Motivation for smoking cessation among pregnant women.

The authors evaluated an expanded measure of intrinsic and extrinsic motivation for smoking cessation in a population-based sample of 897 pregnant smokers (500 current smokers and 397 recent quitters). The measure assessed motivation related to pregnancy and parenthood in addition to general intrinsic and extrinsic dimensions. Current smokers at baseline who quit smoking by 28 weeks of pregnancy (n?=?102) had significantly higher baseline levels of pregnancy-related motivation than continuing smokers. Extrinsic and pregnancy motivation dropped between baseline and 28 weeks of pregnancy among continuing smokers. Higher levels of intrinsic relative to extrinsic motivation at baseline were associated with sustained abstinence during the first 2 months postpartum. Results suggest that both general and pregnancy-specific motivation are important for smoking cessation and relapse prevention during pregnancy. Interventions to enhance the salience of health benefits over and above those related to pregnancy and other intrinsic benefits of a greater sense of self-control could protect against postpartum relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder.

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner support and other determinants of smoking cessation maintenance among women.

Conducted a prospective examination of the effects of naturally occurring partner support on smoking cessation maintenance with 125 newly abstinent female smokers (mean age 41.8 yrs). 123 of the Ss were married, and 2 were living with a partner. Six days after smoking cessation, Ss supplied demographic and smoking habit data and ratings of a variety of their own and their partners' attributes and behaviors. Factor analysis of partner ratings revealed a dominant factor, Partner Facilitation, which accounted for 74% of the common variance, encompassed both quitting-related and general interactions, and loaded on the following behaviors: problem solving, rewarding quitting, understanding, listening, and facilitating the enactment of coping and nonsmoking skills. Results indicate that when the Partner Facilitation factor was entered into a stepwise discriminant analysis with 19 other variables, it emerged as the primary predictor of smoking cessation maintenance, accounting for 32% of the variance in outcome at 6–8 wks and accurately identifying more than 80% of both successful and unsuccessful outcomes. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The misattribution of smoking cessation symptoms.

Asked 15 female nurses who reported smoking at least 10 cigarettes per day to refrain from smoking for 1 day as part of a "study of heart rate." Experimental Ss were given a placebo and told that this pill would cause increased irritability, nervousness, and appetite. Controls received no information about side effects. It was predicted that experimental Ss would attribute their discomfort to the action of the pill and report less cessation difficulty than controls, who would attribute their discomfort to cigarette deprivation. This effect would be expected to appear only after several hours of deprivation when symptoms would be intense. Self-reports revealed a significant Condition * Time interaction, confirming the prediction. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smoking predicts development of depressive symptoms among U.S. adolescents

Latent inhibition (LI) refers to retarded conditioning to a stimulus as a consequence of its nonreinforced preexposure. LI is impaired in acute schizophrenic patients and in rats treated with amphetamine. Neuroleptic drugs enhance LI, and this effect is selective and specific for this class of drugs. The present experiments tested the proposition that neuroleptic-induced enhancement of LI stems from decreased capacity of stimulus-preexposed animals to switch responding according to the new stimulus-reinforcement contingency in the conditioning stage. LI was assessed using an off-baseline conditioned emotional response (CER) procedure in rats licking for water, consisting of three stages: preexposure to the-to-be conditioned stimulus, tone; conditioning, in which the preexposed stimulus was paired with a foot-shock; and test, in which LI was indexed by animals' degree of suppression of licking during tone presentation. Whereas in previous studies that demonstrated LI enhancement by neuroleptics, preexposure consisted of 10 to 40 tones, and conditioning included two tone-shock pairings, the present experiments used 40 tone preexposures, followed by an extended conditioning stage with five tone-shock pairings. It was expected that under these conditions no LI effect would be evident in untreated animals, but that animals treated with a neuroleptic drug, either during the entire LI procedure or only in conditioning, would show LI. Experiments 1 and 2 showed that LI was obtained in rats treated with haloperidol (0.1 mg/kg in experiment 1, 0.03 and 0.2 mg/kg in experiment 2) but not in the untreated controls. Experiment 3 showed that the same outcome was obtained when haloperidol (0.1 mg/kg) administration was confined to the conditioning stage. Experiment 4 showed that clozapine (5 mg/kg)-treated animals showed LI when the drug was confined to conditioning, but not to the preexposure stage. The implications of these results for the mechanism of action of neuroleptic drugs are discussed.     

Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms.

Objective: Depressive symptoms are associated with poor smoking cessation outcomes, and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology. In this pilot study, we examined whether a behavioral activation treatment for smoking (BATS) can enhance cessation outcomes. Method: A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years of age; 48.5% were women; 72.7% were African American) seeking smoking cessation treatment were randomized to receive either BATS paired with standard treatment (ST) smoking cessation strategies including nicotine replacement therapy (n = 35) or ST alone including nicotine replacement therapy (n = 33). BATS and ST were matched for contact time and included 8 sessions of group-based treatment. Quit date was assigned to occur at Session 4 for each treatment condition. Participants completed a baseline assessment; furthermore, measures of smoking cessation outcomes (7-day verified point-prevalence abstinence), depressive symptoms (Beck Depression Inventory–II; Beck, Steer, & Brown, 1996), and enjoyment from daily activities (Environmental Reward Observation Scale; Armento & Hopko, 2007) were obtained at 1, 4, 16, and 26 weeks post assigned quit date. Results: Across the follow-ups over 26 weeks, participants in BATS reported greater smoking abstinence (adjusted odds ratio = 3.59, 95% CI [1.22, 10.53], p = .02) than did those in ST. Participants in BATS also reported a greater reduction in depressive symptoms (B = ?1.99, SE = 0.86, p = .02) than did those in ST. Conclusions: Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of quitting and dropout among women in a clinic-based smoking cessation program.

Most cessation studies assume that dropouts are smokers. Instead, the authors analyzed these outcomes separately using multinomial regression to model the relative risk of quitting versus continued smoking and dropping out. Female (N = 281) smokers were randomly assigned to a 12-week smoking cessation program plus either a 3-times-per-week exercise program or a contact control wellness program. Higher body mass index and longer prior quit attempts predicted cessation. Self-efficacy was associated with a lower likelihood of dropout. Greater nicotine dependence and lower education predicted continued smoking or dropout versus quitting among exercisers. Patterns of smoking, dropping out, and quitting between Weeks 5 and 12 were different between exercisers and controls. Dropouts should be considered as a separate category from smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delay discounting predicts postpartum relapse to cigarette smoking among pregnant women.

Delay discounting (DD), a measure of impulsivity, describes the rate at which rewards lose value as the delay to their receipt increases. Greater discounting has been associated with cigarette smoking and various other types of drug abuse in recent research. The present study examined whether DD predicts treatment outcome among cigarette smokers. More specifically, the authors examined whether baseline discounting for hypothetical monetary rewards predicted smoking status at 24 weeks postpartum among women who discontinued smoking during pregnancy. Participants were 48 pregnant women (10.5 = 4.1 weeks gestational age at study entry) who participated in a clinical trial examining the use of incentives to prevent postpartum relapse. Several sociodemographic characteristics (being younger, being less educated, and reporting a history of depression) assessed at study entry were associated with increased baseline DD, but in multivariate analyses only DD predicted smoking status at 24 weeks postpartum. Greater baseline DD was a significant predictor of smoking status at 24 weeks postpartum. DD was reassessed periodically throughout the study and did not significantly change over time among those who eventually resumed smoking or those who sustained abstinence. The results extend the association of DD with risk for substance abuse to pregnant and recently postpartum cigarette smokers and demonstrate a significant relationship between DD and treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress and unaided smoking cessation: A prospective investigation.

A prospective design was used to determine the outcomes associated with unaided smoking cessation and the influence of stress on cessation. Heavy smokers (N?=?308) completed stress-related measures and were then recontacted at 1, 6, and 12 mo. At each follow-up, they indicated their smoking status (which was confirmed by collateral report and biochemical tests) and completed several stress-related questionnaires. Results indicate that 33% of Ss smoked continuously throughout the year, 39% quit briefly but subsequently relapsed, and 15% quit (confirmed biochemically). An additional 7% reported they had quit, but this could not be confirmed, and 6% were lost to follow-up. Compared with nonquitters, quitters reported less perceived stress, greater self-efficacy, greater use of problem solving and cognitive restructuring, and less reliance on wishful thinking, self-criticism, and social withdrawal. A model to forecast quitting was built and cross-validated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional style and depressive symptoms among children.

