to 6-month abstinence. This effect remained significant after controlling for treatment, possible depression history, baseline smoking rates, and several other demographic factors. Postcessation self-efficacy, at the 2-, 4-, and 8-week postquit assessments, was the strongest mediator of the effects of precessation depressed mood on abstinence, accounting for 32%, 38%, and 48% of the effect of mood on abstinence, respectively. [ABSTRACT FROM AUTHOR]

Background. This study examined the characteristics, tobacco use patterns over time, and predictors of tobacco cessation among concomitant users of cigarettes and smokeless tobacco.Methods. Participants were employed adults residing in the southeastern United States who participated in the Working Well cancer prevention trial. Participants were assessed at baseline and followed-up 4 years later.Results and Conclusions. The study yielded several key findings: (a) the prevalence of concomitant smoking and smokeless tobacco use was high among males and nonexistent among females, (b) the characteristics of concomitant users were relatively distinct from those of both smokers and smokeless tobacco users, (c) concomitant users exhibited substantial variability in their tobacco use patterns and were less likely to stop using tobacco than were smokers or smokeless tobacco users, (d) indicators of nicotine dependence predicted tobacco cessation for both smokers and smokeless tobacco users, but were largely unrelated to tobacco cessation among concomitant users, and (e) demographics, environmental variables, and measures derived from the transtheoretical model were not consistent predictors of tobacco cessation after controlling for nicotine dependence. [Copyright &y& Elsevier]

The current study examined the relation between drinking and smoking abstinence in a community-based sample from the Working Well Trial (WWT). At baseline, drinking level was related to smoking history (never, former, or current smoker; P<.0001) and abstinence history. Mean monthly alcohol consumption increased linearly with decreases in duration of recent abstinence (i.e., longest period quit in the past year among current smokers; P<.05) and current abstinence (i.e., time since quitting among former smokers; P<.0001), even controlling for relevant demographic factors. Among baseline smokers, lower beer consumption predicted smoking abstinence at 4-year follow-up (P<.01). A trend towards significance was found for total alcohol consumption (P=.06). The results suggest (a) a dose–response relation between baseline drinking and duration of smoking abstinence, and (b) that heavier drinkers are less likely to quit smoking over a 4-year period. [Copyright &y& Elsevier]

Focuses on the abstinence of tobacco habit. Implication of clinical trials; Development of regression models; Creation of prediction models.

The use of spit tobacco (ST) products is a serious public health problem in the United States. Use of ST is associated with increased risk of oral cancer, gastrointestinal neoplasms, and other deleterious effects. The prevalence of ST use among adolescents is high in many areas, especially in predominantly rural states (e.g., South Dakota, Montana). Community-wide efforts aimed at prevention and cessation of ST use among young people are needed. A total of 4089 clinicians and educators were surveyed in 1998 regarding their personal ST use and several other characteristics associated with ST prevention and cessation counseling. Educators reported significantly higher rates of ST use than did clinicians. The most prevalent barriers to ST counseling among clinicians were perceptions of patient resistance to referral to ST cessation programs and the lack of community services that effectively treat ST use. Lack of training was a major barrier to ST counseling among all educator subgroups. Although knowledge of the health effects of ST was fairly high among all subgroups, more than 10% of dentists and dental hygienists failed to report that ST use causes gum disease. Most clinicians believed that they should demonstrate leadership in efforts aimed at ST control; however, only 64% of dentists believed that repeated counseling attempts were necessary with patients who continued to use ST. Compared with clinicians, educators generally felt less obligated to provide ST counseling. Eighty percent of physicians reported counseling activities, but fewer than half of the dental professionals did. More than 75% of Drug Abuse Resistance Education (DARE) officers reported having delivered ST counseling, whereas only 4% of volunteer leaders did. Fewer than 50% of educators believed that the ST program they taught was effective. Training of various professionals in ST interventions may benefit from emphasizing different issues (reduction of personal ST use, knowledge, commitment, etc.). Our findings have implications for community-based efforts aimed at controlling ST use among young people. [ABSTRACT FROM AUTHOR]

Background Affect states are posited to play a pivotal role in addiction-related processes, including tobacco lapse (i.e. smoking during a quit attempt), and distinct affective states (e.g. joy vs. happiness) may differentially influence lapse likelihood. However, few studies have examined the influence of distinct affective states on tobacco lapse. Purpose This study examines the influence of 23 distinct affect states on tobacco lapse among a sample of tobacco users attempting to quit. Methods Participants were 220 adults who identified as African American (50% female, ages 18–74). Ecological momentary assessment was used to assess affect and lapse in real-time. Between and within-person associations testing links between distinct affect states and lapse were examined with multilevel modeling for binary outcomes. Results After adjusting for previous time's lapse and for all other positive or negative affect items, results suggested that at the between-person level, joy was associated with lower odds of lapse, and at the within-person level, attentiveness was associated with lower odds of lapse. Results also suggested that at the between-person level, guilt and nervous were associated with higher odds of lapse, and at the within-person level, shame was associated with higher odds of lapse. Conclusions The present study uses real-time, real-world data to demonstrate the role of distinct positive and negative affects on momentary tobacco lapse. This work helps elucidate specific affective experiences that facilitate or hinder the ability to abstain from tobacco use during a quit attempt. [ABSTRACT FROM AUTHOR]

