Publications by authors named "Richard A Brown"

151 Publications

Transcatheter Mitral Valve Replacement: An Update on Current Techniques, Technologies, and Future Directions.

JACC Cardiovasc Interv 2021 Mar 1;14(5):489-500. Epub 2021 Mar 1.

Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Growing clinical data support the use of transcatheter therapies for significant mitral valve disease. Currently, edge-to-edge repair is the transcatheter treatment of choice, but many anatomies are not suitable. Transcatheter mitral valve replacement offers several potential advantages over transcatheter repair, most notably a greater and more sustained reduction in mitral regurgitation post-implantation, but also potential disadvantages. To enable the successful treatment of mitral valve disease in a wide range of patients and anatomies, we require an armory of transcatheter devices, including transcatheter mitral valve replacement systems.
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http://dx.doi.org/10.1016/j.jcin.2020.12.038DOI Listing
March 2021

Photogrammetric Three-dimensional Modeling and Printing of Cetacean Skeleton using an Omura's Whale Stranded in Hong Kong Waters as an Example.

J Vis Exp 2020 09 3(163). Epub 2020 Sep 3.

Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong.

The preparation of cetacean, in particular baleen whale, skeletons presents a great challenge due to their high lipid content and uncommon size. Documentation of the skeletal morphology is important to produce accurate and reliable models for both research and educational purposes. In this paper, we used a 10.8-meter long Omura's whale stranded in Hong Kong waters in 2014 as an example for the illustration. This rare and enormous specimen was defleshed, macerated, and sun-dried to yield the skeleton for research and public display. Morphology of each bone was then documented by photogrammetry. The complex contour of the skeleton made automated photoshoot inadequate and 3 manual methods were used on bones of different sizes and shapes. The captured photos were processed to generate three-dimensional (3D) models of 166 individual bones. The skeleton was printed half-size with polylactic acid for display purposes, which was easier to maintain than the actual cetacean bones with high residual fat content. The printed bones reflected most anatomical features of the specimen, including the bowing out rostral region and the caudal condylar facet that articulated with Ce1, yet the foramina on the parieto-squamosal suture, which are diagnostic character of Balaenoptera omurai, and an indented groove on the frontal bone at the posterior end of the lateral edge were not clearly presented. Extra photoshoots or 3D surface scanning should be performed on areas with meticulous details to improve precision of the models. The electronic files of the 3D skeleton were published online to reach a global audience and facilitate scientific collaboration among researchers worldwide.
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http://dx.doi.org/10.3791/61700DOI Listing
September 2020

CT-Derived Fractional Flow Reserve (FFR): From Gatekeeping to Roadmapping.

Can Assoc Radiol J 2020 May 24;71(2):201-207. Epub 2020 Jan 24.

Department of Medical Imaging, St Paul's Hospital, Vancouver, BC, Canada.

Coronary computed tomography angiography (CCTA) has emerged as the preferred modality in the diagnosis of coronary artery disease, but it is limited by modest specificity. By applying principles of computational fluid dynamics, flow fraction reserve, a measure of lesion-specific ischemia that is used to guide revascularization, can be noninvasively derived from CCTA, the so-called computed tomography-derived flow fractional reserve (FFR). The accuracy of FFR in discriminating ischemia has been extensively validated, and it has been shown to improve the specificity of CCTA. Compared to other stress myocardial perfusion imaging, FFR has superior or comparable accuracy. Clinical studies have provided strong evidence that FFR has significant prognostic implications and informs clinical decisions for revascularization, serving as a gatekeeper to invasive coronary angiography. In addition, FFR tools can be used to simulate the physiological consequences of different revascularization strategies, thus providing the roadmap to achieve complete revascularization. Although challenges remain, ongoing research and randomized controlled trials are expected to address current limitations and better define its role in clinical practice.
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http://dx.doi.org/10.1177/0846537119893752DOI Listing
May 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

Unlocking Prognostic Information from Cardiac CT: Does Aortic Mitral Continuity Calcification Matter?

