David W Wetter

University of Texas MD Anderson Cancer Center, Houston, TX, United States

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Publications (193)601.73 Total impact

  • [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).
    Psychology of Addictive Behaviors 03/2014; 28(1):163-72. · 2.09 Impact Factor
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    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.
    Addictive behaviors 03/2014; 39:717-720. · 2.25 Impact Factor
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    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. · 2.32 Impact Factor
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    ABSTRACT: Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR.
    Progress in Community Health Partnerships Research Education and Action 01/2014; 8(2):157-68.
  • Mindfulness 01/2014;
  • Progress in community health partnerships : research, education, and action. 01/2014; 8(2):141-2.
  • American journal of health behavior 01/2014; 38(31):41. · 1.31 Impact Factor
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    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.
    Nicotine & Tobacco Research 01/2014; 16:569-575. · 2.48 Impact Factor
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    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. · 1.31 Impact Factor
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    ABSTRACT: Cardiovascular disease (CVD) risk factors are prevalent among Black adults. Studies have demonstrated that functional social support buffers CVD risk. The objective of our study is to assess whether specific types of functional social support or their cumulative total buffers CVD risk factors among a convenience sample of Black adults, and whether these associations differ by sex or partner status. Cross-sectional study using self-reported survey data. Large church in Houston, TX. A total of 1,381 Black adults reported their perceived social support using appraisal, belonging, and tangible subscales of the Interpersonal Support Evaluation List-12. A cumulative score was created based on the three subscales. Participants also reported on a number of sociodemographic characteristics. Three self-reported CVD risk factors: diabetes, high blood pressure, and high cholesterol (yes vs no). A series of multivariate logistic regressions controlling for sociodemographic characteristics were used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for CVD risk factors. Cumulative social support, rather than any specific type of social support, was significantly related to diabetes and high blood pressure. Higher cumulative social support was associated with lower odds of experiencing diabetes (aOR = .97, 95% CI = .94, .99) and high blood pressure (aOR = .98, 95% CI = .95, .99). Neither sex nor partner status moderated associations. In a high risk population for CVD, increasing all types of social support--appraisal, belonging, and tangible--might be useful in preventing or delaying the onset of CVD.
    Ethnicity & disease 01/2014; 24(4):444-50. · 0.92 Impact Factor
  • Mindfulness 12/2013;
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    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.
    Nicotine & Tobacco Research 12/2013; · 2.48 Impact Factor
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    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. · 4.24 Impact Factor
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    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
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    ABSTRACT: To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans. A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male). Greater discrimination was associated with poorer self-rated health (β =-.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05). Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.
    American journal of health behavior 11/2013; 37(6):745-54. · 1.31 Impact Factor
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    ABSTRACT: Over 10 years ago, Baer and colleagues proposed the integration of skills training and motivational strategies for the treatment of substance abuse. Since that time, several studies evaluating the efficacy of such hybrid approaches have been published, but few have been efficacious. Motivation and Problem Solving (MAPS) is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework, and has been demonstrated to be effective in a randomized clinical trial focused on the prevention of postpartum smoking relapse. MAPS was designed to be applicable to not only relapse prevention but also the cessation of substance use, and is relevant for individuals regardless of their motivation to change. MAPS views motivation as dynamically fluctuating from moment to moment throughout the behavior change process, and comprehensively addresses multiple issues important to the individual and relevant to change through the creation of a wellness program. As a result, we believe that MAPS enhances the likelihood that individuals will successfully achieve and maintain abstinence from substance use, and that its comprehensive focus on addressing diverse and salient issues enhances both engagement in treatment and its applicability in modifying other health risk behaviors. The current paper introduces MAPS, distinguishes it from other hybrid and stage-based substance use treatments, and provides detailed information and clinical text regarding how MAPS is specifically and uniquely implemented to address key mechanisms relevant to quitting smoking and maintaining abstinence.
    Cognitive and Behavioral Practice 11/2013; 20(4):501–516. · 1.33 Impact Factor
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    ABSTRACT: To evaluate a conceptual model of the psychosocial pathways linking socioeconomic status and body mass index (BMI) among smokers. A latent variable modeling approach was used to evaluate the interrelationships among socioeconomic status, perceived neighborhood disadvantage, social support, negative affect, and BMI among smokers recruited from the Houston metropolitan area (N = 424). A total of 42.4% of participants were obese, with the highest prevalence of obesity among Latinos followed by African Americans. Across all racial/ethnic groups, perceived neighborhood disadvantage, social support, and negative affect functioned as pathways linking socioeconomic status and BMI. Findings indicate the need for interventions that target obesity among socioeconomically disadvantaged smokers and provide potential intervention targets for the prevention and treatment of obesity.
    American journal of health behavior 09/2013; 37(5):587-98. · 1.31 Impact Factor
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    ABSTRACT: Some studies using ecological momentary assessment (EMA) have revealed an association between craving for cigarettes and relapse. It is, therefore, important to understand the correlates of craving during smoking cessation. Attentional bias to smoking cues is a potential correlate of craving, but it has not previously been assessed using EMA during smoking cessation. Smokers enrolled in a research smoking cessation study were offered the opportunity to take part in an EMA study. Volunteers carried around a personal digital assistant (PDA) for the first week of their quit attempt. They completed up to 4 random assessments (RAs) per day as well as assessments when they experienced a temptation to smoke and when they relapsed. Craving for cigarettes was assessed with a single item (1-7 scale). Attentional bias was assessed with a smoking Stroop task (a reaction time task) at every other assessment, as was self-reported attention to cigarettes. Data were available from 119 participants. Across 882 assessments, participants exhibited a significant smoking Stroop effect. Linear mixed models revealed a significant between-subject association between craving and the smoking Stroop effect. Individuals with higher levels of craving exhibited greater attentional bias. The within-subject association was not significant. Similar results were obtained for the relationship between self-reported attention to cigarettes and attentional bias. Attentional bias can be assessed in the natural environment using EMA during smoking cessation, and attentional bias is a correlate of craving during the early stages of a quit attempt.
    Nicotine & Tobacco Research 07/2013; · 2.48 Impact Factor
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    ABSTRACT: Objective: We evaluated whether childhood trauma moderated the treatment effect on depression and smoking outcomes in pregnant smokers. Method: The sample included pregnant smokers participating in a randomized trial evaluating the efficacy of a 10-session interpersonally focused therapy-cognitive behavioral analysis system of psychotherapy (CBASP)-versus a time-matched health and wellness control (HW) for smoking cessation and depression reduction. Women (N = 248) who completed the Childhood Trauma Questionnaire (CTQ) were included. On average, women were 25 years old (SD = 5.91) and smoked 10 (SD = 6.9) cigarettes per day. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CES-D), and women had an average score of 21 (SD = 11.03). Seventy-six percent of women had experienced some form of moderate to severe childhood trauma as assessed by the CTQ. Results: In women with a history of moderate to severe childhood trauma, there was a dose-response association of treatment on depression outcome through 6 months postpartum; those with increasing amounts of childhood trauma benefitted more from CBASP, whereas those in the HW condition did not. Childhood trauma did not moderate the treatment effect on abstinence, although increasing amounts of trauma were associated with reduced likelihood of abstinence at 6 months posttreatment. Conclusions: An interpersonally focused therapy may be beneficial for the treatment of depression during the prenatal period in pregnant smokers with childhood trauma histories, and such treatment becomes increasingly more important with cumulative trauma experience. Childhood trauma increases risk for cessation failure in pregnant smokers. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 06/2013; · 4.85 Impact Factor
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    ABSTRACT: Abstract Background: Most women in the United States do not meet minimum recommendations for physical activity or fruit/vegetable consumption. Thus, many are overweight/obese and are at increased risk for cancer morbidity and mortality. This study investigated women's perceptions about the importance of physical activity and a healthy diet in preventing cancer, perceptions of engaging in these behaviors, and whether or not the behaviors met cancer prevention recommendations. Method: A cross-sectional, national, random-digit-dialed telephone survey was conducted with 800 women, ages 18 and older. The response rate was 24.5%. Measures assessed demographics, perceived health status, beliefs about the role of physical activity and diet in cancer prevention, perceived engagement in these behaviors, and actual behaviors. Results: Only 9.9% of women who reported eating a healthy diet met minimum fruit and vegetable recommendations; 39.7% of women who reported regular physical activity met the minimum recommendation. Analyses adjusted for demographics indicated that low education was associated with reporting regular physical activity to prevent cancer, yet failing to meet the minimum recommendation (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.82-0.98, p=0.01). Racial/ethnic minority status was marginally significantly associated with reporting eating a healthy diet to prevent cancer, yet failing to consume sufficient fruits and vegetables (OR=2.94, 95% CI: 0.99-8.71, p=0.05). Conclusions: Most women who reported eating a healthy diet and being physically active to prevent cancer failed to meet the minimum cancer prevention recommendations. Furthermore, low socioeconomic status and racial/ethnic minority women may be particularly vulnerable to discrepancies between beliefs and behavior.
    Journal of Women's Health 06/2013; 22(6):487-93. · 1.90 Impact Factor