Aims: Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol‐related problems during a smoking cessation attempt and to explore co‐action with smoking abstinence. Design: CARE and PNS were longitudinal cohort cessation studies; Break Free was a two‐arm randomized clinical trial. Setting: Texas, USA. Participants: Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish‐speaking Mexican‐American smokers. Measurements Weekly alcohol consumption was collected multiple times pre and post‐quit, and binge drinking and alcohol‐related problems were collected at baseline and 26 weeks post‐quit. Analyses included only those who indicated current alcohol use. Findings Average alcohol consumption decreased from baseline to 26 weeks post‐quit in CARE (F = 17.09, P < 0.001), Break Free (F = 12.08, P < 0.001) and PNS (F = 10.21, P < 0.001). Binge drinking decreased from baseline to 26 weeks post‐quit in CARE (F = 3.94, P = 0.04) and Break Free (F = 10.41, P < 0.001) but not PNS. Alcohol‐related problems decreased from baseline to 26 weeks post‐quit in CARE (Chi‐sq = 6.41, P = 0.010) and Break Free (Chi sq = 14.44, P = 0.001), but not PNS. Conclusions: Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co‐action, with smoking abstainers and relapsers showing similar change in alcohol use/problems. [ABSTRACT FROM AUTHOR]

Examines gender differences in smoking cessation. Higher cessation rates in men than women at all follow-ups; Impact of gender on abstinence; Mediation and moderation effects.

Presents information on a 2-year research project which was conducted by the Agency for Health Care Policy and Research (AHCPR) on psychological issues relating to smoking in the United States, that were published in the Smoking Cessation Clinical Guideline. Reason the AHCPR was established; Relevance of smoking cessation to psychologists; Characteristics of intensive psychological interventions in smoking.

Examines the dimensional structure, predictive validity and discriminant validity of expectancies for cigarette smoking in a prospective study. Factor structure of expectancies; Smoking outcome expectancies; Predictive and discriminant validity of expectancies; Subject pooling and attrition; Predicting cessation success.

Investigates the impact of tobacco withdrawal and nicotine replacement on sleep parameters assessed by standardized polysomnographic recording among smokers motivated to quit. Details of a study on the issue; Analysis of results; Discussion; Implications; Limitations; Suggestions for future research.

Editorial. Praises the publication of the Smoking Cessation Clinical Practice Guideline by the Agency for Health Care Policy and Research (AHCPR). Aspects of the Guideline that are particularly important for addiction specialists; Important Guideline findings; Implementation of the treatment model for health care settings derived from the findings; Why the author view the publication as highly useful.

The increasing sophistication of mobile and sensing technology has enabled the collection of intensive longitudinal data (ILD) concerning dynamic changes in an individual's state and context. ILD can be used to develop dynamic theories of behavior change which, in turn, can be used to provide a conceptual framework for the development of just-in-time adaptive interventions (JITAIs) that leverage advances in mobile and sensing technology to determine when and how to intervene. As such, JITAIs hold tremendous potential in addressing major public health concerns such as cigarette smoking, which can recur and arise unexpectedly. In tandem, a growing number of studies have utilized multiple methods to collect data on a particular dynamic construct of interest from the same individual. This approach holds promise in providing investigators with a significantly more detailed view of how a behavior change processes unfold within the same individual than ever before. However, nuanced challenges relating to coarse data, noisy data, and incoherence among data sources are introduced. In this manuscript, we use a mobile health (mHealth) study on smokers motivated to quit (Break Free; R01MD010362) to illustrate these challenges. Practical approaches to integrate multiple data sources are discussed within the greater scientific context of developing dynamic theories of behavior change and JITAIs. [ABSTRACT FROM AUTHOR]

The article discusses the association between socioeconomic status (SES) and smoking cessation. Topics covered include the neighborhood contextual factors underlying the SES-health relationship, neighborhood characteristics that predict smoking cessation rates, and the need to create comprehensive conceptual models that elucidate pathways between tobacco cessation and SES.

Presents a letter to the editor in response to the articles featured in the December 2004 supplemental issue of the journal "Nicotine & Tobacco Research."

