[Show abstract][Hide abstract] ABSTRACT: Negative affect, alcohol consumption, and presence of others smoking have consistently been implicated as risk factors in smoking lapse and relapse. What is not known, however, is how these factors work together to affect smoking outcomes. This paper uses ecological momentary assessment (EMA) collected during the first 7 days of a smoking cessation attempt to test the individual and combined effects of high-risk triggers on smoking urge and lapse.
Participants were 300 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants completed EMA, which recorded negative affect, alcohol consumption, presence of others smoking, smoking urge, and smoking lapse, for 7 days starting on their quit date.
Alcohol consumption, presence of others smoking, and negative affect were, independently and in combination, associated with increase in smoking urge and lapse. The results also found that the relationship between presence of others smoking and lapse and the relationship between negative affect and lapse were moderated by smoking urge.
The current study found significant individual effect of alcohol consumption, presence of other smoking, and negative affect on smoking urge and lapse. Combing the triggers increased smoking urge and the risk of lapse to varying degrees and the presence of all 3 triggers resulted in the highest urge and lapse risk.
[Show abstract][Hide abstract] ABSTRACT: To explore associations between financial strain and self-rated health among 1341 black adults.
Associations were investigated using a covariate-adjusted linear regression model. Mediation (via stress and/or depressive symptoms) was explored in additional models using a nonparametric bootstrapping procedure.
Higher financial strain was associated with poorer self-rated health (p < .001). Stress and depressive symptoms were each significant mediators of this relation in both single and multiple mediator models (p values < .05).
Financial strain may contribute to poorer health among black adults, partially via greater stress and depressive symptoms. Potential theoretical, intervention, and policy implications are discussed. Future studies with longitudinal designs are needed to confirm these results.
American journal of health behavior 05/2014; 38(3):340-50. DOI:10.5993/AJHB.38.3.3 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: African Americans suffer disproportionately from the adverse consequences of behavioral risk factors for cancer relative to other ethnic groups. Recent studies have assessed how financial strain might uniquely contribute to engagement in modifiable behavioral risk factors for cancer, but not among African Americans. The current study examined associations between financial strain and modifiable cancer risk factors (smoking, at-risk alcohol use, overweight/obesity, insufficient physical activity, inadequate fruit and vegetable intake, and multiple risk factors) among 1278 African American adults (age=46.5+12.6, 77% female) and explored potential mediators (stress and depressive symptoms) of those associations. Methods: Logistic regression models were used to examine associations between financial strain and cancer risk factors. Analyses were adjusted for age, sex, partner status, income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Nonparametric bootstrapping procedures were used to assess mediation. Results: Greater financial strain was associated with greater odds of insufficient physical activity (p<.003) and smoking (p=.005) and was positively associated with the total number of cancer risk factors (p<.0001). There was a significant indirect effect of both stress and depressive symptoms on the relations of financial strain with physical inactivity and multiple risk factors, respectively. Conclusions: Future interventions aimed at reducing cancer disparities should focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms. Impact: Longitudinal studies are needed to assess the temporal and causal relations between financial strain and modifiable behavioral cancer risk factors among African Americans.
[Show abstract][Hide abstract] ABSTRACT: Background
Prominent theories of drug use underscore the importance of considering the inter-relationships (e.g., reciprocal relations, indirect effects) of determinants of drug use behavior. In the area of smoking, few studies have examined multiple determinants of cessation in this way, and in prospective analyses. The current study is an examination of the prospective cross-lagged relationships among five intrapersonal determinants of cessation
Data from a longitudinal cohort study on racial differences in the process of smoking cessation were used to examine reciprocal relations among abstinence motivation, abstinence self-efficacy, positive affect, negative affect, and craving. Each of these five measures assessed on the quit day were regressed onto the same measures assessed 1-2 weeks pre-quit. The relationships of these variables at quit day with 1-week post-quit abstinence from smoking were also examined.
When the five variables were examined simultaneously in a cross-lagged path analysis, motivation and self-efficacy, and self-efficacy and positive affect showed cross-lagged relations. Only self-efficacy on the quit day uniquely predicted 1-week post quit abstinence. There were significant indirect effects of motivation and positive affect on cessation via self-efficacy.
The current study reaffirms the importance of motivation and self-efficacy in smoking cessation, and suggests that positive affect may play a role in smoking cessation.
