Erin N. Stevens

How low should you go? Determining the optimal cutoff for exhaled carbon monoxide to confirm smoking abstinence when using cotinine as reference.

INTRODUCTION Confirming abstinence during smoking cessation clinical trials is critical for determining treatment effectiveness. Several biological methods exist for verifying abstinence (e.g., exhaled carbon monoxide [CO], cotinine), and while cotinine provides a longer window of detection, it is not easily used in trials involving nicotine replacement therapy. The Society for Research on Nicotine and Tobaccos Subcommittee on Biochemical Verification cite 8-10 parts per million (ppm) for CO as a viable cutoff to determine abstinence; however, recent literature suggests this cutoff is likely too high and may overestimate the efficacy of treatment. METHODS This study examined the relationship between CO and cotinine in a sample of 662 individuals participating in a smoking cessation clinical trial. A receiver operating characteristics curve was calculated to determine the percentage of false positives and false negatives at given CO levels when using cotinine as confirmation of abstinence. Differences were also examined across race and gender. RESULTS A CO cutoff of 3 ppm (97.1% correct classification) most accurately distinguished smokers from nonsmokers. This same cutoff was accurate for both racial and gender groups. The standard cutoffs of 8 ppm (14.0% misclassification of smokers as abstainers) and 10 ppm (20.6% misclassification of smokers as abstainers) produced very high false-negative rates and inaccurately identified a large part of the sample as being abstinent when their cotinine test identified them as still smoking. CONCLUSIONS It is recommended that researchers and clinicians adopt a more stringent CO cutoff in the range of 3-4 ppm when complete abstinence from smoking is the goal.

Preadolescent Temperament and Risky Behavior: Bicycling Across Traffic-Filled Intersections in a Virtual Environment

OBJECTIVE This investigation used a bicycling simulator to examine how preadolescent temperament is related to risky behavior. METHODS Children aged 10 and 12 years (N = 109) rode a bicycle through a virtual environment where they crossed intersections with continuous cross traffic. Mothers filled out the Early Adolescent Temperament Questionnaire-Revised. RESULTS Older children and male participants timed their entry into the intersection more precisely than did younger children and female participants, as did 10-year-old children higher in inhibitory control and 10-year-old boys higher in aggression. However, only 10-year-old children higher in inhibitory control had more time to spare when they cleared the intersection. For 10-year-old boys higher in aggression, cutting in more closely behind the lead vehicle was accompanied by less stopping at intersections, less waiting before crossing, and choosing smaller gaps to cross. CONCLUSIONS The Discussion section focuses on inhibitory control as a protective factor and aggression as a risk factor for car-bicycle collisions.

Risk factors for concurrent use of benzodiazepines and opioids among individuals under community corrections supervision.

BACKGROUND The use of heroin and prescription opioids has increased over the past decade. The concurrent use of opioids with other depressants such as benzodiazepines increases the risk of overdose death compared with use of either drug alone. This study examined factors associated with concurrent use of opioids and benzodiazepines in a criminal justice sample in the state of Alabama. METHODS The Addiction Severity Index (ASI) and urine drug screen results from 28,570 individuals who were under community corrections supervision from 2002-2012 were examined for independent or concurrent opioid and benzodiazepine use. Multinomial logistic regression analyses were conducted to determine associations between socio-demographic characteristics and drug use. RESULTS Concurrent use was detected in 11.5% of the sample. Concurrent use of opioids and benzodiazepines or use of either drug alone was associated with being White, female, married, prescribed psychiatric medications, having seen a physician in the past two years, cannabis use, and having a drug-related offense. Concurrent users were more likely to be unemployed or disabled and have received counseling, and less likely to have completed college, live with relatives or friends, have a history of hallucinations, or have an offense against a person relative to nonusers. DISCUSSION While significant overlap of risk factors exists between individuals with concurrent use versus sole use of opioids or benzodiazepines, individuals with concurrent use generally have more social dysfunction than individuals who tested for either substance alone. Concurrent users may need more psychosocial resources and intensive treatments to promote recovery.

Anxiety sensitivity as a moderator of the relationship between trait anxiety and illicit substance use.

