(PS1-B33) Methodological Considerations for an Integrated Female-specific Model of Anxiety and Smoking Comorbidity

Aims: Both estradiol and progesterone, two primary ovarian hormones that fluctuate across female menstrual cycles, have been implicated in anxiety psychopathology and nicotine reinforcement in disparate literatures. To date, extant literature is methodically limited due to systematic exclusion of anxiety pathology and lack of direct or repeated assessment of ovarian hormones, limiting the generalizability of existing findings as they relate to the nuanced relationship between hormones with anxiety and craving.

Design: To address these gaps and harmonize these disparate literatures, we developed a novel ecological momentary assessment (EMA) protocol using objective, daily saliva samples to examine how between- and within- person fluctuations in ovarian hormones throughout the menstrual cycle influence anxiety and cigarette craving among female smokers, both with and without anxiety psychopathology.

Participants: The sample comprised of non-treatment seeking, biologically female smokers (N = 50; M_age = 32.4, SD = 5.3; 70.0% White), who reported being daily combustible cigarette users for 14.9 (SD = 5.9) years and smoked an average of 12.2 (SD = 5.3) cigarettes per day.

Measures: Participants completed an initial baseline assessment to determine eligibility and were subsequently oriented to the daily protocol. Throughout one complete menstrual cycle, objective and frequent assessment of progesterone and estradiol were collected via at-home salivary collection. The EMA protocol encompassed within-day momentary ratings of anxiety and nicotine reinforcement with a mobile application.

Findings: Overall, participant’s protocol compliance, including completion of assessments and saliva samples, was >90%, solidifying the feasibility of an integrated and comprehensive protocol. Further, example data from two demographically similar individuals, one with elevated anxiety sensitivity and previous psychopathology and one without, illustrate significant heterogeneity regarding intra- and inter-individual fluctuations revealed from objective measures of progesterone and estradiol, and self-reported anxiety, and craving over the course of a single menstrual cycle. Such heterogeneity highlights discrepancies between individual-level data and hypothesized models of hormonal fluctuations, as well as proposed covariation of hormones and risk for smoking and anxiety.


Conclusion: We aimed to integrate the anxiety and addiction literatures through development of this novel protocol to highlight the need to increase individual-level granularity in hormonal fluctuations as they relate to both anxiety and nicotine reinforcement. Continued work in this area might aid in identification of individuals at elevated risk for negative reinforcement precipitated craving and smoking behavior.