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Gros DF, Pavlacic JM, Wray JM, Szafranski DD. Investigating Relations Between the Symptoms of Panic, Agoraphobia, and Suicidal Ideation: The Significance of Comorbid Depressive Symptoms in Veterans with Panic Disorder. J Psychopathol Behav Assess 2023; 45:1154-1162. [PMID: 38585157 PMCID: PMC10996580 DOI: 10.1007/s10862-023-10082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 04/09/2024]
Abstract
Although panic disorder has been frequently associated with increased suicidal ideation and behaviors, there are multiple explanations for this association in the literature. For example, some research has demonstrated panic disorder symptoms to mediate agoraphobia and suicidal ideation, while other researchers have hypothesized that comorbid depression symptoms contribute to suicidal ideation across anxiety disorders. Of note, none of these studies were completed in veterans, a population at higher risk for suicide relative to civilian samples. The present study investigated relations between the symptoms of panic, agoraphobia, depression, and suicidal ideation in 58 veterans diagnosed with panic disorder via correlations, hierarchical regression, and exploratory path analyses. Multiple models were investigated based on prior research. The final path model demonstrated that symptoms of panic disorder predicted agoraphobia symptoms, with agoraphobia predicting symptoms of depression. Symptoms of depression, then, predicted suicidal ideation. Discussion of the findings related to comorbid depressive symptoms highlight considerations for the assessment and treatment practices for panic disorder, with a particular focus on veterans receiving care within Veterans Affairs Healthcare System.
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Affiliation(s)
- Daniel F. Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, 109 Bee Street, 29401 Charleston, SC, USA
- Department of Psychology & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey M. Pavlacic
- Mental Health Service, Ralph H. Johnson VA Healthcare System, 109 Bee Street, 29401 Charleston, SC, USA
- Department of Psychology & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer M. Wray
- Mental Health Service, Ralph H. Johnson VA Healthcare System, 109 Bee Street, 29401 Charleston, SC, USA
- Department of Psychology & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Funderburk JS, Gass JC, Wray JM, Shepardson RL. Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: a national survey. J Interprof Care 2023; 37:58-65. [PMID: 34979874 DOI: 10.1080/13561820.2021.2004098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary care (PC) settings increasingly use team-based care activities with embedded behavioral health providers (BHPs) to enhance patient care via group medical visits, conjoint appointments, team huddles, and warm handoffs. Aim 1 was to describe the variation of team-based care activities within integrated PC clinics. Aim 2 was to explore whether factors associated with the BHP (e.g., gender, training, and experience) and the PC setting (e.g., perceived teamwork) predict engagement in team-based activities. A national sample of eligible BHPs (n = 345; 14.2% response rate) completed an anonymous survey assessing the presence/intensity of team-based care activities. 90% of BHPs reported regularly engaging in team-based care activities with PC teams. Most engagement occurred when providing feedback to PC providers (90.4% at least daily) and during warm handoffs (90.4% at least once daily). Engagement in team-based care was predicted by the level of teamwork occurring within the PC clinic (βs = .41-.47; ps < .001) and BHP characteristics, such as the number of years spent in PC (βs = .24-.26, ps < .001). Although these data are promising, with many BHPs reportedly engaging in team-based activities with PC teams, there is significant variation. Researchers should continue to explore whether the engagement in these team-based care activities enhances patient care.
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Affiliation(s)
- Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Julie C Gass
- Va Center for Integrated Healthcare, Western New York Va Healthcare System, Buffalo, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jennifer M Wray
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robyn L Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
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Hawk LW, Tiffany ST, Colder CR, Ashare RL, Wray JM, Tyndale RF, Brandon TH, Mahoney MC. Effect of Extending the Duration of Prequit Treatment With Varenicline on Smoking Abstinence: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2241731. [PMID: 36367720 PMCID: PMC9652761 DOI: 10.1001/jamanetworkopen.2022.41731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Even with varenicline, the leading monotherapy for tobacco dependence, smoking abstinence rates remain low. Preliminary evidence suggests that extending the duration of varenicline treatment before quitting may increase abstinence. OBJECTIVE To test the hypotheses that, compared with standard run-in varenicline treatment (1 week before quitting), extended run-in varenicline treatment (4 weeks before quitting) reduces smoking exposure before the target quit date (TQD) and enhances abstinence, particularly among women. DESIGN, SETTING, AND PARTICIPANTS This double-blind, randomized, placebo-controlled clinical trial enrolled participants from October 2, 2017, to December 9, 2020, at a single-site research clinic in Buffalo, New York. Of 1385 people screened, 320 adults reporting smoking 5 or more cigarettes per day (CPD) were randomized and followed up for 28 weeks. Data were analyzed from August 2021 to June 2022. INTERVENTIONS In the pre-TQD period (weeks 1-4), the extended run-in group received 4 weeks of varenicline; the standard run-in group received 3 weeks of placebo followed by 1 week of varenicline. Both groups received open-label varenicline during weeks 5 to 15 and brief quit counseling at 6 clinic visits. MAIN OUTCOMES AND MEASURES The primary outcome consisted of cotinine-verified (at end of treatment [EOT]) self-reported continuous abstinence from smoking (in CPD) during the last 4 weeks of treatment. Secondary outcomes included bioverified self-report of continuous abstinence at the 6-month follow-up and percentage of reduction in self-reported smoking rate during the prequit period (week 1 vs week 4). RESULTS A total of 320 participants were randomized, including 179 women (55.9%) and 141 men (44.1%), with a mean (SD) age of 53.7 (10.1) years. Continuous abstinence during the final 4 weeks of treatment (weeks 12-15; EOT) was not greater in the extended run-in group (64 of 163 [39.3%]) compared with the standard run-in group (57 of 157 [36.3%]; odds ratio [OR], 1.13 [95% CI, 0.72-1.78]), nor was the hypothesized group × sex interaction significant (OR, 0.52 [95% CI, 0.21-1.28]). Similar nonsignificant results were obtained for continuous abstinence at the 6-month follow-up. The mean (SE) decrease in self-reported smoking rate during the prequit period was greater in the extended run-in group (-38.8% [2.8%]) compared with the standard run-in group (-17.5% [2.7%]). CONCLUSIONS AND RELEVANCE Among adult daily smokers, extending the duration of prequit varenicline treatment beyond the standard 1-week run-in period reduced prequit smoking exposure but, more importantly, did not significantly improve continuous abstinence rates. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03262662.
