Evaluation of effectiveness and acceptability of a psychological treatment for smoking cessation combined with a smartphone App: A pilot study.

Despite the increasing number of mobile-based interventions to quit smoking over the last years, few studies have investigated the efficacy of smoking cessation interventions blended with smartphone Apps. The present pilot study aims to examine the preliminary effectiveness and acceptability of a cognitive-behavioral treatment combined with a smartphone App, compared to the same psychological treatment without the App. The sample comprised 206 treatment-seeking smokers, who were assigned to: 1) an experimental group receiving a cognitive-behavioral intervention combined with the "Non Fumo" App (n = 102), and 2) a control group receiving only the cognitive-behavioral intervention to quit smoking (n = 104). Results concerning the primary outcomes showed no significant differences between conditions in point-prevalence abstinence rates at 12-month follow-up (35.30 % in the experimental group vs. 31.70 % in the control group) and in treatment acceptability. Regarding the secondary outcomes, both groups obtained similar point-prevalence abstinence rates at the end of treatment (61.80 % vs. 65.40 %), at 3-month (42.20 % vs. 45.20 %, respectively) and 6-month follow-ups (37.30 % vs. 37.50 %). No significant differences were found between conditions in prolonged abstinence rates at 6-month (35.3 % vs. 35.6 %) and 12-month follow-ups (30.4 % vs. 26.9 %). Overall, good abstinence rates and treatment acceptability were obtained, although there were no significant differences between conditions. More research is needed to establish clear conclusions about the efficacy of psychological smoking cessation treatments blended with smartphone Apps.

The Efficacy of the SinHumo App Combined With a Psychological Treatment to Quit Smoking: A Randomized Clinical Trial.

INTRODUCTION: This study assessed the efficacy of the SinHumo App combined with a cognitive-behavioral smoking cessation treatment on 12-month follow-up abstinence, compared with the same smoking cessation treatment and a control App. AIMS AND METHODS: A sample of 288 treatment-seeking people who smoke were randomized: SinHumo App plus smoking cessation treatment (n = 140) and control App plus smoking cessation treatment (n = 148). The primary outcome was 7-day point prevalence abstinence (PPA) at the 12-month follow-up. Secondary outcomes were abstinence rates at the end of the intervention and 3- and 6-month follow-ups, cigarette per day (CPD) reduction over the 12-month follow-up, intervention engagement, and satisfaction. RESULTS: Intention-to-treat analyses showed nonsignificant differences in self-reported 7-day PPA at the 12-month follow-up (37.1 and 42.6%, respectively; OR = 0.80). No significant differences were found in abstinence at the end of the treatment (68.6 vs. 62.8%) nor on 7-day PPA at 3- (35.7 vs. 45.9%) and 6-month (35.0 vs. 41.2%) follow-up. Complete case and multiple imputation analyses yielded similar results for abstinence outcomes. A significant reduction in CPD across the 12-month follow-up in the subsample of participants who smoked was observed, but nonsignificant differences between conditions were found. Higher engagement with the SinHumo App was a significant predictor of 12-month abstinence. Satisfaction with the intervention was high and similar in both groups. CONCLUSIONS: High abstinence rates over the 12-month follow-up and satisfaction were found in both conditions. The inclusion of the SinHumo App did not improve abstinence rates in the intervention. IMPLICATIONS: Scarce research has examined the long-term efficacy of smoking cessation treatments, including Apps, to support the quitting process. The present randomized controlled trial contributes to the existing literature about including information and communication technologies in behavior change interventions. The development of effective smoking cessation apps and information and communication technologies-based interventions is crucial for reducing the prevalence of smoking, as these interventions have the potential to reach a large number of people who smoke and reduce access-related barriers to treatment.

Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder.

BACKGROUND: Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUDs), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown. OBJECTIVE: To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD. METHODS: We searched PubMed, Scopus, and Web of Knowledge until 30th April 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders. RESULTS: We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g=-0.25, 95% CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g=-0.23, 95% CI: -0.44, -0.02) and increase substance abstinence (g=0.21, 95% CI: 0.04, 0.38). DISCUSSION: There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists.

Boredom Susceptibility and Quit Smoking: The Role of Anxiety Symptoms.

