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1.  Discrimination, Affect, and Cancer Risk Factors among African Americans 
Objectives
To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults.
Methods
Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation.
Results
Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values < .05).
Conclusions
Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender.
doi:10.5993/AJHB.38.1.4
PMCID: PMC3775007  PMID: 24034678
discrimination; stress; depression; cancer risk factors
2.  The Relationship of Childhood Trauma to Nicotine Dependence in Pregnant Smokers 
Pregnant women with high levels of nicotine dependence are the least likely to quit smoking spontaneously during pregnancy or to benefit from smoking cessation interventions. In the general population, there is increasing evidence of a relationship between smoking, nicotine dependence, and exposure to childhood trauma. We examined the relationship of childhood trauma to several measures of nicotine dependence and evaluated whether this relationship was mediated by major depressive disorder or depressive symptom severity in pregnant smokers. Moderate to extreme levels of childhood trauma were significantly related to smoking within 5 minutes or less of waking, and to the Behavioral Choice-Melioration, Negative Reinforcement and Tolerance subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) scale. The relationships between childhood emotional abuse and the WISDM-68 Total and Negative Reinforcement subscale were partially mediated by depressive symptoms. Results suggest that childhood trauma may be a risk factor underlying nicotine dependence in pregnant smokers. Increased understanding of the relationship of affect regulation to smoking in individuals with childhood trauma histories may aid in the development of more effective treatments of nicotine dependence for this population of smokers.
doi:10.1037/a0025529
PMCID: PMC4093831  PMID: 21928869
pregnant smokers; nicotine dependence; childhood trauma
3.  Socioeconomic Status and Smoking Cessation: Neighborhood Context as an Underlying Mechanism 
Texas Heart Institute Journal  2014;41(3):309-310.
doi:10.14503/THIJ-14-4096
PMCID: PMC4060343  PMID: 24955049
Attitude to health/ethnology; educational status; health behavior/ethnology; income; models, theoretical; residence characteristics; risk factors; smoking/psychology; smoking cessation/economics/psychology/statistics & numerical data; social class; social environment; social support; socioeconomic factors; tobacco
4.  Promoting Tobacco Cessation and Smoke-Free Workplaces Through Community Outreach Partnerships in Puerto Rico 
Background
Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR.
Objectives
The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces.
Methods
Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation.
Results
Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006.
Conclusions
This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.
doi:10.1353/cpr.2014.0032
PMCID: PMC4237274  PMID: 25152097
Smoking cessation; quitlines; community outreach; community-based participatory research; health disparities
5.  Mediators of Discrimination and Self-rated Health among African Americans 
Objectives
To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans.
Methods
A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male).
Results
Greater discrimination was associated with poorer self-rated health (β=−.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05).
Conclusions
Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.
doi:10.5993/AJHB.37.6.3
PMCID: PMC3763512  PMID: 24001623
discrimination; self-rated health; depression; stress
6.  Relationship of Childhood Trauma to Depression and Smoking Outcomes in Pregnant Smokers 
Objective
We evaluated whether childhood trauma moderated the treatment effect on depression and smoking outcomes in pregnant smokers.
Method
The sample included pregnant smokers participating in a randomized trial evaluating the efficacy of a 10-session interpersonally focused therapy—cognitive behavioral analysis system of psychotherapy (CBASP), versus a time-matched health and wellness control (HW) for smoking cessation and depression reduction. Women (N = 248) who completed the Childhood Trauma Questionnaire (CTQ) were included. On average, women were 25 years old (SD = 5.91) and smoked 10 (SD = 6.9) cigarettes per day. Depressive symptoms were assessed with the Center for Epidemiological Studies-Depression Scale (CES-D) and women had an average score of 21 (SD = 11.03). Seventy-six percent of women had experienced some form of moderate to severe childhood trauma as assessed by the CTQ.
Results
In women with a history of moderate to severe childhood trauma, there was a dose-response association of treatment on depression outcome through 6 months postpartum; those with increasing amounts of childhood trauma benefitted more from CBASP, while those in the HW condition did not. Childhood trauma did not moderate the treatment effect on abstinence, although increasing amounts of trauma were associated with reduced likelihood of abstinence at 6 months post treatment.