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Affiliation(s)
- Larry W. Hawk
- Department of Psychology, University at Buffalo, Buffalo, New York
| | | | - Craig R. Colder
- Department of Psychology, University at Buffalo, Buffalo, New York
| | - Rebecca L. Ashare
- Department of Psychology, University at Buffalo, Buffalo, New York
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer M. Wray
- Department of Psychiatry, Military Sciences Division, Medical University of South Carolina, Charleston
| | - Rachel F. Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, The Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Thomas H. Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa
- Department of Oncologic Sciences, University of South Florida, Tampa
| | - Martin C. Mahoney
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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White EJ, Wray JM, Shepardson RL. Clinical considerations in designing brief exposure interventions for primary care behavioral health settings. Fam Syst Health 2020; 38:439-449. [PMID: 33119371 PMCID: PMC7928230 DOI: 10.1037/fsh0000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. METHODS The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. RESULTS Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. DISCUSSION Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Jennifer M. Wray
- Ralph H. Johnson VA Medical Center, Charleston, SC
- Medical University of South Carolina, Department of Psychiatry, Charleston, SC
| | - Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY
- Department of Psychology, Syracuse University, Syracuse, NY
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Tomko RL, Saladin ME, Baker NL, McClure EA, Carpenter MJ, Ramakrishnan VR, Heckman BW, Wray JM, Foster KT, Tiffany ST, Metts CL, Gray KM. Sex Differences in Subjective and Behavioral Responses to Stressful and Smoking Cues Presented in the Natural Environment of Smokers. Nicotine Tob Res 2020; 22:81-88. [PMID: 30371887 PMCID: PMC7297015 DOI: 10.1093/ntr/nty234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Some evidence suggests that female smokers may show more context-dependent smoking and that males may show more stereotyped smoking (regardless of stress or cue exposure). The goal of this study was to characterize sex differences in response to stressful and smoking cues ecologically presented in daily life and variability in day-to-day smoking behavior. METHODS Adult smokers (N = 177) provided ratings of mood and cigarette craving before and after stress and smoking cues were presented four times daily for 14 days via a mobile device. Linear mixed models tested whether (1) female smokers exhibited greater reactivity to stressful cues than male smokers; (2) pre-cue negative affect increased reactivity to smoking cues more in female smokers than male smokers; (3) across both sexes, greater reactivity to stressful and smoking cues correlated with greater quantity of smoking within a day; and (4) female smokers exhibited greater variability in cigarettes per day (CPD) relative to males. RESULTS Relative to male smokers, female smokers reported greater negative affect, stress, and craving in response to stressful cues, but not smoking cues, after accounting for time since last cigarette and pre-cue responding. No sex differences in CPD or variability in CPD were detected. Days with higher subjective reactivity to cues were not associated with increased smoking, in either males or females. CONCLUSIONS Sex differences were observed in response to stress but not smoking cues in the natural environment of regular cigarette smokers. Further research is necessary to evaluate whether stress reactivity in female smokers is associated with reduced latency to smoke following stress exposure in daily life. IMPLICATIONS This study provides naturalistic evidence that female smokers may not be more reactive to smoking cues than males, but experience heightened stress and craving following stress exposure. There was no evidence to support the hypothesis that amount smoked per day varied more for females, relative to males, as a result of more context-driven smoking for females.
