Objective Depressive symptoms are associated with poor smoking cessation outcomes and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology. This pilot study examined whether a behavioral activation treatment for smoking can enhance cessation outcomes. Method A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years old, 48.5% female, 72.7% African-American) seeking smoking cessation treatment were randomized to receive either behavioral activation treatment for smoking (BATS) paired with standard smoking cessation strategies including nicotine replacement therapy (n = 35) or standard smoking cessation strategies (ST) alone including nicotine replacement therapy (n = 33). BATS and ST were matched for contact time and included 8 sessions of group-based treatment. Quit date was assigned to occur at session 4 for each treatment condition. Participants completed a baseline assessment, and measures of smoking cessation outcomes (7-day verified point prevalence abstinence), depressive symptoms (BDI-II), and enjoyment from daily activities (EROS) were obtained at 1, 4, 16, and 26 weeks post assigned quit date. Results Across the follow-ups over 26 weeks, participants in BATS reported greater smoking abstinence (adjusted odds ratio = 3.59; 95% confidence interval = 1.22, 10.53; p =.02) than did those in ST. Participants in BATS also reported a greater reduction in depressive symptoms (B = -1.99, SE = .86, p = .02) than did those in ST. Conclusions Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse backgrounds.

Delay discounting (DD) and probability discounting (PD) refer to the reduction in the subjective value of outcomes as a function of delay and uncertainty, respectively. Elevated measures of discounting are associated with a variety of maladaptive behaviors, and confidence in the validity of these measures is imperative. The present research examined (1) the statistical equivalence of discounting measures when rewards were hypothetical or real, and (2) their 1-week reliability. While previous research has partially explored these issues using the low threshold of nonsignificant difference, the present study fully addressed this issue using the more-compelling threshold of statistical equivalence. DD and PD measures were collected from 28 healthy adults using real and hypothetical $50 rewards during each of two experimental sessions, one week apart. Analyses using area-under-the-curve measures revealed a general pattern of statistical equivalence, indicating equivalence of real/hypothetical conditions as well as 1-week reliability. Exceptions are identified and discussed.

The study examined discrepancies in mother and child reports of parental knowledge (PK) of a child's whereabouts, activities, and companions, as well as the extent to which discrepancies in reports of PK are related to child risk-taking behavior concurrently and prospectively across two time points. The sample consisted of 219 mother and early adolescent youth (Mn age = 11.0, SD = .8) dyads. Mother and child reports of PK significantly differed and, at both waves, scores on the risk taking composite related negatively to both mother and child reports of PK and positively to the discrepancy between the two reports. A significant interaction between mother and child reports was found at wave 2, such that the relation between child reported PK and risk behavior was stronger when mothers reported high levels of parental knowledge versus low levels of parental knowledge. Prospective analyses indicated a main effect of mother report. KeywordsParental Knowledge; Discrepancy; Risk Behavior; Early Adolescence Early adolescence, typically defined as ages 10 to 14 years, is a critical developmental period during which engagement in risky behaviors emerges. In particular, there often is a significant increase in the onset of substance use (Donovan, 2007), delinquency (Moffitt, Caspi, Harrington, & Milne, & 2002), and other health-compromising behaviors (DiClemente, Hansen, & Ponton, 1996;Smith-Khuri et al., 2004). Both concurrently and prospectively, one factor consistently associated with and considered to be an important predictor of the emergence of risk behavior engagement is parental knowledge, defined as knowledge of a child's whereabouts, activities, and companions . It is notable that the term parental monitoring initially was the commonly accepted term for this variable but Stattin and Kerr (2000) argued that unless active parental monitoring was measured (i.e., tracking and surveillance), the narrower construct of "parental knowledge" is more appropriate.Studies examining the relation between parental knowledge and adolescent risk behavior have shown that lower levels of parental knowledge are associated with alcohol and illicit drug use (Chilcoat & Anthony, 1996;DiClemente, et. al., 2001;Lahey, Van Hulle, D'Onofrio, Rodgers, & Waldman 2008), cigarette smoking (Lahey et. al., 2008), risky sexual behaviors (DiClemente, et. al., 2001;Sneed, Strachman, Nguyen, & Morisky, 2009) Correspondence concerning this article should be addressed to Elizabeth K. Reynolds, Department of Psychology, Biology Psychology Building, University of Maryland, College Park, MD 20742. ereynolds@psyc.umd.edu (Slovak & Singer, 2001). It is possible that parental knowledge is not as much a byproduct of parental practices (e.g., tracking, surveillance) but that parents receive information about their adolescent's activities through the adolescent's self-disclosure . Consequently, higher levels of child disclosure have been found to correspond with lower levels of rule breaking among adolescents , later initiation to and lower rates o...

