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Anxiety symptoms and disorders are the most common psychiatric problems world-wide and are vastly overrepresented among individuals with chronic illness and poor health behavior. The purpose of the current special series is to bolster attention and highlight new research on cognitive processes as a basic element that may undergird the association between anxiety and chronic illness and health behavior. Findings in this issue highlight cognitive-based risk and resilience factors related to anxiety in individuals with various chronic conditions and problematic health behavior.

Cigarette smoking and poor weight control independently and synergistically increase risk for morbidity and mortality. However, few studies have examined the etiological role of emotion-regulatory dysfunction in the link between smoking and poor weight control, as well as the possible moderating role of sex. Participants (n = 577; Mage = 44.42; SD = 13.80; 52.7% female) were daily smokers who completed a single survey online through Qualtrics. Emotional vulnerability was indexed by a latent construct comprised of the subscales from the Distress Tolerance Scale (DTS) and the Anxiety Sensitivity Index-3 (ASI-3). A regression model was constructed to examine the relation between emotional vulnerability and poor weight control, measured via body mass index (BMI). Emotional vulnerability was significantly and positively associated with BMI (b = .08, p = .020). The effect was moderated by sex, such that emotional vulnerability was significantly related to BMI in female smokers (b = .15, p = .002), but not in male smokers (b = .01, p = .806). Emotional vulnerability appears to be a novel female-specific psychological mechanism related to poor weight control in smokers. Possible limitations are discussed.

Frequency of cannabis use and cognitive vulnerabilities such as anxiety sensitivity (i.e., the fear of bodily sensations), have been independently linked with poor physical health, however the interplay between these health-mental health processes may compound poor physical health and functioning in cannabis users. Thus, the current study evaluated the direct and interactive effects of cannabis use frequency and anxiety sensitivity on physical health and functioning among cannabis-using veterans. Participants (N = 138) were post-9/11 United States veterans recruited from a Veterans Affairs hospital who reported cannabis use in the past six months. Cannabis use frequency in the past month and anxiety sensitivity were significantly negatively correlated with perceived overall physical health. There was a significant interaction between cannabis use frequency and anxiety sensitivity, such that more frequent cannabis use was associated with poorer overall health and role functioning due to health problems among veterans with higher anxiety sensitivity (but not lower). Findings suggest that anxiety sensitivity is a cognitive vulnerability linked to poor perceived physical health and impairment among frequent cannabis users and could be targeted, along with cannabis use, for health-promotion in cannabis users.

BACKGROUND: The subjective affective response to, and enjoyment of, physical activity are strong predictors of engagement in physical activity. Anxiety sensitivity, the fear of bodily sensations, is a cognitive factor that may inhibit the pleasurable affective experience of physical activity, possibly contributing to low levels of physical activity. The current study evaluated anxiety sensitivity in relation to PA enjoyment and affective experience before and after exercise in smokers. METHOD: Participants were low-active treatment-seeking smokers (n = 201) enrolled in a smoking cessation intervention. At baseline, participants completed self -report assessments of anxiety sensitivity, cigarette dependence, and physical activity enjoyment. State affect was also reported before and after a submaximal exercise test to index pre-exercise activity affect and affective response to exercise. RESULTS: Anxiety sensitivity was significantly negatively correlated with physical activity enjoyment, specifically lower enjoyable physical feelings of physical activity. Anxiety sensitivity was significantly correlated with lower state mood and higher state anxiety prior to the submaximal exercise test, and higher anxiety immediately after the exercise test. Additionally, anxiety sensitivity predicted increased anxiety, but not lower mood, in response to the submaximal exercise test. CONCLUSIONS: This is the first study to document an association of anxiety sensitivity with affective determinants of physical activity behavior in smokers. Anxiety sensitivity was associated with lower physical activity enjoyment, higher negative affect prior to after exercise testing, and an anxiogenic response to exercise. Future work is needed to understand how the current findings generalize beyond smokers.

The Smoking and Weight Eating Episodes Test (SWEET; Adams et al. 2011) is a self-report measure designed to assess multiple reasons why and when smokers use cigarettes for appetite, weight, and shape management, that was initially developed and validated in young female smokers. The aim of the current study was to evaluate the factor structure and psychometric properties of the SWEET measure among both male and female daily cigarette smokers. Participants (n = 577; Mage = 44.42; SD = 13.80; 52.7% female) were daily smokers recruited through Qualtrics Online Sample for an anonymous study on smoking and health. On average, participants reported smoking for 25.7 years (SD = 14.35), smoked 17.0 cigarettes per day (SD = 8.38), and had moderate levels of tobacco dependence. Confirmatory factor analyses supported the initial factor structure found in the original SWEET measure suggesting a four-factor structure fit the data well, but not a one-factor structure. Factors included using cigarettes for appetite suppression, using cigarettes to prevent overeating, smoking to cope with body dissatisfaction, and using cigarettes to cope with appetite-related withdrawal symptoms. Tests of measurement invariance revealed no significant differences when evaluating SWEET scores by participant sex. The SWEET factor scores evidenced internal consistency, known groups validity, convergent validity with related constructs (compensatory eating behaviors, tobacco dependence) and cessation-relevant variables (smoking abstinence expectancies, prior withdrawal symptoms), and discriminant validity with physical activity and sedentary behavior. The present study provides evidence in support of the validity and reliability of scores on the SWEET as a multidimensional measure of smoking for appetite, weight, and body-related concerns in male and female daily cigarette smokers.