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Affiliation(s)
- Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Jennifer M Wray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Ralph H. Johnson VA Medical Center, Charleston, SC
- VA Center for Integrated Healthcare, Buffalo, NY
| | | | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Wray JM, Funderburk JS, Gass JC, Maisto SA. Barriers to and Facilitators of Delivering Brief Tobacco and Alcohol Interventions in Integrated Primary Care Settings. Prim Care Companion CNS Disord 2019; 21. [PMID: 31730303 DOI: 10.4088/pcc.19m02497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/12/2019] [Indexed: 10/25/2022] Open
Abstract
Objective Tobacco and excessive alcohol use are 2 of the top 3 preventable causes of death in the United States, yet most patients using these substances do not pursue treatment. Most patients do visit their primary care provider (PCP) annually, but PCPs report that they are not very effective in addressing behavior change with patients. Brief interventions for alcohol and tobacco use are effective and can be delivered by behavioral health providers (BHPs) embedded in the primary care setting. However, BHPs do not report frequent use of these interventions. The aim of the current study was to conduct the first examination of barriers to and facilitators of implementing brief interventions for at-risk drinking and tobacco use among integrated BHPs. Methods BHPs (N = 285) working in a primary care setting for at least 6 months with at least 10% effort allocated to clinical activities were recruited through professional listservs (August-September 2016) and completed an online survey that assessed barriers to and facilitators of delivering brief tobacco and alcohol interventions in routine clinical practice. Results BHPs were primarily psychologists (48%) and social workers (33%) with cognitive-behavioral orientation (51%). The primary barriers to addressing tobacco use and at-risk drinking reported by BHPs was the perception that patients did not want to discuss or did not want to change these behaviors. The primary facilitators of addressing tobacco use and at-risk drinking were patients identifying cessation or reduction as a treatment goal, positive provider-patient relationship, and receiving referrals specifically for tobacco or alcohol use. Conclusions Clinicians, researchers, and administrators should focus on strategies to increase the regularity with which BHPs assess and provide intervention for smoking and alcohol use in the context of other primary presenting concerns.
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Affiliation(s)
- Jennifer M Wray
- Mental Health Service 116, Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401. .,Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.,VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA.,Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Julie C Gass
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA
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Gros DF, Oglesby ME, Wray JM. An Open Trial of Behavioral Activation in Veterans With Major Depressive Disorder or Posttraumatic Stress Disorder in Primary Care. Prim Care Companion CNS Disord 2019; 21. [PMID: 31600432 PMCID: PMC10098453 DOI: 10.4088/pcc.19m02468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/26/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Integrated behavioral health programs provide brief evaluations and interventions to patients with psychiatric symptoms in primary care. These programs seek to decrease stigma and improve access to mental health services. Several psychotherapeutic interventions are available to providers, each with its own strengths and weaknesses. One treatment with particular promise is behavioral activation treatment for depression (BATD) due to its potential clinical efficacy, transdiagnostic potential, and ease of dissemination and implementation in primary care settings. The objective of this study was to investigate the efficacy of BATD across 2 DSM-5 diagnoses: major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). METHODS Participants were recruited from October 2014 to December 2017. Thirty-one participants were referred from primary care and consented to receive a 12-session trial of BATD. Participants endorsed criteria consistent with a principal diagnosis of either MDD (n = 20) or PTSD (n = 11). Self-report measures were completed at baseline and immediately posttreatment to monitor treatment progress in symptoms of PTSD and MDD. RESULTS Twelve of the 31 participants completed all 12 sessions of BATD, although over 70% completed at least 4 sessions. Participants demonstrated significant symptom improvement across symptoms of MDD and PTSD (all P < .004). No disorder group differences were evidenced for symptom reduction, treatment completion, or treatment satisfaction. CONCLUSIONS The present study provides support for the efficacy of BATD for patients with MDD and PTSD. These findings may have implications for the dissemination and implementation efforts for psychotherapies in integrated primary care settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01947647.
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Wray JM, Funderburk JS, Acker JD, Wray LO, Maisto SA. A Meta-Analysis of Brief Tobacco Interventions for Use in Integrated Primary Care. Nicotine Tob Res 2019; 20:1418-1426. [PMID: 29059419 DOI: 10.1093/ntr/ntx212] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/15/2017] [Indexed: 11/14/2022]
Abstract
Introduction The integration of behavioral health services in primary care settings presents an opportunity to enhance the delivery of tobacco cessation interventions in the primary care setting, but guidance on evidence-based treatments for tobacco use disorder that fits the brief format of integrated primary care (IPC) is limited. This meta-analysis summarizes the outcomes of brief behavioral interventions targeting tobacco use that can be delivered in IPC settings. Methods A literature search was conducted to locate empirical studies examining tobacco cessation interventions that could be implemented in an IPC setting. A random effects meta-analytic approach was utilized with odds ratios as the effect size. Subgroup analyses were conducted to determine the extent to which a number of study, participant, and intervention characteristics affected treatment outcome. Results A total of 36 studies were included (n = 12975 patients). Patients in the intervention groups exhibited significantly greater odds of smoking cessation compared with those in the comparison groups (OR = 1.78, p < .001). Subgroup analyses did not reveal significant sources of heterogeneity attributable to moderators such as methodological quality, gender, bioverification, follow-up time period, or intervention characteristics (such as setting, type, or length of intervention). Conclusions Brief tobacco cessation interventions that can be delivered in IPC settings were found to be effective. Future research in this area might evaluate ways to improve the dissemination and implementation of these types of interventions in IPC settings. Implications The integration of behavioral health services into primary care presents a unique opportunity to increase the delivery of tobacco cessation interventions, as behavioral health providers in these settings are experts in behavior change interventions and may have more time to deliver these interventions than primary care providers. Results from the current meta-analysis demonstrate that brief tobacco cessation interventions that can be implemented in the IPC setting are effective. Future research in this area might examine ways to improve the dissemination and implementation of brief interventions for tobacco use in IPC settings.
