Andrew Waters

Uniformed Services University of the Health Sciences | USUHS · Department of Medical & Clinical Psychology

Background/Objectives: Attention bias (AB) toward food is associated with obesity, but it is unclear if programs designed to reduce AB can impact adolescents’ eating behavior. We investigated whether a two-week, smartphone-delivered attention retraining (AR) program (vs a control program) altered food AB in adolescent girls with overweight. Methods...

Background: Despite high co-occurrence, chronic pain is often unaddressed in treatment for opioid use disorder (OUD) and little is known about mechanisms that may underlie associations between pain and opioid use. Using an attentional bias (AB) task with both pain and opioid cues, we evaluated a cognitive bias modification (CBM) task administered...

Unhealthy food advertisements (“advertisements” hereafter referred to as “ads”) are linked to poor diet and obesity, and food companies disproportionally target Black youth. Little is known about the mechanisms whereby food ads influence diet. One possibility may be racially-targeted ads that appeal to Black youth. Those with food-related attention...

Studies have examined burnout and its impact on health, to include its influence on sleep. While many studies report a significant relationship between burnout and insomnia in civilian populations, no studies have examined this relationship in a military population. The United States Air Force (USAF) Pararescue personnel are an elite combat force w...

Background. Chronic and acute stress and emotion predict incidence/recurrence of CHD, but long-term effects on HF exacerbations are poorly understood. This study determined long-term chronic and episodic effects of stress, anxiety, and anger on hospitalizations or death, and worsened health status in HF. Methods and Results. 147 patients with heart...

Background. Chronic and acute stress and emotion predict incidence/recurrence of CHD, but long-term effects on HF exacerbations are poorly understood. This study determined long-term chronic and episodic effects of stress, anxiety, and anger on hospitalizations or death, and worsened health status in HF. Methods and Results. 147 patients with heart...

Electronic Nicotine Delivery Systems (ENDS) are an increasingly popular form of a nicotine delivery device, particularly among young adults and adolescents. The health consequences of long-term ENDS use are not known. Two populations that warrant special consideration are members of the United States Military (service members) and US Veterans. In t...

Cigarette smoking remains the largest cause of preventable death in the United States and worldwide. In South Korea and other Asian countries, a large proportion of males smoke, increasing the need to examine cigarette smoking in these populations. Research suggests that the association between positive affect and negative affect, and between affec...

Introduction: Although cigarettes and alcohol are frequently used together, few studies have evaluated evidence of attentional bias to both smoking and alcohol cues. Attentional bias (AB) is defined as preferential attention to drug-specific cues and is most often studied in a laboratory with one cue type. AB may be an important mechanism associat...

Cigarette smoking remains an important public health concern, and novel smoking cessation interventions are needed. Craving for cigarettes is a well-established target for intervention. Recent research has identified cognitive processes associated with craving, such as attentional bias to smoking cues, as targets for intervention. One intervention...

It is unclear whether nicotine and perceived nicotine exposure can influence automatic evaluations of cigarette stimuli. In the present study, we investigated the effects of nicotine dose and instructed dose on motivational responses to smoking cues. Forty overnight nicotine-deprived smokers completed an Implicit Association Test (IAT) at each of t...

Rationale Minocycline, a tetracycline antibiotic, inhibits activation of microglia. In preclinical studies, minocycline prevented development of opioid tolerance and opioid-induced hyperalgesia (OIH). The goal of this study was to determine if minocycline changes pain threshold and tolerance in individuals with opioid use disorder who are maintaine...

Objectives: One way to enhance the impact of smoking health risk messages may be to tailor their content to individual difference factors such as need for cognition (NFC). In this study, we examined how NFC influenced responses to different smoking risk messages. Outcomes included knowledge, risk perceptions, and behavioral expectations related to...

Hazardous alcohol use remains a significant global public health problem. A better understanding of relapse may assist the development of new interventions. Low levels of dispositional mindfulness may be a risk factor for craving and alcohol use, but few studies have examined these associations prospectively in an alcohol-dependent sample. In an ec...

Although the prevalence of cigarette smoking has declined in Western countries over the past few decades, a comparable decline among males has not been observed in Asian countries, especially in South Korea, where approximately 40%-50% of men and 4%-8% of women have been identified as smokers, and there is a pressing need to understand the backgrou...

Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 ye...

Reducing smoking among adolescents is a public health priority. Affect, craving, and cognitive processes have been identified as predictors of smoking in adolescents. The current study examined associations between implicit attitude for smoking (assessed via the positive–negative valence implicit association test) and affect, craving, and smoking a...

Background: Opioid use in the United States is a national public health emergency. The primary treatment for opioid use disorder (OUD) is medication assisted treatment (MAT). Although effective in improving treatment outcomes in OUD, there is a need to develop behavioral treatments adjunctive to MAT. The current study investigates attentional bias...

