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Neuroeconomic predictors of smoking cessation outcomes: A preliminary study of delay discounting in treatment-seeking adult smokers.

ABSTRACT: Large proportions of smokers are unsuccessful in evidence-based smoking cessation treatment and identifying prognostic predictors may inform improvements in treatment. Steep discounting of delayed rewards (delay discounting) is a robust predictor of poor smoking cessation outcome, but the underlying neural predictors have not been investigated. Forty-one treatment-seeking adult smokers completed a functional magnetic resonance imaging (fMRI) delay discounting paradigm prior to initiating a 9-week smoking cessation treatment protocol. Behavioral performance significantly predicted treatment outcomes (verified 7-day abstinence, n = 18; relapse, n = 23). Participants in the relapse group exhibited smaller area under the curve (d = 1.10) and smaller AUC was correlated with fewer days to smoking relapse (r = 0.56, p < 0.001) Neural correlates of discounting included medial and dorsolateral prefrontal cortex, posterior cingulate, precuneus and anterior insula, and interactions between choice type and relapse status were present for the dorsolateral prefrontal cortex, precuneus and the striatum. This initial investigation implicates differential neural activity in regions associated with frontal executive and default mode activity, as well as motivational circuits. Larger samples are needed to improve the resolution in identifying the neural underpinnings linking steep delay discounting to smoking cessation.

SUBMITTER: Amlung M

PROVIDER: S-EPMC9729436 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Neuroeconomic predictors of smoking cessation outcomes: A preliminary study of delay discounting in treatment-seeking adult smokers.

Amlung Michael M Owens Max M MM Hargreaves Tegan T Gray Joshua C JC Murphy Cara M CM MacKillop James J Sweet Lawrence H LH

Psychiatry research. Neuroimaging 20221021

Large proportions of smokers are unsuccessful in evidence-based smoking cessation treatment and identifying prognostic predictors may inform improvements in treatment. Steep discounting of delayed rewards (delay discounting) is a robust predictor of poor smoking cessation outcome, but the underlying neural predictors have not been investigated. Forty-one treatment-seeking adult smokers completed a functional magnetic resonance imaging (fMRI) delay discounting paradigm prior to initiating a 9-wee ...[more]

PMID: 36327864

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Project description:BackgroundTobacco smoking remains the leading cause of preventable death and disease worldwide. Digital interventions delivered through smartphones offer a promising alternative to traditional methods, but little is known about their effectiveness.ObjectiveOur objective was to test the preliminary effectiveness of Quit Genius, a novel digital therapeutic intervention for smoking cessation.MethodsA 2-arm, single-blinded, parallel-group randomized controlled trial design was used. Participants were recruited via referrals from primary care practices and social media advertisements in the United Kingdom. A total of 556 adult smokers (aged 18 years or older) smoking at least 5 cigarettes a day for the past year were recruited. Of these, 530 were included for the final analysis. Participants were randomized to one of 2 interventions. Treatment consisted of a digital therapeutic intervention for smoking cessation consisting of a smartphone app delivering cognitive behavioral therapy content, one-to-one coaching, craving tools, and tracking capabilities. The control intervention was very brief advice along the Ask, Advise, Act model. All participants were offered nicotine replacement therapy for 3 months. Participants in a random half of each arm were pseudorandomly assigned a carbon monoxide device for biochemical verification. Outcomes were self-reported via phone or online. The primary outcome was self-reported 7-day point prevalence abstinence at 4 weeks post quit date.ResultsA total of 556 participants were randomized (treatment: n=277; control: n=279). The intention-to-treat analysis included 530 participants (n=265 in each arm; 11 excluded for randomization before trial registration and 15 for protocol violations at baseline visit). By the quit date (an average of 16 days after randomization), 89.1% (236/265) of those in the treatment arm were still actively engaged. At the time of the primary outcome, 74.0% (196/265) of participants were still engaging with the app. At 4 weeks post quit date, 44.5% (118/265) of participants in the treatment arm had not smoked in the preceding 7 days compared with 28.7% (76/265) in the control group (risk ratio 1.55, 95% CI 1.23-1.96; P<.001; intention-to-treat, n=530). Self-reported 7-day abstinence agreed with carbon monoxide measurement (carbon monoxide <10 ppm) in 96% of cases (80/83) where carbon monoxide readings were available. No harmful effects of the intervention were observed.ConclusionsThe Quit Genius digital therapeutic intervention is a superior treatment in achieving smoking cessation 4 weeks post quit date compared with very brief advice.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 65853476; https://www.isrctn.com/ISRCTN65853476.