Radiol Cardiothorac Imaging 2019 Dec 19;1(5):e190229. Epub 2019 Dec 19.

Centre for Heart Valve Innovation, St Paul's Hospital, 1081 Burrard St, Vancouver BC, Canada V6Z 1Y6; and Department of Radiology, University of British Columbia, Vancouver, Canada.

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http://dx.doi.org/10.1148/ryct.2019190229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977804PMC
December 2019

Smoking abstinence effects on emotion dysregulation in adult cigarette smokers with and without attention-deficit/hyperactivity disorder.

Drug Alcohol Depend 2019 12 27;205:107594. Epub 2019 Sep 27.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.

Background: Cigarette smoking is robustly associated with attention-deficit/hyperactivity disorder (ADHD), but little is known about psychological mechanisms accounting for this comorbid relationship. This study examined difficulties in emotion regulation, or emotion dysregulation, among adult cigarette smokers with and without ADHD. Emotion dysregulation was predicted to be higher in an ADHD group at screening and after 24 -h smoking abstinence compared to a non-ADHD group.

Methods: Cigarette smokers with (n = 19) and without (n = 20) ADHD completed a screening visit, baseline visit, and two experimental visits: smoking as usual (i.e., smoking satiated) and after biochemically-verified 24 -h smoking abstinence (i.e., smoking abstinent). Three emotion dysregulation rating scales (two self-report and one clinician rated) were administered at the screening visit and experimental sessions. Experimental sessions also included two emotion dysregulation behavioral tasks.

Results: The ADHD group scored higher on all three rating scales at screening (p's < .001). For experimental sessions, group (ADHD, non-ADHD) x condition (smoking satiated, smoking abstinence) interactions were not significant across measures. However, group main effects emerged indicating higher emotion dysregulation in the ADHD group across all measures (p's < .001). Main effects also emerged for experimental condition, but were more mixed across emotion dysregulation measures.

Conclusions: Emotion dysregulation was higher among adult smokers with ADHD and during smoking abstinence across diagnostic groups, suggesting that this malleable psychological mechanism plays a role in smoking both for those with and without ADHD-such findings can inform treatment and prevention efforts.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938720PMC
December 2019

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

Anxiety Sensitivity is Associated with Lower Enjoyment and an Anxiogenic Response to Physical Activity in Smokers.

Cognit Ther Res 2019 Feb 27;43(1):78-87. Epub 2018 Jul 27.

Alpert Medical School of Brown University, Providence, Rhode Island.

Background: The subjective affective response to, and enjoyment of, physical activity are strong predictors of engagement in physical activity. Anxiety sensitivity, the fear of bodily sensations, is a cognitive factor that may inhibit the pleasurable affective experience of physical activity, possibly contributing to low levels of physical activity. The current study evaluated anxiety sensitivity in relation to PA enjoyment and affective experience before and after exercise in smokers.

Method: Participants were low-active treatment-seeking smokers ( = 201) enrolled in a smoking cessation intervention. At baseline, participants completed self -report assessments of anxiety sensitivity, cigarette dependence, and physical activity enjoyment. State affect was also reported before and after a submaximal exercise test to index pre-exercise activity affect and affective response to exercise.

Results: Anxiety sensitivity was significantly negatively correlated with physical activity enjoyment, specifically lower enjoyable physical feelings of physical activity. Anxiety sensitivity was significantly correlated with lower state mood and higher state anxiety prior to the submaximal exercise test, and higher anxiety immediately after the exercise test. Additionally, anxiety sensitivity predicted increased anxiety, but not lower mood, in response to the submaximal exercise test.

Conclusions: This is the first study to document an association of anxiety sensitivity with affective determinants of physical activity behavior in smokers. Anxiety sensitivity was associated with lower physical activity enjoyment, higher negative affect prior to after exercise testing, and an anxiogenic response to exercise. Future work is needed to understand how the current findings generalize beyond smokers.
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http://dx.doi.org/10.1007/s10608-018-9948-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502475PMC
February 2019

Monocyte-platelet cross-talk in peripheral artery disease-how much does the pathogenesis of atherosclerosis depend on anatomical location?

