Visceral sensitivity,anxiety, and smoking among treatment-seeking smokers

It is widely recognized that smoking is related to abdominal pain and discomfort, as well as gastrointestinal disorders. Research has shown that visceral sensitivity, experiencing anxiety around gastrointestinal sensations, is associated with poorer gastrointestinal health and related health outcomes. Visceral sensitivity also increases anxiety symptoms and mediates the relation with other risk factors, including gastrointestinal distress. No work to date, however, has evaluated visceral sensitivity in the context of smoking despite the strong association between smoking and poor physical and mental health. The current study sought to examine visceral sensitivity as a unique predictor of cigarette dependence, threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), and perceived barriers for cessation via anxiety symptoms. Eighty-four treatment seeking adult daily smokers (M_age = 45.1 years [SD = 10.4]; 71.6% male) participated in this study. There was a statistically significant indirect effect of visceral sensitivity via general anxiety symptoms on cigarette dependence (b = 0.02, SE = 0.01, Bootstrapped 95% CI [0.006, 0.05]), smoking abstinence somatic expectancies (b = 0.10, SE = 0.03, Bootstrapped 95% CI [0.03, 0.19]), smoking abstinence harmful experiences (b = 0.13, SE = 0.05, Bootstrapped 95% CI [0.03, 0.25]), and barriers to cessation (b = 0.05, SE = 0.06, Bootstrapped 95% CI [0.01, 0.13]). Overall, the present study serves as an initial investigation into the nature of the associations between visceral sensitivity, anxiety symptoms, and clinically significant smoking processes among treatment-seeking smokers. Future work is needed to explore the extent to which anxiety accounts for relations between visceral sensitivity and other smoking processes (e.g., withdrawal, cessation outcome).     

Anxiety sensitivity and smoking among Spanish-speaking Latinx smokers

Despite the documented health disparities for smoking among the Latinx population, there is limited understanding of transdiagnostic constructs that may help explain smoking among Spanish-speaking Latinx smokers. The present study examined one promising transdiagnostic factor, anxiety sensitivity (fear of anxiety and related sensations), in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced when trying to quit among a large sample of Latinx smokers. Participants were 367 Spanish-speaking Latinx daily smokers (59.1% female, M_age = 33.20 years, SD = 11.81). As hypothesized, anxiety sensitivity was significantly related to the severity of cigarette dependence, perceived barriers for quitting, and problems when trying to quit. Inspection of the lower-order dimensions of anxiety sensitivity indicated that Physical Concerns was significantly related to cigarette dependence whereas Cognitive Concerns was associated with greater perceived barriers for quitting and severity of problems experienced during past quit attempts. The present study provides novel empirical evidence that anxiety sensitivity is related to a moderate, yet clinically meaningful, proportion of the variance in cigarette dependence, perceived barriers for quitting, and problems experienced during quit attempts. These findings underscore the value of examining anxiety sensitivity among Latinx smokers and focusing greater attention on this construct in efforts to reduce or quit smoking among this population.     

Situational fears: Association with negative affect-related smoking cognition among treatment seeking smokers

Despite the consistent clinically-significant relation between smoking and anxiety and its disorders, there is limited understanding of how specific fears relate to smoking processes. To isolate therapeutic targets for smoking-anxiety treatment development, there is a need to identify the underlying situational fears most related to smoking processes. Thus, the present study examined the association between interoceptive, agoraphobic, and social fears in terms of clinically significant negative affect-related smoking cognitions including negative affect reduction expectancies, coping motives, and perceived internal barriers to cessation. Participants were 469 treatment seeking smokers (48.2% female, M_age = 36.59, SD = 13.58) enrolled in a smoking cessation trial and completed baseline measures of smoking cognitions and situational fears. Results indicated that the there was a significant effect for social fears, relative to interoceptive and agoraphobic fears, for each of the studied clinically relevant smoking variables. Overall, this study offers initial empirical evidence that social fears are significantly and consistently related to several clinically-significant types of smoking cognition.     

