Left-digit price effects on smoking cessation motivation.

BACKGROUND: Cigarette price increases have been associated with increases in smoking cessation, but relatively little is known about this relationship at the level of individual smokers. To address this and to inform tax policy, the goal of this study was to apply a behavioural economic approach to the relationship between the price of cigarettes and the probability of attempting smoking cessation. METHODS: Adult daily smokers (n=1074; ie, 5+ cigarettes/day; 18+ years old; ≥8th grade education) completed in-person descriptive survey assessments. Assessments included estimated probability of making a smoking cessation attempt across a range of cigarette prices, demographics and nicotine dependence. RESULTS: As price increases, probability of making a smoking cessation attempt exhibited an orderly increase, with the form of the relationship being similar to an inverted demand curve. The largest effect size increases in motivation to make a quit attempt were in the form of 'left-digit effects,' (ie, maximal sensitivity across pack price whole-number changes; eg, US$5.80-6/pack). Significant differences were also observed among the left-digit effects, suggesting the most substantial effects were for price changes that were most market relevant. Severity of nicotine dependence was significantly associated with price sensitivity, but not for all indices. CONCLUSIONS: These data reveal the clear and robust relationship between the price of cigarettes and an individual's motivation to attempt smoking cessation. Furthermore, the current study indicates the importance of left-digit price transitions in this relationship, suggesting policymakers should consider relative price positions in the context of tax changes.

Trait- and State-Fear of Missing Out: Influences on Alcohol Craving and Drinking Likelihood.

OBJECTIVE: A growing body of research implicates Fear of Missing Out (FoMO) as a risk factor for collegiate alcohol use. However, little research has explored the causal mechanisms of this association, which may depend on examining FoMO at both trait and state levels. We therefore examined how predispositions toward experiencing FoMO (i.e., trait-FoMO) interacted with state-level cues indicating that one was "missing out" (i.e., state-FoMO) and cues indicating the presence or absence of alcohol. METHOD: College students (n = 544) participating in an online experiment completed a measure of trait-FoMO and were then randomly assigned to one of four guided-imagery script conditions (FoMO/Alcohol cue, FoMO/No Alcohol cue, No FoMO/Alcohol cue, No FoMO/No Alcohol cue). Participants then completed measures of alcohol craving and drinking likelihood for the given scenario. RESULTS: Two hierarchical regressions (one per dependent variable) revealed significant two-way interactions. Greater trait-FoMO demonstrated the strongest, positive associations with alcohol craving following scenarios with FoMO cues present. Reported drinking likelihood was strongest when state-level cues for FoMO and alcohol were both present, moderate when either cue was independently present, and lowest when both cues were absent. CONCLUSIONS: FoMO's impact on alcohol craving and drinking likelihood varied across trait/state levels. Although trait-FoMO was associated with alcohol craving, state-level cues indicating "missing out" affected both alcohol-related variables and interacted with alcohol cues in imagery scenarios to predict drinking likelihood. Although additional research is needed, targeting psychological variables related to meaningful social connection may reduce collegiate alcohol use with respect to FoMO.

Delivery Mode Affects Stability of Early Infant Gut Microbiota.

Mode of delivery strongly influences the early infant gut microbiome. Children born by cesarean section (C-section) lack Bacteroides species until 6-18 months of age. One hypothesis is that these differences stem from lack of exposure to the maternal vaginal microbiome. Here, we re-evaluate this hypothesis by comparing the microbial profiles of 75 infants born vaginally or by planned versus emergent C-section. Multiple children born by C-section have a high abundance of Bacteroides in their first few days of life, but at 2 weeks, both C-section groups lack Bacteroides (primarily according to 16S sequencing), despite their difference in exposure to the birth canal. Finally, a comparison of microbial strain profiles between infants and maternal vaginal or rectal samples finds evidence for mother-to-child transmission of rectal rather than vaginal strains. These results suggest differences in colonization stability as an important factor in infant gut microbiome composition rather than birth canal exposure.

Treatment of social anxiety with paroxetine: mediation of changes in anxiety and depression symptoms.

Investigation of relationship patterns between co-occurring symptoms has greatly improved the efficacy of psychiatric care. Depression and anxiety often present together, and identification of primary vs secondary psychiatric symptoms has implications for treatment. Previous psychotherapy research investigating the relationship between social anxiety and depression, across social anxiety treatment, found that severity of social anxiety accounted for most of the change in depression severity across time. Conversely, severity of depression accounted for little variation in severity of social anxiety. The current investigation was conducted to extend these findings by examining this mediational relationship in a pharmacologic trial comparing paroxetine (n = 20) and placebo (n = 22). Social anxiety and depression severity were assessed weekly for 16 weeks. Consistent with the previous study, results indicated that social anxiety severity mediated most of the variance in depression severity, with little variance accounted for by a test of the reverse mediation. Surprisingly, this same pattern was also found in the placebo group. These findings suggest that this pattern of mediational relationships may be fundamental to social anxiety, rather than specific to treatment modality or secondary comorbidity.