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Affiliation(s)
- Jennifer M Wray
- Ralph H. Johnson VA Medical Center, Charleston, SC.,VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Department of Psychology, Syracuse University, Syracuse, NY.,Department of Psychiatry, University of Rochester, Rochester, NY
| | - John D Acker
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Division of Geriatrics and Palliative Medicine, University at Buffalo, Buffalo, NY.,Department of Psychology, University at Buffalo, Buffalo, NY
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Department of Psychology, Syracuse University, Syracuse, NY
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Wray JM, Coulon S, Wong N, Szafranski D, Gros DF. A Single Integrated Behavioral Health Appointment Improves Patients’ Perceptions of Behavioral Health Treatment. Prim Care Companion CNS Disord 2019; 21. [DOI: 10.4088/pcc.18m02378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
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Al-Baeity H, Allard LS, Arreza L, Asbury TA, Bandayrel JA, Brar S, Ellen Brien N, Chan LL, Chimney KP, de Leon MAR, Farrell AC, Forsberg BA, Ghimire H, Heschuk DJ, Highfield ML, Hole DT, Ilagan GM, Jantz A, Kapasi MS, Ko OE, Krupka EV, Lemon C, Luna PE, Marshall CL, Mucowinka LP, Oleniuk TW, Palmer MCL, Paskvalin I, Rodrigues M, Rutherford KA, Sachs M, Stokowski RKS, Sullivan DS, Taillieu RR, Thulasiram MR, Tsang JH, Wiwchar CE, Wray JM, Marcus JM. The complete mitochondrial genome of the North American pale summer sedge caddisfly Limnephilus hyalinus (Insecta: Trichoptera: Limnephilidae). Mitochondrial DNA B Resour 2019. [DOI: 10.1080/23802359.2018.1547158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Harith Al-Baeity
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Lauren S. Allard
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Leanne Arreza
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Theresa A. Asbury
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Sipy Brar
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Laura L. Chan
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | - Himesh Ghimire
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Daniel J. Heschuk
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Darian T. Hole
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Gladys M. Ilagan
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Amanda Jantz
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Moiz S. Kapasi
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Oliver E. Ko
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily V. Krupka
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Cassie Lemon
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Paulette E. Luna
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Trevor W. Oleniuk
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Ivan Paskvalin
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Melissa Rodrigues
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Maria Sachs
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Daniel S. Sullivan
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Renee R. Taillieu
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Justin H. Tsang
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Cobi E. Wiwchar
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer M. Wray
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
| | - Jeffrey M. Marcus
- Department of Biological Sciences, University of Manitoba, Winnipeg, Canada
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Wray JM, Funderburk JS, Maisto SA. Willingness to Engage in Health Behavior Change Interventions Among Primary Care Patients Positive For Tobacco Use and At-Risk Drinking. Prim Care Companion CNS Disord 2017; 19. [PMID: 29141122 DOI: 10.4088/pcc.17m02209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022] Open
Abstract
Objective To examine intervention preferences of primary care patients who recently screened positive for tobacco use and at-risk drinking. Methods Primary care patients who screened positive for recent tobacco use and at-risk drinking were eligible to participate in a one-time telephone-based survey conducted from August 2015 to December 2015. The survey asked questions about how willingness to engage in an intervention in integrated primary care was influenced by the described format and focus of the intervention. Data from patients who smoked cigarettes and met criteria for at-risk drinking in the last 30 days (N = 53) were included in the analyses. Results Participants reported that they would be more willing to engage in an intervention focused on helping them reduce their risk of medical problems than in services focused specifically on discussing cigarette or alcohol use (P = .00). Participants did not indicate a preference related to whether the intervention was delivered during a primary care appointment, immediately following a primary care appointment, or as a scheduled follow-up (P = .693). Conclusions Patients may be more willing to engage in a behavior intervention when general health is emphasized over a focus specifically on tobacco or alcohol use. Patients were equally receptive to receiving brief interventions in several different formats available within an integrated primary care setting.
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Affiliation(s)
- Jennifer M Wray
- Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401. .,Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,VA Center for Integrated Healthcare, VA Western New York Healthcare System, Syracuse, New York, USA
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,VA Center for Integrated Healthcare, VA Western New York Healthcare System, Syracuse, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA.,Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.,VA Center for Integrated Healthcare, VA Western New York Healthcare System, Syracuse, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA
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12
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Motschman CA, Gass JC, Wray JM, Germeroth LJ, Schlienz NJ, Munoz DA, Moore FE, Rhodes JD, Hawk LW, Tiffany ST. Selection criteria limit generalizability of smoking pharmacotherapy studies differentially across clinical trials and laboratory studies: A systematic review on varenicline. Drug Alcohol Depend 2016; 169:180-189. [PMID: 27863344 DOI: 10.1016/j.drugalcdep.2016.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The selection criteria used in clinical trials for smoking cessation and in laboratory studies that seek to understand mechanisms responsible for treatment outcomes may limit their generalizability to one another and to the general population. METHODS We reviewed studies on varenicline versus placebo and compared eligibility criteria and participant characteristics of clinical trials (N=23) and laboratory studies (N=22) across study type and to nationally representative survey data on adult, daily USA smokers (2014 National Health Interview Survey; 2014 National Survey on Drug Use and Health). RESULTS Relative to laboratory studies, clinical trials more commonly reported excluding smokers who were unmotivated to quit and for specific medical conditions (e.g., cardiovascular disease, COPD), although both study types frequently reported excluding for general medical or psychiatric reasons. Laboratory versus clinical samples smoked less, had lower nicotine dependence, were younger, and more homogeneous with respect to smoking level and nicotine dependence. Application of common eligibility criteria to national survey data resulted in considerable elimination of the daily-smoking population for both clinical trials (≥47%) and laboratory studies (≥39%). Relative to the target population, studies in this review recruited participants who smoked considerably more and had a later smoking onset age, and were under-representative of Caucasians. CONCLUSIONS Results suggest that selection criteria of varenicline studies limit generalizability in meaningful ways, and differences in criteria across study type may undermine efforts at translational research. Recommendations for improvements in participant selection and reporting standards are discussed.