The interplay of history of depression and craving in terms of smoking relapse among treatment seeking smokers

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.     

Unaided smoking cessation among smokers in treatment for alcohol dependence

To investigate the possible impact of treatment of alcohol dependence on smoking, we studied 144 smokers in an alcohol treatment center for whom 6-month data were available. Of those, 18 reported not smoking at 6 months. No significant differences in age, gender, or race were observed between quitters and continuing smokers. Quitters at 6 months were significantly more likely to be low dependent smokers than were continuing smokers and were significantly more likely to report no drinking during the past 28 days at the end of 1 month's treatment (93%) than continuing smokers (62%). These findings suggest that quitting smoking may be associated with low levels of nicotine dependence and favorable alcohol treatment response in alcoholic smokers.     

Study of the relationship between anxiety sensitivity,smoking abstinence expectancies,nicotine withdrawal,and cigarette dependence among daily smokers

Introduction: Anxiety sensitivity (AS) is the fear of anxiety symptoms related to physical, cognitive, and social concerns. AS has been implicated in amplifying negative emotional states and maintaining smoking behavior. Aims: The current cross-sectional study evaluated the lower-order facets of AS (Physical, Cognitive, Social concerns) in relation to current nicotine withdrawal symptoms, short-term consequences of abstaining from smoking, and cigarette dependence. Methods: 331 adult Italian smokers were recruited from the general population and asked to fill in scales assessing AS, nicotine withdrawal symptoms, and cigarette dependence. Results: All ASI-3 subscales were associated with psychological symptoms of nicotine abstinence (β?=?0.30–0.10; p?≥?0.001), whereas ASI-3 physical concerns (β?=?0.62; p?≥?0.001) and ASI-3 cognitive concerns (β?=?0.25; p?≥?0.001) were associated with physical symptoms of nicotine abstinence. No ASI-3 subscales were associated with short-term smoking abstinence expectancies. ASI-3 physical concerns (β?=?0.72; p?≥?0.001) and ASI-3 cognitive concerns (β?=?0.25; p?≥?0.001) were associated with cigarette dependence. Discussion: ASI-3 physical concerns and ASI-3 cognitive concerns could amplify withdrawal-related factors, thereby increasing the negative reinforcement processes which might motivate smoking.     

Prospects for smoking treatment in individuals seeking treatment for alcohol and other drug problems

Alcohol and drug using clients of the Addiction Research Foundation were asked about their interest in receiving treatment for cigarette smoking. Forty-six percent said that they were "moderately" to "very much" interested in attending a treatment program if it were available. Despite a consistent preference for receiving smoking treatment after their alcohol or drug problem was treated, there was moderate interest in receiving smoking treatment during the alcohol or drug treatment among those who were very interested in receiving smoking treatment in general. Seventy-one percent reported that it would be "as difficult" or "more difficult" to give up cigarettes than the drug or alcohol which brought them to the hospital for treatment. The importance of treating smoking in alcohol and drug using clients is discussed.     

Emotion dysregulation and smoking among treatment-seeking smokers

IntroductionThere has been increased scholarly interest in advancing the study of emotion dysregulation and substance use. However, there is limited study of emotion dysregulation in the context of smoking. The current study examined the emotion dysregulation global construct and sub facets in relation to negative affect reduction expectancies, coping motives, perceived barriers for quitting, and the severity of problems experienced during quit attempts.MethodTreatment seeking smokers (n = 469; 48.2% female, M_age = 36.59, SD = 13.58) enrolled in a smoking cessation trial and completed baseline measures of smoking cognitions and emotion dysregulation.ResultsResults indicated that the emotion dysregulation global score was significantly associated with each of the smoking dependent variables. Additionally, difficulty accessing emotion regulation strategies and difficulty engaging in goal-directed behavior were significantly associated with the dependent variables.ConclusionOverall, this is the first study to evaluate relations between multidimensional facets of emotion dysregulation and clinically relevant smoking variables. Emotion dysregulation may be an important treatment target for changing smoking.     

