Publications by authors named "Erika Litvin Bloom"

27 Publications

  • Page 1 of 1

Relationships among Self-Efficacy, Quality of Life, Perceived Vulnerability, and Readiness to Quit Smoking in People Living with HIV.

J Smok Cessat 2021 11;2021:6697404. Epub 2021 May 11.

University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705, USA.

Smoking-related diseases (e.g., lung cancer) are the leading cause of mortality in HIV-infected patients. While many PLWH who smoke report a desire to quit, a majority of them have low readiness to quit. This study used logistic and linear regression to examine the relations among two (continuous vs. binary) measures of readiness to quit, smoking cessation self-efficacy (SE), quality of life (QoL), and perceived vulnerability (PV) using baseline data from 100 PLWH who smoke who participated in a clinical trial. Results showed no significant main effects (SE, QoL, and PV) or interaction effects (SE × QoL and SE × PV) on a continuous measure of readiness to quit. However, a follow-up analysis revealed that SE had a curvilinear effect on readiness to quit such that self-efficacy was positively associated with readiness to quit except at the highest levels of self-efficacy where readiness to quit declined. Greater SE significantly increased the likelihood of reporting readiness to quit (yes/no) among those with low QoL or high PV. For PLWH who smoke, improving self-efficacy may increase readiness to quit especially among those with lower quality of life. Psychoeducation tailored to PLWH designed to reduce unrealistic invulnerability to smoking-related diseases along with interventions that target self-efficacy may improve readiness to quit.
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http://dx.doi.org/10.1155/2021/6697404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279192PMC
May 2021

A pilot randomized controlled trial of smartphone-assisted mindfulness-based intervention with contingency management for smokers with mood disorders.

Exp Clin Psychopharmacol 2021 Jul 22. Epub 2021 Jul 22.

School of Nursing.

Cigarette smoking disproportionately affects individuals with mood disorders, but smoking cessation interventions have modest effects in this population. Home mindfulness practice during abstinence incentivized via contingency management (CM) may help those in affective distress quit smoking.

Method: Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, = 25) or enhanced standard treatment (EST, = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) ≤ 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day.

Results: Of the 49 participants, 63.3% were Latinx and 30.6% Black; 75.5% reported household incomes < $25,000. Abstinence rates for SMI-CM were 40.0%, 36.0%, and 16.0% versus 4.2%, 8.3%, and 4.2% in EST at weeks 2, 4, and 13. A generalized estimating equations (GEE) model showed significant overall differences in abstinence rates in SMI-CM versus EST (adjusted odds ratio [A] = 8.12, 95% CI = 1.42-46.6, = .019). Those who received SMI-CM reported significantly greater reduction in smoking-specific experiential avoidance from baseline to 3 days prior to quit date (β = -7.21, 95% CI = -12.1-2.33, = .006).

Conclusions: SMI-CM may increase cessation rates among smokers with mood disorders, potentially through reduced smoking-specific experiential avoidance. SMI-CM is a promising intervention, and warrants investigation in a fully powered randomized controlled trial (RCT). (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000506DOI Listing
July 2021

Pilot trial of QuitBet: A digital social game that pays you to stop smoking.

Exp Clin Psychopharmacol 2021 Jun 10. Epub 2021 Jun 10.

WayBetter, Inc.

Contingency management is an effective treatment for cigarette smoking cessation but feasibility and acceptability concerns have been barriers to implementation. We conducted a pilot test of QuitBet, a commercial, digital (smartphone) social game for smoking cessation during which participants earned financial incentives for abstinence. QuitBet included a social feed for posting messages and entirely participant-funded incentives in the form of a deposit contract (the "bet"). QuitBet had a bet of $30 and lasted for 28 days. After a week to prepare for quitting, the quit day was Day 8. Between Day 9-28 (a 20-day period), participants earned back $1 of their $30 bet for each day of carbon monoxide (CO)-verified abstinence (≤ 6 ppm). Remaining bet money was pooled into a "grand prize" pot. Participants who were abstinent on at least 19 of the 20 days (1 "lapse" day allowed) were declared "winners" and split the grand prize pot equally. A game host posted a daily message containing evidence-based education about smoking cessation or a discussion topic. Recruitment goals were met. Among the players ( = 50 U.S. adults, 78% female), 17 (34%) were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000487DOI Listing
June 2021

Longitudinal Associations Between Changes in Cigarette Smoking and Alcohol Use, Eating Behavior, Perceived Stress, and Self-Rated Health in a Cohort of Low-Income Black Adults.

Ann Behav Med 2021 May 10. Epub 2021 May 10.

RAND Corporation, Pittsburgh, PA, USA.

Background: Black adults in the U.S. experience significant health disparities related to tobacco use and obesity. Conducting observational studies of the associations between smoking and other health behaviors and indicators among Black adults may contribute to the development of tailored interventions.

Purpose: We examined associations between change in cigarette smoking and alcohol use, body mass index, eating behavior, perceived stress, and self-rated health in a cohort of Black adults who resided in low-income urban neighborhoods and participated in an ongoing longitudinal study.

Methods: Interviews were conducted in 2011, 2014, and 2018; participants (N = 904) provided at least two waves of data. We fit linear and logistic mixed-effects models to evaluate how changes in smoking status from the previous wave to the subsequent wave were related to each outcome at that subsequent wave.

