The Impact of Cigarette Relighting on Nicotine Dependence and Smoking Cessation Treatment Outcome Measures Among Adults With Mood Disorders.

INTRODUCTION: The number of cigarettes smoked per day (CPD) is a component of commonly used nicotine dependence measures and often used as a smoking cessation treatment outcome. Yet relighting (ie, smoking used cigarette butts) is not usually considered when CPD is assessed, which may underestimate nicotine dependence and result in an inaccurate picture of smoking behaviors. AIMS AND METHODS: Data from a randomized controlled trial of a smoking cessation intervention were used. Fagerström Test for Cigarette Dependence (FTCD), CPD, and the frequency of smoking (number of smoking episodes/day) assessed at baseline and 3-month follow-up were used. RESULTS: Participants were 49 adults with mood disorders who smoke daily receiving outpatient psychiatric treatment. At baseline, 27 (55.1%) participants reported relighting cigarettes, and 6 (27.3%) of those who did not report relighting at baseline reported relighting at 3-month follow-up. Replacing CPD with the frequency of smoking to recalculate the total FTCD score increased the score for 21 participants (43%). The mean FTCD scores increased from 4.61 to 5.16, from a classification of low to medium dependence, and 16 participants (33%) moved up in the dependence classification. Of the 31 participants who reported a >=50% reduction in CPD at 3-month follow-up, 5 (16%) did not achieve the outcome of >=50% reduction in the frequency of smoking per day. CONCLUSIONS: In this sample of adults with mood disorders who smoke, over half reported relighting cigarettes. Results underscore the importance of incorporating the frequency of smoking/relighting when assessing nicotine dependence and patterns of smoking behaviors in high-risk populations. IMPLICATIONS: This is the first study to investigate the patterns of relighting behavior and its impact on nicotine dependence and smoking cessation treatment outcome measures among treatment-seeking adults with mood disorders who smoke. The majority were relighting, and over a quarter of those who did not report relighting at baseline subsequently reported relighting in the context of a quit attempt. The findings demonstrate that overlooking relighting may underestimate nicotine dependence and overestimate the rates of those who have made meaningful changes in smoking behavior. Incorporating the frequency of smoking/relighting may help to more accurately capture nicotine dependence and patterns of smoking behavior among high-risk populations.

The Impact of Coping With Stressful Events on Negative Affect and Cravings Among Smokers With Mood Disorders.

INTRODUCTION: Smokers with mental illness report elevated levels of stress and negative affect. Craving is often cited as a key precipitant of smoking. Coping with stress has been associated with reduced cravings among smokers attempting to quit. However, the effect of coping with stress on negative affect and craving among smokers with mental illness is not well understood. This study investigated whether coping with stress predicts lower subsequent craving, mediated by reduced negative affect, among socioeconomically disadvantaged smokers with mood disorders. AIMS AND METHODS: This study used ecologically momentary assessment (EMA) data from a randomized controlled trial involving smokers with mood disorders. The final sample included 39 participants. RESULTS: Traditional mediation path analyses showed that coping with stress predicts lower craving (p = .02) through its impact on negative affect (p < .001) for the contemporaneous model (ie, when craving was measured at the same report as coping). However, coping with stress did not have a prospective effect on craving (ie, when craving was measured at the next report, up to 12 hours later) (p = .11). CONCLUSIONS: The results suggest that coping with stress reduces craving through negative effect, but only for a limited timeframe. The findings could guide future research on the length of time that the effect of coping lasts and research on interventions to increase coping with stress among smokers with mental illness. IMPLICATIONS: This is the first study to use EMA to demonstrate that coping with stressful events effectively reduces craving through reducing negative affect among smokers with mood disorders. This finding suggests that individuals heavily burdened with stress and negative affect benefit from coping with stress. We utilized within-subject analyses of EMA data which allowed us to understand these effects within an individual near real time. Our sample is hard to reach and ethnoculturally diverse. Findings could guide intervention research on helping smokers with mental illness cope when experiencing stress.

