"Healthier health in more ways than one": Perspectives on a program for changing both smoking and obesity-related health behaviors.

INTRODUCTION: Individuals with obesity who smoke cigarettes have increased risk of morbidity and mortality. The goal of the current study was to inform the development of a multiple health behavior change intervention designed to facilitate smoking cessation while also targeting weight gain. METHODS: Four qualitative focus groups were conducted with individuals who smoked cigarettes and had overweight or obesity (n = 16) to explore the combined effects of smoking and obesity, past attempts to quit smoking or lose weight, and preferences for a combined health intervention. RESULTS: Focus groups converged on five themes including: the interactive effects of weight and smoking; lack of experience with evidence-based weight loss approaches; a desire and expectation to lose weight quickly; rapid weight gain during past attempts at smoking cessation; and interest in a multiple health behavior change intervention with weight management preceding smoking cessation and an emphasis on planning for the future and receiving encouragement and support. CONCLUSIONS: Groups provided insight into key topics to highlight in a combined intervention and key issues that have interfered with success in both domains.

Development and Evaluation of a Measure of Drinking Behavior in Response to Acculturation Stressors for Latinx Adults Entering Alcohol Treatment.

Introduction: The current study presents the development of a scale to assess drinking behavior in response to acculturation and immigration stress. Methods: The 19-item Measure of Immigration and Acculturation Stressors (MIAS) and a parallel assessment, a Measure of Drinking in Response to Immigration and Acculturation Stressors (MDRIAS), were administered at baseline, 6 months, and 12 months in a completed randomized controlled trial testing culturally adapted motivational interviewing to reduce heavy drinking and related problems in Latinx individuals who met criteria for heavy drinking (n=149). Results: Exploratory factor analysis of the MIAS showed best fit for a four-factor solution (Relational Stress, Perceived Ethnic Discrimination, Attenuated Aspirations, and Sense of Alienation) with 15 items. The MIAS subscales and the four corresponding MDRIAS subscales were shown to have good reliability (i.e., internal consistency, intercorrelations, and test-retest) and criterion-related validity (i.e., concurrent, convergent, and predictive). Conclusions: These findings suggest that the MIAS can be used to assess different types of immigration and acculturation stressors for Latinx adults and the MDRIAS can be used to assess drinking in response to those experiences. The MIAS and MDRIAS could be used in the future to adapt alcohol interventions to relevant stressors that contribute to Latinx adults' alcohol use.

Circumstances Around Cigarette Use after Enforced Abstinence From Smoking in an American Prison.

OBJECTIVES: Most adults return to smoking after enforced tobacco abstinence when incarcerated in US prisons. Little is known about the specific relapse triggers on reentry. This study examines situational, affective, and motivational antecedents of return to smoking immediately after release from a tobacco-free prison. METHODS: Assessments were administered before release and 1 and 7 days after release to 190 incarcerated adults who were smokers before incarceration. Those reporting smoking within 7 days after release were asked about circumstances surrounding their first cigarette. RESULTS: Two-thirds reported smoking in the 7 days after release (76% of those in the first day) with the first cigarette smoked 21 hours after release on average. Smoking occurred more quickly for women than men and for those who planned to smoke after release ( P values from 0.05 to 0.001). Forty-one percent of participants smoked while waiting for a ride or on the way home, 68% were given their first cigarette, 28% reported first smoking when reuniting with others, 42% first smoked with smokers, and 26% first smoked as celebration. The moods most reported before smoking were happy (60%) or excited (41.5%). Factors reported that could have prevented smoking were avoiding other smokers (27%), avoiding stress (16%), not drinking/using drugs (12%), and not having access to cigarettes (11%). CONCLUSIONS: High rates of return to smoking occurred rapidly when around other smokers, using other substances, and in a positive mood. Interventions that focus specifically on these factors and can be immediately accessed upon release are required to help sustain people's desired abstinence.

Treatment outcomes associated with medications for opioid use disorder (MOUD) among criminal justice-referred admissions to residential treatment in the U.S., 2015-2018.

