Nicotine psychobiology: how chronic-dose prospective studies can illuminate some of the theoretical issues from acute-dose research

E-Cigarette Dependence and Depressive Symptoms Among Youth

INTRODUCTION

Although the relationship between smoking and depression has been well-established, little is known about the association between use of e-cigarette and depression, particularly among youth and young adults. This study proposes that e-cigarette dependence, rather than simply use, serves as a potential stressor and may interact with pre-existing vulnerabilities to contribute to depression in youth, consistent with the diathesis-stress theory. This study examines the longitudinal association of vaping dependence and vaping frequency on depression symptoms among youth and young adults who have never smoked cigarettes.

METHODS

People who used e-cigarettes in the past month who reported never smoking a cigarette (N=1,226) aged between 16 and 25 years were followed longitudinally every 3 months for up to 1 year beginning in 2020. The Penn State E-Cigarette Dependence Index at time t was used to predict depression symptoms assessed using the Center for Epidemiologic Studies Depression Scale at time t+1.

RESULTS

A total of 32.1% reported vaping in the past month with the Penn State E-Cigarette Dependence Index score (M=8.5) and a Center for Epidemiologic Studies Depression Scale score (M=15.8). Higher vaping dependence scores were significantly associated with increased depression symptoms scores at follow-up among youth and adults (β=0.08; 95% CI=0.01, 0.15), controlling for baseline depression symptom scores and covariates. Although vaping dependence was highly associated with vaping frequency level, no significant association between the frequency of vaping and depression was found (β= -0.33; 95% CI= 1.21, 0.54).

CONCLUSIONS

These results are consistent with the diathesis-stress model of the relationship between substance use and depression. Vaping dependence but not vaping frequency was associated with increased depressive symptoms among people who never smoked cigarettes.

Cigarettes, heated tobacco products and dual use: exhaled carbon monoxide, saliva cotinine and total tobacco consumed by Hong Kong tobacco users

BACKGROUND

Independent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking.

METHODS

A total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression.

RESULTS

Both exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (p<0.05). Exhaled CO levels were similar between HTP and EC users, as were saliva cotinine levels among the seven groups. Compared with exclusive CC users, those who also used HTPs or ECs smoked fewer CCs (CCs+HTPs: adjusted coefficient -2.79, 95% CI -3.90 to -1.69; CCs+ECs: -1.34, 95% CI -2.34 to -0.34), but consumed more tobacco sticks equivalent in total (2.79 (95% CI 1.61 to 3.96); 1.95 (95% CI 0.79 to 3.12)).

CONCLUSIONS

HTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.

Sex and age moderate the trajectory of guilt among children and adolescents with and without recent suicidal ideation

We aimed to examine whether the trajectories of ecologically derived guilt differ among a transdiagnostic sample of youth with and without recent suicidal ideation and whether sex and age moderated this association. We assessed guilt 3 times a day over a 2-week period via ecological momentary assessment (EMA) technology in 102 children recruited from the community, outpatient, and inpatient settings. The average age of children was 10.95 y.o. (SD = 2.26, range 8-16) and the majority were male (54.9%) and White (76.5%). We found that the real-world guilt during a two-week EMA period was higher among youth with greater suicidal ideation severity in the past six months. Moreover, there was a significant moderating effect of sex and age on this association, such that the association between suicidal ideation severity and guilt was particularly strong among females compared to males and youth who were 10 years old or older. The findings were maintained when we adjusted for the relevant demographic and clinical characteristics, including age, minority status, parental income, EMA response rate, and current internalising symptoms. These preliminary findings highlight the clinical relevance of assessing and targeting feelings of guilt in the day-to-day lives of youth, particularly for females and older youth.

Neurological repercussions of neonatal nicotine exposure: A review

Smoking during pregnancy is hazardous to both the mother and the foetus, according to a substantial amount of recorded data. Exposure to nicotine and other compounds in cigarette smoke increases the risk of sudden infant death syndrome (SIDS) by two to five times during pregnancy. Serotonergic abnormalities have been discovered in SIDS infants in the zone of the medulla oblongata, which is known to control cardio-respiratory function. SIDS establishes a connection between depression, learning difficulties and behavioural disorders. Prenatal nicotine intake during the second trimester affects the dopaminergic neurological system, making the foetal brain more susceptible to nicotine and developing ADHD symptoms not just in a foetus but in adolescents also. Prenatal nicotine exposure alters the neurological route of neurotransmitters, acetylcholine and dopamine. Nicotine enhances neuronal activity in adults but desensitizes these processes in babies and young children exposed prenatally. The impact of a neurotoxin like nicotine is determined by the amount and duration of exposure. Continued exposure throughout pregnancy will influence a wide range of activities in the neurodevelopment, whereas exposure confined to a single stage of pregnancy may only affect the processes that are forming at that stage. To decrease the effect of nicotine on neonates due to maternal smoking strategies like nicotine replacement therapy (NRT), folic acid treatment and other behavioural treatments have been studied. Hence, this review focuses on the impact of exposure to nicotine on neonates, which results in various neurological consequences and smoking cessation therapies.

Adolescent Cannabinoid and Nicotine Exposure Differentially Alters Adult Nicotine Self-Administration in Males and Females

INTRODUCTION

During adolescence, exposure to nicotine or cannabis independently induces effects on neuromaturation and later cognitive function. However, the potential effect of both drugs under co-use conditions has become of increasing concern given the prevalence of e-cigarettes, legalization of cannabis, and availability of synthetic "spice" cannabinoid agonists.

AIMS AND METHODS

The current studies investigated the effects of exposure to a cannabinoid receptor agonist (WIN55,212-2) and/or nicotine over a discrete time period in mid-adolescence on later intravenous nicotine self-administration in adult male and female mice. We further examined whether cannabinoid agonist administration in adulthood would alter nicotine reinforcement, with either acute or chronic pairing across 7 days.

RESULTS

We found that adult males exhibited increased nicotine self-administration at a lower, rewarding nicotine dose following adolescent cannabinoid exposure, either alone or with nicotine coadministration. In contrast, adult females demonstrated an opposing effect in which adolescent cannabinoid and nicotine coexposure resulted in decreased nicotine intake compared with the nicotine only and control groups. Furthermore, after maintaining nicotine self-administration across sessions, pretreatment with a low dose of the cannabinoid agonist decreased nicotine intake in both male and female control mice, and this lowering effect was evidenced after both acute and chronic treatment. However, the cannabinoid agonist was ineffective in altering nicotine intake in mice previously exposed to nicotine, cannabinoid agonist, or both during adolescence.