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Affiliation(s)
- Courtney A Motschman
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Julie C Gass
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; VA Center for Integrated Healthcare, VA Western NY Medical Center, Buffalo, NY, 14215, USA
| | - Lisa J Germeroth
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Nicolas J Schlienz
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Diana A Munoz
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Faith E Moore
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; Department of Psychology, University of Central Florida, Orlando, FL, 32816, USA
| | - Jessica D Rhodes
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA.
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Wray JM, Gass JC, Miller EI, Wilkins DG, Rollins DE, Tiffany ST. A comparative evaluation of self-report and biological measures of cigarette use in nondaily smokers. Psychol Assess 2016; 28:1043-50. [PMID: 26479132 PMCID: PMC4837099 DOI: 10.1037/pas0000227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A large subset of individuals who smoke cigarettes do not smoke regularly, but the assessments used to collect data on cigarette consumption in nondaily smokers have not been rigorously evaluated. The current study examined several self-report and biomarker approaches to the assessment of cigarette use in a sample of nondaily smokers (n = 176). Participants were randomly assigned to a daily monitoring condition (n = 89), requiring a daily report of the number of cigarettes smoked in the previous 24 hours, or a no monitoring condition (n = 87). Number of cigarettes smoked over the first 28 days of the study was assessed using 2 quantity frequency measures, a graduated frequency measure, and a timeline follow back (TLFB) interview at the Session 5 study visit. Hair nicotine (NIC), hair cotinine (COT), and expired-air carbon monoxide (CO) were collected from each participant. Total cigarettes reported via daily report were strongly correlated with all Session 5 measures of total cigarettes, but were most strongly associated with TLFB total cigarettes. Collapsed CO across 5 sessions was the biomarker most strongly correlated with daily report total cigarettes. The results support the use of daily report and TLFB methods of assessing cigarette use in nondaily smokers. Results also support the use of CO as appropriate biological markers of exposure in nondaily smokers, and point to some limitations in the use of hair biomarkers in this population. (PsycINFO Database Record
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Affiliation(s)
- Jennifer M Wray
- Center for Integrated Healthcare, VA Western New York Healthcare System
| | | | | | - Diana G Wilkins
- Department of Pharmacology and Toxicology, University of Utah
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14
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Gass JC, Germeroth LJ, Wray JM, Tiffany ST. The Reliability and Stability of Puff Topography Variables in Non-Daily Smokers Assessed in the Laboratory. Nicotine Tob Res 2016; 18:484-90. [PMID: 25744955 PMCID: PMC6091051 DOI: 10.1093/ntr/ntv045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/13/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Puff topography variables, often measured using the Clinical Research Support System device, have traditionally been studied in regular, daily smokers and have been shown to be highly stable. However, more recent research has focused on non-daily smokers as a population of interest. As such, the aim of this article was to examine puff topography stability (cross-cigarette agreement over time) and reliability (within-cigarette consistency) in non-daily smokers across six laboratory sessions. METHODS One hundred seven non-daily smokers attended six laboratory sessions over the course of 3 months. At each session, they smoked one cigarette through the Clinical Research Support System pocket, in addition to completing questionnaires about their smoking history and dependence. RESULTS Puff topography measurements were highly reliable (α values ranged from 0.87-0.95) and puff behavior was highly stable across sessions (r values ranged from 0.38-0.84). Adding sessions substantially improved reliability estimates. Aspects of puffing behavior observed in session, including puff volume, puff duration, time of puff peak, and total cigarette volume were related to level of smoke exposure, measured by expired carbon monoxide. Instability in puffing behavior was not predicted by recent or long-term smoking patterns. CONCLUSIONS Puff topography appears to be a stable and routinized aspect of smoking in non-daily smokers. The feasibility of assessing puff topography in this population is supported by the high reliabilities observed, though it should be noted that reliability greatly improved by having more than one session.