AIMS: To examine the use and association of medications for opioid use disorder (MOUD) with treatment completion and retention for criminal justice referred (CJR) admissions to residential treatment. METHODS: A retrospective analysis of the Treatment Episode Dataset-Discharge (TEDS-D; 2015-2018) for adults (N = 205,348) admitted to short-term (ST) (< 30 days) or long-term (LT) (>30 days) residential treatment for OUD. Outcomes were MOUD in treatment plans, and treatment completion and retention (ST >10 days; LT > 90 days). Logistic regression analyses were conducted separately for ST and LT settings. RESULTS: CJR admissions were less likely to have MOUD than non-CJR admissions (ST, 11% vs. 21%; LT, 10% vs. 24%, respectively) and were more likely to complete and be retained in treatment. In ST settings, MOUD was associated with higher likelihood of treatment completion and retention. In LT settings, MOUD was associated with higher likelihood of treatment retention and lower likelihood of treatment completion. These associations tended to be slightly weaker for CJR admissions, with the exception of treatment completion in LT settings, but the moderating effect size of CJR status in all models was very small. Small differences in the moderating effect of CJR status by race and ethnicity were observed in LT settings. CONCLUSIONS: MOUD is greatly under-utilized for CJR patients, and given that MOUD was associated with positive outcomes, there is a critical need to find ways to increase access to MOUD for CJR patients in residential treatment. Race and ethnicity appear to have relatively little impact on outcomes.

Using implementation interventions and peer recovery support to improve opioid treatment outcomes in community supervision: Protocol.

OBJECTIVE: The purpose is to determine whether a facilitated local change team (LCT) intervention improves linkage to medication for opioid use disorder (MOUD) and implementation outcomes, and whether participant-level outcomes are further enhanced by use of peer support specialists (PSS). METHODS: This Type 1 hybrid implementation-effectiveness study involves a pre-post design (implementation study) followed by a randomized trial of PSS (effectiveness study). Participants are at least 114 justice and service staff from 7 sites in three states: probation officers, community treatment providers, a supervisor from each agency, and key stakeholders. The study will recruit up to 680 individuals on probation from seven adult community probation offices; eligible individuals will be recently committed, English speakers, with opioid use disorder (OUD). Core Implementation Study: The study will use the exploration, preparation, implementation, sustainability (EPIS) framework to guide system-change through facilitated LCTs of probation and community treatment staff given a core set of implementation strategies to set goals. The study will collect program-level and staff survey data at the end of each EPIS stage. Implementation outcomes: Organizational engagement in MOUD (primary), plus changes in staff knowledge/attitudes and organizational outcomes (secondary). Effectiveness Study of PSS: After completing implementation, the study will randomize adults on probation to receive PSS vs. treatment as usual, with assessments at baseline, 3, 6 and 12 months. Effectiveness outcomes include participant engagement in MOUD (primary), probation revocation, illicit opioid use, and overdoses. Other aims include identifying barriers and facilitators, and cost-benefit analysis of PSS. Adaptations in response to COVID-19 included moving many procedures to remote methods.

Preparing for the Quit Day: Comparing Beliefs of Nondaily Versus Daily Young Adult Smokers as They Prepare for a Quit Attempt.