CONCLUSIONS

These data provide evidence that adolescent drug exposure can alter later nicotine reinforcement in a sex-specific manner and can further modulate the effectiveness of interventions in reducing nicotine intake during adulthood.

IMPLICATIONS

These studies demonstrate a significant impact of nicotine, cannabinoids, or coexposure on developmental processes during adolescence. Differential effects were observed within each sex, with opposing results found for cannabinoid exposure on nicotine intake in males and females. Intriguingly, we also evidenced resistance to the lowering effects of a cannabinoid agonist on nicotine intake in adulthood based on adolescent drug exposure. Thus, these findings have important implications for our understanding of the impact of nicotine and cannabinoids (eg, Δ9-tetrahydrocannabinol (THC) and synthetic "spice" cannabinoids) during development, with further implications for the effectiveness of therapeutic interventions based on prior drug exposure in youth.

A comparative study to assess general health status and oral health score of tobacco users and nonusers in geriatric population in central India

Background:

Globally about 5 million deaths every year can be ascribed to tobacco use. It leads to many systemic and oral diseases. These diseases in geriatric population are common and more hazardous.

Methods:

Cross-sectional study was conducted in rural area of a teaching hospital to assess general health status and oral health scores of 500 geriatric age group tobacco users and non users. Data analysis was done with SPSS version-20. Chi square test and Mann Whitney U rank test were applied.

Results:

Poor self assessed health status was found in tobacco users as compared to nonusers. Significant limitation was found among the tobacco users as compared to nonusers. Significant association was found between the presence of diabetes, COPD, and tobacco use. Tobacco use was found to be significantly associated with poor oral health.

Conclusion:

Statistically significant poor general and oral health was found in tobacco users than nonusers.

Effects of time-varying changes in tobacco and alcohol use on depressive symptoms following pharmaco-behavioral treatment for smoking and heavy drinking

BACKGROUND

Complete abstinence from alcohol as well as smoking cessation have been shown to predict reductions in depressive symptoms over time. However, whether reducing alcohol use or smoking positively affect depressive symptoms has yet to be examined. The current study examined depressive symptoms as a function of time-varying changes in alcohol use and smoking status following a pharmaco-behavioral treatment addressing smoking cessation and alcohol reduction.

METHODS

Participants were heavy-drinking smokers (n = 150) followed for 26 weeks after their quit smoking date, with assessments of smoking, alcohol use, and depressive symptoms at baseline and 2, 8, 16, and 26 weeks.

RESULTS

Abstinence from smoking was associated with significantly lower depressive symptoms, as compared to little to no reduction in smoking (B = -6.1) as well as significant reductions in smoking (B = 4.01). Exploratory analyses, which excluded observations in which a participant was abstinent, revealed a significant effect of percent change in cigarettes smoked, modeled continuously, on depressive symptoms, (B = 4.39). By contrast, no differences were observed in depressive symptoms in relation to changes in alcohol use.

CONCLUSION

It appears that smoking abstinence is associated with improvements in depression as compared to any level of sustained or reduced use and that the magnitude of smoking reduction may be associated with lower depressive symptoms among those who did not quit successfully. If replicated, these findings may inform treatment for individuals for whom depression is a major barrier to cessation and who have been unable or are unwilling to be completely abstinent from smoking.

Mood Fluctuation and Psychobiological Instability: The Same Core Functions Are Disrupted by Novel Psychoactive Substances and Established Recreational Drugs

Many novel psychoactive substances (NPS) have entered the recreational drug scene in recent years, yet the problems they cause are similar to those found with established drugs. This article will debate the psychobiological effects of these newer and more traditional substances. It will show how they disrupt the same core psychobiological functions, so damaging well-being in similar ways. Every psychoactive drug causes mood states to fluctuate. Users feel better on-drug, then feel worse off-drug. The strength of these mood fluctuations is closely related to their addiction potential. Cyclical changes can occur with many other core psychobiological functions, such as information processing and psychomotor speed. Hence the list of drug-related impairments can include: homeostatic imbalance, HPA axis disruption, increased stress, altered sleep patterns, neurohormonal changes, modified brain rhythms, neurocognitive impairments, and greater psychiatric vulnerability. Similar patterns of deficit are found with older drugs such as cocaine, nicotine and cannabis, and newer substances such as 3,4-methylenedioxymethamphetamine (MDMA), mephedrone and spice. All psychoactive drugs damage human well-being through similar basic neuropsychobiological mechanisms.

Smoking by people with mental illness and benefits of smoke-free mental health services

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.

A reverse factual analysis of the association between smoking and memory decline in China

Background

Whether smoking accelerates memory recession has been a topic of significant research. However, randomised controlled trials are not easy to carry out, and does not comply with the ethics of research. And observation method which based on the most readily observed data is easy to draw the wrong conclusions without adjustment. The memory difference between smokers and non-smokers may not really represent the real differences between their memories.

Methods

In response to these limitations, we adopt propensity score method to match the samples and solve the estimated selection bias and confounding bias on elderlies aged 60 years and over based on Chinese Longitudinal Healthy Longevity Survey (2011) data. The respondents are divided into non-smokers, people who used to smoke but not now, and people who used to smoke and still now. To balance the similarity between different groups on their propensity score weighted distributions of pretreatment covariates, we use generalized boosted models to estimate the multiply treatment propensity scores.

Results

The results show that compared with non-smokers, people who used to smoke and still now respectively have a decrease 0.0283, 0.0735, 0.0091 on self-evaluation memory, daily living activities, and cognitive function. People who used to smoke but not now have a decrease 0.0224 on daily living activities, while have an increase 0.0054 and 0.0104 on self-evaluation memory, and cognitive function.

Conclusion

The PSM has considerable utility to control pre-treatment imbalances on observed covariates in non-randomised or observational data.

Why all stimulant drugs are damaging to recreational users: an empirical overview and psychobiological explanation

AIMS

Stimulant drugs such as nicotine and Ecstasy/3, 4-methylenedioxymethamphetamine (MDMA) are taken for positive reasons, yet their regular use leads to deficits rather than gains. This article outlines the psychobiological rationale for this paradox.

METHODS

The empirical literature on nicotine, cocaine, amphetamine, Ecstasy/MDMA, and mephedrone are reviewed. A theoretical explanation for why they are problematic to humans is then described.

