Gender, dietary restraint, and smoking's influence on hunger and the reinforcing value of food

Understanding daily life experiences of women who smoke: The role of smoking-related weight control expectancies

Smoking-related weight control expectancies are a motivational factor for maintaining cigarette use, particularly among women. Yet, less research has investigated the physiological and behavioral daily life weight-related experiences of women with smoking-related weight control expectancies. Increased research could contribute to understanding of maintenance factors for this group of smokers as well as unique intervention targets. Female smokers completed a baseline survey of smoking-related weight control expectancies and 35-days of ecological momentary assessment of physiological (i.e., smoking-related reduction in hunger, end-of-day perceived weight gain and bloating) and behavioral (i.e., daily exercise and sitting) weight-related experiences. Higher smoking-related weight control expectancies were associated with perceived smoking-related reductions in hunger and end-of-day perceived weight gain. Smoking-related weight control expectancies did not significantly associate with end-of-day bloating, daily exercise, or sitting. Given these findings, smoking-related weight control expectancies may maintain smoking in order to reduce hunger and to cope with perceived fluctuations in weight in daily life. It is critical for smoking cessation programs to assess smoking-related weight control expectancies and implement targeted treatments for these women.

Maternal nicotine dependence is associated with longitudinal increases in child obesogenic eating behaviors

BACKGROUND

Meta-analysis shows that parental cigarette smoking is associated with child obesity.

OBJECTIVES

This study tested for associations between severity of maternal nicotine dependence and longitudinal changes in child eating behavior in archival data analysis.

METHODS

Maternal nicotine dependence was assessed with the Fagerstrom Test for Nicotine Dependence. Child eating behavior was assessed with the Child Eating Behavior Questionnaire when children were ages 4, 6, 8, and 10.

RESULTS

Over and above the influence of child age, child biological sex, and family income-to-needs ratio, more severe maternal nicotine dependence was associated with greater increases in child Food Responsiveness (γ = 0.07, SE_γ  = 0.03, P = .014, 95% CI [0.01, 0.13]) and Emotional Overeating (γ = 0.06, SE_γ  = 0.03, P = .024, 95% CI [0.01, 0.11]) across 6 years.

CONCLUSIONS

Maternal nicotine dependence may be a transdiagnostic risk factor that identifies children at risk for reward-driven, obesogenic eating behavior.

Comparing the reward value of cigarettes and food during tobacco abstinence and nonabstinence

BACKGROUND

Some addiction theories propose that nicotine dependence is characterized by an imbalance between motivation for cigarettes compared to non-drug rewards. This imbalance may become increasingly polarized during abstinence, which further potentiates smoking. The present study evaluated motivation for cigarettes and food during abstinence and nonabstinence in daily smokers. This study modified a previously validated cue-reactivity procedure to include food as a cue condition, thereby allowing the comparison of cigarettes to food and neutral cues. The Choice Behavior Under Cued Conditions (CBUCC) procedure, in which participants are presented with cues and spend money in order to gain immediate access to that cue, generates multiple variables to evaluate motivational factors and drug use behaviors including reward value, craving, seeking, choice time, and consumption.

METHODS

Fifty daily cigarette smokers underwent two CBUCC sessions under overnight abstinent and nonabstinent conditions.

RESULTS

As an index of reward value, participants spent more money to access cigarettes than food or water and more for food relative to water. Abstinence increased the reward value of cigarettes but did not significantly affect the reward value of food or water. Participants also demonstrated cue-specific craving for cigarettes and food, although overall cigarette craving was greater than food craving.

CONCLUSIONS

This study indicated that motivation was greater for cigarettes than food. Abstinence increased motivation for cigarettes but had little impact on motivation for food. This suggests that heavy smokers do not reallocate motivational resources towards cigarettes during abstinence; rather, motivational processes for food remain constant from nonabstinent to abstinent sessions.

Influence of sedentary, social, and physical alternatives on food reinforcement

OBJECTIVE

This study examined the potential for nonfood alternative activities to compete with the reinforcing value of food. Participants rated the frequency and pleasantness of engaging in a variety of activities and made hypothetical choices between food and 4 types of alternatives; cognitive-enriching (reading, listening to music), social (attending a party or event), sedentary (watching TV), and physically active (running, biking).

METHOD

Two-hundred seventy-six adults completed an online survey using a crowdsourcing platform.