INTRODUCTION: Most smoking cessation approaches are modeled on heavy daily smoking. With increasing prevalence of nondaily smoking, it may be necessary to modify these approaches for nondaily smokers. AIMS: To provide information about beliefs and attitudes relevant to smoking cessation for nondaily smokers. METHODS: Secondary analysis of two prospective studies on young adult smokers (18-24 years of age) provided brief advice to quit smoking. Measures include baseline levels of constructs relevant to smoking cessation counseling and perceived benefits of and barriers to smoking cessation. RESULTS: Participants (n = 40 nondaily, 122 daily smokers) were predominantly White (70% and 84%, respectively), gender-balanced (50% and 43% female), full-time college students (89% and 95%). At baseline, nondaily smokers reported lower levels of nicotine dependence (p < .001; nondaily: Fagerström Test for Nicotine Dependence (FTND) = 0.8 ± 1.5, daily: FTND = 3.1 ± 1.9), lower urge to smoke (p < .001), greater self-efficacy when facing external smoking stimuli (p = .03), expecting to experience fewer positive effects (reduced negative affect, p = <.001, stimulation, p = .02), and valuing the importance of smoking effects less (ps < .01) than daily smokers. During counseling, nondaily smokers generated both fewer benefits of cessation (Wald X2(df = 1) = 4.91, p = .027) and fewer barriers (Wald X2(df = 1) = 5.99, p =.014) than daily smokers. Withdrawal was not listed by nondaily smokers as a barrier (p < .01). CONCLUSIONS: Constructs relevant to smoking cessation for daily smokers were less salient to young nondaily smokers, compared with moderately addicted young daily smokers, as indicated by responses to standardized scales and by the generation of fewer benefits and barriers in counseling. Interventions may need to find novel ways to engage nondaily smokers, particularly young adult, in smoking cessation efforts. IMPLICATIONS: This study is unique in eliciting benefits and barriers from nondaily smokers as they are about to make a quit attempt. This is a critically important point in time, as this is the point in time in which an action plan is formed and can be informed and enhanced by smoking cessation support. Our study further allowed direct comparison to daily smokers undergoing the same procedures, which allowed the identification of unique factors that may impact nondaily smokers in their quit attempt, which may guide intervention efforts. Use of a mixed method design further strengthen the rigor of this study.

COVID-19 Impact on Smokers Participating in Smoking Cessation Trials: The Experience of Nondaily Smokers Participating in a Smartphone App Study.

Objectives: To provide initial insight into how the COVID-19 pandemic could affect smoking behaviors and cessation efforts that were underway at its onset. Methods: An additional survey was added to follow-up assessments in an ongoing smoking cessation study for nondaily smokers: a measure of impact of COVID-19 and a subset of previously administered scales measuring smoking, emotional well-being, and alcohol use. Pre-post tests were conducted (84 ± 28 days apart). Results: Participants (81/100 of enrolled; 67% female, 75% white, 10% Hispanic, 37 ± 11 years old) reported experiencing changes regarding work (35% income reduction/loss; 35% remote work) and living situation (15% consolidated residences). Participants reported their motivation to quit smoking "slightly" increased after COVID-19 (p < 0.001), more so in those having achieved 30-day abstinence (p = 0.0045). Worry, fear, and a desire to support the greater good increased (ps < 0.05). Increases in motivation to quit correlated positively with prosocial and wellness changes. Data from pre- to post-COVID-19 onset showed decreases in emotional well-being (increased stress, negative affect, decreased coping, positive affect, all ps < 0.01), but not changes in smoking abstinence (p = 0.65), readiness to quit (p = 0.16), smoking frequency (p = 0.96), or cigarettes per day (p = 0.96). Heavy drinking decreased (p < 0.01). Trying e-cigarettes increased (p = 0.04). Conclusions: Nondaily smokers participating in a smoking cessation study during the COVID-19 pandemic reported worsened emotional well-being without effects on smoking outcomes and said their motivation to quit was slightly increased. Correlations of motivation to quit with prosocial and wellness changes suggest that targeting these constructs may be particularly helpful during a pandemic.

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers.

OBJECTIVE: Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators. METHODS: Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates. RESULTS: Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months). CONCLUSIONS: Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers.

Pilot trial investigating a brief behavioral economic intervention as an adjunctive treatment for alcohol use disorder.

