Publications by authors named "Haruka Minami"

42 Publications

First-year trajectories of medical cannabis use among adults taking opioids for chronic pain: an observational cohort study.

Pain Med 2021 Aug 19. Epub 2021 Aug 19.

Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, NY.

Objective: To describe first-year trajectories of medical cannabis use and identify characteristics associated with patterns of use in a cohort of adults using opioids for chronic pain.

Design: Latent class trajectory analysis of prospective cohort study using data on 14-day frequency of medical cannabis use.

Setting: Large academic medical center and four medical cannabis dispensaries in the New York City metropolitan area.

Subjects: Adults with chronic pain using opioids and newly certified for medical cannabis in New York between 2018-2020.

Methods: Using latent class trajectory analysis, we identified clusters of participants based on 14-day frequency of medical cannabis use. We used logistic regression to determine factors associated with cluster membership including sociodemographic characteristics, pain, substance use, and mental health symptoms.

Results: Among 99 participants, mean age was 53 years; 62% were women and 52% were White. We identified three clusters of medical cannabis use: infrequent use (n = 30, mean use = 1.5 days/14-day period), occasional use (n = 28, mean = 5.7 days/14-day period), and frequent use (n = 41, mean = 12.1 days/14-day period). Within clusters, use patterns did not vary significantly over 52 weeks. Differences were observed in two sociodemographic variables: frequent (vs. infrequent) use was associated with non-Hispanic White race/ethnicity (aOR 4.54, 95% CI 1.49-14.29), while occasional (vs. infrequent) use was associated with employment (aOR 13.84, 95% CI 1.21-158.74).

Conclusions: Three clusters of medical cannabis use patterns emerged and were stable over time. Results suggest that structural factors related to race/ethnicity and employment may be a major driver of medical cannabis utilization, even among adults certified for use.
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http://dx.doi.org/10.1093/pm/pnab257DOI Listing
August 2021

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

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

CAPS2 Deficiency Impairs the Release of the Social Peptide Oxytocin, as Well as Oxytocin-Associated Social Behavior.

J Neurosci 2021 May 12;41(20):4524-4535. Epub 2021 Apr 12.

Department of Applied Biological Science, Faculty of Science and Technology, Tokyo University of Science, Chiba 278-8510, Japan

Ca-dependent activator protein for secretion 2 (CAPS2) regulates dense-core vesicle (DCV) exocytosis to facilitate peptidergic and catecholaminergic transmitter release. CAPS2 deficiency in mice has mild neuronal effects but markedly impairs social behavior. Rare alterations also occur in autism spectrum disorder, although whether CAPS2-mediated release influences social behavior remains unclear. Here, we demonstrate that CAPS2 is associated with DCV exocytosis-mediated release of the social interaction modulatory peptide oxytocin (OXT). CAPS2 is expressed in hypothalamic OXT neurons and localizes to OXT nerve projection and OXT release sites, such as the pituitary. KO mice exhibited reduced plasma albeit increased hypothalamic and pituitary OXT levels, indicating insufficient release. OXT neuron-specific conditional KO supported CAPS2 function in pituitary OXT release, also affording impaired social interaction and recognition behavior that could be ameliorated by exogenous OXT administered intranasally. Thus, CAPS2 appears critical for OXT release, thereby being associated with social behavior. The role of the neuropeptide oxytocin in enhancing social interaction and social bonding behavior has attracted considerable public and neuroscientific attention. A central issue in oxytocin biology concerns how oxytocin release is regulated. Our study provides an important insight into the understanding of oxytocin-dependent social behavior from the perspective of the CAPS2-regulated release mechanism.
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http://dx.doi.org/10.1523/JNEUROSCI.3240-20.2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152601PMC
May 2021

Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain.

BMJ Open 2020 12 29;10(12):e043400. Epub 2020 Dec 29.

Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA.

Introduction: In the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study's overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events.

Methods And Analyses: We are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants' 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation).

Ethics And Dissemination: This study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders.

Trial Registration Number: ClinicalTrials.gov Registry (NCT03268551); Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-043400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778768PMC
December 2020

A Systematic Review of Treatments for Problematic Khat Use.