Alcohol outcome expectancies and drinking to cope with social situations.

Repeated use of alcohol as a coping strategy to reduce anxiety or discomfort increases one's risk of developing alcohol dependence. Previous studies have found alcohol outcome expectancies (AOE) strongly predict drinking behavior, in general, and also are related to drinking to cope. The purpose of the current study was to examine AOE that may be related to drinking to cope with discomfort in social situations. It was hypothesized that positive AOE, especially related to assertion and tension reduction, would be most associated with drinking to cope with social situations. Fifty-six community volunteers from a larger study on attentional bias and drinking to cope were divided into high (n=36) and low (n=20) drinking to cope groups following completion of a questionnaire battery. Findings indicated AOE were well able to classify drinking to cope status, with 91% of cases correctly classified. As hypothesized, assertion and tension reduction AOE uniquely contributed to the discriminant function in classifying drinking to cope groups. These findings have implications for the prevention and treatment of alcohol use disorders and suggest that AOE should be further investigated as potential moderators of the relationship between social anxiety and alcohol use disorders.

Associations between nicotine dependence, anhedonia, urgency and smoking motives.

Models of nicotine dependence have suggested that the association between urgency, a subconstruct of impulsivity, and smoking behaviors may be mediated by motivations. Motives that are driven by expectations that smoking will relieve negative affect or increase positive affect may be especially salient in persons who have depression symptoms such as anhedonia. Support for associations between symptoms of depression, urgency, and addiction has been found for alcohol dependence, but empirical analysis is lacking for an interactive effect of urgency and depression symptoms on nicotine dependence. The current study investigated relationships among the urgency facet of impulsivity, anhedonia, smoking motives, and nicotine dependence with secondary analyses of a sample of 1084 daily smokers using simultaneous moderation and multiple mediation analyses. The moderation analysis revealed that although urgency was significantly associated with smoking at average or higher levels of anhedonia, it was unrelated to smoking when few anhedonia symptoms were endorsed. Further, multiple mediation analyses revealed that the smoking motives of craving, cue exposure, positive reinforcement, and tolerance significantly mediated the relationship between urgency and nicotine dependence. Results suggest that models of alcohol addiction that include an interactive effect of urgency and certain symptoms of depression may be applied to nicotine dependence. Examination of the multiple mediational pathways between urgency and nicotine dependence suggests directions for intervention efforts.

The relationship between smoking motives and smoking urges experienced in response to a negative affect induction.

INTRODUCTION: The present study attempted to further elucidate the relationship between self-reported smoking motives and affect in college students. METHOD: Smoking motives were measured via self-report, and following a laboratory negative affect (NA) mood induction, urge to smoke was assessed via three questions. Participants were college students (N=84) who reported smoking an average of 8.74 (SD=5.36) cigarettes per day. RESULTS: Results indicated that smoking motives for Positive Reinforcement and Automaticity significantly predicted participants' responses on two measures of urge to smoke immediately following the NA induction. Positive Reinforcement motives were predictive of urge to smoke, and Automaticity motives were predictive of the number of cigarettes participants stated that they would smoke if cigarettes were provided for free. CONCLUSIONS: These findings indicate that (1) the association between NA and smoking is perhaps more complex than previously thought; and (2) merely two (Positive Reinforcement, Automaticity) of possibly thirteen smoking motives were identified as predictive of smoking urges. It is particularly surprising that other smoking motives (e.g., Negative Reinforcement) were not significant predictors of urge following the NA induction. Implications for relapse risk and treatment considerations among smokers experiencing elevated NA are considered.

Attentional bias and drinking to cope with social anxiety.

This study investigated the sensitivity of the emotional Stroop test for identifying individuals who reported drinking to cope with social fears. Community volunteers completed a modified Stroop task during which social threat, alcohol-related, and control words were presented. High scores on drinking-to-cope measures were hypothesized to be associated with longer response latencies to both social threat and alcohol-related words. Consistent with previous studies, alcohol dependence was correlated with latencies for alcohol-related words, and level of social anxiety was correlated with response latency to social threat words. As expected, drinking-to-cope measures predicted response latency to alcohol-related and social threat words. These results suggest that the emotional Stroop test is useful in studying the relationship between social anxiety and alcohol consumption.

Self-medication in social phobia: a review of the alcohol literature.

It is well documented that many individuals endorse the belief that alcohol reduces social anxiety. Individuals with social phobia, therefore, might be expected to use alcohol as a coping strategy in an attempt at self-medication. The purpose of the present paper was to review the published literature on the relationship between alcohol use and social phobia to test the self-medication hypothesis (SMH). Support for one aspect of the SMH was found; individuals with social phobia use alcohol to reduce anxiety. Support for the second premise, that alcohol actually reduces social anxiety, was less conclusive.

Exposure to negative affect cues and urge to smoke.