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Affiliation(s)
- Julie C Gass
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Lisa J Germeroth
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Jennifer M Wray
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
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15
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Wray JM, Gray KM, McClure EA, Carpenter MJ, Tiffany ST, Saladin ME. Gender differences in responses to cues presented in the natural environment of cigarette smokers. Nicotine Tob Res 2015; 17:438-42. [PMID: 25762753 DOI: 10.1093/ntr/ntu248] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Although the evidence is mixed, female smokers appear to have more difficulty quitting smoking than male smokers. Craving, stress, and negative affect have been hypothesized as potential factors underlying gender differences in quit rates. METHODS In the current study, the cue-reactivity paradigm was used to assess craving, stress, and negative affect in response to cues presented in the natural environment of cigarette smokers using ecological momentary assessment. Seventy-six daily smokers (42% female) responded to photographs (smoking, stress, and neutral) presented 4 times per day on an iPhone over the course of 2 weeks. RESULTS Both smoking and stress cues elicited stronger cigarette craving and stress responses compared to neutral cues. Compared with males, females reported higher levels of post-stress cue craving, stress, and negative affect, but response to smoking cues did not differ by gender. DISCUSSION Findings from this project were largely consistent with results from laboratory-based research and extend previous work by measuring response to cues in the natural environment of cigarette smokers. This study extends previous cue reactivity ecological momentary assessment research by using a new platform and by measuring response to stress cues outside of the laboratory. Findings from this project highlight the importance of addressing coping in response to stress cues in clinical settings, especially when working with female smokers.
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Affiliation(s)
- Jennifer M Wray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC; University at Buffalo, State University of New York, Buffalo, NY
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Stephen T Tiffany
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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16
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Abstract
Drug craving is typically measured through explicit ratings of craving levels. We examined response time to craving ratings as an implicit measure of craving processes in cigarette smokers. Response time and inter-item variability were investigated as potential indices of certainty in craving ratings. Cigarette smokers, categorized as tobacco dependent or nondependent, completed multiple cue-reactivity sessions with smoking and neutral cues. After each cue, craving level and response time was assessed. Significant inverted-U relationships emerged between craving level and both response time and inter-item variability across conditions, sessions, and groups. Faster response times and less inter-item variability emerged after neutral relative to smoking cues for nondependent smokers and after smoking relative to neutral cues for dependent smokers. Response time provided incremental validity beyond craving level in predicting dependence. Results support use of response time as an implicit measure of craving processes and further distinguish craving experiences between dependent and nondependent smokers.
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Affiliation(s)
- Lisa J Germeroth
- Department of Psychology, University at Buffalo, The State University of New York
| | - Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, The State University of New York
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17
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Heckman BW, Carpenter MJ, Correa JB, Wray JM, Saladin ME, Froeliger B, Drobes DJ, Brandon TH. Effects of experimental negative affect manipulations on ad libitum smoking: a meta-analysis. Addiction 2015; 110:751-60. [PMID: 25641624 PMCID: PMC4398635 DOI: 10.1111/add.12866] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/14/2014] [Accepted: 01/22/2015] [Indexed: 12/17/2022]
Abstract
AIMS To quantify the effect of negative affect (NA), when manipulated experimentally, upon smoking as measured within laboratory paradigms. Quantitative meta-analyses tested the effects of NA versus neutral conditions on (1) latency to smoke and (2) number of puffs taken. METHODS Twelve experimental studies tested the influence of NA induction, relative to a neutral control condition (n = 1190; range = 24-235). Those providing relevant data contributed to separate random-effects meta-analyses to examine the effects of NA on two primary smoking measures: (1) latency to smoke (nine studies) and (2) number of puffs taken during ad libitum smoking (11 studies). Hedge's g was calculated for all studies through the use of post-NA cue responses relative to post-neutral cue responses. This effect size estimate is similar to Cohen's d, but corrects for small sample size bias. RESULTS NA reliably decreased latency to smoke (g = -0.14; CI = -0.23 to -0.04; P = 0.007) and increased number of puffs taken (g = 0.14; CI = 0.02 to 0.25; P = 0.02). There was considerable variability across studies for both outcomes (I(2) = 51 and 65% for latency and consumption, respectively). Potential publication bias was indicated for both outcomes, and adjusted effect sizes were smaller and no longer statistically significant. CONCLUSIONS In experimental laboratory studies of smokers, negative affect appears to reduce latency to smoking and increase number of puffs taken, but this could be due to publication bias.
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Affiliation(s)
- Bryan W. Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425
| | - Mathew J. Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425
| | - John B. Correa
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL 33617
| | - Jennifer M. Wray
- Center for Integrated Healthcare, VA Western NY Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215
| | - Michael E. Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425
| | - Brett Froeliger
- Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425
| | - David J. Drobes
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL 33617
| | - Thomas H. Brandon
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD4118G, Tampa, FL 33620
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL 33617
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Saladin ME, Wray JM, Carpenter MJ, McClure EA, LaRowe SD, Upadhyaya HP, Gray KM. Menstrual cycle phase effects in the gender dimorphic stress cue reactivity of smokers. Nicotine Tob Res 2014; 17:607-11. [PMID: 25324432 DOI: 10.1093/ntr/ntu203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We previously reported that female smokers evidence greater subjective craving and stress/emotional reactivity to personalized stress cues than males. The present study employed the same dataset to assess whether females in the follicular versus luteal phase of the menstrual cycle accounted for the gender differences. METHODS Two objective criteria, onset of menses and luteinizing hormone surge (evaluated via home testing kits), were used to determine whether female smokers were in either the follicular (n = 22) or the luteal (n = 15) phase of their menstrual cycle, respectively. The females and a sample of male smokers (n = 53) were then administered a laboratory-based cue reactivity paradigm that involved assessment of craving, stress, and emotional reactivity in response to counterbalanced presentations of both a personalized stress script and neutral/relaxed script. RESULTS While there were no significant differences between females in the follicular versus luteal phase on any outcome measure, females in the luteal menstrual phase reported greater craving than males whereas females in the follicular phase reported greater stress and arousal than males and perceived the stress cues as more emotionally aversive than males. CONCLUSIONS This preliminary investigation suggests that gender differences in craving versus affective responding to stress cues may, in part, be explained variation by menstrual cycle phase. Study limitations and implications of the findings for future research and treatment are briefly discussed.