Subst Use Misuse 2020 25;55(4):590-601. Epub 2019 Nov 25.

Department of Psychology, Fordham University, Bronx, New York, USA.

Khat, a psychostimulant cultivated and commonly used in Eastern Africa and the Arabian penin-sula, has a longstanding history of use embedded within the cultures of these regions. Due to changing patterns of use and the adverse effects of dependence, khat has become a growing pub- lic health concern. Despite extensive findings regarding the detrimental psychiatric, physical, and social consequences of khat dependence, research on interventions in this area is glaringly sparse. The present paper aims to summarize the consequences of chronic khat use and review existing research on interventions.
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http://dx.doi.org/10.1080/10826084.2019.1691595DOI Listing
June 2021

Adaptation of a sustained care cessation intervention for smokers hospitalized for psychiatric disorders: Study protocol for a randomized controlled trial.

Contemp Clin Trials 2019 08 15;83:18-26. Epub 2019 Jun 15.

School of Nursing, The University of Texas at Austin, Austin, TX, United States of America. Electronic address:

Background: Individuals with serious mental illness (SMI) smoke at disproportionately higher rates than those without SMI, have lifespans 25-32 years shorter, and thus bear an especially large burden of tobacco-related morbidity and mortality. Several recent studies demonstrate that smokers with SMI can successfully quit smoking with adequate support. Further evidence shows that using technology to deliver sustained care interventions to hospitalized smokers can lead to smoking cessation up to 6 months after discharge. The current comparative effectiveness trial adapts a technology-assisted sustained care intervention designed for smokers admitted to a general hospital and tests whether this approach can produce higher cessation rates compared to usual care for smokers admitted to a psychiatric inpatient unit.

Methods: A total of 353 eligible patients hospitalized for psychiatric illness are randomized by cohort into one of two conditions, Sustained Care (SusC) or Usual Care (UC), and are followed for six months after discharge. Participants assigned to UC receive brief tobacco education delivered by a hospital nurse during or soon after admission. Those assigned to SusC receive a 40-min, in-hospital motivational counseling intervention. Upon discharge, they also receive up to 8 weeks of free nicotine patches, automated interactive voice response (IVR) telephone and text messaging, and access to cessation counseling resources lasting 3 months post discharge. Smoking cessation outcomes are measured at 1-, 3- and 6-months post hospital discharge.

Conclusion: Results from this comparative effectiveness trial will add to our understanding of acceptable and effective smoking cessation approaches for patients hospitalized with SMI.
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http://dx.doi.org/10.1016/j.cct.2019.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197194PMC
August 2019

The impact of e-cigarette price changes on vaping and smoking behaviors.

Subst Use Misuse 2019 22;54(10):1599-1610. Epub 2019 May 22.

b Department of Political Science , Seton Hall University , South Orange , New Jersey , USA.

Understanding the relations between e-cigarette prices and e-cigarette/cigarette use may shed light on the possible impact of e-cigarette regulations on public health. This study aimed to assess potential impacts of e-cigarette price changes on vaping and smoking behaviors by smoking status (current, former, and never smokers) and e-cigarette type (pre-filled only vs. refillable). : A total of 918 US-based adult e-cigarette users completed an online survey, designed to assess behavioral intention of e-cigarette/cigarette use in hypothetical situations with varying prices of e-cigarettes, in 2017. : With reduction in e-cigarette prices, more than 50% of current smokers reported they would reduce or quit smoking, but with greater increases in price, the rates of not only those who would quit (12.5-19.4%), but also those who would increase smoking rose (15.1-25.1%). Current smokers (vs. former/never) were more likely to increase e-cigarette use at reduced e-cigarette prices. Among current smokers, pre-filled users were less likely to quit smoking with reduced prices. At higher prices, pre-filled users were more likely to quit e-cigarettes (former smokers), but also more likely to start smoking (never smokers). Among former smokers, recent quitters were more likely to restart smoking with any e-cigarette price changes, and less likely to reduce or quit e-cigarettes with increased prices. : Both smoking and e-cigarette use seem to be sensitive to e-cigarette price changes. Increases in e-cigarette price may have both positive and negative effects on smoking behavior, and e-cigarette price changes may disproportionately affect pre-filled users and recent quitters.
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http://dx.doi.org/10.1080/10826084.2019.1592195DOI Listing
April 2020

Testing the Feasibility of a Mindfulness-Based Intervention With Underserved Adolescents at Risk for Depression.

