Expectancies for the effectiveness of different tobacco interventions account for racial and gender differences in motivation to quit and abstinence self-efficacy.

INTRODUCTION: Racial and gender disparities for smoking cessation might be accounted for by differences in expectancies for tobacco interventions, but few studies have investigated such differences or their relationships with motivation to quit and abstinence self-efficacy. METHODS: In this cross-sectional study, 673 smokers (African American: n = 443, 65.8%; women: n = 222, 33.0%) under criminal justice supervision who enrolled in a clinical smoking cessation trial in which all received bupropion and half received counseling. All participants completed pretreatment measures of expectancies for different tobacco interventions, motivation to quit, and abstinence self-efficacy. The indirect effects of race and gender on motivation to quit and abstinence self-efficacy through expectancies for different tobacco interventions were evaluated. RESULTS: African Americans' stronger expectancies that behavioral interventions would be effective accounted for their greater motivation to quit and abstinence self-efficacy. Women's stronger expectancies for the effectiveness of pharmacotherapy accounted for their greater motivation to quit, whereas their stronger expectancies for the effectiveness of behavioral treatments accounted for their greater abstinence self-efficacy. CONCLUSIONS: Findings point to the mediating role of expectancies for treatment effectiveness and suggest the importance of exploring expectancies among African Americans and women as a way to augment motivation and self-efficacy.

How low should you go? Determining the optimal cutoff for exhaled carbon monoxide to confirm smoking abstinence when using cotinine as reference.

INTRODUCTION: Confirming abstinence during smoking cessation clinical trials is critical for determining treatment effectiveness. Several biological methods exist for verifying abstinence (e.g., exhaled carbon monoxide [CO], cotinine), and while cotinine provides a longer window of detection, it is not easily used in trials involving nicotine replacement therapy. The Society for Research on Nicotine and Tobacco's Subcommittee on Biochemical Verification cite 8-10 parts per million (ppm) for CO as a viable cutoff to determine abstinence; however, recent literature suggests this cutoff is likely too high and may overestimate the efficacy of treatment. METHODS: This study examined the relationship between CO and cotinine in a sample of 662 individuals participating in a smoking cessation clinical trial. A receiver operating characteristics curve was calculated to determine the percentage of false positives and false negatives at given CO levels when using cotinine as confirmation of abstinence. Differences were also examined across race and gender. RESULTS: A CO cutoff of 3 ppm (97.1% correct classification) most accurately distinguished smokers from nonsmokers. This same cutoff was accurate for both racial and gender groups. The standard cutoffs of 8 ppm (14.0% misclassification of smokers as abstainers) and 10 ppm (20.6% misclassification of smokers as abstainers) produced very high false-negative rates and inaccurately identified a large part of the sample as being abstinent when their cotinine test identified them as still smoking. CONCLUSIONS: It is recommended that researchers and clinicians adopt a more stringent CO cutoff in the range of 3-4 ppm when complete abstinence from smoking is the goal.

Understanding the relationship between actual:ideal discrepancies and depressive symptoms: a developmental examination.

Self-discrepancy theory (SDT) is one framework for understanding how goal failure is associated with depressive symptoms. The present studies sought to examine the variance in depressive symptoms explained by actual:ideal discrepancies, beyond what is accounted for by actual-self ratings. Additionally, gender and grade were examined as potential moderators in the relationship. In Study 1 (N = 228), discrepancies accounted for additional variance in the level of depressive symptoms beyond what was explained by actual-self ratings in a college sample. In Study 2 (N = 192), while similar global patterns were found, gender and grade differences emerged. For boys, the relationship between actual:ideal discrepancies and depressive symptoms was due to actual-self ratings. For girls, a developmental pattern suggested that actual:ideal discrepancies become more important to the prediction of depressive symptoms among older girls. Implications for the emergence of the discrepancy-depression association are discussed.

When do self-discrepancies predict negative emotions? Exploring formal operational thought and abstract reasoning skills as moderators.