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Affiliation(s)
- Michael E Saladin
- Department of Health Sciences and Research, Medical University of South Carolina (MUSC), Charleston, SC; Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC;
| | - Jennifer M Wray
- Department of Health Sciences and Research, Medical University of South Carolina (MUSC), Charleston, SC; Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC
| | - Matthew J Carpenter
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC; Hollings Cancer Center, MUSC, Charleston, SC
| | - Erin A McClure
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC
| | - Steven D LaRowe
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC; Substance Abuse Treatment Center, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Kevin M Gray
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC; Youth Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC
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Wray JM, Gass JC, Tiffany ST. The magnitude and reliability of cue-specific craving in nondependent smokers. Drug Alcohol Depend 2014; 134:304-308. [PMID: 24309295 DOI: 10.1016/j.drugalcdep.2013.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cue-reactivity is a robust phenomenon in regular cigarette smokers (Carter and Tiffany, 1999), but it has not been widely investigated in nondependent smokers. Further, most research on cue-specific craving assesses response to cues in a single experimental session. As such, investigations of cue-specific craving have primarily measured state-like but not trait-like responses to smoking stimuli. METHODS This study measured general and cue-specific craving in nondependent smokers and assessed the within-session and cross-session reliability of these two facets of craving. Participants (n=154) attended five laboratory sessions over the course of three months and completed multiple cue-reactivity trials (using smoking and neutral in vivo and photographic stimuli) during each study visit. RESULTS Results indicated that smoking cues elicited significantly stronger craving than neutral cues across study sessions, and that craving ratings following smoking cues decreased across subsequent sessions. Within-session and cross-session reliability was extremely high. CONCLUSIONS Overall, findings indicate that nondependent smokers experience reactivity to smoking cues, and that this response is quite reliable within and across sessions. Further, the magnitude of cue-specific craving was comparable to what has been observed in heavy, dependent smokers.
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Affiliation(s)
- Jennifer M Wray
- University at Buffalo, The State University of New York, United States.
| | - Julie C Gass
- University at Buffalo, The State University of New York, United States
| | - Stephen T Tiffany
- University at Buffalo, The State University of New York, United States
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20
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Germeroth LJ, Wray JM, Gass JC, Tiffany ST. Diagnostic utility of craving in predicting nicotine dependence: impact of craving content and item stability. Nicotine Tob Res 2013; 15:1988-95. [PMID: 23817585 DOI: 10.1093/ntr/ntt088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Craving is useful in the diagnosis of drug dependence, but it is unclear how various items used to assess craving might influence the diagnostic performance of craving measures. This study determined the diagnostic performance of individual items and item subgroups of the 32-item Questionnaire on Smoking Urges (QSU) as a function of item wording, level of craving intensity, and item stability. METHODS Nondaily and daily smokers (n = 222) completed the QSU on 6 separate occasions, and item responses were averaged across the administrations. Nicotine dependence was assessed with the Wisconsin Inventory of Smoking Dependence Motives. The discriminative performance of the QSU items was evaluated with receiver-operating characteristic curves and area under the curve statistics. RESULTS Although each of the QSU items and selected subgroups of items significantly discriminated dependent from nondependent smokers, certain item subgroups outperformed others. There was no difference in discriminative performance between use of the specific terms urge and crave or between items assessing intention to smoke relative to those assessing desire to smoke, but there were significant differences in the two major factors represented on the QSU and in craving items reflecting more intense relative to less intense craving. Stability of the item scores was strongly related to the discriminative performance of craving. CONCLUSIONS Items indexing stable, high-intensity aspects of craving that reflect the negative reinforcing effects of smoking will likely be most useful for diagnostic purposes. Future directions and implications are discussed.
