Psychosocial Mechanisms of Smoking Abstinence among Smokers of Low Socioeconomic Status. Yessenia Castro, Ph.D. May 31, 2013

Transcription

1 Psychosocial Mchanisms of Smoking Abstinnc among Smokrs of Low Socioconomic Status Yssnia Castro, Ph.D. May 31, 2013

2 Ovrviw Stat of tobacco us and disparitis among low socioconomic status (SES) smokrs Explanatory modl of drug us and halth bhavior Rcnt work tsting aspcts of this modl among: Pripartum womn in rlaps prvntion counsling Low SES smokrs in cssation counsling Summaris and Implications

3 Stat of Tobacco Us and Disparitis 2010 adult smoking prvalnc rat, 19.3% (CDC, 2012) Profound disparitis in prvalnc by rac, gndr, and spcially SES. [SES] is commonly concptualizd as th social standing or class of an individual or group. It is oftn masurd as a combination of ducation, incom and occupation. (APA, 2013)

4 Stat of Tobacco Us and Disparitis Smoking prvalnc rats by SES indicators, 2009 Education Womn Mn Total GED Diploma Som Collg Undrgraduat Dgr Graduat Dgr Povrty Status Womn Mn Total Blow At or Abov CDC. Vital Signs: Currnt Cigartt Smoking among Adults 18 yars---u.s MMWR 2010:59;

5 Stat of Tobacco Us and Disparitis Thus, smoking is bcoming incrasingly concntratd within lowr SES groups (Gilman t al., 2003) Lowr SES is rlatd to: Highr lvl of nicotin dpndnc (Siahpush t al., 2006) Smoking bans at hom and work (Shopland t al., 2006) Dcrasd liklihood of quitting (Barbau t al., 2004; CDC, 2012; Rid, t al, 2010)

6 Stat of Tobacco Us and Disparitis W know vry littl about: 1) What mdiats th rlationship btwn SES and smoking cssation? 2) How do multipl mchanisms of cssation com togthr to affct smoking among low SES smokrs?

7 Stat of Tobacco Us and Disparitis Incrasd knowldg in ths aras may Highlight potntial tratmnt targts within this disadvantagd population Improv currnt smoking cssation intrvntions Ultimatly lad to incrasd cssation succss and rduc tobacco rlatd halth disparitis and disas burdn in low SES groups

8 Social-Cognitiv Modl of Drug Us Witkiwitz K. & Marlatt GA. Rlaps prvntion for alcohol and drug problms: That was Zn, this is Tao. Am Psychol 2004:59;

9 What mdiats th rlationship btwn SES and smoking cssation? Study 1 MECHANISMS LINKING SES AND POST-PARTUM SMOKING RELAPSE BUSINELLE MS, KENDZOR DE, REITZEL LR, VIDRINE JI, CASTRO Y, MULLEN PD, VELASQUEZ MM, COFTA-WOERPEL L, CINCIRIPINI PM, GREISINGER AJ, & WETTER DW. PATHWAYS LINKING SOCIOECONOMIC STATUS AND POSTPARTUM SMOKING RELAPSE. ANN BEHAV MED OCT 20. [EPUB AHEAD OF PRINT].

10 Study Ovrviw Data from Projct MOM (Ritzl, t al. 2009) Randomizd clinical trial valuating a tratmnt for rducing postpartum smoking rlaps among womn who quit smoking during prgnancy Rcruitd at wks Quit smoking during prgnancy or within 2 months prior Providd rlaps prvntion counsling Baslin SES and mdiators, 8 wks postpartum abstinnc status

11 Analyss Structural Equation Modling using man and varianc adjustd wightd las squars (WLSMV) Four modls wr dvlopd basd on thortical modls and tstd to dtrmin a modl that would bst fit th currnt data. SES was controlld for rac/thnicity, ag, partnr status, # prvious births Rlaps status was controlld for tratmnt group

12 Study Masurs Outcom: Rlaps status at 8 wks post-partum Prdictors: Four Latnt Variabls SES Educational Lvl Employmnt Status Insuranc Status Agncy /Confidnc Scal (SECS) affct/social situations SECS ngativ affct situation SECS habit/craving situations Affctiv Information Procssing Qustionnair (AIPQ) Positiv And Ngativ affct Schdul, subscal (PANAS-NA) Cntr for Epidmiological Studis Dprssion Scal (CES-D) Prcivd Strss Scal (PSS) Craving Wisconsin Smoking Withdrawal Scal, Craving Subscal itms: Urg to smok Thoughts about smoking Dsir to smok Focus on smoking cus