Conclusions
An interpersonally-focused therapy may be beneficial for the treatment of depression during the prenatal period in pregnant smokers with childhood trauma histories and such treatment becomes increasingly more important with cumulative trauma experience. Childhood trauma increases risk for cessation failure in pregnant smokers.
doi:10.1037/a0033381
PMCID: PMC3905676  PMID: 23750463
childhood trauma; pregnant smokers; depression
7.  Mechanisms Linking Socioeconomic Disadvantage and BMI in Smokers 
Objectives
To evaluate a conceptual model of the psychosocial pathways linking socioeconomic status and body mass index (BMI) among smokers.
Methods
A latent variable modeling approach was used to evaluate the interrelationships among socioeconomic status, perceived neighborhood disadvantage, social support, negative affect, and BMI among smokers recruited from the Houston metropolitan area (N = 424).
Results
A total of 42.4% of participants were obese, with the highest prevalence of obesity among Latinos followed by African Americans. Across all racial/ethnic groups, perceived neighborhood disadvantage, social support, and negative affect functioned as pathways linking socioeconomic status and BMI.
Conclusions
Findings indicate the need for interventions that target obesity among socioeconomically disadvantaged smokers and provide potential intervention targets for the prevention and treatment of obesity.
doi:10.5993/AJHB.37.5.2
PMCID: PMC3903428  PMID: 23985281
socioeconomic status; African American; Latino; race; smoking; BMI
8.  The Effects of Varenicline and Bupropion-SR plus Intensive Counseling on Prolonged Abstinence from Smoking, Depression, Negative Affect and Other Symptoms of Nicotine Withdrawal 
JAMA psychiatry  2013;70(5):522-533.
Context
Smoking cessation clinical trial
Objective
Assess the relative efficacy of bupropion and varenicline on smoking cessation and emotional functioning.
Design
Placebo controlled randomized clinical trial
Setting
University Medical Center
Patients
294 community volunteers who wanted to quit smoking
Interventions
12 weeks of Varenicline, Bupropion-SR, or Placebo plus intensive smoking cessation counseling (10 sessions ~240 minutes).
Main Outcome Measures
Prolonged abstinence from smoking, and weekly measures of depression, negative affect and other symptoms of nicotine withdrawal
Results
Significant differences were found in abstinence at the end of treatment and through the 3-month post-quit follow-up favoring both active medications vs. placebo At the 6 month follow-up only the varenicline vs. placebo comparison remained significant. Varenicline was also associated with a generalized suppression of depression and reduced smoking reward compared to the other treatments, while both medications improved concentration, reduced craving, and decreased negative affect and sadness compared to placebo, while having little impact (increase or decrease) on anxiety and anger. No differences were noted in self-reported rates of neuropsychiatric adverse events.
Conclusions
Varenicline exerts a robust and favorable impact on smoking cessation relative to placebo and may have a favorable (suppressive effect) on symptoms of depression and other affective measures with no clear unfavorable impact on neuropsychiatric adverse events in a community sample
doi:10.1001/jamapsychiatry.2013.678
PMCID: PMC4128024  PMID: 23536105
9.  Lower health literacy predicts smoking relapse among racially/ethnically diverse smokers with low socioeconomic status 
BMC Public Health  2014;14:716.
Background
Nearly half of U.S. adults have difficulties with health literacy (HL), which is defined as the ability to adequately obtain, process, and understand basic health information. Lower HL is associated with negative health behaviors and poor health outcomes. Racial/ethnic minorities and those with low socioeconomic status (SES) are disproportionately affected by poor HL. They also have higher smoking prevalence and more difficulty quitting smoking. Thus, lower HL may be uniquely associated with poorer cessation outcomes in this population.
Methods
This study investigated the association between HL and smoking cessation outcomes among 200, low-SES, racially/ethnically diverse smokers enrolled in smoking cessation treatment. Logistic regression analyses adjusted for demographics (i.e., age, gender, race/ethnicity, relationship status), SES-related characteristics (i.e., education, income), and nicotine dependence were conducted to investigate associations between HL and smoking relapse at the end of treatment (3 weeks post quit day).