Objective Drugs that enhance cholinergic transmission have demonstrated promise treating addictive disorders. Galantamine, an acetylcholinesterase inhibitor, may reduce cigarette smoking in otherwise healthy treatment‐seeking smokers. Methods The current study is a double‐blind, placebo‐controlled, study that randomized daily smokers (n = 60) to r...

Introduction While sleep disturbance is common among smokers, few studies that investigated nicotine dependence and sleep. Previous studies have indicated that individuals who tend to worry about sleep report more symptoms of insomnia, and this may in turn increase negative affect and smoking. This study examined associations between worry about sl...

Introduction: Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to...

Objective: Attentional bias (AB) may be one mechanism contributing to the development and/or maintenance of disordered eating. AB has traditionally been measured using reaction time in response to a stimulus. Novel methods for AB measurement include eye tracking to measure visual fixation on a stimulus, and electroencephalography to measure brain...

Background Efforts are needed to ensure that smokers with lower health literacy are provided with understandable and impactful information about the health consequences of smoking and benefits of quitting. Purpose To test the influence of health literacy on smokers’ responses to health risk messages manipulated on framing (gain vs. loss) and emoti...

Introduction Difficulties in emotion regulation are associated with addictive behaviors, including smoking. Difficulties in emotion regulation may underlie large, rapid changes in negative affect that can increase likelihood of relapse. We investigated the association between emotion regulation ability and negative affect in smokers assessed both i...

Substance use disorders (SUDs) are a growing problem for the U.S. military. Each branch of the military has its own dedicated substance abuse treatment program. However, there has been limited attention to the research conducted on these programs. The purpose of this narrative review is to describe SUD treatment programs in the U.S. military and to...

Introduction: Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to...

Introduction: Many African Americans live in communities with a disproportionately high density of tobacco advertisements compared to Whites. Some research indicates that point-of-sale advertising is associated with impulse purchases of cigarettes and smoking. Ecological Momentary Assessment (EMA) can be used to examine associations between tobacc...

Introduction: Tobacco use among persons living with HIV represents an important risk factor for poor treatment outcomes, morbidity, and mortality. Thus, efforts designed to inform the development of appropriate smoking cessation programs for this population remains a public health priority. To address this need, a study was conducted to longitudin...

Objective: To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. Method: Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Lati...

African American cigarette smokers have lower rates of cessation than Whites and live in communities with a higher number of tobacco advertisements. Exposure to smoking cues may promote smoking and undermine cessation. It may be possible to reduce attention to smoking cues (“attentional bias”). In this study, we investigated the effect of attention...

Purpose of Review Novel approaches are needed to improve the treatment of tobacco use disorder (TUD). Two distinct literatures have examined the impact of cognitive function in the maintenance of TUD. One approach has focused on automatic cognitive processes, and the second approach has addressed the role of executive cognitive processes. This revi...

Measuring the construct, component processes, and practice of mindfulness remains challenging. This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported mindfulness and performance-based cognition. Adult community smokers were rand...

Objective: Physical activity is beneficial for cancer survivors, but exercise participation is low in this population. It is therefore important to understand the psychological factors underlying exercise uptake so that more effective interventions can be developed. Social-cognitive theory constructs such as outcome expectancies predict exercise b...

Objective: To examine whether initial orienting (IO) and inability to disengage (ITD) attention from negative affective stimuli moderate the association of negative affect with smoking abstinence during a quit attempt. Method: Data were from a longitudinal cohort study of smoking cessation (N = 424). A negative affect modified Stroop task was ad...

Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs...

Objective: To compare the efficacy of Mindfulness-Based Addiction Treatment (MBAT) to a Cognitive Behavioral Treatment (CBT) that matched MBAT on treatment contact time, and a Usual Care (UC) condition that comprised brief individual counseling. Method: Participants (N = 412) were 48.2% African American, 41.5% non-Latino White, 5.4% Latino, and...

We investigated the effects of acute nicotine dose and expected dose on attentional bias (AB) to smoking and affective cues in overnight nicotine-deprived smokers (n=51; 24 women) using a balanced placebo design, which counterbalanced given nicotine dose (Given-NIC vs. Given-DENIC) with instructed nicotine dose expectancy (Told-NIC vs. Told-DENIC)....

Background: Post-traumatic stress disorder (PTSD) is often comorbid with alcohol dependence (AD), but little is known about the characteristics of AD treatment-seeking inpatients with PTSD. We examined differences between treatment-seeking alcohol dependent inpatients with and without comorbid PTSD. We hypothesized that those with AD and PTSD woul...