Boredom is one of the main reported motives for smoking. However, scarce research has examined the relationship between boredom susceptibility and abstinence achievement in treatment-seeking smokers. The aim of this study is to examine the mediating effect of anxiety symptoms in the relationship between boredom susceptibility and abstinence at the end of a smoking cessation treatment. The sample was composed of 481 Spanish smokers who received a cognitive-behavioral treatment to quit (Mage= 45.51, SD = 11.16; 60.6% female). The Boredom Susceptibility subscale of the Sensation Seeking Scale Form-V and the Beck Anxiety Inventory were used. Pearson correlations and mediation analyses were conducted to examine the relationships between the study variables. Boredom susceptibility was significantly and positively correlated to anxiety symptoms, but not to abstinence. Anxiety symptoms were significantly and negatively correlated to abstinence. A significant indirect effect of boredom susceptibility on abstinence at the end of treatment through anxiety symptoms was found. There was no direct relation between boredom susceptibility and abstinence. These findings extend previous literature by showing that higher boredom susceptibility is associated with less likelihood to be abstinent at the end of the treatment through higher anxiety symptoms. These results highlight the relevance of considering the inclusion of boredom and anxiety management techniques in smoking cessation interventions.

Knowledge, Perceptions, and Perspectives of Medical Students Regarding the Use of Antibiotics and Antibiotic Resistance: A Qualitative Research in Galicia, Spain.

Antibiotic resistance is a significant public health concern, with numerous studies linking antibiotic consumption to the development of resistance. As medical students will play a pivotal role in prescribing antibiotics, this research aimed to identify their perceptions of current use and factors that could influence future inappropriate use of antibiotics. The study employed a qualitative research approach using Focus Group discussions (FGs) consisting of students from the final theoretical course of the Medicine degree. The FGs were conducted based on a pre-script developed from factors contributing to antibiotic misuse identified in previous studies. All sessions were recorded and transcribed for analysis by two independent researchers, with all participants signing informed consent. Seven focus groups were conducted, with a total of 35 participants. The study identified factors that could influence the future prescription of antibiotics, including the low applicability of knowledge, insecurity, clinical inertia, difficulties in the doctor-patient relationship, unawareness of available updates on the topic, and inability to assess their validity. The students did not perceive antibiotic resistance as a current problem. However, the study found several modifiable factors in medical students that could explain the misuse of antibiotics, and developing specific strategies could help improve their use.

Perceived Stress and Smoking Cessation: The Role of Smoking Urges.

Despite the fact that perceived stress is related to abstinence smoking outcomes, no studies have investigated the mediational effect of specific tobacco-related variables on this relationship. This study aimed to explore the indirect effect of perceived stress on abstinence at the end of treatment through smoking urges. The sample comprised 260 treatment-seeking smokers (58.5% female; Mage = 46.00; SD = 11.1) who underwent psychological smoking cessation treatment. The brief version of the Questionnaire of Smoking Urges (QSU) and the Perceived Stress Scale (PSS14) were used. Mediation analyses were conducted in which smoking urges and their dimensions were potential mediators in the relationship between perceived stress and abstinence at the end of treatment. The results showed a non-significant direct effect of perceived stress on abstinence. However, a significant indirect effect was found through smoking urges (QSU-total) and, specifically, through smoking urges associated with the expectation of negative affect relief (QSU-Factor 2). A non-significant indirect effect through smoking urges related to the expectation of tobacco use as a pleasurable experience (QSU-Factor 1) was also found. Analyzing possible mediator variables could contribute to understanding previous conflicting data. These findings point to potential interest in including treatment components targeting perceived stress and smoking urges to improve the effectiveness of smoking cessation treatments.

Drug use, risk perceptions and attitudes towards drug use amongst medical and dentistry students.