OBJECTIVE: Behavioral economic research suggests that increasing the salience of a delayed reward may improve capacity for delaying gratification and increase behavior allocated toward obtaining larger, delayed substance-free reward rather than smaller, more immediate reward such as alcohol use. This study aimed to improve the efficacy of outpatient alcohol use disorder (AUD) treatment by adding elements that target behavioral economic mechanisms of change. METHOD: Forty-one (N = 41) adults in outpatient AUD treatment were recruited and 37 participants were retained at follow-up. Following baseline assessment, participants received either the Substance Free Activity Session (SFAS), a single-session behavioral economic-informed intervention focused on increasing future orientation and engagement in values-based substance-free activities or a health education control intervention. Participants in both conditions received weekly prompts (via text or email) relevant to their respective intervention for four weeks. Participants (68.3% male; 70.7% Caucasian, M age = 38.24, SD = 12.69) reported an average of 3.95 (SD = 4.72) binge drinking episodes (4/5 drinks per occasion for a woman/man) and 5.05 (SD = 5.32) drinks per drinking day 30-days prior to treatment entry. RESULTS: The study provided initial support for the feasibility and acceptability of implementing the SFAS within a treatment setting. Participants reported high levels of satisfaction with the SFAS (M = 9.08 (SD = 0.94), on a scale of 1-10). At 3-month follow-up, the SFAS was associated with reductions in the proportion of activity participation and enjoyment (reinforcement) related to substance-use relative to substance-free activities and in alcohol demand compared to control. CONCLUSION: These preliminary results provide initial support for targeting behavioral economic mechanisms of change in an outpatient AUD treatment with a single-session intervention plus remote delivery of booster prompts.

A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs.

OBJECTIVE: This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored. METHOD: Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months. RESULTS: Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]). CONCLUSIONS: Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Smokers with opioid use disorder may have worse drug use outcomes after varenicline than nicotine replacement.

INTRODUCTION: Smokers with opioid use disorder (OUD) have little success with smoking cessation, possibly due to interactions between nicotine and opioid receptor systems. Smokers with OUD versus non-opioid substance use disorders (NOUD) have not been compared for response to smoking treatment. Data to make this comparison came from our previous study of 12 weeks (plus dose run-up) of varenicline (VAR) versus 12 weeks of nicotine patch (NRT), in a double-placebo design. METHODS: The current study reports secondary analyses comparing smokers with OUD (n = 47) and NOUD (n = 90) on pretreatment smoking, alcohol and drug use, intolerance of physical discomfort, smoking medication adherence, and 3- and 6-month smoking and substance use outcomes (by VAR versus NRT). RESULTS: Smokers with OUD did not differ on pretreatment alcohol or smoking measures while reporting significantly more drug use days. Smokers with OUD versus NOUD had significantly fewer days adherent to VAR or placebo capsules but not to patches, and were more tolerant of physical discomfort. While smoking and heavy drinking days at follow-ups did not differ by diagnosis, smokers with OUD had significantly more drug use days in months 4-6 when assigned to VAR (16.4 days) than to NRT (8.1 days). CONCLUSIONS: NRT might be a better choice than VAR for smokers with OUD due to lower adherence and more drug use days with VAR. However, this novel comparison of smoking pharmacotherapy response in smokers with OUD versus NOUD needs to be confirmed with larger numbers of participants.

Behavioral economic tobacco demand in relation to cigarette consumption and nicotine dependence: a meta-analysis of cross-sectional relationships.

BACKGROUND AND AIMS: A cigarette purchase task (CPT) aims to characterize individual variation in the reinforcing value of tobacco. This meta-analysis estimated the associations between cigarette demand, tobacco consumption and nicotine dependence using this task. DESIGN: A meta-analysis of cross-sectional studies identified by PubMed and PsycINFO databases was conducted. Fixed- and random-effects models were used. The study also examined the model used to derive elasticity of demand (exponential or exponentiated) as a potential moderator. Publication bias was assessed using 'fail-safe N', Begg-Mazumdar test, Egger's test, Tweedie's trim-and-fill approach and meta-regression of publication year with effect size. SETTING: Studies from any setting that reported coefficient correlations on the tested associations. PARTICIPANTS: Daily cigarette users (i.e. 5 to 38 cigarettes per day; n = 7649). MEASUREMENTS: Cigarette consumption, nicotine dependence and five tobacco demand indicators: intensity (i.e. consumption at no cost), elasticity (i.e. sensitivity to rises in costs), Omax (maximum expenditure), Pmax (i.e. price at which consumption becomes elastic) and breakpoint (i.e. price at which consumption ceases). FINDINGS: Twenty-three studies met inclusion criteria. All the CPT indices were significantly correlated with smoking behavior (rs = 0.044-0.572, Ps = 0.012-10-8 ). Medium-to-large effect size associations were present for intensity, Omax, and elasticity, whereas small effects were obtained for breakpoint and Pmax . Evidence of a moderating effect of the different elasticity modeling approaches was not present. There was limited evidence of publication bias. CONCLUSIONS: All five demand indices derived from the cigarette purchase task by (CPT) were robustly associated with cigarette consumption and tobacco dependence. Of the demand indices, maximum expenditure, intensity and elasticity exhibited the largest magnitude associations.