13 Hypothsizd Modls SES Ngativ Affct/ Strss Craving Modl 1 - Agncy Group Rlaps Status χ 2 (43, N = 251) = 54.59, p =.11 Ngativ CFI =.959 Affct/ Agncy Strss - - TLI =.967 Group RMSEA =.033 Craving WRMR =.83 - Modl 2 BIC = SES Rlaps Status - SES Ngativ Affct/ Strss Agncy Craving Group Rlaps Status χ 2 (45, N = 251) = 53.90, p =.17 Ngativ CFI =.969 Affct/ Craving Strss TLI =.975 Group RMSEA =.028 Agncy WRMR =.79 SES Rlaps Status

14 Rsults: Th Final Modl Ag Partnr AA Latino hr Rac #Births SES Education Employmnt PANAS-NA PSS CESD Incom Ngativ Affct/Strss Urg Thoughts Dsir Craving.673 Focus Rlaps by Wk 8 Postpartum Agncy Modl 2: χ 2 (45) = 53.90, p =.17; CFI =.969; TLI =.975; RMSEA =.028; WRMR =.799 SECS - PA Situations SECS - NA SECS - Habit AIPQ Situations Craving Group

15 Rsults: Th Final Modl Ag Partnr AA Latino hr Rac Births SES Education Employmnt PANAS-NA PSS CESD Incom Ngativ Affct/Strss Urg Thoughts Dsir Craving.673 Focus Rlaps by Wk 8 Postpartum Agncy Standardizd stimat =.02; p =.03 SECS - PA Situations SECS - NA SECS - Habit AIPQ Situations Craving Group

16 Rsults: Th Final Modl Ag Partnr AA Latino hr Rac Births SES Education Employmnt PANAS-NA PSS CESD Incom Ngativ Affct/Strss Urg Thoughts Dsir Craving.673 Focus Rlaps by Wk 8 Postpartum Agncy Standardizd stimat = -.02; p =.02 SECS - PA Situations SECS - NA SECS - Habit AIPQ Situations Craving Group

17 Study 1 Summary Idntifid ngativ affct, agncy, and craving as mdiators of SES-rlaps rlationship Craving as sol dirct pathway to rlaps Important vn long aftr cssation Craving as important tratmnt targt in rlaps prvntion Limitations: spcial population, mostly crosssctional, not a comprhnsiv tst of modl

18 How do multipl mchanisms of cssation com togthr to affct smoking among low SES smokrs? Study 2 RECIPROCAL RELATIONS AMONG MECHANISMS OF SMOKING CESSATION CASTRO Y, CANO MA, MAZAS CA, BUSINELLE MS, CORREA-FERNANDEZ V, HEPPNER WL, & WETTER DW. A CROSS-LAGGED PANEL ANALYSIS OF FIVE INTRAPERSONAL DETERMINANTS OF SMOKING CESSATION. MANUSCRIPT IN PREPARATION.

19 Study Ovrviw Data from Projct CARE: a longitudinal cohort study of low SES smokrs in tratmnt Rcivd smoking cssation counsling and NRT Assssd on svral psychosocial variabls at baslin and follow-ups Data from 2-wks pr-quit, quit day, and 1-wk post-quit

20 Analyss Cross-laggd panl path analysis using WLSMV Initial fully-cross laggd modl was tstd for fit Paths systmatically rmovd and ach rsulting modl tstd for fit DIFFTEST for significant loss of fit Most parsimonious modl that fit th data.

21 Study Masurs Fiv-itm masur adaptd from Hppnr, t al., 2010 SECS total scor PANAS subscal PANAS subscal Craving WSWS Craving subscal

22 Participant Charactristics (N = 434) Charactristic Rac/thnicity % or M (SD) Mal 46.8% Ag 41.2 (11.2) Yars of Education 12.9 (2.0) Marrid/Living with Partnr 34.3% Incom (< 20000) 58% Unmployd 41.6% Cigartts pr day 21 (10.3) 32% African Amrican/Black 30% Hispanic/Latina 32% Whit