Ann Transl Med 2019 Mar;7(Suppl 1):S19

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

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http://dx.doi.org/10.21037/atm.2019.01.47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462589PMC
March 2019

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers.

Cogn Behav Ther 2020 03 5;49(2):137-148. Epub 2019 Apr 5.

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

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.
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http://dx.doi.org/10.1080/16506073.2019.1583277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778490PMC
March 2020

Approach bias retraining to augment smoking cessation: Study protocol for a randomized controlled trial.

Contemp Clin Trials Commun 2019 Jun 28;14:100340. Epub 2019 Feb 28.

Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States.

Heavy users and addicted individuals have shown to develop an approach action tendency - or approach bias - toward stimuli related to the substance of interest. Emerging evidence points to approach bias retraining (ABR) as an effective aid for the treatment of addictive behaviors. The current study seeks to extend this work by testing, in a pilot study, whether standard smoking cessation treatment involving cognitive-behavioral therapy (CBT) and nicotine replacement therapy can be augmented by ABR. To this end, we will randomly assign 100 adult smokers to either ABR-augmented treatment or placebo-augmented treatment and compare the two conditions on short-term and long-term abstinence rates. The hope is that the findings of this study can inform treatment development for adult smokers.
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http://dx.doi.org/10.1016/j.conctc.2019.100340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406622PMC
June 2019

Anxiety sensitivity and smoking outcome expectancies among Spanish-speaking Latinx adult smokers.

Exp Clin Psychopharmacol 2019 Dec 21;27(6):569-577. Epub 2019 Mar 21.

Health Behavior Solutions, The University of Texas at Austin.

Smoking is among the most important health behaviors linked to premature death and disability among the Latinx population. Yet there is limited understanding of whether transdiagnostic factors like anxiety sensitivity may help explain smoking expectancies among Spanish-speaking Latinx smokers. The present investigation evaluated anxiety sensitivity in regard to smoking outcome expectancy factors among a large sample of adult Latinx smokers. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.8). As expected, anxiety sensitivity was significantly related to expectancies of negative reinforcement and negative personal consequences. Anxiety sensitivity also was a significant predictor of smoking expectancies of appetite control and positive reinforcement. The present study provides novel empirical evidence that anxiety sensitivity explains a notable degree of variance in smoking outcome expectancies over the variance accounted for by a range of theoretically relevant covariates among Latinx smokers. These results highlight the clinical utility in assessing anxiety sensitivity among Latinx smokers and focusing greater attention on this construct in efforts to better understand cognitive-based smoking expectancies among this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000270DOI Listing
December 2019

Extreme cardiac iron loading in transfusion-dependent thalassaemia major: cardiac T2* and T1 mapping guiding treatment.

Eur Heart J 2019 Nov;40(43):3578

Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.

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http://dx.doi.org/10.1093/eurheartj/ehz137DOI Listing
November 2019

Acute effects of aerobic exercise on negative affect and obsessions and compulsions in individuals with obsessive-compulsive disorder.

J Affect Disord 2019 02 14;245:991-997. Epub 2018 Nov 14.

University of Rhode Island, Department of Kinesiology, Kingston, RI USA.

Background: The acute effects of aerobic exercise on improved mood and anxiety reduction have been demonstrated across clinical and nonclinical populations. Limited work has evaluated the acute effects of aerobic exercise on negative affect, obsessions, and compulsions in patients with Obsessive Compulsive Disorder (OCD).

Method: Fifty-five patients (64% female) with treatment-resistant OCD were randomized to either 12 weeks of aerobic exercise (AE) or health education contact (HEC) control. Participants rated negative affect (i.e., mood and anxiety), obsessions and compulsions before and after each weekly AE or HEC session. Multilevel models were constructed to evaluate the effect of intervention condition, treatment week (time), and their interaction in terms of acute change in affect, obsession, and compulsions.

