Sensibilidad a la ansiedad como factor de vulnerabilidad transdiagnóstico para el consumo de tabaco: implicaciones clínicas y para el tratamiento

El tabaquismo es la principal causa evitable de morbilidad y muerte prematura a nivel mundial (López, Pérez-Ríos, Schiaffino y Fernández, 2016; Soriano et al., 2018; Organización Mundial de la Salud [OMS], 2019). En general, hay 1,3 mil millones de fumadores adultos en el mundo y se estima una prevalencia media de 42,5 % de intentos de dejar de fumar en el último año (Ahluwalia et al., 2018; Asma et al., 2015). En España, el porcentaje de fumadores diarios mostró una tendencia al alza en 2018, alcanzando el 34 % de la población. Sin embargo, casi dos tercios de ellos (65,85 %) han informado de al menos un intento de dejar de fumar en el último año (Plan Nacional sobre Drogas, 2019)

Concurrent validity of the alcohol purchase task in relation to alcohol involvement: protocol for a systematic review and meta-analysis

Introduction Alcohol demand, as measured by an alcohol purchase task (APT), provides a multidimensional assessment of the relative reinforcing efficacy of alcohol. The objective of this meta-analysis is to critically appraise the existing literature on the concurrent validity of the APT by meta-analysing the cross-sectional relationships between indices of the APT (ie, breakpoint, Omax, Pmax, elasticity and intensity) and alcohol-related measures. It also aims to examine methodological procedures used to obtain APT indices and individual variables as potential moderators on the assessed estimations. Methods and analysis A comprehensive literature search conducted from inception to April 2020 will be conducted in the PubMed, PsycINFO, Web of Science and Scopus databases. Two authors will independently screen and extract data from articles using a predefined protocol search and extraction forms. Disagreements will be resolved through discussion with two additional reviewers. All results will be tabulated, and a random-effect meta-analysis will be conducted. Participants’ sex, number of prices and APT methodological procedures will be examined as potential moderators on the observed effect sizes. Ethics and dissemination Results of this meta-analysis will characterise the concurrent validity of the APT in the existing literature. Further, the results are anticipated to provide evidence on which index (or indices) is most robustly associated with alcohol use and severity. Ethics approval was not required for this study and the results will be published in a peer-reviewed journal

Concurrent validity of the Alcohol Purchase Task for measuring the reinforcing efficacy of alcohol: an updated systematic review and meta-analysis

Background and aims: An early meta-analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol''s relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta-analysis sought to: (1) estimate the relationships between trait-based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects. Methods: A meta-analysis of 50 cross-sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg–Mazumdar, Egger''s and Duval & Tweedie''s trim-and-fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol-related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), Omax (i.e. maximum expenditure), Pmax (i.e. price associated to Omax) and breakpoint (i.e. price at which consumption ceases). Results: All alcohol demand indices were significantly associated with all alcohol-related outcomes (r = 0.132–0.494), except Pmax, which was significantly associated with alcohol-related problems only (r = 0.064). The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between Omax and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small-study effects was limited. Conclusions: The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and Omax are the most relevant indices to account for alcohol involvement

Does e-assessment always fit digital natives? A within-subject comparison between paper- and tablet-based gambling assessments in adolescents