RESULTS

Adults with higher BMI reported engaging in fewer activities within the cognitive-enriching, social, and physically active categories. When examining how well each alternative activity type was able to compete with food, sedentary alternatives were associated with the highest food reinforcement, or were least able to compete with food reinforcers, as compared with cognitive-enriching, social, and physical. Social activities were associated with the lowest food reinforcement, or the best able to compete with food reinforcers.

CONCLUSION

These results suggest that increasing the frequency and range of nonfood alternative activities may be important to obesity. This study also suggests that the class of social activities may have the biggest impact on reducing food reinforcement, and the class of sedentary may have the smallest effect on food reinforcement. These tools have relevance to clinical interventions that capitalize on increasing access to behaviors that can reduce the motivation to eat in clinical interventions for obesity. (PsycINFO Database Record

Behavioral sensitization of the reinforcing value of food: What food and drugs have in common

Sensitization is a basic property of the nervous system whereby repeated exposure to a stimulus results in an increase in responding to that stimulus. This increase in responding contributes to difficulty with treatment of drug abuse, as stimuli associated with substance use become signals or triggers for drug craving and relapse. Our work over the past decade has applied the theoretical framework of incentive sensitization to overeating. We have shown, in several studies, that lean adults do not commonly demonstrate behavioral sensitization after repeated exposure to snack food, but a subset of obese adults reliably does. This review will discuss this change in behavioral response to repeated consumption of snack food in obese individuals and apply the theoretical framework of incentive sensitization to drugs of abuse to high fat/high sugar snack foods. We will also show data that suggest that behavioral sensitization to repeated administration of snack food is predictive of weight gain, which may enhance its utility as a diagnostic tool for identifying at-risk individuals for obesity. Finally, we will discuss the future directions of this line of research, including studying the phenomenon in children and adolescents and determining if similar principles can be used to increase motivation to eat healthier food. A combination of reductions in unhealthy food intake and increases and healthy food intake is necessary to reduce obesity rates and improve health.

The substitutability of cigarettes and food: A behavioral economic comparison in normal weight and overweight or obese smokers

Obesity and cigarette smoking contribute to a multitude of preventable deaths in the United States and eating and smoking behavior may influence each other. The field of behavioral economics integrates principles from psychology and economics and permits systematic examination of how commodities interrelate with one another. Using this framework, the current study evaluated the effects of rising food and cigarette prices on consumption to investigate their substitutability and their relationship to BMI and associated variables. Behavioral economics categorizes commodities as substitutable when the consumption of one increases as a function of a price increase in the other. Smokers (N = 86) completed a 2-part hypothetical task in which money was allocated to purchase cigarettes and fast-food-style reinforcers (e.g., hamburgers, ice cream) at various prices. Results indicated that food and cigarettes were not substitutes for one another (cross-price elasticity coefficients < .20). Food purchases were independent of cigarette price, whereas cigarette purchases decreased as food price rose. Cross-price elasticity coefficients were significantly associated with confidence in one's ability to control weight without smoking (rs = -.23 and .29), but not BMI (rs = .04 and .04) or postcessation weight concerns (rs = -.05 and .12). Perceived ability to manage weight without cigarettes may influence who substitutes food for cigarettes when quitting. In addition, given observed decreases in purchases of both commodities as food prices increased, these findings imply that greater taxation of fast-food-style reinforcers could potentially reduce consumption of these foods and also cigarettes among smokers. (PsycINFO Database Record

Habituation of reinforcer effectiveness

In this paper we propose an integrative model of habituation of reinforcer effectiveness (HRE) that links behavioral- and neural-based explanations of reinforcement. We argue that HRE is a fundamental property of reinforcing stimuli. Most reinforcement models implicitly suggest that the effectiveness of a reinforcer is stable across repeated presentations. In contrast, an HRE approach predicts decreased effectiveness due to repeated presentation. We argue that repeated presentation of reinforcing stimuli decreases their effectiveness and that these decreases are described by the behavioral characteristics of habituation (McSweeney and Murphy, 2009; Rankin etal., 2009). We describe a neural model that postulates a positive association between dopamine neurotransmission and HRE. We present evidence that stimulant drugs, which artificially increase dopamine neurotransmission, disrupt (slow) normally occurring HRE and also provide evidence that stimulant drugs have differential effects on operant responding maintained by reinforcers with rapid vs. slow HRE rates. We hypothesize that abnormal HRE due to genetic and/or environmental factors may underlie some behavioral disorders. For example, recent research indicates that slow-HRE is predictive of obesity. In contrast ADHD may reflect “accelerated-HRE.” Consideration of HRE is important for the development of effective reinforcement-based treatments. Finally, we point out that most of the reinforcing stimuli that regulate daily behavior are non-consumable environmental/social reinforcers which have rapid-HRE. The almost exclusive use of consumable reinforcers with slow-HRE in pre-clinical studies with animals may have caused the importance of HRE to be overlooked. Further study of reinforcing stimuli with rapid-HRE is needed in order to understand how habituation and reinforcement interact and regulate behavior.