Holist Nurs Pract 2018 Nov/Dec;32(6):316-323

The University of Texas at Austin, School of Nursing (Drs Young and Brown and Mr Aguilar); and Department of Psychology, Fordham University, Bronx, New York (Dr Minami).

This study tested the feasibility, acceptability, and preliminary effects of a mindfulness-based intervention with at-risk adolescents from a predominantly Hispanic/Latino community. Seven adolescents (57% female, 85% Hispanic/Latino) completed the mindfulness-based intervention, demonstrating feasibility, and reported acceptability as well as sustained improvements in depressive symptoms, perceived stress, and self-esteem.
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http://dx.doi.org/10.1097/HNP.0000000000000295DOI Listing
December 2018

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

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

Momentary assessment of impulsive choice and impulsive action: Reliability, stability, and correlates.

Addict Behav 2018 08 22;83:130-135. Epub 2017 Nov 22.

Carnegie Mellon University, Department of Social & Decision Sciences, Pittsburgh, PA, United States.

Impulsivity is associated with substance use, including tobacco use. The degree to which impulsivity fluctuates over time within persons, and the degree to which such intra-individual changes can be measured reliably and validly in ambulatory assessments is not known, however. The current study evaluated two novel ambulatory measures of impulsive choice and impulsive action. Impulsive choice was measured with an eight-item delay discounting task designed to estimate the subjective value of delayed monetary rewards. Impulsive action was measured with a two-minute performance test to assess behavioral disinhibition (the inability to inhibit a motor response when signaled that such a response will not be rewarded). Valid data on impulsive choice were collected at 70% of scheduled reports and valid data on impulsive action were collected on 55% of scheduled reports, on average. Impulsive choice and action data were not normally distributed, but models of relations of these measures with within- and between-person covariates were robust across distributional assumptions. Intra-class correlations were substantial for both impulsive choice and action measures. Between persons, random intercepts in impulsive choice and action were significantly related to laboratory levels of their respective facets of impulsivity, but not self-reported or other facets of impulsivity. Validity of the ambulatory measures is supported by associations between abstinence from smoking and increased impulsivity, but challenged by an association between strong temptations to smoke and reduced impulsive choice. Results suggest that meaningful variance in impulsive choice and action can be captured using ambulatory methods, but that additional measure refinement is needed.
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http://dx.doi.org/10.1016/j.addbeh.2017.11.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963975PMC
August 2018

Development and preliminary pilot evaluation of a brief tablet computer intervention to motivate tobacco quitline use among smokers in substance use treatment.

Am J Addict 2017 Sep 11;26(6):587-594. Epub 2017 Aug 11.

Merrill-Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan.

Background And Objectives: The majority of individuals in substance use disorder (SUD) treatment also smoke cigarettes; yet, the availability of smoking cessation services in SUD treatment remains limited. In this study, we developed and piloted a brief intervention for smokers in SUD treatment intended to motivate engagement in tobacco quitline treatment (TIME-TQ).

Methods: First, we interviewed 19 smokers in SUD treatment to inform the development of TIME-TQ (Phase 1). Second, we delivered a prototype TIME-TQ to 16 smokers in the same SUD treatment program and followed them for 3 months post-discharge (Phase 2).

Results: Feedback from Phase 1 participants was used to refine response choices and video segments included in the prototype TIME-TQ. Phase 2 participants rated TIME-TQ high on relevance, interest, respectfulness, and helpfulness. Additionally, they reported significant increases in readiness to quit and perceived importance of quitting after receiving TIME-TQ. A total of 8 of the 16 accepted a quitline referral, and 8 of 13 reached for follow-up (four referral acceptors, four decliners) reported efforts to quit or reduce smoking during the follow-up period. However, only three received quitline counseling and none achieved a sustained period of abstinence.

