Mood and smoking behavior: The role of expectancy accessibility and gender.

Weinberger, A.H., & McKee, S.A. (2012). Addictive Behaviors, 37(12), 1349-1352. doi: 10.1016/j.addbeh.2012.07.010.

Little is known about overall or gender-specific factors that may influence the relationship between negative affect and smoking behavior such as smoking expectancies. This paper presents a secondary analysis from a laboratory studying gender differences in smoking behavior following a musical mood induction [Weinberger, A.H., & McKee, S.A., 2012, Gender differences in smoking following an implicit mood induction. Nicotine & Tobacco Research, 14(5), 621-625]. The current analyses examine the role of expectancies (endorsement and accessibility) in the relationship of gender, affect, and smoking. Ninety adult smokers (50% female) were randomly assigned to a negative mood induction, positive mood induction, or neutral condition while completing a single laboratory session. Expectancy endorsement, expectancy accessibility, affect, and smoking topography were assessed following the mood induction. Female smokers with faster accessibility of negative reinforcement expectancies smoked more cigarettes, had longer puff durations, and had shorter inter-puff intervals. Women with faster expectancy accessibility were also more likely to endorse negative reinforcement smoking expectancies. This study was the first to demonstrate links among gender, mood, and accessibility of smoking-related beliefs. Information about the role of expectancy accessibility in smoking behavior can lead to both a better understanding of gender-specific mechanisms of smoking behavior and new directions for smoking treatment development.

Two decades of smoking cessation treatment research on smokers with depression: 1990-2010.

Weinberger, A.H., Mazure, C.M., Morlett, A., McKee, S.A. (in press, 2012). Nicotine & Tobacco Research.

Introduction: Adults with depression smoke at higher rates than other adults leaving a large segment of this population, who already incur increased health-related risks, vulnerable to the enormous harmful consequences of smoking. Yet, the impact that depression has on smoking cessation is not clear due to the mixed results of past research. The primary aims of this review were to synthesize the research examining the relationship of depression to smoking cessation outcomes over a twenty year period, to examine the gender and racial composition of these studies, and to identify directions for future research.

Methods: Potential articles published between January 1, 2000 and December 31, 2010 were identified through a MEDLINE search of the terms "clinical trial," "depression," and "smoking cessation." Sixty-eight studies used all three terms and met the inclusion criteria.

Results: The majority of studies examined either a past diagnosis of major depression or current depression symptoms. Within the few studies that examined the interaction of gender and depression on smoking cessation, depression had a greater impact on treatment outcomes for women than men. No study reported examining the interactive impact of race and depression on treatment outcomes.

Conclusions: While attention to the relationship of depression and smoking cessation outcomes has increased over the past twenty years, little information exists to inform a treatment approach for smokers with Current MDD, Dysthymia, and Minor Depression and few studies report gender and racial differences in the relationship of depression and smoking cessation outcomes, thus suggesting major areas for targeted research.

How can our knowledge of alcohol-tobacco interactions inform treatment for alcohol use?

McKee, S.A., & Weinberger, A.H. (in press). Annual Review of Clinical Psychology. 10.1146/annurev-clinpsy-050212-185549

Currently, 8.5% of the US population meets criteria for alcohol use disorders, with a total cost to the US economy estimated at $234 billion per year. Alcohol and tobacco use share a high degree of comorbidity and interact across many levels of analysis. This review begins by highlighting alcohol and tobacco comorbidity and presenting evidence that tobacco increases the risk for alcohol misuse and likely has a causal role in this relationship. We then discuss how knowledge of alcohol and tobacco interactions can be used to reduce alcohol use, focusing on whether (a) smoking status can be used as a clinical indicator for alcohol misuse, (b) tobacco policies reduce alcohol use, and (c) nicotinic acetylcholine medications can be used to treat alcohol use disorders.

Intimate partner violence victimization and cigarette smoking: A meta-analytic review.

Crane, C.A., Hawes, S.W., & Weinberger, A.H. (in press). Trauma, Violence, and Abuse.