Technological development has enabled the use of sophisticated methods for assessing multiple human behaviors. Despite the advantages of these new technologies, concerns exist regarding their equivalence with paper-based measures in epidemiological and health-related surveys. To date, literature on this topic in relation to adolescents is virtually nonexistent. This study compares respondents’ performance on the same survey using both paper- and electronic tablet- based assessment methods. A final sample of 135 adolescents (mean age 17.30 years, SD = 0.59; 56.3% males) consecutively completed two versions of the same survey on gambling behaviors and two questionnaires: The Gambling Motives Questionnaire (GMQ) and the South Oaks Gambling Screening-Revised for Adolescents (SOGS-RA). An ad-hoc questionnaire assessing participants’ satisfaction levels with each method was also used. The digital survey yielded a lifetime, past year, and past month gambling prevalence of 54.1%, 45.2%, and 27.4%, respectively. Paper-based prevalence rates were 3.7-5.2% lower (all p >.092) and there were discrepancies in gambling activities. Although the reliability of the questionnaires was high in both formats, total scores were consistently higher in the paper-based format. GMQ and SOGS-RA intraclass correlations between versions ranged from .856-.884. Unexpectedly, students preferred the paper-based survey to the e-assessment (51.5% vs. 48.5%) and also enjoyed it more (31.3% vs 26.1%). Paper- and tablet-based surveys yield different, albeit non-statistically significant, estimations of gambling behaviors even when the same participants were surveyed at one time. We recommend that consistency be routinely checked across assessment formats when adapting paper-and-pencil measures to digital formats¿La evaluación electrónica siempre se adapta a los nativos digitales? Una comparación intra-sujeto de la evaluación del juego de azar entre papel y tabletas electrónicas en adolescentes. El desarrollo tecnológico ha permitido el uso de métodos sofisticados de evaluación de múltiples comportamientos humanos. A pesar de los avances de estas nuevas tecnologías, existen preocupaciones sobre su equivalencia con las medidas de papel y lápiz en encuestas epidemiológicas y de salud. Hasta la fecha, la literatura en el tema en relación con los adolescentes es prácticamente inexistente. Este estudio compara el desempeño de los participantes sobre la misma encuesta utilizando métodos de evaluación de papel y lápiz y electrónicos. Una muestra de 135 adolescentes (edad media 17.30 años, DT = 0.59; 56.3% hombres) completaron consecutivamente os versiones de la misma encuesta sobre conductas de juego y dos cuestionarios: el Cuestionario de Motivos de Juego (GMQ) y el Cribado de Juego de South Oaks en su versión revisada para adolescentes (SOGS-RA). También se utilizó un cuestionario ad-hoc para evaluar el nivel de satisfacción de los participantes en cada método. La encuesta digital arrojó una prevalencia de juego vida, año y mes de 54,1%, 45,2%, y 27,4%, respectivamente. Las prevalencias en papel fueron 3,7-5,2% menores (todas p >,092) y se mostraron discrepancias en las actividades de apuestas. A pesar de que la fiabilidad de los cuestionarios fue alta en ambos formatos, las puntuaciones totales fueron consistentemente más altas en el formato en papel. Las correlaciones intraclase en el GMQ y SOGS-RA oscilaban entre ,856 - ,884. Inesperadamente, los estudiantes preferían la encuesta en papel sobre el formato digital (51,5% vs. 48,5%) y también lo disfrutaron más (31,3% vs 26,1%). La encuesta en papel y en tableta electrónica mostraron estimaciones diferentes, aunque no estadísticamente significativas, en las conductas de juego, incluso a pesar de haber sido encuestados en el mismo momento. Recomendamos comprobar de manera rutinaria la consistencia entre formatos de evaluación cuando se adapten medidas de papel y lápiz a formato digita

Validation of the Food Purchase Task (FPT) in a clinical sample of smokers with overweight and obesity