Drug and Alcohol Dependence 04/2014; 137:98-105. DOI:10.1016/j.drugalcdep.2014.01.013 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although over 70% of homeless individuals smoke, few studies have examined the effectiveness of smoking cessation interventions in this vulnerable population. The purpose of this pilot study was to compare the effectiveness of shelter-based smoking cessation clinic usual care (UC) to an adjunctive contingency management (CM) treatment that offered UC plus small financial incentives for smoking abstinence. Sixty-eight homeless individuals in Dallas, Texas (recruited in 2012) were assigned to UC (n = 58) or UC plus financial incentives (CM; n = 10) groups and were followed for 5 consecutive weeks (1 week pre-quit through 4 weeks post-quit). A generalized linear mixed model regression analysis was conducted to compare biochemically-verified abstinence rates between groups. An additional model examined the interaction between time and treatment group. The participants were primarily male (61.8%) and African American (58.8%), and were 49 years of age on average. There was a significant effect of treatment group on abstinence overall, and effects varied over time. Follow-up logistic regression analyses indicated that CM participants were significantly more likely than UC participants to be abstinent on the quit date (50% vs. 19% abstinent) and at 4 weeks post-quit (30% vs. 1.7% abstinent). Offering small financial incentives for smoking abstinence may be an effective way to facilitate smoking cessation in homeless individuals.
[Show abstract][Hide abstract] ABSTRACT: Background
Although studies have shown a cross-sectional link between discrimination and smoking, the prospective influence of discrimination on smoking cessation has yet to be evaluated. Thus, the purpose of the current study was to determine the influence of everyday and major discrimination on smoking cessation among Latinos making a quit attempt.
Participants were 190 Spanish speaking smokers of Mexican Heritage recruited from the Houston, TX metropolitan area who participated in the study between 2009 and 2012. Logistic regression analyses were conducted to evaluate the associations of everyday and major discrimination with smoking abstinence at 26 weeks post-quit.
Most participants reported at least some everyday discrimination (64.4%), and at least one major discrimination event (56%) in their lifetimes. Race/ethnicity/nationality was the most commonly perceived reason for both everyday and major discrimination. Everyday discrimination was not associated with post-quit smoking status. However, experiencing a greater number of major discrimination events was associated with a reduced likelihood of achieving 7-day point prevalence smoking abstinence, OR = .51, p = .004, and continuous smoking abstinence, OR = .29, p = .018, at 26 weeks post-quit.
Findings highlight the high frequency of exposure to discrimination among Latinos, and demonstrate the negative impact of major discrimination events on a smoking cessation attempt. Efforts are needed to attenuate the detrimental effects of major discrimination events on smoking cessation outcomes.
Drug and alcohol dependence 03/2014; 136:143-148. DOI:10.1016/j.drugalcdep.2014.01.003 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nearly half of U.S. adults have health literacy (HL) difficulties, and lack the ability to effectively obtain, process, and understand health information. Poor HL is associated with depression, yet mechanisms of this relation are unclear. This study examined whether social support mediated the relation between HL and depressive symptoms in 200 low-socioeconomic status (SES), racially/ethnically diverse smokers enrolled in cessation treatment. Mediation analyses were conducted using bootstrapping and controlling for SES and nicotine dependence. In simple mediation models, social support [Interpersonal Support Evaluation List (ISEL) total, subscales (Appraisal, Belonging, Tangible)] mediated the effect of HL on depression, such that lower HL was associated with lower perceived support, which predicted higher depressive symptoms (ps < .05). A multiple mediation model, with ISEL subscales entered simultaneously as mediators, was significant (p < .05) but only the Belonging subscale demonstrating independent significance (p < .05). Thus, social support may be a critical factor underlying the HL-depression relationship in low-SES, racially/ethnically diverse smokers.
Journal of Behavioral Medicine 03/2014; 37(6). DOI:10.1007/s10865-014-9566-5 · 3.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Social learning models of addiction hypothesize that situational factors interact with cognitive determinants to influence a person's motivation to use substances. Ecological momentary assessment was used to examine the association between alcohol consumption, smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 113 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants carried a palm-top personal computer for 7 days and were instructed to complete 4 random assessments each day and to initiate an assessment when they were tempted to smoke. Multilevel mediational analyses were used to examine (a) the effects of alcohol consumption before time j and positive smoking outcome expectancies at time j on smoking urge at time j + 1 (Model 1) and (b) the effects of alcohol consumption before time j and smoking urge at time j on positive smoking outcome expectancies at time j + 1 (Model 2). Model 1 found a significant effect of alcohol consumption before time j on smoking urge at time j + 1 (p = .04), and this effect was significantly mediated by positive smoking outcome expectancies at time j (p < .0001). Model 2 failed to find a significant effect of alcohol consumption before time j on positive smoking outcome expectancies at time j + 1. The findings suggest that alcohol consumption is significantly associated with increased positive smoking outcome expectancies that, in turn, are associated with increased smoking urge in women seeking to quit smoking. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: To explore the associations between shelter proximity and real-time affect during a specific smoking quit attempt among 22 homeless adults.