Effects of 21 days of varenicline versus placebo on smoking behaviors and urges among non-treatment seeking smokers

Varenicline promotes smoking cessation and reduces urges to smoke. However, the mechanisms associated with these effects and their time course are not well characterized. One mechanism may be extinction, but the duration of the current dosing protocol may not be sufficient. We examined the effect of extended pre-treatment with varenicline on smoking behavior among 17 non-treatment seeking adult smokers. Using a within-subjects, double-blind, placebo-controlled crossover design, participants received standard dosing of varenicline for 21 days, followed by a 14-day washout period and 21 days of placebo; order counterbalanced. Cigarettes per day (CPD), smoking topography, smoking urges (QSU), and side effects were assessed every three days. Biomarkers (e.g. nicotine metabolites) were collected on days 1, 7, and 21. There was a significant drug by time interaction indicating a reduction in CPD during varenicline phase (between days 10-21), but no reduction during placebo. Varenicline also led to reductions in nicotine metabolites and urges to smoke. Among this sample of non-treatment seeking smokers, varenicline significantly reduced smoking behavior. Results have important treatment implications because changes in CPD and craving did not occur until after the typical one-week run-up period. This suggests that a longer duration of pre-treatment may be beneficial for some smokers.     

The relationship of anxiety and smoking behaviors to medication adherence among cigarette smokers living with HIV

IntroductionPeople living with HIV/AIDS [PLWH] who smoke cigarettes report lower medication adherence. The purpose of the current study was to examine the relationship between anxiety and smoking behaviors (e.g., smoking quantity and frequency) and medication adherence in a sample of PLWH who smoke.MethodsPLWH who reported current cigarette smoking and use of antiretroviral medication were recruited from Center for Positive Living at Montefiore Medical Center (New York, US). Participants completed questions about their current smoking behavior, anxiety symptoms, and medication adherence.ResultsThe analytic sample included sixty-eight PLWH who smoked cigarettes (female 48.5%, mean age = 49.1 ± 8.8 years, 52.2% Latino/a). The participants smoked an average of 10.53 (SD = 8.6) cigarettes daily and just over half of participants (55.9%) reported high medication adherence. There was a significant association between greater anxiety symptoms and poorer medication adherence (OR = 1.09, CI = 1.04–1.15, p = .001). Participants with higher anxiety symptoms were more likely to report forgetting to take their medication, forgetting to take medication when leaving on a trip, stopping medication when feeling symptoms are under control, and when feeling hassled about sticking to the treatment plan. Within this sample of current smokers, there were no significant associations between smoking quantity or frequency and medication adherence and no interactive effects of these smoking behaviors and anxiety on medication adherence.DiscussionCurrent cigarette smoking PLWH who reported greater anxiety symptoms were less likely to adhere to their medication than current smoking PLWH who reported fewer anxiety symptoms. PLWH who smoke may benefit from assessment and management of anxiety.     

Reasons for smoking among extremely heavy smokers

Four factors describing reasons for smoking were identified in 200 heavy smokers. When these four factor scores were correlated with other variables, the Addictive/Habitual Needs factor correlated most often with increased use of tobacco, alcohol, and coffee. The Pleasure factor was associated with obesity and the Stress Reaction factor with more perceived stress. The Stress Reaction factor was consistently correlated with more unfavorable ratings on psychological adjustment. Persons who smoked to alleviate stress or for addictive/habitual needs had tried to stop more often, whereas those who smoked for pleasure had little motivation to stop smoking. Findings suggest that there are individual differences in reasons for smoking among extremely heavy smokers and that these need to be taken into account in trying to help such individuals.     