AIMS: To analyse the use of psychoactive substances and the risk perceptions amongst odontology and medical students. To study their perceptions, attitudes and knowledge, and to evaluate their motivation when helping their patients to stop using these substances. METHODS: A cross-sectional study was conducted amongst 962 students in Spain, using validated questionnaires on an anonymous basis. RESULTS: Amongst these students, drug use varies and increases with age as assessed by the DAST and CAST tests, with more problematic use being observed as the academic cycle progresses (p < .001). Participants in the 2nd cycle presented higher consumption than those in the 1st cycle, in the univariate model (OR = 1.77, IC 95% 1.27-2.48, p = .001) and in the adjusted model (OR = 1.86, IC 95% 1.32-2.62, p < .001). Regarding CAST, non-problematic use in the 1st cycle versus the 3rd cycle presented an OR = 8.69 (IC 95% 4.50-16.78, p < .001) and for low risk use it presented an OR = 15.18 (IC 95% 1.83-14.68). Only 46.7% considered using marijuana on a regular basis as a high risk, whilst 60.5% stated that smoking a pack of cigarettes represents a high risk. Alcohol was the substance for which the risk perception was lowest. 66.2% are in the maintenance stage "I provide my regular drug-using patients help to give up," with women being more likely to be in this stage (p = .012). CONCLUSIONS: High risk of drug use increases after the 1st cycle in Dentistry and in Medicine. Training programmes should be implemented in both degrees, focusing on the 1st years in order to simultaneously prevent drug use amongst students.

Understanding Primary Care Physician Vaccination Behaviour: A Systematic Review.

BACKGROUND: Vaccine hesitancy decreases adult vaccination coverage and has been recognized by WHO as a major health threat. Primary care physicians (PCP) play a key role in vaccination by giving vaccine counselling to their patients. The aim of this systematic review is to identify the knowledge, beliefs, attitudes and barriers (KBAB) associated with own vaccination and patient recommendation in primary care physicians. METHODS: MEDLINE/PubMed, EMBASE and Cochrane Library databases were used to search and identify relevant studies based on their title and abstract. In the next step, the full text of each previously selected article was read for eligibility. Articles were selected by two independent reviewers and data extraction was performed using tables. The following information was extracted: methodological characteristics, demographic factors, professional characteristics, and intrinsic or extrinsic factors influencing vaccination or recommendation. RESULTS: Our search yielded 41 eligible papers, data-sources, previous practices, belief in the effectiveness or safety of the vaccine, perceived risk, and trust in health authorities were all shown to be related to own vaccination and patient recommendation. CONCLUSION: Internet is the main source of information for PCP related to vaccine hesitancy. It is therefore essential to increase the presence and access to pro-vaccination content in this area. In addition, involving PCP in the establishment of vaccination recommendations could improve their credibility in the institutions. On the other hand, training in communication skills and establishing reminder systems could reflect higher vaccination coverage among their patients.

A Randomized Clinical Trial to Assess the Efficacy of a Psychological Treatment to Quit Smoking Assisted with an App: Study Protocol.

Numerous studies have shown the efficacy of smoking cessation interventions. However, some challenges, such as relapse rates, remain. The availability of information technologies (ICTs) offers promising opportunities to address such challenges. The aim of this paper is to describe the protocol followed to assess the efficacy of a face-to-face cognitive-behavioral intervention for smoking cessation using a smartphone application as a complement, compared with a control group. A single blind, two-arm, randomized controlled trial is proposed (NCT04765813). The participants will be smokers over 18 years old, who smoke at least eight cigarettes per day. Participants will be randomized to one of two conditions, using a 1:1 allocation ratio: (1) cognitive-behavioral smoking cessation treatment along with an App with active therapeutic components (SinHumo App); or (2) cognitive-behavioral treatment along with the use of a control App (without active components). The experimental App will be used during the eight treatment sessions and for 12 months after the end of treatment. The primary outcome measures will be 7-days point-prevalence abstinence at 12-months follow-up. We expect the experimental App to obtain higher abstinence rates at the end of treatment and at one-year post-treatment follow-ups and lower relapse rates, compared to the control App.

Brooding Rumination and Anxiety Sensitivity: Associations With Depressive and Anxiety Symptoms in Treatment-seeking Smokers.

BACKGROUND: This study explores the shared and specific associations of brooding rumination and anxiety sensitivity to depression and anxiety symptomatology in a sample of treatment-seeking smokers. METHODS: The sample was composed of 275 treatment-seeking adult smokers. Hierarchical linear regression analyses were conducted to examine the relations of both variables with depressive and anxiety symptoms. RESULTS: Greater brooding rumination and anxiety sensitivity predicted higher levels of depression and anxiety symptoms. A specific relationship emerged after controlling for comorbid symptoms (depressive or anxiety symptoms) where brooding rumination was associated with depressive symptoms and anxiety sensitivity with anxiety symptoms. CONCLUSIONS: The findings showed that the variables examined are transdiagnostically related to emotional symptoms, but this relationship was symptomatology-specific when controlling for comorbid symptoms (depressive or anxiety symptoms). Due to the impact of affective symptoms on abstinence outcomes, these findings have relevant clinical implications. In the context of smoking cessation treatment, identifying shared and specific vulnerabilities might contribute to tailoring and designing more precise and effective interventions for quitting smoking.

