David R. Strong

Evaluation of a Behavioral Measure of Risk Taking: The Balloon Analogue Risk Task (BART)

The present study (N = 86) sought to evaluate a laboratory-based behavioral measure of risk taking (the Balloon Analogue Risk Task; BART) and to test associations between this measure and self-report measures of risk-related constructs as well as self-reported real-world risk behaviors. The BART evidenced sound experimental properties, and riskiness on the BART was correlated with scores on measures of sensation seeking, impulsivity, and deficiencies in behavioral constraint. Also, riskiness on the BART was correlated with the self-reported occurrence of addictive, health, and safety risk behaviors, with the task accounting for variance in these behaviors beyond that accounted for by demographics and self-report measures of risk-related constructs. These results indicate that the BART may be a useful tool in the assessment of risk taking.

Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence

IMPORTANCE Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. OBJECTIVE To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). DESIGN, SETTING, AND PARTICIPANTS Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. EXPOSURE Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. MAIN OUTCOMES AND MEASURES Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). RESULTS Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. CONCLUSIONS AND RELEVANCE Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.

The Balloon Analogue Risk Task (BART) differentiates smokers and nonsmokers.

In trying to better understand why individuals begin and continue to smoke despite the obvious health consequences, researchers have become interested in identifying relevant personality variables, such as risk taking. In this study, the authors compared the ability of 2 behavioral measures of risk taking, the Bechara Gambling Task (BGT) and the Balloon Analogue Risk Task (BART), to differentiate smokers and nonsmokers. Self-report measures of impulsivity and sensation seeking were taken for comparison with the 2 behavioral risk-taking tasks. Results indicate that behavior on the BART, and not the BGT, was related to smoking status. Further, when considered in a logistic regression analysis, only the Sensation Seeking total score and the BART score contributed uniquely to the differentiation of smokers and nonsmokers.

Toward efficient and comprehensive measurement of the alcohol problems continuum in college students: the brief young adult alcohol consequences questionnaire.

BACKGROUND Although a number of measures of alcohol problems in college students have been studied, the psychometric development and validation of these scales have been limited, for the most part, to methods based on classical test theory. In this study, we conducted analyses based on item response theory to select a set of items for measuring the alcohol problem severity continuum in college students that balances comprehensiveness and efficiency and is free from significant gender bias. METHOD We conducted Rasch model analyses of responses to the 48-item Young Adult Alcohol Consequences Questionnaire by 164 male and 176 female college students who drank on at least a weekly basis. An iterative process using item fit statistics, item severities, item discrimination parameters, model residuals, and analysis of differential item functioning by gender was used to pare the items down to those that best fit a Rasch model and that were most efficient in discriminating among levels of alcohol problems in the sample. RESULTS The process of iterative Rasch model analyses resulted in a final 24-item scale with the data fitting the unidimensional Rasch model very well. The scale showed excellent distributional properties, had items adequately matched to the severity of alcohol problems in the sample, covered a full range of problem severity, and appeared highly efficient in retaining all of the meaningful variance captured by the original set of 48 items. CONCLUSIONS The use of Rasch model analyses to inform item selection produced a final scale that, in both its comprehensiveness and its efficiency, should be a useful tool for researchers studying alcohol problems in college students. To aid interpretation of raw scores, examples of the types of alcohol problems that are likely to be experienced across a range of selected scores are provided.

The Relation Between Mood and Sexuality in Heterosexual Men

This paper reports on a study of individual variability in the relationship between negative mood and sexuality in men. Part 1 involves a questionnaire survey of 919 white heterosexual men, asking what typically happens to sexual interest and response when (a) depressed and (b) anxious/stressed, using the Mood and Sexuality Questionnaire (MSQ). Trait measures of sexual inhibition and excitation, depression, anxiety, and sensation seeking were also used. Relationships between trait measures and MSQ scores were tested using multiple linear and ordinal logistic regression. Of those reporting the experience of depression, 9.4% indicated increased and 42% decreased sexual interest when depressed; for anxiety/stress, the percentages were 20.6 and 28.3%, respectively. Increase in sexual interest during negative mood states was negatively related to age and trait measures of sexual inhibition and positively related to depression proneness and sexual excitation. In Part 2, the relationship between mood and sexuality was explored qualitatively, using in-depth interviews with 43 participants from Part 1. This supported the findings in Part 1, while finding more complex relations with depression than anxiety. Sex when depressed can serve needs for intimacy and self-validation as well as sexual pleasure. Sex when anxious appears to be more simply related to the calming effect of sexual release, plus a possible “excitation transfer” effect of anxious arousal. Further research is needed to explore these relationships in clinical mood disorders. Paradoxical increases of sexual interest with negative mood may help explain high risk as well as “out of control” patterns of sexual behavior.

Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.

