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OBJECTIVE:Smokers with bipolar disorder (BD) have low rates of successful quitting, yet no prior studies have evaluated the process of quitting among these smokers in the context of a current quit attempt. To facilitate development of more effective interventions, we conducted a qualitative exploration of challenges and facilitators of quitting in an intervention study for smokers with BD. METHODS:Participants were adult daily smokers with BD (n = 10) who completed a 10-week smoking cessation intervention consisting of Acceptance and Commitment Therapy (ACT) and nicotine patch. We administered semistructured interviews focused on the quitting process at the end of treatment and used inductive content analysis to extract themes. RESULTS:Emergent themes representing challenges of quitting included social impediments, lack of awareness, avoidance, maladaptive beliefs, ambivalence, benefits of smoking, and difficulties with nicotine replacement. Themes representing change facilitators included positive treatment effects (ACT-specific, nonspecific, and nicotine patch-related), coping behaviors, reasons to quit, changes in self-perception, and social benefits. CONCLUSIONS:Results suggest a need for assistance with obtaining social support and handling social impediments, interrupting the automaticity of smoking, expanding the behavioral repertoire to handle aversive internal states that tend to be avoided by smoking, preventing maladaptive beliefs from interfering with quitting, taking meaningful action toward change while experiencing ambivalence, either replacing the benefits of smoking or accepting their loss, and troubleshooting difficulties with nicotine replacement. Findings regarding facilitators of quitting supported previous quantitative findings that the ACT intervention impacted theory-based targets and highlighted the importance of the counseling relationship.

ObjectivesPeople with bipolar disorder are two to three times more likely to smoke and 50% less likely to quit than the general population. New treatments are needed to improve smoking cessation outcomes in this group. The study aim was to develop and pilot test a novel cessation intervention for smokers with bipolar disorder using Acceptance and Commitment Therapy (ACT) combined with nicotine patches.MethodsThe ten-session ACT intervention was initially evaluated as in-person, individual counseling (n = 10), then as telephone-delivered counseling (n = 6). Participants were adult smokers with no more than mild current symptoms of bipolar disorder.ResultsFor the in-person protocol, end-of-treatment outcomes were: 80% retention, 40% of participants with carbon monoxide (CO)-verified seven-day point prevalence abstinence (PPA), 90% satisfied with treatment, 8.3 of ten sessions attended, and 54% increase in acceptance of cravings to smoke (i.e., ACT's theory-based change process) from baseline. The seven-day PPA at one-month follow-up was 30%. For the telephone protocol, end-of-treatment outcomes were: 67% retention, 33% reporting seven-day PPA, 100% satisfied with treatment, 6.7 of ten treatment calls completed, and 55% increase in acceptance from baseline. At one-month follow-up, seven-day PPA was 17%. The proportion of treatment completers who used at least 80% of the nicotine patches was 62.5% for the in-person protocol and 0% for the telephone protocol.ConclusionsBoth in-person and telephone-delivered ACT were feasible. Despite low adherence to nicotine patches, the intervention showed preliminary evidence of facilitating quitting and impacting ACT's change mechanism. A randomized, controlled trial of this targeted ACT intervention is now needed.

Objectives:Although social anxiety is associated with higher prevalence of smoking and lower cessation rates, little is known about the underlying mechanisms of these relationships. Research suggests that socially anxious smokers have higher levels of smoking-specific experiential avoidance and are inclined to smoke to avoid internal smoking cues. However, it is unknown which types of internal smoking cues they avoid. Thus, this study aimed to address this gap in the literature.Methods:Participants (N= 450) were adult smokers from a group-based trial for smoking cessation. Bivariate correlations and hierarchical linear regression models examined relationships between baseline levels of social anxiety and acceptance of internal smoking cues—physical sensations, emotions, and cognitions.Results:Social anxiety was associated with lower levels of acceptance of thoughts, sensations, and emotions that cue smoking. After controlling for levels of nicotine dependence, depression, generalized anxiety, and posttraumatic stress disorder, social anxiety still explained unique variability in overall acceptance of internal smoking cues and in acceptance of physical sensations and emotions that serve as smoking cues. Social anxiety no longer explained unique variability in acceptance of thoughts that trigger smoking.Conclusions:Smokers with high levels of social anxiety are less accepting of internal smoking cues. For physical and emotional cues, this effect was independent of level of dependence and mental health comorbidity. Results help explain why smokers with social anxiety are less likely to quit and can inform the development of targeted cessation treatments for smokers with social anxiety. [ABSTRACT FROM PUBLISHER]