Results: Results reflected a main effect of condition, such that AE resulted in significantly larger increases in positive mood, and reductions in anxiety and compulsions, as compared to HEC. There was also a main effect of time in predicting acute anxiety reduction, such that linear reductions in anxiety over the course of treatment were observed. No significant effects were observed for acute changes in obsessions.

Limitations: The sample was small and was limited in demographic heterogeneity. Bouts of aerobic exercise were not standardized in terms of duration and mode, which could impact affective response to exercise, and acute affective OCD effects were exclusively self-reported.

Discussion: The current findings may help elucidate potential mechanisms of action of exercise on OCD outcomes. In addition, these results point toward the potential of designing exercise interventions that can teach patients to utilize individual bouts of physical activity, "in-the-moment" to improve mood and reduce anxiety and compulsions.
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http://dx.doi.org/10.1016/j.jad.2018.11.074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037579PMC
February 2019

Multi-method assessment of distress tolerance and smoking-related factors among adult daily smokers.

Exp Clin Psychopharmacol 2019 Apr 27;27(2):136-145. Epub 2018 Dec 27.

Department of Psychiatry and Behavioral Sciences.

Although distress tolerance (DT) is associated with smoking lapse and relapse outcomes, few studies have conducted a rigorous assessment of DT across domain and method in the context of acute abstinence. In a human laboratory-based study of 106 adult daily smokers, we examined between multiple indices of DT and smoking lapse, withdrawal processes, and motivation to quit. We expected that low DT would be associated with shorter latency to smoke, greater withdrawal severity, and lower motivation to quit. Following a smoking abstinence period (≥ 6 hr deprived), participants completed an assessment battery including both behavioral (mirror-tracing, serial addition, cold pressor, and breath-holding tasks) and self-report measures of DT (general and smoking-specific), withdrawal processes (craving, negative affect, and positive affect), and motivation to quit. Latency to smoke (range = 0-50 min) was assessed in a laboratory analogue task in which delaying smoking was monetarily rewarded. Behavioral and self-report DT indices displayed only modest intercorrelations, indicating different facets of this construct by domain and method of assessment. Tolerance of physical pain was uniquely associated with smoking choice. Both self-report DT measures were associated with abstinence-induced increases in negative affect, while only smoking-specific DT was positively associated with craving. Results are discussed within the context of guiding targeted behavioral interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561662PMC
April 2019

YMCA exercise intervention to augment smoking cessation treatment in adults with high anxiety sensitivity: Study protocol for a randomized controlled trial.

Contemp Clin Trials 2019 02 15;77:1-7. Epub 2018 Dec 15.

Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States.

Extant evidence suggests that exercise can reduce anxiety related vulnerability factors, such as anxiety sensitivity (AS), or fear of bodily sensations related to anxiety, that negatively impact smoking cessation outcomes. Building upon emerging evidence supporting the efficacy of exercise as an aid for smoking cessation in adults with high AS, we are conducting a trial to examine the efficacy and feasibility of this clinical application when implemented in a community setting. Partnering with the YMCA, this study aims to enroll 150 adults in a standard smoking cessation protocol (i.e. counseling and nicotine replacement therapy) and randomly assign them to either 15 weeks of programmed vigorous-intensity or low-intensity exercise. Smoking abstinence data will be collected up to 6 months following the quit attempt.
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http://dx.doi.org/10.1016/j.cct.2018.12.001DOI Listing
February 2019

Anxiety sensitivity and smoking among Spanish-speaking Latinx smokers.

Addict Behav 2019 03 19;90:55-61. Epub 2018 Oct 19.

Health Behavior Solutions, Austin, TX, USA; School of Nursing, The University of Texas at Austin, Austin, TX, USA.