Dietary, Lifestyle, and Health Correlates of Overweight and Obesity in Adults 19 to 39 Years of Age

Diet and lifestyle factors of young adults and their relationship to health risk factors are understudied. Data from the Bogalusa Heart Study population (n = 1214; 19-39 years; 74.1% white; 60.8% female) were used to study associations of lifestyle, health risk factors, and reported health problems with the National Institutes of Health body mass index (BMI) categories of normal, overweight, and obese. Data from self-reported questionnaires and laboratory measures were evaluated using covariate-adjusted multinomial logistic regression and analysis of covariance, linear trend test, and the Cochran–Armitage trend test. Obese individuals had lower odds of consuming high-fat dairy products (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.62-0.96) and fruit/fruit juice/vegetables (OR = 0.83; CI = 0.75-0.93) and had higher odds of consuming hamburgers/sandwiches (OR = 2.81; CI = 1.52-5.20); processed meats (OR = 6.95; CI = 2.20-21.96); and sweetened (OR = 1.20; CI = 1.01-1.43) or diet beverages (OR = 1.27; CI = 1.02-1.58) than those of normal weight. Obese participants also had higher odds of being physically inactive versus being very active (OR = 2.65; CI = 1.64-4.29). Mean serum total and low-density lipoprotein cholesterol, triglycerides, apolipoprotein-B, and insulin resistance were higher ( P < .05 for all) in the overweight/obese when compared with normal weight individuals. Values were higher in those with higher weight status (linear trend P < .0001 for all). Self-reported health problems also increased with BMI. Interventions to improve diet and physical activity patterns among overweight/obese adults in this age group are needed.

Point process analyses of variations in smoking rate by setting, mood, gender, and dependence

The immediate emotional and situational antecedents of ad-libitum smoking are still not well understood. We reanalyzed data from ecological momentary assessment using novel point process analyses to assess how craving, mood, and social setting influence smoking rate, as well as to assess the moderating effects of gender and nicotine dependence. Smokers (N = 304) recorded craving, mood, and social setting using electronic diaries when smoking and at random nonsmoking times over 16 days of smoking. Point process analysis, which makes use of the known random sampling scheme for momentary variables, examined main effects of setting and interactions with gender and dependence. Increased craving was associated with higher rates of smoking, particularly among women. Negative affect was not associated with smoking rate, even in interaction with arousal, but restlessness was associated with substantially higher smoking rates. Women's smoking tended to be less affected by negative affect. Nicotine dependence had little moderating effect on situational influences. Smoking rates were higher when smokers were alone or with others who were smoking, and smoking restrictions reduced smoking rates. However, the presence of others who are smoking undermined the effects of restrictions. The more sensitive point process analyses confirmed earlier findings, including the surprising conclusion that negative affect by itself was not related to smoking rates. Contrary to hypothesis, men's and not women's smoking was influenced by negative affect. Both smoking restrictions and the presence of others who are not smoking suppress smoking, but the presence of others who are not smoking undermines the effects of restrictions. Point process analyses of ecological momentary assessment data can bring out even small influences on smoking rate.

The reinforcement-enhancing effects of nicotine: implications for the relationship between smoking, eating and weight