While much of the cue exposure literature for cigarette smoking has focused on external cues, little has been done in the area of exposing participants to internal cues, such as negative affect (NA), despite the important role of such cues in maintaining smoking behavior. Smokers were exposed to an NA mood induction to induce an urge to smoke and then exposed to NA cues over several trials in an attempt to decrease this urge. Participants (N = 32) were undergraduate smokers assigned to either the exposure or control group for the mood induction procedure, which occurred over 8 trials. All participants viewed NA images and listened to NA music at Trial 1. The exposure group continued to view NA images and listened to NA music, and the control group viewed neutral images and listened to neutral music for 6 subsequent trials lasting about 5 min each. Both groups were exposed to NA images and NA music at Trial 8. NA and urge to smoke ratings were assessed at the end of each trial; heart rate was measured continuously. Results indicated that the mood induction procedure induced NA and urge to smoke, but the extinction procedure did not decrease urge over trials. Heart rate data were not associated with self-report data. In conclusion, the mood induction procedure in the present study appears to be an efficient way to induce urge to smoke. However, further research is necessary to determine why urge to smoke seems to be resistant to extinction.

The relationship between depression level and smoking motives in college smokers.

While the link between cigarette smoking and depression symptomatology has been well established, more research is needed to determine how smoking motives are related to depression levels in smokers. Specifically, smoking motives related to the friendship-like attachment to smoking (i.e., affiliative attachment) may play an important role in individuals reporting depressive symptomatology. The present study examined the relationship between three smoking motives and depression levels in a sample of 79 mildly nicotine-dependent, college student cigarette smokers. A hierarchical multiple regression analysis was conducted with depression as the dependent variable and gender and cigarettes per day as the independent variables (Step 1), positive and negative reinforcement motives (Step 2), and affiliative attachment motives (Step 3). Results of regression analyses indicated that affiliative attachment motives explained significant variance in participant depression level above and beyond that explained by positive and negative reinforcement motives. These findings suggest that smokers with elevated depression should be assessed for social functioning and affiliative attachment smoking motives, and future research should be conducted to determine if individuals with high levels of affiliative attachment may benefit from smoking cessation treatment programs with an enhanced social support component.

High-resolution behavioral economic analysis of cigarette demand to inform tax policy.

AIMS: Novel methods in behavioral economics permit the systematic assessment of the relationship between cigarette consumption and price. Towards informing tax policy, the goals of this study were to conduct a high-resolution analysis of cigarette demand in a large sample of adult smokers and to use the data to estimate the effects of tax increases in 10 US States. DESIGN: In-person descriptive survey assessment. SETTING: Academic departments at three universities. PARTICIPANTS: Adult daily smokers (i.e. more than five cigarettes/day; 18+ years old; ≥8th grade education); n = 1056. MEASUREMENTS: Estimated cigarette demand, demographics, expired carbon monoxide. FINDINGS: The cigarette demand curve exhibited highly variable levels of price sensitivity, especially in the form of 'left-digit effects' (i.e. very high price sensitivity as pack prices transitioned from one whole number to the next; e.g. $5.80-6/pack). A $1 tax increase in the 10 states was projected to reduce the economic burden of smoking by an average of $530.6 million (range: $93.6-976.5 million) and increase gross tax revenue by an average of 162% (range: 114-247%). CONCLUSIONS: Tobacco price sensitivity is non-linear across the demand curve and in particular for pack-level left-digit price transitions. Tax increases in US states with similar price and tax rates to the sample are projected to result in substantial decreases in smoking-related costs and substantial increases in tax revenues.

Drinking to cope in socially anxious individuals: a controlled study.

BACKGROUND: Several hypotheses exist to account for the higher than normal rate of alcoholism in individuals with high trait anxiety (or anxiety disorders). Most of these suggest that the practice of drinking alcohol to reduce anxiety leads to an increased risk of alcoholism in vulnerable individuals. The first assumption of the hypothesis is that anxious individuals use alcohol to cope with their anxiety. Few studies have examined this issue systematically, and none have used a nonanxious matched control group. METHODS: Twenty-three individuals with high social anxiety and 23 nonsocially anxious matched controls were included in the study. Groups were similar on demographic variables and alcohol use. All participants were queried regarding the use of alcohol to cope, the practice of avoiding social situations if alcohol was not available, and the degree of relief attained by alcohol. Participants also were asked about using alcohol in 11 specific situations. RESULTS: The socially anxious group was significantly more likely than controls to report using alcohol to feel more comfortable in social situations and to avoid social situations if alcohol was unavailable. They also reported a greater degree of relief of anxiety from alcohol. Exploratory analyses revealed that socially anxious individuals reported using alcohol more to cope with social interactions than with social performance situations. CONCLUSIONS: Individuals high in social anxiety deliberately drink alcohol to cope with their social fears. They report that alcohol is moderately effective at reducing their anxiety, which is seemingly sufficient to allow them to endure social situations. The data support the first assumption of the self-medication hypothesis-that alcohol is used to reduce social discomfort in socially anxious individuals; however, the study was not designed to address the veracity of the self-medication hypothesis as a whole. Results can help guide future studies that examine the relationship between social anxiety and alcohol.