RESULTS

The acute effects of central nervous system (CNS) stimulants are typically positive, with greater alertness and emotional intensity. However, in the post-drug recovery period, the opposite feelings develop, with lethargy and low moods. All recreational stimulants cause mood fluctuation, although it is most pronounced in drugs with rapid onset and comedown (e.g. nicotine and cocaine), explaining why they are the most addictive. Parallel fluctuations occur across many psychological and neurocognitive functions, with users suffering various off-drug deficits. CNS stimulants also affect the hypothalamic-pituitary-adrenal axis, impairing sleep, disrupting homeostasis, and exacerbating psychiatric distress. Neuroimaging studies reveal altered brain activity patterns in regular users. These problems are related to lifetime usage but commence in novice users.

CONCLUSIONS

Repetitive CNS stimulation is potentially damaging to the organism, both acutely and chronically. The review describes the various psychobiological systems through which recreational stimulant drugs impair human well-being.

Mood, mood regulation, and frontal systems functioning in current smokers, long-term abstinent ex-smokers, and never-smokers

Indices of mood, mood regulation, and executive functioning were examined in 61 current smokers who have smoked daily for at least one year, 36 ex-smokers who had not smoked a cigarette for at least one year, and 86 never-smokers. All participants completed the following measures online: Depression Anxiety Stress Scales (DASS-21), the Negative Mood Regulation (NMR) scale, the Frontal Systems Behavior Scale (FrSBe), the Fagerström Test for Cigarette Dependence (FTCD), and the Alcohol Use Disorders Identification Test (AUDIT). Multivariate analysis of variance (MANOVA) followed by Tukey post-hoc tests revealed significant differences (p < .01) such that current smokers indicated worse functioning than both ex-smokers and never-smokers on DASS, NMR, and FrSBe, as well as heavier drinking as measured by AUDIT. These differences remained significant even after controlling for AUDIT scores. Results most plausibly reflect a return to pre-smoking baseline brain function in long-term abstinent ex-smokers.

Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT)

BACKGROUND

Smoking cessation improves physical health but it has been suggested that in vulnerable individuals it may worsen mental health. This study aimed to identify the short- and longer-term effects of stopping smoking on depression and anxiety in the general population and in those with a history of these disorders.

METHOD

Sociodemographic and smoking characteristics, and mental and physical health were assessed using established measures in the ATTEMPT cohort, an international longitudinal study of smokers (n = 3645). Smokers who had stopped for at least 3 months or less than 3 months at the 12-month follow-up were compared with current smokers (n = 1640).

RESULTS

At follow-up, 9.7% [95% confidence interval (CI) 8.3-11.2] of smokers had stopped for less than 3 months and 7.5% (95% CI 6.3-8.9) for at least 3 months. Compared with current smokers, prevalence of depression prescriptions obtained in the last 2 weeks was lower for those who had stopped for less than 3 months [odds ratio (OR) 0.37, 95% CI 0.14-0.96] or at least 3 months (OR 0.25, 95% CI 0.06-0.94) after adjusting for baseline prescription levels and confounding variables. Adjusted prevalence of recent depression symptoms was also lower for ex-smokers who had stopped for less than 3 months (OR 0.34, 95% CI 0.15-0.78) or at least 3 months (OR 0.24, 95% CI 0.09-0.67) than among continuing smokers. There was no change in anxiety measures in the general population or any increase in anxiety or depression symptoms in ex-smokers with a past history of these conditions.

CONCLUSIONS

Smoking cessation does not appear to be associated with an increase in anxiety or depression and may lead to a reduced incidence of depression.

Mood, mood regulation expectancies and frontal systems functioning in current smokers versus never-smokers in China and Australia

Indices of mood, mood regulation expectancies and everyday executive functioning were examined in adult current smokers and never-smokers of both genders in Australia (N = 97), where anti-smoking campaigns have dramatically reduced smoking prevalence and acceptability, and in China (N = 222), where smoking prevalence and public acceptance of smoking remain high. Dependent measures included the Depression Anxiety Stress Scales (DASS-21), the Negative Mood Regulation (NMR) expectancies scale, the Frontal Systems Behavior Scale (FrSBe), the Fagerström Test for Nicotine Dependence (FTND) and the Alcohol Use Disorders Identification Test (AUDIT). Multivariate analyses of covariance (MANCOVAs) controlling for demographic and recruitment related variables revealed highly significant differences between current smokers and never-smokers in both countries such that smokers indicated worse moods and poorer functioning than never-smokers on all dependent measures. Chinese smokers scored significantly worse on all dependent measures than Australian smokers whereas Chinese and Australian never-smokers did not differ on any of the same measures. Although nicotine dependence level as measured by FTND was significantly higher in Chinese than Australian smokers and was significantly correlated with all other dependent measures, inclusion of FTND scores as another covariate in MANCOVA did not eliminate the highly significant differences between Chinese and Australian smokers. Results are interpreted in light of the relative ease of taking up and continuing smoking in China compared to Australia today.

Inverted U shaped effect of nicotine on the severity of depressive symptoms: A population-based survey

OBJECTIVES

To investigate whether that nicotine concentration represented by the degree of smoking dependence variably influence the rate and severity of depressive symptoms.

METHODS

Cross-sectional, analytical study, involving 300 medical students selected by random sampling techniques were asked to complete a questionnaire contains three parts: demographic information, Beck Depression Inventory with cutoff point for depression is 17 and the Fagerström Test for Nicotine dependence with cutoff point for severe dependence is five.

RESULTS

A total of 233 medical students completed the questionnaire; their mean age was (21.38 ± 1.74). The rate of smoking was 22.7% while that of depression was 32.2%. Low dependent smokers in contrast to other groups of smokers and non-smokers display the lowest rate of depressive symptoms (15%), while the highest rate recorded among severely dependent smokers (71.4%, p = 0.0001). After adjustment of other risk factors, regression analysis reveal that severe dependent smokers associated with 12.5 odds of depressive symptoms than non-smokers (p = 0.0001, C.I. 4.10-38.29).

CONCLUSION

In comparison with light and moderate smokers, heavy smokers demonstrate higher risk of depressive symptoms in medical students.