The current meta analytic review represents the first comprehensive empirical evaluation of the strength of the relationship between intimate partner violence (IPV) victimization and cigarette smoking. Thirty-nine effect sizes, drawn from 31 peer reviewed publications, determined the existence of a small to medium composite effect size for the victimization-smoking relationship (d = .41, 95% CI = .35-.47). Results indicate that victims of IPV are at greater smoking risk than non victims. Subsequent moderator analyses indicated that the association between victimization and smoking is moderately stronger among pregnant compared to non pregnant victims. The strength of the victimization-smoking relationship did not differ by relationship type or ethnicity. More research is needed on the smoking behavior of male victims, victims of physical violence, and victims who identify as Latino/a. It would be useful for professionals working with IPV victims to assess for smoking and incorporate smoking prevention and cessation skills in intervention settings.

The association of tobacco use and gender to cardiac rehabilitation outcomes: A preliminary Investigation.

Weinberger, A.H., Mazure, C.M., McKee, S.A., & Caulin-Glaser, T. (in press). Journal of Substance Use.

Introduction: Cardiac rehabilitation (CR) outcomes are measured in terms of cardiovascular disease (CVD) risk factor reductions, and these predict long-term cardiac status. This report examines whether reported tobacco use has differential effects on successful cardiovascular risk factor modification, especially for women who have greater smoking-related CVD consequences than men.

Methods: A retrospective cohort analysis was conducted on 1138 adults (74% male) with diagnosed CVD who participated in ≥7 weeks of a comprehensive CR program. Eleven CVD risk factors were assessed at CR entry and completion. Tobacco use was assessed by self-report at CR entry. The primary outcomes were attainment of goal levels for each risk factor.

Results: Fewer current and former tobacco users reached the preset goal for Maximal Exercise Capacity. Fewer women than men reached the preset goal for HDL. Women who were current or former tobacco users were less likely to meet the target goals for Triglycerides and more likely to meet target goals for Total Cholesterol and Non-HDL Cholesterol.

Conclusions: This preliminary study suggests the importance of identifying the effect of tobacco use and gender on CR outcomes and the need to evaluate modification of key cardiovascular risk factors for subgroups of cardiac patients.

Changes in smoking for adults with and without alcohol and drug use disorders: Longitudinal evaluation in the U.S. population.

Weinberger, A.H., Pilver, C.E., Hoff, R.A., Mazure, C.M., & McKee, S.A. (in press). The American Journal of Drug and Alcohol Abuse.

Background: Little is known about the smoking cessation and smoking relapse behavior of adults with alcohol use disorders (AUDs) and drug use disorders (DUDs).

Objectives: The current study used longitudinal data from a representative sample of the U.S. adult population to examine changes in smoking over three years for men and women with and without AUD and DUD diagnoses.

Methods: Participants were current or former daily cigarette smokers at Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions who completed the Wave 2 assessment three years later (n=11,973; 46% female). Analyses examined the main and gender-specific effects of AUD and DUD diagnoses on smoking cessation and smoking relapse.

Results: Wave 1 Current Daily Smokers with a Current AUD (OR=0.70, 95% CI=0.55, 0.89), Past AUD (OR=0.73, 95% CI=0.60, 0.89), Current DUD (OR=0.48, 95% CI=0.31, 0.76), and Past DUD (OR=0.62, 95% CI=0.49, 0.79) were less likely to have quit smoking at Wave 2 than those with no AUD or DUD diagnosis. Wave 1 Former Daily Smokers with a Current AUD (OR=2.26, 95% CI=1.36, 3.73), Current DUD (OR=7.97, 95% CI=2.51, 25.34), and Past DUD (OR=2.69, 95% CI=1.84, 3.95) were more likely to have relapsed to smoking at Wave 2 than those with no AUD or DUD diagnosis. The gender-by-diagnosis interactions were not significant.

Conclusion: Current and Past AUDs and DUDs were associated with a decreased likelihood of quitting smoking while Current AUDs, Current DUDs, and Past DUDs were associated with an increased likelihood of smoking relapse.