Publication Stats

3k Citations
601.73 Total Impact Points


  • 1999–2014
    • University of Texas MD Anderson Cancer Center
      • • Health Disparities Research
      • • Department of Behavioral Science
      Houston, TX, United States
  • 2012–2013
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States
    • University of Texas at Austin
      • School of Social Work
      Austin, Texas, United States
  • 2007–2012
    • University of Texas Health Science Center at Houston
      • Division of Management, Policy and Community Health
      Houston, TX, United States
  • 2002–2012
    • Baylor College of Medicine
      • Department of Pediatrics
      Houston, Texas, United States
  • 2010
    • University of North Texas at Dallas
      Dallas, Texas, United States
  • 1994–2010
    • University of Wisconsin, Madison
      • • Department of Medicine
      • • Center for Tobacco Research and Intervention
      Madison, MS, United States
  • 2009
    • Uniformed Services University of the Health Sciences
      • Department of Medical & Clinical Psychology
      Bethesda, MD, United States
  • 2008
    • University of Puerto Rico, Medical Sciences Campus
      San Juan, San Juan, Puerto Rico
  • 2005
    • The Menninger Clinic, Inc.
      United States
  • 2002–2005
    • Xavier University
      • Department of Psychology
      Cincinnati, OH, United States
    • Group Health Cooperative
      • Group Health Research Institute
      Seattle, Washington, United States
  • 2000
    • University of Washington Seattle
      • Department of Health Services
      Seattle, WA, United States