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1.
Matern Child Health J ; 26(2): 389-396, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34623574

RESUMO

OBJECTIVES: In non-pregnant populations, cannabis use and cannabis use disorder (CUD) have been linked to tobacco use and less successful quit attempts. We compared perinatal cigarette use in women across 3 groups: never used cannabis (No CU group); used cannabis but did not meet CUD criteria (CU group); history of CUD (CUD group). METHODS: Interviews with 257 pregnant women with overweight/obesity (M age = 28 years; 52% white) were conducted for a study of eating behavior in Western Pennsylvania from 2012-2016. Tobacco use was assessed early in pregnancy (< 20 weeks gestation), late in pregnancy (34-38 weeks gestation) and 6 months postpartum. CUD was measured with the Structured Clinical Interview for DSM-IV (SCID). Data relevant to the proposed analyses were available for 252 women. Generalized mixed effect models were used to predict perinatal cigarette use based on cannabis use group, time and their interaction, adjusting for age, race, education, income, parity, and mood/anxiety disorder. RESULTS: Forty-eight percent of participants reported prior cannabis use and 15% were diagnosed with lifetime CUD. History of cannabis use predicted cigarette smoking in early pregnancy (OR 11.12, CI 3.27-37.85), late pregnancy (OR 6.55, CI 1.70-25.27), and 6 months postpartum (OR 7.57, CI 2.72-21.07), regardless of CUD. CONCLUSIONS: A history of CUD did not appear to confer additional risk for perinatal cigarette use. Given increasing rates of cannabis use among pregnant women, these results highlight the importance of addressing history of cannabis use in conjunction with tobacco use to improve smoking cessation efforts.


Assuntos
Cannabis , Abuso de Maconha , Produtos do Tabaco , Adulto , Estudos de Coortes , Feminino , Humanos , Obesidade/epidemiologia , Sobrepeso , Gravidez
2.
Int J Eat Disord ; 54(4): 633-638, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33368433

RESUMO

OBJECTIVE: Loss of control over eating (LOC) is common among women, particularly those with overweight and obesity (OV/OB), and predicts weight gain. Given the importance of understanding weight and eating behaviors during pregnancy, we sought to characterize LOC across pregnancy and the postpartum period among women with pre-pregnancy OV/OB. METHODS: Pregnant women (N = 257; 28.44 ± 5.48 years old) with self-reported OV/OB prior to pregnancy were interviewed using a pregnancy-adapted version of the Eating Disorder Examination (EDE-PV). Pre-pregnancy LOC was retrospectively assessed during the first trimester and then prospectively assessed monthly throughout pregnancy and postpartum over the course of seven assessments. RESULTS: Rates of LOC were significantly higher during pregnancy compared to prior to ( χ12 =44.845, p < .01) and after ( χ12 =36.379, p < .01) pregnancy, with 37% (n = 95) of women reporting ≥1 LOC episode during pregnancy. LOC during pregnancy was associated with higher likelihood of LOC postpartum. Higher age (OR = 1.084, p = .04) and identifying as a minority (OR = 0.344, p = .02) was associated with greater likelihood of experiencing LOC during pregnancy only. DISCUSSION: LOC during pregnancy is common among women with pre-pregnancy OV/OB, suggesting that screening and intervention for LOC during pregnancy may be warranted. Future research is necessary to examine the relationship between LOC during pregnancy and maternal and infant health outcomes.


Assuntos
Obesidade , Sobrepeso , Comportamento Alimentar , Feminino , Humanos , Hiperfagia , Obesidade/diagnóstico , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Gravidez , Estudos Retrospectivos
3.
Int J Behav Med ; 28(2): 200-206, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32378048

RESUMO

BACKGROUND: Women with prepregnancy overweight/obesity are at high risk for obstetric complications and cardiometabolic disease. Poorer sleep quality is associated with obesity in non-pregnant individuals and, during pregnancy, poor sleep predicts negative obstetric and health outcomes. This study examined sleep patterns among women with overweight/obesity and factors associated with different sleep trajectories during pregnancy. METHODS: Women (N = 146, 17-40 years old) with a prepregnancy body mass index ≥ 25 kg/m2 were recruited during early pregnancy. Participants reported demographic information and completed the Pittsburgh Sleep Quality Index (PSQI) at up to six monthly assessments, with the first assessment occurring between 12 and 20 weeks gestation and the final assessment between 35 weeks gestation and delivery. PSQI scores > 5 indicate "poor sleep." RESULTS: On average, women's PSQI scores were 6.66 ± 3.58 in the first half of pregnancy and were significantly higher (worse) at the end of pregnancy (t(644) = 4.55, p < 0.001), with the greatest change occurring in the third trimester (t(636.3) = 3.72, p < 0.001). Women who currently smoked had poorer sleep than women who did not currently smoke (t(1) = 2.29, p = 0.02). Prepregnancy weight status, age, parity, race, education, and income were not significantly associated with sleep changes (t(1) < 1.76, ps > 0.08). The percentage of women with PSQI scores > 5 (the threshold for poor sleep quality) was 37-63% across assessments, with the greatest increase occurring during the third trimester (t(633) = 2.92, p = 0.004). CONCLUSIONS: Sleep quality worsens during the third trimester and is associated with current smoking. Future studies of sleep during pregnancy should examine health outcomes among women with overweight/obesity and early intervention to mitigate sleep disturbances as pregnancy progresses.


