Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial.

BACKGROUND: African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. OBJECTIVE: This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). METHODS: Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. RESULTS: The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. CONCLUSIONS: No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52776.

Pain interference among adult dual combustible and electronic tobacco users in terms of perceived barriers for quitting.

Electronic cigarette (e-cigarette) use has become increasingly common among combustible cigarette users, and dual use may represent a more severe type of nicotine addiction. Experiencing pain is one prevalent domain that may be important to understand quit processes and behavior among dual users. Although most past research on pain and nicotine/tobacco has focused on combustible cigarette use, initial work on e-cigarette users has found that greater pain severity is associated with higher levels of dependence and negative thinking patterns about e-cigarette use. Yet, there has been no effort to explore the experience of pain among dual users in terms of perceived barriers for quitting combustibles or e-cigarettes. The present study sought to examine pain interference among dual combustible and e-cigarette users in terms of perceived barriers for quitting among 138 (45.9% female; Mage = 35.96 years, SD = 7.16) adult dual users (i.e., users of both combustible cigarette and e-cigarettes). Hierarchical linear regression models indicated that pain interference was significantly associated with both perceived barriers for cessation of combustible cigarettes and perceived barriers for cessation of e-cigarettes. Overall, the present investigation served as an initial evaluation of the role of pain interference in terms of perceived barriers for quitting combustible and e-cigarettes among adult daily dual users. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-reported COVID-19 symptoms and perceived likelihood of suicide attempt among Latinx individuals who experience acculturative stress.

The impact of COVID-19 has led to a substantial economic and psychosocial burden on the Latinx population. However, few studies have evaluated how COVID-19 symptoms may exacerbate suicide risk indicators among Latinx persons, or the particular social determinants of health facilitating such detrimental effects. The present study examined the association between self-reported COVID-19 symptoms and suicide likelihood (i.e., self-reported perceived likelihood that one will attempt suicide in the future) among Latinx individuals within a timeframe involving high COVID-19 contagion before the onset of vaccine dissemination. Further, the possible moderating role of acculturative stress in the association between COVID-19 symptoms and suicide likelihood was examined. The sample included 200 Latinx participants (67.5% male, Mage = 34.67 years, SD = 9.15) who completed self-report measures on COVID-19 symptoms, suicide likelihood, acculturative stress, depressive symptoms, trauma symptoms, somatic symptoms, and general COVID-19 emotional impact. Findings indicated that self-reported COVID-19 symptoms were positively associated with suicide likelihood. Further, the association between COVID-19 symptoms and suicide likelihood was moderated by acculturative stress, such that the association was only statistically significant at mean or higher levels of acculturative stress but was not significant among participants with lower acculturative stress. The moderation effect was statistically significant after controlling for sociodemographic factors, depressive symptoms, trauma symptoms, somatic symptoms, and the general emotional impact of the COVID-19 pandemic. The current findings indicate that, among Latinx individuals, acculturative stress is a key social determinant of health for marked psychological distress in the context of the COVID-19 pandemic.

Study protocol for approach bias retraining for nicotine addiction among dual combustible and electronic cigarette users.

BACKGROUND: Electronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults. Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely. Retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol and CC use treatments. However, approach bias retraining for both CC and (ECIG) users has not been explored. Therefore, the objective of the study is to evaluate the initial efficacy of approach bias retraining among dual CC and ECIG users. METHODS: Eligible dual CC/ECIG using adults (N = 90) will complete a phone-screener, baseline assessment, 4 treatment sessions over 2 weeks, ecological momentary assessments (EMAs) post-intervention, and follow-ups at 4- and 6-week post-intervention. Participants will be assigned to one of three conditions at baseline: (1) CC + ECIG retraining; (2) CC only retraining; and (3) sham retraining. Participants will engage in a self-guided quit attempt to abstain from all nicotine products starting at treatment session 4. CONCLUSIONS: The study may lead to a more effective treatment for at-risk nicotine users while simultaneously isolating explanatory mechanisms. The findings should guide advances in the theoretical conceptualization of nicotine addiction for dual users and mechanisms involved in maintaining and abstaining from CC and ECIG, and provide initial effect size data for a brief intervention, thus providing necessary data for a large-scale follow-up trial. Clinical Trials ID: NCT05306158.

Chronic pain acceptance: Relations to opioid misuse and pain management motives among individuals with chronic low back pain.