Concerns about body weight represent an important barrier to public health efforts aimed at reducing smoking. Epidemiological studies have found that current smokers weigh less than non-smokers, smoking cessation results in weight gain, and weight restriction is commonly cited as a reason for smoking. The mechanisms underlying the relationship between smoking and weight are complex and may involve a number of factors including changes in caloric intake, physical activity, metabolic rate, and lipogenesis. Amongst these possible mechanisms, nicotine-induced enhancement of food reinforcement may be particularly important. In this paper, we first review data from our laboratory that highlight two distinct ways in which nicotine impacts reinforced behavior: 1) by acting as a primary reinforcer; and 2) by directly (non-associatively) enhancing the reinforcing effects of other stimuli. We then elaborate on the reinforcement-enhancing effects of nicotine as they pertain to behaviors and stimuli related to food. Data from both laboratory animals and humans support the assertion that nicotine enhances the reinforcing efficacy of food and suggest that the influence of these effects on eating may be most important after nicotine cessation when nicotine's effects on satiety subside. Finally, we discuss the theoretical and clinical implications of this perspective for understanding and addressing the apparent tradeoff between smoking and weight gain. Better understanding of the mechanisms underlying the reinforcement-enhancing effects of nicotine broadly, and the effects on food reinforcement per se, may aid in the development of new treatments with better long term outcomes.

Relationship between food habituation and reinforcing efficacy of food

Reinforcing value and habituation are two processes that have been used to study eating behaviors, but no research has examined their relationship, how they relate to energy intake, and whether they respond in a similar manner to food deprivation. Twenty-two female subjects were randomized to food deprived or non-deprived conditions, and assessed for food reinforcement, habituation to food and ad libitum eating. Results showed food reinforcement and habituation are correlated (r = 0.62, p = 0.002) and both independently predict energy intake. Hierarchical regression showed that the rate of habituation accounted for 30 percent of the variance in eating (p = 0.008), and adding food reinforcement increased the amount of variance accounted for up to 57.5 percent (p < 0.05). This suggests that both processes may influence energy intake in a meal.

Reactivity to smoking- and food-related cues in currently dieting and non-dieting young women smokers

There is some evidence to suggest that young women dieters who smoke experience greater cigarette cravings in the presence of food-related related cues. The aim of this experiment was to examine reactivity to both smoking-related and water cues by dieting and non-dieting women smokers in the presence or absence of food cues. Eighteen female undergraduates attended two sessions (food present and food absent). At each session, participants were presented with a cigarette and water cue in a counterbalanced order. Pre- and post-cue measures included the brief version of the Questionnaire for Smoking Urges, heart rate and self-reported mood. All smokers showed enhanced reactivity (increased craving and heart rate) to smoking versus water cues. For dieters there was a larger increase in cigarette craving and heart rate in response to the smoking-related cues in the presence of food compared with the absence of food, whereas for non-dieters there was a smaller increase in cigarette craving and heart rate in response to the smoking-related cues in the presence of food compared with the absence of food. Mood and appetite ratings were not significantly affected by either cue type or session. The results suggest that cue reactivity to smoking-related cues is modulated by the presence of incentive stimuli relevant to the individual.

Nicotine and food deprivation decrease the ability to resist smoking

RATIONALE

Attempts to simultaneously control food intake and smoking may lead to smoking cessation failure. We sought to model this relationship using a human laboratory paradigm of smoking lapse behavior.

OBJECTIVES

We examined the combined effect of food and nicotine deprivation, compared to nicotine deprivation alone, on the ability to resist smoking and on subsequent ad libitum smoking.

METHODS

In a between-subjects design, daily smokers (N = 30) were all deprived of nicotine for 18 h and were either food-deprived (12 h) or not during a laboratory session. Following exposure to individualized food cues, participants had the option of initiating tobacco self-administration or delaying up to 50 min in exchange for monetary reinforcement. Subsequently, the tobacco self-administration period consisted of 1 h in which participants could choose to smoke or receive monetary reinforcement for cigarettes not smoked.

RESULTS

Smokers who had been deprived of food and nicotine smoked their first cigarette sooner and were more likely to smoke at some point during the laboratory session, compared to those who were only nicotine-deprived. Those who were food- and nicotine-deprived smoked slightly more cigarettes than those who were nicotine-deprived only, although this difference was not statistically significant. There were no sex differences in outcomes. Hunger and food craving ratings while trying to resist smoking were greater in the food + nicotine-deprived group. Tobacco craving was predictive of outcome in both conditions.

CONCLUSIONS

These findings support the hypothesis that food deprivation can undermine a smoker's ability to resist smoking.

Endocrine and metabolic effects of smoking cessation

BACKGROUND

Cardiovascular, pulmonary, and oncological hazards of tobacco smoking have been well studied. Smoking may also have multiple effects on endocrine and metabolic systems affecting pituitary, thyroid, and adrenal glands; testicular and ovarian function; as well as energy balance; lipid, and glucose metabolism; and insulin resistance. Less is known about hormonal and metabolic effects that patients may experience while quitting smoking.