Assuntos
Complicações na Gravidez , Gestantes , Adolescente , Adulto , Demografia , Feminino , Humanos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Sono , Adulto Jovem
4.
Ann Behav Med ; 54(2): 119-124, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31219152

RESUMO

BACKGROUND: Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown. PURPOSE: We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions. METHODS: Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum. RESULTS: End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect. CONCLUSION: Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components. CLINICAL TRIAL REGISTRATION: NCT00757068.


Assuntos
Depressão , Avaliação de Processos e Resultados em Cuidados de Saúde , Período Pós-Parto , Complicações na Gravidez , Prevenção Secundária/métodos , Prevenção do Hábito de Fumar/métodos , Adulto , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Gravidez , Complicações na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Prevenção Secundária/estatística & dados numéricos , Prevenção do Hábito de Fumar/estatística & dados numéricos
5.
Nicotine Tob Res ; 18(5): 538-46, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26453669

RESUMO

INTRODUCTION: The cue-reactivity procedure has demonstrated that smokers respond with increases in subjective craving in the presence of smoking-related cues. Virtual reality is an emerging mode of cue presentation for cue-reactivity research. Despite the successful implementation of virtual reality during the last decade, no systematic review has investigated the magnitude of effects across studies. METHODS: This research systematically reviewed findings from studies using virtual reality in cigarette craving assessment. Eligible studies assessed subjective craving for cigarettes in smokers exposed to smoking-related and neutral environments. Cohen's d was used to assess differences in craving between smoking-related and nonsmoking-related virtual environments. A random effects approach was used to combine effect sizes. RESULTS: A total of 18 studies involving 541 smokers was included in the final analyses. Environments with smoking-related cues produced significant increases in craving relative to environments without smoking-related cues. The mean overall effect size (Cohen's d) was 1.041 (SE = 0.12, 95% CI = 0.81 to 1.28, Z = 8.68, P < .001). CONCLUSIONS: The meta-analysis suggested that presentations of smoking cues through virtual reality can produce strong increases in craving among cigarette smokers. This strong cue-reactivity effect, which was comparable in magnitude to the craving effect sizes found with more conventional modes of cue presentation, supports the use of virtual reality for the generation of robust cue-specific craving in cue-reactivity research.


Assuntos
Fissura , Sinais (Psicologia) , Abandono do Hábito de Fumar , Tabagismo/psicologia , Interface Usuário-Computador , Adolescente , Adulto , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Adulto Jovem
6.
Nicotine Tob Res ; 18(4): 484-90, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25744955

RESUMO

INTRODUCTION: Puff topography variables, often measured using the Clinical Research Support System device, have traditionally been studied in regular, daily smokers and have been shown to be highly stable. However, more recent research has focused on non-daily smokers as a population of interest. As such, the aim of this article was to examine puff topography stability (cross-cigarette agreement over time) and reliability (within-cigarette consistency) in non-daily smokers across six laboratory sessions. METHODS: One hundred seven non-daily smokers attended six laboratory sessions over the course of 3 months. At each session, they smoked one cigarette through the Clinical Research Support System pocket, in addition to completing questionnaires about their smoking history and dependence. RESULTS: Puff topography measurements were highly reliable (α values ranged from 0.87-0.95) and puff behavior was highly stable across sessions (r values ranged from 0.38-0.84). Adding sessions substantially improved reliability estimates. Aspects of puffing behavior observed in session, including puff volume, puff duration, time of puff peak, and total cigarette volume were related to level of smoke exposure, measured by expired carbon monoxide. Instability in puffing behavior was not predicted by recent or long-term smoking patterns. CONCLUSIONS: Puff topography appears to be a stable and routinized aspect of smoking in non-daily smokers. The feasibility of assessing puff topography in this population is supported by the high reliabilities observed, though it should be noted that reliability greatly improved by having more than one session.


