{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T21:57:22Z","timestamp":1780437442084,"version":"3.54.1"},"reference-count":115,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Smoking cigarettes remains a leading modifiable risk factor for preventable health conditions. In the United States, the health burden of smoking disproportionately impacts low-income individuals. Multimorbidity is common in this group, complicating treatment and worsening outcomes. Identifying multimorbidity clusters can support targeted, individualized interventions. This study aimed to identify multimorbidity clusters among individuals who smoke and experience economic hardship and provide clinical recommendations to enhance health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Individuals who smoke and experience economic hardship (\n                      <jats:italic>N<\/jats:italic>\n                      = 60) were recruited from the San Francisco Health Network (SFHN) and were assessed for physical and mental conditions. Cluster analysis was conducted using a Mixture of Bernoulli (MoB) model to identify subgroups of participants based on co-occurring physical and mental health conditions. Relative risks (RRs) were calculated to compare the likelihood of each condition across clusters, and 95% confidence intervals were used to assess statistical significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cluster analysis identified three groups:\n                      <jats:italic>Physical Multimorbidity<\/jats:italic>\n                      ,\n                      <jats:italic>Mental-Physical Multimorbidity<\/jats:italic>\n                      , and\n                      <jats:italic>Lower Health Burden<\/jats:italic>\n                      . Gender was significantly associated with cluster membership: males were more likely to be in the\n                      <jats:italic>Physical Multimorbidity<\/jats:italic>\n                      cluster, and females were more likely to be in the\n                      <jats:italic>Mental-Physical Multimorbidity<\/jats:italic>\n                      cluster (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). Findings should be interpreted cautiously given the small sample size and exploratory nature of the cluster analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Individuals who smoke and experience economic hardship exhibited three multimorbidity clusters\u2014\n                      <jats:italic>Physical Multimorbidity<\/jats:italic>\n                      ,\n                      <jats:italic>Mental-Physical Multimorbidity<\/jats:italic>\n                      , and\n                      <jats:italic>Lower Health Burden<\/jats:italic>\n                      \u2014indicating both overlapping and distinct patterns of chronic health conditions. Chronic pain was common across the more complex clusters, whereas depression and anxiety characterized the\n                      <jats:italic>Mental-Physical Multimorbidity<\/jats:italic>\n                      cluster. These findings highlight the need for tailored and person-centered smoking cessation strategies that address both shared and unique physical and mental health challenges in this high-risk population.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1735343","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:10:27Z","timestamp":1774930227000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Patterns of multimorbidity among low-income adults who smoke with implications for tailored interventions: a cluster analysis using a Mixture of Bernoulli model"],"prefix":"10.3389","volume":"13","author":[{"given":"Monique T.","family":"Cano","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine","place":["New Haven, CT, United States"]},{"name":"Institute for International Internet Interventions for Health (i4Health), Palo Alto University","place":["Palo Alto, CA, United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Lindstrom","sequence":"additional","affiliation":[{"name":"School of Mathematical and Statistical Sciences, The University of Texas Rio Grande Valley","place":["Edinburg, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar F. Rojas","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine","place":["New Haven, CT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo F.","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Institute for International Internet Interventions for Health (i4Health), Palo Alto University","place":["Palo Alto, CA, United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3170","DOI":"10.1111\/add.16007","article-title":"The 1964 US Surgeon General\u2019s report on smoking and health.","volume":"117","author":"Hall","year":"2022","journal-title":"Addiction."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1038\/s41591-022-01978-x","article-title":"Health effects associated with smoking: a Burden of Proof study.","volume":"28","author":"Dai","year":"2022","journal-title":"Nat Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"106","DOI":"10.3322\/caac.21444","article-title":"Who\u2019s still smoking? Disparities in adult cigarette smoking prevalence in the United States.","volume":"68","author":"Drope","year":"2018","journal-title":"CA Cancer J Clin."