Dynamic associations of negative mood and smoking across the development of smoking in adolescence

Self-medication models of smoking posit that the emotional benefits of smoking reinforce and maintain cigarette use, yet research demonstrates both positive and adverse affective consequences of smoking. The current study examined longitudinal changes in adolescent mood variability and overall negative mood at various stages of smoking behavior to inform understanding of the etiology of adolescent smoking. Participants included 461 adolescents (M age = 15.67 years, SD = 0.61; 55% girls, 56.8% White) drawn from a longitudinal study of adolescent smoking. Youth provided data on smoking behavior at baseline and a 15-month follow-up wave. Ecological momentary assessments were used to measure overall levels of negative mood as well as within-person mood fluctuations (i.e., negative mood variability) at each wave. Findings revealed that smoking-mood relations vary across different stages of smoking behavior. Youth who rapidly escalated in their smoking during the study experienced improved mood regulation (for girls) and improved overall mood (for boys) as smoking increased. However, mood improvements were not observed among youth with sustained heavy use and symptoms of dependence. The current data argue for a model of smoking that accounts for changes in risk and maintenance factors at different points along the developmental trajectory of smoking, involving elements of both self-medication and dependence.

Life 1 year after a quit attempt: real-time reports of quitters and continuing smokers

BACKGROUND

Smokers are often reluctant to quit because they fear long-lasting withdrawal. Yet little research prospectively examines smokers' withdrawal longer than 1 month post-quit.

PURPOSE

The aim of this study was to compare successful versus unsuccessful quitters' withdrawal, positive affect/pleasure, and lifestyle at 1 year post-quit.

METHODS

Smokers (N = 572) in a cessation trial completed ecological momentary assessments four times a day for 1 week pre-quit, 1 week post-quit, and 1 week at 1 year post-quit.

RESULTS

From pre-quit to 1 year later, only quitters reported sizeable declines in craving and restlessness, and fewer stressful events. At 1 year, quitters, on average, reported no significant craving. Continuing smokers reduced their cigarette consumption considerably from pre-quit to 1 year later.

CONCLUSIONS

Contrary to smokers' worries, long-term quitters reported less craving and restlessness than when they smoked (perhaps because cessation eliminates the acute nicotine withdrawal smokers experience between cigarettes). This information may encourage smokers to quit and endure withdrawal.

Aggression, impulsivity, and psychopathic traits in combined antisocial personality disorder and substance use disorder

Aggression, impulsivity, and psychopathic traits are prominent in both antisocial personality disorder (ASPD) and substance use disorders (SUD), but have rarely been examined collectively. The authors' results show that all three variables were elevated in adults with comorbid ASPD/SUD, relative to SUD-only and control subjects.

Cocaine use during pregnancy and health outcome after 10 years

BACKGROUND

Women who used cocaine during pregnancy may become at risk for increased physical and mental health problems.

METHODS

Three hundred and twenty-one (158 cocaine use during pregnancy (PC), 163 no cocaine (NC)) women were assessed using the Health Survey Questionnaire (SF-36V2) 10 years after infant birth. Factors related to mental and physical health, and co-occurring with PC, were evaluated using multiple regression.

RESULTS

Controlling for age and education, PC women reported poorer total perceived mental health (PMH) (46.3±.9 vs. 50.7±.9, p<.001), more bodily pain (48.1±1.0 vs. 51.5±1.0, p<.02) and poorer health perceptions (46.8±.9 vs. 49.7±.9, p<.03) than NC women. PC women had lower BMI (29% vs. 32%, p<.006), higher current alcoholic drinks per/week (4.05±15.5 vs. 1.29±3.51, p<.005) and number of cigarettes per day (9±10.6 vs. 4±6.5, p<.0001) and greater total life strain (Family Inventory of Life Events and Changes (FILE)) (4.6±4.9 vs. 3.2±3.2, p<.004) than NC women. Regression analyses indicated that body mass index (BMI) mediated the effect of prior cocaine use on perceived physical health (PPH) and total life strain had additive effects. Current cigarette use and total life stress partially mediated the effects of cocaine use on PMH and also had additive independent effects.

CONCLUSIONS

PC use is a marker for poor health after 10 years. Mediators of these relationships (BMI, stressful life events and current tobacco use) should be considered when designing interventions to promote health.

Associations of Cigarette Smoking and Polymorphisms in Brain-Derived Neurotrophic Factor and Catechol-O-Methyltransferase with Neurocognition in Alcohol Dependent Individuals during Early Abstinence

Chronic cigarette smoking and polymorphisms in brain-derived neurotrophic factor (BDNF) and catechol-O-methyltransferase (COMT) are associated with neurocognition in normal controls and those with various neuropsychiatric conditions. The influence of BDNF and COMT on neurocognition in alcohol dependence is unclear. The primary goal of this report was to investigate the associations of single nucleotide polymorphisms (SNPs) in BDNF Val66Met (rs6265) and COMT Val158Met (rs4680) with neurocognition in a treatment-seeking alcohol dependent cohort and determine if neurocognitive differences between non-smokers and smokers previously observed in this cohort persist when controlled for these functional SNPs. Genotyping was conducted on 70 primarily male treatment-seeking alcohol dependent participants (ALC) who completed a comprehensive neuropsychological battery after 33 ± 9 days of monitored abstinence. After controlling for COMT and BDNF genotypes, smoking ALC performed significantly worse than non-smoking ALC on the domains of auditory-verbal and visuospatial learning and memory, cognitive efficiency, general intelligence, processing speed, and global neurocognition. In smoking ALC, greater number of years of smoking over lifetime was related to poorer performance on multiple domains after controlling for genotypes and alcohol consumption. In addition, COMT Met homozygotes were superior to Val homozygotes on measures of executive skills and showed trends for higher general intelligence and visuospatial skills, while COMT Val/Met heterozygotes showed significantly better general intelligence than Val homozygotes. COMT Val homozygotes performed better than heterozygotes on auditory-verbal memory. BDNF genotype was not related to any neurocognitive domain. The findings are consistent with studies in normal controls and neuropsychiatric cohorts that reported COMT Met carriers demonstrated better performance on measures of executive skills and general intelligence. Results also indicated that the poorer performance of smoking compared to non-smoking ALC across multiple neurocognitive domains was not mediated by COMT or BDNF genotype. Overall, the findings lend support to the expanding clinical movement to make smoking cessation programs available to smokers at the inception of treatment for alcohol/substance use disorders.

Smoking cessation and quality of life: changes in life satisfaction over 3 years following a quit attempt

BACKGROUND

There has been limited research addressing changes in subjective well-being as a result of quitting smoking.

PURPOSE

The purpose of this study was to use longitudinal data to determine the relation between smoking cessation and subjective measures of well-being, including global quality of life (QOL), health-related QOL (HR-QOL), affect, relationship satisfaction, and stressor occurrence.