Results: Compared to repeated smoking (smoking at previous and subsequent wave), repeated nonsmoking (nonsmoking at previous and subsequent wave) was associated with greater likelihood of recent dieting (OR = 1.59, 95% CI [1.13, 2.23], p = .007) and future intention (OR = 2.19, 95% CI [1.61, 2.98], p < .001) and self-efficacy (OR = 1.64, 95% CI [1.21, 2.23], p = .002) to eat low calorie foods, and greater odds of excellent or very good self-rated health (OR = 2.47, 95% CI [1.53, 3.99], p < .001). Transitioning from smoking to nonsmoking was associated with greater self-efficacy to eat low calorie foods (OR = 1.89, 95% CI [1.1, 3.26], p = .021), and lower perceived stress (β = -0.69, 95% CI [-1.34, -0.05], p = .036).

Conclusions: We found significant longitudinal associations between smoking behavior and eating behavior, perceived stress, and self-rated health. These findings have implications for the development of multiple behavior change programs and community-level interventions and policies.
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http://dx.doi.org/10.1093/abm/kaab029DOI Listing
May 2021

Sustained Care Smoking Cessation Intervention for Individuals Hospitalized for Psychiatric Disorders: The Helping HAND 3 Randomized Clinical Trial.

JAMA Psychiatry 2021 Aug;78(8):839-847

Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston.

Importance: Smoking among individuals with serious mental illness (SMI) represents a major public health problem. Intervening during a psychiatric hospital stay may provide an opportunity to aid engagement in smoking cessation treatment and facilitate success in quitting.

Objective: To examine the effectiveness of a multicomponent, sustained care (SusC) smoking cessation intervention in adults with SMI receiving inpatient psychiatric care.

Design, Setting, And Participants: The Helping HAND 3 randomized clinical trial compared SusC with usual care (UC) among individuals with SMI who smoked daily and were receiving inpatient psychiatric care in Austin, Texas, in a single hospital. The study was conducted from July 2015 through August 2019.

Interventions: The UC intervention involved brief smoking cessation information, self-help materials and advice from the admitting nurse, and an offer to provide nicotine replacement therapy during hospitalization. The SusC intervention included 4 main components designed to facilitate patient engagement with postdischarge smoking cessation resources: (1) inpatient motivational counseling; (2) free transdermal nicotine patches on discharge; (3) an offer of free postdischarge telephone quitline, text-based, and/or web-based smoking cessation counseling, and (4) postdischarge automated interactive voice response calls or text messages.

Main Outcomes And Measures: The primary outcome was biochemically verified 7-day point-prevalence abstinence at 6-month follow-up. A secondary outcome was self-reported smoking cessation treatment use at 1, 3, and 6 months after discharge.

Results: A total of 353 participants were randomized, of whom 342 were included in analyses (mean [SD] age, 35.8 [12.3] years; 268 White individuals [78.4%]; 280 non-Hispanic individuals [81.9%]; 169 women [49.4%]). They reported smoking a mean (SD) of 16.9 (10.4) cigarettes per day. Participants in the SusC group evidenced significantly higher 6-month follow-up point-prevalence abstinence rates than those in the UC group (8.9% vs 3.5%; adjusted odds ratio, 2.95 [95% CI, 1.24-6.99]; P = .01). The number needed to treat was 18.5 (95% CI, 9.6-306.4). A series of sensitivity analyses confirmed effectiveness. Finally, participants in the SusC group were significantly more likely to report using smoking cessation treatment over the 6 months postdischarge compared with participants in the UC group (74.6% vs 40.5%; relative risk, 1.8 [95% CI, 1.51-2.25]; P < .001).

Conclusions And Relevance: The findings of this randomized clinical trial provide evidence for the effectiveness of a scalable, multicomponent intervention in promoting smoking cessation treatment use and smoking abstinence in individuals with SMI following hospital discharge.

Trial Registration: ClinicalTrials.gov Identifier: NCT02204956.
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http://dx.doi.org/10.1001/jamapsychiatry.2021.0707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100915PMC
August 2021

Prevalence and Characteristics of Telehealth Utilization in the United States.

JAMA Netw Open 2020 10 1;3(10):e2022302. Epub 2020 Oct 1.

RAND Corporation, Arlington, Virginia.

Importance: Telehealth services, which allow patients to communicate with a remotely located clinician, are increasingly available; however, prevalence of telehealth use, including videoconferencing visits, remains unclear.

Objective: To measure the use of and willingness to use telehealth modalities across the US population.

Design, Setting, And Participants: This survey study, conducted between February 2019 and April 2019, asked participants about their use of different telehealth modalities, reasons for not using videoconferencing visits, and willingness to use videoconferencing visits. Questions were continuously posed to panel members and closed after 2555 responses were obtained, at which point 3932 panel members had been invited, for a 65.0% response rate.

Exposures: Demographic characteristics (ie, age, sex, race, rural/urban residency, education level, and income).

Main Outcomes And Measures: Self-reported use of specific telehealth modalities, reasons for nonuse, and willingness to use videoconferencing in the future.

