Dispositional Mindfulness Predicts Enhanced Smoking Cessation and Smoking Lapse Recovery.

BACKGROUND: Although mindfulness has been hypothesized to promote health behaviors, no research has examined how dispositional mindfulness might influence the process of smoking cessation. PURPOSE: The current study investigated dispositional mindfulness, smoking abstinence, and recovery from a lapse among African American smokers. METHODS: Participants were 399 African Americans seeking smoking cessation treatment (treatments did not include any components related to mindfulness). Dispositional mindfulness and other psychosocial measures were obtained pre-quit; smoking abstinence was assessed 3, 31 days, and 26 weeks post-quit. RESULTS: Individuals higher in dispositional mindfulness were more likely to quit smoking both initially and over time. Moreover, among individuals who had lapsed at day 3, those higher in mindfulness were more likely to recover abstinence by the later time points. The mindfulness-early abstinence association was mediated by lower negative affect, lower expectancies to regulate affect via smoking, and higher perceived social support. CONCLUSIONS: Results suggest that mindfulness might enhance smoking cessation among African American smokers by operating on mechanisms posited by prominent models of addiction.

Promoting tobacco cessation and smoke-free workplaces through community outreach partnerships in Puerto Rico.

BACKGROUND: Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR. OBJECTIVES: The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces. METHODS: Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation. RESULTS: Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006. CONCLUSIONS: This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.

A cross-lagged path analysis of five intrapersonal determinants of smoking cessation.

BACKGROUND: Prominent theories of drug use underscore the importance of considering the inter-relationships (e.g., reciprocal relations, indirect effects) of determinants of drug use behavior. In the area of smoking, few studies have examined multiple determinants of cessation in this way, and in prospective analyses. The current study is an examination of the prospective cross-lagged relationships among five intrapersonal determinants of cessation. METHODS: Data from a longitudinal cohort study on racial differences in the process of smoking cessation were used to examine reciprocal relations among abstinence motivation, abstinence self-efficacy, positive affect, negative affect, and craving. Each of these five measures assessed on the quit day were regressed onto the same measures assessed 1-2 weeks pre-quit. The relationships of these variables at quit day with 1-week post-quit abstinence from smoking were also examined. RESULTS: When the five variables were examined simultaneously in a cross-lagged path analysis, motivation and self-efficacy, and self-efficacy and positive affect showed cross-lagged relations. Only self-efficacy on the quit day uniquely predicted 1-week post quit abstinence. There were significant indirect effects of motivation and positive affect on cessation via self-efficacy. CONCLUSIONS: The current study reaffirms the importance of motivation and self-efficacy in smoking cessation, and suggests that positive affect may play a role in smoking cessation.

The influence of discrimination on smoking cessation among Latinos.

BACKGROUND: Although studies have shown a cross-sectional link between discrimination and smoking, the prospective influence of discrimination on smoking cessation has yet to be evaluated. Thus, the purpose of the current study was to determine the influence of everyday and major discrimination on smoking cessation among Latinos making a quit attempt. METHODS: Participants were 190 Spanish speaking smokers of Mexican Heritage recruited from the Houston, TX metropolitan area who participated in the study between 2009 and 2012. Logistic regression analyses were conducted to evaluate the associations of everyday and major discrimination with smoking abstinence at 26 weeks post-quit. RESULTS: Most participants reported at least some everyday discrimination (64.4%), and at least one major discrimination event (56%) in their lifetimes. Race/ethnicity/nationality was the most commonly perceived reason for both everyday and major discrimination. Everyday discrimination was not associated with post-quit smoking status. However, experiencing a greater number of major discrimination events was associated with a reduced likelihood of achieving 7-day point prevalence smoking abstinence, OR=.51, p=.004, and continuous smoking abstinence, OR=.29, p=.018, at 26 weeks post-quit. CONCLUSIONS: Findings highlight the high frequency of exposure to discrimination among Latinos, and demonstrate the negative impact of major discrimination events on a smoking cessation attempt. Efforts are needed to attenuate the detrimental effects of major discrimination events on smoking cessation outcomes.

Mechanisms linking socioeconomic disadvantage and BMI in smokers.

OBJECTIVES: To evaluate a conceptual model of the psychosocial pathways linking socioeconomic status and body mass index (BMI) among smokers. METHODS: A latent variable modeling approach was used to evaluate the interrelationships among socioeconomic status, perceived neighborhood disadvantage, social support, negative affect, and BMI among smokers recruited from the Houston metropolitan area (N = 424). RESULTS: A total of 42.4% of participants were obese, with the highest prevalence of obesity among Latinos followed by African Americans. Across all racial/ethnic groups, perceived neighborhood disadvantage, social support, and negative affect functioned as pathways linking socioeconomic status and BMI. CONCLUSIONS: Findings indicate the need for interventions that target obesity among socioeconomically disadvantaged smokers and provide potential intervention targets for the prevention and treatment of obesity.