Individual differences in higher-order cognitive abilities may be an important piece to understanding how and when self-discrepancies lead to negative emotions. In the current study, three measures of reasoning abilities were considered as potential moderators of the relationship between self-discrepancies and depression and anxiety symptoms. Participants (N = 162) completed measures assessing self-discrepancies, depression and anxiety symptoms, and were administered measures examining formal operational thought, and verbal and non-verbal abstract reasoning skills. Both formal operational thought and verbal abstract reasoning were significant moderators of the relationship between actual:ideal discrepancies and depressive symptoms. Discrepancies predicted depressive symptoms for individuals with higher levels of formal operational thought and verbal abstract reasoning skills, but not for those with lower levels. The discussion focuses on the need to consider advanced reasoning skills when examining self-discrepancies.

Predictors of medication adherence and smoking cessation among smokers under community corrections supervision.

INTRODUCTION: Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. METHODS: Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. RESULTS: The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. CONCLUSIONS: These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.

Further Investigation of the Association between Anxiety Sensitivity and Posttraumatic Stress Disorder: Examining the Influence of Emotional Avoidance.

Anxiety sensitivity (AS) and the tendency to avoid emotions have both been identified as vulnerability factors for the development and maintenance of posttraumatic stress disorder (PTSD). Furthermore, both cross-sectional and prospective research have provided evidence that emotional avoidance and AS interact to predict anxiety symptoms, such that AS may only be associated with anxiety-related pathology among those who exhibit a tendency to avoid their emotions. The purpose of the present study was to determine if this moderator model extends to PTSD within a sample of substance dependent patients. Specifically, this study examined if AS is associated with PTSD only among individuals with high (vs. low) levels of negative emotional avoidance. As predicted, results of a logistic regression analysis revealed a significant interaction between negative emotional avoidance and AS in predicting PTSD status. Follow-up analyses revealed a significant positive association between AS and PTSD status for participants high in negative emotional avoidance; however, AS was not associated with PTSD for those low in negative emotional avoidance. This finding remained even when relevant covariates were included in the model. Results confirm hypotheses and are consistent with the extant anxiety-risk literature.

Cognitive risk profiles for anxiety disorders in a high-risk population.

The purpose of the present study was to identify subgroups of participants who may be at particularly high risk for anxiety pathology based on specific combinations of demographic characteristics and higher-order cognitive abilities in a population at disproportionate risk for deficits in cognitive abilities (i.e., smokers within the criminal justice system). Participants (N=495) provided demographic information, were administered a semi-structured diagnostic interview, and completed a number of measures assessing cognitive abilities. A receiver-operating characteristic (ROC) model using signal detection theory indicated that the strongest predictor of anxiety disorder diagnosis was race, with White participants having a 30.6% likelihood of diagnosis and participants in the non-White category (97% of which identified as Black/African American) having a 18.9% likelihood of diagnosis. Interestingly, the individual risk profile associated with the highest probability of having a current anxiety disorder was characterized by White participants with impaired response inhibition (58.6%), and the lowest probability of having a current anxiety disorder was among non-White males (13.9%). The findings, which indicated that White individuals with impaired response inhibition are at a disproportionately high risk for anxiety disorders, suggest a potential target for prevention and intervention.

Risk factors for concurrent use of benzodiazepines and opioids among individuals under community corrections supervision.

BACKGROUND: The use of heroin and prescription opioids has increased over the past decade. The concurrent use of opioids with other depressants such as benzodiazepines increases the risk of overdose death compared with use of either drug alone. This study examined factors associated with concurrent use of opioids and benzodiazepines in a criminal justice sample in the state of Alabama. METHODS: The Addiction Severity Index (ASI) and urine drug screen results from 28,570 individuals who were under community corrections supervision from 2002-2012 were examined for independent or concurrent opioid and benzodiazepine use. Multinomial logistic regression analyses were conducted to determine associations between socio-demographic characteristics and drug use. RESULTS: Concurrent use was detected in 11.5% of the sample. Concurrent use of opioids and benzodiazepines or use of either drug alone was associated with being White, female, married, prescribed psychiatric medications, having seen a physician in the past two years, cannabis use, and having a drug-related offense. Concurrent users were more likely to be unemployed or disabled and have received counseling, and less likely to have completed college, live with relatives or friends, have a history of hallucinations, or have an offense against a person relative to nonusers. DISCUSSION: While significant overlap of risk factors exists between individuals with concurrent use versus sole use of opioids or benzodiazepines, individuals with concurrent use generally have more social dysfunction than individuals who tested for either substance alone. Concurrent users may need more psychosocial resources and intensive treatments to promote recovery.