Background and Aims: Individuals of lower socio‐economic status (SES) display a higher prevalence of smoking and have more diffxiculty quitting than higher SES groups. The current study investigates whether the within‐person associations of key risk (e.g. stress) and protective (self‐efficacy) factors with smoking lapse varies by facets of SES. Design and setting: Observational study using ecological momentary assessment to collect data for a 28‐day period following a smoking quit attempt. Multi‐level mixed models (i.e. generalized linear mixed models) examined cross‐level interactions between lapse risk and protective factors and indicators of SES on smoking lapse. Participants: A diverse sample of 330 adult US smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation. Measurements: Risk factors included momentary urge, negative affect, stress; protective factors included positive affect, motivation, abstinence self‐efficacy; SES measures: baseline measures of income and financial strain; the primary outcome was self‐reported lapse. Findings Participants provided 43 297 post‐quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within‐person association of negative [odds ratio (OR) = 0.967, 95% CI= 0.945, 0.990, P < 0.01] and positive affect (OR = 1.023, 95% CI = 1.003, 1.044, P < 0.05) and abstinence self‐efficacy (OR = 1.020, 95% CI = 1.003, 1.038, P < 0.05) on lapse varied with financial strain. The within‐person association of negative affect (OR = 1.005, 95% CI = 1.002, 1.008, P < 0.01), motivation (OR = 0.995, 95% CI = 0.991, 0.999, P < 0.05) and abstinence self‐efficacy (OR = 0.996, 95% CI = 0.993, 0.999, P < 0.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self‐efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self‐efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse. Conclusion: Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socio‐economic status groups. [ABSTRACT FROM AUTHOR]

Purpose: This study examined differences in Quitline treatment enrollment, engagement, and smoking cessation outcomes among primary care patients preferring Spanish and English using the evidence-based tobacco treatment Ask-Advise-Connect.Methods: Ask-Advise-Connect was implemented April 2013 through February 2016 in a large safety-net health system to connect smokers with treatment via a link in the electronic health record. Rates of treatment enrollment, engagement, acceptance of nicotine replacement therapy, and smoking abstinence (self-reported and biochemically confirmed) were compared at 6 months among patients who received treatment in Spanish and English using χ2 tests. Logistic regression examined language and nicotine replacement therapy and their interaction as predictors of abstinence.Results: The smoking status of 218,915 patients was assessed and recorded in the electronic health record. Smoking prevalence was 8.4% among patients preferring Spanish and 27.0% among those preferring English. Spanish-preferring patients were less likely to enroll in treatment (10.7% vs 12.0%, χ2 = 12.06, P = .001) yet completed more counseling calls when enrolled (median = 2 vs 1, P <.001). Patients who received treatment in Spanish (vs English) were twice as likely to be abstinent at 6 months (self-reported: 25.1% vs 14.5%, odds ratio [OR] = 1.98, 95% CI, 1.62-2.40; biochemically confirmed: 7.6% vs 3.7%, OR = 2.13, 95% CI, 1.52-2.97). Receipt of nicotine replacement therapy increased abstinence for all patients and language did not interact with nicotine replacement therapy to predict abstinence.Conclusions: Automated point-of-care approaches such as Ask-Advise-Connect have great potential to reach Spanish-preferring smokers. Those who received tobacco treatment in Spanish (vs English) demonstrated better engagement and cessation outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess correlates of human papillomavirus (HPV) awareness, knowledge, and attitudes among older, church-going African-American women. Methods: Participants (N = 759), aged 40-80, answered survey questions about HPV awareness, knowledge, and attitudes toward vaccination of adolescent daughters. Associations between participant characteristics and HPV items were assessed using chi-square tests and logistic regression analyses. Results: Younger age, higher education, a family history of cancer, and less spirituality were each associated with HPV awareness individually, and when considered jointly in a single model (p values <.038). Higher education was related to HPV knowledge (p = .006). Conclusions: African-American women of older age, less education, no family history of cancer, and/or higher spirituality might benefit from targeted church-based HPV educational campaigns. [ABSTRACT FROM AUTHOR]

Purpose. Few studies have assessed how attributes of neighborhood environments contribute to sedentary, in addition to active, behaviors. This study investigated associations of perceived social and physical aspects of neighborhood environments with television (TV) viewing and physical activity (PA) in African-American adults. Design. Gross-sectional an analysis of self-reported survey Setting. Large mega-church in. Houston, Texas. Subjects. A total of 1374 African-American men and women. Measures. Outcomes included log-transformed daily TV viewing and participation in medium/high levels of PA, measured by the short version of the International Physical Activity Questionnaire. Neighborhood perceptions were assessed with the Social Cohesion and Trust and the Neighborhood Problems scales. Analysis. Multivariable models that controlled for clustering within neighborhoods. Results. Reporting more neighborhood problems was significantly associated with greater log- transformed TV viewing in women (β = .017, SE = .006, p = .003), and social cohesion was positively associated with PA in women (odds ratio = 1.06, 95% confidence interval = 1.02, 1.11, p = .006). Concerns about litter and walking after dark and a lack of places to shop were associated with increased TV viewing among women, and concerns about traffic and walking after dark were associated with reduced PA among men. Conclusion. Physical and social neighborhood conditions were associated with TV viewing and PA, particularly in women. Neighborhood-based strategies to reduce sedentary behaviors and enhance PA should include attention to social as well as physical aspects of neighborhood environments. [ABSTRACT FROM AUTHOR]