},{"key":"B4","volume-title":"The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General.","year":"2014"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e2020040253","DOI":"10.1542\/peds.2020-040253","article-title":"Health disparities in tobacco use and exposure: a structural competency approach.","volume":"147","author":"Marbin","year":"2021","journal-title":"Pediatrics."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.3390\/ijerph22071122","article-title":"Rethinking smoking and quitting in low-income contexts: a qualitative analysis with implications for practice and policy.","volume":"22","author":"Cano","year":"2025","journal-title":"Int J Environ Res Public Health."},{"key":"B7","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1093\/ntr\/ntq051","article-title":"Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: findings from the International Tobacco Control Four Country Survey.","volume":"12","author":"Reid","year":"2010","journal-title":"Nicotine Tob Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1037750","DOI":"10.3389\/fphys.2022.1037750","article-title":"Pathogenesis of (smoking-related) non-communicable diseases\u2014evidence for a common underlying pathophysiological pattern.","volume":"13","author":"Kopp","year":"2022","journal-title":"Front Physiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019.","volume":"397","year":"2021","journal-title":"Lancet Lond Engl."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1186\/s12889-024-19457-y","article-title":"Association of cigarette smoking, smoking cessation with the risk of cardiometabolic multimorbidity in the UK Biobank.","volume":"24","author":"Zhang","year":"2024","journal-title":"BMC Public Health."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.1002\/cncr.34132","article-title":"Disparities in smoking prevalence and associations with mental health and substance use disorders in underserved communities across the United States.","volume":"128","author":"Lin","year":"2022","journal-title":"Cancer."},{"key":"B12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.amepre.2018.06.025","article-title":"Non-daily cigarette smokers: mortality risks in the United States.","volume":"56","author":"Inoue-Choi","year":"2019","journal-title":"Am J Prev Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"E107","DOI":"10.5888\/pcd17.200090","article-title":"How much progress have we made? trends in disparities in tobacco use.","volume":"17","author":"Kingsbury","year":"2020","journal-title":"Prev Chronic Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity.","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primer."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1016\/S0140-6736(18)30941-3","article-title":"Making more of multimorbidity: an emerging priority.","volume":"391","author":"Lancet","year":"2018","journal-title":"The Lancet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1081518","DOI":"10.3389\/fpubh.2023.1081518","article-title":"Social determinants of multimorbidity patterns: a systematic review.","volume":"11","author":"\u00c1lvarez-G\u00e1lvez","year":"2023","journal-title":"Front Public Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1136\/jech-2020-214691","article-title":"Household and area-level social determinants of multimorbidity: a systematic review.","volume":"75","author":"Ingram","year":"2021","journal-title":"J Epidemiol Community Health."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-019-1474-7","article-title":"Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.","volume":"18","author":"Freisling","year":"2020","journal-title":"BMC Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"106260","DOI":"10.1016\/j.ypmed.2020.106260","article-title":"Leading determinants for multimorbidity in middle-aged Australian men and women: a nine-year follow-up cohort study.","volume":"141","author":"Shang","year":"2020","journal-title":"Prev Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1370\/afm.245","article-title":"The biopsychosocial model 25 years later: principles, practice, and scientific inquiry.","volume":"2","author":"Borrell-Carri\u00f3","year":"2004","journal-title":"Ann Fam Med."},{"key":"B21","first-page":"372","article-title":"Is lower income associated with greater biopsychosocial morbidity? Implications for physicians working with underserved patients.","volume":"48","author":"Fiscella","year":"1999","journal-title":"J Fam Pract."},{"key":"B22","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1111\/j.1360-0443.2007.01954.x","article-title":"A biopsychosocial approach to examining tobacco-related health disparities among racially classified social groups.","volume":"102","author":"Fernander","year":"2007","journal-title":"Addiction."