Results: A total of 2555 individuals completed the survey with a mean (SD) age of 57.2 (14.2) years; 1453 respondents (weighted percentage, 51.9%) were women, and 2043 (weighted percentage, 73.4%) were White individuals. Overall, 1343 respondents (weighted percentage, 50.8%) reported use of a nontelephone telehealth modality, ranging from 873 respondents (weighted percentage, 31.9%) for patient portals and 89 respondents (weighted percentage, 4.2%) for videoconferencing visits. Although 1309 respondents (weighted percentage, 49.2%) overall answered that they were willing or very willing to use videoconferencing visits, respondents who were Black individuals (OR, 0.58; 95% CI, 0.38-0.91), aged older than 65 years (OR, 0.51; 95% CI, 0.40-0.66), or had less education (high school or less vs advanced degrees: OR, 0.37; 95% CI, 0.25-0.56) were less likely to express willingness.

Conclusions And Relevance: Despite the focused policy attention on videoconferencing visits, the results of this survey study suggest that other forms of telehealth were more dominant prior to 2020. Targeted efforts may be necessary for videoconferencing visits to reach patient groups who are older or have less education, and payer policies supporting other forms of telemedicine may be appropriate to enhance access.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.22302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588937PMC
October 2020

A Pilot Randomized Controlled Trial of Distress Tolerance Treatment for Weight Concern in Smoking Cessation Among Women.

Nicotine Tob Res 2020 08;22(9):1578-1586

University of Texas at Austin School of Nursing, Austin, TX.

Introduction: The majority of women who smoke cigarettes report that concern about weight gain is a barrier to quitting. We developed an intervention incorporating distress tolerance, appetite awareness, and mindful eating skills to target concerns about post-cessation weight gain and emotional eating (DT-W). In the current study, we conducted a pilot randomized controlled trial of DT-W versus a smoking health education (HE) intervention.

Methods: Participants (N = 69 adult female, weight-concerned smokers) were recruited in cohorts of 4-11. Cohorts were randomized to DT-W or HE. DT-W and HE were matched on format (single individual session followed by eight group sessions), inclusion of cognitive behavioral therapy for smoking cessation (CBT) content, and pharmacotherapy (nicotine patches). Follow-up assessments occurred at 1-, 3-, and 6-months post-treatment.

Results: The recruitment goal was met; 61 of the 69 participants attended at least one group session. There were no significant differences between DT-W and HE in the number of group sessions attended (DT-W adjusted M = 5.09, HE adjusted M = 5.03, p = .92), ratings of treatment effectiveness or usefulness of skills, or retention at 6-month follow-up (79% in DT-W vs. 78% in HE) (ps > .05), but comprehension ratings were lower in DT-W than in HE (p = .02).

Conclusions: Overall, these results suggest that the study procedures and interventions were feasible and acceptable, but changes to the DT-W intervention content to improve comprehension should be considered prior to conducting a fully powered trial.

Implications: A distress tolerance-based treatment targeting fear of weight gain after smoking cessation and post-cessation emotional eating was feasible and acceptable relative to a smoking HE comparison condition, but changes should be considered before conducting a larger trial. Continued innovation in treatment development for weight-concerned smokers is needed.
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http://dx.doi.org/10.1093/ntr/ntaa026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443582PMC
August 2020

Pilot feasibility trial of dual contingency management for cigarette smoking cessation and weight maintenance among weight-concerned female smokers.

Exp Clin Psychopharmacol 2020 Oct 24;28(5):609-615. Epub 2019 Oct 24.

Alpert Medical School of Brown University.

Many women who smoke cigarettes report that concern about weight gain is a barrier to quitting. Indeed, most quitters gain weight and some attribute relapses to weight gain concern. Contingency management (CM), which refers to reinforcing a target behavior with financial incentives, has been demonstrated effective for promoting smoking abstinence and weight management independently. We conducted a pilot trial to establish the feasibility of dual CM, in which both smoking cessation and weight maintenance were incentivized, as a smoking cessation intervention for female weight-concerned smokers. Participants ( = 10) received a 12-week intervention during which they earned financial incentives for smoking abstinence, verified by breath carbon monoxide (CO) testing, and for maintaining their weight (larger incentives for gaining less than five pounds, smaller incentives for 5-10 pound gain) while abstaining from smoking. They attended an end of intervention visit at week 13 and a follow-up visit at week 26. Total compensation was up to $550 ($255 for participation independent of smoking and weight, $145 for smoking abstinence incentives, and $150 for weight maintenance incentives). Results indicated that five of the 10 participants (50%) were continuously abstinent for at least 4 weeks and received at least 2 weight maintenance incentives. Three participants (33%) were abstinent at every visit they attended from quit date through week 26; 2 of these 3 had gained more than 10 pounds by week 26. Additional formative research to test alternative incentive schedules and modalities should be conducted before CM-W is evaluated in a larger trial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180087PMC
October 2020

Smoking-related weight and appetite concerns and use of electronic cigarettes among daily cigarette smokers.

Psychol Health Med 2019 02 22;24(2):221-228. Epub 2018 Oct 22.

e Behavioral Medicine and Addictions Research , Butler Hospital , Providence , RI , USA.

