Development and Validation of the Smoker Self-Stigma Questionnaire.

INTRODUCTION: Researchers have become increasingly concerned with the stigmatizing impact that regulations and policies aimed to curve down cigarette smoking may have on smokers. Given the lack of psychometrically validated tools available to assess smoking stigma, we developed and evaluated the Smoker Self-Stigma Questionnaire (SSSQ). AIMS AND METHODS: A total of 592 smokers recruited through Amazon's Mechanical Turk (MTurk) completed an online, Qualtrics survey that included 45 items developed and vetted by tobacco-research experts. The items were assigned a priori to three, theoretical stigma factors or domains (enacted, felt, and internalized). We first conducted a confirmatory factor analysis (CFA) on the responses from one-half of the participants with the goal of distilling the 45-item pool to an 18-item instrument with 6 items per factor. A promising, 18-item, three-factor measure was then cross-validated with the second half of the sample. RESULTS: The second CFA yielded excellent fit indices, as well as adequate and significant factor loadings. Subscale scores obtained from the separated factors differentially predicted nicotine dependence and motivation to quit cigarettes, providing convergent and discriminant validity for the SSSQ and its proposed, three-factor structure. CONCLUSIONS: Overall, the SSSQ fills an important research gap by providing a psychometrically sound measure that investigators can use to study smoking stigma. IMPLICATIONS: Prior research on smoking self-stigma has used a wide variety of psychometrically invalid measures and reported inconsistent findings. This is the first study that presents a measure of smoking self-stigma that is not a merely and arbitrary adaptation of a mental illness stigma measure, but that is theoretically driven and created from a large and comprehensive pool of items vetted by tobacco-research experts. Having demonstrated and then cross-validated its excellent psychometric properties, the SSSQ provides the field with a promising tool to assess, investigate, and replicate the causes and effects of smoking self-stigma.

A review of tobacco regulatory science research on vulnerable populations.

In 2013 the U.S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. This report reviews TCORS-funded research with adult vulnerable populations. The literature search included a list of all TCORS-funded publications compiled by the TCORS coordinating center; all TCORS were requested to share publications not in the coordinating-center's list. Only TCORS-funded reports describing an empirical study with an adult vulnerable population published in a peer-reviewed journal between September 2013 and June 2018 were included. 71 reports met inclusion criteria; 39% (28/71) examined tobacco use among those with mental health and medical comorbidities, 34% (24/71) socioeconomic disadvantage, 31% (22/71) women of reproductive age, 30% (21/71) racial/ethnic minorities, 18% (13/71) rural residents, and 3% (2/71) each among active military/veterans and sexual/gender minorities. Regarding scientific domains, 63% (45/71) investigated behavior, 37% (26/71) addiction, 24% (17/71) health effects, 20% (14/71) impact analyses, 18% (13/71) toxicity, 8% (6/71) marketing influences, and 7% (5/71) communications. Totals exceed 100% because some reports addressed multiple populations/domains. TCORS funding has generated a substantial, multidisciplinary body of new scientific knowledge on tobacco use in adult vulnerable populations. However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward.

Patient Perceptions and Quality of Life After Colon and Rectal Surgery: What Do Patients Really Want?

BACKGROUND: Colorectal surgery outcomes must be accurately assessed and aligned with patient priorities. No study to date has investigated the patient's subjective assessment of outcomes most important to them during and following their surgical recovery. Although surgeons greatly value the benefits of laparoscopy, patient priorities remain understudied. OBJECTIVE: This study aimed to assess what aspects of patients' perioperative care and recovery they value most when queried in the postoperative period. DESIGN: This study is an exploratory cross-sectional investigation of a defined retrospective patient population. Enrollees were stratified into subcategories and analyzed, with statistical analysis performed via χ test and unpaired t test. SETTINGS: This study was conducted at a single academic medical center in New England. PATIENTS: Patients who underwent a colorectal surgical resection between 2009 and 2015 were selected. INTERVENTIONS: Patients within a preidentified population were asked to voluntarily complete a 32-item questionnaire regarding their surgical care. MAIN OUTCOME MEASURES: The primary outcomes measured were patient perioperative and postoperative quality of life and satisfaction on selected areas of functioning. RESULTS: Of 167 queried respondents, 92.2% were satisfied with their recovery. Factors considered most important included being cured of colorectal cancer (76%), not having a permanent stoma (78%), and avoiding complications (74%). Least important included length of stay (13%), utilization of laparoscopy (14%), and incision appearance and length (2%, 4%). LIMITATIONS: The study had a relatively low response rate, the study is susceptible to responder's bias, and there is temporal variability from surgery to questionnaire within the patient population. CONCLUSIONS: Overall, patients reported high satisfaction with their care. Most important priorities included being free of cancer, stoma, and surgical complications. In contrast, outcomes traditionally important to surgeons such as laparoscopy, incision appearance, and length of stay were deemed less important. This research helps elucidate the outcomes patients truly consider valuable, and surgeons should focus on these outcomes when making surgical decisions. See Video Abstract at http://links.lww.com/DCR/A596. See Visual Abstract at https://tinyurl.com/yb25xl66.