Brief Assessment of Cigarette Demand (BACD): Initial development and correlational results in adults and adolescents.

Developing briefer behavioral economic measures is an important priority to ensure that these measures can be used in a variety of different contexts and to reduce participant burden. We developed and sought to validate a Brief Assessment of Cigarette Demand (BACD). A 17-item Cigarette Purchase Task (CPT) and a 3-item BACD were completed concurrently in 2 community samples of smokers (Study 1, adult smokers [n = 80] with substance use disorders; Study 2, adolescent smokers [n = 81]). Responses on the CPT and BACD were compared on the following demand indices: (a) intensity (the number of cigarettes requested at no cost), (b) Omax (the maximum expenditure on cigarettes in a 24-hr period), and (c) breakpoint (the point at which consumption is totally suppressed/no cigarettes are purchased). Correlations of demand indices with cigarettes per day and nicotine dependence were calculated. Measures of cigarette demand on the CPT and BACD were significantly correlated, albeit at very different magnitudes, for all 3 indices in the adult sample (intensity, r = .86; breakpoint, r = .23; and Omax, r = .43) and for 2 of the indices in the adolescent sample (intensity, r = .97; breakpoint, r = .33). The CPT and BACD relationships with smoking and nicotine dependence were similar for breakpoint and intensity but not for Omax. As initial findings were mixed, additional validation work is recommended to improve psychometric properties before adoption. Valid brief measures of demand could have utility for research and treatment of addictive disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Smoking outcome expectancies predict smoking during voucher-based treatment for smokers with substance use disorders.

OBJECTIVE: Strong expectations regarding positive effects of smoking may reduce the likelihood of successfully quitting. The Smoking Effects Questionnaire (SEQ) assesses the importance of seven expected positive and negative effects of smoking. SEQ was used to predict responses to contingent monetary rewards for smoking abstinence among smokers with substance use disorders (SUD). METHODS: Smokers (N = 184) in residential (i.e., 24 h/day) treatment for SUD received 19 consecutive days of either contingent vouchers (CV) for smoking abstinence (twice-daily carbon monoxide [CO] readings) or non-contingent vouchers (NV) plus counseling to motivate smoking cessation. Analyses investigated effects of smoking expectancies on days of smoking within-treatment and number of cigarettes/day at 1 month post-treatment. RESULTS: Higher positive expectancies for reduced negative affect, weight control, stimulation and positive social effects from smoking were related to more days of smoking during treatment only for participants in the CV condition. Post-treatment, expecting positive social and stimulating effects from smoking were related to more smoking only among CV participants. In both conditions, negative expectancies were largely unrelated to smoking outcomes. CONCLUSIONS: The moderation of CV by positive smoking expectancies suggests that those who rate positive expectancies as more important may require a complementary treatment or different incentives to reduce smoking. The SEQ was probably unassociated with smoking in NV due to little reduction in smoking behavior. Helping smokers with SUD develop alternative ways to produce positive effects sought from smoking may be important to improve initial smoking outcomes.

Smoking and weight loss among smokers with overweight and obesity in Look AHEAD.

