Increasing treatment enrollment among smokers who are not motivated to quit: a randomized clinical trial.

There is a significant research-to-practice gap with respect to reaching underserved populations with evidence-based tobacco cessation treatments. Increasing enrollment in evidence-based treatments is necessary to reduce tobacco use and tobacco-related health inequities. The purpose of the current study was to evaluate whether Motivation And Problem Solving (MAPS), a flexible, holistic counseling/navigation approach delivered via phone, and proactive provision of Nicotine Replacement Therapy (NRT) would improve Quitline enrollment among a sample of low SES smokers who were not motivated to quit. In a 3×2 factorial design, cigarette smokers (N = 603) were randomized to one of six treatment conditions (Standard Treatment, MAPS-6, or MAPS-12 by NRT or no NRT). Results indicated that both MAPS-6 and MAPS-12 increased Quitline enrollment compared to Standard Treatment (ps < .03). There were no differences between MAPS conditions. NRT did not increase Quitline enrollment. MAPS is an effective intervention with the potential to be disseminated and implemented in healthcare and community settings to increase the reach of evidence-based interventions for tobacco cessation.

Socioeconomic status, mindfulness, and momentary associations between stress and smoking lapse during a quit attempt.

BACKGROUND: Models of health disparities highlight stress among low socioeconomic status (SES) smokers as a barrier to cessation. Recent studies suggest that mindfulness may improve cessation outcomes by reducing stress during a quit attempt. The current study examined associations of SES and mindfulness with ecological momentary assessments (EMAs) of stress and smoking lapse during a quit attempt. METHODS: EMAs (N = 32,329) were gathered from 364 smokers engaged in a quit attempt. A multilevel structural equation model estimated within person paths from momentary stress to subsequent smoking lapse. Between person paths estimated paths from a latent variable for SES and mindfulness to stress and smoking lapse, the indirect effect of SES and mindfulness on lapse through stress, and moderation of within person stress-lapse associations by SES and mindfulness. RESULTS: Within person estimates found that momentary increases in stress predicted increased risk of subsequent smoking lapse. Between person estimates found that lower SES was indirectly associated with greater risk for smoking lapse through increased stress; and, higher mindfulness was indirectly associated with lower risk for smoking lapse through reduced stress. Additionally, higher SES participants, who reported lower stress during the quit attempt, showed a stronger relationship between momentary increases in stress and risk for subsequent smoking lapse. CONCLUSIONS: Among low SES smokers engaged in a quit attempt, both SES and mindfulness uniquely influenced smoking lapse through their influence on stress. Findings support reports that mindfulness presents a promising intervention target to reduce stress and improve cessation outcomes among low SES smokers.

Mechanisms linking mindfulness and early smoking abstinence: An ecological momentary assessment study.

Research has suggested that individuals with greater dispositional mindfulness (i.e., nonjudgmental, present-focused attention) are more likely to quit smoking, but the underlying mechanisms are unclear. This study investigated mechanisms linking mindfulness and early smoking abstinence using ecological momentary assessment (EMA). Participants were 355 smokers (33% Caucasian, 33% African American, 32% Latino; 55% female) receiving smoking cessation treatment. Mindfulness was assessed at baseline and on the quit date. For 4 days prequit and 1 week postquit, participants completed up to 4 EMAs per day indicating levels of negative affect (NA), positive affect (PA), smoking urges, and affect regulation expectancies. Mean, slope, and volatility were calculated for each prequit and postquit EMA variable. Associations among mindfulness, EMA parameters, and abstinence on the quit day and 7 days postquit, as well as indirect effects of mindfulness on abstinence through EMA parameters, were examined. Mindfulness predicted higher odds of abstinence in unadjusted but not covariate-adjusted models. Mindfulness predicted lower NA, higher PA, and lower affective volatility. Lower stress mediated the association between mindfulness and quit-day abstinence. Higher ratings of happy and relaxed, and lower ratings of bored, sad, and angry, mediated the association between mindfulness and postquit abstinence. Mindfulness appeared to weaken the association between craving and postquit abstinence. This study elucidates real-time, real-life mechanisms underlying dispositional mindfulness and smoking abstinence. During the early process of quitting smoking, more mindful individuals appeared to have more favorable emotional profiles, which predicted higher likelihood of achieving abstinence 1 week after the quit date. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mindfulness predicts lower affective volatility among African Americans during smoking cessation.