In part 3 of this 3-part review of interventions for tobacco dependence, the authors focus on multicomponent interventions for smoking cessation. Interventions that combine behavioral and pharmacological components have been known to increase abstinence relative to a single type of therapy. Therefore, multicomponent interventions are recommended. The authors present both a brief intervention model and a multiple-session intervention model. These models can be used to create brief, intensive, and quitline intervention programs and can be tailored to various types of clinicians and settings. The clinician can choose a multicomponent intervention program that is best suited to the patient's needs and preferences as well as to the clinical setting. [ABSTRACT FROM AUTHOR]

This study investigated DSM-IV depressive disorders as predictors of smoking cessation and reduction in 81 pregnant smokers participating in a smoking cessation trial. Thirty-two percent of the sample met criteria for current dysthymia, major depressive disorder in partial remission, or minor depression. There was no significant reduction in smoking among women with or without current depressive disorders. Unexpectedly, as compared to women without depressive disorders, women with dysthymia significantly increased the mean number of cigarettes smoked (from 8 to 23 cigarettes per day during the 2 to 30 days post-targeted quit date period) and were smoking significantly more cigarettes at 30 days. A main effect approaching significance suggested that women with current depressive disorders were less likely to be abstinent than women without current depressive disorders (OR = 6.3; 3.9% vs. 12.7% at 30 days post-targeted quit date; 0% vs. 6.2% at 30 days post-partum). Results add to previous findings indicating a correlation between depressive symptoms and continued smoking in pregnant women. Further investigation of mood-focused smoking cessation interventions may be warranted. [ABSTRACT FROM AUTHOR]

In part 1 of this 3-part review of interventions for tobacco dependence, the authors present evidence regarding the efficacy of pharmacological treatments for smoking cessation. They also present evidence and recommendations included in the U.S. Department of Health and Human Services Treating Tobacco Use and Dependence: Clinical Practice Guideline (the Guideline), evidence from studies published after the Guideline, and recommendations of their own. The authors review nicotine replacement therapies, antidepressants, and other pharmacotherapies, followed by pharmacological treatments for special populations. The evidence indicates that a variety of effective smoking cessation medications are available. First-line medications include nicotine replacement therapies and bupropion. Pharmacotherapy is a vital component of smoking cessation interventions and should be offered to all smokers who want to quit unless contraindicated. There is a need for further research on pharmacotherapies for smoking cessation, and the authors discuss key areas for future research. [ABSTRACT FROM AUTHOR]

MotionSense HRV is a wrist-worn accelerometery-based sensor that is paired with a smartphone and is thus capable of measuring the intensity, duration, and frequency of physical activity (PA). However, little information is available on the validity of the MotionSense HRV. Therefore, the purpose of this study was to assess the concurrent validity of the MotionSense HRV in estimating sedentary behavior (SED) and PA. A total of 20 healthy adults (age: 32.5 ± 15.1 years) wore the MotionSense HRV and ActiGraph GT9X accelerometer (GT9X) on their non-dominant wrist for seven consecutive days during free-living conditions. Raw acceleration data from the devices were summarized into average time (min/day) spent in SED and moderate-to-vigorous PA (MVPA). Additionally, using the Cosemed K5 indirect calorimetry system (K5) as a criterion measure, the validity of the MotionSense HRV was examined in simulated free-living conditions. Pearson correlations, mean absolute percent errors (MAPE), Bland–Altman (BA) plots, and equivalence tests were used to examine the validity of the MotionSense HRV against criterion measures. The correlations between the MotionSense HRV and GT9X were high and the MAPE were low for both the SED (r = 0.99, MAPE = 2.4%) and MVPA (r = 0.97, MAPE = 9.1%) estimates under free-living conditions. BA plots illustrated that there was no systematic bias between the MotionSense HRV and criterion measures. The estimates of SED and MVPA from the MotionSense HRV were significantly equivalent to those from the GT9X; the equivalence zones were set at 16.5% for SED and 29% for MVPA. The estimates of SED and PA from the MotionSense HRV were less comparable when compared with those from the K5. The MotionSense HRV yielded comparable estimates for SED and PA when compared with the GT9X accelerometer under free-living conditions. We confirmed the promising application of the MotionSense HRV for monitoring PA patterns for practical and research purposes. [ABSTRACT FROM AUTHOR]