The relation between social cohesion and smoking cessation among Black smokers, and the potential role of psychosocial mediators.

BACKGROUND: Social cohesion, the self-reported trust and connectedness between neighbors, may affect health behaviors via psychosocial mechanisms. PURPOSE: Relations between individual perceptions of social cohesion and smoking cessation were examined among 397 Black treatment-seeking smokers. METHODS: Continuation ratio logit models examined the relation of social cohesion and biochemically verified continuous smoking abstinence through 6 months post-quit. Indirect effects were examined in single mediator models using a nonparametric bootstrapping procedure. All analyses controlled for sociodemographics, tobacco dependence, and treatment. RESULTS: The total effect of social cohesion on continuous abstinence was non-significant (ß = 0.05, p = 0.10). However, social cohesion was associated with social support, positive affect, negative affect, and stress, which, in turn, were each associated with abstinence in adjusted models (ps < 0.05). CONCLUSIONS: Results suggest that social cohesion may facilitate smoking cessation among Black smokers through desirable effects on psychosocial mechanisms that can result from living in a community with strong interpersonal connections.

Motivation and Problem Solving (MAPS): Motivationally Based Skills Training for Treating Substance Use.

Over 10 years ago, Baer and colleagues proposed the integration of skills training and motivational strategies for the treatment of substance abuse. Since that time, several studies evaluating the efficacy of such hybrid approaches have been published, but few have been efficacious. Motivation and Problem Solving (MAPS) is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory-based treatment strategies within an overarching motivational framework, and has been demonstrated to be effective in a randomized clinical trial focused on the prevention of postpartum smoking relapse. MAPS was designed to be applicable to not only relapse prevention but also the cessation of substance use, and is relevant for individuals regardless of their motivation to change. MAPS views motivation as dynamically fluctuating from moment to moment throughout the behavior change process, and comprehensively addresses multiple issues important to the individual and relevant to change through the creation of a wellness program. As a result, we believe that MAPS enhances the likelihood that individuals will successfully achieve and maintain abstinence from substance use, and that its comprehensive focus on addressing diverse and salient issues enhances both engagement in treatment and its applicability in modifying other health risk behaviors. The current paper introduces MAPS, distinguishes it from other hybrid and stage-based substance use treatments, and provides detailed information and clinical text regarding how MAPS is specifically and uniquely implemented to address key mechanisms relevant to quitting smoking and maintaining abstinence.

Associations between indicators of acculturation and tobacco dependence among Spanish-speaking Latino smokers.

The current study utilized regression analyses to explore the relationships among demographic and linguistic indicators of acculturation, gender, and tobacco dependence among Spanish-speaking Latino smokers in treatment. Additionally, bootstrapping analyses were used to examine the role of dependence as a mediator of the relationship between indicators of acculturation and cessation. Indicators of time spent in the United States were related to indicators of physical dependence. Preferred media language was related to a multidimensional measure of dependence. Gender did not impact the relationships between acculturation indicators and dependence. A multidimensional measure of dependence significantly mediated the relationship between preferred media language and cessation. Future research would benefit from consideration of acculturation and multidimensional measures of dependence when studying smoking cessation among Latinos, and from further examination of factors accounting for relationships among acculturation, dependence, and cessation.

Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial.

African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U.S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. Thus, the purpose of the current study was to characterize the impact of several individual- and area-level indicators of socioeconomic status on smoking cessation among African Americans. Data were collected as part of a smoking cessation intervention study for African American smokers (N = 379) recruited from the Houston, Texas, metropolitan area, who participated in the study between 2005 and 2007. The separate and combined influences of individual-level (insurance status, unemployment, education, and income) and area-level (neighborhood unemployment, education, income, and poverty) indicators of socioeconomic status on continuous smoking abstinence were examined across time intervals using continuation ratio logit modeling. Individual-level analyses indicated that unemployment was significantly associated with reduced odds of smoking abstinence, while higher income was associated with greater odds of abstinence. However, only unemployment remained a significant predictor of abstinence when unemployment and income were included in the model together. Area-level analyses indicated that greater neighborhood unemployment and poverty were associated with reduced odds of smoking abstinence, while greater neighborhood education was associated with higher odds of abstinence. However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities.