Assuntos
Monóxido de Carbono/análise , Fumaça/análise , Fumar , Produtos do Tabaco/análise , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fumar/tendências , Nicotiana/química , Adulto Jovem
7.
Nicotine Tob Res ; 15(12): 1988-95, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23817585

RESUMO

INTRODUCTION: Craving is useful in the diagnosis of drug dependence, but it is unclear how various items used to assess craving might influence the diagnostic performance of craving measures. This study determined the diagnostic performance of individual items and item subgroups of the 32-item Questionnaire on Smoking Urges (QSU) as a function of item wording, level of craving intensity, and item stability. METHODS: Nondaily and daily smokers (n = 222) completed the QSU on 6 separate occasions, and item responses were averaged across the administrations. Nicotine dependence was assessed with the Wisconsin Inventory of Smoking Dependence Motives. The discriminative performance of the QSU items was evaluated with receiver-operating characteristic curves and area under the curve statistics. RESULTS: Although each of the QSU items and selected subgroups of items significantly discriminated dependent from nondependent smokers, certain item subgroups outperformed others. There was no difference in discriminative performance between use of the specific terms urge and crave or between items assessing intention to smoke relative to those assessing desire to smoke, but there were significant differences in the two major factors represented on the QSU and in craving items reflecting more intense relative to less intense craving. Stability of the item scores was strongly related to the discriminative performance of craving. CONCLUSIONS: Items indexing stable, high-intensity aspects of craving that reflect the negative reinforcing effects of smoking will likely be most useful for diagnostic purposes. Future directions and implications are discussed.


Assuntos
Comportamento Aditivo/psicologia , Fissura , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Síndrome de Abstinência a Substâncias/psicologia , Tabagismo/psicologia , Adolescente , Adulto , Área Sob a Curva , Feminino , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Tabagismo/diagnóstico , Adulto Jovem
8.
J Pediatr Psychol ; 37(1): 23-32, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21880695

RESUMO

OBJECTIVE: Assess the effect of ostracism and social connection-related activities on adolescents' motivation to eat and their energy intake. METHODS: Participants (n = 103; M age = 13.6 years) were either ostracized or included when playing a computer game, Cyberball. Next, they wrote about their friend (social-connection), watched television (distraction), or completed Sudoku puzzles (cognitive-load), and then completed a task to earn points toward snack food and/or socializing. Afterwards, participants were given access to food and social activities. RESULTS: Ostracized adolescents were more motivated to earn food than adolescents who were in the included/control condition. Follow-up contrasts indicated that ostracized adolescents who wrote about friends worked more for food points and consumed more food than other adolescents. CONCLUSION: Results suggest that social connection-related activities following ostracism may further deplete self-regulatory resources, thereby resulting in increased unhealthy food patterns. Study limitations as well as clinical implications of these findings are discussed.


Assuntos
Ingestão de Energia , Comportamento Alimentar/psicologia , Relações Interpessoais , Motivação , Isolamento Social/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Feminino , Alimentos , Humanos , Masculino , Controles Informais da Sociedade , Televisão
9.
Appetite ; 56(1): 39-45, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21094193

RESUMO

There is growing evidence that the experience of being ostracized can impair individuals' abilities to self-regulate, which in turn, leads to negative health behaviors, such as increased unhealthy eating. Research has focused on adults, but deficits in eating regulation in response to ostracism may be particularly detrimental for overweight or obese youth. This study examines the effects of a brief episode of ostracism on the motivation to eat and food intake of overweight and normal-weight young adolescents (M age=13.6 years). A computerized ball-tossing game (Cyberball) was used to induce ostracism or inclusion. Following the inclusion/ostracism manipulation, all participants completed an operant computer task to earn points exchangeable for portions of food or for time socializing with an unfamiliar peer. Participants' responses for food and their subsequent energy intake were recorded. As hypothesized, ostracized overweight participants responded more for food and had a greater energy intake than overweight participants in the inclusion/control condition; whereas this was not the case for normal-weight participants. These results are important as studies indicate that overweight and obese youth may be at risk of social isolation and peer difficulties. Social adversity, if left unchanged, may increase the difficulty of promoting long-term changes in overweight youths' health behaviors.