An evaluation of pain-related anxiety among daily cigarette smokers in terms of negative and positive reinforcement smoking outcome expectancies

The present investigation sought to evaluate the unique explanatory relevance of pain-related anxiety in relation to negative and positive reinforcement smoking outcome expectancies among 135 (40.7% female; M_age = 26.11, SD = 11.23) adult daily cigarette smokers. As predicted, pain-related anxiety was significantly related to greater expectancies that smoking will decrease negative affect, and lesser expectancies that smoking will result in positive outcomes. The observed effects were evident above and beyond the variance accounted for by gender, current level of non-specific bodily pain, daily cigarette use, relations with non-criterion outcome expectancies, and shared variance with anxiety sensitivity. Results suggest that there may be segments of the smoking population who are at relatively greater risk for certain expectancies for tobacco smoking by virtue of individual differences in pain-related anxiety.     

Predictors of persistent smoking and quitting among women smokers

This study examined predictors of persistent tobacco smoking and smoking cessation in a longitudinal study of women's health. The sample consisted of 575 women, with an average age of 34 years at baseline. Follow-up occurred some 13 years later. Two models of smoking behavior were examined, the first identifying correlates of daily smoking at baseline and the second identifying predictors of subsequent quitting at follow-up among those smoking at baseline. Poor maternal education, being young at birth of first child, high level of anxiety, having a partner who smoked, and high tea/coffee consumption were all associated with smoking at baseline. Being a young mother and number of cigarettes smoked at baseline predicted subsequent persistent smoking while high levels of anxiety significantly predicted subsequent quitting.     

Comparison of smoking relapse curves among African-American smokers

We examined the smoking relapse curves for African-American smokers by level of smoking to characterize nicotine dependence in this population of smokers. This analysis was conducted from data originally collected to study differences in level of smoking among African-Americans at an inner-city health center in Midwest. Relatively little research has been conducted to clarify smoking and quitting patterns among African-American smokers. The median number of cigarettes smoked currently was 7 cigarettes per day (cpd) for light smokers and 20 cpd for the moderate to heavy smokers. The heavier smokers reported smoking at this rate longer than light smokers, 11 and 5 years, respectively. The major finding in this study is that African-American light smokers have abstinence rates very similar to heavier smokers and the median length of their most recent quit attempts were also similar. Therefore, stable light smokers may also need smoking cessation interventions similar to those used for heavier smokers in order to successfully stop smoking.     

Anxiety sensitivity: Concurrent associations with negative affect smoking motives and abstinence self-confidence among young adult smokers

The present study evaluated the association between the lower-order facets of Anxiety Sensitivity construct (Physical, Mental Incapacitation and Social Concerns) and theoretically relevant cognitive-based smoking processes. Participants were 151 young adult daily smokers (63 females); mean number of cigarettes/day = 12.3 [S.D. = 5.6]). Both AS Physical and Mental Incapacitation Concerns were significantly associated with greater negative affect reduction smoking motives and lower levels of self-confidence in remaining abstinent from smoking when emotionally distressed. The observed effects were over and above the variance accounted for by nicotine dependence, smoking rate, and gender. Results are discussed in relation to better understanding cognitive-based smoking processes among individuals at heightened risk for panic psychopathology.     

Depression in pregnant women seeking smoking cessation treatment

The proportion of DSM-IV-based threshold and subthreshold depressive disorders was assessed, using the Primary Care Evaluation of Mental Disorders and a DSM-IV based assessment of depression history, in a sample of 139 pregnant smokers seeking smoking cessation treatment. Sixty-three percent of the sample met criteria for a current or past depressive disorder. Forty-six percent had a current threshold or subthreshold depressive disorder. Twenty percent met criteria for current major depression, with half of those having major depression with dysthymia. Twenty-one percent of the sample was chronically depressed (i.e., dysthymia or major depression with dysthymia). Women with current depression were less likely to tell their doctors that they smoked. Our results suggest that investigation of the prevalence of depression in community samples of pregnant smokers is warranted, as depression may present a major obstacle in pregnant women's efforts to quit smoking.     