Despite the documented health disparities for smoking among the Latinx population, there is limited understanding of transdiagnostic constructs that may help explain smoking among Spanish-speaking Latinx smokers. The present study examined one promising transdiagnostic factor, anxiety sensitivity (fear of anxiety and related sensations), in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced when trying to quit among a large sample of Latinx smokers. Participants were 367 Spanish-speaking Latinx daily smokers (59.1% female, M = 33.20 years, SD = 11.81). As hypothesized, anxiety sensitivity was significantly related to the severity of cigarette dependence, perceived barriers for quitting, and problems when trying to quit. Inspection of the lower-order dimensions of anxiety sensitivity indicated that Physical Concerns was significantly related to cigarette dependence whereas Cognitive Concerns was associated with greater perceived barriers for quitting and severity of problems experienced during past quit attempts. The present study provides novel empirical evidence that anxiety sensitivity is related to a moderate, yet clinically meaningful, proportion of the variance in cigarette dependence, perceived barriers for quitting, and problems experienced during quit attempts. These findings underscore the value of examining anxiety sensitivity among Latinx smokers and focusing greater attention on this construct in efforts to reduce or quit smoking among this population.
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http://dx.doi.org/10.1016/j.addbeh.2018.10.022DOI Listing
March 2019

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

Positive psychotherapy for smoking cessation enhanced with text messaging: Protocol for a randomized controlled trial.

Contemp Clin Trials 2018 08 21;71:146-153. Epub 2018 Jun 21.

School of Nursing, University of Texas, Austin, TX, United States.

Background: Despite reductions in cigarette smoking in the U.S., improvements in the efficacy of smoking cessation treatments are needed, as rates of sustained abstinence remain disappointingly low. Both low positive affect and high negative affect contribute to smoking relapse and constitute viable targets for smoking cessation interventions. Although some clinical trials have evaluated interventions to address depression as a smoking relapse risk factor, very few have focused on positive affect. Recently, we developed and conducted a preliminary clinical trial of a smoking cessation treatment that targets positive affect and cognitions by incorporating interventions rooted in positive psychology. The current randomized controlled trial will expand upon this preliminary trial to test whether this positive psychology-informed approach results in higher smoking cessation rates compared to a time-matched standard smoking cessation treatment control.

Methods: Three hundred and forty adult daily smokers will be randomly assigned to either positive psychotherapy for smoking cessation or standard behavioral smoking cessation counseling. Participants will meet weekly with a study counselor for 6 weeks and will receive transdermal nicotine patch and text messaging smoking cessation support. Additionally, text messaging in the positive psychotherapy condition will encourage engagement in positive psychology-specific strategies for boosting mood and staying smoke free. Smoking cessation outcomes will be measured at 12, 26, and 52 weeks following target quit date.

Conclusion: Results from this study will provide evidence on whether incorporating positive psychology interventions into smoking cessation treatment can improve smoking cessation outcomes relative to standard behavioral counseling with nicotine patch and text messaging.
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http://dx.doi.org/10.1016/j.cct.2018.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484849PMC
August 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

Physical Activity Preferences and Attitudes of Individuals With Substance Use Disorders: A Review of the Literature.

Issues Ment Health Nurs 2018 Aug 5;39(8):657-666. Epub 2018 Mar 5.

a School of Nursing , The University of Texas at Austin , Austin , Texas , USA.

