1. 1 Impact of Depression History on Tobacco Withdrawal and Relapse Among Female Smokers David W. Wetter, Ph.D. Department of Behavioral Science Funded by grants from the National Institute on Drug Abuse and the National Cancer Institute.

2. 2 Collaborators UT M.D. Anderson Cancer Center Paul Cinciripini Ludmila Cofta-Gunn GHC Center for Health Studies Jennifer McClure Simon Fraser University Rachel Fouladi

3. 3 Study Purpose Examine the impact of depression history on relapse vulnerability among women. Examine the impact of depression history on acute tobacco withdrawal during the first postcessation week among women. Withdrawal-related constructs were assessed using standard questionnaires and ecological momentary assessments (EMA). Preliminary data are from a just completed clinical trial examining the efficacy of a palmtop computer-delivered treatment among women smokers.

4. 4 Depression and a History of Depression Are: More prevalent among smokers than nonsmokers. More tightly linked to dependent than nondependent smoking. Associated with a decreased likelihood of quitting smoking. More prevalent among women than men (life-time major depression rates of 10-25% for women and 5- 12% for men).

5. 5 Tobacco Withdrawal Trajectories as Key Mechanisms/Outcome Variables Withdrawal trajectories have illuminated NRT versus placebo effects, gender differences in response to NRT, and differences associated with a history of depression (Wetter and colleagues). Differential withdrawal trajectories over the first 1-2 months after quitting smoking are associated with relapse (Piasecki, Baker and colleagues). Both negative affect and urge trajectories appear to independently contribute to the prediction of relapse. Abstinence is a gross measure of the process of quitting, is easily influenced by acute and unpredictable events, and is insensitive to subtle effects.

6. 6 Project WIN “Women’s INtervention”

7. 7 Participant Characteristics By Depression History * p<.05

8. 8 Percent Abstinence By Depression History

9. 9 Potential Mediators/Confounders Demographics (age, race, education) Nicotine dependence Smoking outcome expectancies Self-efficacy Affect (CES-D, PANAS) Perceived Stress

10. 10 Questionnaire Measures of Withdrawal Urge subscale from the Wisconsin Smoking Withdrawal Scale Negative Affect subscale from the Wisconsin Smoking Withdrawal Scale

11. 11 EMA Procedures and Items Hardware and software: Casio palmtop computer running Windows CE and custom EMA software. Rationale for EMA: Data used to individualize each woman’s computer-delivered treatment. Sampling: At random and during temptations/urges during the first postcessation week. EMA Items (prefaced with “right now”) Urge: How strong is your urge to smoke? (no urge, weak, moderate, strong, severe) Negative Mood: My mood is negative. (Definitely NO, Mostly NO, Mostly YES, Definitely YES)

12. 12 EMA (continued) Random assessments: * 4/day were scheduled * Compliance was 81% * 92% of completed assessments begun within 30 seconds of the initial signal * 98% of completed assessments begun within 5 minutes of initial signal Temptation assessments * Completed approximately 3/day

13. 13 Data Analytic Approach Mixed-model regression analyses (PROC MIXED) predicting questionnaire and EMA items with and without covariates. Covariates: treatment, demographics (age, education, race/ethnicity), nicotine dependence (cigs/day, Fagerstrom), affect (PANAS, PSS, CES-D) Questionnaire analyses: Tested for main effects of time, depression history; 2-way interaction. EMA analyses: Tested for main effects of assessment type (random vs. temptation), time, depression history; all 2-way interactions; 3-way interaction. EMA data were not aggregated in the analyses, but were aggregated in the figures to facilitate presentation.

14. 14 WSWS Negative Affect

15. 15 WSWS Urge/Craving

16. 16 Questionnaire Data Summary Women with a positive history of depression exhibited differential withdrawal trajectories compared to women without a history of depression. Differences between depression history groups were most apparent during the postcessation period (i.e., the depression history groups exhibited differential responses to quitting).

17. 17 Negative Affect (EMA) Random Assessment Urge Assessment MDD+MDD-

18. 18 Urge (EMA) Random Assessment Urge Assessment MDD+MDD-

19. 19 EMA Data Summary Women with a positive history of depression exhibited differential withdrawal severity and trajectories compared to women without a history of depression. Differences between depression history groups were most apparent during random assessments (i.e., depression history positive and negative women look more similar during urge episodes than they do when examining random moments from their daily lives). These effects held after controlling for baseline demographic, nicotine dependence, affect, and stress related variables.

20. 20 Conclusions ??? Women with a history of major depression have lower rates of smoking cessation. The impact of depression history on relapse may be mediated by more severe negative reactions to quitting (i.e., less decline in craving and a greater increase in negative affect). Depression history effects may be more pronounced in disruptions in daily functioning than in increased severity of urge episodes.

21. 21 THE END