Weight control is a common motive for cigarette smoking.  Some individuals also report using electronic cigarettes (e-cigarettes) for weight control.  This study tested the hypothesis that the tendency to use combustible cigarettes for weight/appetite control would be associated with higher odds of current e-cigarette use among adult daily combustible cigarette smokers. Participants (n = 577; M = 44.42; 52.7% female) were recruited to participate in an online survey. Smoking for weight/appetite control was assessed via the Smoking-Related Weight and Eating Episodes Test (SWEET). Results indicated that higher scores on two SWEET subscales were significantly associated with increased odds of current e-cigarette use: smoking to suppress appetite (OR = 1.356,CI = 1.116-1.646, p = .002) and smoking to prevent overeating (OR = 1.314, CI = 1.101-1.567, p = .002). Scores on the other SWEET subscales were not significantly associated with current e-cigarette use.  These findings indicate that daily smokers who smoke to manage their appetite and eating may be more likely to use e-cigarettes, potentially because e-cigarettes will also serve this function. Future research should evaluate beliefs about e-cigarettes in management of appetite and eating behavior, and the acute effects of e-cigarettes on weight and eating behavior relative to combustible cigarettes.
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http://dx.doi.org/10.1080/13548506.2018.1537495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368221PMC
February 2019

A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations.

Nicotine Tob Res 2019 11;21(12):1580-1589

Population Health and Cancer Control Program, Cancer Institute, College of Medicine, Penn State University, Hershey, PA.

Introduction: Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy.

Methods: Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date).

Results: The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%).

Conclusions: Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results.

Implications: A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact.
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http://dx.doi.org/10.1093/ntr/nty162DOI Listing
November 2019

Billing Practices Among US Tobacco Use Treatment Providers.

J Addict Med 2018 Sep/Oct;12(5):381-386

Alpert Medical School of Brown University (ELB); Rhode Island Hospital (ELB, LEH); Mayo Clinic College of Medicine and Nicotine Dependence Center (MVB); Steeplechase Cancer Center at Robert Wood Johnson Barnabas Health University Hospital Somerset (CK); University of North Carolina at Chapel Hill School of Medicine (AOG, CR-M); Rutgers Robert Wood Johnson Medical School (MBS); Florida State University College of Medicine Tobacco Program (MD); Fire Department of the City of New York Tobacco Treatment Program, IQuit Smoking at Jersey City Medical Center RWJ Barnabas (MPB); Business Practices Committee of the Association for the Treatment of Tobacco Use and Dependence (ATTUD) (ELB, MVB, CK, AOG, CR-M, MBS, MD, MPB).

Objectives: The US Affordable Care Act (ACA) now requires almost all health insurance plans to cover tobacco use treatment (TUT), but TUT remains underutilized.

Methods: We conducted an anonymous online survey of US TUT providers in 2016 regarding their billing practices.

Results: Participants (n = 131) provided services primarily in medical and behavioral health settings and were from a variety of professions. Most provided intensive individual (>15 minutes per session) and/or group counseling. Although most reported that their organization accepted at least 1 form of insurance, only 34% reported that TUT services were billed, with about equal proportions endorsing billing under their own independent tax ID and "incident to" billing under a supervisor. Half of billers (52%) reported using at least 1 Current Procedural Terminology code. The most common codes were 99406 and 99407, but 18 unique codes were specified. Themes of qualitative responses (n = 101) included concern about how to initiate and sustain adequate reimbursement, and experiences with billing not being "worth" the time or effort.

Conclusions: Overall, results demonstrate a need for providers, administrators, and billing managers to work collaboratively. Even with the ACA mandate, and consistent with prior reports, reimbursement rates may be inadequate for intensive counseling. Areas for advocacy include recognizing that TUT requires similar intensity, expertise, and reimbursement as other substance use disorders and chronic medical conditions; giving Tobacco Treatment Specialists the ability to bill independently; and improving coordination between intensive therapies validated in research and "real-world" logistics.
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http://dx.doi.org/10.1097/ADM.0000000000000423DOI Listing
October 2019

A randomized controlled trial of distress tolerance treatment for smoking cessation.

Psychol Addict Behav 2018 06;32(4):389-400

Department of Psychology, University of Nevada, Reno.

We previously developed a distress tolerance (DT)-based treatment that showed promising results for smokers with a history of early lapse. In the current study, we conducted a randomized controlled trial of this DT treatment for a general population of smokers not limited to those with a history of early lapse. We randomized 116 participants (41% female) to DT or standard treatment (ST). Both treatments included 1 individual session during Week 1 followed by 7 group sessions during Weeks 2-9 (quit date at Session 4), two 20-min phone sessions, and 8 weeks of transdermal nicotine patch. Results indicated no significant differences between conditions in the primary outcome of biochemically verified 7-day point prevalence smoking abstinence or in time to 1st lapse. Verified abstinence rates in DT were 38.7%, 38.7%, 46.77%, 40.32%, 20.9%, and 17.7% versus 40.7%, 37.0%, 53.7%, 44.4%, 33.3%, and 22.2% in ST at 1, 2, 4, 8, 13, and 26 weeks postquit, respectively. Additionally, we found no significant moderators of treatment efficacy and few differences in treatment process variables. These findings stand somewhat in contrast to those in our previous study and other recent studies of similar acceptance-based treatments. However, differences in methodology, inclusion of nicotine replacement therapy in both treatment conditions, and strict inclusion-exclusion criteria that excluded many smokers with affective vulnerabilities may underlie this discrepancy. Future research should evaluate the utility of DT and other acceptance-based treatments in populations with affective vulnerabilities who might specifically benefit from a DT-based approach. (PsycINFO Database Record
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http://dx.doi.org/10.1037/adb0000372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020151PMC
June 2018

Factors related to cigarette smoking and intent to quit among adolescent inpatients with psychiatric and substance use disorders.