METHODS

As part of a randomized, placebo-controlled smoking cessation trial, 1,504 participants (58.2% women, 83.9% white) completed assessments and had their smoking status biochemically confirmed at baseline and years 1 and 3 post-quit.

RESULTS

Compared with continuing smokers, quitters showed improved global QOL, HR-QOL, and affect at years 1 and 3 and fewer stressors by year 3. Smoking status did not influence marital relationship satisfaction.

CONCLUSIONS

Successful quitters, in contrast to continuing smokers, reported improved subjective well-being, which could be used to motivate quit attempts by individuals with concerns about what life will be like without cigarettes.

Smoking and psychological health in relation to country of origin

In English-speaking, Western-Anglo countries, where smoking has become stigmatized in recent decades as a result of widespread anti-smoking campaigns, smokers commonly report poorer psychological health on average than nonsmokers do. This may be indirectly related to the strong pressures to quit in such countries, as poorer psychological health is associated with a reduced likelihood of quitting, thus leading to a selection bias for smokers with relatively poorer psychological health. In the present study, 147 smoker and nonsmoker participants either came from Western-Anglo countries where smoking has become stigmatized (Australia, Canada, USA) or countries in regions where smoking remains relatively more accepted (Asia, Latin America, Europe). Smokers and nonsmokers were assessed on a widely used self-report measure of anxiety, depression, and stress. Multivariate analysis revealed a significant interaction between smoker status (smoker, nonsmoker) and country of origin (Western-Anglo, other) on psychological health ratings, with univariate analysis showing a significant interaction on anxiety scores. Among those from Western-Anglo countries, smokers reported significantly higher levels of anxiety than nonsmokers did, whereas there was no difference in anxiety between smokers and nonsmokers from other countries. There was no difference in the number of cigarettes smoked per day between the samples of smokers, indicating very similar levels of nicotine intake in the two groups. The findings support the notion that a selection bias for smokers with relatively poorer psychological health is occurring in Western-Anglo countries.

Occupational gradients in smoking behavior and exposure to workplace environmental tobacco smoke: the multi-ethnic study of atherosclerosis

OBJECTIVE

This study examines associations of occupation with smoking status, amount smoked among current and former smokers (number of cigarettes per day and lifetime cigarette consumption (pack-years)), and workplace exposure to environmental tobacco smoke (ETS) independent from income and education.

METHODS

This is a cross-sectional analysis of data from a community sample (n = 6355, age range: 45-84) using logistic and multinomial regression. All analyses were stratified by sex and adjusted for socio-demographic variables.

RESULTS

Male blue-collar and sales/office workers had higher odds of having consumed more than 20 pack-years of cigarettes than managers/professionals. For both male and female current or former smokers, exposure to workplace ETS was consistently and strongly associated with heavy smoking and greater pack-years.

CONCLUSIONS

Blue-collar workplaces are associated with intense smoking and ETS exposure. Smoking must be addressed at both the individual and workplace levels especially in blue-collar workplaces.

Modeling between-subject and within-subject variances in ecological momentary assessment data using mixed-effects location scale models

Ecological momentary assessment and/or experience sampling methods are increasingly used in health studies to study subjective experiences within changing environmental contexts. In these studies, up to 30 or 40 observations are often obtained for each subject. Because there are so many measurements per subject, one can characterize a subject's mean and variance and can specify models for both. In this article, we focus on an adolescent smoking study using ecological momentary assessment where interest is on characterizing changes in mood variation. We describe how covariates can influence the mood variances and also extend the statistical model by adding a subject-level random effect to the within-subject variance specification. This permits subjects to have influence on the mean, or location, and variability, or (square of the) scale, of their mood responses. These mixed-effects location scale models have useful applications in many research areas where interest centers on the joint modeling of the mean and variance structure.

Explaining the stress-inducing effects of nicotine to cigarette smokers

AIMS

To explain how nicotine dependency causes mood fluctuation and increases daily stress.

METHODS

Prospective studies show that taking-up smoking leads to higher stress and depression. Cross-sectional studies show that adult smokers report more irritability, stress and depression than non-smokers. Prospective studies show that smoking cessation leads to enduring mood gains. The adverse mood effects of nicotine dependency are explained by the deprivation reversal model. In between cigarettes, most smokers experience subtle abstinence symptoms, and cumulatively these can increase everyday stress. Hence, adolescents who take up smoking become more stressed, and quitting reduces stress. An explanatory leaflet to explain this model was empirically assessed with tobacco smokers.

RESULTS

In a cohort study of 82 cigarette smokers, knowledge levels were significantly enhanced by the explanatory leaflet, and this understanding was maintained 1 week later. Hence, normal cigarette smokers can understand the adverse mood consequences of nicotine addiction. The information leaflet could prove useful for tobacco-education packages in schools, and smoking-cessation packages with adults.

CONCLUSIONS

The deprivation reversal model can be easily described using a simple leaflet. It explains how nicotine dependency can cause mood fluctuation, and outlines the psychological benefits of quitting.

Adult attention deficit hyperactivity disorder and other psychiatric symptoms in recreational polydrug users

AIMS

Previous research has shown that recreational drug use is associated with more psychiatric symptoms and psychobiological distress. This study investigated whether symptoms of adult attention deficit hyperactivity disorder (ADHD) were also raised in polydrug users.

METHODS

We assessed a non-clinical sample of 84 unpaid volunteers (mean age 27.5 years): n = 17 light-novice polydrug users; n = 29 moderate polydrug users; and n = 38 non-user controls (14 non-drug users, 24 alcohol/tobacco users). They completed the Symptom Checklist 90 (SCL-90) self-rating inventory for psychiatric symptoms, the Adult ADHD Self-report Scale symptom checklist for adult ADHD, and also the questions on positive moods and sociability. Saliva samples provided a neuroendocrine cortisol measure.

RESULTS

Moderate polydrug users reported significantly higher adult ADHD symptoms and SCL-90 psychiatric symptoms and lower sociability than non-user controls and light polydrug users. Novice-light polydrug users did not differ from control groups on any measure. There were no significant group differences in cortisol. These findings are debated using the interactive diathesis-distress model. Psychoactive drugs can affect both mood and cognition. When taken regularly, the drug-induced psychobiological vacillation may exacerbate prior problems with mood stability and attentional-cognitive control.

CONCLUSIONS

It is not polydrug usage per se, but rather their regular-repeated usage, that is associated with increased signs of psychiatric and attentional-hyperactivity distress.