Despite a robust association between borderline personality disorder (BPD) and emotion dysregulation, evidence of within-BPD group differences in emotion regulation (ER) difficulties highlights the need to examine factors that increase the risk for ER difficulties within BPD. One factor that warrants consideration is co-occurring avoidant personality disorder (AVPD), the presence of which is associated with worse outcomes in and outside of BPD and theorized to interfere with adaptive ER. Thus, this study examined if co-occurring AVPD among women with BPD is associated with heightened ER difficulties (assessed across self-report, behavioral, and physiological domains). Participants included 39 women with BPD (13 with co-occurring AVPD) and 18 women without BPD. Although results revealed no significant differences in overall self-reported ER difficulties (or the specific dimensions involving emotional clarity and the control of behaviors when distressed) between BPD participants with and without AVPD (with both groups reporting greater ER difficulties than non-BPD participants), other ER difficulties were found to be heightened among BPD participants with AVPD. Specifically, BPD participants with (vs. without) AVPD reported greater difficulties accessing effective ER strategies, evidenced less willingness to experience distress on a laboratory stressor, and exhibited a greater decrease in high frequency heart rate variability in response to this stressor (indicative of poor ER capacity). Findings add to the literature on ER difficulties in BPD, suggesting that co-occurring AVPD within BPD may be associated with a lower capacity for regulating distress and greater difficulties accessing effective ER strategies, potentially leading to greater efforts to avoid emotional distress.

This manuscript provides a comprehensive review of CBT treatments for PDs, including a description of the available treatments and empirical support, drawing on research published between 1980 and 2009. Research generally supports the conclusion that CBT is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with PDs, thereby making it a useful framework for clinicians working with patients with PD symptomotology. However, there is clear need for further the development and evaluation to provide specific and more unambiguous treatment recommendations, with particular relevance for understudied PDs.

The purpose of this study was to evaluate how psychological stress, gender and cortisol response to stress relate to risk behavior among 132 14–18 year old adolescents. Participants completed a laboratory based risk task prior to and immediately after a computerized psychological stress task, and salivary cortisol was collected from pre-stress to 60 minutes following initial stress exposure. Results indicate that adolescent boys (n = 59) and girls (n = 73) demonstrate different patterns of risk taking (RT) in response to stress, such that boys evidenced an increase in RT following stress exposure, whereas girls evidenced a decrease in RT. In addition, a gender by cortisol interaction demonstrated that for boys, both a smaller total cortisol output (AUCg) and peak cortisol response to stress (PC) was associated with greater stress-induced RT. Both cortisol measures were unrelated to stress-induced RT among girls. Taken together, data suggest that among boys, a blunted cortisol response to stress underlies an increase in risk taking in the context of psychological stress. Further research with an additional behavioral stress task is needed prior to drawing conclusions regarding the relation between female gender, cortisol response to stress, and risk taking in the context of psychological stress.

Objectives To assess interest in, concerns about and knowledge of long-acting reversible contraceptives (LARC) among women in medication-assisted treatment (MAT) for opioid use disorder who were at risk of unintended pregnancy. Study Design Women in MAT completed a survey on contraceptive use, attitudes, and knowledge, including LARC methods, as part of eligibility screening for an ongoing trial evaluating family planning interventions for this population. Results Eighty-three women at risk of unintended pregnancy completed the survey, and a subset of 51 completed supplemental questions about implants. All participants had heard of IUDs and 75/83 (90%) had heard of implants, but only 34/83 (41%) and 14/51 (27%) reported being likely to use IUDs and implants, respectively. Thirty-five women reported they were unlikely to use IUDs, with 29/35 (83%) citing unspecified “other reasons” for this position and 24/35 (69%) endorsing concerns about side effects. Seventeen women reported they were unlikely to use implants, with 8/17 (47%) citing “other reasons” and 9/17 (53%) and 10/17 (59%) reporting concerns about insertion and removal, respectively. Participants reported they knew “a little” about LARCs, but only their knowledge of implants was limited. Only 50/83 (60%) participants were aware of the superior effectiveness of IUDs and 26/51 (51%) were aware of the superior effectiveness of implants relative to other reversible methods. Conclusions Participants reported relatively low interest in LARCs. Many women had unspecified reasons for not using LARCs. Participants also lacked information about LARC safety and effectiveness, especially with regard to implants.

IMPORTANCERates of in utero opioid exposure continue to increase in the US. Nearly all of these pregnancies are unintended but there has been little intervention research addressing this growing and costly public health problem.OBJECTIVE To test the efficacy and cost-benefit of onsite contraceptive services with and without incentives to increase prescription contraceptive use among women with opioid use disorder (OUD) at high risk for unintended pregnancy compared with usual care. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial of 138 women ages 20 to 44 years receiving medication for OUD who were at high risk for an unintended pregnancy at trial enrollment between May 2015 and September 2018. The final assessment was completed in September 2019. Data were analyzed from October 2019 to March 2021. Participants received contraceptive services at a clinic colocated with an opioid treatment program.INTERVENTIONS Participants were randomly assigned to receive 1 of 3 conditions: (1) usual care (ie, information about contraceptive methods and community health care facilities) (n = 48); (2) onsite contraceptive services adapted from the World Health Organization including 6 months of follow-up visits to assess method satisfaction (n = 48); or (3) those same onsite contraceptive services plus financial incentives for attending follow-up visits (n = 42).MAIN OUTCOMES AND MEASURES Verified prescription contraceptive use at 6 months with a cost-benefit analysis conducted from a societal perspective. RESULTSIn this randomized clinical trial of 138 women (median age, 31 years [range, 20-44 years]), graded increases in verified prescription contraceptive use were seen in participants assigned to usual care (10.4%; 95% CI, 3.5%-22.7%) vs contraceptive services (29.2%; 95% CI, 17.0%-44.1%) vs contraceptive services plus incentives (54.8%; 95% CI, 38.7%-70.2%) at the 6-month end-of-treatment assessment (P < .001 for all comparisons). Those effects were sustained at the 12-month final assessment (usual care: 6.