The opioid epidemic is a significant public health concern, and opioid consumption rates and opioid-related deaths are on the rise. Chronic pain acceptance, or willingness to experience pain and pain-related distress, is one pain-related psychological mechanism that may reduce maladaptive attempts to avoid or control pain using opioids among individuals with chronic lower back pain (CLBP). However, little work has examined chronic pain acceptance as it relates to opioid use and motives for use among adults with CLBP. The current investigation sought to explore the effects of chronic pain acceptance on opioid misuse and motives for opioid use (i.e., pain management and coping motives) among adults with CLBP. Participants were 291 adults (69.1 % female, Mage = 45.77 years, SD = 11.22) self-reporting current mild to severe CLBP and current opioid use who were recruited via an online survey. Results indicated that higher acceptance of pain was related to lower levels of opioid misuse and lower motivation to use opioids to cope with pain. Contrary to hypotheses, chronic pain acceptance did not predict motivation to use opioids to cope with emotional distress (i.e., coping motives). The current findings provide support for chronic pain acceptance as a potential protective mechanism in terms of opioid misuse and motivation to use opioids to manage pain.

Anxiety sensitivity and reasons for smoking among Black smokers.

Black smokers demonstrate higher nicotine dependence and experience higher rates of smoking-related diseases and mortality relative to European American/White smokers. A potential factor relevant to race-specific smoking health disparities may be smoking motives (i.e., motivational basis of smoking). Yet, little research has been conducted to understand psychological factors that may be associated with specific smoking motives among Black smokers. To address this gap in the literature, the current study explored the association between anxiety sensitivity and smoking motives within a subset sample of Black smokers who were interested in participating in a smoking cessation trial (N = 105; 70.5 % male; Mage = 44.8 years, SD = 11.6 years). Hierarchical regression analyses indicated anxiety sensitivity was associated with smoking motives related to habit (ß = 0.39, p <.001), negative affect reduction (ß = 0.32, p <.001), stimulation (ß = 0.31, p <.001), and sensorimotor manipulation (ß = 0.26, p =.008). Limited support was found for the effect of motives on past quit attempt engagement. These results may broaden understanding of the psychological mechanisms related to smoking motivation among Black smokers and may inform future intervention efforts to reduce smoking motivation among this health disparities population.

Evaluating resilience in terms of COVID-19 related behavioral health among Latinx adults during the coronavirus pandemic.

The mental and behavioral health burden resulting from COVID-19 has disproportionately affected the Latinx population. Yet, no work has investigated the influence of resilience as a protective factor against COVID-19 related consequences. The aim of the current study was to evaluate resilience in relation to COVID-19 related fear, anxiety symptoms, COVID-19 anxiety-related sleep disturbances, and depression among Latinx persons (178 Latinx persons [31.5% female, Mage = 34.1 years, SD = 8.2]). It was hypothesized that greater levels of resilience would be associated with lower levels of all COVID-19 related behavioral health outcomes above and beyond the variance accounted for by years living in the United States (U.S.), degree of COVID-19 exposure, sex, age, education, and COVID-19 related work and financial troubles and home-life distress. Results indicated that greater levels of resilience were associated with lower levels of COVID-19 related fear (ΔR2 = .06, p < .001), anxiety symptoms (ΔR2 = .03, p = .005), COVID-19 anxiety-related sleep disturbances (ΔR2 = .06, p < .001), and depression (ΔR2 = .04, p = .001). Overall, the present study is the first to document the potential importance of resilience in relation to common and clinically significant COVID-19 behavioral health problems among Latinx persons.

Exploring Fatigue Sensitivity in terms of Mental Health and Fatigue Severity among a Racially and Ethnically Diverse Sample with Severe Fatigue.

Background: Fatigue sensitivity, or the misattribution that fatigue symptoms will lead to negative personal consequences, is one individual difference factor related to adverse behavioral health consequences. Methods: The current study investigated whether fatigue sensitivity was related to panic symptoms, depression, as well as fatigue severity among 166 persons of diverse racial/ethnic backgrounds with severe fatigue. Results: As hypothesized, fatigue sensitivity was statistically significantly related to greater panic symptoms, general depression, and fatigue severity. These results were evident over the variance explained by age, sex, neuroticism, and somatic symptoms. Conclusions: This work is the first to evaluate fatigue sensitivity in terms of behavioral health outcomes among a racial/ethnically diverse sample with severe fatigue.