Tobacco smoking is the leading cause of preventable disease, disability, and premature death in the United States. Recent advances have led to two efficacious mobile health (mHealth) treatments for smoking cessation: iCanQuit, an Acceptance and Commitment Therapy-based behavioral treatment promoting cessation through accepting triggers and committing to values; and Motiv8, a contingency management intervention promoting smoking cessation with financial incentives via biochemically verified abstinence. This study will evaluate the comparative effectiveness of the Florida Quitline, iCanQuit alone, and iCanQuit+Motiv8 in a pragmatic trial among patients who smoke in underserved primary care settings. The study will be an individually-randomized controlled trial with three arms (Florida Quitline, iCanQuit alone, iCanQuit+Motiv8 combined) conducted in multiple primary care practices affiliated with the OneFlorida+ Clinical Research Consortium. Adult patients who smoke will be randomized to one of the 3 study arms (n = 444/arm), stratified by healthcare setting (academic vs. community). The primary outcome will be 7-day point prevalence smoking abstinence at 6 months post-randomization. Secondary outcomes will be 12-month smoking abstinence, patient satisfaction with the interventions, and changes in patient quality of life and self-efficacy. The study will also assess how and for whom the interventions help sub-group patients in achieving smoking abstinence by measuring theory-derived factors that mediate smoking outcome-specific baseline moderators. Results from this study will provide evidence for the comparative effectiveness of mHealth smoking cessation interventions in healthcare settings. Use of mHealth interventions can make smoking cessation resources more equitably accessible and have far-reaching impact on community and population health. ClinicalTrials.gov , NCT05415761 , Registered 13 June 2022. [ABSTRACT FROM AUTHOR]

Background: Understanding the characteristics of high and low utilizers of smartphone applications (apps) for smoking cessation would inform development of more engaging and effective apps, yet no studies to date have addressed this critical question. Informed by prior research on predictors of cessation Web site utilization, this study examines the degree to which baseline demographic factors (gender, age, and education), smoking-related factors (smoking level and friends' smoking), and psychological factors (depression and anxiety) are predictive of utilization of a smartphone app for smoking cessation called SmartQuit. Materials and Methods: Data came from 98 participants randomized to SmartQuit as part of a pilot trial from March to May 2013. We used negative binomial count regressions to examine the relationship between user characteristics and utilization of the app over an 8-week treatment period. Results: Lower education (risk ratio [RR] = 0.492; p = 0.021), heavier smoking (RR = 0.613; p = 0.033), and depression (RR = 0.958; p = 0.017) prospectively predicted lower app utilization. Women (RR = 0.320; p = 0.022), those with lower education (RR = 0.491; p = 0.013), and heavier smokers (RR = 0.418; p = 0.039) had lower utilization of app features known to predict smoking cessation. Conclusions: Many of the predictors of utilization of smoking cessation apps are the same as those of cessation Web sites. App-delivered smoking cessation treatment effectiveness could be enhanced by focusing on increasing engagement of women, those with lower education, heavy smokers, and those with current depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Currently, there are over 400 smoking cessation smartphone apps available, downloaded an estimated 780,000 times per month. No prior studies have examined how individuals engage with specific features of cessation apps and whether use of these features is associated with quitting. Objectives: Using data from a pilot trial of a novel smoking cessation app, we examined: (i) the 10 most-used app features, and (ii) prospective associations between feature usage and quitting. Methods: Participants ( n = 76) were from the experimental arm of a randomized, controlled pilot trial of an app for smoking cessation called 'SmartQuit,' which includes elements of both Acceptance and Commitment Therapy (ACT) and traditional cognitive behavioral therapy (CBT). Utilization data were automatically tracked during the 8-week treatment phase. Thirty-day point prevalence smoking abstinence was assessed at 60-day follow-up. Results: The most-used features - quit plan, tracking, progress, and sharing - were mostly CBT. Only two of the 10 most-used features were prospectively associated with quitting: viewing the quit plan ( p = 0.03) and tracking practice of letting urges pass ( p = 0.03). Tracking ACT skill practice was used by fewer participants ( n = 43) but was associated with cessation ( p = 0.01). Conclusions: In this exploratory analysis without control for multiple comparisons, viewing a quit plan (CBT) as well as tracking practice of letting urges pass (ACT) were both appealing to app users and associated with successful quitting. Aside from these features, there was little overlap between a feature's popularity and its prospective association with quitting. Tests of causal associations between feature usage and smoking cessation are now needed. [ABSTRACT FROM AUTHOR]