Smoking cessation is associated with increases in body weight, but little is known about the relationship between participation in a weight loss intervention and smoking. OBJECTIVE: To determine whether (a) weight losses at 1 year differ as a function of baseline smoking status (never smoker, current smoker, ex-smoker) and (b) participation in a weight loss intervention affects smoking behavior. METHOD: This analysis addressed these questions using the publicly available database from Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE; control condition) among individuals with overweight/obesity and Type 2 diabetes, and included 4,387 participants who had self-reported smoking and objective weight measures available at baseline and at 1 year. RESULTS: Although participants in ILI lost a significantly greater percentage of weight than those in DSE at 1 year (ILI, M = -8.8%, SD = 6.8; DSE, M = -0.7%, SD = 4.7), there were no differences in weight loss outcomes between never smokers (n = 2,297), ex-smokers (n = 2,115), and current smokers (n = 188) within either condition. Participation in ILI was not associated with compensatory smoking or likelihood of quitting smoking or relapsing. CONCLUSIONS: Smokers in a weight loss intervention had reductions in weight that were comparable to individuals who did not smoke without any evidence of compensatory smoking to manage eating and appetite. Smokers with obesity should be encouraged to pursue weight loss without concerns regarding the impact on smoking behavior. (PsycINFO Database Record

Effects of six weeks of electronic cigarette use on smoking rate, CO, cigarette dependence, and motivation to quit smoking: A pilot study.

OBJECTIVES: Switching from combustible tobacco cigarettes to electronic cigarettes (e-cigs) may or may not help smokers to reduce cigarette consumption and toxicant exposure. This pilot study investigated the effects of asking smokers to switch to e-cigs for 6weeks on smoking, exhaled carbon monoxide (CO) concentration, dependence, and motivation to quit smoking. METHODS: Non-treatment seeking daily smokers (n=18) were given free e-cigs and instructed to use them instead of smoking cigarettes for 6weeks. Smokers were assessed at baseline, weekly for 6weeks, and at 8 and 10weeks for cigarettes/day, e-cig use, CO, cigarette dependence, and Contemplation Ladder. RESULTS: All participants completed 6weeks; 17 completed 10weeks. At Week 6, cigarettes/day were reduced by two-thirds and CO by 45% from baseline (p's<.001), with reductions maintained at Week 10 (p's<.005). Cigarette dependence scores were a third lower at Weeks 6 (p<.002) and 10 (p<.001) than at baseline. Contemplation Ladder scores were higher at Weeks 6 and 10 (p's<.001) than at baseline. All these statistical effect sizes were large. At Week 6, number of reasons not to use e-cigs increased (p<.011). CONCLUSIONS: Results show preliminary evidence for beneficial effects of short-term switching to e-cigs by non-treatment seeking smokers in terms of reduced smoke toxicant exposure and cigarette dependence, and increased motivation to quit, all maintained at least 4weeks after free e-cigs were no longer provided.

Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment.

INTRODUCTION: Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence. METHODS: College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days). RESULTS: CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase. CONCLUSIONS: These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking.

Electronic Cigarette Expectancies in Smokers with Psychological Distress.

OBJECTIVES: Very few studies have evaluated perceptions of electronic nicotine delivery systems (ENDS) among smokers with mental illness. This study assessed expectancies about the effects of smoking combustible cigarettes or using ENDS among current smokers with and without severe psychological distress (SPD). METHODS: We used a crowdsourcing system to survey 268 smokers on their expectancies for the effects of combustible cigarettes and ENDS. Positive expectancies assessed included negative affect reduction, stimulation, positive social effects and weight control, and negative expectancies included negative physical effects, negative psychosocial effects and future health concerns. RESULTS: Smokers with SPD had higher positive expectancies for weight control and social effects of both products compared to those without such distress, and higher expectancies for stimulation from combustible cigarettes compared to ENDS. All participants had significantly lower negative expectancies for ENDS compared to combustible cigarettes, with no significant differences between the groups. CONCLUSIONS: Smokers with SPD may be more vulnerable toward ENDS use, as they are for combustible cigarette use, due to greater positive expectancies of the products. Challenging positive expectancies may increase the efficacy of tobacco control efforts in this vulnerable population.