Results
Results indicated that smokers with lower HL (score of < 64.5 on the Rapid Estimate of Adult Literacy in Medicine [REALM]) were significantly more likely than those with higher HL (score of ≥ 64.5 on the REALM) to relapse by the end of treatment, even after controlling for established predictors of cessation including demographics, SES, and nicotine dependence (OR = 3.26; 95% CI = 1.14, 9.26).
Conclusions
Findings suggest that lower HL may serve as an independent risk factor for smoking relapse among low-SES, racially/ethnically diverse smokers enrolled in treatment. Future research is needed to investigate longitudinal relations between HL and cessation outcomes and potential mechanisms of this relationship.
doi:10.1186/1471-2458-14-716
PMCID: PMC4226955  PMID: 25018151
Health literacy; Smoking cessation; Health disparities
10.  Associations of perceived neighborhood physical and social environments with physical activity and television viewing in African American men and women 
American journal of health promotion : AJHP  2013;27(6):10.4278/ajhp.120306-QUAN-127.
Purpose
Few studies have assessed how attributes of neighborhood environments contribute to sedentary, in addition to active, behaviors. This study investigated associations of perceived social and physical aspects of neighborhood environments with television (TV) viewing and physical activity (PA) in African American adults.
Design
Cross-sectional analysis of self-reported survey.
Setting
Large mega-church in Houston, TX.
Subjects
1,374 African American men and women.
Measures
Outcomes included log-transformed daily TV viewing and participation in medium/high levels of PA, measured by the short version of the International Physical Activity Questionnaire. Neighborhood perceptions were assessed with the Social Cohesion and Trust and the Neighborhood Problems scales.
Analysis
Multivariable models that controlled for clustering within neighborhoods.
Results
Reporting more neighborhood problems was significantly associated with greater log-transformed TV viewing in women (β=0.017, SE=0.006, p=0.003), and social cohesion was positively associated with PA in women (OR=1.06, 95% CI=1.02, 1.11, p=0.006). Concerns about litter and walking after dark, and a lack of places to shop were associated with increased TV viewing among women, and concerns about traffic and walking after dark were associated with reduced PA among men.
Conclusion
Physical and social neighborhood conditions were associated with TV viewing and PA, particularly in women. Neighborhood-based strategies to reduce sedentary behaviors and enhance PA should include attention to social as well as physical aspects of neighborhood environments.
doi:10.4278/ajhp.120306-QUAN-127
PMCID: PMC3880192  PMID: 23398134
physical activity; television viewing; African American; neighborhood; social environment
11.  Lifestyle and Cancer Prevention in Women: Knowledge, Perceptions, and Compliance with Recommended Guidelines 
Journal of Women's Health  2013;22(6):487-493.
Abstract
Background
Most women in the United States do not meet minimum recommendations for physical activity or fruit/vegetable consumption. Thus, many are overweight/obese and are at increased risk for cancer morbidity and mortality. This study investigated women's perceptions about the importance of physical activity and a healthy diet in preventing cancer, perceptions of engaging in these behaviors, and whether or not the behaviors met cancer prevention recommendations.
Method
A cross-sectional, national, random-digit-dialed telephone survey was conducted with 800 women, ages 18 and older. The response rate was 24.5%. Measures assessed demographics, perceived health status, beliefs about the role of physical activity and diet in cancer prevention, perceived engagement in these behaviors, and actual behaviors.
Results
Only 9.9% of women who reported eating a healthy diet met minimum fruit and vegetable recommendations; 39.7% of women who reported regular physical activity met the minimum recommendation. Analyses adjusted for demographics indicated that low education was associated with reporting regular physical activity to prevent cancer, yet failing to meet the minimum recommendation (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.82–0.98, p=0.01). Racial/ethnic minority status was marginally significantly associated with reporting eating a healthy diet to prevent cancer, yet failing to consume sufficient fruits and vegetables (OR=2.94, 95% CI: 0.99–8.71, p=0.05).