Assuntos
Ingestão de Energia , Comportamento Alimentar/psicologia , Hiperfagia/psicologia , Motivação , Obesidade/psicologia , Isolamento Social , Estresse Psicológico , Adolescente , Computadores , Feminino , Alimentos , Humanos , Hiperfagia/etiologia , Relações Interpessoais , Masculino , Grupo Associado , Valores de Referência , Recompensa , Resposta de Saciedade , Comportamento Social , Controles Informais da Sociedade , Meio Social
10.
Womens Health Issues ; 30(5): 393-400, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32646724

RESUMO

BACKGROUND: Excess weight during pregnancy increases risk for adverse obstetrical outcomes. Physical activity (PA) may buffer these effects, although it is unclear what factors are associated with PA in women who begin pregnancy with overweight/obesity. The present study sought to characterize the demographic and psychological correlates of PA among women with prepregnancy overweight/obesity. METHODS: Pregnant women (N = 249; mean age, 28.48 ± 5.48 years; mean body mass index, 34.13 ± 7.07 kg/m2) at 12-20 weeks of gestation (mean, 15.68 ± 2.44 weeks of gestation) completed ratings of perceived stress and depressive symptoms and were interviewed using the pregnancy version of the Eating Disorders Examination. The Paffenbarger Physical Activity Survey was administered via interview to estimate energy expenditure. Continuous outcomes were evaluated via linear regression, while logistic regression was conducted to assess likelihood of meeting PA guidelines. RESULTS: Mean weekly duration of moderate to vigorous PA was 109.50 ± 248.17 minutes, with 21% of women meeting federal PA guidelines of 150 minutes or more. Higher perceived stress (ß = -0.217; p = .02) and eating psychopathology (ß = -0.213; p < .01) were associated with lower total energy expenditure. Black women reported lower expenditure specifically from walking compared with White women (ß = -0.180; p = .03). Depressive symptoms were not associated with PA. No estimate of PA predicted body mass index. CONCLUSIONS: Pregnant women with overweight/obesity engage in modest amounts of PA early in pregnancy, although few meet PA guidelines. Greater perceived stress and eating psychopathology were associated with lower PA engagement. These factors should be monitored by obstetrics providers to identify women who may particularly benefit from counseling about PA during pregnancy.


Assuntos
Exercício Físico/fisiologia , Obesidade/complicações , Sobrepeso/complicações , Adulto , Índice de Massa Corporal , Metabolismo Energético , Feminino , Humanos , Gravidez , Inquéritos e Questionários , Caminhada , Adulto Jovem
11.
Eat Behav ; 33: 61-66, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30959242

RESUMO

Food cue-reactivity tasks are used to induce and evaluate food cravings. Extant research has implicated the role of tasting foods in heightening cue-elicited food craving. The present study was the first to evaluate a taste manipulation during a food cue-reactivity task to optimize cue-elicited craving and predict food intake. Participants with overweight/obesity (N = 35; M age = 33.46 years [SD = 13.27]; M BMI = 32.91 kg/m2 [SD = 5.34]) engaged in one laboratory session and were randomized to a 'No Taste' or 'Taste' condition. All participants reported baseline food craving and observed two types of high-calorie food cues during a cue-reactivity task: photographic and real foods. The Taste group tasted real food cues and the No Taste group did not. Cue-elicited craving was assessed after the presentation of each food cue. Calorie intake of palatable foods was subsequently measured during a bogus taste test. Results indicated that cue-elicited craving to high-calorie foods was greater for the No Taste relative to the Taste group and that calorie intake was greater for the Taste relative to the No Taste group; both effects were nonsignificant, but of medium-size. Cue-elicited craving was significantly greater following exposure to high-calorie real food cues compared to photographic food cues. Results provide initial evidence that presenting high-calorie real (vs. photographic) food cues and forgoing taste manipulation during a food cue-reactivity task may optimize cue-elicited craving, and that taste manipulation could increase subsequent food intake. Future research should be conducted to replicate findings in larger samples with greater power to detect significant effects.


Assuntos
Fissura/fisiologia , Sinais (Psicologia) , Comportamento Alimentar/psicologia , Paladar/fisiologia , Adulto , Ingestão de Energia/fisiologia , Feminino , Alimentos , Humanos , Masculino , Obesidade/psicologia , Adulto Jovem
12.
Womens Health Issues ; 29(3): 259-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31072756