Drug Alcohol Depend 2018 05 26;186:215-218. Epub 2018 Mar 26.

School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, USA.

Purpose: Smoking behaviors and intent to quit have not been well studied among adolescent psychiatric patients. The current study examined the relationships between smoking-related variables (smoking status/heaviness and intent to quit), psychiatric diagnoses and symptomatology, and substance use among adolescents receiving psychiatric inpatient care.

Methods: Baseline data from a randomized controlled trial, testing the effect of a brief intervention on substance use, with 151 psychiatrically hospitalized adolescents with comorbid psychiatric and substance use disorders (diagnosed using semi-structured interviews) were examined for this study.

Results: Of 151 inpatients aged 13-17 years, 112 (74.2%) were smokers (self-report), of whom 59 (52.7%) expressed intent to quit within 3 months and 36 (32.1%) within 30 days. There were no differences in psychiatric diagnoses or alcohol, marijuana, or any drug use among smokers and nonsmokers. On the other hand, smokers reported significantly greater occurrences of negative consequences from alcohol use, drug use, and total substance use than nonsmokers. Separate analyses also revealed that heavier smokers reported greater negative consequences from alcohol/drug/total use. Similarly, while no difference in externalizing or internalizing symptoms was observed across smokers vs. nonsmokers, heavier smokers reported significantly more severe externalizing symptoms, but not internalizing symptoms, than lighter smokers. Intention to quit smoking did not vary as a function of psychiatric symptomatology or substance use.

Conclusions: Smoking was related to several psychiatric and substance use problems. Notably, adolescent psychiatric inpatient smokers reported intention to quit smoking regardless of psychiatric disorders, psychiatric symptom severity, or other substance use.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.01.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001311PMC
May 2018

A Confirmatory Factor Analysis of the Smoking and Weight Eating Episodes Test (SWEET).

Int J Behav Med 2018 Aug;25(4):465-472

The Warren Alpert Medical School of Brown University, Providence, RI, 02906, USA.

Introduction: The Smoking and Weight Eating Episodes Test (SWEET; Adams et al. 2011) is a self-report measure designed to assess multiple reasons why and when smokers use cigarettes for appetite, weight, and shape management, that was initially developed and validated in young female smokers.

Purpose: The aim of the current study was to evaluate the factor structure and psychometric properties of the SWEET measure among both male and female daily cigarette smokers.

Method: Participants (n = 577; M = 44.42; SD = 13.80; 52.7% female) were daily smokers recruited through Qualtrics Online Sample for an anonymous study on smoking and health. On average, participants reported smoking for 25.7 years (SD = 14.35), smoked 17.0 cigarettes per day (SD = 8.38), and had moderate levels of tobacco dependence.

Results: Confirmatory factor analyses supported the initial factor structure found in the original SWEET measure suggesting a four-factor structure fit the data well, but not a one-factor structure. Factors included using cigarettes for appetite suppression, using cigarettes to prevent overeating, smoking to cope with body dissatisfaction, and using cigarettes to cope with appetite-related withdrawal symptoms. Tests of measurement invariance revealed no significant differences when evaluating SWEET scores by participant sex. The SWEET factor scores evidenced internal consistency, known groups validity, convergent validity with related constructs (compensatory eating behaviors, tobacco dependence) and cessation-relevant variables (smoking abstinence expectancies, prior withdrawal symptoms), and discriminant validity with physical activity and sedentary behavior.

Conclusions: The present study provides evidence in support of the validity and reliability of scores on the SWEET as a multidimensional measure of smoking for appetite, weight, and body-related concerns in male and female daily cigarette smokers.
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http://dx.doi.org/10.1007/s12529-018-9717-0DOI Listing
August 2018

Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND.

Contemp Clin Trials 2018 03 27;66:36-44. Epub 2017 Dec 27.

University of Texas at Austin, United States.

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≤6ppm. 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 3.4times/day (≥3min), 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.
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http://dx.doi.org/10.1016/j.cct.2017.12.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841579PMC
March 2018

Quality of life after quitting smoking and initiating aerobic exercise.

Psychol Health Med 2017 10 19;22(9):1127-1135. Epub 2017 Jan 19.

a Butler Hospital , Providence , RI , USA.