The reformulation of helplessness theory proposes that an insidious attributional style accompanies and predisposes depressive symptoms. The present study investigated predictions of the reformulation among 96 8–13 yr olds who completed the Children's Attributional Style Questionnaire (ASQ) and Children's Depression Inventory twice, 6 mo apart. 83 of their parents completed the adult ASQ and the Beck Depression Inventory at their children's 2nd testing. Children who attributed bad events to internal, stable, and global causes were more likely to report depressive symptoms than were children who attributed these events to external, unstable, and specific causes. This depressive attributional style predicted depressive symptoms 6 mo later, suggesting that it may be a risk factor for depression. Children's attributional style for bad events and their depressive symptoms converged with those of their mothers but not their fathers. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of change in depressive symptoms during smoking cessation: Who's at risk for relapse?

The authors examined patterns of change in depressive symptoms during smoking cessation treatment in 163 smokers with past major depressive disorder (MDD). Cluster analysis of Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) scores identified 5 patterns of change. Although 40% of participants belonged to clusters characterized by increasing depressive symptoms during quitting (rapid increasers, n=31, and delayed increasers, n=35), almost 47% were in clusters characterized by decreasing symptoms (delayed decreasers, n=24, and rapid decreasers, n=52). Both rapid and delayed increasers had especially poor smoking cessation outcomes. Results suggest that among smokers with an MDD history there is substantial heterogeneity in patterns of depressive symptoms during quitting and that patterns involving increased symptoms are associated with low abstinence rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner smoking status and pregnant smoker's perceptions of support for and likelihood of smoking cessation.

Perceptions of support for cessation of smoking during pregnancy, likelihood of quitting, and partner smoking status were explored in a sample of 688 pregnant smokers (372 baseline smokers and 316 baseline quitters). Women with nonsmoking partners were significantly more likely to be baseline quitters than women with partners who smoked. Baseline quitters reported significantly more positive support from their partners than did continuing smokers (p?=?.02). Neither partner smoking status nor partner support at baseline was associated with cessation or relapse later in pregnancy. Women reported greater support, both positive and negative, from nonsmoking partners than from partners who smoked (p?=?.001). Among partner smokers, those who were trying to quit were perceived to be particularly supportive. Cessation interventions for expectant fathers may increase pregnant women's success at quitting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in energy balance following smoking cessation and resumption of smoking in women.

Caloric intake, resting metabolic rate (RMR), leisure-time physical activity, and sensitivity and preference for sweet taste were prospectively examined in 7 female smokers across 3 weeks during periods of normal smoking (Week 1), complete cessation (Week 2), and resumption of smoking (Week 3). Energy balance changed significantly across weeks, as caloric intake increased (largely as a result of alcohol consumption) and RMR decreased during cessation, followed by decreased caloric intake and increased RMR with resumption of smoking. Activity and taste sensitivity and preference remained unchanged. Smoking cessation may thus cause rapid change in energy balance, which is quickly reversed on resumption of smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of self-initiated smoking cessation among young adults.

Applied the cyclic-stage model of self-initiated smoking cessation by J. O. Prochaska and C. C. DiClemente (1984) to data on 3,179 young adults (aged 17–21 yrs) to determine the cross-sectional distribution of stages and the frequency and pattern of changes among stages over time. Compared to older adults, the distribution of the stages differed substantially. There were twice as many relapsers and only half as many maintainers among young adults. One-yr changes in stages were examined using a static model that did not take into account the cyclic nature of the change process and a dynamic model that did. Both models, especially the dynamic model, suggested more movement among stages in younger than in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers.

The study examined how social constraints on discussion of a traumatic experience can interfere with cognitive processing of and recovery from loss. Bereaved mothers were interviewed at 3 weeks (Tl ), 3 months (T2), and 18 months (T3) after their infants' death. Intrusive thoughts at Tl, conceptualized as a marker of cognitive processing, were negatively associated with talking about infant's death at T2 and T3 among socially constrained mothers. The reverse associations were found among unconstrained mothers. Controlling for initial level of distress, there was a positive relation between T1 intrusive thoughts and depressive symptoms over time among socially constrained mothers. However, higher levels of T1 intrusive thoughts were associated with a decrease in T3 depressive symptoms among mothers with unconstrained social relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes, beliefs, and practices regarding smoking and smoking cessation among African-American physicians and dentists