Background: Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes.Objective: In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership.Methods: Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups. Logistic regression was used to determine the association of group membership with the primary outcome of 30-day point prevalence of smoking abstinence at 12 months. Finally, the baseline characteristics associated with group membership were examined using logistic and multinomial logistic regression. The analyses were conducted separately for each app.Results: For iCanQuit, participants were clustered into 3 groups: "1-week users" (610/1069, 57.06%), "4-week users" (303/1069, 28.34%), and "26-week users" (156/1069, 14.59%). For smoking cessation rates at the 12-month follow-up, compared with 1-week users, 4-week users had 50% higher odds of cessation (30% vs 23%; odds ratio [OR] 1.50, 95% CI 1.05-2.14; P=.03), whereas 26-week users had 397% higher odds (56% vs 23%; OR 4.97, 95% CI 3.31-7.52; P<.001). For QuitGuide, participants were clustered into 2 groups: "1-week users" (695/1064, 65.32%) and "3-week users" (369/1064, 34.68%). The difference in the odds of being abstinent at 12 months for 3-week users versus 1-week users was minimal (23% vs 21%; OR 1.16, 95% CI 0.84-1.62; P=.37). Different baseline characteristics predicted the trajectory group membership for each app.Conclusions: Patterns of 1-, 3-, and 4-week smartphone app use for smoking cessation may be common in how people engage in digital health interventions. There were significantly higher odds of quitting smoking among 4-week users and especially among 26-week users of the iCanQuit app. To improve study outcomes, strategies for detecting users who disengage early from these interventions (1-week users) and proactively offering them a more intensive intervention could be fruitful. [ABSTRACT FROM AUTHOR]

Background: Little is known about how individuals engage with electronic health (eHealth) interventions over time and whether this engagement predicts health outcomes.Objective: The objectives of this study, by using the example of a specific type of eHealth intervention (ie, websites for smoking cessation), were to determine (1) distinct groups of log-in trajectories over a 12-month period, (2) their association with smoking cessation, and (3) baseline user characteristics that predict trajectory group membership.Methods: We conducted a functional clustering analysis of 365 consecutive days of log-in data from both arms of a large (N=2637) randomized trial of 2 website interventions for smoking cessation (WebQuit and Smokefree), with a primary outcome of 30-day point prevalence smoking abstinence at 12 months. We conducted analyses for each website separately.Results: A total of 3 distinct trajectory groups emerged for each website. For WebQuit, participants were clustered into 3 groups: 1-week users (682/1240, 55.00% of the sample), 5-week users (399/1240, 32.18%), and 52-week users (159/1240, 12.82%). Compared with the 1-week users, the 5- and 52-week users had 57% higher odds (odds ratio [OR] 1.57, 95% CI 1.13-2.17; P=.007) and 124% higher odds (OR 2.24, 95% CI 1.45-3.43; P<.001), respectively, of being abstinent at 12 months. Smokefree users were clustered into 3 groups: 1-week users (645/1309, 49.27% of the sample), 4-week users (395/1309, 30.18%), and 5-week users (269/1309, 20.55%). Compared with the 1-week users, 5-week users (but not 4-week users; P=.99) had 48% higher odds (OR 1.48, 95% CI 1.05-2.07; P=.02) of being abstinent at 12 months. In general, the WebQuit intervention had a greater number of weekly log-ins within each of the 3 trajectory groups as compared with those of the Smokefree intervention. Baseline characteristics associated with trajectory group membership varied between websites.Conclusions: Patterns of 1-, 4-, and 5-week usage of websites may be common for how people engage in eHealth interventions. The 5-week usage of either website, and 52-week usage only of WebQuit, predicted a higher odds of quitting smoking. Strategies to increase eHealth intervention engagement for 4 more weeks (ie, from 1 week to 5 weeks) could be highly cost effective.Trial Registration: ClinicalTrials.gov NCT01812278; https://www.clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/6yPO2OIKR). [ABSTRACT FROM AUTHOR]