Objective: Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes.Methods: A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes.Results: Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse.Conclusions: Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes.Implications: Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Given that people living with HIV (PLWH) are disproportionately burdened by tobacco-related morbidity and mortality, it is critically important to understand the degree to which evidence-based cessation interventions are utilized by and are effective among PLWH.Aims and Methods: This secondary data analysis aimed to examine differences in Quitline treatment enrollment and 6-month cessation outcomes among smokers seeking care at 1 HIV clinic and 12 non-HIV clinics that were part of a large healthcare system in the greater Houston, Texas metropolitan area, United States. Data were from a 34-month (April 2013-February 2016) one-group implementation trial that evaluated the Ask-Advise-Connect (AAC) approach to linking smokers with Quitline treatment. Primary outcomes included (1) treatment enrollment and (2) 6-month self-reported and biochemically confirmed abstinence.Results: The smoking status of 218 915 unique patients was recorded in the electronic health record; 5285 (2.7%) of these patients were seen at the HIV clinic where the smoking prevalence was 45.9%; smoking prevalence at the non-HIV clinics was 17.9%. The proportion of identified smokers who enrolled in treatment was 10.8% at the HIV clinic and 11.8% at the non-HIV clinics. The self-reported abstinence rate was 18.7% among HIV clinic patients and 16.5% among non-HIV clinic patients. Biochemically confirmed abstinence was lower at 4.2% and 4.5%, respectively (all ps > .05).Conclusions: AAC resulted in rates of Quitline treatment enrollment and abstinence rates that were comparable among patients seen at an HIV clinic and non-HIV clinics. Findings suggest that AAC should be considered for widespread implementation in HIV clinics.Implications: PLWH were as likely as other patients to enroll in evidence-based tobacco cessation treatment when it was offered in the context of a primary care visit. Cessation outcomes were also comparable. Therefore, standard care for PLWH should include routine screening for smoking status and referrals to cessation treatment. [ABSTRACT FROM AUTHOR]

Background: Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that low SES smokers experience barriers to quitting in part due to greater exposure to pro-smoking social contexts.Purpose: The current study examined longitudinal associations among socioeconomic status, pro-smoking social context factors (i.e., exposure to other smokers, places where smoking was allowed), cigarette availability, and smoking lapse during a quit attempt.Methods: Ecological momentary assessments (EMA) were gathered from a multiethnic sample of 365 smokers engaged in a quit attempt. A multilevel structural equation model estimated a latent variable for SES indicated by income, education, health insurance, and employment, associations among EMAs for pro-smoking social contexts and cigarette availability, and indirect effects of SES through, pro-smoking social contexts and cigarette availability to subsequent smoking lapse.Results: Lower SES scores were associated with a higher likelihood of smoking lapse. Decomposition of the path from SES to smoking lapse into indirect effects showed significant paths through exposure to places where smoking is allowed and cigarette availability. Additionally, significant serial indirect paths from SES through both exposure to other smokers and places where smoking was allowed, in turn, through cigarette availability, and, ultimately, to smoking lapse were noted.Conclusions: Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers attempting to quit experienced greater pro-smoking social contexts that affected subsequent risk for lapse. [ABSTRACT FROM AUTHOR]

Background: Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes.Methods: This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching.Discussion: This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations.Trial Registration: This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019. [ABSTRACT FROM AUTHOR]