Tobacco and nicotine delivery product use in a U.S. national sample of women of reproductive age.

This study examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of women of reproductive age. Weighted data were obtained from women aged 15-44 years who were not currently pregnant in the first wave of the Population Assessment of Health and Tobacco (PATH, 2013-2014) study (N = 12,848). 20.1% of women were current cigarette smokers, 5.9% current e-cigarette users, 4.9% current cigar smokers, and 6.5% current hookah users. Prevalence of current use of other tobacco products was <1.0%. Current cigarette smoking was the strongest correlate of current e-cigarette use (OR = 65.7, 95% CI = 44.8-96.5), cigar smoking (OR = 19.2, 95% CI = 14.1-26.1), and hookah use (OR = 6.6, 95% CI = 5.1-8.5). Among former cigarette smokers, 3.8%, 6.9%, and 3.2% were also currently using e-cigarettes, hookah, and cigars, respectively. Use of other tobacco and nicotine delivery products was low among those who never smoked tobacco cigarettes: 2.5% used hookah and <1.0% used other products. Cigarette smoking prevalence remains relatively high among women of reproductive age and strongly correlated with use of other tobacco products. Monitoring tobacco and nicotine use in this population is important due to the additional risk of adverse health impacts should they become pregnant. Clinicians working with cigarette smokers should assess for use of other tobacco products. Among women of reproductive age, use of emerging tobacco and nicotine products appears to be largely, although not exclusively, restricted to current cigarette smokers.

Examining the relationship between pregnancy and quitting use of tobacco products in a U.S. national sample of women of reproductive age.

This study examined quit rates longitudinally for cigarettes, e-cigarettes, hookah, cigars, and all tobacco products in a U.S. national sample of women aged 18-44 who completed both Wave 1 (W1) and Wave 2 (W2) of the Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) study (N = 7814). Quit rates were examined among women who transitioned into pregnancy across survey waves, and among a comparable sample of non-pregnant women to provide contextual information about quitting among the broader population of reproductive-aged women. Multiple logistic regression modeling was used to estimate the associations of pregnancy and quitting adjusting for other demographic and psychosocial characteristics. Quit rates among women who were pregnant in W2 were highest for hookah (98.3%), followed by cigars (88.0%), e-cigarettes (81.3%), and lowest for tobacco cigarettes (53.4%). Slightly more than half (58.7%) of women reported quitting use all tobacco products while pregnant. Pregnancy was independently associated with increased odds of quitting hookah (AOR = 52.9, 95%CI = 3.4, 830.2), e-cigarettes (AOR = 21.0, 95%CI = 2.6, 170.3), all tobacco products (AOR = 9.6, 95%CI = 6.4, 14.5), and cigarettes (AOR = 6.5, 95%CI = 4.2, 10.1), although not cigars. Relative to other demographic and psychosocial characteristics, pregnancy was the strongest predictor of quitting use of each tobacco product. While these data indicate that pregnancy has strong, independent associations with quitting a variety of commercially available tobacco products, the comparatively lower quit rates for cigarettes versus other tobacco products underscores the long-standing need for more intensive, multipronged clinical and regulatory interventions to reduce cigarette use among reproductive-aged women.

Tobacco use in cardiac patients: Perceptions, use, and changes after a recent myocardial infarction among US adults in the PATH study (2013-2015).