RESUMO

BACKGROUND: Postpartum relapse to cigarette smoking is common and relapse prevention interventions have indicated limited efficacy. Abstinence motivations and self-efficacy are two factors that might fluctuate during the postpartum period and predict smoking abstinence. The present study was a secondary analysis that examined statistical trends in motivations and self-efficacy to sustain postpartum abstinence and evaluated their association with sustained abstinence from pregnancy through 52 weeks postpartum. METHODS: Former smokers (N = 300) were recruited for a parent study evaluating two postpartum behavioral relapse prevention interventions. Participants completed assessments prenatally (baseline) and at 12, 24, and 52 weeks postpartum. Motivations to sustain abstinence for internal (intrinsic motivation) and external (extrinsic motivation) reasons, for the health of the baby (baby's health motivation), to maintain a healthy pregnancy (pregnancy motivation), and to avoid children becoming smokers (parenting motivation) were measured at each assessment. Confidence in maintaining abstinence, despite negative affective experiences (internal self-efficacy) and outside circumstances (external self-efficacy), was also assessed. Smoking was biochemically verified at each assessment. RESULTS: Linear mixed models indicated decreasing intrinsic, baby's health, and parenting motivations from baseline to 12 and 24 weeks postpartum and increasing motivations from 24 to 52 weeks postpartum (ps < .03). Higher baseline internal self-efficacy was associated with lower probability of relapse at 24 weeks postpartum (odds ratio, 0.92; 95% CI, 0.87-0.98), although this effect became nonsignificant after adjustment for multiple statistical tests. Abstinence motivations and external self-efficacy were not significantly associated with relapse (ps > .10). CONCLUSIONS: Levels of abstinence motivations fluctuated from pregnancy through postpartum. Future work should investigate more potent predictors of postpartum abstinence.


Assuntos
Mães/psicologia , Motivação , Período Pós-Parto/psicologia , Prevenção Secundária/métodos , Autoeficácia , Abandono do Hábito de Fumar/psicologia , Prevenção do Hábito de Fumar/métodos , Adulto , Feminino , Humanos , Gravidez
13.
Health Psychol ; 38(3): 248-258, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30762404

RESUMO

OBJECTIVE: Smoking and overweight or obesity are preventable causes of disease and death. Women are reluctant to quit smoking because of concerns about postcessation weight gain, underscoring the need to elucidate patterns of weight concerns and associated psychosocial factors that may affect smoking cessation outcomes. The present study aimed to subtype women smokers based on psychosocial and behavioral factors associated with smoking and weight, and examine the utility of these subtypes to predict abstinence and postcessation weight gain. METHOD: Weight-concerned women (N = 343) were randomized to 1 of 2 smoking cessation counseling adjuncts and 1 of 2 cessation medication conditions. At baseline, women were weighed and completed measures of depression, weight or appearance concerns, and eating behaviors. At 3-, 6-, and 12-months after the target quit date, women were weighed and completed self-report and biochemical smoking assessments. RESULTS: Latent profile (LP) analyses supported a 3-profile model. The groups had typical (53%, LP1), minimal (33%, LP2), and high (14%, LP3) levels of depressive symptoms and weight concerns. At 12-months posttarget quit date, women in LP3 were more likely to relapse than women in LP1 (odds ratio, OR = 2.93). Among abstinent women, those in LP2 and LP3 gained more postcessation weight than those in LP1. CONCLUSIONS: Heterogeneity in symptoms of depression, weight or appearance concerns, and eating behaviors was captured by three groups of women smokers, with unique risks for relapse and postcessation weight gain. The distinct profiles identified may help personalize the delivery of care for smoking cessation and, ultimately, reduce disease risk. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Fumar Cigarros/psicologia , Transtorno Depressivo/psicologia , Ingestão de Alimentos/psicologia , Sobrepeso/psicologia , Saúde da Mulher , Adolescente , Adulto , Idoso , Peso Corporal , Aconselhamento , Método Duplo-Cego , Comportamento Alimentar , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade , Recidiva , Abandono do Hábito de Fumar/psicologia , Prevenção do Hábito de Fumar , Aumento de Peso , Adulto Jovem
14.
Contemp Clin Trials ; 79: 111-121, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30851434

RESUMO

Pre-pregnancy overweight/obesity and excessive gestational weight gain (GWG) independently predict negative maternal and child health outcomes. To date, however, interventions that target GWG have not produced lasting improvements in maternal weight or health at 12-months postpartum. Given that interventions solely aimed at addressing GWG may not equip women with the skills needed for postpartum weight management, interventions that address health behaviors over the perinatal period might maximize maternal health in the first postpartum year. Thus, the current study leveraged a sequential multiple assignment randomized trial (SMART) design to evaluate sequences of prenatal (i.e., during pregnancy) and postpartum lifestyle interventions that optimize maternal weight, cardiometabolic health, and psychosocial outcomes at 12-months postpartum. Pregnant women (N = 300; ≤16 weeks pregnant) with overweight/obesity (BMI ≥ 25 kg/m2) are being recruited. Women are randomized to intervention or treatment as usual on two occasions: (1) early in pregnancy, and (2) prior to delivery, resulting in four intervention sequences. Intervention during pregnancy is designed to moderate GWG and introduce skills for management of weight as a chronic condition, while intervention in the postpartum period addresses weight loss. The primary outcome is weight at 12-months postpartum and secondary outcomes include variables of cardiometabolic health and psychosocial well-being. Analyses will evaluate the combination of prenatal and postpartum lifestyle interventions that optimizes maternal weight and secondary outcomes at 12-months postpartum. Optimizing the sequence of behavioral interventions to address specific needs during pregnancy and the first postpartum year can maximize intervention potency and mitigate longer-term cardiometabolic health risks for women.