The effects of galantamine on nicotine withdrawal-induced deficits in contextual fear conditioning in C57BL/6 mice

Current smoking cessation aids are relatively ineffective at maintaining abstinence during withdrawal. Nicotine withdrawal is associated with a variety of symptoms including cognitive deficits and targeting these deficits may be a useful strategy for maintaining abstinence. Galantamine is an acetylcholinesterase inhibitor and allosteric modulator of nicotinic acetylcholine receptors (nAChRs) with cognitive enhancing effects that may alleviate cognitive deficits associated with nicotine withdrawal. The effects of galantamine on nicotine withdrawal-induced deficits in contextual fear conditioning in C57BL/6 mice were examined. An initial acute dose-response experiment revealed that 0.5 and 1mg/kg galantamine had no effect on fear conditioning. To determine if galantamine would reverse nicotine withdrawal-related deficits in contextual fear conditioning, mice were implanted with osmotic mini-pumps that delivered chronic saline or 6.3mg/kg/d nicotine for 12 days and then pumps were removed. Training and testing of fear conditioning occurred 24 and 48 h later, respectively. Nicotine withdrawal disrupted contextual fear conditioning, which was reversed with 1 but not 0.5mg/kg galantamine. Across all conditions in both studies 2mg/kg galantamine led to high levels of freezing that were likely due to nonspecific effects. The ability of galantamine to reverse nicotine withdrawal-deficits in contextual conditioning is likely mediated through enhanced levels of acetylcholine via inhibition of acetylcholinesterase, potentiation of hippocampal α4β2* nAChRs, or both. The present study suggests that acetylcholinesterase inhibitors and/or drugs that act as allosteric modulators of nAChRs might be targets for smoking cessation aids because they may alleviate withdrawal symptoms such as cognitive deficits that can lead to relapse.

A population-based twin study of the genetic and environmental relationship of major depression, regular tobacco use and nicotine dependence

BACKGROUND

Numerous epidemiological studies have reported a positive association between major depression (MD) and regular tobacco use (RU) or nicotine dependence (ND). However, few have used a genetically informative design to assess whether these traits share a common genetic and/or environmental liability.

METHOD

We assessed MD, RU and ND in same-sex twins from the population-based Swedish Twin Registry. In males, we examined both cigarette use and snus (smokeless tobacco) use. We used structural equation modeling to examine the relationship between MD, RU, and ND given RU.

RESULTS

The results suggest modest correlations between MD and RU, and between MD and ND. In males, the liability shared between MD and RU is solely genetic for both cigarettes and snus, while MD and ND share both genetic and unique environmental influences. The continuation to ND given RU differed considerably between cigarette and snus users. In females, both MD-RU and MD-ND relationships are partially attributable to genetic and unique environmental correlations.

CONCLUSIONS

The relationship among MD, RU and ND is at least partially attributable to shared genetic and environmental risk factors. The genetic and environmental correlations between traits are modest. The nature of the shared liability differs by sex, and in males, by the type of tobacco product used. Differences between previous reports and results presented in the current study are suggestive of population differences in how MD and tobacco use inter-relate.

Use of cigarettes to improve affect and depressive symptoms in a longitudinal study of adolescents

Smoking to alleviate negative affect or improve physiological functioning (i.e., self-medication) is one explanation for the association between depression and smoking in adolescents. This study tests whether using cigarettes to improve mood or physiological functioning is associated with the onset, and change over time, of elevated depressive symptoms. Data were drawn from the Nicotine Dependence in Teens study which followed 1293 participants initially aged 12-13 years in Montreal, Canada every three months for five years. The subsample included 662 adolescents who had been current smokers (reported smoking during the previous three months) at any point during the study. Survival analysis was used to test whether self-medication scores predicted onset of elevated depressive symptoms. Changes over time in depressive symptom scores relative to self-medication scores were modeled in growth curve analyses controlling for sex and number of cigarettes smoked per week. Smokers who reported higher self-medication scores had higher depressive symptom scores. The interaction between self-medication scores and the acceleration rate in depressive symptom scores was significant and negative, suggesting that participants with higher self-medication scores had decelerated rates of change in depression over time compared to participants with lower self-medication scores. Smoking appears to be ineffective at reducing depressive symptoms. These findings are consistent with a version of the Positive Resource Model that suggests that smoking will not lower depressive symptoms, but could slow the rate of change over time. Alternatively, the perceived positive benefits may be the result of alleviation of symptoms of withdrawal and craving resulting from abstinence. The self-medication scale may identify a population at risk of increased levels of depressive symptoms.

Chronic cigarette smoking: implications for neurocognition and brain neurobiology

Compared to the substantial volume of research on the general health consequences associated with chronic smoking, little research has been specifically devoted to the investigation of its effects on human neurobiology and neurocognition. This review summarizes the peer-reviewed literature on the neurocognitive and neurobiological implications of chronic cigarette smoking in cohorts that were not seeking treatment for substance use or psychiatric disorders. Studies that specifically assessed the neurocognitive or neurobiological (with emphasis on computed tomography and magnetic resonance-based neuroimaging studies) consequences of chronic smoking are highlighted. Chronic cigarette smoking appears to be associated with deficiencies in executive functions, cognitive flexibility, general intellectual abilities, learning and/or memory processing speed, and working memory. Chronic smoking is related to global brain atrophy and to structural and biochemical abnormalities in anterior frontal regions, subcortical nuclei and commissural white matter. Chronic smoking may also be associated with an increased risk for various forms of neurodegenerative diseases. The existing literature is limited by inconsistent accounting for potentially confounding biomedical and psychiatric conditions, focus on cross-sectional studies with middle aged and older adults and the absence of studies concurrently assessing neurocognitive, neurobiological and genetic factors in the same cohort. Consequently, the mechanisms promoting the neurocognitive and neurobiological abnormalities reported in chronic smokers are unclear. Longitudinal studies are needed to determine if the smoking-related neurobiological and neurocognitive abnormalities increase over time and/or show recovery with sustained smoking cessation.

Postquitting experiences and expectations of adult smokers and their association with subsequent relapse: findings from the International Tobacco Control (ITC) Four Country Survey

INTRODUCTION

This paper explores postquitting experiences and expectations of adult ex-smokers and their utility as predictors of smoking relapse after prolonged abstinence.

