A pilot randomized controlled trial of smartphone-assisted mindfulness-based intervention with contingency management for smokers with mood disorders.

Cigarette smoking disproportionately affects individuals with mood disorders, but smoking cessation interventions have modest effects in this population. Home mindfulness practice during abstinence incentivized via contingency management (CM) may help those in affective distress quit smoking. METHOD: Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, n = 25) or enhanced standard treatment (EST, n = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) ≤ 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day. RESULTS: Of the 49 participants, 63.3% were Latinx and 30.6% Black; 75.5% reported household incomes < $25,000. Abstinence rates for SMI-CM were 40.0%, 36.0%, and 16.0% versus 4.2%, 8.3%, and 4.2% in EST at weeks 2, 4, and 13. A generalized estimating equations (GEE) model showed significant overall differences in abstinence rates in SMI-CM versus EST (adjusted odds ratio [AOR] = 8.12, 95% CI = 1.42-46.6, p = .019). Those who received SMI-CM reported significantly greater reduction in smoking-specific experiential avoidance from baseline to 3 days prior to quit date (ß = -7.21, 95% CI = -12.1-2.33, p = .006). CONCLUSIONS: SMI-CM may increase cessation rates among smokers with mood disorders, potentially through reduced smoking-specific experiential avoidance. SMI-CM is a promising intervention, and warrants investigation in a fully powered randomized controlled trial (RCT). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ecological momentary assessment of recommended postoperative eating and activity behaviors.

BACKGROUND: Successful weight loss after bariatric surgery depends on the patient's adherence to prescribed eating and physical activity behaviors. However, few studies have assessed patients' adherence to the behavioral recommendations and most have used retrospective self-report measures. The present study is the first to use ecological momentary assessment (EMA) via a palmtop computer to assess bariatric surgery patients' eating and activity behaviors in real-time in the natural environment. The study was conducted at Miriam Hospital (Providence, RI). METHODS: A total of 21 patients (14 laparoscopic adjustable gastric banding and 7 Roux-en-Y; 81% women; mean age 48.5 yr) were studied 6.1 ± 2.1 months postoperatively. The participants used a palmtop computer for 6 days to report on all eating and physical activity episodes as they occurred in the natural environment. RESULTS: All participants demonstrated good compliance with the EMA, using the device on ≥5 full days. Most participants (94.8%) adhered to the recommendation to not drink while eating, and most took their vitamin supplements and medication as prescribed (85.7% and 90.5%, respectively). Few (4.8%) participants ate the recommended ≥5 meals daily, most participants exceeded the recommended portion sizes during meals and snacks (100% and 72.0% of the participants, respectively), and 47.6% of the participants consumed ≥5 servings of fruit and vegetables daily. Only 15.8% regularly consumed adequate liquids. Only 23.8% of participants engaged in moderate to vigorous physical activity for ≥30 minutes daily, as recommended. CONCLUSION: The EMA results suggested that adherence to the recommended behaviors varied considerably, depending on the behavior, with greater adherence to simple versus complex behaviors. EMA might eventually be a useful tool to help optimize the outcomes of bariatric surgery by identifying behavioral targets for additional monitoring and intervention.