Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

Does acceptance and relationship focused behavior therapy contribute to bupropion outcomes? A randomized controlled trial of functional analytic psychotherapy and acceptance and commitment therapy for smoking cessation

This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.     

Actions taken by schools when tobacco policies are violated: associations with adolescent smoking prevalence

This study examined the association of adolescent smoking prevalence with actions taken by schools (i.e., informing parents or disciplining pupils at school) for violating the school tobacco policy. Interaction terms between actions taken by schools and role models' smoking behavior or support for adolescents were also examined. Data were collected using self-completed questionnaires from a nationally representative Norwegian sample of 15-year-olds (1,404 pupils, 51% males) and 73 staff members. Informing parents when the school tobacco policy was violated by contrast with other actions taken by schools was not associated with lower levels of adolescent smoking. Disciplining pupils was associated with lower levels of adolescent smoking but the association was no longer significant when examined together with parents' and teachers' smoking behavior or support. Exposure to parents' and teachers' smoking, and teachers' support were associated with adolescent smoking prevalence, irrespective of actions taken by schools. Identifying the mechanism under which these different home and school factors relate to adolescent smoking may be worthwhile to inform intervention initiatives.     

Simulating demand for cigarettes among pregnant women: A Low‐Risk method for studying vulnerable populations

A substantive obstacle to experimentally studying cigarette smoking and use of other tobacco products in pregnant women is the risk of adverse effects on mother and fetus from experimenter administration of the product of interest. The purpose of this study is to investigate bypassing that obstacle by using behavioral economic simulation tasks. In the present study we used the Cigarette Purchase Task (CPT) to simulate changes in demand for hypothetical cigarettes as a function of varying cigarette prices. Participants were 95 pregnant women who completed the CPT prior to participation in a smoking‐cessation trial. Aggregate and individual participant demand varied as an orderly function of price and those changes were well fitted by an exponential equation. Demand also varied in correspondence to two well‐validated predictors of individual differences in smoking cessation among pregnant women (cigarettes smoked per day, pre‐pregnancy quit attempts). Moreover, CPT indices were more effective than these two conventional variables in predicting individual differences in whether women made a quit attempt during the current pregnancy. Overall, these results represent a promising step in demonstrating the validity and utility of the CPT for experimentally examining demand for cigarettes, and potentially other tobacco and nicotine delivery products, among pregnant women.     

Resisting Gendered Smoking Pressures: Critical Consciousness as a Correlate of Women's Smoking Status

Gender is one of the social structures, along with social class and ethnicity, that shapes women's smoking behaviors. We examined how different responses to gender pressures (internalization and resistance) relate to smoking. We analyzed data from a national random digit dial survey of 945 women and found that never smokers scored high on resistance to gender pressure (indicated by high scores on feminist consciousness) and on education and Body Mass Index; current smokers had the reverse pattern. Ex-smokers scored high on one measure of resistance (advertising skepticism) and on two measures of internalization (embodied femininity and weight concern); they were also likely to have high household income and to be European American. Results are discussed in terms of their implications for smoking cessation programs and antismoking campaigns.     

After-School Supervision, Psychosocial Impact, and Adolescent Smoking and Alcohol Use in China

We examined effects of self-care after school hours and psychosocial factors on cigarette smoking and alcohol use among adolescents in China. Survey data were obtained from 4734 7th and 11th grade students from seven cities across China. Students were queried about the frequency and quantity of unsupervised self-care after school in an average week. Tobacco and alcohol usage were also obtained. Odds ratios were calculated to determine the strength of association between unsupervised self-care after school and substance use. Results indicated that the amount of self-care after-school (how many days and how many hours per week) was significantly associated with increased risk for smoking and alcohol use among Chinese adolescents. These associations remained significant even after controlling for anxiety, depressive symptoms, and peer influence. The interaction between unsupervised self-care after school and peer influence indicated that unsupervised self-care after school is a stronger risk factor for smoking among adolescents with pro-smoking friends. The findings suggest that substance use prevention programs for youth in China should try to enhance parental monitoring. As it may not be feasible for families to revert to a lifestyle that includes supervision by relatives, other approaches such as organized after-school care are worthy of consideration.     

Cigarette Smoking, Anxiety, and Depression

This review provides a detailed analysis of anxiety and depression as they relate to each stage of the cigarette smoking cycle: initiation, maintenance, and cessation with an emphasis on nicotine withdrawal. An analysis of the literature confirms that cigarette smoking is highly comorbid with anxiety disorders and clinical depression, and that this relationship appears to be moderated by factors such as age of the smoker, type of disorder, and level of nicotine dependence. Studies also offer evidence to suggest a relationship between smoking and both subclinical anxiety and depression. Research findings have not revealed whether common factors influence the development of anxiety, depression, and smoking, whether anxiety and depression lead to smoking, or whether the reverse is true. Nevertheless, a current understanding of the links among smoking, anxiety, and depression confirms current prevention and cessation techniques, as well as suggests new directions for research and clinical practice.     

Pharmacologic and Behavioral Withdrawal From Addictive Drugs

ABSTRACT— Recent theories suggest that drug withdrawal does not motivate drug use and relapse. However, data now show that withdrawal produces complex changes over time in at least two symptoms (i.e., negative affect and urges) that are highly predictive of relapse. Evidence suggests that falling levels of the drug in the blood and interruption of the drug self-administration ritual both affect these symptoms. Both of these forms of withdrawal motivate renewed drug use in addicted individuals.     

中国县级地区被动吸烟暴露现状分析

采用三阶段随机抽样,对六县级地区被动吸烟状况进行研究,结果发现：六县市被动吸烟率为59．1％,男女被动吸烟率为61．3％和58．0％。在被动吸烟人群中,约50％以上每天遭受危害;家庭、室内工作场所仍是主要暴露地点。建议尽快颁布并有效执行禁烟规定,普及被动吸烟危害知识。     

Exposure to Parental Cigarette Smoking and Child Problem Behaviors: A Longitudinal Study

This study examined exposure to environmental tobacco smoke (ETS), a major public health problem. ETS has been found to be associated with an increased risk of adverse health effects in children. This study utilizes data from a community-based, longitudinal investigation examining the relation between children’s exposure to ETS and later internalizing symptoms and externalizing behaviors. Interviews were administered to a representative community sample of participants from two New York State counties in 1983, with subsequent interviews in 1985–1986, 1992, 1997, and 2002–2003 (when the participants’ mean age was 32). Data was collected on various personality and behavioral characteristics of the participants, and on internalizing symptoms and externalizing behaviors demonstrated by their children. Results indicated that children’s exposure to ETS was associated with an increased risk for both internalizing symptoms and externalizing behaviors. This relationship was maintained despite control on a number of parental psychosocial risk factors (e.g., demographic variables, personality and behavioral attributes) that have been found to be associated with both parental cigarette smoking and behavior problems among children. These data, which indicate an association between exposure to ETS and internalizing symptoms and externalizing behaviors among children, support public health policies to further restrict children’s exposure to ETS.