Trauma exposure and smoking outcomes: The indirect effects of anxious and depressive symptoms.

With a direct link between traumatic stress and poor smoking outcomes established, there is a clinically important need to identify underlying, targetable mechanisms that maintain these relations. The present study employed a parallel mediation model to assess the competing explanatory significance of four distinct facets of depression and anxiety (general anxiety, anxious arousal, general depression, and anhedonic depression) in the relation between traumatic load and perceived barriers for quitting smoking, severity of psychosomatic problems experienced when attempting to quit smoking in the past, and negative reinforcement expectancies related to smoking among 98 adult trauma-exposed daily smokers (Mage = 44.64, SD = 10.66). Results showed that only general anxiety symptoms, when controlling for the competing facets of depression and anxiety, had a statistically significant indirect effect on the relation between traumatic load and all smoking processes, such that general anxiety symptoms significantly, indirectly influenced the relation between traumatic load and barriers for smoking cessation (ab = 0.95, 95% CI [0.163, 0.2.14]), smoking quit problems (ab = 0.07, 95% CI [0.009, 0.165]), and negative reinforcement smoking expectancies (ab = 0.16, 95% CI [0.025, 0.399]). Anxious arousal demonstrated an indirect effect for trauma load on only negative reinforcement smoking expectancies (ab = -0.15, 95% CI [-0.345, -0.023]). The current findings highlight the potential importance of general anxiety symptoms as a targetable mechanism for smoking cessation treatments for trauma-exposed smokers.

Exploring pain experience and anxiety sensitivity among Latinx adults in a federally qualified health center.

The Latinx population is the largest minority group in the United States (U.S.) and is expected to continue to grow through at least 2050. Although there is growing recognition of the importance of pain among Latinx individuals, few studies have examined individualized psychological processes governing pain severity and disability in Latinx populations. One psychological factor that has shown promise in relation to pain experience specifically and clinical conditions more generally is anxiety sensitivity. The present investigation sought to (1) characterize the severity of pain among an unselected sample of adult Latinx individuals attending a Federally Qualified Health Center (FQHC); (2) evaluate the severity of anxiety sensitivity as a function of pain severity; and (3) test the potential explanatory relevance of anxiety sensitivity as an individual difference factor for pain intensity, pain disability, psychological inflexibility for emotional distress, and global life impairment. Participants included 406 adult Spanish-speaking Latinx persons (87.2% female; Mage = 40.26 years, SD = 11.20, and 98.3% used Spanish as their first language) who attended an FQHC in Houston, Texas. Analyses revealed that 62.6% of the sample had at least some pain, and 21.9% of the same had high intensity, moderate interference, or severe interference chronic pain. Further, results provided evidence for anxiety sensitivity as a function of pain grade, such that individuals with grade 2 (high-intensity pain), grade 3 (moderate pain interference), and grade 4 (severe pain interference) chronic pain reported significantly higher levels of anxiety sensitivity than those with grade 0 pain (no chronic pain). Additionally, after controlling for age, gender, marital status, years of education, years living in the U.S., and generalized anxiety, anxiety sensitivity significantly accounted for significant variance in pain intensity, inflexibility in relation to emotional distress, and life impairment. Overall, the current study builds upon what is currently understood about anxiety sensitivity among the Latinx population and uniquely extends past work by linking individual differences in this construct to clinically relevant aspects of pain experience and life impairment among adults attending FQHC's. Additional clinical attention should be focused on anxiety sensitivity to offset pain disparities among this established health disparities group.

Anxiety symptoms and smoking outcome expectancies among Spanish-speaking Latinx adult smokers: Exploring the role of anxiety sensitivity.

Although anxiety symptoms/disorders are consistently implicated in smoking processes, no empirical work has identified individual difference factors that may underlie such relations among Latinx smokers. The current study examined anxiety sensitivity as an explanatory factor underlying the relationship between anxiety symptoms and smoking expectancies among Spanish-speaking Latinx smokers. Participants included 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.81). Results indicated that anxiety symptoms had a significant indirect effect on positive and negative smoking expectancies through anxiety sensitivity. Such findings suggest that anxiety sensitivity is relevant to understanding the anxiety-smoking expectancies association among Latinx smokers.

Evaluating Experiential Avoidance in terms of COVID-19 Fear and Pandemic Emotional Distress Symptoms Among Latinx Adults.

