Cigarette demand among smokers with elevated depressive symptoms: an experimental comparison with low depressive symptoms

The longitudinal analysis for the association between smoking and the risk of depressive symptoms

BACKGROUND

Despite high smoking rate in people with depressive symptoms, there is ongoing debate about relationship between smoking and depressive symptoms.

METHODS

Study participants were 57,441 Korean men. We collected their baseline data between 2011 and 2012, and conducted follow-up from 2013 to 2019. They were categorized by smoking status (never: < 100 cigarettes smoking in life time, former: currently quitting smoking, and current smoker: currently smoking), smoking amount (pack/day and pack-year) and urine cotinine excretion. The development of depressive symptoms was determined in CES-D score ≥ 16. Cox proportional hazards model was used to analyze the multivariable-adjusted hazard ratio (HR) and 95% confidence intervals (CI) for depressive symptoms in relation to smoking status, smoking amount, and urine cotinine excretion.

RESULTS

During 6.7 years of median follow-up, the risk of depressive symptoms increased in order of never (reference), former (HR = 1.08, 95% CI: 1.01-1.15) and current smoker (HR = 1.24, 95% CI: 1.16-1.32). Among current smoker, the risk of depressive symptoms increased proportionally to daily smoking amount (< 1 pack; HR = 1.21, 95% CI: 1.13-1.29, and ≥ 1 pack; HR = 1.34, 95% CI: 1.23 - 1.45). This pattern of relationship was consistently observed for pack-year in former smoker and current smoker. Additionally, urine cotinine excretion was proportionally associated with the risk of depressive symptoms.

CONCLUSION

Exposure to smoking was associated with the increased risk of depressive symptoms. Dose dependent relationship was observed between smoking amount and the risk of depressive symptoms.

A cross-sectional study of smoking and depression among US adults: NHANES (2005-2018)

Background

The relationship between smoking and depression remains controversial. This study aimed to investigate the association between smoking and depression from three aspects: smoking status, smoking volume, and smoking cessation.

Methods

Data from adults aged ≥20 who participated in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were collected. The study gathered information about the participants' smoking status (never smokers, previous smokers, occasional smokers, daily smokers), smoking quantity per day, and smoking cessation. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), with a score ≥10 indicating the presence of clinically relevant symptoms. Multivariable logistic regression was conducted to evaluate the association of smoking status, daily smoking volume, and smoking cessation duration with depression.

Results

Previous smokers [odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.05-1.48] and occasional smokers (OR = 1.84, 95% CI: 1.39-2.45) were associated with a higher risk of depression compared with never smokers. Daily smokers had the highest risk of depression (OR = 2.37, 95% CI: 2.05-2.75). In addition, a tendency toward a positive correlation was observed between daily smoking volume and depression (OR = 1.65, 95% CI: 1.24-2.19) (P for trend < 0.05). Furthermore, the longer the smoking cessation duration, the lower the risk of depression (OR = 0.55, 95% CI: 0.39-0.79) (P for trend < 0.05).

Conclusions

Smoking is a behavior that increases the risk of depression. The higher the smoking frequency and smoking volume, the higher the risk of depression, whereas smoking cessation is associated with decreased risk of depression, and the longer the smoking cessation duration, the lower the risk of depression.

No evidence of the clinical utility of single-item breakpoint to inform on tobacco demand in persons with substance use disorders

RATIONALE

Behavioral economics has shown that single-item demand indicators are promising for capturing crucial aspects of nicotine reinforcement. It is suggested that brief breakpoint measures perform comparably to full-length demand indices in characterizing nicotine dependence; however, there have been no thorough assessments of their validity in clinical settings.

OBJECTIVES

This study aimed to assess the validity and accuracy of a single-item breakpoint in informing on tobacco demand.

METHODS

The sample consisted of 88 treatment-seeking smokers (% males = 70.5%) enrolled in substance use treatment. Participants provided data on smoking characteristics and completed the Fagerström Test for Nicotine Dependence, a single-item breakpoint measure and a 14-item cigarette purchase task (CPT). Hierarchical regressions were performed to compare the predictive capability of a single-item breakpoint and full-length tobacco demand indicators in determining nicotine addiction severity.

RESULTS

The single-item breakpoint was significantly correlated with all indices stemmed from the CPT and both latent factors (all r values = .250-.368). Neither the brief breakpoint nor the full-length breakpoint significantly predicted nicotine dependence. After controlling for sex and smoking variables, factor 2 [β = .565, p < .001] and its observed variables Omax [β = .279, p = .006], 1/elasticity [β = .340, p = .001], and intensity [β = .551, p < .001], robustly predicted nicotine dependence severity.

CONCLUSIONS

Our findings do not support the validity of single-item breakpoint measures for characterizing nicotine dependence in substance users. In a bid to foster translational research, brief demand measures capturing Omax, intensity, and elasticity should be developed.