Treatment seeking for smoking cessation among young adults

Young adult smokers (18–24 year olds) do not seek treatment for smoking cessation as often as older smokers. Two commonly hypothesized reasons for this are that younger smokers are not aware of treatments or cannot afford them. The State of Vermont provides free smoking cessation treatment, and most young smokers are aware of this; thus, we tested whether young adult smokers from Vermont would still underutilize treatment via a secondary analysis of the population-based 2005 VT Adult Tobacco Survey. Young adult smokers from Vermont were less likely to have used medication (24% vs. 58%; relative risk = 0.42) or psychosocial (28% vs. 53%; relative risk = 0.54) treatment than middle-aged smokers (25–44 year olds). We conclude that reasons other than awareness and cost cause young adult smokers to not seek treatment.     

Dependence and motivation to stop smoking as predictors of success of a quit attempt among smokers seeking help to quit

IntroductionIt is not known how well motivation to stop smoking predicts abstinence in a clinical sample relative to the most widely used measure of cigarette dependence.MethodsA secondary analysis was conducted from a trial with 864 smokers making quit attempt. Fagerström Test of Cigarette Dependence (FTCD), Heaviness of Smoking Index (HSI), and motivation to stop smoking (composite of determination to quit and importance of quitting) were measured at baseline. Continuous smoking abstinence, validated by expired-air carbon monoxide, was assessed at 4 weeks, 6 months and 12 months post-quit date. FTCD, HSI, non-HSI items in FTCD, and motivation were assessed as predictors of abstinence.ResultsIn multiple-logistic regressions, controlling for age, gender and medication use, lower scores for FTCD, HSI and non-HSI all significantly predicted abstinence at all follow-ups, while motivation did not predict abstinence at any time. Likelihood ratio tests showed that the FTCD contributed most to the model at 4 weeks and 6 months; at 12 months FTCD and non-HSI equally contributed most to the model. At 4 weeks and 6 months, predictions were improved by combining HSI and non-HSI components, compared with using these components alone.ConclusionsCigarette dependence, measured by the FTCD, or by its HSI or non-HSI components, predicts both short-term and medium-term outcomes of attempts to stop smoking in treatment-seeking smokers involved in a clinical trial, whereas strength of motivation to stop predicts neither. Both the HSI and non-HSI components may be considered as briefer alternatives to the full FTCD.     

Depressive symptoms,drinking problems,and smoking cessation in older smokers

This study modeled the predictive association between depressive symptoms and smoking cessation in a sample of 442 late-middle-aged smokers; assessments occurred at four time-points across a 10-year period. In addition, the study examined the role of baseline drinking problems in moderating the relationship between depressive symptoms and smoking cessation. Findings supported hypotheses. More depressive symptoms prospectively predicted a lower likelihood of smoking cessation. In addition, the presence of baseline drinking problems strengthened the relationship between depressive symptoms and a lower likelihood of smoking cessation. Understanding the mechanisms underlying depression and cigarette smoking among older adults is applicable to secondary prevention and treatment and suggests additional public health benefits from treating depression in older persons.     

Affective style among smokers: Understanding anxiety sensitivity, emotional reactivity, and distress tolerance using biological challenge

The present investigation evaluated affective style in terms of anxiety sensitivity, emotional reactivity, and distress tolerance in heavy smokers. Specifically, heavy smokers (> or = 20 cigarettes per day) were partitioned into those who were able to quit for at least 7 days (n = 10) and those who were able to quit for less than 7 days (n = 12). All participants completed measures of anxiety sensitivity and maximum breath-holding duration and then were exposed to a 20% carbon dioxide-enriched air challenge. Results indicated that heavy smokers who had not been able to remain abstinent from smoking for at least 1 week during a quit attempt demonstrated significantly greater cognitive-affective reactivity to the challenge relative to their counterparts but did not differ at a physiological level of analysis. Contrary to our hypotheses, neither anxiety sensitivity scores nor maximum breath-holding duration significantly differed between the groups. These findings are discussed in relation to better understanding affective style among heavy smokers.