title: The association between changes in alternative reinforcers and short-term smoking cessation.
abstract: BACKGROUND
  While more than 50% of smokers make a serious quit attempt each year, less than 10% quit permanently. Evidence from studies of adolescent smoking and other substances of abuse suggest that alternative reinforcers, a construct of Behavioral Economic Theory, may contribute to the likelihood of smoking cessation in adults. This study examined the behavioral economics of smoking cessation within a smoking cessation clinical trial and evaluated how depressive symptoms and behavioral economic variables are associated with smoking cessation.
  
  
  METHODS
  A sample of 469 smokers, enrolled in an effectiveness trial that provided counseling and 8 weeks of 21 mg nicotine patches, was analyzed. Alternative reinforcers (substitute and complementary reinforcers) and depressive symptoms were examined in relation to 7-day point prevalence abstinence, verified with breath carbon monoxide, 8 weeks after the quit date.
  
  
  RESULTS
  Controlling for covariates associated with cessation (nicotine dependence, age of smoking initiation, patch adherence), participants who were abstinent at week 8 showed significantly higher substitute reinforcers at all time-points, compared to those who were smoking (p's<.05). Participants who were abstinent at week 8 showed lower complementary reinforcers and depressive symptoms at all time-points, compared to those who were smoking, but significant differences were confined to week 8 (p's<.01). There was no significant interaction between alternative reinforcers and depressive symptoms across the 8 weeks on week 8 abstinence.
  
  
  CONCLUSIONS
  These results support continued examination of Behavioral Economic Theory in understanding adult smoking cessation in order to inform future treatments and guidelines.
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States. Electronic address: goelzp@mail.med.upenn.edu.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Goelz
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Audrain-McGovern
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lakeshore Drive, Chicago, IL 60611, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Hitsman
authors.affiliation: Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania Presbyterian Medical Center, 51 N. 39th Street, 1st Floor Rear, Philadelphia, PA 19104, United States.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Leone
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lakeshore Drive, Chicago, IL 60611, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Veluz-Wilkins
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Jepson
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: E Paul
authors.initials: EP
authors.lastname: Wileyto
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Paul A
authors.initials: PA
authors.lastname: D'Avanzo
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Rivera
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schnoll
mesh_terms: D000328:Adult; D003376:Counseling; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011582:Psychological Theory; D012054:Reinforcement, Psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000628:therapy*; D055815:Young Adult
keywords: Alternative reinforcers; Behavioral economics; Depression; Smoking cessation