Conclusions And Scientific Significance: Our results suggest that TIME-TQ activated these patients to quit smoking, but our referral method (standard fax referral) was unsuccessful in helping participants fully engage in quitline treatment or achieving a period of abstinence.

Scientific Significance: We are now conducting an RCT to evaluate TIME-TQ with a revised referral procedure intended to increase treatment engagement and, ultimately, abstinence rates. (Am J Addict 2017;26:587-594).
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http://dx.doi.org/10.1111/ajad.12559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892843PMC
September 2017

Ecological momentary analysis of the relations among stressful events, affective reactivity, and smoking among smokers with high versus low depressive symptoms during a quit attempt.

Addiction 2018 02 12;113(2):299-312. Epub 2017 Oct 12.

Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.

Aims: To assess whether individuals trying to quit smoking who have high depressive symptoms (HD), compared with low depressive symptoms (LD): (1) report more frequent stressful events (SEs), (2) are more likely to smoke after SEs, (3) experience greater acute or persistent changes in affect after an SE, and (4) are at greater risk of smoking following affective changes.

Design: Smoking cessation data were analyzed using multi-level path modeling to examine the moderating effects of depressive symptoms on relations among SEs, subsequent affect, and smoking.

Setting: An academic research center in Central New Jersey, USA.

Participants: Seventy-one adult treatment-seeking daily smokers recruited from 2010 to 2012.

Measurements: Baseline depressive symptoms [HD: Center for Epidemiological Studies Depression Scale (CES-D) ≥ 16 versus LD: CES-D < 16]; and real-time ecological momentary assessment (EMA) reports of SEs, affect, and smoking assessed during 21 days post-quit.

Findings: Multi-level models indicated that HD smokers were more likely than LD smokers to report stressful events [odds ratio (OR) = 2.323, P = 0.009], but had similar post-stress acute affective changes (negative affect: b = -0.117, P = 0.137, positive affect: b = 0.020, P = 0.805). Only HD smokers reported increased negative affect (NA) (b = 0.199, P = 0.030) and decreased positive affect (PA) up to 12 hours later (b = -0.217, P = 0.021), and greater lapse risk up to 24 hours after an SE (OR = 3.213, P = 0.017). The persistence of elevated NA and suppressed PA was partially explained by increased odds of subsequent SEs among HD smokers. However, the heightened stress-lapse association over 24 hours found in HD smokers was not fully explained by sustained aversive affect or subsequent SEs.

Conclusions: Depressed and non-depressed smokers trying to quit appear to experience similar acute affective changes following stress: however, depressed smokers experience higher rates of exposure to stress, longer-lasting post-stress affective disturbance and greater risk of smoking lapse 12-24 hours after a stressful event than non-depressed smokers.
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http://dx.doi.org/10.1111/add.13964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760357PMC
February 2018

Drinking and exercise behaviors among college students: between and within-person associations.

J Behav Med 2017 Dec 7;40(6):964-977. Epub 2017 Jun 7.

University of Buffalo, The State University of New York, Buffalo, NY, USA.

Prior work has suggested a paradoxical positive relationship between the risk behavior alcohol use and the health behavior exercise, particularly in young adults. Though seldom tested, different theoretical perspectives exist on the mechanisms that may explain the positive relationship. The aims of this study were to test theorized mechanisms of association, including common causes shared by both behaviors (e.g., personality, motives, affective), compensatory processes such as exercising to compensate for calories from alcohol consumption, and methodological confounds (e.g., between vs. within subject effects) in a college sample (N = 132; 56.3% male; 76% Caucasian; M  = 19.15, SD = 0.99) using a cross-sectional design and time line follow back methods. A positive, between-subjects association between alcohol and exercise was found and explained by exercising to compensate for calories of alcohol consumption, enhancement motives, and physical activity enjoyment. However, we also observed a significant and negative within-subjects association between the two constructs, suggesting that, on a given day, individuals who exercise more tended to drink less. Furthermore, individuals who exercised more during the week tended to have declines in weekend drinking over time. Results suggest a complex relationship between exercise and alcohol use among young adults, and highlight the importance of distinguishing between and within subject processes, as well as the temporal ordering of the two behaviors. Implications are discussed in regard to theory, prevention, and intervention.
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http://dx.doi.org/10.1007/s10865-017-9863-xDOI Listing
December 2017

Acute Effects of Aerobic Exercise on Affect and Smoking Craving in the Weeks Before and After a Cessation Attempt.