METHODS

Data are from 1,449 ex-smokers (providing 2,234 observations) recruited as smokers as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, the United Kingdom, and the United States) but surveyed after they had quit. Controlling for length of time quit, reported postquitting experiences, and expectations assessed at one of three waves were used as predictors. Smoking status (whether they had relapsed) at the next wave was used as the outcome of interest.

RESULTS

Postquitting experiences and expectations, such as capacity to enjoy life's simple pleasures, ability to cope with stress, ability to control negative emotions, and health concerns, changed systematically over time but at different rates. The trajectory of change for life enjoyment and health concerns followed a rapidly asymptoting logarithmic function, while that of stress and negative affect coping followed a slower asymptoting square root function. After controlling for sociodemographic and abstinence duration, only reported decline in capacity to control negative affect since quitting was associated with increased relapse risk.

DISCUSSION

The varying patterns of change in postquitting experiences suggest that psychological gains over time following smoking cessation do not all occur at the same rate. The relative importance of each factor in maintaining abstinence is also not the same with deficits in perceived control of negative emotions being the only one predictive of subsequent relapse. Strategies to improve impulse control over negative emotions postquitting may help to reduce relapse risk.

The long-term effects of prenatal nicotine exposure on neurologic development

A large body of documented evidence has found that smoking during pregnancy is harmful to both the mother and the fetus. Prenatal exposure to nicotine in various forms alters neurologic development in experimental animals and may increase the risk for neurologic conditions in humans. There is a positive association between maternal smoking and sudden infant death syndrome (SIDS); however, the connection between nicotine addiction, depression, attention disorders, and learning and behavior problems in humans is not straightforward. Nicotine's action on the production and function of neurotransmitters makes it a prime suspect in the pathology of these diseases. Nicotine accentuates neurotransmitter function in adults but desensitizes these functions in prenatally exposed infants and children. This desensitization causes an abnormal response throughout the lifespan. Furthermore, nicotine use by adolescents and adults can alleviate some of the symptoms caused by these neurotransmitter problems while they increase the risk for nicotine addiction. Although nicotine replacement drugs are used by pregnant women, there is no clear indication that they improve outcomes during pregnancy, and they may add to the damage that occurs to the developing neurologic system in the fetus. Understanding the effects of nicotine exposure is important in providing safe care for pregnant women, children, and families and for developing appropriate smoking cessation programs during pregnancy.

Is the relationship between smoking and mental health influenced by other unhealthy lifestyle factors? Results from a 3-year follow-up study among adolescents in Oslo, Norway

PURPOSE

Several studies have confirmed that smoking is a risk factor for depression in adolescence. These studies have not controlled for other lifestyle factors. The aim of this longitudinal study was to assess the relationship between smoking and depressive symptoms, controlling for other lifestyle factors.

METHODS

This school-based longitudinal self-report survey was conducted among 15- and 18-year-old students in Oslo, Norway. From a baseline cohort of 3811 students, 2489 (65%) participants were followed up after 3 years and completed questionnaires at baseline and follow-up. Mental distress was assessed with Hopkins Symptom Checklist, version 10.

RESULTS

There was a statistically significant association between daily smoking at age 15 and mental distress at age 18 for girls, but not for boys (odds ratio [OR]=2.0 [1.5-2.8] and 1.3 [0.7-2.4], respectively). In girls, the association remained statistically significant even after adjustment for sociodemographic variables and several lifestyle factors. In an analysis of 15-years-old "never smokers," a statistically significant association was found between smoking and mental distress for both genders at age 18. Mentally distressed adolescents at age 15 did not show a higher proportion of smoking at age 18 compared with those not distressed.

CONCLUSIONS

In addition to supporting earlier findings that smoking seems to be causally related to depressive symptoms among adolescent girls, the contribution of this study is that this association only to some extent is confounded by other unhealthy lifestyle habits.

Smoking, nicotine and neuropsychiatric disorders

Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.

Acquired appetitive responding to intravenous nicotine reflects a Pavlovian conditioned association

Recent research examining Pavlovian appetitive conditioning has extended the associative properties of nicotine from the unconditioned stimulus or reward to include the role of a conditional stimulus (CS), capable of acquiring the ability to evoke a conditioned response. To date, published research has used presession extravascular injections to examine nicotine as a contextual CS in that appetitive Pavlovian drug discrimination task. Two studies in the current research examined whether a nicotine CS can function discretely, multiple times within a session using passive iv infusions. In Experiment 1, rats readily acquired a discrimination in conditioned responding between nicotine and saline infusions when nicotine was selectively paired with sucrose presentations. In Experiment 2, rats were either trained with nicotine paired with sucrose or explicitly unpaired with sucrose. The results showed that rats trained with explicitly unpaired nicotine and sucrose did not increase dipper entries after the infusions. Nicotine was required to be reliably paired with sucrose for control of conditioned responding to develop. Implications of these findings are discussed in relation to tobacco addiction, learning theory, and pharmacology.

Modeling mood variation associated with smoking: an application of a heterogeneous mixed-effects model for analysis of ecological momentary assessment (EMA) data

AIMS

Mixed models are used increasingly for analysis of ecological momentary assessment (EMA) data. The variance parameters of the random effects, which indicate the degree of heterogeneity in the population of subjects, are considered usually to be homogeneous across subjects. Modeling these variances can shed light on interesting hypotheses in substance abuse research.

DESIGN

We describe how these variances can be modeled in terms of covariates to examine the covariate effects on between-subjects variation, focusing on positive and negative mood and the degree to which these moods change as a function of smoking.

SETTING

The data are drawn from an EMA study of adolescent smoking.

PARTICIPANTS

Participants were 234 adolescents, either in 9th or 10th grades, who provided EMA mood reports from both random prompts and following smoking events.

MEASUREMENTS

We focused on two mood outcomes: measures of the subject's negative and positive affect and several covariates: gender, grade, negative mood regulation and smoking level.

FINDINGS AND CONCLUSIONS

Following smoking, adolescents experienced higher positive affect and lower negative affect than they did at random, non-smoking times. Our analyses also indicated an increased consistency of subjective mood responses as smoking experience increased and a diminishing of mood change.

Smoking is associated with worse mood on stressful days: results from a national diary study

BACKGROUND

Many smokers report smoking because it helps them modulate their negative affect (NA). The stress induction model of smoking suggests, however, that smoking causes stress and concomitant NA. Empirical support for the stress induction model has primarily derived from retrospective reports and experimental manipulations with non-representative samples of smokers. Moreover, prior studies have typically not considered contextual factors (e.g., daily stressors) that may impact the smoking-NA relationship.