[EN] Obesity is a major health problem associated with disease burden and mortality. In this context, analyzing food as a powerful reinforcer from a behavioral economics framework could be relevant for the treatment and prevention of obesity. The purposes of this study were to validate a food purchase task (FPT) in a clinical sample of Spanish smokers with overweight and obesity and to assess the internal structure of the FPT. We also analyzed the clinical utility of single-item breakpoint (i.e., commodity price that suppresses demand). A total of 120 smokers [% females: 54.2; Mage = 52.54; SD = 10.34] with overweight and obesity completed the FPT and weight/eating-related variables. Principal component analysis was used to examine the FPT structure, and a set of correlations were used to examine the relationship between the FPT, eating and weight-related variables. The FPT demonstrated robust convergent validity with other measures of eating. Higher food demand was related to higher food craving (r = .33), more binge eating problems (r = .39), more weight gain concerns (r = .35), higher frequency of both controlled (r = .37) and uncontrolled (r = .30) grazing, as well as to an eating style in response to emotions (r = .34) and external eating (r = .34). Of the demand indices, Intensity and Omax showed the highest magnitudes of effects. The FPT factors, persistence and amplitude, do not improve individual FPT indices; and the single-item breakpoint was not related to any eating or weight variable. The FPT is a valid measure of food reinforcement with potential clinical utility in smokers with obesity/overweight.S

Episodic future thinking for the prevention and treatment of health risk behaviors

Non-communicable diseases (i.e., cardiovascular, oncological, respiratory, and endocrine diseases) represent the main cause of death and morbidity in the world, with tobacco and alcohol use, an unhealthy diet, and a sedentary lifestyle being the main risk factors. From reinforcer pathology theory, based on behavioral economics (BE), these health risk behaviors are understood as choice disorders, characterized by an excessive valuation of the reinforcer (e.g., the drug) and a preference for immediate reinforcers over delayed ones. Episodic future thinking (EFT) is a psychological intervention that consists of vividly visualizing future events and projecting oneself into them, in order to increase the valuation of the reinforcers associated with the execution of a healthy behavior. This technique shows promising results in reducing impulsive decision-making and increasing health-related behaviors (e.g., abstinence, diet, physical activity)

Insights from behavioral economics to characterize substance use involvement in adolescents: a cluster analysis

Reinforcement pathology (RP), a framework rooted in behavioral economics, has contributed to advances in the etiology and treatment of substance use. Drug demand and delay discounting (DD) have gained considerable interest, as they inform on the risk for escalation to substance use as well as treatment-specific targets. No prior study conducted in Spain has explored the interplay of demand and DD in adolescents. This study was aimed to: 1) identify whether DD and alcohol demand can yield empirically driven subgroups, and 2) examine differences in substance use involvement. The sample comprised 107 (% females = 54.2) adolescents (M=15.46, SD=1.25) from a high school in Asturias (Spain). Participants filled out an ad-hoc survey on substance use over the prior 30 days and one year. A 20-item alcohol purchase task (APT) was used to assess the reinforcing value of alcohol. The 21-item Monetary Choice Questionnaire evaluated impulsive choice. Two subgroups emerged: Cluster 1 (n = 72) and Cluster 2 (n = 35). Participants in C2 consistently showed higher impulsivity and demand for alcohol, signifying lower responsiveness to alcohol pricing. As compared to C1, those in C2 had a higher prevalence of past-month substance use [C1: 26/72 (36.1%) vs. C2: 33/35 (94.3%), p <.001], and a greater frequency of drunkenness [p <.001] and binge drinking episodes [p <.001]. RP differentiate between subgroups of adolescent substance users with patterns of more versus less substance use involvement. The existence of specific drug use subpopulations should be considered when designing environmental preventive policiesLa economía conductual para caracterizar el uso de drogas en adolescentes: análisis de cluster. La patología del refuerzo (PR), basada en la economía conductual, ha contribuido al avance de la etiología y el tratamiento de drogas. La demanda y el descuento por demora (DD) informan sobre el incremento en el consumo y los objetivos de tratamiento. Ningún estudio realizado en España ha examinado la interacción entre ambas variables en adolescentes. Los objetivos fueron: 1) identificar si el DD y la demanda de alcohol pueden identificar distintos subgrupos y, 2) examinar sus diferencias en el consumo de sustancias. La muestra incluyó 107 (% mujeres = 54,2) adolescentes (M =15,46, DT =1,25) de enseñanza obligatoria en Asturias (España). Se evaluó el consumo de drogas en los últimos 30 días y el último año. El poder reforzante del alcohol se evaluó mediante una tarea de compra de 20 ítems (APT). La toma de decisiones impulsiva se evaluó mediante el Cuestionario de Elección Monetaria. Se identificaron dos subgrupos: Grupo 1 (n = 72) y Grupo 2 (n = 35). El Grupo 2 mostró una demanda e impulsividad más elevada, indicando menor sensibilidad a incrementos en el precio. Comparado con el Grupo 1, el 2 obtuvo una prevalencia más elevada de consumo en el último mes [G1: 26/72 (36,1%) vs. G2: 33/35 (94,3%), p <,001], mayor frecuencia de borracheras (p <,001) y episodios de consumo intensivo de alcohol (p <,001). La PR permite caracterizar e identificar grupos con distintos patrones de consumo de sustancias. La existencia de distintos perfiles debería ser considerada a la hora de desarrollar políticas preventiva