Nicotine Tob Res 2018 04;20(5):575-582

University of Texas at Austin, Austin, TX.

Introduction: Aerobic exercise may improve smoking abstinence via reductions in craving and negative affect and increases in positive moods. Acute changes in craving and affect before and after structured exercise sessions have not been examined during the weeks prior to and following quit attempts nor has smoking status been examined in relation to these effects. Given that regular cigarette smoking can be perceived as affect enhancing and craving reducing, it is not known whether exercise could contribute additional affective benefit beyond these effects.

Method: Participants (N = 57; 68.4% women) were low-active daily smokers randomized to cessation treatments plus either group-based aerobic exercise (AE) or a health-education control (HEC). Mood, anxiety, and craving were assessed before and after each intervention session for each of the 12 weeks. Carbon monoxide (CO) breath samples ≤ 5ppm indicated smoking abstinence.

Results: During the prequit sessions, significantly greater decreases in anxiety following AE sessions relative to HEC sessions were observed. Changes in mood and craving were similar after AE and HEC sessions prior to quitting. Postquit attempt, significant reductions in craving and anxiety were observed after AE sessions but not following HEC. During the postquit period, positive mood increased following AE sessions relative to HEC only among individuals who were abstinence on that day.

Conclusions: AE may be effective in acutely reducing anxiety prior to a quit attempt and both anxiety and craving following the quit attempt regardless of abstinence status. The mood-enhancing effects of AE may occur only in the context of smoking abstinence.

Implications: The current findings underscore the importance of examining the acute effects of aerobic exercise prior to and after a cessation attempt and as a function of smoking status. Given the equivocal results from previous studies on the efficacy of exercise for smoking cessation, increasing our understanding of how aerobic exercise produces its reinforcing benefits for smokers attempting to quit could potentially inform the refinement (e.g., timing/sequencing) of exercise interventions within smoking cessation programs.
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http://dx.doi.org/10.1093/ntr/ntx104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892859PMC
April 2018

The brain-specific RasGEF very-KIND is required for normal dendritic growth in cerebellar granule cells and proper motor coordination.

PLoS One 2017 6;12(3):e0173175. Epub 2017 Mar 6.

Laboratory for Molecular Neurogenesis, RIKEN Brain Science Institute, Wako, Saitama, Japan.

Very-KIND/Kndc1/KIAA1768 (v-KIND) is a brain-specific Ras guanine nucleotide exchange factor carrying two sets of the kinase non-catalytic C-lobe domain (KIND), and is predominantly expressed in cerebellar granule cells. Here, we report the impact of v-KIND deficiency on dendritic and synaptic growth in cerebellar granule cells in v-KIND knockout (KO) mice. Furthermore, we evaluate motor function in these animals. The gross anatomy of the cerebellum, including the cerebellar lobules, layered cerebellar cortex and densely-packed granule cell layer, in KO mice appeared normal, and was similar to wild-type (WT) mice. However, KO mice displayed an overgrowth of cerebellar granule cell dendrites, compared with WT mice, resulting in an increased number of dendrites, dendritic branches and terminals. Immunoreactivity for vGluT2 (a marker for excitatory presynapses of mossy fiber terminals) was increased in the cerebellar glomeruli of KO mice, compared with WT mice. The postsynaptic density around the terminals of mossy fibers was also increased in KO mice. Although there were no significant differences in locomotor ability between KO and WT animals in their home cages or in the open field, young adult KO mice had an increased grip strength and a tendency to exhibit better motor performance in balance-related tests compared with WT animals. Taken together, our results suggest that v-KIND is required for compact dendritic growth and proper excitatory synaptic connections in cerebellar granule cells, which are necessary for normal motor coordination and balance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173175PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338823PMC
August 2017

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

An exploratory analysis of changes in mood, anxiety and craving from pre- to post-single sessions of exercise, over 12 weeks, among patients with alcohol dependence.