Substance use disorders (SUDs) are prevalent in the United States and costly to society. SUDs contribute significantly to decreased quality of life and overdose deaths. Physical activity (PA) interventions may be one efficacious method to improve recovery and long-term abstinence from substance use; although PA interventions have resulted in positive physical and psychological outcomes, their adherence and attrition rates have been problematic. To address lack of adherence and high attrition rates, it is important to understand the preferences and attitudes for PA among patients in SUD treatment. We, therefore, conducted a literature review to examine preferences and attitudes for PA among adults with SUDs. Five articles met inclusion and exclusion criteria. The findings from this small sample of studies suggest that adults with SUDs are interested in PA. Walking, strength training, and cycling were the activities preferred most frequently. Participants said that they would like to engage in these activities either alone or with small groups and would prefer their exercise options to be located at facilities they already frequented, such as treatment clinics. Nurses are well positioned to assess patient preferences and attitudes and to enhance recovery efforts in this population. Further exploration of this population's unique preferences and attitudes regarding PA may lay the groundwork for efficacious PA interventions with improved adherence and attrition rates, which may lead to improved recovery outcomes.
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http://dx.doi.org/10.1080/01612840.2018.1429510DOI Listing
August 2018

Impact of Mon2 monocyte-platelet aggregates on human coronary artery disease.

Eur J Clin Invest 2018 May 7;48(5):e12911. Epub 2018 Mar 7.

Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, UK.

Background: Monocyte-platelet aggregates (MPAs) form when Mon1, Mon2 or Mon3 monocyte subsets adhere to platelets. They are pathophysiologically linked to coronary artery disease (CAD). However, their individual roles in the occurrence of diffuse CAD remain unknown.

Materials And Methods: Peripheral blood from 50 patients with diffuse CAD, 40 patients with focal CAD and 50 age-matched patients with normal coronary arteries was analysed by flow cytometry to quantify MPAs associated with individual monocyte subsets. Cutaneous forearm microcirculation was assessed using laser Doppler flowmetry at rest and after iontophoresis of acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation) at 100 μA for 60 seconds. Patients with CAD had repeat assessment at 6 and 12 months.

Results: Baseline counts of MPAs with Mon2 subset (CD14++CD16+CC2+ monocytes) were significantly higher in patients with diffuse CAD compared to focal CAD (P = .001) and patients without CAD (P = .006). On multivariate regression, MPAs with Mon2 independently predicted diffuse CAD (odds ratio 1.10, 95% confidence interval 1.02-1.19, P = .01) and correlated negatively with endothelium-dependent microvascular vasodilation (r = -.37, P = .008), an association which persisted after adjustment for covariates. Longitudinal observation confirmed the persistence of an inverse relationship between MPAs with Mon2 and endothelium-dependent microvascular function.

Conclusion: Monocyte-platelet aggregates with Mon2 are increased in patients with diffuse CAD and therefore could represent an important contributor to accelerated coronary atherosclerotic progression by a mechanism involving microvascular endothelial dysfunction.
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http://dx.doi.org/10.1111/eci.12911DOI Listing
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

Effects of Negative Affect, Urge to Smoke, and Working Memory Performance (n-back) on Nicotine Dependence.

Subst Use Misuse 2018 06 29;53(7):1177-1183. Epub 2017 Nov 29.

c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , Rhode Island , USA.

Background: Three key domains including negative emotionality, incentive salience, and executive function form the core functional elements of addictive behaviors. Variables related to these broader domains have been studied extensively in relation to one another; however, no studies to date, have examined models including variables from all three domains, in relation to nicotine dependence.

Method: Smokers (N = 117), 65.8% female, 78% white, mean age of 44.4 (SD = 10.8), enrolled in a smoking cessation program completed measures of negative affect (a component of negative emotionality), urge to smoke (incentive salience), and working memory (WM; a core executive function), during a baseline assessment period prior to initiating treatment.

Results: Negative affect was associated with greater urge to smoke, and this elevated urge to smoke was associated with higher levels of nicotine dependence. Further, a significant moderated mediation indicated that WM moderated the relationship between increased urge to smoke and nicotine dependence. For those with low to average WM, urge to smoke was significantly related to nicotine dependence; however, for those with higher WM (+1 SD), urge to smoke stemming from negative affect was not associated with nicotine dependence.