},{"key":"B23","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1037\/hea0000762","article-title":"Multimorbidity: implications and directions for health psychology and behavioral medicine.","volume":"38","author":"Suls","year":"2019","journal-title":"Health Psychol Off J Div Health Psychol Am Psychol Assoc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1093\/ntr\/ntac085","article-title":"Active smokers are at higher risk of COVID-19 death: a systematic review and meta-analysis.","volume":"25","author":"Patanavanich","year":"2023","journal-title":"Nicotine Tob Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"634","DOI":"10.3390\/medicina60040634","article-title":"Treatment nonadherence among multimorbid chronic disease patients: evidence from 3515 subjects in Indonesia.","volume":"60","author":"Pradipta","year":"2024","journal-title":"Medicina (Mex)."},{"key":"B26","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3390\/medicina61010153","article-title":"Enhancing therapy adherence: impact on clinical outcomes, healthcare costs, and patient quality of life.","volume":"61","author":"Religioni","year":"2025","journal-title":"Medicina (Mex)."},{"key":"B27","doi-asserted-by":"publisher","first-page":"114","DOI":"10.7861\/futurehosp.3-2-114","article-title":"Person-centred care: what is it and how do we get there?","volume":"3","author":"Coulter","year":"2016","journal-title":"Future Hosp J."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e12746","DOI":"10.1111\/wvn.12746","article-title":"A meta-analysis of person-centered care interventions for improving health outcomes in persons living with dementia.","volume":"22","author":"Saragih","year":"2025","journal-title":"Worldviews Evid Based Nurs."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1148277","DOI":"10.3389\/fpubh.2023.1148277","article-title":"More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients.","volume":"11","author":"Yu","year":"2023","journal-title":"Front Public Health."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1038\/s41388-025-03424-x","article-title":"A targeted literature review on the impact of tailored interventions on patient outcomes in oncology.","volume":"44","author":"Ferrier","year":"2025","journal-title":"Oncogene."},{"key":"B31","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1001\/jamapsychiatry.2021.0707","article-title":"Sustained care smoking cessation intervention for individuals hospitalized for psychiatric disorders: the helping HAND 3 randomized clinical trial.","volume":"78","author":"Brown","year":"2021","journal-title":"JAMA Psychiatry."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/j.1525-1497.2004.30395.x","article-title":"Does patient-centered care improve provision of preventive services?","volume":"19","author":"Flach","year":"2004","journal-title":"J Gen Intern Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"100231","DOI":"10.1016\/j.dadr.2024.100231","article-title":"Cigarettes and e-cigarettes use among US adults with multimorbidity.","volume":"11","author":"Osibogun","year":"2024","journal-title":"Drug Alcohol Depend Rep."},{"key":"B34","doi-asserted-by":"publisher","first-page":"81","DOI":"10.18332\/tid\/166110","article-title":"Association of smoking status and nicotine dependence with multi-morbidity in China: a nationally representative crosssectional study.","volume":"21","author":"Zou","year":"2023","journal-title":"Tob Induc Dis."},{"key":"B35","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1056\/NEJMsa1407211","article-title":"Smoking and mortality \u2014 beyond established causes.","volume":"372","author":"Carter","year":"2015","journal-title":"N Engl J Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1093\/ntr\/ntaa156","article-title":"Cigarette smoking reduction and health risks: a systematic review and meta-analysis.","volume":"23","author":"Chang","year":"2021","journal-title":"Nicotine Tob Res."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2022.104154","article-title":"Appraising the causal role of smoking in multiple diseases: a systematic review and meta-analysis of Mendelian randomization studies.","volume":"82","author":"Larsson","year":"2022","journal-title":"EBioMedicine"},{"key":"B38","doi-asserted-by":"publisher","first-page":"60","DOI":"10.18332\/tid\/123845","article-title":"Smoking increases the risk of infectious diseases: a narrative review.","volume":"18","author":"Jiang","year":"2020","journal-title":"Tob Induc Dis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"3866","DOI":"10.21037\/jtd.2020.02.47","article-title":"Cardiovascular risk of smoking and benefits of smoking cessation.","volume":"12","author":"Gallucci","year":"2020","journal-title":"J Thorac Dis."},{"key":"B40","doi-asserted-by":"publisher","first-page":"3776","DOI":"10.1038\/s41598-025-87763-5","article-title":"Socioeconomic disparities in multimorbidity of chronic diseases in the RaNCD cohort study.","volume":"15","author":"Safari Faramani","year":"2025","journal-title":"Sci Rep."