Drug demand, or relative value, can be assessed via analysis of behavioral economic purchase task performance. Five demand indices are typically obtained from drug purchase tasks.The goal of this research was to determine whether metrics of marijuana reinforcement from a marijuana purchase task (MPT) exhibit a latent factor structure that efficiently characterizes marijuana demand.Participants were regular marijuana users (n = 99; 37.4% female, 71.5% marijuana use days [5 days/week], 15.2% cannabis dependent) who completed study assessments, including the MPT, during a baseline session. Principal component analysis was used to examine the latent structure underlying MPT indices. Concurrent validity was assessed via examination of relationships between latent factors and marijuana use, past quit attempts, and marijuana expectancies.A two-factor solution was confirmed as the best fitting structure, accounting for 88.5% of the overall variance. Factor 1 (65.8% variance) reflected "Persistence," indicating sensitivity to escalating marijuana price, which comprised four MPT indices (elasticity, OConsistent with research on alcohol and cigarette purchase tasks, the MPT can be characterized with a latent two-factor structure. Thus, demand for marijuana appears to encompass distinct dimensions of price sensitivity and volumetric consumption, with differential relations to other aspects of marijuana motivation.

There is little knowledge about how emotion regulation difficulties interplay with psychopathology in terms of smoking cessation. Participants (n = 250; 53.2 % female, Mage = 39.5, SD = 13.85) were community-recruited daily smokers (≥8 cigarettes per day) who self-reported motivation to quit smoking; 38.8 % of the sample met criteria for a current (past 12-month) psychological disorder. Emotion regulation deficits were assessed pre-quit using the Difficulties with Emotion Regulation Scale (DERS; Gratz and Roemer in J Psychopathol Behav Assess 26(1):41–54, 2004) and smoking behavior in the 28 days post-quit was assessed using the Timeline Follow-Back (TLFB; Sobell and Sobell in Measuring alcohol consumption: psychosocial and biochemical methods. Humana Press, Totowa, 1992). A Cox proportional-hazard regression analysis was used to model the effects of past-year psychopathology, DERS (total score), and their interaction, in terms of time to lapse post-quit day. After adjusting for the effects of gender, age, pre-quit level of nicotine dependence, and treatment condition, the model revealed a non-significant effect of past-year psychopathology (OR = 1.14, CI95 % = 0.82–1.61) and difficulties with emotion regulation (OR = 1.01, CI95 % = 1.00–1.01) on likelihood of lapse rate. However, the interactive effect of psychopathology status and difficulties with emotion regulation was significant (OR = 0.98, CI95 % = 0.97–0.99). Specifically, there was a significant conditional effect of psychopathology status on lapse rate likelihood at low, but not high, levels of emotion regulation difficulties. Plots of the cumulative survival functions indicated that for smokers without a past-year psychological disorder, those with lower DERS scores relative to elevated DERS scores had significantly lower likelihood of early smoking lapse, whereas for smokers with past-year psychopathology, DERS scores did not differentially impact lapse rate likelihood. Smokers with emotion regulation difficulties may have challenges quitting, and not having such difficulties, especially without psychopathology, decreases the potential likelihood of early lapse.

There is a growing literature that documents the direct and indirect effects of anxiety sensitivity in terms of the maintenance of cigarette smoking and cessation problems, as maintained, at least in part, by affective-regulatory expectancies effects and motives for smoking. Yet, the role of expectancies about the interoceptive-specific consequences of smoking abstinence has yet to be empirically examined. Participants (N = 110) were daily tobacco smokers recruited as part of a self-guided tobacco cessation study. Baseline (pre-treatment) data were utilized. A structural equation model was constructed to examine the relations between anxiety sensitivity in terms of interoceptively-relevant smoking abstinence expectancies (somatic symptoms and harmful consequences) in regard to perceived barriers to smoking cessation, number of problematic symptoms experienced during past quit attempts, and the number of prior quit attempts. Anxiety sensitivity was significantly related to interoceptive threat abstinence expectancies (β = .56, p