Assuntos
Ganho de Peso na Gestação , Promoção da Saúde/organização & administração , Saúde Mental , Sobrepeso/terapia , Cuidado Pré-Natal/organização & administração , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Depressão/epidemiologia , Depressão/terapia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta , Dislipidemias/epidemiologia , Dislipidemias/prevenção & controle , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Estilo de Vida , Obesidade/psicologia , Obesidade/terapia , Sobrepeso/psicologia , Período Pós-Parto , Gravidez , Projetos de Pesquisa , Autocontrole , Sono , Apoio Social , Estresse Psicológico/epidemiologia , Estresse Psicológico/terapia , Saúde da Mulher
15.
Addict Behav ; 76: 250-257, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28865363

RESUMO

PURPOSE: Concern about postcessation weight gain may be one potential barrier to quitting smoking. In this 'mini-review' of recent literature, we summarize findings on the relationship between postcessation weight gain concern and smoking cessation, and evaluate varied use of postcessation weight gain concern assessments and potential moderators of the postcessation weight gain concern-cessation association. METHODS: We conducted a search using the terms "smoking" OR "smoking cessation" AND "weight concern" for articles published between January 1, 2011 and December 31, 2016. We identified 17 studies assessing postcessation weight gain concern, seven of which evaluated the postcessation weight gain concern-cessation association. RESULTS: The relationship between postcessation weight gain concern and smoking cessation was mixed. Recent studies varied in their assessments of postcessation weight gain concern, many of which were not validated and assessed correlates of this construct. Studies varied in their adjustment of demographic (e.g., sex), smoking-specific (e.g., smoking level), and weight-specific (e.g., body mass index) variables. CONCLUSIONS: The use of non-validated assessments and variability in testing covariates/moderators may contribute to conflicting results regarding the postcessation weight gain concern-cessation relationship. We recommend validating an assessment of postcessation weight gain concern, maintaining vigilance in testing and reporting covariates/moderators, and investigating trajectories of this construct over time and by smoking status to inform future assessment and intervention efforts.


Assuntos
Fumar Cigarros/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Aumento de Peso , Humanos
16.
Psychopharmacology (Berl) ; 235(7): 2001-2012, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29704217

RESUMO

RATIONALE: Current research on factors that predict smoking lapse behavior is limited in its ability to fully characterize the critical moments leading up to decisions to smoke. OBJECTIVES: We used a validated and widely used experimental analogue for smoking lapse to assess how moment-to-moment dynamics of craving relate to decisions to smoke. METHODS: Heavy smokers (N = 128, M age = 35.9) participated in a 50-min laboratory delay to smoking task on 2 consecutive days, earning money for each 5 min they remained abstinent or ending the task by choosing to smoke. Participants rated craving and negative affect levels immediately prior to each choice. Participants were randomized to smoking as usual (n = 50) or overnight abstinence (n = 50 successfully abstained, n = 22 failed abstaining) prior to session 2. Discrete-time hazard models were used to examine craving and negative affect as time-varying predictors of smoking. RESULTS: Higher craving levels prior to smoking opportunities predicted increased risk of smoking. When controlling for craving levels, incremental increases in craving predicted increased smoking risk. Increases in negative affect incrementally predicted increased smoking risk at session 2 only. Smokers who failed to abstain were at a higher risk of smoking than those who successfully abstained, whereas abstinent and non-abstinent smokers did not differ in smoking risk. CONCLUSIONS: Findings demonstrate an extension of the smoking lapse paradigm that can be utilized to capture momentary changes in craving that predict smoking behavior. Evaluations of nuanced craving experiences may inform clinical and pharmacological research on preventing smoking lapse and relapse.