},{"key":"B41","doi-asserted-by":"publisher","first-page":"4799","DOI":"10.1097\/JS9.0000000000002482","article-title":"Association between socioeconomic status and multimorbidity indices across 15 countries: a multi-regional cohort study.","volume":"111","author":"Li","year":"2025","journal-title":"Int J Surg."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1645486","DOI":"10.3389\/fpubh.2025.1645486","article-title":"Sociodemographic inequalities in multimorbidity and lifestyle risk factors among young adults: a national population-based study.","volume":"13","author":"Tavares","year":"2025","journal-title":"Front Public Health."},{"key":"B43","doi-asserted-by":"publisher","first-page":"59","DOI":"10.18332\/tid\/138241","article-title":"Factors associated with smoking in low-income persons with and without chronic illness.","volume":"19","author":"Cano","year":"2021","journal-title":"Tob Induc Dis."},{"key":"B44","volume-title":"Who is Low Income and Very Low Income in the Bay Area? (An Updated Look).","author":"Fukumori","year":"2023"},{"key":"B45","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1186\/s12888-016-0929-z","article-title":"Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study.","volume":"16","author":"Atwoli","year":"2016","journal-title":"BMC Psychiatry"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7.","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9.","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2705","DOI":"10.1016\/S0031-3203(01)00242-4","article-title":"On the use of Bernoulli mixture models for text classification.","volume":"35","author":"Juan","year":"2002","journal-title":"Pattern Recognit."},{"key":"B49","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.trb.2023.03.001","article-title":"Finite mixture (or latent class) modeling in transportation: trends, usage, potential, and future directions.","volume":"172","author":"Kim","year":"2023","journal-title":"Transp Res Part B Methodol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.idm.2019.12.010","article-title":"A primer on model selection using the Akaike Information Criterion.","volume":"5","author":"Portet","year":"2020","journal-title":"Infect Dis Model."},{"key":"B51","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s40745-015-0040-1","article-title":"A comprehensive survey of clustering algorithms.","volume":"2","author":"Xu","year":"2015","journal-title":"Ann Data Sci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1093\/bib\/bbz016","article-title":"Sensitivity and specificity of information criteria.","volume":"21","author":"Dziak","year":"2020","journal-title":"Brief Bioinform."},{"key":"B53","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1162\/089976600300015925","article-title":"Practical identifiability of finite mixtures of multivariate bernoulli distributions.","volume":"12","author":"Carreira-Perpinan","year":"2000","journal-title":"Neural Comput."},{"key":"B54","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1136\/bmj.296.6632.1313","article-title":"Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates.","volume":"296","author":"Morris","year":"1988","journal-title":"Br Med J Clin Res Ed."},{"key":"B55","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1038\/s41586-020-2649-2","article-title":"Array programming with NumPy.","volume":"585","author":"Harris","year":"2020","journal-title":"Nature."},{"key":"B56","doi-asserted-by":"publisher","first-page":"2529","DOI":"10.1002\/(sici)1097-0258(19971130)16:223.0.co;2-j","article-title":"Some comments on frequently used multiple endpoint adjustment methods in clinical trials.","volume":"16","author":"Sankoh","year":"1997","journal-title":"Stat Med."},{"key":"B57","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s12889-023-15070-7","article-title":"Symptom patterns and health service use of women in early adulthood: a latent class analysis from the Australian Longitudinal Study on Women\u2019s Health.","volume":"23","author":"Wilson","year":"2023","journal-title":"BMC Public Health."},{"key":"B58","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1080\/10705510701575396","article-title":"Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study.","volume":"14","author":"Nylund","year":"2007","journal-title":"Struct Equ Model Multidiscip J."},{"key":"B59","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1080\/10705511.2013.824781","article-title":"Statistical power to detect the correct number of classes in latent profile analysis.","volume":"20","author":"Tein","year":"2013","journal-title":"Struct Equ Model Multidiscip J."},{"key":"B60","doi-asserted-by":"crossref","DOI":"10.1201\/9780429246593","volume-title":"An Introduction to the Bootstrap.","author":"Efron","year":"1994"},{"key":"B61","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3758\/BF03206482","article-title":"AIC model selection using Akaike weights.","volume":"11","author":"Wagenmakers","year":"2004","journal-title":"Psychon Bull Rev."},{"key":"B62","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1159\/000531588","article-title":"Depression in women: potential biological and sociocultural factors driving the sex effect.","volume":"83","author":"Di Benedetto","year":"2024","journal-title":"Neuropsychobiology."