Objective: Smoking-related illnesses are the leading cause of death among Latinos, and within this ethnic group, Mexican Americans are the largest subgroup in the U.S. Understanding the factors associated with successful smoking cessation could inform interventions for this population. Although socioeconomic status (SES) is a powerful predictor of cessation outcomes in the general U.S. population, it has generally been a poor predictor of quitting smoking among Latinos. Within a sample of Spanish-speaking Mexican Americans (n = 199), this study examined a broad array of objective and subjective indicators of SES (i.e. income, education, employment, subjective social status, financial strain, insurance status) as predictors of smoking cessation. Design: Data for the current study came from a longitudinal cohort study examining the pathways linking the social determinants of health with smoking cessation. Generalized estimating equation modeling examined the association of each predictor variable with smoking abstinence across quit day, and the 3 and 26-weeks post-quit time points. Results: Results indicated that both low financial strain and insurance status predicted an increased likelihood of abstinence when controlling for covariates in the intention-to-treat analyses (p =.02 and p =.01, respectively). However, these models only approached significance in the multiple imputation analyses (all ps >.05). Other indicators of SES (i.e. income, education, employment) that have been predictive of cessation in other populations were not predictive of abstinence in this sample. Conclusions: These findings suggest that SES may indeed influence smoking cessation among Spanish-speaking Mexican Americans similarly to its influence in other populations, but that capturing the construct of SES may require assessing a broader range of SES indicators. Specifically, low financial strain and having insurance predicted a greater likelihood of achieving smoking abstinence, whereas other indicators of SES (i.e. income, education) were not predictive. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the agreement between self-reported and accelerometer-assessed physical activity (PA) in African-American adults by sex, education, income, and weight status. Methods: Participants (N = 274) completed the International PA Questionnaire short form (IPAQS), Behavioral Risk Factor Surveillance System (BRFSS) PA questions, and PA Questionnaire (PAQ) and a 7-day accelerometer protocol using a waist-worn ActiGraph GT3X accelerometer. Inter-relationships among PA measures were assessed by sociodemographics. Results: Participants consistently reported doing ≥150 minutes of moderate-to-vigorous-intensity PA (MVPA) per week via self-report measures and did 113.5±179.4 minutes of accelerometer-assessed MVPA/week. Men self-reported and did more MVPA than women (p < .01). Regardless of sex, there were low correlations between self-report and accelerometer-assessed MVPA (r = .092-.190). Poor agreement existed between self-report and accelerometry for classifying participants as meeting PA recommendations (Cohen κ = .054-.136); only half of the participants were classified the same by both self-report and accelerometry. Conclusions: There was generally poor relative agreement between self-report and accelerometer-based assessments of MVPA in this sample of African-American adults. Findings suggest that self-report measures may perform better among African-American women than men, regardless of socioeconomic or weight status. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the treatment needs and preferences of low socioeconomic status cervical cancer survivors to inform the adaptation of a theoretically- and empirically-based Motivation and Problem-Solving approach to facilitate cessation in this at-risk population. Methods: Individual in-depth interviews were conducted with 12 female smokers with cervical cancer. Interviews were audio-recorded, transcribed, and analyzed using NVivo 10. Results: Most participants did not believe that smoking caused cervical cancer and attributed their diagnosis solely to human papillomavirus. They suggested that cessation treatment for cervical cancer survivors include psychoeducation about the impact of smoking on health and cancer and the benefits of quitting, pharmacotherapy, planning for quitting, strategies for coping with cravings/withdrawal, social support, real-time support, a nonjudgmental and understanding counselor, tailoring, and follow-up. They recommended that negativity/judgment and being told that "smoking is bad" not be included in treatment. Participants also suggested that treatment address stress management, issues specific to cervical cancer survivorship, and physical activity and healthy eating. Conclusions: Results highlight the unique treatment needs of low socioeconomic status smokers with cervical cancer and will inform the adaptation of an existing evidence-based intervention to encourage smoking cessation in this population. [ABSTRACT FROM AUTHOR]

Background: A well-established gender-differentiated association between acculturation and current smoking exists among Latino adults. There are far fewer studies on the potential influence of acculturation on smoking cessation, and extant findings are mixed.Purpose: Using a multidimensional measure of acculturation, the current study examined the independent and interactive associations of gender and acculturation with smoking cessation among Mexican American smokers engaged in a quit attempt.Methods: Using a latent variable modeling approach to repeated measures analysis, the independent and interaction effects of acculturation in two cultural directions (American and Mexican) were examined for their prospective associations with smoking abstinence. Interactions of acculturation domains with gender were also examined. Acculturation was assessed at baseline and abstinence status was assessed at 3 and 26 weeks post-quit.Results: The interaction of American and Mexican cultural identity was significantly associated with smoking abstinence, such that greater American cultural identity was positively associated with abstinence only among those with high Mexican cultural identity. The interaction of English proficiency with gender was significant such that English proficiency was positively associated with abstinence among men but not women.Conclusions: Findings in the cultural identity domain are consistent with a "benefits of biculturalism" perspective, and may be particularly relevant to the adoption of an American cultural orientation among persons with an already-strong heritage-culture orientation. Findings also replicate a gender-differentiated association between acculturation and cessation. Implications for treatment development and future research are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Varenicline and bupropion are two effective smoking cessation pharmacotherapies. Researchers have hypothesized that they might be effective, in part, because they reduce cue reactivity and cue-induced cravings. Here, we used event-related potentials (ERPs) to directly measure brain responses to cigarette-related and other motivationally relevant images during a pharmacologically aided quit attempt.Methods: Smokers involved in a 12-week placebo-controlled double-blind clinical trial of smoking cessation medications (varenicline, bupropion, placebo) took part in the study. We assessed participants at two time points: 24 h (n = 140) and 4 weeks (n = 176) after the quit date. At both sessions, we measured the amplitude of the late positive potential (LPP), an ERP component reliably associated with motivational relevance, and self-reported tonic craving using the brief version of the Questionnaire of Smoking Urges (QSU-Brief).Results: At both sessions, emotional and cigarette-related images evoked significantly larger LPPs than neutral images. Neither drug type nor smoking abstinence altered this effect at either session. At both sessions, varenicline and bupropion significantly reduced self-reported tonic craving relative to the placebo condition.Conclusions: While both varenicline and bupropion reduced self-reported tonic craving, neither medication altered the amplitude of the LPP to cigarette-related or emotional pictures in smokers attempting to quit. These medications may influence abstinence by means other than by reducing neuroaffective responses to cigarette-related cues. Smokers should be prepared for the likelihood that even after several weeks of successful abstinence, once treatment ends, cigarette-related cues may remain motivationally relevant and trigger cravings that might lead to relapse.Implications: Bupropion and varenicline do not alter electrophysiological responses, as measured by the LPP, to cigarette-related and emotional images. These findings help explain why cigarette-related cues can trigger relapse when smoking cessation medication treatments end. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Despite the availability of several efficacious smoking cessation treatments, fewer than 25% of smokers who quit remain abstinent 1 year post‐treatment. This study aimed to determine if varenicline and bupropion combination treatment would result in higher abstinence rates than varenicline alone. Design: A double‐blind, randomized, parallel‐group smoking cessation clinical trial in which participants were exposed to 12 weeks of treatment and followed for 12 months. Setting: Hospital‐based out‐patient clinic in Texas, USA specializing in cancer prevention. Participants: A total of 385 community smokers (58.44% male) who smoked 1 pack of cigarettes/day [mean = 19.66 cigarettes/day, standard deviation (SD) = 9.45]; had average carbon monoxide (CO) of 26.43 parts per million (SD = 13.74); and were moderately dependent (Fagerström Test for Cigarette Dependence = 4.79; SD = 2.07). Interventions and comparator: Smokers were randomized in a 3 : 1 (active: Placebo) ratio to 12 weeks of treatment as follows: placebo (n = 56), varenicline (Var; n = 166), and varenicline + bupropion (Combo; n = 163). Measurements: A priori primary outcome: prolonged abstinence at 12 months. Secondary outcomes: 7‐day point prevalence abstinence and continuous abstinence; all abstinence measures at end of treatment and 6‐month follow‐ups. Findings: Intention‐to‐treat analysis: the Combo group (n = 163) failed to demonstrate superiority to the Var group (n = 166) for prolonged abstinence at 12 months [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.50–1.64], supported by Bayes factor = 0.06. Both the Var (OR = 6.66, 95% CI = 1.61–59.27) and Combo groups (OR = 6.06, 95% CI = 1.45–54.09) demonstrated superiority to the Placebo group (n = 56; score = 8.38, P < 0.016). Conclusions: The addition of bupropion to varenicline treatment does not appear to increase smoking abstinence rates above that of varenicline alone. The findings support previous research showing a consistently favorable effect of both varenicline and the combination of varenicline and bupropion on smoking cessation compared with placebo. [ABSTRACT FROM AUTHOR]