A longitudinal assessment of nicotine dependence, mental health, and attempts to quit Smoking: Evidence from waves 1-4 of the Population Assessment of Tobacco and Health (PATH) study

BACKGROUND

Adult smokers with symptoms of any mental illness (AMI) are highly dependent on nicotine and may face additional difficulty quitting smoking. While there is evidence that adult smokers with AMI have high dependence, there is insufficient evidence regarding the unique role that AMI may play in moderating the relationship between dependence and cessation outcomes over time.

METHODS

7290 current established adult smokers at Wave 1 (2013-2014) of the PATH Study also participated in data collection in Waves 2-4 (2014-2018). Linear probability models with individual-level random effects were fit to the data, modeling associations between AMI, nicotine dependence, and the 1) likelihood of achieving cessation during the study period, 2) making a cessation attempt within the previous 12 months, and 3) log of past 30-day total consumption of cigarettes.

RESULTS

Adults who experienced both AMI symptoms and high dependence were 4.7 percentage points (PP) less likely to achieve cessation at any point during the study period (p < 0.01) and smoked more cigarettes per month (β = 0.214, p < 0.05) than adults with AMI who were not highly dependent, despite being as likely to attempt to quit. Adults with AMI who were not highly dependent were 4.6 PP more likely to report a quit attempt and 1.6 PP more likely to achieve cessation than those with neither AMI nor high dependence.

CONCLUSIONS

Adults with AMI are particularly affected by the burden of tobacco use, in part because of the likely interaction between nicotine dependence and AMI. Tobacco control efforts that focus on this interplay may provide an opportunity to better target interventions for this vulnerable population.

Effects of acute distress and tobacco cues on tobacco demand

INTRODUCTION

Cigarette demand, or relative value, can be assessed via analysis of performance on a hypothetical behavioral economic cigarette purchase task (CPT). Substance purchase tasks are highly amenable to manipulation, namely, external stimuli, instructional changes, or acute stressors. In this regard, the current secondary analysis evaluates the role a novel, computerized stress induction paradigm, the Contextual-Frustration Intolerance Typing Task (C-FiTT), plays in eliciting varying levels of stress and resulting demand.

METHOD

Daily smokers (n = 484) completed the C-FiTT wherein they were randomly assigned to one of five distress conditions: combination of task difficulty (low or high difficulty) with neutral or withdrawal cues, and a neutral control group. Tobacco demand was assessed immediately following the distress task using the hypothetical CPT.

RESULTS

The C-FiTT distress-induction task significantly increased key cigarette demand indices, including price at maximum expenditure (Pmax) and first price where consumption was suppressed to zero (breakpoint). Moreover, demand increased with severity of C-FiTT condition, with the high-difficulty condition resulting in significantly higher breakpoint and Pmax, compared to other conditions. C-FiTT condition was not related to a significant increase in Omax, intensity, or elasticity.

DISCUSSION

The novel C-FiTT paradigm produced comparable effects on tobacco demand relative to in vivo withdrawal induction, indicating that the C-FiTT is a viable procedure by which to influence demand. Reduction of internal and external stressors may be effective in lowering motivation for tobacco. These results highlight the importance of state distress in tobacco demand, and offer a potential avenue for intervention.

Behavioral economic measurement of cigarette demand: A descriptive review of published approaches to the cigarette purchase task

The cigarette purchase task (CPT) is a behavioral economic method for assessing demand for cigarettes. Growing interest in behavioral correlates of tobacco use in clinical and general populations as well as empirical efforts to inform policy has seen an increase in published articles employing the CPT. Accordingly, an examination of the published methods and procedures for obtaining these behavioral economic metrics is timely. The purpose of this investigation was to provide a review of published approaches to using the CPT. We searched specific Boolean operators (["behavioral economic" AND "purchase task"] OR ["demand" AND "cigarette"]) and identified 49 empirical articles published through the year 2018 that reported administering a CPT. Articles were coded for participant characteristics (e.g., sample size, population type, age), CPT task structure (e.g., price framing, number and sequence of prices; vignettes, contextual factors), and data analytic approach (e.g., method of generating indices of cigarette demand). Results of this review indicate no standard approach to administering the CPT and underscore the need for replicability of these behavioral economic measures for the purpose of guiding clinical and policy decisions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Latent Structure of the Cigarette Purchase Task Among Treatment-Seeking Smokers With Depression and Its Predictive Validity on Smoking Abstinence

INTRODUCTION

Research has recently shown that nicotine reinforcement is better characterized by a bifactorial latent structure: persistence (insensitivity to cigarette pricing) and amplitude (consumption at inexpensive prices). No study to date has examined its value as a predictor of abstinence. This study aimed to provide new evidence on the latent structure of the cigarette purchase task (CPT) in smokers with depressive symptoms and to examine whether the latent structure performs better as a predictor of continuous abstinence than do the individual indices.

METHODS

Participants (n = 205 smokers; 72% female: Beck Depression Inventory, Second Edition, M = 24.68, SD = 10.45) were randomized to two smoking cessation treatments for quitting smoking: cognitive behavioral treatment (CBT) or CBT + contingency management (CM). A principal-components analysis was conducted to examine the latent structure of the CPT and a set of regression models were performed to assess its predictive validity.

