Available online 2 May 2023, 101480

Author links open overlay panel, , , , , , , AbstractBackground

Individuals with mobility impairments (MI; use equipment to ambulate) have a high prevalence of both smoking and depression. Behavioral Activation (BA) purports that depressed mood is remediated through valued activity engagement, and may facilitate smoking cessation in MI populations

Objective

We examined cross-sectional associations between activity engagement and variables important for smoking cessation among a high-risk group of smokers (people with MIs) and also describe a smoking cessation intervention based on BA, given the lack of studies on smokers with MIs.

Methods

This study used data from a smoking cessation trial enrolling smokers with MIs (n=263). We assessed valued activities, activity type, activity restriction due to MI, and replacement of restricted activities. Motivation and confidence to quit smoking, number of cigarettes per day, and mood were also assessed. Analysis was performed with generalized linear (or logistic) regression models adjusted for age and physical functioning using aggregated data at baseline.

Results

Greater number and frequency of valued activities was associated with less smoking, depression, negative affect, and stress; and higher positive affect and self-efficacy to quit. Activity restriction was associated with greater odds of major depression, and activity replacement with lower odds of major depression, lower stress, and higher positive affect and self-efficacy. Strength of associations varied by activity type.

Conclusions

Consistent with our theoretical model, BA activity constructs were associated with several mediators of smoking outcomes in the expected directions. Smokers engaging in valued activities have more favorable profiles for smoking cessation and mood management.

Section snippetsFunding

This work was supported by the National Cancer Institute at the National Institutes of Health (grant number 5R01CA137616; Belinda Borrelli, Principal Investigator). The study was conducted at Alpert Medical School at Brown University and The Miriam Hospital, when B. Borrelli was employed there. The funding organization had no role in the design and conduct of the study, in the collection, analysis, and interpretation of data, or in the preparation of the manuscript, review, or approval of the

Author Credit Statement:

Belinda Borrelli: funding acquisition, conceptualized the study, methodology, project administration, wrote the original draft, review and editing. Romano Endrighi: data management and data analyses, writing, editing and review. Shira Dunsiger: data analyses, writing, review. Andrew Busch: conceptualization, methodology, project administration, writing, review. Beth Bock: writing, review and editing. Patricia Markham Risica: methodology, project administration, writing, review and editing.

Design and participants.

For the parent study (ABLE), smokers with MIs were recruited from disability organizations, hospital-based clinics and the general community. Eligibility criteria included: ≥18 years of age, smoke >3 cigarettes per day and >100 in lifetime, a physical disability for >1 year, use of an assistive device to ambulate (e.g., cane, walker, wheelchair) on an ongoing basis (e.g., not for short-term injury), and difficulty walking short (100 yards or 91.4 meters) and long (1/3 of a mile or 531 meters)

Sample characteristics.

The sample was 54.8% females and racially and ethnically diverse, and the majority (69.2%) received disability/SSI income (Table 1). On average, participants reported using ambulatory equipment for 5.9 years (SD = 7.0), 21.3% reported needing help with personal care, and 64.3% with routine care. The sample's mean nicotine dependence score was 5.2 (SD = 2.1), indicating moderate to high levels of nicotine dependence (Table 2). Participants reported an average of 3.1 quitting attempts in the last

Discussion.

Smokers with MIs have a high prevalence of smoking and are at disproportionate risk for depression. There are no studies examining intervention approaches for smokers with MIs. BA is a promising approach for helping people manage their mood through valued activity engagement. We examined associations between BA theoretical constructs and variables hypothesized to be important for smoking cessation using baseline data from a smoking cessation induction trial among smokers with MIs. Overall, our

Conflict of Interest

1) Belinda Borrelli has no conflict of interest to declare, and no conflict of interest with the organization that sponsored this research. 2) Romano Endrighi has no conflict of interest to declare, and no conflict of interest with the organization that sponsored this research. 3) Shira Dunsiger has no conflict of interest to declare, and no conflict of interest with the organization that sponsored this research. 4) Andrew Busch has no conflict of interest to declare, and no conflict of

Acknowledgements

The authors would like to thank the advisory board, ABLE video participants, and experts in the video, including William Miller, PhD, Saul Shiffman, PhD., Nancy Rigotti, MD., Herbert Benson, MD, and Alice Domar, PhD.

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