Recent research suggests that mindfulness benefits emotion regulation and smoking cessation. However, the mechanisms by which mindfulness affects emotional and behavioral functioning are unclear. One potential mechanism, lower affective volatility, has not been empirically tested during smoking cessation. This study examined longitudinal associations among mindfulness and emotional responding over the course of smoking cessation treatment among predominantly low-socioeconomic status (SES) African American smokers, who are at high risk for relapse to smoking and tobacco-related health disparities. Participants (N = 399, 51% female, mean age = 42, 48% with annual income <$10,000) completed a baseline measure of trait mindfulness. Negative affect, positive affect, and depressive symptoms were assessed at five time points during smoking cessation treatment (up to 31 days postquit). Volatility indices were calculated to quantify within-person instability of emotional symptoms over time. Over and above demographic characteristics, nicotine dependence, and abstinence status, greater baseline trait mindfulness predicted lower volatility of negative affect and depressive symptoms surrounding the quit attempt and up to 1 month postquit, ps < 0.05. Although volatility did not mediate the association between greater mindfulness and smoking cessation, these results are the first to show that mindfulness is linked to lower affective volatility (or greater stability) of negative emotions during the course of smoking cessation. The present study suggests that mindfulness is linked to greater emotional stability and augments the study of mindfulness in diverse populations. Future studies should examine the effects of mindfulness-based interventions on volatility and whether lower volatility explains effects of mindfulness-based treatments on smoking cessation.

Affective reactivity during smoking cessation of never-quitters as compared with that of abstainers, relapsers, and continuing smokers.

Much effort has been devoted to examining the differences in postcessation affective experience between smoking abstainers and relapsers. However, little attention has been given to the affective changes of smokers who, despite their motivation to quit, fail to achieve even a brief period of abstinence. Using affect-modulated startle response and self-report questionnaires, we measured the postcessation affective changes of 115 smokers (60 men, 55 women) who participated in a laboratory investigation of affective reactivity during smoking cessation. Among our participants, 34 were abstainers (16 men, 18 women), 16 were never-quitters (8 men, 8 women), 19 were relapsers (8 men, 11 women), and 46 were controls (28 men, 18 women). We found a significant Stimulus Valence × Session × Group interaction effect on startle responses, which suggested that while abstainers, relapsers, and control exhibited the prototypical affect-modulated startle response across postcessation sessions, never-quitters displayed an atypical response pattern in which emotional pictures no longer modulated the startle response. Never-quitters also reported increasingly higher negative and lower positive affect across postcessation sessions. Using affect-modulated startle response and self-report questionnaires, this study found a significant difference in the affective reactivity between smokers who could and smokers who could not establish an initial abstinence of 24 hours.

The serotonin transporter gene and startle response during nicotine deprivation.

Affective startle probe methodology was used to examine the effects of nicotine administration and deprivation on emotional processes among individuals carrying at least one s allele versus those with the l/l genotype of the 5-Hydroxytryptamine (Serotonin) Transporter Linked Polymorphic Region, 5-HTTLPR in the promoter region of the serotonin transporter gene [solute ligand carrier family 6 member A4 (SLC6A4) or SERT]. Smokers (n=84) completed four laboratory sessions crossing deprivation (12-h deprived vs. non-deprived) with nicotine spray (nicotine vs. placebo). Participants viewed affective pictures (positive, negative, neutral) while acoustic startle probes were administered. We found that smokers with the l/l genotype showed significantly greater suppression of the startle response when provided with nicotine vs. placebo than those with the s/s or s/l genotypes. The results suggest that l/l smokers, who may have higher levels of the serotonin transporter and more rapid synaptic serotonin clearance, experience substantial reduction in activation of the defensive system when exposed to nicotine.