_____________________________________________________________________________________________Pennsylvania Department of Health – 2012-2013 Annual C.U.R.E. Report

Indiana University of Pennsylvania – 2010 Formula Grant – Page 1

Indiana University of Pennsylvania Annual Progress Report: 2010 Formula Grant Reporting Period July 1, 2012 – June 30, 2013 Formula Grant Overview Indiana University of Pennsylvania received $9,268 in formula funds for the grant award period January 1, 2011 through December 31, 2014. Accomplishments for the reporting period are described below. Research Project 1: Project Title and Purpose Executive Function as a Predictor of Tobacco Dependence and Response to Treatment - This project will examine the relationship between executive function and tobacco use, dependence, and response to treatment. Executive functions represent a set of higher order regulatory abilities associated with the frontal lobes of the brain. While executive dysfunction has been well linked to addiction across many drugs, the relationship between executive dysfunction and tobacco dependence has received much less attention. This project will compare executive abilities across nonsmokers, previous smokers, and current smokers using a battery of neuropsychological tests. Executive abilities will also be compared across time and as a function of success in participants enrolled in two forms of tobacco cessation treatment. Anticipated Duration of Project 1/1/2011 - 12/31/2014 Project Overview There are two major research objectives of this project. The first research objective is to investigate the relationship between executive dysfunction and vulnerability to tobacco dependence. Project participants will be administered the Delis-Kaplan Executive Function System (D-Kefs), a battery of neuropsychological tests designed to measure multiple aspects of executive function. Participants will also complete the Frontal Systems Behavioral Scale (FrSBe) a self-report measure of daily activities linked to executive functioning. The results will then be compared as a function of nicotine use and dependence which will be measured using a widely validated measure of tobacco dependence, the Fagerström Test for Nicotine Dependence (FTND). The second research objective is to examine the relationship between executive dysfunction and participant’s response to tobacco cessation treatment as a function of treatment type, treatment success, and across time. Participants enrolled in one of two types of tobacco cessation therapy (Nicotine Replacement Therapy using the nicotine patch and Motivational Interviewing Therapy or Motivational Interviewing Therapy alone) will be compared using the

_____________________________________________________________________________________________Pennsylvania Department of Health – 2012-2013 Annual C.U.R.E. Report

Indiana University of Pennsylvania – 2010 Formula Grant – Page 2

D-Kefs, FrSBe, and FDNT. Treatment success will also be validated using the NicAlert system, a saliva based test which measures the extent of recent nicotine use. Participants will be assessed prior to the initiation of treatment and at three and six months after the start of treatment. While the focus of this project is on tobacco, it is also important to note that participant’s use and dependence on alcohol and other drugs will also be assessed using the Michigan Alcoholism Screening Test (MAST) and other questions of use modified from the Monitoring For the Future Study (MTF). This project will also examine the relationship between executive dysfunction and other variables related to drug addiction and therefore participants will also be administered a demographics questionnaire, the Perceived Stress Scale (PSS), and the Zuckerman Sensation Seeking Scale (SSS-V). Principal Investigator William M. Meil, PhD Professor of Psychology Indiana University of Pennsylvania Department of Psychology 222 Uhler Hall 1020 Oakland Avenue Indiana, PA 15705-1064 Other Participating Researchers David J. LaPorte, PhD, John A. Mills, PhD, ABPP, Ann Sesti, MA, NBCC, LPC - employed by Indiana University of Pennsylvania Expected Research Outcomes and Benefits Tobacco consumption has been clearly linked to increased mortality and a variety of negative health outcomes such as stroke, cardiovascular disease, respiratory disease, and cancer. A greater understanding of the variables which influence vulnerability to tobacco abuse and dependence as well as an appreciation for variables which alter treatment success rates have the potential to impact the millions who are directly and indirectly impacted by tobacco dependence. While the role of frontal lobe dysfunction and its subsequent impact on executive abilities is well documented across the addiction literature, relatively few studies have addressed the executive dysfunction in nicotine dependence. This project should clarify the extent to which executive abilities are impaired among those who develop tobacco dependence compared to nonsmokers and thus help characterize the extent to which this impairment is a fundamental element across the addictive process and in the process may aid in identifying populations in which to target treatment interventions. Moreover, the extent to which changes in executive function accompany recovery from treatment represents a new and growing body of literature. By examining the extent to which executive function varies by abstinence, treatment type, and time in treatment, this research will likely contribute to our growing understanding of variables that influence treatment outcomes.