Brooding Rumination and Anxiety Sensitivity: Associations WithDepressive and Anxiety Symptoms in Treatment-seeking Smokers / Rumiación y Sensibilidad a la Ansiedad: Asociaciones con SíntomasDepresivos y de Ansiedad en Fumadores que Buscan Tratamiento ParaDejar de Fumar

Background: This study explores the shared and specific associations of brooding rumination and anxiety sensitivity to depression and anxiety symptomatology in a sample of treatment-seeking smokers. Methods: The sample was composed of 275 treatment-seeking adult smokers. Hierarchical linear regression analyses were conducted to examine the relations of both variables with depressive and anxiety symptoms. Results: Greater brooding rumination and anxiety sensitivity predicted higher levels of depression and anxiety symptoms. A specific relationship emerged after controlling for comorbid symptoms (depressive or anxiety symptoms) where brooding rumination was associated with depressive symptoms and anxiety sensitivity with anxiety symptoms. Conclusions: The findings showed that the variables examined are transdiagnostically related to emotional symptoms, but this relationship was symptomatology-specific when controlling for comorbid symptoms (depressive or anxiety symptoms). Due to the impact of affective symptoms on abstinence outcomes, these findings have relevant clinical implications. In the context of smoking cessation treatment, identifying shared and specific vulnerabilities might contribute to tailoring and designing more precise and effective interventions for quitting smoking.

Antecedentes: este estudio explora las asociaciones compartidas y específicas entre el factor reproches de la rumiación y la sensibilidad a la ansiedad con la sintomatología depresiva y ansiosa en una muestra de fumadores. Método: la muestra estaba formada por 275 fumadores adultos que demandaron tratamiento para dejar de fumar. Se realizó un análisis de regresión lineal jerárquica para examinar las relaciones de ambas variables con los síntomas depresivos y ansiosos. Resultados: mayores puntuaciones en rumiación-reproches y en sensibilidad a la ansiedad predijeron niveles más elevados de síntomas depresivos y ansiosos. Sin embargo, cuando se controlaron los síntomas comórbidos (depresivos o ansiosos), emergieron relaciones específicas entre la rumiación-reproches y los síntomas depresivos y entre la sensibilidad a la ansiedad y los síntomas ansiosos. Conclusiones: las variables examinadas se relacionan transdiagnósticamente con la sintomatología emocional, pero esta relación pasa a ser específica cuando se controlan los síntomas comórbidos (depresivos o ansiosos). Debido al impacto negativo que tienen los síntomas emocionales en la abstinencia, estos resultados pueden aportar implicaciones clínicas relevantes. La identificación de vulnerabilidades compartidas y específicas podría contribuir a adaptar y diseñar intervenciones más precisas y eficaces para dejar de fumar.

Smoking Cessation Apps: A Systematic Review of Format, Outcomes, and Features.

Smoking cessation interventions are effective, but they are not easily accessible for all treatment-seeking smokers. Mobile health (mHealth) apps have been used in recent years to overcome some of these limitations. Smoking cessation apps can be used in combination with a face-to-face intervention (FFSC-Apps), or alone as general apps (GSC-Apps). The aims of this review were (1) to examine the effects of FFSC-Apps and GSC-Apps on abstinence, tobacco use, and relapse rates; and (2) to describe their features. A systematic review was conducted following the internationally Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of the total 6016 studies screened, 24 were included, of which nine used GSC-Apps and 15 FFSC-Apps. Eight studies reported significant differences between conditions in smoking cessation outcomes, with three of them being in favor of the use of apps, and two between different point-assessments. Concerning Apps features, most GSC-Apps included self-tracking and setting a quit plan, whereas most of the FFSC-Apps included self-tracking and carbon monoxide (CO) measures. Smartphone apps for smoking cessation could be promising tools. However, more research with an adequate methodological quality is needed to determine its effect. Nevertheless, smartphone apps' high availability and attractiveness represent a great opportunity to reach large populations.