Randomized Controlled Trial of Behavioral Activation Smoking Cessation Treatment for Smokers with Elevated Depressive Symptoms

OBJECTIVE Depressive symptoms are associated with poor smoking cessation outcomes, and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology. In this pilot study, we examined whether a behavioral activation treatment for smoking (BATS) can enhance cessation outcomes. METHOD A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years of age; 48.5% were women; 72.7% were African American) seeking smoking cessation treatment were randomized to receive either BATS paired with standard treatment (ST) smoking cessation strategies including nicotine replacement therapy (n = 35) or ST alone including nicotine replacement therapy (n = 33). BATS and ST were matched for contact time and included 8 sessions of group-based treatment. Quit date was assigned to occur at Session 4 for each treatment condition. Participants completed a baseline assessment; furthermore, measures of smoking cessation outcomes (7-day verified point-prevalence abstinence), depressive symptoms (Beck Depression Inventory-II; Beck, Steer, & Brown, 1996), and enjoyment from daily activities (Environmental Reward Observation Scale; Armento & Hopko, 2007) were obtained at 1, 4, 16, and 26 weeks post assigned quit date. RESULTS Across the follow-ups over 26 weeks, participants in BATS reported greater smoking abstinence (adjusted odds ratio = 3.59, 95% CI [1.22, 10.53], p = .02) than did those in ST. Participants in BATS also reported a greater reduction in depressive symptoms (B = -1.99, SE = 0.86, p = .02) than did those in ST. CONCLUSIONS Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse backgrounds.

Sexual Activity and Risk Taking in Young Heterosexual Men: The Relevance of Sexual Arousability, Mood, and Sensation Seeking

In this research we explored three aspects of personality relevant to sexual activity and sexual risk taking in heterosexual men. Men with low inhibition of sexual arousal in the face of risk (low SIS2) reported more partners with whom they use no condoms and more lifetime “one night stands.” Men who experience increased sexual interest in states of depression (MSQ) reported more partners in the past year and more one night stands. The disinhibition subscale of the Sensation Seeking Scale was predictive of whether sexual intercourse had occurred in the past 6 months, and also of the number of sexual partners in the past year. A measure of an intention to practice safer sex was strongly related to measures of sexual arousability and inhibition (SIS/SES). We discuss some clear similarities and also some interesting differences with a parallel study of gay men. Individual differences in sexual excitation and inhibition proneness and the relation between mood and sexuality are clearly relevant to high‐risk sexual behavior and should be taken into consideration when designing behavioral interventions.

The Relation Between Mood and Sexuality in Gay Men

Negative mood, such as depression and anxiety, is usually associated with a decrease in sexual interest and responsiveness. In a minority of individuals, the reverse applies, often with an associated tendency to use sex as a mood regulator. In homosexual men, the prevalence of depression and anxiety states is increased, and the relationship between negative mood and sexuality is, therefore, of particular interest. A new brief instrument, The Mood and Sexuality Questionnaire, was administered to a sample of 662 gay men, with other trait measures of depression and anxiety, propensity for sexual inhibition and sexual excitation, sensation seeking, and questions about sexual activity and response. Sixteen percent reported that, when depressed, they typically experienced increased sexual interest with 7% reporting increased capacity for erectile response; 47% and 37% reported a decrease, respectively; the remainder reported no change. When experiencing anxiety, 24% reported that they typically experienced increased sexual interest, with 14% reporting increased responsiveness, and 39% and 31% reporting a decrease. Forty-three men were interviewed in depth. The resulting qualitative data showed depression to have a more complex relationship to sexual interest than anxiety; other mediating mechanisms, such as need for intimacy and self-validation, were sometimes involved. Fourteen percent of those interviewed reported reduced concern about sexual risk when depressed. Paradoxical increases in sexual interest or activity during negative mood states are relevant to high risk sexual behavior among gay men, and deserve closer study.

Psychological distress tolerance and duration of most recent abstinence attempt among residential treatment-seeking substance abusers.

This study investigated the relationship between duration of most recent drug and alcohol abstinence attempt and psychological distress tolerance, as indexed by persistence on a mental arithmetic task (the Paced Auditory Serial Addition Task; D. M. A. Gronwall, 1977), in 89 individuals in an inner-city residential substance abuse treatment facility. Results indicated that most recent abstinence duration was related to persistence on the psychological stressor, beyond the influence of demographics, substance use level, and negative affect. These findings extend previous work (T. H. Brandon et al., 2003; R. A. Brown, C. W. Lejuez, C. W. Kahler, & D. Strong, 2002) reporting significant relationships between persistence on laboratory challenge procedures and duration of abstinence following a quit attempt in smokers, suggesting that common processes account for relapse across addictions. Systematic replications including a prospective design are recommended.