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Affiliation(s)
- Lisa J Germeroth
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
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21
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Wray JM, Gass JC, Tiffany ST. A systematic review of the relationships between craving and smoking cessation. Nicotine Tob Res 2013; 15:1167-82. [PMID: 23291636 PMCID: PMC3682845 DOI: 10.1093/ntr/nts268] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 11/12/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Craving is often portrayed as a defining feature of addiction, but the role of craving in the addictive process is controversial. Particularly contentious is the extent to which drug craving predicts subsequent relapse. METHODS This review synthesizes findings from 62 smoking cessation studies published through December 2011. Eligible studies measured craving for cigarettes in treatment-seeking smokers and related this to subsequent smoking status. The relationships of general craving and cue-specific craving with treatment outcome were examined separately. Further, analyses that related general craving to smoking status were divided into those that used craving data collected before the quit attempt, after the quit attempt, and those that used change in craving over time as a predictor. RESULTS Results across studies revealed a total of 198 indices of association with 94 (47%) of these being significant. In general, the findings indicated (a) there were only a few cases of significant associations between craving collected as part of cue-reactivity studies and treatment outcome, (b) postquit craving was a stronger predictor of treatment outcome than prequit craving, and (c) several moderators likely influence the relationship between craving and cessation outcome. CONCLUSIONS The overall results suggest that craving is not a necessary condition of relapse. In addition, inconsistent relationships between craving and treatment outcome call into question the value of craving as a target of treatment and underscore limitations in the prognostic utility of craving.
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Affiliation(s)
- Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA.
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Gass JC, Wray JM, Hawk LW, Mahoney MC, Tiffany ST. Impact of varenicline on cue-specific craving assessed in the natural environment among treatment-seeking smokers. Psychopharmacology (Berl) 2012; 223:107-16. [PMID: 22476610 PMCID: PMC3419339 DOI: 10.1007/s00213-012-2698-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 03/17/2012] [Indexed: 11/27/2022]
Abstract
RATIONALE Varenicline is believed to work, in part, by reducing craving responses to smoking cues and by reducing general levels of craving; however, these hypotheses have never been evaluated with craving assessed in the natural environments of treatment-seeking smokers. OBJECTIVES Ecological momentary assessment procedures were used to assess the impact of varenicline on cue-specific and general craving in treatment-seeking smokers prior to quitting. METHODS For 5 weeks prior to quitting, 60 smokers carried personal digital assistants that assessed their response to smoking or neutral cues. During week 1 (baseline), participants did not receive medication; during weeks 2-4 (drug manipulation), participants were randomized to receive varenicline or placebo; during week 5 (standard therapy), all participants received varenicline. Craving was assessed before each cue; cue-specific craving and attention to cue were assessed after each cue. RESULTS During all phases, smoking cues elicited greater craving than neutral cues; the magnitude of this effect declined after the first week. General craving declined across each phase of the study. Relative to the placebo condition, varenicline was associated with a greater decline in general craving over the drug manipulation phase. Varenicline did not significantly attenuate cue-specific craving during any phase of the study. CONCLUSIONS Smoking cues delivered in the natural environment elicited strong craving responses in treatment-seeking smokers, but cue-specific craving was not affected by varenicline administered prior to the quit attempt. These findings suggest that the clinical efficacy of varenicline is not mediated by changes in cue-specific craving during the pre-quit period of treatment-seeking smokers.
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Affiliation(s)
- Julie C Gass
- Department of Psychology, University at Buffalo, State University of New York, Park 206, Buffalo, NY 14260, USA
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Abstract
Although drug craving has received considerable research attention over the past several decades, to date there has been no systematic review of the general clinical significance of craving. This paper presents an overview of measurement issues of particular relevance to a consideration of use of craving in clinical settings. The paper then considers the relevance of craving across a broad array of clinical domains, including diagnosis, prognostic utility, craving as an outcome measure, and the potential value of craving as a direct target of intervention. The paper is both descriptive and prescriptive, informed by the current state of the science on craving with recommendations for the definition of craving, assessment practices, future research, and clinical applications. We conclude that craving has considerable utility for diagnosis and as a clinical outcome, and that findings from future research will likely expand the clinical potential of the craving construct in the domains of prognosis and craving as a treatment target.
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Affiliation(s)
- Stephen T Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA.
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Wray JM, Godleski SA, Tiffany ST. Cue-reactivity in the natural environment of cigarette smokers: the impact of photographic and in vivo smoking stimuli. Psychol Addict Behav 2011; 25:733-7. [PMID: 21553947 DOI: 10.1037/a0023687] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The cue-reactivity paradigm has been used extensively in laboratory settings to study cue-specific craving responses to drug-related cues. However, this procedure has been used in only one study to assess craving in the drug user's natural environment (Warthen & Tiffany, 2009). The present study combined cue-reactivity with ecological momentary assessment (CREMA) to evaluate smokers' cue reactions in natural environments as a further validation and extension of this procedure. A total of 66 daily cigarette smokers carried a personal digital assistant (PDA) and had the opportunity to respond to 32 cue-reactivity sessions across 8 days. Cues were presented through in vivo and photographic modes. During in vivo sessions, participants handled and looked at a cigarette or neutral object, while during photographic sessions, participants looked at a smoking-related or neutral photograph on the PDA. Craving and mood were assessed before and after cue presentations. Cues were also presented in the laboratory both before (Lab I) and after (Lab II) the 8-day CREMA procedure. Participants completed over 90% of cue-reactivity sessions delivered with the CREMA procedure. Analyses revealed robust cue-reactivity in the natural environment and laboratory across both modes of presentation. Photographic cues elicited significantly stronger cue-reactivity effects than in vivo cues across all sessions. The CREMA procedure has been shown to elicit robust cue-reactivity effects across multiple modes of cue presentation. Results support the use of the CREMA procedure for examining cue-specific craving in the natural environment of smokers.
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Affiliation(s)
- Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA
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