Causes of smoking relapse in the 12 months after smoking cessation treatment: Affective and cigarette dependence-related factors.

Despite advances in smoking cessation treatments, smoking relapse remains common. Experiencing positive or negative affect and cigarette dependence are the most common causes of relapse; however, little is known about the characteristics that increase the risk of relapse from these causes among current treatment-seeking smokers. Thus, this study aimed to identify the most frequent causes of relapse and the individual characteristics that increase the risk of relapse from these causes during a 12-month period after smoking cessation. Participants included 121 treatment-seeking smokers who quit smoking at the end of treatment and relapsed during a 12-month follow-up period (60.3% female;Mage = 42.57, SD = 11.07). Results indicated that the most frequent smoking relapse situations occurred when smokers experienced positive (e.g., being relaxed; 43.0%) or negative (e.g., being angry; 37.2%) affect or cigarette dependence-related situations (e.g., craving; 19.8%). At an individual level, males with a higher level of education and without a psychopharmaceutical prescription had a higher risk of relapsing in positive-affect situations. Smoking the first cigarette at an older age increased the risk of relapse in negative-affect situations. Finally, being younger and less motivated to quit at pretreatment increased the likelihood of relapse in cigarette dependence-related situations. These findings provide detailed information about smoking relapse situations and identify a set of characteristics that might help to improve current relapse-prevention interventions.

Treatment completion and anxiety sensitivity effects on smoking cessation outcomes.

INTRODUCTION: Treatment completion is associated with abstinence outcomes in smoking cessation interventions. Previous research has stated that anxiety sensitivity (AS) is associated with smoking-related variables and smoking-cessation outcomes. To date, research has not examined the interaction between AS and treatment completion on smoking-cessation outcomes over time. This study aims to examine the main and the interactive effects of treatment completion and AS (total score and specific dimensions) on smoking-cessation outcomes at 3-, 6-, and 12-month follow-ups. METHOD: The sample consisted of 210 smokers enrolled in an eight-session smoking-cessation cognitive-behavioral treatment (62.1% women; Mage = 45.2, SD = 11.0). Participants were classified as completers (attended the eight treatment sessions) and non-completers (attended ≤ 7 sessions). Abstinence was biochemically confirmed. RESULTS: Main effects indicated that completers had a higher likelihood of being abstinent over time when compared to non-completers. Regarding AS, those with greater AS-Physical Concerns had lower abstinence rates. Besides, a significant interaction between treatment completion, time and AS-Physical Concerns was found. Particularly, completers with greater AS-Physical Concerns had a higher likelihood of being abstainers than non-completers over time, while no significant differences were found for those with lower AS-Physical Concerns. CONCLUSION: These data highlight the relevance of AS-Physical levels and smoking-cessation treatment completion on abstinence outcomes over time among treatment-seeking smokers.

Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial.

OBJECTIVES: This study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care. DESIGN: Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial. SETTING: All primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain). PARTICIPANTS: The seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters. INTERVENTIONS: One-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system. MAIN OUTCOME MEASURES: Changes in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings. RESULTS: Median follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was - 4.2% (95% CI: - 5.3% to - 3.2%), with this being more pronounced for penicillins - 6.5 (95% CI: - 7.9% to - 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides - 9.0% (95% CI: - 14.0 to - 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively. CONCLUSIONS: Interventions designed on the basis of gaps in physicians' knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN24158380 . Registered 5 February 2009.

Does the problem begin at the beginning? Medical students' knowledge and beliefs regarding antibiotics and resistance: a systematic review.