Conclusions
Most women who reported eating a healthy diet and being physically active to prevent cancer failed to meet the minimum cancer prevention recommendations. Furthermore, low socioeconomic status and racial/ethnic minority women may be particularly vulnerable to discrepancies between beliefs and behavior.
doi:10.1089/jwh.2012.4015
PMCID: PMC3678579  PMID: 23751163
12.  Cigarette cues capture smokers’ attention: Evidence from event-related potentials 
Psychophysiology  2010;47(3):435-441.
Before starting a smoking cessation treatment, 51 smokers took part in a study aimed at investigating brain mechanisms associated with attention allocation. ERPs to acoustic startle probes were recorded from 129 sensors during the presentation of neutral, pleasant, unpleasant, and cigarette-related pictures. Results indicated that the amplitude of the startle probe P3 component was reduced for pleasant, unpleasant, and cigarette-related conditions relative to neutral. Surface Laplacian estimates showed that sources of electrocortical activity under frontal and parietal sensors contributed to the modulation of this effect. For smokers, cigarette-related stimuli, like intrinsically motivating ones, capture attentional resources and therefore reduce the ability to process competing stimuli. The depletion of attentional resources in the presence of cigarette-related cues may contribute to the high relapse rate observed during smoking quit attempts.
doi:10.1111/j.1469-8986.2009.00946.x
PMCID: PMC4037813  PMID: 20070579
Smoking; Attention; ERP; P3; Startle; Emotion
14.  Efficacy of Ask Advise Connect in a Safety Net Healthcare System 
Background
Since smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The US Public Health Service recommends that all patients be asked about their smoking at every visit, and that smokers be given brief advice to quit and referred to treatment.
Purpose
Initiatives to facilitate these practices include the 5 A’s (i.e., Ask, Advise, Assess, Assist, Arrange) and Ask Advise Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask Advise Connect (AAC) approach to linking smokers with treatment in a large, safety-net public healthcare system.
Design
Pair-matched-two-treatment arm group-randomized trial.
Setting/participants
Ten safety-net clinics in Houston, TX.
Intervention
Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed Vocational Nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record (EHR). Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas Quitline daily, and patients were proactively called within 48 hours. In AAR, smokers were offered a Quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012.
Main Outcome Measure
The primary outcome – impact – was defined as the proportion of identified smokers that enrolled in treatment.
Results
The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t (4) = 14.61, p = 0.0001, OR = 32.10 (95% CI 16.60–62.06).
Conclusions
AAC has tremendous potential to reduce tobacco-related health disparities.
doi:10.1016/j.amepre.2013.07.011
PMCID: PMC4023543  PMID: 24237916
15.  Alpha Oscillations in Response to Affective and Cigarette-Related Stimuli in Smokers 
Nicotine & Tobacco Research  2012;15(5):917-924.
Introduction:
The presence of cigarette-related cues has been associated with smoking relapse. These cues are believed to activate brain mechanisms underlying emotion, attention, and memory. Electroencephalography (EEG) alpha desynchronization (i.e., reduction in alpha power) has been suggested to index the engagement of these mechanisms. Analyzing EEG alpha desynchronization in response to affective and smoking cues might improve our understanding of how smokers process these cues, and the potential impact of this processing on relapse.
Methods:
Before the start of a medication-assisted cessation attempt, we recorded EEG from 179 smokers during the presentation of neutral, pleasant, unpleasant, and cigarette-related pictures. Wavelet analysis was used to extract EEG alpha oscillations (8–12 Hz) in response to these pictures. Alpha oscillations were analyzed as a function of picture valence and arousal dimensions.
Results:
Emotional and cigarette-related stimuli induced a higher level of alpha desynchronization (i.e., less power in the alpha frequency band) than neutral stimuli. In addition, the level of alpha desynchronization induced by cigarette-related stimuli was similar to that induced by highly arousing stimuli (i.e., erotica and mutilations).