23 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

24 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

25 Hypothsizd Modl Pr-quit Quit Day Post-quit Slf-ffiacy Abstinnc

26 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

27 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

28 Hypothsizd Modl Pr-quit Quit Day Post-quit Outcom Expctancis Outcom Expctancis Abstinnc

29 Hypothsizd Modl Pr-quit Quit Day Post-quit Slf-ffiacy Abstinnc

30 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

31 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

32 Hypothsizd Modl Pr-quit Quit Day Post-quit Slf-ffiacy Abstinnc

33 Hypothsizd Modl Pr-quit Quit Day Post-quit Abstinnc

34 Rsults: Hypothsizd Modl Good fit of th cross-laggd modl (χ 2 [5] = 8.91, p =.11; RMSEA =.04, CFI =.99, TLI =.98; WRMR =.24) 15 paths wr systmatically rmovd Most parsimonious modl Good fit for th data

35 Pr-quit (5 itm scal) Rsults: Final Modl.18**.49**.15** Quit Day (5 itm scal) On Wk Post-quit (SECS).15**.39** (SECS).12* (PANAS-PA).14**.53**.20** (PANAS-PA).23** Abstinnc -.13** (PANAS-NA) Craving (WSWS-C).67**.13**.06.31** -.11* (PANAS-NA) Craving (WSWS-C) (χ 2 [19] = 19.82, p =.41; RMSEA =.01 CFI =.99 TLI =.99 WRMR =.37

36 Pr-quit (5 itm scal) Rsults: Final Modl.18**.49**.15** Quit Day (5 itm scal) On Wk Post-quit (SECS).15**.39** (SECS).12* (PANAS-PA).14**.53**.20** (PANAS-PA).23** Abstinnc -.13** (PANAS-NA) Craving (WSWS-C).67**.13**.06.31** -.11* (PANAS-NA) Craving (WSWS-C) (χ 2 [19] = 19.82, p =.41; RMSEA =.01 CFI =.99 TLI =.99 WRMR =.37

37 Pr-quit (5 itm scal) Rsults: Final Modl.18**.49**.15** Quit Day (5 itm scal) On Wk Post-quit (SECS).15**.39** (SECS).12* (PANAS-PA).14**.53**.20** (PANAS-PA).23** Abstinnc -.13** (PANAS-NA) Craving (WSWS-C).67**.13**.06.31** -.11* (PANAS-NA) Craving (WSWS-C) (χ 2 [19] = 19.82, p =.41; RMSEA =.01 CFI =.99 TLI =.99 WRMR =.37

38 Pr-quit (5 itm scal) Rsults: Final Modl.18**.49**.15** Quit Day (5 itm scal) On Wk Post-quit (SECS).15**.39** (SECS).12* (PANAS-PA).14**.53**.20** (PANAS-PA).23** Abstinnc -.13** (PANAS-NA) Craving (WSWS-C).67**.13**.06.31** -.11* (PANAS-NA) Craving (WSWS-C) (χ 2 [19] = 19.82, p =.41; RMSEA =.01 CFI =.99 TLI =.99 WRMR =.37

39 Pr-quit (5 itm scal) Rsults: Final Modl.18**.49**.15** Quit Day (5 itm scal) On Wk Post-quit (SECS).15**.39** (SECS).12* (PANAS-PA).14**.53**.20** (PANAS-PA).23** Abstinnc -.13** (PANAS-NA) Craving (WSWS-C).67**.13**.06.31** -.11* (PANAS-NA) Craving (WSWS-C) (χ 2 [19] = 19.82, p =.41; RMSEA =.01 CFI =.99 TLI =.99 WRMR =.37

40 Study 2 Summary and SE; SE and PA; NA and Craving to hav rciprocal ffcts Affirms prominnt drug tratmnt modl Novl tratmnt targt in PA? Only motivation and SE dirctly affct cssation Consistnt with al Intrviwing Limitations: short tim span; not a comprhnsiv tst of modl

41 Gnral Summary/Conclusions Idntifid som mchanisms of SES-rlaps rlation Within Low-SES smokrs, gaind insight on intrrlationships of thos mchanisms Highlightd potntial tratmnt targts among Low SES smokrs Many novl findings in nd of rplication Futur modls might considr rol of contxtual and intrprsonal factors

42 Acknowldgmnts Collaborators: Michal Businll Migul Angl Cano Paul Cinciripini Ludmila Cofta-Worpl Virmari Corra-Frnandz Anthony Grisingr Whitny Hppnr Jnnifr Irvin Vidrin Darla Kndzor Carlos Mazas Patricia Dolan Mulln Lorrain Ritzl Mary Vlasquz David Wttr Funding Sourcs: NCI K01CA157689, PI: Yssnia Castro ACS MRSGT CPPB, PI: Michal Businll NCI R01CA89350, PI: David Wttr (Projct MOM) NIDA R01DA014818, PI: David Wttr (Projct CARE)