Conclusions: To our knowledge, this is the first reported relationship between negative affect, urge to smoke, WM, and nicotine dependence. Although preliminary, results indicate that WM may moderate the relationship between urge to smoke associated with negative affect and nicotine dependence. Treatments targeting WM may be particularly useful for individuals with average to low WM who experience urge to smoke related to negative affect.
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http://dx.doi.org/10.1080/10826084.2017.1400569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376498PMC
June 2018

A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment.

Gen Hosp Psychiatry 2017 11 23;49:51-55. Epub 2017 Jun 23.

Butler Hospital, Providence, RI 02906, United States; Alpert Medical School of Brown University, Providence, RI 02906, United States; Providence Veterans Affairs Medical Center, Providence, RI 02908, United States.

Objective: The purpose of the current study was to conduct a randomized controlled trial testing the efficacy of aerobic exercise for decreasing OCD symptom severity, other mental health outcomes, and increasing exercise behaviors and cardiorespiratory fitness among individuals with OCD.

Method: Fifty-six patients (64% female; mean age=38.8years) with OCD and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 16 or greater despite engaging in OCD treatment were randomized to 12-weeks of supervised plus home-based moderate-intensity aerobic exercise (AE; n=28) or to 12-weeks of health education sessions (HE; n=28).

Results: Random intercepts mixed models examined differences between conditions at post-treatment. Though no difference between conditions on outcomes was observed, both AE and HE showed significant reduction in OCD symptom severity, depression and anxiety at post-treatment. Relative to HE, significant increases were noted in amount of exercise and cardiorespiratory fitness for those in the AE condition. At post-treatment, 30.4% of the AE condition (7 of 23) were treatment-responders (using the commonly accepted measure of 35% symptom reduction from baseline). In the HE condition, 7.7% of the sample (2 of 26) met this criterion at post-treatment.

Conclusion: The results of this preliminary study suggest that exercise and health-focused interventions may be beneficial adjuncts to existing OCD treatment. Future studies with larger samples are needed to more definitively answer questions the efficacy of AE for reducing OCD symptoms and improving related clinical outcomes.
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http://dx.doi.org/10.1016/j.genhosppsych.2017.06.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726421PMC
November 2017

The Role of Physical Activity Enjoyment on the Acute Mood Experience of Exercise among Smokers with Elevated Depressive Symptoms.

Ment Health Phys Act 2017 Mar 10;12:37-43. Epub 2017 Feb 10.

Butler Hospital, Providence, Rhode Island.

Problem: Depressive symptoms are consistently shown to be related to poor smoking cessation outcomes. Aerobic exercise is a potential treatment augmentation that, given its antidepressant and mood enhancing effect, may bolster cessation outcomes for smokers with elevated depressive symptoms. Lower enjoyment of physical activity may inhibit the acute mood enhancing effects of aerobic exercise. The current study investigated the associations between depressive symptoms, physical activity enjoyment and the acute mood experience from exercise among low-active smokers with elevated depressive symptoms.

Method: Daily smokers with elevated depressive symptoms (N=159; = 45.1, = 10.79; 69.8% female) were recruited for a randomized controlled exercise-based smoking cessation trial. Participants self-reported levels of depressive symptoms, physical activity enjoyment, and rated their mood experience (assessed as "mood" and "anxiety") before and after a standardized aerobic exercise test.

Results: Hierarchical regression analysis revealed that depressive symptom severity accounted for significant unique variance in physical activity enjoyment ( =.041, = -2.61, = .010), beyond the non-significant effects of gender and level of tobacco dependence. Additionally, physical activity enjoyment was a significant mediator of the association between depressive symptom severity and acute mood experience ("mood" and "anxiety") following the exercise test.

Conclusions: Physical activity enjoyment may explain, at least in part, how depressive symptom severity is linked to the acute mood experience following a bout of activity. Interventions that target increasing physical activity enjoyment may ultimately assist in enhancing the mood experience from exercise, and therefore improve smoking cessation likelihood, especially for smokers with elevated depressive symptoms.
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http://dx.doi.org/10.1016/j.mhpa.2017.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625337PMC
March 2017

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

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