Ment Health Phys Act 2016 Oct 12;11:1-6. Epub 2016 May 12.

Butler Hospital/Alpert Medical School of Brown University.

Aerobic exercise is currently being studied as a relapse prevention strategy for individuals with alcohol use disorders. Negative affect and cravings predict relapse. The acute effects of moderate-intensity exercise have been shown to improve mood and reduce craving. The current study examined the acute effects of exercise on changes in mood, anxiety, and craving from pre- to post-exercise at each week of a 12-week moderate intensity exercise intervention with sedentary alcohol dependent adults. Twenty-six participants in the exercise condition of a larger randomized clinical trial (Brown et al., 2014) exercised in small groups at moderate intensity for 20 to 40 minutes per session. Participants rated mood, anxiety, and cravings in the present moment before and after each exercise session over the course of the 12-week intervention. Data analyses focused on effect size and interval estimation. Joinpoint analysis was used to model longitudinal trends. Increases in mood and decreases in anxiety and craving were apparent at every session. Effect size estimates revealed that average change from pre- to post-exercise was in the small to medium range with some individual sessions reaching the large range. Joinpoint analyses revealed that the pre-post exercise changes in mood increased, anxiety remained stable, and craving diminished across the 12 weeks. This study provides provisional support for a change in mood, anxiety and alcohol cravings for the role of exercise in the early recovery period for alcohol dependence. Acute single bouts of moderate-intensity exercise may help individuals with alcohol dependence manage mood, anxiety, and craving thereby reducing relapse risk, but further research is needed with a more rigorous study design.
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http://dx.doi.org/10.1016/j.mhpa.2016.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878084PMC
October 2016

A randomized clinical trial of a tailored behavioral smoking cessation preparation program.

Behav Res Ther 2016 Mar 15;78:19-29. Epub 2015 Dec 15.

Rutgers, The State University of New Jersey Department of Psychology, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA. Electronic address:

Despite considerable progress in reducing cigarette smoking prevalence and enhancing smoking cessation treatments, most smokers who attempt to quit relapse. The current randomized clinical trial evaluated the efficacy of an adjunctive behavioral smoking cessation treatment based on learning theory. Adult daily smokers were randomly assigned to standard treatment (N = 47) with nicotine patch and individual counseling or to standard treatment plus a "practice quitting" program involving seven sessions of escalating prescribed abstinence periods (N = 46) prior to a target stop smoking date. Practice quitting was designed to extinguish smoking in response to withdrawal symptoms. Retention in treatment was excellent and the treatment manipulation increased the interval between cigarettes across practice quitting sessions on average by 400%. The primary endpoint, seven-day point-prevalence abstinence four weeks post-quit, was not significantly affected by practice quitting (31.9% in the standard treatment condition, 37.0% in the practice quitting condition). Practice quitting increased latency to a first lapse among those who quit smoking for at least one day and prevented progression from a first lapse to relapse (smoking daily for a week) relative to standard treatment, however. Practice quitting is a promising adjunctive treatment in need of refinement to enhance adherence and efficacy.
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http://dx.doi.org/10.1016/j.brat.2015.11.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790439PMC
March 2016

Reliability and validity of measures of impulsive choice and impulsive action in smokers trying to quit.

Exp Clin Psychopharmacol 2016 Apr 11;24(2):120-30. Epub 2016 Jan 11.

Department of Psychology, Rutgers, The State University of New Jersey.