},{"key":"B63","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1176\/appi.focus.20160042","article-title":"Anxiety disorders among women: a female lifespan approach.","volume":"15","author":"Hantsoo","year":"2017","journal-title":"Focus J Life Long Learn Psychiatry."},{"key":"B64","doi-asserted-by":"publisher","first-page":"589687","DOI":"10.3389\/fpsyt.2021.589687","article-title":"A hypothesis of gender differences in self-reporting symptom of depression: implications to solve under-diagnosis and under-treatment of depression in males.","volume":"12","author":"Shi","year":"2021","journal-title":"Front Psychiatry."},{"key":"B65","doi-asserted-by":"publisher","first-page":"00368504221135469","DOI":"10.1177\/00368504221135469","article-title":"Factors associated with gender and sex differences in anxiety prevalence and comorbidity: a systematic review.","volume":"105","author":"Farhane-Medina","year":"2022","journal-title":"Sci Prog."},{"key":"B66","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1557988316630953","article-title":"Reviewing the assumptions about men\u2019s mental health: an exploration of the gender binary.","volume":"12","author":"Smith","year":"2018","journal-title":"Am J Mens Health."},{"key":"B67","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.1016\/j.socscimed.2011.11.029","article-title":"Women\u2019s health, men\u2019s health, and gender and health: implications of intersectionality.","volume":"74","author":"Hankivsky","year":"2012","journal-title":"Soc Sci Med."},{"key":"B68","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1097\/j.pain.0000000000001631","article-title":"Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry.","volume":"160","author":"Khan","year":"2019","journal-title":"Pain."},{"key":"B69","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/0145445515610744","article-title":"Anxiety and depression in bidirectional relations between pain and smoking: implications for smoking cessation.","volume":"40","author":"Zale","year":"2016","journal-title":"Behav Modif."},{"key":"B70","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/B978-0-323-91497-0.00246-0","article-title":"Negative affect (and disorders of).","volume-title":"Encyclopedia of Mental Health.","author":"Naragon-Gainey","year":"2023"},{"key":"B71","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.drugalcdep.2018.01.037","article-title":"Associations between pain intensity and urge to smoke: testing the role of negative affect and pain catastrophizing.","volume":"187","author":"Kosiba","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"B72","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1037\/0033-295X.111.1.33","article-title":"Addiction motivation reformulated: an affective processing model of negative reinforcement.","volume":"111","author":"Baker","year":"2004","journal-title":"Psychol Rev."},{"key":"B73","doi-asserted-by":"publisher","first-page":"2295","DOI":"10.1056\/NEJMra0809890","article-title":"Nicotine addiction.","volume":"362","author":"Benowitz","year":"2010","journal-title":"N Engl J Med."},{"key":"B74","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1037\/\/0022-006x.61.5.761","article-title":"Nicotine, negative affect, and depression.","volume":"61","author":"Hall","year":"1993","journal-title":"J Consult Clin Psychol."},{"key":"B75","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1037\/0022-006X.72.4.563","article-title":"Influences of mood, depression history, and treatment modality on outcomes in smoking cessation.","volume":"72","author":"Haas","year":"2004","journal-title":"J Consult Clin Psychol."},{"key":"B76","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.genhosppsych.2011.09.004","article-title":"Psychiatric disorders as assessed with SCID in chronic pain patients: the anxiety disorders precede the onset of pain.","volume":"34","author":"Knaster","year":"2012","journal-title":"Gen Hosp Psychiatry."},{"key":"B77","doi-asserted-by":"publisher","first-page":"2470547017704763","DOI":"10.1177\/2470547017704763","article-title":"Chronic pain and chronic stress: two sides of the same coin?","volume":"1","author":"Abdallah","year":"2017","journal-title":"Chronic Stress."},{"key":"B78","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1002\/ejp.2232","article-title":"Anxiety, history of childhood adversity, and experiencing chronic pain in adulthood: a systematic literature review and meta-analysis.","volume":"28","author":"Dalechek","year":"2024","journal-title":"Eur J Pain Lond Engl."},{"key":"B79","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1002\/ejp.1218","article-title":"Comorbidity between pain and mental illness \u2013 evidence of a bidirectional relationship.","volume":"22","author":"Bondesson","year":"2018","journal-title":"Eur J Pain."},{"key":"B80","doi-asserted-by":"publisher","first-page":"e106907","DOI":"10.1371\/journal.pone.0106907","article-title":"The association of depression and anxiety with pain: a study from NESDA.","volume":"9","author":"de Heer","year":"2014","journal-title":"PLoS One."