_____________________________________________________________________________________________Pennsylvania Department of Health – 2012-2013 Annual C.U.R.E. Report

Indiana University of Pennsylvania – 2010 Formula Grant – Page 3

Summary of Research Completed Aim 1: To investigate the relationship between executive dysfunction and vulnerability to tobacco dependence Progress: During the period covered by this annual report data was collected for 137 participants bringing the total to 228 participants for this part of the research project. However, data for 10 subjects has had to be discounted primarily because English was not their native language. This will likely skew their executive functioning and other scores. The target number of participants for the first part of this study is 300 participants and therefore the 218 participants for which useable data has been collected represents 73% of our target number. To date approximately 40% of the data collected has been scored. Analysis of certain measures (Sensation Seeking Scale, The Perceived Stress Scale, gender and substance use questionnaire) was conducted for the 176 participants whose data had been collected prior January 2013. The purpose of these analyses was to examine the influence of sensation seeking, perceived stress and gender on frequency of alcohol, tobacco, and marijuana use. These results were presented on May 26th 2013 at the Annual Meeting of the Association for Psychological Science in Washington DC. The primary findings of this analysis were that sensation seeking scores were significantly higher among more frequent alcohol (F (3,162) = 10.89, p < .01), tobacco (F (3,162) = 5.36, p < .002), and marijuana users (F (3,162) = 13.44, p < .001). For all drugs, participants who reported using daily or within the last 30 days had higher sensation seeking scores compared to those who had never used or used within the last year (p < .05). In addition there was a significant correlation between sensation seeking and frequency of combined use of alcohol, tobacco and marijuana (r = .53, p<.01). Males showed significantly higher sensation seeking scores among alcohol users (F (1,162) = 4.91, p<.03) but there were no significant interactions between gender and drug use frequency on sensation seeking. Sensation seeking scores were also correlated with frequency of binge drinking (r=.46, p<.01). Frequency of alcohol , tobacco and marijuana use were also associated with increased scores on the Boredom Susceptibility and the Disinhibition sensation seeking subscales, while frequency of tobacco and marijuana use were also significantly related to the Experience Seeking subscale (p<.01). Male alcohol and marijuana users also scored higher than females on the Boredom Susceptibility subscale of sensation seeking (p<.01). The frequency of combined alcohol, tobacco, and marijuana use was also significantly correlated with all of the sensation seeking subscales (p<.01). In contrast to the effects of sensation seeking on substance use frequency, perceived stress had little influence. Perceived stress was not related to sensation seeking overall, any of the sensation seeking subscales, or frequency of alcohol, tobacco, and marijuana use alone or in combination. However, among alcohol (F (1,160) = 6.88, p <.01) and marijuana users (F (1,160) = 740, p <.01) female participants scored significantly higher on perceived stress, an effect which was not seen among tobacco users. These results suggest that long standing less malleable characteristics such as sensation seeking may be more influential on current substance use among college students compared to more transient variables such as perceived stress.

_____________________________________________________________________________________________Pennsylvania Department of Health – 2012-2013 Annual C.U.R.E. Report

Indiana University of Pennsylvania – 2010 Formula Grant – Page 4

Aim 2: To examine the relationship between executive dysfunction and participant’s response to tobacco cessation treatment as a function of treatment type, treatment success, and across time Progress: Data collection for the second part of this study began during the period of this annual report after being delayed because funding was cut for the Tobacco Cessation Treatment program at Indiana University of Pennsylvania. After receiving additional funds from the Dean of the College of Natural Sciences and Math at Indiana University of Pennsylvania and a commitment that university’s Drug and Alcohol Program would have sufficient resources to run the treatment aspect of this project, data collection began. Participant recruitment was more challenging than anticipated as we could not capitalize on the momentum of the previously existing program. However, after broadening the recruitment procedures from recruitment posters to include recruitment through the Psychology Department’s Subject Pool in January and February 2013, recruitment improved. Ten participants entered tobacco cessation treatment and participated in this study. One participant was tested at all three time points. Five participants were tested at two time points. Four participants were tested at a single time point. Several observations have been made as the second part of this study has progressed. This study was initially designed to compare students’ choosing tobacco cessation and Motivational Interviewing Therapy with and without the Nicotine Replacement Patch. To date all participants have only expressed interest in being in the former group [A1] (Motivational Interviewing Therapy with the Nicotine Replacement Patch). However, one participant had a reaction to the patch and discontinued its use. [A2] Recruiting a significant number of study participants interested in receiving Motivational Interviewing Therapy alone may be difficult. In addition, very few study participants appear to be achieving complete abstinence and thus our ability to access the relationship between treatment success and executive function may be limited. Data regarding treatment engagement and executive function will be a likely outcome of this part of the study. However, because a goal of this study is to evaluate a university-based tobacco cessation program, these observations may not substantially hamper the value of this study given the overarching emphasis on external validity in this part of the study. Data collection is approximately five months behind the original time line for this project. Several factors have contributed to the delay. There have also been delays in running the second part of this project which are described above.