African-American physicians and dentists in metropolitan Atlanta were surveyed to assess smoking cessation practices and perceptions. Questionnaires were mailed to 373 physicians and 90 dentists. A total of 154 questionnaires were returned, for an overall response rate of 33.3%. More physicians than dentists considered smoking a "very serious" threat to patients' health, and physicians were more likely to document smoking status in charts and to counsel smokers to quit. Physicians also were approached more frequently by patients seeking cessation advice. Both types of practitioners considered the nicotine patch, formal cessation programs, and behavior modification/psychotherapy to be among the most effective cessation methods, and nicotine gum and acupuncture to be among the least effective. These results indicate African-American physicians are much more involved than dentists in promoting smoking cessation among patients. Advice of health professionals generally is viewed as a powerful influence for African-American patients. Further work is needed to utilize fully the power of health care providers, especially dentists, in the fight against tobacco-related morbidity and mortality.     

Chronic financial strain, social support, and depressive symptoms among older adults.

The purpose of this study is twofold: one, to determine whether chronic financial strain is related to depressive symptoms among a random community sample of older adults, and two, to assess whether social support counterbalances or buffers the deleterious effects of financial strain. The findings suggest that elderly people suffering from financial strain are more likely to be depressed than are older adults with fewer financial problems. In addition, the data support the stress-buffering hypothesis, that is, that older people who have more informational support and who provide support to others, more often report fewer symptoms of depression as a result of financial strain than do elderly respondents who have less informational support and who do not provide support to others. Tangible and emotional support are found to be less effective coping resources when financial strain is present. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress, depressive symptoms, and depressive disorder among caregivers of patients with brain injury

OBJECTIVE: To examine the prevalence and correlates of major depression in caregivers of individuals with moderate to severe traumatic brain injuries. DESIGN: Repeated-measures design involving structured diagnostic interview and self-report of psychological distress administered on two occasions separated by 6 months. SETTING: Three acute care rehabilitation hospitals. SUBJECTS: Fifty-nine caregivers (39 mothers and 20 spouses) of individuals with moderate to severe brain injuries recruited from previous inpatient rosters. All caregivers were currently residing with the person with traumatic brain injury. MAIN OUTCOME MEASURE: The Diagnostic Interview Schedule-Revised [DIS-R] was utilized to assess depression. The Symptom Checklist 90-Revised (SCL 90-R) measured general psychological distress. RESULTS: Forty-seven percent of caregivers initially met diagnostic criteria for depression, and 43% met criteria 6 months later. Nearly two thirds of those who were initially depressed continued to be depressed 6 months later, and 17% of those who were not depressed initially subsequently met criteria for depression. The best predictor of depression was a previous (pre-brain injury) depressive episode. Neither time since injury nor injury severity predicted diagnostic status, and spouses were no more likely to be depressed than were mothers. The SCL 90-R, including its depression scale, showed high specificity but low sensitivity in predicting diagnostic status. CONCLUSIONS: The prevalence of major depression is high in caregivers of individuals with brain injuries. Because depression may interfere with the capacity to provide care and contribute to the rehabilitation process, it is important for clinicians to carefully assess both the current and preaccident affective status of primary caregivers.     

Coping and depressive symptoms among young people with AIDS.

This study examined coping behaviors of people with AIDS, using a large sample (N?=?736) that was both geographically and sociodemographically diverse. In-person interviews were conducted with people receiving AlDS-related medical or social services; follow-up interviews were conducted approximately 11 mo later. Factor analyses of 16 coping behaviors revealed 3 factors: positive coping, seeking social support, and avoidance coping. Respondents with a history of injected drug use, as compared with gay or bisexual men, had higher scores for avoidance coping and lower scores for positive coping. Each coping scale was significantly related to depressive symptoms in cross-sectional analyses. In longitudinal analyses that controlled for prior depressive symptoms, positive coping was significantly related to decreases in symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a history of alcohol dependence.

This study examined the effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a past history of alcohol dependence. Participants (24 women, 27 men) were randomly assigned to behavioral counseling (BC) or behavioral counseling plus cognitive-behavioral mood management training (CBT). The Hamilton -Rating Scale for Depression (HRSD; A Hamilton, 1967) was administered to assess baseline depressive symptoms. Participants who received CBT and had higher HRSD scores were more likely to achieve short-term abstinence from smoking and attend more treatment sessions than those with lower depression scores, whereas for BC participants the effect of HRSD scores was the opposite. Smokers with a history of alcohol dependence reporting high levels of depressive symptoms may benefit from a mood management intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)