Neighborhood perceptions are associated with tobacco dependence among African American smokers.

INTRODUCTION: The animal and human research literatures suggest that deprived environmental conditions may be associated with drug dependence, but the relation of neighborhood perceptions with a multidimensional measure of tobacco dependence has not been previously studied. The purpose of this study was to examine the associations between neighborhood perceptions (neighborhood problems and neighborhood vigilance) and tobacco dependence among smokers as measured by the Wisconsin Inventory of Smoking Dependence Motives-68 (WISDM). METHODS: Participants were 384 African American smokers (49% men, 80% < $30,000 annual household income) enrolled in a randomized clinical trial of a smoking cessation intervention. A series of regression models were conducted to examine the associations between neighborhood perceptions and tobacco dependence using a generalized estimating equation approach, which accounted for potential correlation in tobacco dependence between participants from the same neighborhood. RESULTS: Results indicated that more self-reported neighborhood problems and greater neighborhood vigilance were significantly associated with tobacco dependence as measured by the WISDM total score in analyses adjusted for age, gender, income, education, employment status, and partner status (p ≤ .002). Neighborhood perceptions were related to both primary and secondary dependence motives (p ≤ .005). CONCLUSIONS: Results suggest that the neighborhood context is associated with dependence on tobacco among African American smokers but longitudinal studies are needed to assess causation. Future research should also explore the mechanisms that account for the associations between neighborhood perceptions and tobacco dependence to better inform intervention development.

Differential effects of depression on smoking cessation in a diverse sample of smokers in treatment.

BACKGROUND: Recent cross-sectional evidence suggests that the effect of depression on smoking prevalence and quit ratios differs by race/ethnicity. PURPOSE: This study prospectively examined the main and interactive effects of race/ethnicity and depressive symptoms on smoking cessation during a specific quit attempt among smokers receiving cessation treatment. METHODS: Data from a longitudinal study of smokers in treatment were examined using continuation ratio logit modeling. Continuous abstinence across Weeks 1, 2, and 4 post-quit was the outcome variable. Data were collected between March 2005 and November 2007, and the current study analyses were conducted in April 2010. RESULTS: Depressive symptoms predicted significantly lower cessation rates for whites and African Americans. In contrast, among Latinos there was no relationship between depression and cessation. CONCLUSIONS: This research is the first to prospectively demonstrate a racially/ethnically differentiated effect of depressive symptoms on smoking cessation, and it has implications for targeted smoking-cessation treatments as it indicates that depression may not be a key treatment target for Latinos.

The efficacy of computer-delivered treatment for smoking cessation.

BACKGROUND: The current study evaluated the efficacy of an individualized, hand-held computer-delivered treatment (CDT) versus standard treatment (ST) for the maintenance of smoking abstinence following a quit attempt. METHODS: Participants were 303 adult daily smokers randomized to CDT or ST, plus pharmacotherapy. Abstinence though 1 year was examined using logistic random intercept models, a type of generalized linear mixed model regression. RESULTS: Results did not support the efficacy of the CDT program through 1 year postquit in analyses adjusted for time and study site (OR = 0.84, 95% CI = 0.55-1.30), or after further adjusting for race/ethnicity, age, gender, education, marital status, and the number of cigarettes smoked per day before quitting (OR = 0.89, 95% CI = 0.57-1.39). CONCLUSIONS: CDT did not increase short- or long-term abstinence rates over ST in this study. IMPACT: Findings differ from some in the literature and suggest the need for continued research on the use of CDT for smoking cessation.

Structural and predictive equivalency of the Wisconsin Smoking Withdrawal Scale across three racial/ethnic groups.

INTRODUCTION: The Wisconsin Smoking Withdrawal Scale (WSWS) is a valid and reliable scale among non-Latino Whites but has not been validated for use among other racial/ethnic groups despite increasing use with these populations. The current study examined the structural invariance and predictive equivalency of the WSWS across three racial/ethnic groups. METHODS: The WSWS scores of 424 African American, Latino, and White smokers receiving smoking cessation treatment were analyzed in a series of factor analyses and multiple-group analyses. Additionally, hierarchical logistic regression analyses were conducted to determine whether WSWS scores differentially predicted smoking relapse across racial/ethnic groups. These analyses were consistent with a step-down hierarchical regression procedure for examination of test bias. RESULTS: The 7-factor structure of the WSWS was largely confirmed in the current study, with the exception of the removal of two offending items. Evidence of full invariance across race/ethnicity was found in multiple-group analyses. The WSWS total score and subscales measuring anger, anxiety, concentration, and sadness predicted relapse, whereas the hunger, craving, and sleep subscales did not. None of these scales displayed differential predictive ability across race/ethnicity. The WSWS sleep subscale showed a significant interaction with race/ethnicity such that it was a significant predictor of relapse among Whites but not African Americans or Latinos. CONCLUSIONS: Overall, the WSWS is similar in structure and predictive of relapse across racial/ethnic groups. Caution should be exercised when using the WSWS sleep subscale with African Americans and Latinos.