Assuntos
Fissura , Abandono do Hábito de Fumar/métodos , Fumar Tabaco , Tabagismo/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Fumantes , Fumar , Prevenção do Hábito de Fumar , Adulto Jovem
17.
Addict Behav ; 84: 13-19, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29597136

RESUMO

INTRODUCTION: The Intolerance for Smoking Abstinence Discomfort Questionnaire (IDQ-S) assesses distress tolerance specific to nicotine withdrawal. Though developed to assess withdrawal-related distress, the IDQ-S has not been validated among nicotine-deprived, treatment-seeking smokers. The present study extended previous research by examining the predictive utility of the IDQ-S among abstinent, motivated-to-quit smokers. METHODS: Abstinent, treatment-seeking smokers completed the IDQ-S Withdrawal Intolerance and Lack of Cognitive Coping scales, assessments of nicotine dependence and reinforcement, and smoking history at baseline. At baseline and at 24-h, 2-week, and 1-month follow-up, participants completed a smoking cue-reactivity task (collection of cue-elicited craving and negative affect), and assessments of cigarettes per day (CPD; daily diaries at follow-up), carbon monoxide (CO), and cotinine. RESULTS: Greater IDQ-S Withdrawal Intolerance was associated with younger age, higher nicotine dependence and reinforcement, and less smoking years (ps < .03). Greater IDQ-S Lack of Cognitive Coping was associated with less education, lower nicotine dependence and reinforcement, higher baseline CPD, and no prior quit attempts (ps < .04). IDQ-S scales did not significantly predict cue-elicited craving or negative affect, CPD, CO, or cotinine levels at follow-up (ps > .10). CONCLUSIONS: Withdrawal intolerance and lack of cognitive coping did not predict smoking outcomes among nicotine-deprived, treatment-seeking smokers, but were associated with smoking characteristics, including nicotine dependence and reinforcement. Withdrawal intolerance and lack of cognitive coping may not be especially useful in predicting craving and smoking behavior, but future studies should replicate the present study's findings and assess the stability of the IDQ-S before forming firm conclusions about its predictive utility.


Assuntos
Adaptação Psicológica , Fissura , Sinais (Psicologia) , Abandono do Hábito de Fumar , Síndrome de Abstinência a Substâncias/psicologia , Tabagismo/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/efeitos adversos , Agonistas Nicotínicos/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde , Síndrome de Abstinência a Substâncias/etiologia
18.
J Consult Clin Psychol ; 86(11): 903-914, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30335423

RESUMO

OBJECTIVE: Long-term abstinence can be undermined by cessation fatigue-an exhaustion of coping resources attributable to quitting smoking/staying quit. The current study examines the predictive validity of a Cessation Fatigue Scale (CFS; three subscales). Among current smokers, we hypothesized higher fatigue would predict longer latency to both quit initiation and achieving 7-day point prevalence abstinence (7-day PPA). Among recent quitters, we expected higher cessation fatigue would confer greater lapse/relapse risk. Lower rates of abstinence at 2-month follow-up were expected for those with higher fatigue. METHOD: Current smokers motivated to quit in the next month (n = 301) and recent quitters (n = 242) were assessed biweekly over the course of 2 months. Retention rates were high (>85%). Cox and logistic regression analyses tested hypotheses. RESULTS: Among smokers, greater emotional exhaustion predicted longer delay to achieving 7-day PPA (HR = .53, 95% CI [.40, -.68], p < .001) and lower likelihood of 7-day PPA at 2-month follow-up (OR = .27, 95% CI [.16, -.46], p < .001), even after controlling for nicotine dependence and motivation to quit. Among recent quitters, emotional exhaustion progressively increased over the first 6 weeks since quit initiation. Elevated exhaustion was associated with greater lapse (HR = 1.65, 95% CI [1.06, 2.56], p < .05) and relapse (HR = 2.33, 95% CI [1.37, 3.97], p < .01) risk, and lower likelihood of 7-day PPA at 2-month follow-up (OR = .39, 95% CI [.16, .94], p < .05), even after controlling for nicotine withdrawal and motivation to quit. CONCLUSIONS: Cessation fatigue, as measured by the CFS's emotional exhaustion subscale, prospectively predicted important cessation milestones. Findings suggest that cessation fatigue is a novel process that undermines smoking cessation and a viable target for intervention. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Motivação , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Tabagismo/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nicotina/efeitos adversos , Recidiva , Síndrome de Abstinência a Substâncias/psicologia , Tabagismo/reabilitação , Adulto Jovem
19.
JAMA Psychiatry ; 74(3): 214-223, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28146243