RESULTS

The principal-components analysis revealed a bifactorial solution, which was interpreted as persistence (breakpoint, Omax, Pmax, and elasticity) and psychological inertia (intensity and elasticity of demand). Evidence on the convergent validity was obtained through significant associations between the two latent factors and smoking variables (all r values ≥.17). Psychological inertia was negatively related to the number of days of continuous abstinence at the end of treatment regardless of the treatment condition [R2 = .038; F(2, 202) = 4.989, p = .008].

CONCLUSIONS

Psychological inertia informs on which patients benefit less from smoking cessation treatments incorporating CM and CBT. Treatment components that affect individuals' excessive valuation of cigarettes might improve cessation outcomes.

IMPLICATIONS

This is the first attempt to examine the latent structure of the CPT in depressed smokers and to yield evidence on its predictive validity. A specific bifactorial solution exists for this population: persistence (breakpoint, Omax, Pmax, and elasticity) and psychological inertia (intensity and elasticity). Isolating demand indices and factors provides a high-resolution characterization of nicotine reinforcement for depressed smokers in that it informs on treatment response. Compared to the individual CPT indices, psychological inertia more effectively predicts which patients benefit most from either CM or CBT. Treatment components that affect individuals' excessive valuation of cigarettes (eg, episodic future thinking) should be integrated into smoking cessation treatments.

Behavioral economic tobacco demand in relation to cigarette consumption and nicotine dependence: a meta-analysis of cross-sectional relationships

BACKGROUND AND AIMS

A cigarette purchase task (CPT) aims to characterize individual variation in the reinforcing value of tobacco. This meta-analysis estimated the associations between cigarette demand, tobacco consumption and nicotine dependence using this task.

DESIGN

A meta-analysis of cross-sectional studies identified by PubMed and PsycINFO databases was conducted. Fixed- and random-effects models were used. The study also examined the model used to derive elasticity of demand (exponential or exponentiated) as a potential moderator. Publication bias was assessed using 'fail-safe N', Begg-Mazumdar test, Egger's test, Tweedie's trim-and-fill approach and meta-regression of publication year with effect size.

SETTING

Studies from any setting that reported coefficient correlations on the tested associations.

PARTICIPANTS

Daily cigarette users (i.e. 5 to 38 cigarettes per day; n = 7649).

MEASUREMENTS

Cigarette consumption, nicotine dependence and five tobacco demand indicators: intensity (i.e. consumption at no cost), elasticity (i.e. sensitivity to rises in costs), Omax (maximum expenditure), Pmax (i.e. price at which consumption becomes elastic) and breakpoint (i.e. price at which consumption ceases).

FINDINGS

Twenty-three studies met inclusion criteria. All the CPT indices were significantly correlated with smoking behavior (rs = 0.044-0.572, Ps = 0.012-10-8 ). Medium-to-large effect size associations were present for intensity, Omax, and elasticity, whereas small effects were obtained for breakpoint and Pmax . Evidence of a moderating effect of the different elasticity modeling approaches was not present. There was limited evidence of publication bias.

CONCLUSIONS

All five demand indices derived from the cigarette purchase task by (CPT) were robustly associated with cigarette consumption and tobacco dependence. Of the demand indices, maximum expenditure, intensity and elasticity exhibited the largest magnitude associations.

Sensitivity of hypothetical purchase task indices when studying substance use: A systematic literature review

Hypothetical Purchase Tasks (HPTs) simulate demand for a substance as a function of escalating price. HPTs are increasingly used to examine relationships between substance-related correlates and outcomes and demand typically characterized using a common battery of indices (Intensity, Omax, Pmax, Breakpoint, Elasticity). This review examines the relative sensitivity of the HPT indices. Reports were identified using the search term "purchase task" in PubMed and Web of Science. For inclusion, reports had to be original studies in English, examine relationships between HPT indices and substance-related correlates or outcomes, and appear in a peer-reviewed journal through December 2017. Indices were compared using effect sizes (Cohen's d) and the proportion of studies in which statistically significant relationships were observed. The search identified 1274 reports with 114 (9%) receiving full-text review and 82 (6%) meeting inclusion criteria. 41 reports examined alcohol, 34 examined cigarettes/nicotine products, and 10 examined other substances. Overall, statistically significant relationships between HPT indices and substance-related correlates and outcomes were most often reported for Intensity (88.61%, 70/79), followed by Omax (81.16%, 56/69), Elasticity (72.15%, 57/59), Breakpoint (62.12%, 41/66), and Pmax (48.08%; 25/52). The largest effect sizes were observed for Intensity (0.75 ± 0.04, CI 0.67-0.84) and Omax (0.64 ± 0.04, CI 0.56-0.71), followed by Elasticity (0.44 ± 0.04, CI 0.37-0.51), Breakpoint (0.30 ± 0.03, CI 0.25-0.36), and Pmax (0.25 ± 0.04, CI 0.18-0.33). Patterns were largely consistent across substances. In conclusion, HPTs can be highly effective in revealing relationships between demand and substance-related correlates and outcomes, with Intensity and Omax exhibiting the greatest sensitivity.