BACKGROUND: The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial psychological distress across the United States and the world. However, emerging work suggests that prominent COVID-19 consequences such as fear of COVID-19 infection and emotional distress resulting from economic adversity and social distancing may afflict the Latinx population disproportionately. The current study sought to investigate the influence of experiential avoidance (EA), or an individual's tendency to rigidly avoid negative internal experiences (i.e. feelings, thoughts, etc.), on the severity of COVID-19 fear and emotional distress symptoms due to economic adversity and social distancing. METHOD: Participants included 188 Latinx persons recruited via an online survey panel program. RESULTS: Results indicated that EA was a statistically significant contributing factor to fear of COVID-19 and emotional distress associated with economic adversity and social distancing. These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and COVID-19 related work and home life stress. CONCLUSIONS: Overall, the present work is the first to document empirically EA as it relates to fear of COVID-19 infection and related emotional distress resulting from economic adversity and social distancing among Latinx persons.

Pain intensity, pain-related anxiety, and somatic and mental health symptoms: a test among latinx young adults.

Latinx individuals demonstrate significant pain-related health disparities compared to other racial/ethnic groups. Moreover, young adulthood (18-25 years of age) is a primary developmental window wherein pain-related health problems are first encountered and may be related to more severe somatic and mental health symptoms. Pain-related anxiety may be one mechanistic construct linking individual differences in the experience of pain intensity to poorer somatic experiences and mental health among Latinx young adults. Thus, the current study examined pain-related anxiety as an explanatory factor underlying the relationship between pain intensity and body vigilance, perceptions of health, worry, anxious arousal, and depressive symptoms among Latinx young adults. Participants included 401 Latinx young adults (Mage = 21 years; SD = 2.02; age range: 18-25 years; 83% female) at a large, southwestern university. Results revealed that individual differences in pain intensity had a significant indirect effect on the studied somatic and negative affect variables through pain-related anxiety. These novel findings suggest future work should continue to explore pain-related anxiety in the association between the experience of pain and somatic and mental health among Latinx young adults.

Exploring positive expectancies and quit status among adult electronic cigarette users.

Initial research on electronic cigarette (e-cigarette) use suggests differences exist in levels of use, beliefs, and cessation difficulties among users. However, little research has explored how these factors interact to confer worse e-cigarette outcomes. The current study examined the association between positive expectancies of e-cigarette use and e-cigarette processes among 544 (51.1% female; Mage = 35.4 years, SD = 10.12) adult e-cigarette users who had and had not attempted to quit e-cigarettes, a defining characteristic believed to distinguish those with and without greater e-cigarette quit difficulty. Results indicated that greater positive outcome expectancies of e-cigarette use were significantly related to increased perceived risks, benefits, and barriers to quitting. The strength of the associations was stronger for those who reported past quit attempts compared to those who never attempted quitting. Overall, the current study highlights the potentially important role that positive expectancies for e-cigarette use and quit attempt status play in e-cigarette processes. Findings suggest a possible need to contextualize positive expectancies for e-cigarette use within future e-cigarette cessation tactics and tailoring treatments based on quit attempt status.

The Effects of Cannabis Use: A Test Among Dual Electronic and Combustible Cigarette Users.

BACKGROUND AND OBJECTIVES: Despite greater rates of cannabis use among those that smoke combustible cigarettes, it is currently unknown whether cannabis use is related to e-cigarette dependence or maladaptive beliefs about combustible cigarettes. Therefore, the current study sought to identify whether adult dual users of combustible and e-cigarettes (ie, dual users) who also used cannabis differed from dual users who did not use cannabis on e-cigarette dependence severity, perceived barriers to quitting, and perception of risks and of benefits of e-cigarettes. METHODS: Participants were 414 current dual users (48.3% female, Mage = 35.1 years, SD = 10.0), 51% of whom were current cannabis users. RESULTS: Dual users who reported current cannabis use evidenced more severe dependence on e-cigarettes (ηp 2 = 0.12), higher perceived barriers for quitting e-cigarettes (ηp 2 = 0.06), and greater perceived benefits (ηp 2 = 0.03) as well as higher perception of risks (ηp 2 = 0.03) for using e-cigarettes. The results were evident after controlling for the variance associated with sex, age, education, income, and frequency of e-cigarette use. DISCUSSION AND CONCLUSIONS: Overall, the current findings suggest cannabis may be an important type of substance use behavior that is relevant to e-cigarette dependence and beliefs about use and quitting among adult dual users. SCIENTIFIC SIGNIFICANCE: The present data extend current understanding of dual users by contextualizing cannabis use within e-cigarette and combustible cigarette use behaviors and highlight a potential substance use behavior that may be targetable in the framework of nicotine cessation. (Am J Addict 2020;00:00-00).