},{"key":"B81","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1001\/archfami.3.9.774","article-title":"Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment.","volume":"3","author":"Kroenke","year":"1994","journal-title":"Arch Fam Med."},{"key":"B82","doi-asserted-by":"publisher","first-page":"49","DOI":"10.4088\/pcc.v02n0204","article-title":"Psychiatric and somatic markers of anxiety: identification and pharmacologic treatment.","volume":"2","author":"Gelenberg","year":"2000","journal-title":"Prim Care Companion J Clin Psychiatry."},{"key":"B83","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1001\/archpsyc.1991.01810320024004","article-title":"Recognition, management, and course of anxiety and depression in general practice.","volume":"48","author":"Ormel","year":"1991","journal-title":"Arch Gen Psychiatry."},{"key":"B84","doi-asserted-by":"publisher","first-page":"22279","DOI":"10.3390\/ijms151222279","article-title":"Smoking and rheumatoid arthritis.","volume":"15","author":"Chang","year":"2014","journal-title":"Int J Mol Sci."},{"key":"B85","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1038\/s41591-019-0675-0","article-title":"Chronic inflammation in the etiology of disease across the life span.","volume":"25","author":"Furman","year":"2019","journal-title":"Nat Med."},{"key":"B86","doi-asserted-by":"publisher","first-page":"eadt1083","DOI":"10.1126\/sciadv.adt1083","article-title":"The inflammatory and genetic mechanisms underlying the cumulative effect of co-occurring pain conditions on depression.","volume":"11","author":"Jiang","year":"2025","journal-title":"Sci Adv."},{"key":"B87","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/1741-7015-11-200","article-title":"So depression is an inflammatory disease, but where does the inflammation come from?","volume":"11","author":"Berk","year":"2013","journal-title":"BMC Med."},{"key":"B88","doi-asserted-by":"publisher","first-page":"3190","DOI":"10.3390\/cells11203190","article-title":"Immunological insights into cigarette smoking-induced cardiovascular disease risk.","volume":"11","author":"Dahdah","year":"2022","journal-title":"Cells."},{"key":"B89","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1038\/hr.2016.35","article-title":"Hypertension as an autoimmune and inflammatory disease.","volume":"39","author":"Solak","year":"2016","journal-title":"Hypertens Res."},{"key":"B90","doi-asserted-by":"publisher","first-page":"3057","DOI":"10.1145\/3025453.3025725","article-title":"Lessons from practice: designing tools to facilitate individualized support for quitting smoking.","volume":"2017","author":"Bhattacharya","year":"2017","journal-title":"ACM Trans Comput-Hum Interact Publ Assoc Comput Mach."},{"key":"B91","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1037\/\/0022-006x.62.1.141","article-title":"Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers.","volume":"62","author":"Hall","year":"1994","journal-title":"J Consult Clin Psychol."},{"key":"B92","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.ypmed.2008.05.006","article-title":"Physical activity as a strategy for maintaining tobacco abstinence: a randomized trial.","volume":"47","author":"Prochaska","year":"2008","journal-title":"Prev Med."},{"key":"B93","doi-asserted-by":"publisher","first-page":"231","DOI":"10.3109\/10673229709030550","article-title":"The self-medication hypothesis of substance use disorders: a reconsideration and recent applications.","volume":"4","author":"Khantzian","year":"1997","journal-title":"Harv Rev Psychiatry."},{"key":"B94","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1177\/10497323221083353","article-title":"\u201cThe drug use unfortunately isn\u2019t all bad\u201d: chronic disease self-management complexity and strategy among marginalized people who use drugs.","volume":"32","author":"Boucher","year":"2022","journal-title":"Qual Health Res."},{"key":"B95","doi-asserted-by":"publisher","first-page":"106427","DOI":"10.1016\/j.addbeh.2020.106427","article-title":"Depressive symptoms predict smoking cessation in a 20-year longitudinal study of adult twins.","volume":"108","author":"Ranjit","year":"2020","journal-title":"Addict Behav."},{"key":"B96","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1037\/a0015206","article-title":"Longitudinal analysis of abstinence-specific social support and smoking cessation.","volume":"28","author":"Lawhon","year":"2009","journal-title":"Health Psychol Off J Div Health Psychol Am Psychol Assoc."},{"key":"B97","doi-asserted-by":"publisher","first-page":"CD008286","DOI":"10.1002\/14651858.CD008286.pub3","article-title":"Combined pharmacotherapy and behavioural interventions for smoking cessation.","volume":"3","author":"Stead","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"key":"B98","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1176\/appi.ajp.161.11.2100","article-title":"Extended nortriptyline and psychological treatment for cigarette smoking.","volume":"161","author":"Hall","year":"2004","journal-title":"Am J Psychiatry."