PURPOSE

The aim of this study was to assess the stress induction model of smoking using a prospective design in a nationally representative sample of smokers while simultaneously examining the impact of daily stressors on the relationship between smoking and NA. We hypothesized that smoking and NA would be positively related, and this relationship would be intensified by exposure to daily stressors.

METHODS

A national sample of middle-aged smokers (N = 256) were called on eight consecutive evenings to assess stressor exposure and intensity. Participants also reported on their daily NA and indicated the number of cigarettes they smoked. Analyses were conducted using hierarchical linear modeling to determine the relationship between daily smoking, NA, and stress.

RESULTS

Smoking more than usual was associated with increased NA on days when respondents were exposed to any stressors. Smoking more than usual had no effect on NA on days when no stressors were encountered. Moreover, the moderating effect of stressor exposure remained significant even after controlling for the number and intensity of daily stressors reported.

CONCLUSIONS

While smokers report that smoking alleviates their NA, our study suggests that the exact opposite may occur, particularly on stressful days. When smokers smoke more than usual on days when the encounter stress, they are likely to feel emotionally worse off.

The effects of cigarette smoking and abstinence on auditory verbal learning

Smoking has been associated with both enhanced and impaired cognitive performance; across a variety of domains, but there is limited evidence demonstrating the effects on verbal learning. The current study assessed the effect of smoking and abstinence on verbal learning, immediate memory and retention using the Auditory Verbal Learning Test (AVLT). Three groups: 20 smokers, 20 abstaining smokers and 20 non-smoking adults were assessed on the AVLT on two occasions. At session one, abstaining smokers refrained from smoking for 12 h (pre-cigarette), whilst smokers had continued to smoke to satiety. Session two commenced after a 15-min break when both smoking groups were instructed to smoke a cigarette, followed by administration of the second version of the AVLT (post-cigarette). Abstaining smokers showed significant deficits in learning compared to smokers during the pre-cigarette session. Following re-initiation of smoking in the abstaining smokers, these learning decrements were no longer evident. There were trends towards significant group findings in immediate memory and retention during the pre-cigarette session, which again were no longer evident in the post-cigarette session. These findings provide further evidence that smoking abstinence affects verbal learning and furthermore smoking simply restores cognitive performance to pre-abstinence levels.

The effects of acute exercise on cognitive functioning and cigarette cravings during temporary abstinence from smoking

BACKGROUND

Abstinence from smoking is associated with increased cravings, risk of accidents and self-reported poor concentration. A single exercise session can reduce cravings and self-reported poor concentration and can enhance cognitive performance among non-smokers.

OBJECTIVE

To assess whether acute exercise impacts on the cognitive performance and cravings of abstaining smokers.

METHODS

In a counterbalanced cross-over design, participants (n = 23) did a 15 min passive or exercise condition, following cigarette abstinence. Cognitive functioning was measured by a computerised version of the Stroop colour-word interference task. Cravings were measured using the 10-item, 2-factor QSU-Brief and a single item for 'desire to smoke'. Measures were recorded at baseline, immediately post, 5, 10 and 15-min post treatment.

RESULTS

A 2-way ANOVA showed no significant condition x time interaction for cognitive functioning. Significant interaction effects were found for desire to smoke, QSU Factor 1 (desire-behave) and 2 (desire-affect). Exercise reduced cravings for up to 15 min post treatment.

DISCUSSION

Findings support previous research that acute exercise reduces cravings to smoke. Future research should determine if exercise can enhance other objective aspects of cognitive performance, and repeat the present study with a more homogeneous sample, in terms of Stroop performance.

CONCLUSION

This is the first study to show that exercise can reduce both factors of the QSU-Brief, but effects on cognitive functioning were not observed.

Effects of progression to cigarette smoking on depressed mood in adolescents: evidence from the National Longitudinal Study of Adolescent Health

AIMS

To investigate the relationship between smoking status and continuously distributed depressed mood among a cohort of adolescents.

DESIGN

Quasi-experimental design, selecting the subset of adolescents who reported never having smoked a cigarette at baseline, some of whom progressed subsequently to smoking at follow-up approximately 1 year later.

SETTING

Data were drawn from the National Longitudinal Study of Adolescent Health, an ongoing study designed to assess the health status of adolescents, and explore the causes of adolescent health-related behaviours.

PARTICIPANTS

Nationally representative sample of adolescents from the USA (n = 12 149), including a subsample who reported never having smoked a cigarette at baseline (n = 5475), aged on average 15 years at baseline and of predominantly European ancestry.

MEASUREMENTS

Logistic and linear regression models controlling for potential confounders to explore the relationship between smoking status and depressed mood measured using the Centers for Epidemiological Studies Depression Scale (CES-D).

FINDINGS

Various relationships between smoking status and depressed mood were observed, with a general trend for these effects to be greater among females. Smoking status at baseline did not significantly predict CES-D score at follow-up, although this effect approached significance in females (P = 0.077). Among never smokers at baseline, level of depressed mood at baseline predicted subsequent progression to smoking initiation (P = 0.022) but not progression to regular smoking (P = 0.229). Among never smokers at baseline, progression to smoking initiation during the follow-up period was associated with higher CES-D scores at follow-up, even after adjusting for baseline depressed mood (P < 0.001), with this effect greater for females than for males. Among those who initiated smoking, progression to regular smoking was associated with higher CES-D score at follow-up among females (P = 0.001), but not males (P = 0.966).

CONCLUSIONS

These data appear to support a complex model of the relationship between depressed mood and smoking status which includes elements of both confounding and causal models. The relationship between cigarette smoking and depression may be a factor in the development of subsequent dependence.

Clinical Implications of Smoking and Aging: Breaking Through the Barriers

In the United States, there are almost 4 million smokers older than 65. Yet, older smokers often receive suboptimal care. Inaccurate information and myths about older smokers may have become ingrained in the attitudes and beliefs of both older smokers and health care providers. In this article, prominent myths about older smokers will be explored and refuted. The realities include the following: Smoking tobacco has no benefit; it does not improve cognition or mood; smoking cessation, even among older, frail adults, produces significant benefits in terms of health and quality of life; and using filtered cigarettes or reducing the number of cigarettes smoked per day does not reduce harm. Gerontological nurses are at the forefront of treating tobacco use among older smokers. They should assess the smoking status of all older adults at every contact, treat smokers with pharmacotherapy and counseling, follow up with patients, and stay informed.