Conclusions:
These results suggest that, for smokers, cigarette-related cues are motivationally significant stimuli that may engage emotional, attentional, and memory-related neural mechanisms at a level comparable to that seen in response to highly arousing stimuli. This finding suggests that activation of emotional, attentional, and memory-related brain mechanisms may be an important contributor to cue-induced smoking relapse.
doi:10.1093/ntr/nts209
PMCID: PMC3621581  PMID: 23060019
16.  Race Moderates the Effect of Menthol Cigarette Use on Short-Term Smoking Abstinence 
Nicotine & Tobacco Research  2013;15(5):883-889.
Introduction:
The Food and Drug Administration is in the process of reviewing evidence of the impact of mentholated cigarettes on smoking behaviors and smoking cessation in order to determine if these products should be removed from the market. More empirical research is needed to inform those decisions. The goal of this study was to examine associations of menthol cigarette use with biochemically verified continuous short-term smoking abstinence, and potential moderation by race, among adult current smokers enrolled in a cohort study (N = 183; 57.4% female; 48.1% non-Hispanic Black, 51.9% non-Hispanic White).
Methods:
Continuation ratio logit models, adjusted for age, race, gender, total annual household income, educational level, employment status, and partner status, were used to examine associations of menthol use with smoking abstinence with and without an interaction term for race.
Results:
Menthol cigarette use was not significantly associated with smoking abstinence in the sample as a whole; however, there was a significant interaction of menthol use with race (p = .03). Follow-up analyses stratified by race indicated that among White participants, menthol users had significantly lower odds of maintaining continuous abstinence than nonmenthol users (p = .05). Exploratory analyses suggested that tobacco dependence may lie along the causal pathway and partially explain this effect.
Conclusions:
White menthol smokers in this sample were at increased risk of smoking relapse relative to White nonmenthol smokers, at least partially due to greater tobacco dependence. Results should be replicated among other treatment-seeking samples with a greater representation of White menthol and Black nonmenthol smokers.
doi:10.1093/ntr/nts335
PMCID: PMC3621585  PMID: 23288873
17.  Neighborhood Vigilance, Health Locus of Control, and Smoking Abstinence 
Objectives
To examine whether health locus of control mediated relations of self-reported neighborhood vigilance and biochemically verified, continuous short-term smoking abstinence among 200 smokers enrolled in a cohort study.
Methods
A nonparametric bootstrapping procedure was used to assess mediation.
Results
Health locus of control-chance mediated relations between neighborhood vigilance and smoking abstinence in analyses adjusted for sociodemographics and tobacco dependence (p < .05). Greater vigilance was associated with greater attributions that health was affected by chance, which was associated with a lower likelihood of smoking abstinence.
Conclusions
Results suggest that neighborhood perceptions influence residents’ attributions for health outcomes, which can affect smoking abstinence.
doi:10.5993/AJHB.37.3.6
PMCID: PMC3761415  PMID: 23985180
neighborhood vigilance; neighborhood threat; smoking cessation; locus of control; chance attributions
18.  The Relation between Social Cohesion and Smoking Cessation among Black Smokers, and the Potential Role of Psychosocial Mediators 
Background
Social cohesion, the self-reported trust and connectedness between neighbors, may affect health behaviors via psychosocial mechanisms.
Purpose
Relations between individual perceptions of social cohesion and smoking cessation were examined among 397 Black treatment-seeking smokers.
Methods
Continuation ratio logit models examined the relation of social cohesion and biochemically-verified continuous smoking abstinence through 6 months post-quit. Indirect effects were examined in single mediator models using a nonparametric bootstrapping procedure. All analyses controlled for sociodemographics, tobacco dependence, and treatment.
Results
The total effect of social cohesion on continuous abstinence was non-significant (β=.05, p=.10). However, social cohesion was associated with social support, positive affect negative affect, and stress, which, in turn, were each associated with abstinence in adjusted models (ps<.05).