Affect was measured via 485 smartphone-based Ecological Momentary Assessments randomly administered during the weeks immediately before and after the quit day, and proximity to the shelter was measured via GPS. Adjusted linear mixed model regressions examined associations between shelter proximity and affect.
Closer proximity to the shelter was associated with greater negative affect only during the post-quit attempt week (p = .008). All participants relapsed to smoking by one week post-quit attempt.
Among homeless smokers trying to quit, the shelter may be associated with unexpected negative affect/stress. Potential intervention applications are suggested.
American journal of health behavior 03/2014; 38(2):161-9. DOI:10.5993/AJHB.38.2.1 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border.
The characteristics of Mexican Americans with diabetes living in Brownsville, TX (N = 492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c).
Participants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c).
Overall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.
BMC Public Health 02/2014; 14(1):176. DOI:10.1186/1471-2458-14-176 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: • To create a sustainable, community-based partnership (the Outreach Pilot Program [OPP]) to promote tobacco control and decrease tobacco use in Puerto Rico through community-based participatory research.
• The public health burden of smoking in Puerto Rico is substantial as the fifth leading causes of death in Puerto Rico are associated with smoking (heart disease, malignant neoplasm, stroke, hypertension, and chronic pulmonary disease).
• Despite the clear need for tobacco control interventions, the availability of treatment in Puerto Rico is low.
• The OPP carried out activities which fell under the following broad categories: 1) Network development, 2) research activities, 3) training and education, and 4) community awareness. Eighty organizations participated in the OPP.
• The OPP contributed to the creation of one of the most rigorous smoke-free laws in the United States.
• OPP activities increased the number of callers to the Puerto Rico Quitline and created a shift in the source of callers away from costly mass media promotion toward a higher proportion of callers referred through health care providers and via low-cost print materials promoted by the network outreach activities. Physicians’ referrals to the Puerto Rico Quitline increased from 2.6% to 7.2% and brochure referrals from 1.4% to 4.6%. The number of annual smokers receiving cessation services increased from 703 in 2005 to 1,086 in 2008.
• Utilizing a community-based participatory approach, outreach programs can empower community organizations to take action via networking, education, research, and the provision of tangible solutions for service provision. These efforts can bring organizations together under a common goal, influence public policy, provide critical training in tobacco control, and increase the utilization of treatment programs in a manner that is culturally sensitive and relevant for the local community.
• Health professionals.
• Community-based organizations and community health centers.
• Educators responsible for training health professionals.
• The description of the development and implementation of the OPP provides an example of how community networking is feasible, sustainable, and can contribute to tobacco control.
• Challenges will occur and therefore should be expected and addressed. Challenges identified by OPP network members include: Tobacco control was not always perceived as a priority by their managers, time constraints and limited funding to implement outreach activities, and perceived lack of professional competence in tobacco-related topics.
• Network participants suggested the following: Continue providing information regarding tobacco-related research and other accomplishments by collaborators, integrate tobacco awareness within other chronic diseases campaigns throughout the year, and continue trainings on evidence-based practices for tobacco control.
• Network members noted that an outreach program’s sustainability relies on building of capacity of its members, and this should be a key component of network activities.
• Community networks such as the OPP should continue to be analyzed in terms of their governance, accountability, operations, risks, and benefits.
Progress in Community Health Partnerships Research Education and Action 01/2014; 8(2):141-2. DOI:10.1353/cpr.2014.0025
[Show abstract][Hide abstract] ABSTRACT: To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults.
Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation.
Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values < .05).
Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender.
American journal of health behavior 01/2014; 38(1):31-41. DOI:10.5993/AJHB.38.1.4 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mindfulness-based strategies have received empirical support for improving coping with stress and reducing alcohol use. The present study presents a moderated mediation model to explain how mindfulness might promote healthier drinking patterns. This model posits that mindfulness reduces perceived stress, leading to less alcohol use, and also weakens the linkage between stress and alcohol use. African American smokers (N = 399, 51 % female, M
age = 42) completed measures of dispositional mindfulness, perceived stress, quantity of alcohol use, frequency of binge drinking, and alcohol use disorder symptoms. Participants with higher levels of dispositional mindfulness reported less psychosocial stress and lower alcohol use on all measures. Furthermore, mindfulness moderated the relationship between perceived stress and quantity of alcohol consumption. Specifically, higher perceived stress was associated with increased alcohol use among participants low, but not high, in mindfulness. Mindfulness may be one strategy to reduce perceived stress and associated alcohol use among African American smokers.
