TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center.
Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston.
Psychol Addict Behav. 2021 Feb;35(1):52-61. doi: 10.1037/adb0000595.
Emerging evidence suggests that adults with chronic pain have poor smoking cessation outcomes, but the exact mechanisms are less understood. This study examined whether depression, anxiety, stress, and then, positive outcome expectancy for smoking mediated the association between pain and smoking relapse during a quit attempt.
This study is a secondary data analysis of a three-armed randomized clinical trial that compared in-person and smartphone-based smoking cessation interventions. Participants (N = 81) self-reported the amount of bodily pain they experienced in the past 4 weeks at baseline. Depression, anxiety, stress, and positive outcome expectancy for smoking were measured daily, via a smartphone app, throughout the first week of the quit attempt, and were aggregated to the week level for analyses. Biochemically verified smoking abstinence was assessed 4 weeks postquit date.
Sequential mediation analyses showed that pain was indirectly associated with smoking relapse through greater feelings of stress and then higher expectations that smoking would improve mood (B = 0.22 [95% CI = 0.03, 0.65]). The pathways for depression and anxiety were not significant mediators of pain and smoking relapse.
Findings from this study indicate that pain is indirectly associated with smoking relapse through feelings of stress and then positive outcome expectancy for smoking. Smoking cessation treatment for adults who experience high levels of bodily pain should include psychoeducation that teaches adaptive coping responses, such as mindfulness, to manage stress, and challenge expectations about the ability of smoking to improve mood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
新出现的证据表明，慢性疼痛的成年人戒烟效果不佳，但确切机制尚不清楚。本研究旨在探讨抑郁、焦虑、压力是否以及随后对吸烟的积极预期是否会在戒烟尝试中调节疼痛与吸烟复发之间的关系。
本研究是一项三臂随机临床试验的二次数据分析，该试验比较了面对面和基于智能手机的戒烟干预措施。参与者（N=81）在基线时自我报告过去 4 周内身体疼痛的程度。抑郁、焦虑、压力和对吸烟的积极预期通过智能手机应用程序在戒烟尝试的第一周内每天进行测量，并在分析时汇总到周水平。在戒烟后 4 周评估生物化学验证的吸烟戒断情况。
顺序中介分析表明，疼痛通过增加压力感与吸烟复发间接相关，然后通过更高的期望吸烟能改善情绪（B=0.22[95%CI=0.03,0.65]）。抑郁和焦虑的途径不是疼痛和吸烟复发的显著中介因素。
本研究的结果表明，疼痛通过压力感和对吸烟的积极预期与吸烟复发间接相关。对于经历身体疼痛水平较高的成年人，戒烟治疗应包括心理教育，教授适应应对压力的方法，如正念，并挑战对吸烟改善情绪能力的期望。