},{"key":"B99","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1037\/\/0022-006x.64.5.1003","article-title":"Mood management and nicotine gum in smoking treatment: a therapeutic contact and placebo-controlled study.","volume":"64","author":"Hall","year":"1996","journal-title":"J Consult Clin Psychol."},{"key":"B100","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/archpsyc.55.8.683","article-title":"Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking.","volume":"55","author":"Hall","year":"1998","journal-title":"Arch Gen Psychiatry."},{"key":"B101","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1001\/archpsyc.59.10.930","article-title":"Psychological intervention and antidepressant treatment in smoking cessation.","volume":"59","author":"Hall","year":"2002","journal-title":"Arch Gen Psychiatry."},{"key":"B102","doi-asserted-by":"publisher","first-page":"259","DOI":"10.2147\/COPD.S10771","article-title":"Improved patient outcome with smoking cessation: when is it too late?","volume":"6","author":"Wu","year":"2011","journal-title":"Int J Chron Obstruct Pulmon Dis."},{"key":"B103","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1037\/hea0000737","article-title":"Depression and multimorbidity: considering temporal characteristics of the associations between depression and multiple chronic diseases.","volume":"38","author":"Birk","year":"2019","journal-title":"Health Psychol."},{"key":"B104","doi-asserted-by":"publisher","first-page":"eaay0214","DOI":"10.1126\/science.aay0214","article-title":"Poverty, depression, and anxiety: causal evidence and mechanisms.","volume":"370","author":"Ridley","year":"2020","journal-title":"Science."},{"key":"B105","doi-asserted-by":"publisher","first-page":"eaay9763","DOI":"10.1126\/sciadv.aay9763","article-title":"Current advances in research in treatment and recovery: nicotine addiction.","volume":"5","author":"Prochaska","year":"2019","journal-title":"Sci Adv."},{"key":"B106","first-page":"12","article-title":"Breathing exercises, cold-water immersion, and meditation: mind-body practices lead to reduced stress and enhanced well-being.","volume":"36","author":"Faid","year":"2022","journal-title":"Adv Mind Body Med."},{"key":"B107","doi-asserted-by":"publisher","first-page":"5924040","DOI":"10.1155\/2021\/5924040","article-title":"Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation.","volume":"2021","author":"Toussaint","year":"2021","journal-title":"Evid-Based Complement Altern Med ECAM."},{"key":"B108","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/JAN.0000000000000367","article-title":"The effect of breathing exercise on nicotine withdrawal symptoms, cigarette cravings, and affect.","volume":"31","author":"Klinsophon","year":"2020","journal-title":"J Addict Nurs."},{"key":"B109","doi-asserted-by":"publisher","first-page":"1567725","DOI":"10.3389\/fmed.2025.1567725","article-title":"The dialogue dilemma: the role of patient-clinician communication for low-income people who smoke and manage multiple conditions.","volume":"12","author":"Cano","year":"2025","journal-title":"Front Med."},{"key":"B110","doi-asserted-by":"publisher","first-page":"4113","DOI":"10.2147\/JMDH.S525146","article-title":"Clinical applications and potential mechanism of cold acclimation therapy.","volume":"18","author":"Wang","year":"2025","journal-title":"J Multidiscip Healthc."},{"key":"B111","volume-title":"Lifestyle Mental Wellbeing for the Primary Care Visit.","author":"Kang","year":"2025"},{"key":"B112","doi-asserted-by":"publisher","first-page":"4627","DOI":"10.3390\/nu15214627","article-title":"Effects of healthy lifestyles on chronic diseases: diet, sleep and exercise.","volume":"15","author":"Oster","year":"2023","journal-title":"Nutrients."},{"key":"B113","doi-asserted-by":"publisher","first-page":"e60","DOI":"10.2196\/jmir.1463","article-title":"Using evidence-based internet interventions to reduce health disparities worldwide.","volume":"12","author":"Mu\u00f1oz","year":"2010","journal-title":"J Med Internet Res."},{"key":"B114","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1177\/2167702615583840","article-title":"Massive open online interventions: a novel model for delivering behavioral-health services worldwide.","volume":"4","author":"Mu\u00f1oz","year":"2016","journal-title":"Clin Psychol Sci."},{"key":"B115","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.invent.2016.06.001","article-title":"Mood management effects of brief unsupported internet interventions.","volume":"5","author":"Bunge","year":"2016","journal-title":"Internet Interv."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1735343\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:10:34Z","timestamp":1774930234000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1735343\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":115,"alternative-id":["10.3389\/fmed.2026.1735343"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1735343","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"article-number":"1735343"}}