Smoking status following cardiac events strongly predicts future morbidity and mortality. Using a nationally representative sample of United States adults, aims of this study were (1) to estimate use of, and attitudes towards, tobacco products as a function of level of cardiac risk, and (2) to explore changes in attitudes and tobacco use among adults experiencing a recent myocardial infarction (MI). Data were obtained from the first and second waves of the Population Assessment of Tobacco and Health (PATH) study. Use and attitudes towards tobacco products were examined at Wave 1 among adults with no chronic health condition (n = 18,026), those with risk factors for heart disease (n = 4593), and those who reported ever having had an MI (n = 643). Changes in perceived risk of tobacco and use between the two waves and having an MI in the last 12 months (n = 240) were also examined. Those who reported lifetime MI were more likely to believe that smoking/using tobacco was causing/worsening a health problem. Having had a recent MI event increased perceived tobacco-related risk and attempts at reduction/quitting, but did not significantly impact combusted tobacco cessation/reduction or uptake of non-combusted tobacco products. Sociodemographic characteristics and use of other tobacco products were associated with change in use of tobacco products. Those who have an MI are sensitized to the harm of continued smoking. Nonetheless, having an MI does not predict quitting combusted tobacco use or switching to potentially reduced harm products. Intense intervention is necessary to reduce combusted use in this high-risk population.

Patterns of Single and Multiple Tobacco Product Use Among US Women of Reproductive Age.

Introduction: Understanding patterns of single and multiple tobacco product use among reproductive-aged women is critical given the potential for adverse health effects on mother and infant should a woman become pregnant. Methods: Patterns of tobacco use over a 2-year period were examined among all women (18-44 years) who completed wave 1 (W1) and wave 2 (W2) of the US Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) Study. We examined the most common patterns of single and multiple tobacco product use in W1, and longitudinal trajectories of women engaged in each of these patterns of use from W1 to W2, among women not pregnant in either wave (n = 7480), not pregnant in W1 and pregnant in W2 (n = 332), and pregnant in W1 and not pregnant in W2 (n = 325). Results: The most prevalent patterns of tobacco use in W1 among all three subgroups were using cigarettes alone followed by using cigarettes plus e-cigarettes. In all three subgroups, women using multiple products in W1 were more likely to adopt new use patterns in W2 relative to single-product users, with the new patterns generally involving dropping rather than adding products. The majority of multiple product use included cigarettes, and transitions to single product use typically involved dropping the noncigarette product. The most common trajectory among tobacco users transitioning to or from pregnancy was to use cigarettes alone in W2. Discussion: This study contributes new knowledge characterizing tobacco use patterns across time and reproductive events among reproductive-aged women.

Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products.

BACKGROUND: Disparities in tobacco use are worsening in the United States, disproportionately affecting those with chronic medical conditions. One possible contributor is that physicians may not screen and advise cessation uniformly across patients and/or tobacco products. OBJECTIVE: This study examined provider communications regarding cigarette and non-cigarette tobacco products among adults with chronic conditions. DESIGN: Cross-sectional study drawn from two waves (2013-2014) of the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS: Adults (≥ 18 years) who used tobacco in the past year. MAIN MEASURES: Prevalence of tobacco use included past-year use of cigarettes, cigars, or smokeless tobacco among those with and without chronic conditions. Chronic conditions included asthma, anxiety, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Odds ratio of receipt of screening and advice to quit across chronic condition and tobacco product type were reported. Data were analyzed using logistic regression, controlling for basic sociodemographic factors and number of provider visits. KEY RESULTS: Adults with anxiety, depression, and substance use disorders had the highest prevalence of past-year cigarette (37.2-58.2%), cigar (9.1-28.0%), and smokeless tobacco (3.1-11.7%) use. Patients with any chronic condition were more likely to receive advice to quit than those without a condition (OR 1.21-2.37, p < 0.01), although the odds were lowest among adults with mental health and substance use disorders (OR 1.21-1.35, p < 0.01). Cigarette smokers were more likely to report being screened and advised to quit than non-cigarette tobacco users (OR 1.54-5.71, p < 0.01). CONCLUSIONS: Results support the need for provider training to expand screening and cessation interventions to include the growing spectrum of tobacco products. Screening and referral to interventions are especially needed for those with mental health and substance use disorders to reduce the disparate burden of tobacco-related disease and death.

Rural Versus Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013-2014.

OBJECTIVES: To examine urban-rural differences in US prevalences of traditional and emerging tobacco product use as well as dual or polytobacco use of these products. METHODS: Our data were derived from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. We estimated weighted prevalences of adult tobacco use across urban-rural geographies and examined prevalences classified by gender, poverty level, and region of the country. RESULTS: Nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas. Conversely, cigarillo and hookah use and dual or polytobacco use of emerging products were higher in urban areas. There was no significant urban-rural difference in use of e-cigarettes. Gender, poverty, and region of the country did not seem to be driving most urban-rural differences, although differences related to cigarillo use and dual or polytobacco use of emerging products became nonsignificant after control for covariates. CONCLUSIONS: Our findings highlight important urban-rural differences in tobacco use. Whether the changing tobacco product landscape will contribute to a continuation of rural health disparities remains to be seen.

