Suicidality prospectively predicts greater urges to smoke following a cessation attempt: Mediation through perceived barriers to cessation

Abstract

Growing interest in developing more effective smoking cessation treatments has facilitated the need to further investigate cognitive-affective factors that inhibit successful smoking cessation, such as urges to smoke. Research has strongly supported an association between suicidality and smoking, yet no work has investigated whether suicidality may increase urges to smoke. The current study sought to evaluate the impact of suicidality on smoking-related cognitive-affective factors predictive of smoking relapse among a community sample of 209 daily smokers engaged in a smoking cessation program. Structural equation modeling (SEM) was used to test the effects of self-reported pre-cessation suicidality on urges to smoke 1 month post-cessation as well as whether this effect was mediated by greater barriers to cessation. Results indicated that internal barriers to cessation significantly mediated the effect of pre-cessation suicidality on greater urges to smoke 1 month following smoking cessation attempt. These findings suggest that elevated suicidality may affect perceived internal barriers to cessation and subsequently urges to smoke 1 month following a quit attempt.

Psychometric evaluation of the Barriers to Cessation Scale.

“…Unlike prior work (Albanese et al, 2016;Macnee & Talsma, 1995a), the BCS did not differentiate quitters from nonquitters. Indeed, quitters and nonquitters at quit day reported similar baseline scores across the BCS total score and its subscales, after controlling for gender, baseline tobacco dependence, and condition.…”

“…Future work may consider replicating the present study with a sample of smokers from the general population not presently interested in quitting. Third, although guided by prior work and content evaluation (Albanese et al, 2016; Steenkamp & Baumgartner, 1998), modification indices were utilized to assist with improving model fit and demonstrating measurement invariance. Considering that the data were modified and then reanalyzed, there is an increased likelihood of sampling error.…”

“…Regarding the total score, although the one-factor model resulted in an overall poor factor solution for the BCS, the higher order factor structure provided a parsimonious, well-fitting measurement model that explained unique covariance between items and subscales. The first-order structure was slightly modified based on findings from the three-factor comparison model and prior research (Albanese et al, 2016). Specifically, the current three-factor model deviated slightly from the original model (Macnee & Talsma, 1995a), such that Item 17 (“Seeing things or people which remind you of smoking”) loaded poorly on the External subscale and was better accounted for by the Addiction subscale.…”

“…Finally, limited work has examined the relation between the BCS and abstinence or severity of withdrawal symptoms. Although the BCS has been found to differentiate quitters from nonquitters after a quit attempt (Albanese et al, 2016; Macnee & Talsma, 1995a), this work has focused on posttreatment assessments of BCS to predict abstinence at the same or later time point. Thus, it remains unknown whether pretreatment BCS scores might have clinical utility to identify smokers who may experience more difficulty quitting.…”

“…Of the available work, the Addiction and External subscales have demonstrated some initial clinical utility to differentiate exclusive cigarette smokers from smokers who use multiple tobacco products (El-Shahawy & Haddad, 2015) as well as identify a smoker's stage of change and readiness to change (Haddad & Petro-Nustas, 2006). Other work has found that the Addiction and Internal subscales assessed at quit day are related to abstinence at 1-month postquit (Albanese et al, 2016).…”