Alba González-Roz

Delay discounting in e-cigarette users, current and former smokers

Background/Objective: Despite the fact that electronic cigarettes, or e-cigarettes, are being increasingly used as an alternative to smoking tobacco cigarettes, few studies have explored psychological factors associated with e-cigarette use. Prior studies aimed at exploring correlates of e-cigarette use have focused on sociodemographic and smoking-related characteristics. However, no previous work has examined psychological features such as impulsivity among e-cigarettes users. The main objective of this study was to compare impulsivity rates across four groups of participants: current e-cigarette users who were former smokers; current smokers; former smokers; and controls. Method: A sample of 136 participants completed a computerized delay discounting task for hypothetical monetary values. Results: Delay discounting was greater among e-cigarette users than former smokers. E-cigarette users also showed an intermediate discounting that did not differ from smokers and controls. Moreover, delay discounting was significantly greater among current smokers compared to former smokers and controls. Conclusions: Taken together, our results extend previous research on delay discounting by providing evidence on impulsivity levels among current e-cigarette users for the first time.

Contingency management for cigarette smokers with depressive symptoms.

Despite depressive symptoms being very common among smokers from the general population, few studies have examined the effects of depressive symptoms on smoking treatment outcomes, and even less research has been carried out in the context of contingency management (CM). The authors conducted a secondary analysis to assess the interrelation between treatment condition, depressive symptoms and treatment outcomes among treatment-seeking smokers. The sample was made up of 147 treatment-seeking smokers who were randomly allocated 2 treatment conditions: cognitive behavioral treatment (CBT; n = 74), or CBT + CM (n = 73). CBT was applied in 1-hr group-based sessions over 6 weeks. The CM protocol was voucher-based with maximum earnings of €300 (US

Psychological, pharmacological, and combined smoking cessation interventions for smokers with current depression: A systematic review and meta-analysis

339). Depressive symptoms were assessed using the Beck Depression Inventory-II. Smoking abstinence was verified though cotinine and carbon monoxide. Several analyses were conducted to explore the effect of treatment condition and baseline depressive symptoms on treatment outcomes, as well as the effect of treatment condition and smoking status on depressive symptoms. The CBT + CM condition was more effective than CBT, independent of depressive symptoms. The presence of depressive symptoms decreased the number of days of continuous smoking abstinence. Participants with a greater number of days of continuous smoking abstinence had fewer depressive symptoms than those with fewer days of continuous smoking abstinence. Findings suggest that health care providers should consider encouraging their patients with depressive symptoms to seek smoking cessation services that include both smoking cessation protocols and behavioral activation for mood management, thus maximizing both smoking and depressive outcomes.

Latent structure of the CPT among treatment-seeking smokers with depression and its predictive validity on smoking abstinence

We conducted a systematic literature review and meta-analysis (ID: CRD42016051017) of smoking cessation interventions for patients with current depression. We examined the effectiveness of smoking cessation treatments in improving abstinence rates and depressive symptoms. The following electronic databases were used for potentially eligible studies: PUBMED, PSYCINFO, DIALNET and WEB OF KNOWLEDGE. The search terms used were: smoking cessation, depressive disorder, depression, mood, depressive, depressed, smoking, smokers, nicotine, nicotine dependence, and tobacco cigarette smoking. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality assessment tool (EPHPP). Of the 6,584 studies identified, 20 were eligible and included in the review. Trial designs of studies were 16 randomized controlled trials and 4 secondary studies. Studies included three types of intervention: psychological (6/30%), pharmacological (6/30%) or combined (8/40%). Four trials comprised special populations of smokers. Four studies received a strong methodological quality, 7 were scored as moderate and 9 studies received a weak methodological rating. Analyses of effectiveness showed that smoking cessation interventions appear to increase short-term and long-term smoking abstinence in individuals with current depression. Subgroup analyses revealed stronger effects among studies that provided pharmacological treatments than in studies using psychological treatments. However, the evidence is weak due to the small number of studies. Smoking abstinence appears to be associated with an improvement in depressive symptoms. Heterogeneity in protocols in similar types of treatment also prevent firm conclusions being drawn on the effectiveness of any particular treatment model to optimally manage abstinence among depressed smokers. Further research is required to strengthen the evidence base.

Validity evidence of the Behavioral Activation for Depression Scale-Short Form among depressed smokers

Introduction Research has recently shown that nicotine reinforcement is better characterized by a bi-factorial latent structure: Persistence (insensitivity to cigarette pricing) and Amplitude (consumption at inexpensive prices). No study to date has examined its value as a predictor of abstinence. This study aimed to provide new evidence on the CPT´s latent structure in smokers with depressive symptoms, and to examine whether the latent structure performs better as a predictor of continuous abstinence than do the individual indices. Methods Participants [n = 205 smokers; 72% female: BDI-II M = 24.68, SD = 10.45] were randomized to two smoking cessation treatments for quitting smoking [Cognitive Behavioral Treatment (CBT) or CBT + Contingency Management (CM)]. A Principal Component Analysis (PCA) was conducted to examine the latent structure of the CPT and a set of regression models were performed to assess its predictive validity. Results The PCA revealed a bi-factorial solution which was interpreted as Persistence (breakpoint, Omax, Pmax, elasticity) and Psychological inertia (intensity and elasticity of demand). Evidence on the convergent validity was obtained through significant associations between the two latent factors and smoking variables (all r values ≥.17). Psychological inertia was negatively related to the number of days of continuous abstinence at the end of treatment regardless of the treatment condition [R2 = .038; F(2, 202) = 4.989, p = .008]. Conclusions Psychological inertia informs on which patients benefit less from smoking cessation treatments incorporating CM and CBT. Treatment components that impact individuals´ excessive valuation of cigarettes might improve cessation outcomes.