Quitting smoking and aerobic exercise each improve health. Although smokers may be concerned that quitting smoking will reduce their quality of life (QOL), recent research has shown that cessation is associated with QOL benefits. Elements of smoking cessation interventions, such as exercise, may contribute to changes in QOL. However, it is unknown whether initiating exercise in the context of smoking cessation is associated with greater or different effects on QOL than smoking cessation alone. The current study is a secondary analysis of data from a randomized trial (n = 61) of an exercise intervention for smoking cessation. We hypothesized that smoking abstinence and engagement in exercise would have positive, additive effects on QOL at end-of-treatment, 6- and, 12-month follow-ups. Sedentary adult smokers were randomized to the exercise intervention or a health education control (HEC) group. Additionally, all participants received smoking cessation counseling and nicotine patches. Data were analyzed using actual engagement in exercise, rather than group assignment as a proxy for exercise engagement, because some HEC participants also began exercising. Abstinence was positively associated with higher total and physical health QOL at follow-up. Exercise was not associated with total QOL and only marginally associated with physical health QOL, but was positively related to overall sense of well-being. Emphasizing that smoking cessation is associated with higher QOL may help motivate smokers to initiate quit attempts.
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http://dx.doi.org/10.1080/13548506.2017.1282159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624525PMC
October 2017

Distress Tolerance Treatment for Weight Concern in Smoking Cessation Among Women: The WE QUIT Pilot Study.

Behav Modif 2017 07 27;41(4):468-498. Epub 2016 Dec 27.

1 Alpert Medical School of Brown University, Providence, RI, USA.

Fear of gaining weight after quitting cigarette smoking is a major barrier to smoking cessation among women. Distress tolerance, which refers to one's ability and willingness to tolerate physical and emotional discomfort, predicts successful behavior change. Novel interventions rooted in Acceptance and Commitment Therapy (ACT) have emerged that aim to increase distress tolerance and engagement in values-oriented behavior. In this study, we developed a 9-week, group-based distress tolerance intervention for weight concern in smoking cessation among women (DT-W). Using an iterative process, we piloted DT-W with two small groups ( n = 4 and n = 7) of female weight-concerned smokers. Results indicated that we successfully established the feasibility and acceptability of DT-W, which was well-attended and well-received. Biochemically verified 7-day point-prevalence abstinence rates at post-intervention, 1, 3, and 6 months were 64%, 36%, 27%, and 27%, respectively. We are now evaluating DT-W in a randomized controlled trial.
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http://dx.doi.org/10.1177/0145445516683500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453845PMC
July 2017

Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity.

J Subst Abuse Treat 2015 Dec 3;59:20-9. Epub 2015 Jul 3.

Alpert Medical School of Brown University, Providence, RI; Bradley Hospital, East Providence, RI.

Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.
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http://dx.doi.org/10.1016/j.jsat.2015.06.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831620PMC
December 2015

The moderating role of experiential avoidance in the relationships between internal distress and smoking behavior during a quit attempt.

Psychol Addict Behav 2015 Jun 27;29(2):400-7. Epub 2014 Oct 27.

Department of Psychiatry and Human Behavior, Alpert Medical School.

Recent smoking cessation studies have shown that decreasing experiential avoidance (EA; i.e., tendency to reduce or avoid internal distress) improves success, but to date none have examined the moderating effect of EA on the role of specific internal distress in smoking cessation. This study examined whether prequit general EA (Acceptance and Action Questionnaire) and smoking-specific EA (Avoidance and Inflexibility Scale) moderated the relations between 4 measures of postquit internal distress (depressive symptoms, negative affect, physical withdrawal symptoms, craving) and smoking. Forty adult smokers participated in a randomized controlled trial of distress tolerance treatment for smokers with a history of early lapse. Multilevel models showed that prequit smoking-specific EA, but not general EA, significantly moderated the relationship between all measures of internal distress, except craving, and smoking over 13 weeks postquit. When examined over 26 weeks, these relations remained unchanged for all, but the moderating effect became trend-level for depressive symptoms. Significant associations between postquit internal distress and smoking were found only in those with high prequit smoking-specific EA. Moreover, prequit smoking-specific EA did not predict postquit levels or changes in internal distress, suggesting that decreasing smoking-specific EA prequit may not reduce internal distress, but may instead reduce smoking risk in response to such distress during a quit attempt. Results mainly supported hypothesized relations, but only for smoking-specific EA. Smoking cessation interventions focusing on EA reduction may especially benefit those vulnerable to greater postquit depressive and withdrawal symptoms, and those who smoke to regulate aversive internal states. (PsycINFO Database Record
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http://dx.doi.org/10.1037/adb0000030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557624PMC
June 2015

Capsule commentary on Hess et al. A randomized controlled pilot trial of the functional assessment screening tablet to engage patients at the point of care.

J Gen Intern Med 2014 Dec;29(12):1690

Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,

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http://dx.doi.org/10.1007/s11606-014-3043-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242877PMC
December 2014

Post-operative smoking status in lung and head and neck cancer patients: association with depressive symptomatology, pain, and fatigue.

Psychooncology 2015 Sep 25;24(9):1012-9. Epub 2014 Sep 25.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.

Objective: An estimated 35-50% of lung and head and neck cancer patients are smoking at diagnosis; most try to quit; however, a substantial proportion resumes smoking. As cancer treatments improve, attention to the effects of continued smoking on quality of life in the survivorship period is increasing. The current study examines if smoking abstinence following surgical treatment is associated with better quality of life.

Methods: Participants were 134 patients with head and neck or lung cancer who received surgical treatment. Smoking status and indices of quality of life (depressive symptoms, fatigue, and pain) were assessed at the time of surgery (baseline) and at 2, 4, 6, and 12 months post-surgery. Analyses were performed using a generalized estimating equations approach. A series of models examined the correlation between smoking status and post-surgery quality of life while adjusting for demographics, clinical variables, and baseline smoking status and quality of life.