[Show abstract][Hide abstract] ABSTRACT: The reasons that some smokers find it harder to quit than others are unclear. Understanding how individual differences predict smoking cessation outcomes may allow the development of more successful personalized treatments for nicotine dependence. Theoretical models suggest that drug users might be characterized by increased sensitivity to drug cues and by reduced sensitivity to nondrug-related natural rewards. We hypothesized that baseline differences in brain sensitivity to natural rewards and cigarette-related cues would predict the outcome of a smoking cessation attempt.
Using functional magnetic resonance imaging, we recorded prequit brain responses to neutral, emotional (pleasant and unpleasant), and cigarette-related cues from 55 smokers interested in quitting. We then assessed smoking abstinence, mood, and nicotine withdrawal symptoms over the course of a smoking cessation attempt.
Using cluster analysis, we identified 2 groups of smokers who differed in their baseline responses to pleasant and cigarette-related cues in the posterior visual association areas, the dorsal striatum, and the medial and dorsolateral prefrontal cortex. Smokers who showed lower prequit levels of brain reactivity to pleasant stimuli than to cigarette-related cues were less likely to be abstinent 6 months after their quit attempt, and they had higher levels of negative affect over the course of the quit attempt.
Smokers with blunted brain responses to pleasant, relative to cigarette related, stimuli had more difficulty quitting smoking. For these individuals, the lack of alternative forms of reinforcement when nicotine deprived might be an important factor underlying relapse. Normalizing these pathological neuroadaptations may help them achieve abstinence.
[Show abstract][Hide abstract] ABSTRACT: Because smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment.
Initiatives to facilitate these practices include the 5A's (ask, advise, assess, assist, arrange) and Ask-Advise-Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask-Advise-Connect (AAC) approach to linking smokers with treatment in a large, safety net public healthcare system.
The study design was a pair-matched group-randomized trial with two treatment arms.
Ten safety net clinics in Houston TX.
Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed vocational nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record. Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily, and patients were proactively called by the quitline within 48 hours. In AAR, smokers were offered a quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012.
The primary outcome was impact, defined here as the proportion of identified smokers that enrolled in treatment.
The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t(4)=14.61, p=0.0001, OR=32.10 (95% CI=16.60, 62.06).
The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities.
This study is registered at ISRCTN78799157.
American journal of preventive medicine 12/2013; 45(6):737-41. DOI:10.1016/j.amepre.2013.07.011 · 4.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Although considerable research has demonstrated associations between neighborhood contextual factors and health-related outcomes, the mechanisms through which neighborhoods influence health are not well understood. Building on empirical and theoretical research, this study investigates mediational pathways linking neighborhood economic deprivation to health that include perceived neighborhood problems and neighborhood social cohesion as possible mediators. Methods: Cross-sectional data were collected from a church-based sample of African American adults (n=1,374; 75% female; mean age=45 years) in 2009. Neighborhood data were derived from the 2006-2010 American Community Survey. A neighborhood deprivation index comprised of 11 commonly used Census tract-level variables was developed using principal components analysis. Generalized estimating equations assessed the direct association between neighborhood deprivation and self-rated health (SRH). Monte Carlo confidence intervals were used to test the significance of mediational pathways. Analyses controlled for participant sociodemographics. Results: Greater neighborhood deprivation was associated with reporting worse health (OR=1.29; 95% CI: 1.02, 1.65). Neighborhood deprivation was inversely associated with social cohesion and positively associated with neighborhood problems. Both of these variables were, in turn, associated with SRH, with greater social cohesion predicting better health, and increased neighborhood problems predicting worse health. Single mediation models revealed that both social cohesion (OR=1.04; 95% CI: 1.01, 1.09) and neighborhood problems (OR=1.09; 95% CI: 1.01, 1.18) mediated the association between neighborhood deprivation and SRH. Conclusions: Findings emphasize the importance of the neighborhood socioeconomic context to neighborhood conditions and social cohesion as potential pathways influencing health. These attributes should be considered in the development of efforts to address neighborhood-based disparities in health.
141st APHA Annual Meeting and Exposition 2013; 11/2013