Tobacco and nicotine delivery product use in a national sample of pregnant women.

Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19.

Introduction: Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling. Methods: The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135). Results: Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19. Discussion: Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

Impact of fasting on food craving, mood and consumption in bulimia nervosa and healthy women participants.

Researchers have found that dietary restraint increases food cravings and may contribute to loss of control over eating. Negative mood states often precede food cravings and binge eating. In the present study, we tested the influence of a prolonged food deprivation period over emotional states and food cravings. Twenty-one bulimia nervosa participants and 20 healthy women participants were asked to refrain from any eating for 20 hours and reported, at baseline, after 6 hours and at the end of the fasting period, their mood and craving states. Food consumption was also measured. Fasting increased food cravings in both groups but increased negative mood in healthy women only. Bulimia nervosa participants reported improved mood following food deprivation. Whereas Bulimia nervosa and healthy women participants ate moderate and similar amounts of food following the 20-hour fasting period, food cravings were significantly associated with the number of calories ingested. These findings are congruent with self-regulation theories that predict that prolonged fasting may reduce negative emotions in women with bulimia nervosa.

Psychological inflexibility and mental health symptoms during the COVID-19 lockdown in Spain: A longitudinal study.

Spain, one of the European countries most affected by the COVID-19 pandemic, underwent a strict lockdown between March and May 2020. This study examines longitudinally the evolution of both psychological inflexibility and mental health symptoms in a sample of college students from the beginning and throughout the end of the mandated lockdown period. We present the results from 197 participants who responded to an online survey at least at two of three data-collection waves scheduled at the beginning (N = 226), halfway (N = 172), and end (N = 188) of the lockdown. The analyses revealed that psychological inflexibility and symptomatology increased over time, and that inflexibility at the beginning of the lockdown indirectly predicted self-reported symptoms at the end of the lockdown via autoregressive parallel paths that also connected cross-sectionally to reveal that changes in inflexibility were predictive of changes in mental health. These results present a dynamic and robust relationship between psychological inflexibility and mental health symptoms throughout a relatively long and presumably stressful period of time.

Two scales to evaluate cocaine craving.

The cocaine craving questionnaire-brief (CCQ-Brief English) asks cocaine users to report their level of craving now. We constructed two brief scales of cocaine craving in a sample of 107 Spanish-speaking natives in treatment for cocaine abuse or dependence: the CCQ-Brief(Spanish) and the pictographic assessment of desire (PAD), which relies less on language. Principal component analyses yielded a one-component solution for the CCQ-Brief, explaining between 62% and 68% of the sample variability. Cronbach's alpha ranged from .92 to .94. The CCQ-Brief and the PAD were strongly correlated; effect sizes ranged from .42 to .68 in separate trials. Laboratory cue-exposure results showed that in both scales craving was higher upon presentation of cocaine-related rather than neutral pictorial stimuli. The CCQ-Brief and PAD are potentially valuable scales for evaluating cocaine craving.

Nicotine Effects, Body Weight Concerns and Smoking: A Literature Review.

How people become addicted to cigarette smoking and remain addicted despite repeated attempts to quit requires piecing together a rather complex puzzle. The present review contextualizes the role of nicotine and smoking sensory stimulation on maintaining smoking, describes nicotine's effects on feeding behavior and body weight, and explores the impact of smoking outcome expectancies, including the belief that nicotine suppresses appetite and body weight, on the decision to smoke or vape (use of e-cigarettes). The analysis concludes with a review of rat models of human nicotine intake that attempt to isolate the effects of nicotine on appetite and weight gain. Animal research replicates with relative closeness phenomena observed in smokers, but the rat model falls short of replicating the long-term weight gain observed post-smoking cessation.

Food cravings discriminate between anorexia and bulimia nervosa. Implications for "success" versus "failure" in dietary restriction.

Food cravings are subjective, motivational states thought to induce binge eating among eating disorder patients. This study compared food cravings across eating disorders. Women (N=135) diagnosed with anorexia nervosa, restrictive (ANR) or binge-purging (ANBP) types, or bulimia nervosa, non-purging (BNNP) or purging (BNP) types completed measures of food cravings. Discriminant analysis yielded two statistically significant functions. The first function differentiated between all the four group pairs except ANBP and BNNP, with levels of various food-craving dimensions successively increasing for ANR, ANBP, BNNP, and BNP participants. The second function differentiated between ANBP and BNNP participants. Overall, the functions improved classification accuracy above chance level (44% fewer errors). The findings suggest that cravings are more strongly associated with loss of control over eating than with dietary restraint tendencies.