Relationships among Self-Efficacy, Quality of Life, Perceived Vulnerability, and Readiness to Quit Smoking in People Living with HIV.

Smoking-related diseases (e.g., lung cancer) are the leading cause of mortality in HIV-infected patients. While many PLWH who smoke report a desire to quit, a majority of them have low readiness to quit. This study used logistic and linear regression to examine the relations among two (continuous vs. binary) measures of readiness to quit, smoking cessation self-efficacy (SE), quality of life (QoL), and perceived vulnerability (PV) using baseline data from 100 PLWH who smoke who participated in a clinical trial. Results showed no significant main effects (SE, QoL, and PV) or interaction effects (SE × QoL and SE × PV) on a continuous measure of readiness to quit. However, a follow-up analysis revealed that SE had a curvilinear effect on readiness to quit such that self-efficacy was positively associated with readiness to quit except at the highest levels of self-efficacy where readiness to quit declined. Greater SE significantly increased the likelihood of reporting readiness to quit (yes/no) among those with low QoL or high PV. For PLWH who smoke, improving self-efficacy may increase readiness to quit especially among those with lower quality of life. Psychoeducation tailored to PLWH designed to reduce unrealistic invulnerability to smoking-related diseases along with interventions that target self-efficacy may improve readiness to quit.

The impact of menthol cigarette use on quit attempts and abstinence among smokers with opioid use disorder.

An exceedingly high proportion of persons with opioid use disorder (OUD) smoke cigarettes. Smokers with OUD face multiple barriers to smoking cessation. While menthol cigarette use has been associated with low cessation rates, research has not explored the impact of menthol cigarette use on tobacco use outcomes among smokers with OUD. Participants were current smokers, in methadone treatment for OUD, participating in randomized controlled trials of smoking cessation therapies. We examined the use of menthol cigarettes, and the association between menthol cigarette use and achieving 24-hour quit attempts and seven-day point prevalence abstinence. Of 268 participants, 237 (88.4%) reported menthol use. A similar proportion of menthol and non-menthol smokers achieved a 24-hour quit attempt (83.1% vs. 83.8%, p = 0.92). Though fewer menthol smokers (vs. non-menthol smokers) achieved abstinence (12.7% vs. 22.6%), this did not reach statistical significance (p = 0.14). In this sample of smokers with OUD, menthol smoking was nearly ubiquitous. Menthol smoking was not associated with differences in quit attempts, but was associated with differences in cessation that were not statistically significant. Menthol smoking may contribute to the challenges in achieving abstinence among smokers with OUD.

Context and craving among individuals with alcohol use disorder attempting to moderate their drinking.

Many individuals with alcohol use disorder (AUD) prefer a goal of moderation, because they do not see their drinking as causing severe enough consequences to merit abstinence. Given that individuals attempting to moderate will continue to put themselves in contexts where drinking occurs, understanding how distinct external alcohol cues prompt craving is important for implementing the optimal treatments for individuals with AUD. Using data from a randomized controlled trial of stepped care brief interventions for AUD, this study explored the relationship between drinking contexts and craving in individuals attempting to moderate their drinking using ecological momentary assessment (EMA). At baseline, participants were asked to prospectively identify drinking contexts that were particularly likely to elicit intense craving and heavy drinking, called highly valued drinking contexts (HVCs). During EMA, participants were asked to report three times a day (morning, afternoon, evening) on their non-mutually exclusive contexts and their level of craving. Using multilevel modeling, all drinking contexts were tested as concurrent predictors of craving across the 84 days of the study. Next, AUD severity was tested as a moderator of HVC on craving. Results demonstrated that being in an HVC corresponded to greater reports of any craving and intensity of craving, over and above the influences of several other contextual factors (e.g., negative affect and already drinking). AUD severity significantly moderated HVC's impact on any craving, such that greater AUD severity potentiated HVC's already high odds of any craving. Implications for treatments for individuals with AUD are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).