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Suicidality prospectively predicts greater urges to smoke following a cessation attempt: Mediation through perceived barriers to cessation.

ABSTRACT: Growing interest in developing more effective smoking cessation treatments has facilitated the need to further investigate cognitive-affective factors that inhibit successful smoking cessation, such as urges to smoke. Research has strongly supported an association between suicidality and smoking, yet no work has investigated whether suicidality may increase urges to smoke. The current study sought to evaluate the impact of suicidality on smoking-related cognitive-affective factors predictive of smoking relapse among a community sample of 209 daily smokers engaged in a smoking cessation program. Structural equation modeling (SEM) was used to test the effects of self-reported pre-cessation suicidality on urges to smoke 1 month post-cessation as well as whether this effect was mediated by greater barriers to cessation. Results indicated that internal barriers to cessation significantly mediated the effect of pre-cessation suicidality on greater urges to smoke 1 month following smoking cessation attempt. These findings suggest that elevated suicidality may affect perceived internal barriers to cessation and subsequently urges to smoke 1 month following a quit attempt.

SUBMITTER: Albanese BJ

PROVIDER: S-EPMC4750401 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Suicidality prospectively predicts greater urges to smoke following a cessation attempt: Mediation through perceived barriers to cessation.

Albanese Brian J BJ Allan Nicholas P NP Boffa Joseph W JW Chavarria Jesus J Raines Amanda M AM Zvolensky Michael J MJ Schmidt Norman B NB

Journal of affective disorders 20151021

Growing interest in developing more effective smoking cessation treatments has facilitated the need to further investigate cognitive-affective factors that inhibit successful smoking cessation, such as urges to smoke. Research has strongly supported an association between suicidality and smoking, yet no work has investigated whether suicidality may increase urges to smoke. The current study sought to evaluate the impact of suicidality on smoking-related cognitive-affective factors predictive of ...[more]

PMID: 26519643

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Project description:ObjectivesTo identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth.DesignA systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups.Data sourcesMEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014.Study selectionStudies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included.Data extractionTwo authors independently assessed studies for inclusion and extracted data.Results65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco).ConclusionsVulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups.Trial registration numberA protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761).

Project description:BackgroundScreening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents' and parents' reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments.ObjectiveThis qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW.MethodsWe interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups.ResultsWe identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions.ConclusionsWe identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.

Dataset Information

Suicidality prospectively predicts greater urges to smoke following a cessation attempt: Mediation through perceived barriers to cessation.

Publications

Suicidality prospectively predicts greater urges to smoke following a cessation attempt: Mediation through perceived barriers to cessation.

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