SCOPE

The objective of this article is to review systematically data on the endocrine and metabolic effects of smoking cessation. Articles based upon clinical trials, randomised controlled trials, and meta-analyses were obtained via a MEDLINE search (articles published between 1 August 1998 and 31 July 2008, inclusive; English language; human subjects; including abstracts) using key search terms relating to smoking cessation and endocrine or metabolic parameters. Additional studies were identified from the bibliographies of reviewed literature. Studies related to the search criteria were reviewed, 199 papers were identified, and 57 pertinent to this review were included.

FINDINGS

Limited data are available on the short- and long-term effects of smoking cessation on hypothalamic- and thyroid-pituitary-adrenal axes, sex hormones, energy homeostasis, and lipid and glucose metabolism. Initial data indicate that smoking cessation is associated with decreased cortisol levels and in the short-term, smoking cessation does not correct the diminished adrenocortical responses to stress caused by chronic smoking. Cessation reverses smoking's effects on thyroid disorders and may reduce the risk of osteoporosis. Finally, smoking cessation increases transiently food intake and sustained weight gain and is associated with increases in high-density lipoprotein cholesterol levels that occur rapidly on cessation.

CONCLUSION

Further research may provide insight into post-cessation endocrine changes that may be caused by alterations to central and peripheral systems. Such research may increase the understanding of underlying biological mechanisms that lead to symptoms and clinical features of smoking cessation.

Resisting tempting foods and smoking behavior: implications from a self-control theory perspective

OBJECTIVE

Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking.

DESIGN

Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess.

MAIN OUTCOME MEASURES

Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable.

RESULTS

As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), chi2(1, N = 101) = 3.65 p < .05.

CONCLUSIONS

The findings support the tenets of the self-control strength model and suggest the mechanism by which dietary restraint may harm efforts at quitting smoking.

Physical activity as a strategy for maintaining tobacco abstinence: a randomized trial

OBJECTIVES

For smoking cessation, physical activity (PA) may help manage withdrawal symptoms, mood, stress, and weight; yet studies of PA as an aid for smoking cessation have been mixed. This study examined: (1) the impact of an extended relapse prevention program on increasing moderate to vigorous PA (MVPA) in adults enrolled in a tobacco cessation treatment trial; (2) whether changes in MVPA were associated with sustained abstinence from smoking; and (3) mechanisms by which MVPA may support sustained abstinence from smoking.

METHODS

In a randomized controlled trial conducted from 2003-2006 in San Francisco, California, 407 adult smokers received a 12 week group-based smoking cessation treatment with bupropion and nicotine patch with the quit date set at week 3. At week 12, participants were randomized to no further treatment or to 40 weeks of bupropion or placebo with or without an 11-session relapse prevention intervention of which 2 sessions (held at weeks 16 and 20) focused on PA. Participants receiving the PA intervention (n=163) received a pedometer, counseling to increase steps 10% biweekly towards a 10,000 steps/day goal, and personalized reports graphing progress with individualized goals. The International Physical Activity Questionnaire assessed weekly minutes of MVPA at baseline and weeks 12 and 24. Sustained abstinence from tobacco at week 24 was validated with expired carbon monoxide.

RESULTS

In a repeated mixed model analysis, intervention participants significantly increased their MVPA relative to control participants, F(1,475)=3.95, p=.047. Pedometer step counts also increased significantly, t(23)=2.36, p=.027, though only 15% of intervention participants provided 6 weeks of pedometer monitoring. Controlling for treatment condition, increased MVPA predicted sustained smoking abstinence at week 24, odds ratio=1.84 (95% CI: 1.07, 3.05). Among participants with sustained abstinence, increased MVPA was associated with increased vigor (r=0.23, p=.025) and decreased perceived difficulty with staying smoke-free (r=-0.21, p=.038).

CONCLUSION

PA promotion as an adjunct to tobacco treatment increases MVPA levels; changes in MVPA predict sustained abstinence, perhaps by improving mood and self-efficacy.

Smoking status relationships with the food and fluid intakes of free-living humans

OBJECTIVE

The relation of cigarette smoking to food and fluid intakes was studied.

METHODS

Ninety-nine smoking and 551 non-smoking free-living adult humans provided a detailed record of their eating and drinking in 7-d diaries.