Cigarette smoking remains the leading preventable cause of death and disability in the United States and frequently co-occurs with anxiety and depressive symptoms. A novel and integrative, theory-driven approach to address the heterogeneity of mood-related symptoms associated with cigarette use is to focus on transdiagnostic processes, such as distress tolerance, that underpin both mood-related symptoms and smoking behavior. The current study sought to develop and examine the feasibility, acceptability, and initial efficacy of a digitally delivered integrated personalized feedback intervention (PFI) that addresses smoking-distress tolerance relations. Participants included 121 adults (71.1 % male; M age = 29.33 years, SD = 7.52) who smoked cigarettes daily and reported low distress tolerance. The study randomized participants to the Active PFI (feedback on distress tolerance and smoking) or the Control PFI (feedback on smoking only). Results indicated feasibility and acceptability demonstrated by the ability to retain participants through the 1-month follow-up (98.2 % retention rate) and positive feedback from participants, including satisfaction regarding the Active PFI. The Active PFI (vs. Control PFI) was also a statistically significant predictor of change in motivation and intention to quit smoking and willingness to use adaptive coping strategies from baseline to 1-month follow-up. For individuals with low distress tolerance who smoke cigarettes, this study's findings suggest that the current intervention may be a first-step to aid in increasing motivation/intention to quit smoking and willingness to use adaptive coping strategies. • Distress tolerance underpins emotional disturbances and smoking behavior. • Lower tolerance for distress is associated with increased smoking behavior. • The Active PFI evidenced greater motivation and intention to quit smoking. • Computer-delivered PFI's addressing distress tolerance may have clinical utility. [ABSTRACT FROM AUTHOR]

• Emotion dysregulation was related to clinically significant smoking processes. • Emotion dysregulation is a key transdiagnostic relevant to smoking. • Emotion dysregulation may impact Hispanics' smoking maintenance and relapse. Hispanic/Latinx (hereafter Hispanic) individuals in the United States (US) experience serious tobacco-related disparities and factors contributing to such disparities need to be adequately identified and clinically addressed. Emotion dysregulation is a key transdiagnostic relevant to smoking. The present cross-sectional investigation sought to test if emotion dysregulation was related to more severe problems during smoking quit attempts (e.g., irritability, weight gain), perceptions of difficulty about quitting, as well as negative and positive beliefs about smoking abstinence in a sample of English-speaking Hispanic adults residing in the US who smoke. Participants included 332 Hispanic adults who engaged in daily cigarette smoking (35.46 years old, 37 % identified as female). Emotion dysregulation was significantly related to more severe problems when quitting and perceived barriers for quitting, as well as negative beliefs about smoking abstinence. Additionally, emotion dysregulation was significantly and negatively related to positive outcomes about smoking abstinence. The amount of change in the various smoking criterion variables accounted for by emotion dysregulation was small (sr2 range: 0.028-0.085), but evident in adjusted models that accounted for a wide range of factors (e.g., depression, drug use severity). Overall, this investigation found consistent empirical evidence that individual differences in emotion dysregulation in Hispanic individuals were associated with several clinically significant smoking processes, suggesting this construct may represent an important factor involved in the maintenance and relapse of smoking among this ethnic population. [ABSTRACT FROM AUTHOR]