Differential Effects of Anxiety Sensitivity on E-Cigarettes Processes: The Importance of E-Cigarette Quit Attempt History.

BACKGROUND AND OBJECTIVES: Electronic cigarettes (e-cigarettes) are recognized as a prevalent form of substance use among adults in the United States. The rise in e-cigarette use has motivated research to identify subgroups of the population that may be particularly vulnerable to e-cigarette use and its associated harm. Individuals with elevated psychological vulnerability are one such group more at risk for being a lifetime or current e-cigarette user. Yet, little is known about how factors of psychological vulnerability relate to perceptions of e-cigarette use within the context of e-cigarette quit attempts. The current study evaluated the differential relations of anxiety sensitivity (AS), a core affective vulnerability factor, on several relevant e-cigarette processes across those with and without a previous attempt to quit using e-cigarettes. METHODS: Our sample consisted of 547 current e-cigarette users (51% female, Mage = 35.38 years, SD = 10.1). RESULTS: Results indicated that AS significantly related to greater perceived risks, benefits, and positive outcome expectancies of e-cigarette use among current e-cigarette users who reported at least one attempt to quit e-cigarettes but was unrelated among those who had never attempted to quit. DISCUSSION AND CONCLUSIONS: Findings identify e-cigarette users who fail to quit as a potential vulnerable subgroup of users who experience more strongly held perceptions about e-cigarettes because of increased AS. SCIENTIFIC SIGNIFICANCE: This work provides initial evidence for a conceptual model in which levels of AS and e-cigarette processes are strengthened by and differ across e-cigarette quit attempt history. (Am J Addict 2019;28:390-397).

Distinguishing Characteristics of E-Cigarette Users Who Attempt and Fail to Quit: Dependence, Perceptions, and Affective Vulnerability.

OBJECTIVE: Electronic cigarettes (e-cigarettes) are a prevalent form of substance use among adults. Because of the novelty of e-cigarettes, users may not fully understand the consequences of long-term use and the potential difficulties involved with quitting e-cigarettes. Given the projected rise in the use of e-cigarettes, it is important to understand possible contributing factors that may influence e-cigarette quit difficulty. METHOD: In the current study, we evaluated whether those with a previous e-cigarette quit attempt differed from those who made no such attempt on specific and broad-based use factors among 560 current adult e-cigarette users (51.5% female; mean age = 35.27 years, SD = 10.22). RESULTS: Results demonstrated that e-cigarette users with previous quit attempts had significantly higher rates of e-cigarette dependence, had perceived barriers to quitting, and held both positive and negative expectancies regarding e-cigarette use. Those with previous e-cigarette quit attempts also endorsed higher levels of affective vulnerability across most studied constructs. CONCLUSIONS: Findings suggest that a substantial portion of current e-cigarette users struggle to remain abstinent from e-cigarette use and highlight potential factors that may portend relapse. Longitudinal work is needed to provide a more thorough understanding of e-cigarette use patterns, perceptions, and quit behavior.

Pain severity and e-cigarette health literacy: the moderating role of sex.

Although electronic cigarette (e-cigarette) use has increased among adults in the United States, there is still little knowledge of factors that may influence e-cigarette use or beliefs about use. Prior research suggests that health literacy plays an important role in e-cigarette beliefs, including perceived benefits and risks of e-cigarette use, as well as e-cigarette dependence. Yet, limited work has examined risk factors of poor e-cigarette health literacy. From a biopsychological perspective, sex and pain severity represent two constructs that may impact e-cigarette health literacy. To date, however, no research has investigated differences in e-cigarette health literacy across pain, sex, or their interrelation. Thus, the present study was conducted to evaluate the interactive effect of pain severity and sex on e-cigarette health literacy. Participants included 319 current, adult e-cigarette users (60.5% female, Mage = 36.82 years, SD = 10.62). Findings supported a significant pain by sex interaction, such that pain related to e-cigarette health literacy among women (b = .10, SE = .03, P < .001), but not men (b = .01, SE = .03, P = .60). The present findings suggest that pain may uniquely impact the degree to which women, but not men, seek and understand information on e-cigarettes.