Anxiety sensitivity as a moderator of the relationship between trait anxiety and illicit substance use.

Anxiety and substance use problems are common and often comorbid, and past research has shown that young adults in particular are especially at risk for developing these disorders. To further delineate the relationship between anxiety and substance use, the current study evaluated anxiety sensitivity (AS)-a cognitive vulnerability factor-as a moderator of the association between trait anxiety and illicit substance use in a large sample of young adults (N = 845; M = 18.7 years, SD = 1.0). It was hypothesized that AS would moderate the association between trait anxiety and illicit substance use, such that trait anxiety would significantly predict illicit substance use among those with high, but not low, AS. Consistent with prediction, a significant trait Anxiety × AS interaction was found, χ²(5) = 29.38, p < .001. Specifically, analyses of simple slopes revealed that for the high-AS group, as trait anxiety increased, so did frequency of illicit substance use (odds ratio [OR] = 1.03, p = .005; 95% confidence interval [CI] [1.01, 1.06]). The slope for the low AS was not significant (OR = 0.98, p = .100; 95% CI [0.95, 1.01]). Results also showed significant moderation effects for the AS physical concerns and cognitive concerns facets but not AS social concerns. These findings suggest that AS may be an important cognitive vulnerability that may help to identify those at particular risk for substance use, and that interventions should target AS reduction in anxiety-prone individuals to reduce and prevent substance abuse.

Exploring the relationship between positive and negative emotional avoidance and anxiety symptom severity: the moderating role of attentional control.

BACKGROUND AND OBJECTIVES: Emotional avoidance has been found to be associated with higher levels of anxiety. However, no research to date has differentiated between the avoidance of positive and negative emotions in relation to anxiety. Additionally, no studies have examined the extent to which attentional control moderates the relation between the avoidance of emotions and anxiety. Thus, the purpose of this study was to (a) clarify relations between both positive and negative emotional avoidance and anxiety, and (b) examine attentional control as a moderator of the relations between both positive and negative emotional avoidance and anxiety. METHODS: A community sample of adults (N = 93) completed a series of questionnaires, as well as a laboratory-based measure of attentional control. RESULTS: Greater avoidance of both positive and negative emotions was associated with higher levels of anxiety. Additionally, attentional control moderated the relationship between negative (but not positive) emotional avoidance and anxiety. Specifically, the avoidance of negative emotions was associated with higher levels of anxiety for those with lower attentional control. LIMITATIONS: Limitations include a cross-sectional design, use of self-report measures, and the examination of hypotheses within a non-clinical sample. CONCLUSION: Findings are consistent with a growing body of research demonstrating the moderating role of attentional control in the relation between risk factors and negative outcomes. Findings also suggest that empirically-based treatment approaches that contain attention-based components may be beneficial for emotionally avoidant individuals with poor attentional control abilities.

Use of antibiotic resistance analysis for representativeness testing of multiwatershed libraries.

The use of antibiotic resistance analysis (ARA) for microbial source tracking requires the generation of a library of isolates collected from known sources in the watershed. The size and composition of the library are critical in determining if it represents the diversity of patterns found in the watershed. This study was performed to determine the size that an ARA library needs to be to be representative of the watersheds for which it will be used and to determine if libraries from different watersheds can be merged to create multiwatershed libraries. Fecal samples from known human, domesticated, and wild animal sources were collected from six Virginia watersheds. From these samples, enterococci were isolated and tested by ARA. Based on cross-validation discriminant analysis, only the largest of the libraries (2,931 isolates) were found to be able to classify nonlibrary isolates as well as library isolates (i.e., were representative). Small libraries tended to have higher average rates of correct classification, but were much less able to correctly classify nonlibrary isolates. A merged multiwatershed library (6,587 isolates) was created and was found to be large enough to be representative of the isolates from the contributing watersheds. When isolates that were collected from the contributing watersheds approximately 1 year later were analyzed with the multiwatershed library, they were classified as well as the isolates in the library, suggesting that the resistance patterns are temporally stable for at least 1 year. The ability to obtain a representative, temporally stable library demonstrates that ARA can be used to identify sources of fecal pollution in natural waters.