In-treatment cigarette demand among treatment-seeking smokers with depressive symptoms

Background/Objective A measure of Behavioral Activation (BA) is highly recommended when evaluating BA treatment effects for smokers with depression. Recently, a short version of the Behavioral Activation for Depression scale (BADS-SF) has been developed as a means of assessing changes in activation and avoidance patterns. To date there is no validated version of this questionnaire in Spanish. This study sought to adapt the BADS-SF to a Spanish population of depressed smokers. Method A sample of 169 smokers (72.2% female) with elevated depressive symptomatology completed the BADS-SF. Results A bi-factorial structure was obtained: Activation and Avoidance. Results indicated an acceptable internal consistency for both the Activation (ω = .85) and the Avoidance subscales (ω =.70). Overall, convergent validity was obtained with Activation and Avoidance subscales being related to other depression-related measures such as depressive symptomatology (Activation r = −.29; Avoidance r = .35), environmental reward (Activation r = .40; Avoidance r = −.41) and, nicotine dependence (Avoidance r = .23). This latter variable was the only one not showing a statistically significant association with the Activation factor (r = −.12). Conclusions The Spanish BADS-SF can be considered as a reliable and valid instrument when assessing behavioral activation among clinically depressed smokers.

Effects of combining contingency management with behavioral activation for smokers with depression

INTRODUCTION Despite previous evidence supporting the use of the Cigarette Purchase Task (CPT) as a valid tool for assessing smoking reinforcement, research assessing how environmental changes affect CPT performance is scarce. AIMS This study addressed for the first time the differential effect of treatment condition [Cognitive Behavioral Treatment (CBT) + Behavioral Activation (BA) versus CBT + BA + Contingency Management (CM)] on cigarette demand among treatment seeking smokers with depressive symptoms. It also sought to assess whether reductions in smoking consumption arranged over the course of an intervention for smoking cessation impact on in-treatment cigarette demand. METHOD Participants were 92 smokers with depressive symptoms from a randomized clinical trial that received eight weeks of either CBT + BA or CBT + BA + CM. Individuals completed the CPT 8 times; the first during the intake visit and the remaining 7 scheduled once a week in midweek sessions. Cotinine samples were collected in each session. RESULTS Participants receiving CBT + BA + CM showed higher reduction in cigarette demand across sessions than participants receiving CBT + BA, although this comparison was only significant for the intensity index (p = .004). Cotinine was positively related to cigarette demand (all p values < .001), although this association became less prominent across sessions. In-treatment cotinine decreases were associated with demand reductions (all p values < .001), but this association was not significant for elasticity. CONCLUSIONS Reductions in nicotine intake arranged over the course of an intervention for smoking cessation impact in-treatment cigarette demand.

Contingency management effects on delay discounting among patients receiving smoking cessation treatment

Abstract Background: Few studies on Behavioral Activation (BA) have been conducted among smokers with depression and very scarce evidence on Contingency Management (CM) in this population exists. This study aimed to examine the effectiveness of cognitive behavioral treatment (CBT) plus BA and the same treatment alongside CM on smoking abstinence and depression at the end of treatment. Method: A sample of 74 treatment-seeking smokers (78.4% female) were randomly assigned to two treatment conditions delivered in 90-minute sessions over 8 weeks: CBT + BA (n = 41), or CBT + BA + CM (n = 33). Depression was assessed through clinical interviews and using the Beck Depression Inventory-II. Smoking abstinence was verified through both carbon monoxide and urinalyses. Results: A greater percentage of patients receiving CBT + BA + CM attended all treatment sessions than those in CBT + BA (93.5% vs 71.1%). Among the total sample, 67.6% gave up smoking at the end of treatment. Abstinence rates were equivalent for CBT + BA and CBT + BA + CM at post-treatment (63% vs 72.7%). Participants showed a statistically significant improvement in depressive symptoms with no differences across treatments (CBT + BA: Mdn = 11, IQR = 5, 15 vs CBT + BA + CM: Mdn = 10, IQR = 5, 14). Conclusions: Findings support and expand previous evidence by showing that smokers with depression achieve high cessation rates without suffering negative mood changes. These results also offer a novel contribution by suggesting that BA and CM are promising interventions for this difficult to treat population. Additionally, research exploring long-term effects of both treatments is warranted.

Prevalence of Problem Gambling Among Adolescents: A Comparison Across Modes of Access, Gambling Activities, and Levels of Severity.

BACKGROUND Increasing evidence suggests that delay discounting may change following effective interventions. Nonetheless, previous studies that assessed the effect of contingency management (CM) on delay discounting are scarce, and their results are mixed. The current study assessed whether CM in conjunction with a cognitive-behavioral treatment (CBT) for smoking cessation was associated with changes in delay discounting at end-of-treatment and at 6-month follow-up compared to CBT alone. METHOD One hundred and sixteen treatment-seeking smokers were randomly assigned either to CM + CBT (n = 69) or to CBT alone (n = 47). Participants completed delay discounting assessments at the intake, at end-of-treatment, and at 6-month follow-up. We evaluated CM’s effect on discounting with parametric and nonparametric methods. RESULTS Between-group analyses showed that none of the interventions changed delay discounting from intake to end-of-treatment or to 6-month follow-up. Nonetheless, some within-group analyses showed that the CM + CBT condition evidenced some degree of reduction. CONCLUSIONS The current results suggest that CM intervention is not robustly associated with delay discounting changes. Future studies should address treatments that may potentially change delay discounting.