Cross-sectional research suggests that smokers are more impulsive than are nonsmokers, but few studies have examined relations between impulsiveness and later success in quitting smoking. The purpose of this study was to investigate the reliability and predictive validity of facets of impulsiveness in adult smokers trying to quit. Baseline behavioral measures of impulsive choice (assessed with a delay discounting task) and impulsive action (assessed with a measure of behavioral disinhibition) were used as predictors of smoking cessation success over 12 weeks. The sample included 116 adult (18 years old or older) daily smokers from central New Jersey. Impulsive choice, impulsive action, and self-reported impulsiveness were not significantly related to one another at baseline. Impulsive choice had high test-retest reliability from pre- to postquit, whereas impulsive action was less stable. Test-retest reliability from prequit to 3 weeks' postquit was moderated by achievement of 7-day abstinence. Baseline impulsive action was significantly negatively related to quitting for at least 1 day in the first 2 weeks of a quit attempt and of prolonged abstinence (no relapse over the next 10 weeks). Baseline impulsive choice was robustly associated with biochemically verified 7-day point-prevalence abstinence 12 weeks' postquit, such that those with lower delay discounting were more likely to achieve abstinence. Facets of impulsiveness appear to function largely independently in adult smokers, as indicated by their lack of intercorrelation, differential stability, and differential relations with abstinence. Impulsive action may impede initial quitting, whereas impulsive choice may be an obstacle to maintaining lasting abstinence.
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http://dx.doi.org/10.1037/pha0000061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887270PMC
April 2016

Independent and interactive effects of real-time risk factors on later temptations and lapses among smokers trying to quit.

Drug Alcohol Depend 2016 Jan 30;158:30-7. Epub 2015 Oct 30.

Uniformed Services University of the Health Sciences, Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA.

Purpose: The current study sought to expand our understanding of relapse mechanisms by identifying the independent and interactive effects of real-time risk factors on temptations and the ability to resist temptations in smokers during a quit attempt.

Procedures: This study was a secondary analysis of data from 109 adult, treatment-seeking daily smokers. Ecological momentary assessment data was collected 4 times a day for 21 days following a quit attempt and was used to assess affect, urge, impulsiveness, recent cigarette exposure, and alcohol use as predictors of temptations to smoke and smoking up to 8h later. All smokers received nicotine replacement therapy and smoking cessation counseling.

Findings: In multinomial hierarchical linear models, there were significant main (agitation odds ratio (OR)=1.22, 95% CI=1.02-1.48; urge OR=1.60, 95% CI=1.35-1.92; nicotine dependence measured by WISDM OR=1.04, 95% CI=1.01-1.08) and interactive effects (agitation×urge OR=1.12, 95% CI=1.01-1.27; urge×cigarette exposure OR=1.38, 95% CI=1.10-1.76; positive affect×impulsiveness OR=2.44, 95% CI=1.02-5.86) on the odds of temptations occurring, relative to abstinence without temptation. In contrast, prior smoking (OR=3.46, 95% CI=2.58-4.63), higher distress (OR=1.30, 95% CI=1.06-1.60), and recent alcohol use (OR=3.71, 95% CI=1.40-9.89) predicted smoking versus resisting temptation, and momentary impulsiveness was related to smoking for individuals with higher baseline impulsiveness (OR=1.12, 95% CI=1.04-1.22).

Conclusions: The risk factors and combinations of factors associated with temptations and smoking lapses differ, suggesting a need for separate models of temptation and lapse.
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http://dx.doi.org/10.1016/j.drugalcdep.2015.10.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698113PMC
January 2016

Regulation of the chitin degradation and utilization system by the ChiX small RNA in Serratia marcescens 2170.

Biosci Biotechnol Biochem 2016 12;80(2):376-85. Epub 2015 Sep 12.

a Graduate School of Science and Technology , Niigata University , Niigata , Japan.

Serratia marcescens 2170 produces three different types of chitinases and chitin-binding protein CBP21. We found that transposon insertion into the 5' untranslated region (5' UTR) of chiPQ-ctb led to defective chitinase and CBP21 production. ChiX small RNA possessed the complementary sequence of the 5' UTRs of the chiPQ-ctb and chiR and repressed the expression of chiP and chiR. ChiX was detected in a medium containing glucose, glycerol, GlcNAc, and (GlcNAc)2, but the expression of both chiP and chiR was only observed in a medium containing (GlcNAc)2. ∆chiX mutant produced chitinases, CBP21, and chitobiase without induction. chiP transcripts were more abundant than those of chiR or chiX in a medium containing (GlcNAc)2. These results suggest that the constitutively expressed ChiX binds to the highly abundant chiP 5' UTR, thereby leading to the induction of chiR mRNA translation and the subsequent expression of chitinases and CBP21.
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http://dx.doi.org/10.1080/09168451.2015.1083399DOI Listing
October 2016

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

Generation of Brain Microvascular Endothelial-Like Cells from Human Induced Pluripotent Stem Cells by Co-Culture with C6 Glioma Cells.