RESUMO

IMPORTANCE: Recent research on addiction-related memory processes suggests that protracted extinction training following brief cue-elicited memory retrieval (ie, retrieval-extinction [R-E] training) can attenuate/eradicate the ability of cues to elicit learned behaviors. One study reported that cue-elicited craving among detoxified heroin addicts was substantially attenuated following R-E training and through 6-month follow-up. OBJECTIVE: To build on these impressive findings by examining whether R-E training could attenuate smoking-related craving and behavior. DESIGN, SETTING, AND PARTICIPANTS: This prospective, mixed-design, human laboratory randomized clinical trial took place between December 2013 and September 2015. Participants were recruited in Charleston, South Carolina. Study sessions took place at the Medical University of South Carolina. The participants were 168 screened volunteer smokers, of whom 88 were randomized; 72 of these 88 participants (81.8%) attended all the follow-up sessions through 1 month. The primary eligibility criteria were current nicotine dependence (DSM criteria), smoking 10 or more cigarettes per day, and a willingness to attempt smoking cessation. INTERVENTIONS: Participants were randomly assigned to receive either smoking-related memory retrieval followed by extinction training (the R-E group) or nonsmoking-related retrieval followed by extinction training (the NR-E group). MAIN OUTCOMES AND MEASURES: Primary outcomes were cue-elicited craving and physiological responding to familiar and novel cues in the R-E group vs the NR-E group over a 1-month follow-up period. Secondary outcomes were smoking-related behaviors. RESULTS: A total of 44 participants were randomly assigned to the R-E group (mean age, 48.3 years; 72.7% male); a total of 44 participants were randomly assigned to the NR-E group, with 43 attending at least 1 training session (mean age, 46.7 years; 55.8% male). The mean craving response to both familiar and novel smoking cues was significantly lower for participants in the R-E group than for participants in the NR-E group at 1-month follow-up (for both cue types: t1225 = 2.1, P = .04, d = 0.44, and Δ = 0.47 [95% CI, 0.04-0.90]). The mean numbers of cigarettes smoked per day at 2 weeks and 1-month were significantly lower for the R-E group than for the NR-E group (treatment main effect: F1,68 = 5.4, P = .02, d = 0.50, and Δ = 2.4 [95% CI, 0.4-4.5]). Significant differences in physiological responses, urine cotinine level, number of days abstinent, lapse, and relapse were not observed between groups (all between P = .06 and .75). CONCLUSIONS AND RELEVANCE: Retrieval-extinction training substantially attenuated craving to both familiar and novel smoking cues and reduced the number of cigarettes smoked per day by participants 1 month after treatment relative to extinction training alone. Between-group differences were not observed for physiological responses, cotinine level, number of days abstinent, relapse, or lapse. In summary, R-E training is a brief behavioral treatment that targets smoking-related memories and has the potential to enhance relapse prevention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02154685.


Assuntos
Aprendizagem , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Prevenção do Hábito de Fumar , Fumar/psicologia , Adulto , Fissura , Sinais (Psicologia) , Extinção Psicológica , Feminino , Seguimentos , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Adulto Jovem
20.
Drug Alcohol Depend ; 169: 180-189, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27863344

RESUMO

BACKGROUND: The selection criteria used in clinical trials for smoking cessation and in laboratory studies that seek to understand mechanisms responsible for treatment outcomes may limit their generalizability to one another and to the general population. METHODS: We reviewed studies on varenicline versus placebo and compared eligibility criteria and participant characteristics of clinical trials (N=23) and laboratory studies (N=22) across study type and to nationally representative survey data on adult, daily USA smokers (2014 National Health Interview Survey; 2014 National Survey on Drug Use and Health). RESULTS: Relative to laboratory studies, clinical trials more commonly reported excluding smokers who were unmotivated to quit and for specific medical conditions (e.g., cardiovascular disease, COPD), although both study types frequently reported excluding for general medical or psychiatric reasons. Laboratory versus clinical samples smoked less, had lower nicotine dependence, were younger, and more homogeneous with respect to smoking level and nicotine dependence. Application of common eligibility criteria to national survey data resulted in considerable elimination of the daily-smoking population for both clinical trials (≥47%) and laboratory studies (≥39%). Relative to the target population, studies in this review recruited participants who smoked considerably more and had a later smoking onset age, and were under-representative of Caucasians. CONCLUSIONS: Results suggest that selection criteria of varenicline studies limit generalizability in meaningful ways, and differences in criteria across study type may undermine efforts at translational research. Recommendations for improvements in participant selection and reporting standards are discussed.


Assuntos
Ensaios Clínicos como Assunto/métodos , Laboratórios , Seleção de Pacientes , Abandono do Hábito de Fumar/métodos , Fumar/tratamento farmacológico , Vareniclina/uso terapêutico , Adulto , Bupropiona/uso terapêutico , Ensaios Clínicos como Assunto/normas , Feminino , Humanos , Laboratórios/normas , Pessoa de Meia-Idade , Nicotina/administração & dosagem , Agonistas Nicotínicos/uso terapêutico , Fumar/epidemiologia
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