Anxiety and substance use problems are common and often comorbid, and past research has shown that young adults in particular are especially at risk for developing these disorders. To further delineate the relationship between anxiety and substance use, the current study evaluated anxiety sensitivity (AS)-a cognitive vulnerability factor-as a moderator of the association between trait anxiety and illicit substance use in a large sample of young adults (N = 845; M = 18.7 years, SD = 1.0). It was hypothesized that AS would moderate the association between trait anxiety and illicit substance use, such that trait anxiety would significantly predict illicit substance use among those with high, but not low, AS. Consistent with prediction, a significant trait Anxiety × AS interaction was found, χ²(5) = 29.38, p < .001. Specifically, analyses of simple slopes revealed that for the high-AS group, as trait anxiety increased, so did frequency of illicit substance use (odds ratio [OR] = 1.03, p = .005; 95% confidence interval [CI] [1.01, 1.06]). The slope for the low AS was not significant (OR = 0.98, p = .100; 95% CI [0.95, 1.01]). Results also showed significant moderation effects for the AS physical concerns and cognitive concerns facets but not AS social concerns. These findings suggest that AS may be an important cognitive vulnerability that may help to identify those at particular risk for substance use, and that interventions should target AS reduction in anxiety-prone individuals to reduce and prevent substance abuse.

When do self-discrepancies predict negative emotions? Exploring formal operational thought and abstract reasoning skills as moderators

Individual differences in higher-order cognitive abilities may be an important piece to understanding how and when self-discrepancies lead to negative emotions. In the current study, three measures of reasoning abilities were considered as potential moderators of the relationship between self-discrepancies and depression and anxiety symptoms. Participants (N = 162) completed measures assessing self-discrepancies, depression and anxiety symptoms, and were administered measures examining formal operational thought, and verbal and non-verbal abstract reasoning skills. Both formal operational thought and verbal abstract reasoning were significant moderators of the relationship between actual:ideal discrepancies and depressive symptoms. Discrepancies predicted depressive symptoms for individuals with higher levels of formal operational thought and verbal abstract reasoning skills, but not for those with lower levels. The discussion focuses on the need to consider advanced reasoning skills when examining self-discrepancies.

Predictors of medication adherence and smoking cessation among smokers under community corrections supervision

INTRODUCTION Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. METHODS Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. RESULTS The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. CONCLUSIONS These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.

Understanding the relationship between actual:ideal discrepancies and depressive symptoms: A developmental examination

Self-discrepancy theory (SDT) is one framework for understanding how goal failure is associated with depressive symptoms. The present studies sought to examine the variance in depressive symptoms explained by actual:ideal discrepancies, beyond what is accounted for by actual-self ratings. Additionally, gender and grade were examined as potential moderators in the relationship. In Study 1 (N = 228), discrepancies accounted for additional variance in the level of depressive symptoms beyond what was explained by actual-self ratings in a college sample. In Study 2 (N = 192), while similar global patterns were found, gender and grade differences emerged. For boys, the relationship between actual:ideal discrepancies and depressive symptoms was due to actual-self ratings. For girls, a developmental pattern suggested that actual:ideal discrepancies become more important to the prediction of depressive symptoms among older girls. Implications for the emergence of the discrepancy-depression association are discussed.

Cognitive risk profiles for anxiety disorders in a high-risk population

The purpose of the present study was to identify subgroups of participants who may be at particularly high risk for anxiety pathology based on specific combinations of demographic characteristics and higher-order cognitive abilities in a population at disproportionate risk for deficits in cognitive abilities (i.e., smokers within the criminal justice system). Participants (N=495) provided demographic information, were administered a semi-structured diagnostic interview, and completed a number of measures assessing cognitive abilities. A receiver-operating characteristic (ROC) model using signal detection theory indicated that the strongest predictor of anxiety disorder diagnosis was race, with White participants having a 30.6% likelihood of diagnosis and participants in the non-White category (97% of which identified as Black/African American) having a 18.9% likelihood of diagnosis. Interestingly, the individual risk profile associated with the highest probability of having a current anxiety disorder was characterized by White participants with impaired response inhibition (58.6%), and the lowest probability of having a current anxiety disorder was among non-White males (13.9%). The findings, which indicated that White individuals with impaired response inhibition are at a disproportionately high risk for anxiety disorders, suggest a potential target for prevention and intervention.