Introduction: The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses.Methods: Using 9872 Service member-spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics.Results: Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking.Conclusions: Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk. [ABSTRACT FROM AUTHOR]

Introduction: Although engagement is generally predictive of positive outcomes in technology-based behavioral change interventions, engagement measures remain largely atheoretical and lack treatment-specificity. This study examines the extent to which adherence measures based on the underlying behavioral change theory of an Acceptance and Commitment Therapy (ACT) app for smoking cessation predict smoking outcomes, and user characteristics associated with adherence.Methods: Study sample was adult daily smokers in a single arm pilot study (n=84). Using the app's log file data, we examined measures of adherence to four key components of the ACT behavior change model as predictors of smoking cessation and reduction. We also examined baseline user characteristics associated with adherence measures that predict smoking cessation.Results: Fully adherent users (24%) were over four times more likely to quit smoking (OR=4.45; 95% CI=1.13, 17.45; p=0.032). Both an increase in tracking the number of urges passed (OR=1.02; 95% CI=1.00, 1.03; p=0.043) and ACT modules completed (OR=1.27; 95% CI=1.01, 1.60; p=0.042) predicted cessation. Lower baseline acceptance of cravings was associated with over four times higher odds of full adherence (OR=4.59; 95% CI=1.35, 15.54; p=0.014).Conclusions: Full adherence and use of specific ACT theory-based components of the app predicted quitting. Consistent with ACT theory, users with low acceptance were most likely to adhere to the app. Further research is needed on ways to promote app engagement. [ABSTRACT FROM AUTHOR]

Background: Adolescent smoking cessation efforts to date have tended to focus on regular smokers. Consequently, infrequent and occasional smokers' receptivity and response to smoking cessation interventions is unknown. To address this gap, this study examines data from the Hutchinson Study of High School Smoking-a randomized trial that examined the effectiveness of a telephone-delivered smoking cessation intervention for a large, population-based cohort of adolescent smokers proactively recruited in an educational setting.Methods: The study population included 1837 proactively identified high school smokers. Intervention receptivity, engagement, and outcomes were examined among adolescent infrequent (1-4days/month) and occasional (5-19days/month) smokers and compared with regular smokers (20 or more days/month).Results: With regard to treatment receptivity, intervention recruitment did not differ by smoking frequency. For engagement, intervention completion rates were higher for infrequent smokers (80.5%) compared with occasional (63.8%) and regular smokers (61.5%, p<0.01). Intervention effect sizes were not statistically different across groups.Conclusions: Adolescent infrequent and occasional smokers are at least as receptive to a proactively delivered smoking cessation intervention as regular smokers and can benefit just as much from it. Including these adolescent smokers in cessation programs and research-with the goal of interrupting progression of smoking before young adulthood-should help reduce the high smoking prevalence among young adults. [ABSTRACT FROM AUTHOR]

No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors' use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors' use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists' techniques as predictors of outcome during the course of treatment. [ABSTRACT FROM AUTHOR]

Background. The effects of mothers'' attitudes and concerns about tobacco use on whether their children take up smoking are largely unknown. This study examined the predictive effects of mothers'' attitudes about tobacco and concerns about their children smoking.Methods. Self-reported data from a large number of 12th-grade students (2,736) and their mothers were used. Mothers'' attitudes and concerns were assessed when their children were 3rd graders (age 8), at the start of the smoking acquisition period; their children were then followed prospectively (with attrition of only 5%) for 9 years to the end of the period (12th grade) for the assessment of smoking behavior.Results. In households in which both parents are nonsmokers, strong maternal antismoking attitudes are associated with a statistically significant approximately 50% reduction (P < 0.05) in the prevalence of smoking by adolescent children. In contrast, in households in which one or both parents are current smokers, there was no reduction in adolescent smoking associated with mothers'' antismoking attitudes.Conclusions. Maternal antismoking attitudes when their children are young predict adolescents'' adoption of smoking at 12th grade, but only when parental behavior is consistent with these attitudes. [Copyright &y& Elsevier]