Results: Continuous post-surgery abstinence was associated with lower levels of depressive symptoms and fatigue; however, the relationship with fatigue became nonsignificant after adjusting for baseline fatigue and income. There was no significant relationship observed between smoking status and pain.

Conclusions: Findings add to a growing literature showing that smoking cessation is not associated with detrimental effects on quality of life and may have beneficial effects, particularly with regard to depressive symptoms. Such information can be used to motivate smoking cessation and continued abstinence among cancer patients and increase provider comfort in recommending cessation.
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http://dx.doi.org/10.1002/pon.3682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374041PMC
September 2015

Effects of sequential fluoxetine and gender on prequit depressive symptoms, affect, craving, and quit day abstinence in smokers with elevated depressive symptoms: a growth curve modeling approach.

Exp Clin Psychopharmacol 2014 Oct 4;22(5):392-406. Epub 2014 Aug 4.

Department of Psychiatry and Human Behavior, Butler Hospital/Alpert Medical School of Brown University.

Although the important roles of postquit affect and withdrawal symptoms in the process of smoking cessation have been well established, little is known about the relations between prequit affective trajectories and cessation outcome on the target quit date (TQD). This study examined whether a 16-week course of fluoxetine initiated 8 weeks prequit ("sequential" fluoxetine) improved TQD abstinence relative to placebo through its effects on prequit depressive symptoms, affect (withdrawal-relevant negative affect, general negative affect, and positive affect), and craving to smoke among 206 smokers with elevated depressed symptoms. The moderating effects of gender were also examined. In total, 83 smokers (40%) failed to achieve abstinence on TQD, with no difference between treatment conditions or gender. Overall structural equation models showed that fluoxetine had significant indirect effects on TQD abstinence through changes in prequit withdrawal-relevant negative affect and craving, but not depressive symptoms. However, multigroup analyses revealed gender differences. Sequential fluoxetine reduced prequit depressive symptoms, withdrawal-relevant negative affect, and craving only among women. Reduction in prequit depressive symptoms and craving among women, and withdrawal-relevant negative affect among men was associated with TQD abstinence. Moreover, exploratory analysis showed negative trend-level indirect effects of fluoxetine on TQD abstinence via increased side effects, regardless of gender. This study demonstrated the importance of considering gender when examining treatment efficacy. Identifying ways to further reduce prequit depressive symptoms and craving for women and withdrawal-relevant negative affect for men whereas alleviating side effects may help smokers with elevated depressed symptoms achieve the first smoking cessation milestone.
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http://dx.doi.org/10.1037/a0037156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428342PMC
October 2014

A pilot study of a distress tolerance treatment for opiate-dependent patients initiating buprenorphine: rationale, methodology, and outcomes.

Behav Modif 2014 Sep 27;38(5):730-59. Epub 2014 Jun 27.

Alpert Medical School of Brown University/Butler Hospital, Providence, RI, USA.

Buprenorphine, an opioid that is a long-acting partial opiate agonist, is an efficacious treatment for opiate dependence that is growing in popularity. Nevertheless, evidence suggests that many patients will lapse within the first week of treatment and that lapses are often associated with withdrawal-related or emotional distress. Recent research suggests that individuals' reactions to this distress may represent an important treatment target. In the current study, we describe the development and outcomes from a preliminary pilot evaluation (N = 5) of a novel distress tolerance (DT) treatment for individuals initiating buprenorphine. This treatment incorporates exposure-based and acceptance-based treatment approaches that we have previously applied to the treatment of tobacco dependence. Results from this pilot study establish the feasibility and acceptability of this approach. We are now conducting a randomized controlled trial of this treatment that we hope will yield clinically significant findings and offer clinicians an efficacious behavioral treatment to complement the effects of buprenorphine.
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http://dx.doi.org/10.1177/0145445514538279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876823PMC
September 2014

A preliminary randomized controlled trial of a behavioral exercise intervention for smoking cessation.

Nicotine Tob Res 2014 Aug 8;16(8):1094-103. Epub 2014 May 8.

Butler Hospital, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI;

Introduction: Previous exercise intervention studies for smoking cessation have been challenged by a number of methodological limitations that confound the potential efficacy of aerobic exercise for smoking cessation.

Methods: The preliminary efficacy of a behavioral exercise intervention that incorporated features designed to address prior limitations was tested in a randomized controlled trial (RCT). Sixty-one smokers (65.6% female, mean age = 47.3 years, smoked a mean of 19.7 cigarettes/day) were randomized to receive either a 12-week exercise intervention or a 12-week health education contact control. Participants in both conditions received an 8-week telephone-delivered, standard smoking cessation protocol (with the transdermal nicotine patch). Follow-ups were conducted at the end of treatment (EOT), 6- and 12-month timepoints.

Results: There were no differences between conditions with respect to the number of weekly exercise or health education sessions attended (9.3±2.8 vs. 9.3±3.0, respectively). While not statistically significant, participants in the exercise condition demonstrated higher verified abstinence rates (EOT: 40% vs. 22.6%, odds ratio [OR] = 2.28; 6- and 12-month follow-ups: 26.7% vs. 12.9%, OR = 2.46). Irrespective of treatment condition, higher levels of moderate-to-vigorous exercise were associated with lower levels of depressive symptoms during the intervention.