Stimulant use disorder is an important public health problem, with an estimated 2.1 million current users in the United States alone. No pharmacological treatments are approved by the U.S. Food and Drug Administration (FDA) for stimulant use disorder and behavioral treatments have variable efficacy and limited availability. Most individuals with st...

Black cigarette smokers have lower rates of smoking cessation compared with Whites. However, the mechanisms underlying these differences are not clear. Many Blacks live in communities saturated by tobacco advertisements. These cue-rich environments may undermine cessation attempts by provoking smoking. Moreover, attentional bias to smoking cues (at...

Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation. This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on s...

Cigarette smoking is the primary cause of preventable death in developed countries, so there is a profound need to develop more effective treatments for nicotine addiction. The development of new treatments requires a better understanding of the individual factors that contribute to the initiation and maintenance of nicotine addiction. Accumulating...

As professional psychology becomes increasingly involved in providing healthcare services beyond traditional mental healthcare, the enactment of President Obama's Patient Protection and Affordable Care Act provides a unique opportunity to shape the nation's rapidly evolving healthcare environment. The study of health policy should be incorporated i...

Cocaine use disorder (CUD) continues to be an important public health problem, and novel approaches are needed to improve the effectiveness of treatments for CUD. Recently, there has been increased interest in the role of automatic cognition such as attentional bias (AB) in addictive behaviors, and AB has been proposed to be a cognitive marker for...

Background Nearly half of U.S. adults have difficulties with health literacy (HL), which is defined as the ability to adequately obtain, process, and understand basic health information. Lower HL is associated with negative health behaviors and poor health outcomes. Racial/ethnic minorities and those with low socioeconomic status (SES) are dispropo...

The imminence of drug use (i.e., drug availability) has been found to be related to intensity of drug craving, but its effects on attentional bias to drug cues are unclear. This study investigated the effects of nicotine availability on attentional bias to smoking, affective, and neutral cues in a sample of adult smokers during a vigilance task. At...

Objective: Attentional retraining (AR) is a potential new treatment for addiction. AR trains addicts to attend away from drug-related cues, thereby reducing exposure to drug cues and reducing craving. We examined the utility of delivering AR to smokers on a personal digital assistant (PDA) in the natural environment. Method: Smokers (N = 60) not...

The aim of this study was to examine the effect of acute tobacco abstinence on cortisol levels in regular smokers, and whether abstinence-induced changes in cortisol levels are correlated with various signs and symptoms of the tobacco withdrawal syndrome. Smokers (N = 77, ≥15 cigarettes/day) attended two counterbalanced sessions (avg = 1 h), one fo...

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-...

Nicotine dependence is a serious public health concern. Optimal treatment of nicotine dependence will require greater understanding of the mechanisms that contribute to the maintenance of smoking behaviors. A growing literature indicates sex and menstrual phase differences in responses to nicotine. The aim of this study was to assess sex and menstr...

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...

Objectives: We examined associations between health literacy and predictors of smoking cessation among 402 low-socioeconomic status (SES), racially/ethnically diverse smokers. Methods: Data were collected as part of a larger study evaluating smoking health risk messages. We conducted multiple linear regression analyses to examine relations betwe...

To examine whether health locus of control mediated relations of self-reported neighborhood vigilance and biochemically verified, continuous short-term smoking abstinence among 200 smokers enrolled in a cohort study. A nonparametric bootstrapping procedure was used to assess mediation. Health locus of control-chance mediated relations between neigh...

Black smokers have greater difficulty quitting tobacco than White smokers, but the mechanisms underlying between-race differences in smoking cessation are not clear. One possibility is that Black smokers experience greater acute withdrawal than Whites. We investigated whether Black (n = 104) and White smokers (n = 99) differed in abstinence-induced...

Objective: This study evaluated whether social-cognitive theory (SCT) variables, as measured by questionnaire and ecological momentary assessment (EMA), predicted exercise in endometrial cancer survivors. Method: One hundred posttreatment endometrial cancer survivors received a 6-month home-based exercise intervention. EMAs were conducted by usi...

Introduction: The Food and Drug Administration is in the process of reviewing evidence of the impact of mentholated cigarettes on smoking behaviors and smoking cessation in order to determine if these products should be removed from the market. More empirical research is needed to inform those decisions. The goal of this study was to examine assoc...

Objective: Relapse is a major problem in drug addiction treatment. Both drug craving and drug-related cognitions (e.g., attentional bias and implicit attitudes to drugs) may contribute to relapse. Using ecological momentary assessments, we examined whether craving and cognitions assessed during drug detoxification treatment were associated with re...

For over 90 million adults in the United States, difficulty with health literacy (HL) interferes with the capacity to obtain, process, and understand health information. Moreover, these individuals have an increased risk of disease. Because tobacco smoking is the leading behavioral risk factor contributing to social disparities in the incidence and...