Ambulatory assessment of smoking behavior has greatly advanced our knowledge of the smoking cessation process. The current article first provides a brief overview of ecological momentary assessment for smoking cessation and highlights some of the primary advantages and scientific advancements made from this data collection method. Next, a discussion of how certain data collection tools (i.e., smoking topography and carbon monoxide detection) that have been traditionally used in lab-based settings are now being used to collect data in the real world. The second half of the paper focuses on the use of wearable wireless sensors to collect data during the smoking cessation process. Details regarding how these sensor-based technologies work, their application to newer tobacco products, and their potential to be used as intervention tools are discussed. Specific focus is placed on the opportunity to utilize novel intervention approaches, such as Just-In-Time Adaptive Interventions, to intervene upon smoking behavior. Finally, a discussion of some of the current challenges and limitations related to using sensor-based tools for smoking cessation are presented, along with suggestions for future research in this area. [ABSTRACT FROM AUTHOR]

Background: Smartphone apps can provide real-time, tailored interventions for smoking cessation. The current study examines the effectiveness of a smartphone-based smoking cessation application that assessed risk for imminent smoking lapse multiple times per day and provided messages tailored to current smoking lapse risk and specific lapse triggers.Methods: Participants (N=59) recruited from a safety-net hospital smoking cessation clinic completed phone-based ecological momentary assessments (EMAs) 5 times/day for 3 consecutive weeks (1week pre-quit, 2weeks post-quit). Risk for smoking lapse was estimated in real-time using a novel weighted lapse risk estimator. With each EMA, participants received messages tailored to current level of risk for imminent smoking lapse and self-reported presence of smoking urge, stress, cigarette availability, and motivation to quit. Generalized linear mixed model analyses determined whether messages tailored to specific lapse risk factors were associated with greater reductions in these triggers than messages not tailored to specific triggers.Results: Overall, messages tailored to smoking urge, cigarette availability, or stress corresponded with greater reductions in those triggers than messages that were not tailored to specific triggers (p's=0.02 to <0.001). Although messages tailored to stress were associated with greater reductions in stress than messages not tailored to stress, the association was non-significant (p=0.892) when only moments of high stress were included in the analysis.Conclusions: Mobile technology can be used to conduct real-time smoking lapse risk assessment and provide tailored treatment content. Findings provide initial evidence that tailored content may impact users' urge to smoke, stress, and cigarette availability. [ABSTRACT FROM AUTHOR]