Contingency management effects on delay discounting among patients receiving smoking cessation treatment

Antecedentes: la evidencia sugiere que el descuento por demora puede cambiar tras recibir intervenciones eficaces. No obstante, estudios previos que evaluaron el efecto del manejo de contingencias (MC) sobre el descuento por demora son escasos y presentan resultados mixtos. Se evaluó si el MC combinado con tratamiento cognitivo-conductual (TCC) para dejar de fumar se asoció con cambios en el descuento por demora al final del tratamiento y a los seis de seguimiento comparado con TCC. Método: Ciento dieciséis fumadores fueron asignados aleatoriamente a MC+TCC (n = 69) o a TCC solo (n = 47). Completaron la tarea de descuento por demora en la línea base, al final del tratamiento y a los seis meses de seguimiento. Evaluamos el efecto del MC en el descuento por demora con métodos paramétricos y no paramétricos. Resultados: Los análisis entre-grupos mostraron que ninguno de los tratamientos modificó el descuento por demora al final del tratamiento y a los seis meses de seguimiento. No obstante, algunos análisis intra-grupos mostraron que la condición de MC + TCC evidenció cierta reducción. Conclusiones: una intervención de MC no se asocia robustamente con cambios en el descuento por demora. Futuros estudios han de abordar qué tratamientos pueden modificarlo

A prognostic DNA methylation signature for stage I non-small-cell lung cancer

Purpose Non-small-cell lung cancer (NSCLC) is a tumor in which only small improvements in clinical outcome have been achieved. The issue is critical for stage I patients for whom there are no available biomarkers that indicate which high-risk patients should receive adjuvant chemotherapy. We aimed to find DNA methylation markers that could be helpful in this regard. Patients and Methods A DNA methylation microarray that analyzes 450,000 CpG sites was used to study tumoral DNA obtained from 444 patients with NSCLC that included 237 stage I tumors. The prognostic DNA methylation markers were validated by a single-methylation pyrosequencing assay in an independent cohort of 143 patients with stage I NSCLC. Results Unsupervised clustering of the 10,000 most variable DNA methylation sites in the discovery cohort identified patients with high-risk stage I NSCLC who had shorter relapse-free survival (RFS; hazard ratio [HR], 2.35; 95% CI, 1.29 to 4.28; P = .004). The study in the validation cohort of the significant methylated sites from the discovery cohort found that hypermethylation of five genes was significantly associated with shorter RFS in stage I NSCLC: HIST1H4F, PCDHGB6, NPBWR1, ALX1, and HOXA9. A signature based on the number of hypermethylated events distinguished patients with high-and low-risk stage I NSCLC (HR, 3.24; 95% CI, 1.61 to 6.54; P = .001). Conclusion The DNA methylation signature of NSCLC affects the outcome of stage I patients, and it can be practically determined by user-friendly polymerase chain reaction assays. The analysis of the best DNA methylation biomarkers improved prognostic accuracy beyond standard staging. (C) 2013 by American Society of Clinical Oncology