Subjective social status predicts long-term smoking abstinence.

BACKGROUND: The relationship between subjective social status (SSS), a person's perception of his/her relative position in the social hierarchy, and the ability to achieve long-term smoking abstinence during a specific quit attempt is unknown. The purpose of this study was to examine the relationship between SSS and long-term smoking abstinence among 421 racially/ethnically diverse smokers undergoing a specific quit attempt, as well as the interactive effects of race/ethnicity and sex. METHODS: The main effects and moderated relationships of SSS on biochemically-confirmed, continuous smoking abstinence through 26 weeks post-quit were examined using continuation ratio logit models adjusted for sociodemographics and smoking characteristics. RESULTS: Even after adjusting for the influence of socioeconomic status and other covariates, smokers endorsing lower SSS were significantly less likely to maintain long-term smoking abstinence during a specific quit attempt than those with higher SSS (OR = 1.14, 95% CI: 1.00 - 1.28; p = 0.044). The statistical significance of this relationship, however, did not vary by race/ethnicity or sex. CONCLUSIONS: SSS independently predicts long-term smoking abstinence during a specific quit attempt. SSS may be a useful screener to identify smokers at elevated risk of relapse who may require additional attention to facilitate long-term abstinence. More research is needed to understand the mechanisms underlying the relationship between SSS and long-term smoking abstinence in order to appropriately tailor treatment to facilitate abstinence among lower SSS smokers.

The effect of tobacco outlet density and proximity on smoking cessation.

OBJECTIVES: We examined the influence of tobacco outlet density and residential proximity to tobacco outlets on continuous smoking abstinence 6 months after a quit attempt. METHODS: We used continuation ratio logit models to examine the relationships of tobacco outlet density and tobacco outlet proximity with biochemically verified continuous abstinence across weeks 1, 2, 4, and 26 after quitting among 414 adult smokers from Houston, Texas (33% non-Latino White, 34% non-Latino Black, and 33% Latino). Analyses controlled for age, race/ethnicity, partner status, education, gender, employment status, prequit smoking rate, and the number of years smoked. RESULTS: Residential proximity to tobacco outlets, but not tobacco outlet density, provided unique information in the prediction of long-term, continuous abstinence from smoking during a specific quit attempt. Participants residing less than 250 meters (P = .01) or less than 500 meters (P = .04) from the closest tobacco outlet were less likely to be abstinent than were those living 250 meters or farther or 500 meters or farther, respectively, from outlets. CONCLUSIONS: Because residential proximity to tobacco outlets influences smoking cessation, zoning restrictions to limit tobacco sales in residential areas may complement existing efforts to reduce tobacco use.

Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach.

OBJECTIVE: Although there has been a socioeconomic gradient in smoking prevalence, cessation, and disease burden for decades, these disparities have become even more pronounced over time. The aim of the current study was to develop and test a conceptual model of the mechanisms linking socioeconomic status (SES) to smoking cessation. DESIGN: The conceptual model was evaluated using a latent variable modeling approach in a sample of 424 smokers seeking treatment (34% African American; 33% Latino; 33% White). Hypothesized mechanisms included social support, neighborhood disadvantage, negative affect/stress, agency, and craving. MAIN OUTCOME MEASURE: The primary outcome was Week 4 smoking status. RESULTS: As was hypothesized, SES had significant direct and indirect effects on cessation. Specifically, neighborhood disadvantage, social support, negative affect/stress, and agency mediated the relation between SES and smoking cessation. A multiple group analysis indicated that the model was a good fit across racial/ethnic groups. CONCLUSION: The present study yielded one of the more comprehensive models illuminating the specific mechanisms that link SES and smoking cessation. Policy, community, and individual-level interventions that target low SES smokers and address the specific pathways identified in the current model could potentially attenuate the impact of SES on cessation.

Subjective social status affects smoking abstinence during acute withdrawal through affective mediators.