Conclusions: The results of this small RCT point toward the benefit of a behavioral exercise intervention designed to address previous methodological limitations for smoking cessation. Given the potential public health impact of the demonstrated efficacy of exercise for smoking cessation, the continued development and optimization of exercise interventions for smokers through larger RCTs merits pursuit.
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http://dx.doi.org/10.1093/ntr/ntu036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155424PMC
August 2014

Cue reactivity in smokers: an event-related potential study.

Int J Psychophysiol 2013 Nov 16;90(2):258-64. Epub 2013 Aug 16.

Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; University of South Florida, Department of Psychology, United States; Moffitt Cancer Center, Tobacco Research and Intervention Program, United States.

Drugs-of-abuse may increase the salience of drug cues by sensitizing the dopaminergic (DA) system (Robinson and Berridge, 1993), leading to differential attention to smoking stimuli. Event-related potentials (ERPs) have been used to assess attention to smoking cues but not using an ERP component associated with DA-mediated salience evaluation. In this study the DA-related P2a and the P3, were compared in smokers (N = 21) and non-smokers (N = 21) during an attention selection cue exposure task including both cigarette and neutral images. We predicted that both the P2a and P3 would be larger to targets than non-targets, but larger to non-target cigarette images than non-target neutral images only in the smokers, reflecting smokers' evaluation of smoking stimuli as relevant even when they were not targets. Results indicated that smokers showed behavioral cue reactivity, with more false alarms to cigarette images (responding to cigarette images when they were not targets) than non-smokers; however, both smokers and non-smokers had a larger P2a and P3 to cigarette images. Thus, while smokers showed behavioral evidence of differential salience evaluation of the cigarette images, this group difference was not reflected in differential brain activity. These findings may reflect characteristics of the ERPs (both ERP components were smaller in the smokers), the smoking sample (they were not more impulsive, i.e. reward sensitive, than the non-smokers, in contrast to prior studies) and the design (all participants were aware that the aim of the study was related to smoking).
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http://dx.doi.org/10.1016/j.ijpsycho.2013.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282775PMC
November 2013

Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse.

Nicotine Tob Res 2013 Dec 24;15(12):2005-15. Epub 2013 Jul 24.

Department of Psychiatry and Human Behavior, Butler Hospital/Alpert Medical School of Brown University, Providence, RI;

Introduction: An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt. We conducted a preliminary randomized controlled trial to compare a distress tolerance (DT) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to standard smoking cessation treatment (ST).

Methods: Smokers with a history of early lapse in prior quit attempts received either DT (N = 27; 9 2-hr group and 6 50-min individual sessions) or ST (N = 22; 6 90-min group and 1 20-min individual session), plus 8 weeks of transdermal nicotine patch.

Results: At the end of behavioral treatment, odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST (66.7% vs. 31.8%), equivalent to a medium- to large-effect size. Odds of abstinence for DT were still 1.73 times greater at 8 weeks, corresponding to a small- to medium-effect size, although neither this difference nor those at 13 and 26 weeks were statistically significant. Furthermore, of those who lapsed to smoking during the first week postquit, DT participants had more than 4 times greater odds of abstinence than ST participants at the end of treatment. Relative to ST, DT participants also reported a larger decrease in experiential avoidance, a hypothesized DT treatment mediator, prior to quit day. The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses.

Conclusions: Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed.
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http://dx.doi.org/10.1093/ntr/ntt093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819975PMC
December 2013

Gender Differences in the Relationship Between Physical Activity and Smoking Among Psychiatrically Hospitalized Adolescents.

Ment Health Phys Act 2012 Dec 2;5(2):136-140. Epub 2012 Nov 2.

Alpert Medical School of Brown University ; Butler Hospital.

Physical activity has been identified as a protective factor with regard to tobacco use, such that physically active adolescents are less likely to initiate smoking, and smokers are less physically active than non-smokers. These findings, along with the well-documented benefits of exercise on mood and well-being in adults, have stimulated interest in exercise-based smoking cessation interventions. However, little research has explored the relationship between physical activity and smoking characteristics within adolescent smokers. Also, gender differences in adolescents' motives for smoking and exercise may have implications for intervention development, especially in clinical populations. The current study explored the relationship between physical activity and smoking in a sample of adolescent smokers (N = 191) and non-smokers (N = 48) receiving inpatient psychiatric treatment (61% female, mean age 15.3 years). Results indicated that smokers were less likely to be physically active than non-smokers. Additionally, there was a consistent pattern of gender differences in the relationship between smoking and physical activity within smokers. Specifically, physically active male smokers were less nicotine dependent and less prone to withdrawal, and had a trend toward greater motivation to quit, than their non-active counterparts. In contrast, physically active female smokers did not differ in dependence or withdrawal and were less motivated to quit than non-active female smokers. Taken together, these results suggest that within clinical populations of adolescent females, smoking and exercise may be used jointly as weight control strategies. Exercise-based interventions for smoking cessation for adolescent females, especially clinical populations, should address weight and body image concerns.
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http://dx.doi.org/10.1016/j.mhpa.2012.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582671PMC
December 2012
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