PLoS One 2015 10;10(6):e0128890. Epub 2015 Jun 10.

Laboratory of Stem Cell Regulation, National Institute of Biomedical Innovation, 7-6-8, Saito-Asagi, Ibaraki, Osaka 567-0085, Japan; Laboratory of Biomedical Innovation, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871, Japan.

The blood brain barrier (BBB) is formed by brain microvascular endothelial cells (BMECs) and tightly regulates the transport of molecules from blood to neural tissues. In vitro BBB models from human pluripotent stem cell (PSCs)-derived BMECs would be useful not only for the research on the BBB development and function but also for drug-screening for neurological diseases. However, little is known about the differentiation of human PSCs to BMECs. In the present study, human induced PSCs (iPSCs) were differentiated into endothelial cells (ECs), and further maturated to BMECs. Interestingly, C6 rat glioma cell-conditioned medium (C6CM), in addition to C6 co-culture, induced the differentiation of human iPSC-derived ECs (iPS-ECs) to BMEC-like cells, increase in the trans-endothelial electrical resistance, decreased in the dextran transport and up-regulation of gene expression of tight junction molecules in human iPS-ECs. Moreover, Wnt inhibitors attenuated the effects of C6CM. In summary, we have established a simple protocol of the generation of BMEC-like cells from human iPSCs, and have demonstrated that differentiation of iPS-ECs to BMEC-like cells is induced by C6CM-derived signals, including canonical Wnt signals.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128890PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464886PMC
March 2016

An experimental investigation of reactivity to ecological momentary assessment frequency among adults trying to quit smoking.

Addiction 2015 Oct 23;110(10):1549-60. Epub 2015 Jul 23.

Department of Psychology and Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.

Aims: Ecological Momentary Assessment (EMA) captures real-time reports in subjects' natural environments. This experiment manipulated EMA frequency to estimate effects on abstinence and peri-cessation subjective experiences.

Design: In this randomized trial, subjects had an equal chance of being assigned to low-frequency (once) or high-frequency (six times) daily EMA for 4 weeks (1 week pre- and 3 weeks post-cessation). Participants completed six office visits over 5 weeks and 6- and 12-week follow-up telephone interviews.

Setting: Community participants were recruited from central New Jersey, USA.

Participants: One hundred and ten adult daily smokers seeking to quit smoking were included in intent-to-treat analyses of tobacco abstinence; 94 were available for secondary analyses of peri-cessation subjective ratings.

Measurements: Primary outcomes were cessation (abstaining at least 24 hours within 2 weeks of attempting to quit) and prolonged abstinence (no relapse between weeks 2 and 12 post-quit). Secondary outcomes were mean levels and growth in ratings of cigarette craving, affect and quitting motivation and self-efficacy.

Findings: EMA frequency was unrelated to cessation (odds ratio = 1.367, 95% confidence interval = 0.603-3.098) or prolonged abstinence (odds ratio = 1.040, 95% confidence interval = 0.453-2.388) in intent-to-treat analyses. High-frequency EMA was associated with lower craving (B = -0.544, standard error (SE) = 0.183, P = 0.004, anxiety (B = -0.424, SE = 0.170, P = 0.015), anger (B = -0.474, SE = 0.139, P = 0.001), hunger (B = -0.388, SE = 0.170, P = 0.025) and positive affect (B = -0.430, SE = 0.196, P = 0.03).

Conclusions: In smokers trying to quit, more frequent ecological momentary assessment self-monitoring results in lower craving, anxiety, anger, hunger and positive affect. It is not clear whether this translates into higher rates of smoking abstinence.
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http://dx.doi.org/10.1111/add.12996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565778PMC
October 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
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