Body Mass Index and Nationality (Argentine vs. Spanish) Moderate the Relationship Between Internalization of the Thin Ideal and Body Dissatisfaction: A Conditional Mediation Model.

It is believed that Women's exposure to Western sociocultural pressures to attain a "thin-ideal" results in the internalization of a desire to be thin that consequently leads to body dissatisfaction (BD). It is also well documented that body mass index (BMI; kg/m2) correlates with BD. We tested for the first time a conditional mediation model where thin-ideal Awareness predicted BD through Internalization of the thin ideal and the path from Internalization to BD was hypothesized to be moderated by BMI and Nationality (Argentine vs. Spanish). The model was tested with a sample of 499 young women (age = 18 to 29) from Argentina (n = 290) and Spain (n = 209). Awareness and internalization were measured with the SATAQ-4 (Schaefer et al., 2015) and BD was measured with the BSQ (Cooper et al., 1987). The model was analyzed using PROCESS v3.1 (Hayes, 2018). As hypothesized, thin-ideal awareness predicted BD through internalization and the path from internalization to BD was moderated by BMI and nationality. Specifically, internalization predicted BD at all level of BMI and in both samples, but the relationship between internalization and BD increased with BMI and was also stronger among Spaniards than Argentines. We argue that the findings are congruent with theories that predict that economic development and modernization contribute to normative female BD through internalization of the thin ideal and that upward social comparisons or cognitive discrepancy between self-perceived body image and the sociocultural thin ideal interacts synergistically with thin-ideal internalization to increase BD.

English and Spanish versions of the Body Shape Questionnaire: measurement equivalence across ethnicity and clinical status.

OBJECTIVE: We evaluated the psychometric properties and measurement equivalence of various forms of the Body Shape Questionnaire (BSQ) (Cooper et al., Int J Eat Disord, 6, 485-494, 1987) in American and Spanish women with and without an eating disorder diagnosis. METHOD: Participants included four groups of women: Euro-American (n = 505), Hispanic-American (n = 151), and Spanish (n = 445) females without an eating disorder and Spanish women being treated for an eating disorder (n = 177). RESULTS: Single and multigroup confirmatory factor analyses using maximum likelihood estimation with robust standard errors tested the data for configural and metric invariance. Goodness-of-fit statistics indicated that the original and all alternate forms of the BSQ fit the data well across groups. Most factor loadings were similar across groups. We also developed a 10-item version that appeared to be invariant across groups. CONCLUSION: Results strongly support configural invariance and offer some support for metric invariance.

Clinical validation of the trait and state versions of the Food Craving Questionnaire.

This is the first study to evaluate the psychometric properties of the Food Craving Questionnaire-Trait (FCQ-T), and Food Craving Questionnaire-State (FCQ-S) measures using a clinically heterogeneous sample of eating disorder patients (N = 177) recruited from seven different outpatient eating disorder treatment centers in Spain. Confirmatory factor analyses (CFAs) corroborated the factor structures of the FCQ-T and FCQ-S. The measures' scores and their factor-derived scale-scores yielded internal consistency reliability indexes that ranged from adequate to excellent. The measures were predictive of eating disorder symptoms. As expected, the FCQ-T was more strongly associated with eating disorder psychopathology than the FCQ-S. The results replicated the psychometric properties of the FCQ-T and FCQ-S in eating disorder populations and could become useful tools in clinical and research settings.

Development of the brief Spanish Cocaine Craving Questionnaire-General.

Combining two different samples of cocaine users (N = 183), we tested the factor structure of a brief (12-item), Spanish version of the Cocaine Craving Questionnaire-General using confirmatory factor analysis. The four-factor model provided excellent fit to the measure. Moreover, the measure significantly differentiated between recent cocaine users and abstainers, as well as between participants with different levels of severity of drug-use history. Factor 1 expresses highly intense and overwhelming desires, Factor 2 expresses lack of self-control over cocaine use, Factor 3 items express lack of positive reinforcement expectancies, and Factor 4 expresses stimulating expectancies for cocaine use. The results revealed the validity of the CCQ-General brief as an instrument to assess cocaine craving in Spanish and supported the conceptualization of cocaine craving as a multifaceted construct.