{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T20:15:17Z","timestamp":1762460117588,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T00:00:00Z","timestamp":1678320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brown University","award":["P30AI042853"],"award-info":[{"award-number":["P30AI042853"]}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases\/Providence\/Boston Cneter","doi-asserted-by":"publisher","award":["P30AI042853"],"award-info":[{"award-number":["P30AI042853"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: People with HIV (PWH) who smoke have reported that managing anxiety is a barrier to making a quit attempt and maintaining abstinence post-quit. This study examined the feasibility and acceptability of an app-based mindfulness intervention, Unwinding Anxiety, to reduce anxiety prior to a quit attempt in PWH who were not planning to quit in the next 30 days. Methods: Sixteen PWH (mean age 51.5 [SD = 13.2]; mean cigarettes per day 11.4 [SD = 5.4]) were enrolled and followed for eight weeks. A smartphone-based app with 30 modules designed to reduce anxiety was introduced at baseline; participants were encouraged to complete one module daily for four weeks. Symptoms of anxiety and readiness to quit smoking were measured at baseline and weeks 4 and 8. The mean number of modules completed, session attendance, and number of study completers were examined. Generalized estimating equations (GEE) were used to examine changes in self-reported anxiety and readiness to quit at baseline, week 4, and week 8. A brief qualitative interview was conducted at week 4 to explore the acceptability of the app. Results: Feasibility was high, with 93% of participants completing the study. The mean number of study sessions completed was 2.7 (SD = 0.59), and the mean number of modules completed was 16.0 (SD 16.8). Anxiety was high at baseline (M = 14.4, SD = 3.9), but lower at week 4 (b = \u22125.5; CI: [\u22129.4, \u22121.7]; p = 0.004) and week 8 (b = \u22125.1; CI: [\u22128.8, \u22121.3]; p = 0.008), and stable between weeks 4 and 8 (b = 0.48; CI: [\u22122.0, 3.0]; p = 0.706). Readiness to quit significantly increased from baseline M = 5.5 (SD = 1.6) to week 4 (b = 0.56; CI: [0.20, 0.91]; p = 0.002) but was not significantly different from baseline at week 8 (b = 0.34; CI: [\u22120.30, 1.0]; p = 0.30). Ad-hoc moderation analyses found that anxiety had a small significantly positive association with readiness to quit at baseline (main effect: b = 0.10; SE = 0.03; p &lt; 0.001) and significantly attenuated the increase in readiness to quit observed at week 4 (anxiety by week 4 interaction: b = \u22120.08; SE = 0.03; p = 0.009). Conclusions: App-based mindfulness training appears to be feasible and acceptable for PWH who smoke and report baseline anxiety. At week 4, anxiety was reduced and readiness to quit was increased, perhaps a key time point for a smoking cessation attempt.<\/jats:p>","DOI":"10.3390\/ijerph20064826","type":"journal-article","created":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T03:03:23Z","timestamp":1678331003000},"page":"4826","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["App-Delivered Mindfulness Training to Reduce Anxiety in People with HIV Who Smoke: A One-Armed Feasibility Trial"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-7819","authenticated-orcid":false,"given":"Patricia","family":"Cioe","sequence":"first","affiliation":[{"name":"Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3545-5745","authenticated-orcid":false,"given":"Alexander","family":"Sokolovsky","sequence":"additional","affiliation":[{"name":"Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judson","family":"Brewer","sequence":"additional","affiliation":[{"name":"Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6248-4149","authenticated-orcid":false,"given":"Christopher","family":"Kahler","sequence":"additional","affiliation":[{"name":"Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/QAI.0b013e318134257a","article-title":"HIV-Infected Adults with a CD4 Cell Count Greater Than 500 Cells\/mm3 on Long-Term Combination Antiretroviral Therapy Reach Same Mortality Rates as the General Population","volume":"46","author":"Charlotte","year":"2007","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"key":"ref_2","first-page":"582","article-title":"Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals","volume":"23","author":"Pacek","year":"2014","journal-title":"Am. J. Addict.\/Am. Acad. Psychiatr. Alcohol. Addict."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/QAD.0000000000000540","article-title":"Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America","volume":"29","author":"Helleberg","year":"2015","journal-title":"Aids"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1038\/bjc.2011.558","article-title":"Lung cancer in the Swiss HIV Cohort Study: Role of smoking, immunodeficiency and pulmonary infection","volume":"106","author":"Clifford","year":"2012","journal-title":"Br. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1097\/QAD.0000000000000283","article-title":"Risk of cancer among HIV-infected individuals compared to the background population: Impact of smoking and HIV","volume":"28","author":"Marie","year":"2014","journal-title":"Aids"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1097\/QAD.0000000000001434","article-title":"Immunodeficiency, AIDS-related pneumonia, and risk of lung cancer among HIV-infected individuals","volume":"31","author":"Marcus","year":"2017","journal-title":"Aids"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/QAD.0000000000001721","article-title":"Cancer burden attributable to cigarette smoking among HIV-infected people in North America","volume":"32","author":"Altekruse","year":"2018","journal-title":"Aids"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1093\/ntr\/ntaa277","article-title":"National Estimates of Prevalence, Time-Trend, and Correlates of Smoking in US People Living with HIV (NHANES 1999\u20132016)","volume":"23","author":"Asfar","year":"2021","journal-title":"Nicotine Tob. Res. Off. J. Soc. Res. Nicotine Tob."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s11904-015-0281-9","article-title":"Tobacco Use, Use Disorders, and Smoking Cessation Interventions in Persons Living with HIV","volume":"12","author":"Pacek","year":"2015","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1080\/09540121.2018.1489103","article-title":"Perceived barriers to smoking cessation and perceptions of electronic cigarettes among persons living with HIV","volume":"30","author":"Cioe","year":"2018","journal-title":"AIDS Care"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Cartujano-Barrera, F., Lee D\u2019Abundo, M., Arana-Chicas, E., Chock, S., Valera, P., Kamen, C.S., and Cupertino, A.P. (2021). Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Lead-ers of Community-Based Organizations and Clinics. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073437"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s40429-016-0090-2","article-title":"Current research on cigarette smoking among people with HIV","volume":"3","author":"Cooperman","year":"2016","journal-title":"Curr. Addict. Rep."},{"key":"ref_13","first-page":"237834","article-title":"Evaluation of a Smoking Cessation Program for HIV Infected Individuals in an Urban HIV Clinic: Challenges and Lessons Learned","volume":"2014","author":"Chew","year":"2014","journal-title":"AIDS Res. Treat."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"75","DOI":"10.5993\/AJHB.36.1.8","article-title":"Cigarette smoking behaviors and beliefs in persons living with HIV\/AIDS","volume":"36","author":"Shuter","year":"2012","journal-title":"Am. J. Health Behav."},{"key":"ref_15","unstructured":"(2022, January 09). Data Table 1: Lifetime Prevalence of DSM-IV\/WMH-CIDI Disorders by Sex and Cohort [Internet]. National Comorbidity Survey. Available online: https:\/\/www.hcp.med.harvard.edu\/ncs\/index.php."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.cpr.2016.11.005","article-title":"Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature","volume":"51","author":"Brandt","year":"2017","journal-title":"Clin. Psychol. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/13548506.2014.945601","article-title":"A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy","volume":"20","author":"Claborn","year":"2015","journal-title":"Psychol. Health Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"595","DOI":"10.4088\/JCP.12r07757","article-title":"Patient preference for psychological vs. pharmacologic treatment of psychiatric disorders: A meta-analytic review","volume":"74","author":"McHugh","year":"2013","journal-title":"J. Clin. Psychiatry"},{"key":"ref_19","unstructured":"Kabat-Zinn, J. (1990). Full Catastropher Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness."},{"key":"ref_20","first-page":"1035","article-title":"Mindfulness: An Emerging Treatment for Smoking and other Addictions?","volume":"2","author":"Brewer","year":"2015","journal-title":"J. Fam. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.ctim.2013.01.008","article-title":"A narrative review of yoga and mindfulness as complementary therapies for addiction","volume":"21","author":"Khanna","year":"2013","journal-title":"Complement. Ther. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1093\/clipsy.9.1.54","article-title":"Expanding Our Conceptualization of and Treatment for Generalized Anxiety Disorder: Integrating Mindfulness\/Acceptance-Based Approaches with Existing Cognitive-Behavioral Models","volume":"9","author":"Roemer","year":"2002","journal-title":"Clin. Psychol. Sci. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1176\/ajp.149.7.936","article-title":"Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders","volume":"149","author":"Massion","year":"1992","journal-title":"Am. J. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/0163-8343(95)00025-M","article-title":"Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders","volume":"17","author":"Miller","year":"1995","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.janxdis.2007.07.005","article-title":"Mindfulness-based cognitive therapy for generalized anxiety disorder","volume":"22","author":"Evans","year":"2008","journal-title":"J. Anxiety Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1037\/0022-006X.68.4.615","article-title":"Prevention of relapse\/recurrence in major depression by mindfulness-based cognitive therapy","volume":"68","author":"Teasdale","year":"2000","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1037\/0022-006X.72.1.31","article-title":"Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects","volume":"72","author":"Ma","year":"2004","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/clipsy.bph077","article-title":"Mindfulness: A proposed operational definition","volume":"11","author":"Bishop","year":"2004","journal-title":"Clin. Psychol.-Sci. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1037\/a0028490","article-title":"Craving to Quit: Psychological Models and Neurobiological Mechanisms of Mindfulness Training as Treatment for Addictions","volume":"27","author":"Brewer","year":"2013","journal-title":"Psychol. Addict. Behav."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Carim-Todd, L., Mitchell, S.H., and Oken, B.S. (Drug Alcohol Depend., 2013). Mind\u2013body practices: An alternative, drug-free treatment for smoking cessation? A systematic review of the literature, Drug Alcohol Depend., in press.","DOI":"10.1016\/j.drugalcdep.2013.04.014"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/j.1360-0443.2007.01832.x","article-title":"Acute effects of a guided relaxation routine (body scan) on tobacco withdrawal symptoms and cravings in abstinent smokers","volume":"102","author":"Cropley","year":"2007","journal-title":"Addiction"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Davis, J.M., Fleming, M.F., Bonus, K.A., and Baker, T.B. (2007). A pilot study on mindfulness based stress reduction for smokers. BMC Complement. Altern. Med., 7.","DOI":"10.1186\/1472-6882-7-2"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.drugalcdep.2011.05.027","article-title":"Mindfulness training for smoking cessation: Results from a randomized controlled trial","volume":"119","author":"Brewer","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1037\/a0017127","article-title":"Surfing the urge: Brief mindfulness-based intervention for college student smokers","volume":"23","author":"Bowen","year":"2009","journal-title":"Psychol. Addict. Behav."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.drugalcdep.2012.11.015","article-title":"Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use","volume":"130","author":"Elwafi","year":"2013","journal-title":"Drug Alcohol Depend."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.addbeh.2017.01.022","article-title":"Efficacy of mindfulness meditation for smoking cessation: A systematic review and meta-analysis","volume":"69","author":"Maglione","year":"2017","journal-title":"Addict. Behav."},{"key":"ref_37","doi-asserted-by":"crossref","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":"ref_38","first-page":"360","article-title":"The Contemplation Ladder: Validation of a measure of readiness to consider smoking cessation","volume":"10","author":"Biener","year":"1991","journal-title":"Health Psychol. Off. J. Div. Health Psychol. Am. Psychol. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e15608","DOI":"10.2196\/15608","article-title":"Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training","volume":"8","author":"Roy","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1093\/ntr\/nty126","article-title":"Craving to Quit: A Randomized Controlled Trial of Smartphone App-Based Mindfulness Training for Smoking Cessation","volume":"22","author":"Garrison","year":"2020","journal-title":"Nicotine Tob. Res. Off. J. Soc. Res. Nicotine Tob."},{"key":"ref_41","unstructured":"Brooke, J. (1996). Usability Evaluation in Industry, CRC Press."},{"key":"ref_42","unstructured":"R Core Team (2013). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v015.i02","article-title":"The R package geepack for generalized estimating equations","volume":"15","author":"Halekoh","year":"2006","journal-title":"J. Stat. Softw."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1080\/09540121.2020.1808163","article-title":"Symptoms of generalized anxiety disorder as a risk factor for substance use among adults living with HIV","volume":"33","author":"Mannes","year":"2021","journal-title":"AIDS Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e2012598","DOI":"10.1001\/jamanetworkopen.2020.12598","article-title":"Association of Mindfulness-Based Interventions with Anxiety Severity in Adults with Cancer: A Systematic Review and Meta-analysis","volume":"3","author":"Oberoi","year":"2020","journal-title":"JAMA Netw Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"102599","DOI":"10.1016\/j.janxdis.2022.102599","article-title":"Mindfulness-based cognitive group therapy for treatment-refractory anxiety disorder: A pragmatic randomized controlled trial","volume":"90","author":"Spinhoven","year":"2022","journal-title":"J. Anxiety Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1007\/s12671-022-01946-z","article-title":"Self-Efficacy as a Potential Mechanism of Behavior Change in Mindfulness-Based Relapse Prevention","volume":"13","author":"Stein","year":"2022","journal-title":"Mindfulness"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1001\/jamapsychiatry.2013.4546","article-title":"Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial","volume":"71","author":"Bowen","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Foster, M.G., Toll, B.A., Ware, E., Eckard, A.R., Sterba, K.R., and Rojewski, A.M. (2022). Optimizing the Implementation of Tobacco Treatment for People with HIV: A Pilot Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912896"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4826\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:51:39Z","timestamp":1760122299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4826"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,9]]},"references-count":49,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20064826"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20064826","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2023,3,9]]}}}