Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit

Abstract

Background Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation. Methods Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26. Results In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps > 0.20). Conclusions Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.

Cognitive impairment in chronic obstructive pulmonary disease: disease burden, determinants and possible future interventions

“…Brega et al [56] showed that older persons with impaired executive functioning were less likely to quit smoking than those with normal executive functioning. However, recent data did not confirm the relationship between executive cognitive dysfunction and smoking cessation [57]. Moreover, another study even showed that persons over 75 years of age who quit smoking had lower cognitive functioning than persons who continued smoking [58].…”

Increasing smoking cessation adherence: Do we need to consider the role of executive function and rumination?

“…EFs have a key role in planning, sequencing and monitoring goal-directed thoughts, behaviours and emotions ( Allan et al, 2016 ; Hofmann, Schmeichel, & Baddeley, 2012 ; Razani, Boone, Lesser, & Weiss, 2004 ), and alteration of higher cognitive processes, for example, self-regulation and planning ( Fox et al, 2017 ), reduce the probability to achieve personal goals. In line with Meyers and colleagues (2015) , emotion processing and executive function decrements may interfere with an individual's ability to quit smoking ( Meyers et al, 2015 ).…”

“…Nevertheless, it is not clear how rumination and EF affect the adoption of the smoking behavior and/or the motivation to quit, as research conducted until now tends to be limited by methodological and theoretical shortcomings. Particularly, Fox and colleagues (2017) stressed the tendency to use different types of methodologies to assess EF, and for each of them to assess a specific component of EF for example, Wisconsin Card Sorting Test (set-shifting), Stroop Test (response inhibition), Go/No-go task (attention and set-shifting), Trail Making Test (visual attention), etc. with research often providing mixed results.…”

“…Furthermore, rumination and EF are typically studied separately ( Glass et al, 2009 ; Stautz, Pechey, Couturier, Deary, & Marteau, 2016 ) and/or in association with other psychological factors, for example, anxiety, depression, emotion perception (referring to the capacity to correctly recognize facial expressions associated to the emotions etc.) ( Fox et al, 2017 ; Meyers et al, 2015 ; O’Loughlin et al, 2017 ). Moreover, research that has examined the role of rumination in smokers has mainly focused on people having depressive disorders ( Herrera & McChargue, 2011 ).…”

A fractionated analysis of hot and cool self-regulation in cigarette smokers from different socioeconomic backgrounds

“…In the few studies that controlled for acute and/or withdrawal effects of nicotine on measures of self-regulation, smokers did not show deficits in Inhibition or Verbal Fluency, but they were more impulsive [9] and showed Planning difficulties [67], suggesting that performance on some, but not all hot abilities are more impaired in this population. Indeed, Fox et al [68] did not observe associations between smoking and cool executive functions, including Inhibition. Assuming that chronic smoking impairs hot more than cool cognitive abilities makes sense because the former are related to emotional/motivational responses that lead people to smoke and have difficulty quitting (e.g., [14–16]).…”