Conclusions
Results suggest that social cohesion may facilitate smoking cessation among Black smokers through desirable effects on psychosocial mechanisms that can result from living in a community with strong interpersonal connections.
doi:10.1007/s12160-012-9438-6
PMCID: PMC3587036  PMID: 23135831
social cohesion; neighborhood trust; smoking cessation; mediation
19.  Pathways Linking Socioeconomic Status and Postpartum Smoking Relapse 
Background
Low socioeconomic status (SES) exacerbates the high rate of smoking relapse in women following childbirth.
Purpose
This study examined multiple models of potential mechanisms linking SES and postpartum smoking relapse among women who quit smoking due to pregnancy.
Methods
Participants were 251 women enrolled in a randomized clinical trial of a new postpartum smoking relapse prevention intervention. Four models of the prepartum mechanisms linking SES and postpartum smoking relapse were evaluated using a latent variable modeling approach.
Results
Each of the hypothesized models were a good fit for the data. As hypothesized, SES indirectly influenced postpartum smoking relapse through increased prepartum negative affect/stress, reduced sense of agency, and increased craving for cigarettes. However, the model that included craving as the sole final pathway between SES and relapse demonstrated superior fit when compared with all other models.
Conclusions
Findings have implications for future interventions that aim to reduce postpartum relapse.
doi:10.1007/s12160-012-9434-x
PMCID: PMC3854787  PMID: 23086590
Smoking; Postpartum; Structural Equation Modeling; Relapse; Socioeconomic Status
20.  The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U.S.-Mexico border 
BMC Public Health  2014;14:176.
Background
The prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border.
Methods
The characteristics of Mexican Americans with diabetes living in Brownsville, TX (N = 492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c).
Results
Participants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c).
Conclusions
Overall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.
doi:10.1186/1471-2458-14-176
PMCID: PMC3929559  PMID: 24548487
21.  Alcohol Consumption and Urges to Smoke among Women during a Smoking Cessation Attempt 
Experimental and clinical psychopharmacology  2013;21(1):10.1037/a0031009.
Laboratory and ad libitum smoking studies have indicated that alcohol consumption increases the frequency and intensity of smoking urges. However, few studies have examined the relation between smoking urges and alcohol use in natural settings during a quit attempt. The purpose of this study was to examine the relationships between smoking urge and alcohol use in women who reported drinking on at least one occasion during the first 7 days of a smoking quit attempt (N = 134). Participants were asked to use a palmtop computer to complete assessments that recorded smoking urges and recent alcohol use. Multilevel analyses examined the relation between smoking urge parameters and alcohol use. Smoking urges were higher during assessments where alcohol had been recently consumed compared to assessments where no alcohol had been consumed. Interestingly, the first urge rating of the day was higher and urges were more volatile on days where alcohol would eventually be consumed as compared to days where no alcohol was consumed. A closer examination of urge parameters on drinking days indicated that smoking urge trajectory was significantly flatter and urge volatility was significantly higher following alcohol consumption. However, smoking urge trajectory also flattened later in the day on nondrinking days. The findings suggest that there may be reciprocal relations between smoking urge and alcohol use (e.g., higher initial urges and more volatile urges may increase the likelihood of alcohol use; and, alcohol use may impact within day smoking urge parameters), and these relations could potentially impact smoking cessation and relapse.
doi:10.1037/a0031009
PMCID: PMC3854865  PMID: 23379613
Smoking; Smoking urge; Alcohol; Ecological Momentary Assessment; Multilevel Analysis
22.  Subjective Social Status and Health Behaviors Among African Americans 
Objectives
To examine associations of the US and community subjective social status (SSS) ladders with smoking status, at-risk drinking, fruit and vegetable intake, physical activity, and body mass index among 1467 church-going African American adults from a larger cohort study.
Methods
Regression analyses, adjusted for sociodemographics, examined associations between SSS ladders and health behaviors.
Results
The SSS-US ladder was significantly associated with fruit and vegetable consumption (p = .007) and physical activity (p = .005). The SSS-community ladder was not significantly associated with any health behaviors.
Conclusions
Among this sample of African Americans, the SSS-US ladder is more predictive of some health behaviors than is the SSS-community ladder.
doi:10.5993/AJHB.37.1.12
PMCID: PMC3433853  PMID: 22943107
African Americans; social status; cancer risk behavior; physical activity; fruit and vegetable intake
23.  Associations Between Health Literacy and Established Predictors of Smoking Cessation 
American journal of public health  2013;103(7):e43-e49.
Objectives
We examined associations between health literacy and predictors of smoking cessation among 402 low-socioeconomic status (SES), racially/ethnically diverse smokers.
Methods
Data were collected as part of a larger study evaluating smoking health risk messages. We conducted multiple linear regression analyses to examine relations between health literacy and predictors of smoking cessation (i.e., nicotine dependence, smoking outcome expectancies, smoking risk perceptions and knowledge, self-efficacy, intentions to quit or reduce smoking).
Results
Lower health literacy was associated with higher nicotine dependence, more positive and less negative smoking outcome expectancies, less knowledge about smoking health risks, and lower risk perceptions. Associations remained significant (P < .05) after controlling for demographics and SES-related factors.
Conclusions
These results provide the first evidence that low health literacy may serve as a critical and independent risk factor for poor cessation outcomes among low-socioeconomic status, racially/ethnically diverse smokers. Research is needed to investigate potential mechanisms underlying this relationship.
doi:10.2105/AJPH.2012.301062
PMCID: PMC3682601  PMID: 23678912
24.  Ask Advise Connect: A New Approach to Smoking Treatment Delivery in Healthcare Settings 
JAMA internal medicine  2013;173(6):10.1001/jamainternmed.2013.3751.
Background
Several national healthcare-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments such as those delivered by quitlines. The most notable examples are the 5 A’s (i.e., Ask, Advise, Assess, Assist, Arrange) and Ask Advise Refer (AAR). Unfortunately, primary care referrals to quitlines are low and the majority of smokers referred fail to call for assistance. This study evaluated a new approach -Ask Advise Connect (AAC) - designed to address barriers to linking smokers with treatment.
Methods
A pair-matched-two-treatment arm group-randomized design in 10 family practice clinics in the Houston, TX metropolitan area was utilized. Five clinics were randomized to AAC (intervention) and five were randomized to AAR (control). In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record (EHR), and smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Quitline daily, and patients were proactively called by the Quitline within 48 hours. In AAR, smokers were offered a Quitline referral card and encouraged to call on their own. All data were collected between February and December 2011. The primary outcome – impact – was based on the RE-AIM conceptual framework. Impact was defined as the proportion of all identified smokers that enrolled in treatment.
Results
In AAC, 7.8% of all identified smokers enrolled in treatment versus 0.6% in AAR (t(4)=9.19, p=0.0008, OR=11.60 (95% CI 5.53-24.32), a 13-fold increase in the proportion of smokers enrolling in treatment in AAC compared to AAR.
Conclusions
The system changes implemented in AAC could be adopted broadly by other healthcare systems and AAC has tremendous potential to reduce tobacco-related morbidity and mortality.
doi:10.1001/jamainternmed.2013.3751
PMCID: PMC3858085  PMID: 23440173
25.  Associations between indicators of acculturation and tobacco dependence among Spanish-speaking Latino smokers 
Addictive Behaviors  2012;37(10):1101-1108.
The current study utilized regression analyses to explore the relationships among demographic and linguistic indicators of acculturation, gender, and tobacco dependence among Spanish-speaking Latino smokers in treatment. Additionally, bootstrapping analyses were used to examine the role of dependence as a mediator of the relationship between indicators of acculturation and cessation. Indicators of time spent in the United States were related to indicators of physical dependence. Preferred media was related to a multidimensional measure of dependence. Gender did not impact the relationships between acculturation indicators and dependence. A multidimensional measure of dependence significantly mediated the relationship between preferred media language and cessation. Future research would benefit from consideration of acculturation and multidimensional measures of dependence when studying smoking cessation among Latinos, and from further examination of factors accounting for relationships among acculturation, dependence, and cessation.
doi:10.1016/j.addbeh.2012.05.003
PMCID: PMC3389212  PMID: 22688345
acculturation; tobacco dependence; Latinos; smoking cessation

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