OBJECTIVES: Direct and mediated associations between subjective social status (SSS), a subjective measure of socio-economic status, and smoking abstinence were examined during the period of acute withdrawal among a diverse sample of 421 smokers (33% Caucasian, 34% African American, 33% Latino) undergoing a quit attempt. METHODS: Logistic regressions examined relations between SSS and abstinence, controlling for socio-demographic variables. Depression, stress, positive affect and negative affect on the quit day were examined as potential affective mediators of the SSS-abstinence association, with and without adjusting for pre-quit mediator scores. RESULTS: SSS predicted abstinence to 2 weeks post-quit. Abstinence rates were 2.6 (postquit week 1) and 2.4 (postquit week 2) times higher in the highest versus the lowest SSS quartile. Depression and positive affect mediated the SSS-abstinence relationships, but only depression maintained significance when adjusting for the baseline mediator score. CONCLUSIONS: Among a diverse sample of quitting smokers, low SSS predicted relapse during acute withdrawal after controlling for numerous covariates, an effect accounted for partially by quit day affective symptomatology. Smokers endorsing lower SSS face significant hurdles in achieving cessation, highlighting the need for targeted interventions encompassing attention to quit day mood reactivity.

Financial strain and smoking cessation among racially/ethnically diverse smokers.

OBJECTIVES: We evaluated the influence of financial strain on smoking cessation among Latino, African American, and Caucasian smokers of predominantly low socioeconomic status. METHODS: Smokers enrolled in a smoking cessation study (N = 424) were followed from 1 week prequit through 26 weeks postquit. We conducted a logistic regression analysis to evaluate the association between baseline financial strain and smoking abstinence at 26 weeks postquit after control for age, gender, race/ethnicity, educational level, annual household income, marital status, number of cigarettes smoked per day, and time to first cigarette of the day. RESULTS: Greater financial strain at baseline was significantly associated with reduced odds of abstinence at 26 weeks postquit among those who completed the study (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.62, 0.94; P = .01). There was a significant association as well in analyses that included those who completed the study in addition to those lost to follow-up who were categorized as smokers (OR = 0.78; 95% CI = 0.64, 0.96; P = .02). CONCLUSIONS: Greater financial strain predicted lower cessation rates among racially/ethnically diverse smokers. Our findings highlight the impact of economic concerns on smoking cessation and the need to address financial strain in smoking cessation interventions.

Acculturative and neighborhood influences on subjective social status among Spanish-speaking Latino immigrant smokers.

Subjective social status (SSS) reflects an individual's perception of her/his relative position in the social hierarchy. However, little is known about culturally-relevant, multilevel predictors of low SSS among low socioeconomic status (SES), minority populations. The goal of this study was to identify individual- and neighborhood-level variables predicting SSS among 297 Spanish-speaking Latino immigrant smokers living in several locations in Texas, with an emphasis on the association of SSS with acculturative and socioeconomic variables. Participants were recruited and enrolled through the National Cancer Institute's Cancer Information Service from August 2002 to March 2004. Determinants of SSS were explored using a series of linear regressions. In analyses adjusting for demographics (including objective indicators of SES), speaking Spanish at home and work and living in economically disadvantaged neighborhoods, respectively, were associated with low SSS. However, in analyses including demographics, acculturation, and neighborhood characteristics, only income, education, and acculturation remained associated with SSS. Consistent with results from a previous study in the area (Franzini & Fernandez-Esquer, 2006), less acculturation predicted low SSS among immigrant Latino smokers. However, unlike previous research, these associations were maintained after controlling for SES. Results suggest that the density of less acculturated Latinos within economically deprived neighborhoods might account for the disappearance of neighborhood effects in the final model.

Acculturation differentially predicts smoking cessation among Latino men and women.

OBJECTIVES: The current study examined the influence of gender, acculturation indicators, and their interaction on smoking cessation among Latinos. METHODS: Logistic regression analysis was used to examine the main effects of gender, acculturation indicators, and their interactions on self-reported 7-day abstinence at 12-week follow-up among 271 Latino smokers seeking cessation counseling. RESULTS: Analyses revealed significant main effects for several acculturation indicators and significant interactions of gender with number of years lived in the United States, proportion of life lived in the United States, and preferred media language (all P values <0.05). Follow-up analyses indicated no significant relationships between abstinence and acculturation indicators among women. Among men, abstinence rates increased with years in the United States, proportion of life in the United States, and preferred media language of English. CONCLUSIONS: Greater acculturation predicted higher abstinence rates, but this relationship was restricted to men. This study is among the first to examine the effects of gender and acculturation on smoking abstinence among Latinos. Findings highlight the need for research focused on mechanisms underlying these relationships.