Background Although individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. Methods In phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO ≤ 6 ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). Results The results from the pilot feasibility study ( N = 8) showed that participants practiced mindfulness an average of 3.4 times/day (≥ 3 min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall ( M = 4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking ( Ms = 4.50/5). Conclusions The results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders. [ABSTRACT FROM AUTHOR]

To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. Method: Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual income <$30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From quit date through 26 weeks postquit, participants completed measures of emotions, craving, dependence, withdrawal, self-efficacy, and attentional bias. Biochemically confirmed 7-day smoking abstinence was assessed at 4 and 26 weeks postquit. Although the parent study did not find a significant treatment effect on abstinence, mixed-effects regression models were conducted to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on abstinence were tested. Results: Participants receiving MBAT perceived greater volitional control over smoking and evidenced lower volatility of anger than participants in both other treatments. However, there were no other significant differences between MBAT and CBT. Compared with those receiving UC, MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as well as higher self-efficacy for managing negative affect without smoking. Indirect effects of MBAT versus UC on abstinence occurred through each of these mechanisms. Conclusions: Whereas several differences emerged between MBAT and UC, MBAT and CBT had similar effects on several of the psychosocial mechanisms implicated in tobacco dependence. Results help to shed light on similarities and differences between mindfulness-based and other active smoking cessation treatments. [ABSTRACT FROM AUTHOR]

The combined use of cigarettes and alcohol is associated with a synergistic increase in the risk of morbidity and mortality. Continued alcohol use during a smoking quit attempt is a considerable risk factor for smoking relapse. As such, there is a need for interventions that address both behaviors concurrently. Mindfulness-based interventions hold much promise for simultaneously addressing tobacco and alcohol use. This pilot study evaluated the feasibility and acceptability of a mindfulness-based intervention using a two-arm randomized controlled trial of Mindfulness-Based Relapse Prevention for Smoking and Alcohol (MBRP-SA) vs Cognitive Behavioral Therapy (CBT). Interventions were delivered via telehealth in a group setting; all participants received a 6-week supply of the nicotine patch. Participants (N = 69) were adults who smoked cigarettes who reported binge drinking and were motivated to both quit smoking and change their alcohol use. Primary outcomes were feasibility and acceptability of MBRP-SA compared to CBT. Changes in tobacco and alcohol use are also presented. Participants in MBRP-SA and CBT indicated that the treatments were highly acceptable, meeting a priori benchmarks. Feasibility was mixed with some outcomes meeting benchmarks (e.g., recruitment) and others falling below (e.g., retention). Participants in both conditions demonstrated significant reductions in tobacco and alcohol use at the end of treatment. In sum, MBRP-SA had comparable outcomes to CBT on all metrics measured. Future research should evaluate the efficacy of MBRP-SA on smoking abstinence and drinking reductions in a large-scale, fully powered trial. This study was registered on clinicaltrials.gov (NCT03734666). • Both MBRP-SA and CBT were highly acceptable, meeting a priori benchmarks. • Both MBRP-SA and CBT had significant reductions in tobacco and alcohol use. • Telehealth was acceptable as a group-treatment delivery modality. • MBRP-SA had comparable outcomes to CBT on all metrics measured. [ABSTRACT FROM AUTHOR]

The article discusses the use of social support to mitigate the health-related quality of life (HRQoL) effects of personal financial problems. Topics include the use of appraisal and belonging as means of social support, the relevance of the research for intervention programs, and the relation of financial strain to socioeconomic status (SES).

Neurobiological models of addiction posit that drug use can alter reward processes in two ways: (1) by increasing the motivational relevance of drugs and drug-related cues and (2) by reducing the motivational relevance of non-drug-related rewards. Here, we discuss the results from a series of neuroimaging studies in which we assessed the extent to which these hypotheses apply to nicotine dependence. In these studies, we recorded smokers’ and nonsmokers’ brain responses to a wide array of motivationally relevant visual stimuli that included pleasant, unpleasant, cigarette-related, and neutral images. Based on these findings, we highlight the flaws of the traditional cue reactivity paradigm and we conclude that responses to non-drug-related motivationally relevant stimuli should be used to appropriately gauge the motivational relevance of cigarette-related cues and to identify smokers attributing higher motivational relevance to drug-related cues than to non-drug-related rewards. Identifying these individuals is clinically relevant as they achieve lower rates of long-term smoking abstinence when attempting to quit. Finally, we show how this approach may be extended beyond nicotine dependence to inform theoretical and clinical research in the study of obesity.Implications: The cue reactivity paradigm (ie, comparing responses evoked by drug-related cues to those evoked by neutral cues) cannot provide conclusive information about the motivational relevance of drug-related cues. Responses to non-drug-related motivationally relevant stimuli should be used to appropriately gauge the level of motivational relevance that substance-dependent individuals attribute to drug-related cues. [ABSTRACT FROM AUTHOR]