BACKGROUND: Studies have detected that prescribers display gaps in knowledge and inappropriate attitudes regarding antibiotics and resistances, but it is not known whether these are generated during professional practice or derive from the undergraduate stage of their education. Accordingly, the aim of this study was to identify medical students' knowledge, beliefs and attitudes regarding antibiotic use and antibiotic resistance, and whether these change over the course of their time at medical school. METHODS: We conducted a search of the MEDLINE and EMBASE databases, and included studies that measured knowledge and/or beliefs and/or attitudes regarding antibiotic prescribing and/or resistance, among medical students. RESULTS: Of the 509 studies retrieved, 22 met the inclusion criteria. While medical students perceived resistance as posing a major public health problem, both worldwide and in their own countries, students in the last two course years were more aware of overprescription of antibiotics in general, and of broad-spectrum antibiotics, at their teaching hospital. There was a considerable lack of knowledge about the treatment of high-incidence infections, and upper respiratory tract infections in particular (41-69% of participants believed antibiotics to be useful for treating these), without any differences by course year. Students were conscious of their personal shortcomings and thus showed willing to improve their education. CONCLUSIONS: Future physicians display important gaps in knowledge, particularly in terms of treatment of high-incidence infections. This finding may be of use when it comes to designing more effective training in antibiotic stewardship for undergraduates.

Specific Relapse Predictors: Could Cognitive-Behavioral Treatment for Smoking Cessation Be Improved?

Relapse remains a frequent and complex phenomenon that is not yet well understood. An under-researched area of study that may provide relevant information concerns the assessment of specific post-treatment variables, rather than the composite measures commonly used to predict smoking relapse. The current study sought to examine the effects of post-treatment smoking-related variables, including withdrawal symptomatology, abstinence self-efficacy, and smoking urgency in negative-affect situations and smoking relapse at the 3 month follow-up. The sample comprised 130 participants who achieved abstinence for at least 24 h through a cognitive-behavioral smoking cessation treatment. Regression analysis was conducted for both composite measures and specific subscales and items. Data showed that composite measures of tobacco withdrawal, self-efficacy, and smoking urgency in negative-affect situations were not significant predictors of smoking relapse. However, the analysis including subscales, and specific items showed that lower self-efficacy in negative-affect-related situations (OR = 1.36) and three withdrawal symptoms-irritability/frustration/anger (OR = 2.99), restlessness/impatience (OR = 1.87), and craving (OR = 2.31)-were significant predictors of relapse. These findings offer new insights into the role of different smoking-related post-treatment variables in short-term relapse. Considering and specifically targeting these variables after achieving abstinence may potentially contribute to reducing smoking relapse.

Correction to: Effects of behavioural activation on substance use and depression: a systematic review.

An amendment to this paper has been published and can be accessed via the original article.

Environmental reward and depressive symptoms in the relationship between avoidance and cigarette dependence in treatment-seeking smokers / Reforzamiento ambiental percibido y sintomatología depresiva en la relación entre la evitación conductual y la dependencia del tabaco en fumadores que buscan tratamiento para dejar de fumar

BACKGROUND: The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence. METHOD: The sample included 275 adult treatment-seeking daily smokers (Mage = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted. RESULTS: A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms. CONCLUSIONS: Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions

ANTECEDENTES: el presente estudio tiene como objetivo examinar la relación entre la conducta de evitación, el reforzamiento ambiental percibido, la sintomatología depresiva y la dependencia del tabaco. MÉTODO: la muestra estaba formada por 275 fumadores que demandan tratamiento para dejar de fumar (Medad = 45,36, DT = 10,96; 61,5% mujeres). Para examinar la relación entre las variables de estudio se realizaron análisis de correlación y de mediación serial. RESULTADOS: se encontró una correlación positiva significativa entre la dependencia del tabaco, la evitación y la sintomatología depresiva, y una correlación negativa significativa con el reforzamiento ambiental percibido. El análisis de mediación serial reveló una vía indirecta significativa entre la evitación y la dependencia del tabaco a través de la sintomatología depresiva; así como entre la evitación y la dependencia del tabaco a través del reforzamiento ambiental percibido y la sintomatología depresiva. CONCLUSIONES: los resultados de este estudio contribuyen a la comprensión de factores conductuales y psicológicos implicados en la dependencia del tabaco, la cual es considerada una barrera para lograr la abstinencia. Por lo tanto, la evaluación y abordaje de estas variables podría considerarse un aspecto relevante en el contexto de las intervenciones para dejar de fumar

Environmental reward and depressive symptoms in the relationship between avoidance and cigarette dependence in treatment-seeking smokers.

BACKGROUND: The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence. METHOD: The sample included 275 adult treatment-seeking daily smokers (M age = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted. RESULTS: A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms. CONCLUSIONS: Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions.