Positive Affect as a Predictor of Smoking Cessation and Relapse: Does It Offer Unique Predictive Value among Depressive Symptom Domains?

ABSTRACT

Background: Prior studies have suggested that, among the domains of depressive symptoms, low positive affect (PA) may have a distinct relationship with smoking cessation and relapse. However, the empirical basis for PA-focused interventions cessation is limited, with some mixed findings. Objectives: Using a large, diverse sample of treatment-seeking smokers, this study tested the hypothesis that PA adds unique predictive value beyond the effects of the other symptom domains in models of cessation and relapse. Methods: Adult smokers participating in a smoking cessation trial (n = 450) were included in this post hoc analysis. Cessation outcomes included smoking abstinence at end of treatment and at 6-month follow-up. Relapse was defined as recurrence of smoking at 6-month follow-up among the end-of-treatment abstainers. Depressive symptoms were assessed at baseline using the Center for Epidemiologic Studies-Depression (CES-D) scale. Results: With the exception of PA, all of the CES-D domains predicted reduced likelihood of smoking abstinence at end of treatment and cotinine-confirmed (but not self-reported) abstinence at 6 months, as did total CES-D score (all p-values < .05). None of the symptom domains predicted relapse. Conclusions/Importance: Our results provide further evidence that current depressive symptoms predict worse cessation outcomes, but they fail to support recent work suggesting that low PA has incremental predictive value for cessation or relapse beyond the other depressive symptom domains. To improve quit rates for smokers with depressive symptoms, evidence-based mood management interventions should be included in treatment planning.

KEYWORDS:

• Tobacco cessation
• nicotine
• mood

Acknowledgments

The authors wish to thank Katrina Akioka; Madelon Bolling, PhD, Wade Copeland, MS; Jessica Harris, MA; Jackie St. John; Karen Riggs; Mary Shea; and Emily Whitish, MA; for their assistance on the project. Group Health is now known as Kaiser Permanente Washington.

Financial disclosures

This work was supported by a grant from the National Cancer Institute at the National Institutes of Health (grant number R01CA151251, to JBB). The funding agency had no role in the study design; collection, analysis and interpretation of the data; the writing of this report; or the decision to submit this manuscript for publication. Dr. Bricker has served as a consultant for GlaxoSmithKline and serves on the advisory board of Chrono Therapeutics. None of the other authors have financial conflicts to disclose.