Project description:INTRODUCTION The number of cessation clinics in China have been increasing ever since the Chinese government supported the establishment of smoking cessation clinics (SCCs) in each province in 2014. Many studies have examined smoking cessation behaviors among male smokers, but few of female smokers. This study aimed to understand female smokers’ quitting behaviors in SCCs and identify predictors of successful cessation. METHODS This study used data of the SCCs Platform in China from 2018 to 2020. The self-reported 7-day point prevalence of abstinence rate (PPAR) at 1 month and at 3 months follow-up and the continuous abstinence rate (CAR) at 3 months follow-up are reported based on smokers’ characteristics and intention to treat analysis. A multiple logistic regression model was used to identify predictors of continuous abstinence at 3 months follow-up. RESULTS The 7-day PPAR of female outpatients in SCCs was 29.20% at 1 month follow-up and 28.36% at 3 months follow-up. The CAR at 3 months follow-up was 19.88%. Female smokers who were prepared to quit within 7 days (AOR=2.86; 95% CI: 1.53–5.32), today (AOR=4.01; 95% CI: 2.35–6.85), had started to quit (AOR=7.11; 95% CI: 4.12–12.27), and used a combination of counseling and drugs (AOR=2.41; 95% CI: 1.73–3.35) were more likely to quit smoking. Associated with lower quitting rates were: living in the central region of China (AOR=0.47; 95% CI: 0.31–0.73) and the west region (AOR=0.48; 95% CI: 0.31–0.73); being aged 30–39 years (AOR=0.39; 95% CI: 0.23–0.64), and 40–49 years (AOR=0.41; 95% CI:0.24–0.69); being unemployed (AOR=0.64; 95% CI: 0.45–0.91); having a fair perceived health status at the first visit (AOR=0.65; 95% CI: 0.47–0.91) and a poor one (AOR=0.37; 95% CI: 0.21–0.64); having a moderate nicotine dependence (AOR=0.64; 95% CI: 0.44–0.92) and a severe one (AOR=0.50; 95% CI: 0.34–0.72). CONCLUSIONS In our study, the region of residence, age, employment, perceived health status, Fagerström test for nicotine dependence (FTND), readiness to quit, and intervention model were independent predictors of quitting for female smokers. Improving the motivation to quit, providing intensive psychological interventions and equipping SCCs with cessation medication would assist female smokers to quit.

Project description:Many lifelong smokers establish smoking habits during young adulthood. A university can be an effective setting for early smoking cessation. We evaluated long-term predictors of smoking cessation among smokers in a university setting.We longitudinally followed a cohort of smokers enrolled in a university smoking cessation program in Seoul, South Korea. Sociodemographic factors, smoking-related variables, and changes in smoking habits were assessed during 6-week visit sessions and follow-up telephone interviews conducted 1 year or more later.A total of 205 participants were followed up (mean follow-up duration: 27.1 months). Cessation rates were 47.3% at the end of the visit sessions and 28.8% at follow-up. The long-term persistent smoking rate was significantly higher among individuals with peers who smoked (odds ratio [OR] = 8.64; 95% confidence interval [CI] = 1.75, 42.80), with family members who smoked (OR = 3.28; 95% CI = 1.20, 9.00), and who smoked 10 to 19 cigarettes/day (OR?=?4.83; 95% CI?=?1.49, 15.69). Conversely, persistent smoking was less likely among those who attended the program regularly (OR?=?0.84 per visit; 95% CI?=?0.72, 0.99) and attempted quitting more frequently (OR?=?0.93 per attempt; 95% CI?=?0.87, 0.99). Use of smoking cessation medications (varenicline or bupropion) was not significantly associated with long-term quitting (OR?=?0.71; 95% CI?=?0.26, 1.93).Peer influences were the strongest predictors of failure in long-term cessation among smokers who attempted to quit. Similarly, the existence of smokers in the family was negatively associated with successful quitting. Regular attendance at a smoking cessation program and a high number of attempts to quit were positively associated with successful quitting. Targeting peer and family smoking groups together rather than targeting individual smokers alone, implementing active cessation programs encouraging regular attendance, and providing comprehensive antismoking environments might be effective strategies in a university setting.

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Neuroeconomic predictors of smoking cessation outcomes: A preliminary study of delay discounting in treatment-seeking adult smokers.

Publications

Neuroeconomic predictors of smoking cessation outcomes: A preliminary study of delay discounting in treatment-seeking adult smokers.

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