Effects of varenicline versus transdermal nicotine replacement therapy on cigarette demand on quit day in individuals with substance use disorders.

RATIONALE: Cigarette demand is a behavioral economic measure of the relative value of cigarettes. Decreasing the value of cigarette reinforcement may help with quitting smoking. OBJECTIVES: This study aimed to evaluate the effects of initial use of varenicline (VAR) versus nicotine replacement therapy (NRT) on demand for cigarettes on quit day among smokers with substance use disorders (SUD) and to determine whether reduced demand was associated with subsequent abstinence from smoking at 1 and 3 months. METHODS: Participants (N = 110) were randomized to double-blind, double-placebo conditions: VAR with placebo NRT or NRT with placebo capsules. The cigarette purchase task (CPT) was used to assess demand for cigarettes at baseline and on quit day, following a 1-week medication dose run-up/placebo capsule lead-in and first day use of the patch. RESULTS: Demand for cigarettes decreased from baseline to quit day without significant differences between medications. Reductions in CPT intensity (number of cigarettes that would be smoked if they were free) and CPT breakpoint (lowest price at which no cigarettes would be purchased) predicted greater likelihood of abstaining on quit day. Reduced intensity predicted length of abstinence at 1 and 3 months while reduced breakpoint predicted only 1 month length of abstinence. CONCLUSIONS: Initial therapeutic doses of VAR and NRT resulted in similar reductions in cigarette reinforcement. Larger initial reductions in demand on quit day were associated with early success with abstaining from cigarettes. Behavioral economic approaches may be useful for identifying individuals who benefit less from pharmacotherapy and may need additional treatment resources. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00756275.

Varenicline versus nicotine patch with brief advice for smokers with substance use disorders with or without depression: effects on smoking, substance use and depressive symptoms.

AIMS: Varenicline was compared with transdermal nicotine (NRT) for smokers with current substance use disorders (SUD) for effects on 3-month smoking abstinence (primary outcome) and, secondarily, on 3- and 6 month abstinence while adjusting for medication adherence, and on additional smoking and substance use outcomes. Moderation by major depressive disorder history (MDD) and adherence were investigated. DESIGN: Double-blind double-placebo-controlled randomized design, stratifying by MDD, gender and nicotine dependence, with 3 and 6 months follow-up. SETTING: University offices in Rhode Island, USA. PARTICIPANTS: Adult smokers (n = 137), in SUD treatment, substance abstinent <12 months (n = 77 varenicline, 60 NRT). INTERVENTION AND COMPARATOR: Twelve weeks of varenicline (2 mg/day, after 1-week dose run-up) or NRT (21 mg/day decreasing to 7 mg/day). MEASUREMENTS: Primary: point-prevalence smoking abstinence (7-day, confirmed) at 3 months. Secondary: point-prevalence abstinence at 6 months, quantity and frequency of smoking and substance use at 3 and 6 months, and within-treatment abstinence, medication adherence and depressive symptoms. Smoking outcome analyses were repeated controlling for adherence and investigating adherence as a moderator. FINDINGS: Effects on 3-month abstinence were P < 0.065 without a covariate (Bayes factor 3.35, supporting the effect strongly) and differed significantly when controlling for baseline smoking [varenicline: 13%, NRT: 3%; odds ratio (OR) = 4.81, 95% confidence interval (CI) 1.00, 23.13, P < 0.05]. The threefold difference at 6 months was not significant. Medication effect on abstinence across time was significant (P < 0.05) covarying adherence and baseline smoking (OR = 6.40, 95% CI = 1.00, 40.93). Medication differences in 3-month abstinence occurred among participants with ≥ 77% adherence (P < 0.02). No significant medication effects on heavy drinking, drug use or depressive symptoms were found. CONCLUSIONS: Varenicline appears to improve the chances of achieving at least 3 months of smoking abstinence in smokers with substance use disorders trying to stop, compared with transdermal nicotine patches, the effect being independent of history of depressive disorder.