Drug addiction continues to be an important public health problem, with an estimated 22.6 million current illicit drug users in the United States alone. For many addictions, including cocaine, methamphetamine, and marijuana addiction, there are no approved pharmacological treatments. Behavioral treatments are effective but effects vary widely acros...

Rationale: Galantamine (GAL), a reversible and competitive inhibitor of acetylcholinesterase, is used clinically in the treatment of Alzheimer's dementia. Some preclinical and clinical studies support the potential efficacy of cholinesterase inhibitors for smoking cessation, although their effects on the behavioral and physiological responses to n...

Introduction: Difficulty concentrating is a symptom of nicotine withdrawal that can contribute to relapse in individuals trying to quit smoking. The purpose of this study was to determine the effects of nicotine on executive and alerting attention in smokers and nonsmokers. Methods: Thirty daily smokers who were not tobacco deprived and 30 nonsm...

Most people do not engage in recommended levels of physical activity. Social cognition research indicates that self‐reported outcome expectancies (OEs) are associated with exercise behavior, but self‐report assessments have limitations. We investigated whether reaction times (RTs) to endorse outcome expectancies would capture unique information abo...

Appearance changes resulting from breast cancer treatment impact the quality of life of breast cancer survivors, but current approaches to evaluating breast characteristics are very limited. It is challenging, even for experienced plastic surgeons, to describe how different aspects of breast morphology impact overall assessment of esthetics. Moreov...

In preclinical and clinical studies, medications enhancing the GABA neurotransmission attenuate nicotine reward. Pregabalin, a GABA analogue, presumably interacts with brain glutamate and GABA neurotransmission. The goal of this study was to determine pregabalin's effects on smoking behavior, nicotine withdrawal, craving for cigarettes, and cogniti...

Relapse is an important problem in substance dependence treatment. When drug users try to abstain from drug use, they often report strong temptations to use drugs. Temptation episodes have commonalities with relapse episodes, and assessment of temptation episodes may help to identify individuals at risk of relapse. This study aims to examine affect...

Cocaine-dependent subjects show attentional bias to cocaine-related stimuli, increased impulsivity on questionnaires, and impaired inhibitory control (one component of impulsivity on behavioral tasks). However, the relationship between attentional bias, impulsivity, and inhibitory control in cocaine-dependent subjects is unknown. To investigate the...

Chronic cocaine users are known to have cognitive deficits that are predictive of poor treatment response. Whether these deficits improve with medications targeting specific cognitive functions has not been examined in previous studies. The goal of this study was to evaluate galantamine's efficacy on selected cognitive outcomes, including measures...

Physical activity has been shown to benefit cancer survivors' physical functioning, emotional well-being, and symptoms. Physical activity may be of particular benefit to survivors of endometrial cancer because they are more likely to be obese and sedentary than the general population, as these are risk factors for the disease, and thus experience a...

Minocycline, a tetracycline antibiotic, interacts with brain glutamate and dopamine neurotransmission. In preclinical studies, minocycline attenuated amphetamine-induced acute dopamine release and subsequent behavioral sensitization. The goal of this study was to determine minocycline's effects on the acute physiological, behavioral, and subjective...

Previous studies have documented the existence of signs and symptoms of the acute tobacco abstinence syndrome; however, less attention has been paid to quantifying the magnitude of these effects. The present study quantified the relative magnitude of subjective, cognitive, and physiological manifestations of acute tobacco abstinence. Smokers (N=203...

Black and White smokers may experience aspects of nicotine dependence, including craving, differently. This study used a naturalistic technique, ecological momentary assessment (EMA), to explore differences in craving, mood, expectancy, and smoking enjoyment between Black and White smokers. Participants carried personal digital assistants (PDAs) pr...

The Implicit Association Test (IAT) is widely used to assess automatic associations in memory. The feasibility of administering the test in an Ecological Momentary Assessment setting was examined with 15 smokers and 15 nonsmokers who carried a handheld computer for 1 wk. as they went about their daily lives. They completed the Implicit Association...

Studies have shown that expectations about exercise outcomes are associated with exercise behavior. Outcome expectations can be assessed by self-report questionnaires, but a new method-the expectancy accessibility task-may convey unique information about outcome expectations that is less subject to respondent biases. This method involves measuring...

Quitting smoking is a major life stressor that results in numerous aversive consequences, including persistently increased level of post-cessation negative affect and relapse. The identification of factors that may enhance behavioral and emotional regulation after quitting may be useful in enhancing quit rates and preventing relapse. One factor bro...

Theory suggests that mindful individuals exhibit enhanced attentional processing (e.g., attentional control) and that they maintain a detached perspective to problematic stimuli. For smokers, smoking and affective stimuli are problematic stimuli when they try to quit. In this cross-sectional study, smokers (n = 158) completed 3 modified Stroop task...