RESULTS

Cigarette smoking was associated with significant changes in overall intakes and meal pattern. Smokers had higher intakes of fluids in the form of drinks due to higher levels of alcohol and coffee/tea consumption. Smokers were less hungry but more responsive to social facilitation and time of day. There were also substantial gender differences in smoking relations to intake, with male smokers tending to have higher overall and meal intakes particularly of fats than non-smokers, whereas female smokers tended to have lower overall intakes, fewer meals, and lower amounts of carbohydrates than non-smokers. Male smokers tended to be less responsive to their before-meal stomach content, their level of hunger, and the palatability of the meal than non-smokers, whereas females tend to be more responsive to all of these influences on meal size.

CONCLUSION

These results suggest that smoking has very few direct simple effects on intake but rather influences intake indirectly through its covariation with alcohol and caffeine intakes and with dietary restraint and that smoking has different, sometimes opposite, influences in males and females.

Associations between dieting and smoking-related behaviors in young women

Many young women report smoking due to weight concerns, but little is known about the relationship between weight concerns and current smoking behavior. The present study examined smoking topography and the acute sensory and physiological responses to smoking in dieting and non-dieting young women. In addition, the effect of presentation of food cues on these responses was examined. Self-reported female current dieters (n=15) and non-dieters (n=15) attended two laboratory sessions (food cues present/food cues absent). Physiological and subjective responses were recorded pre- and post-cigarette at each session. Smoking topography was assessed by video analysis. Dieters scored higher than non-dieters on measures of weight control smoking, dietary restraint, and disinhibition. At both sessions, they smoked less of the cigarette, had shorter inhalation durations, longer inter-puff intervals, experienced smaller physiological effects and gave lower ratings of the sensory aspects of smoking than non-dieters. The presence of food cues did not alter smoking topography or sensory/physiological responses but the dieters reported a greater desire to smoke in the presence of food cues. These data suggest that sensory factors may be less important influences on smoking for weight control smokers than non-weight control smokers and that further investigation of the role of food cues in maintaining smoking behavior in weight control smokers is warranted.

Treating tobacco use and dependence in clinical practice

Physicians are in a unique position to advise smokers to quit by the ability to integrate the various aspects of nicotine dependence. This review provides an overview of the intervention strategies for smokers presented in a primary care setting. The strategies that are used for smoking cessation counselling differ according to the patient's readiness to quit. For smokers who do not intend to give up smoking, physicians should inform about tobacco use and the benefits of cessation. For smokers who are dissonant, physicians should use motivational strategies, such as discussing the barriers to successful cessation and their solutions. For smokers who are ready to quit, the physician should show strong support, help set a date to quit, prescribe pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e., gum, transdermal patch, nasal spray, mouth inhaler, lozenges, and micro and sublingual tablets) and/or bupropion (an atypical antidepressant thought to work by blocking the neural re-uptake of dopamine and/or noradrenaline), with instructions for use, and suggest behavioural strategies to prevent relapse. The efficacy of all of these pharmacotherapies is comparable, roughly doubling the cessation rates over control conditions.

The appetite-suppressant effect of nicotine is enhanced by caffeine

AIM

To test whether the anorectic effect of nicotine may be amplified by caffeine.

METHODS

Chewing gums with nicotine and caffeine were administered to 12 healthy young men of normal weight. Different combinations of 0, 1 or 2 mg of nicotine and 0, 50 or 100 mg of caffeine were applied during a 2-h period in a randomized, double blind, cross over design. Appetite sensations were measured using visual analogue scales.

RESULTS

Hunger and prospective food consumption were negatively associated with the increasing doses of nicotine, whereas satiety and fullness were positively associated with the increasing doses of nicotine (p < 0.05). Caffeine appeared to amplify the effects of nicotine on hunger and fullness as a caffeine x nicotine x time interaction was observed in these scores (p < 0.05). The 2-mg dose of nicotine in combination with the 100-mg dose of caffeine caused nausea in four of the non-smokers. However, the effects of nicotine and the caffeine x nicotine x time interaction persisted after the exclusion of these subjects.

CONCLUSION

Caffeine added to nicotine chewing gum appears to amplify its attenuating effects on appetite and the combinations of 1-mg of nicotine with caffeine seem to be well tolerated.

Effects of mood induction on eating behavior and cigarette craving in dietary restrainers

Women high in dietary restraint ("restrainers") increase food intake more than nonrestrainers following emotional arousal. When restrained smokers are deprived of cigarettes during elevated mood states, nicotine craving should increase with food craving. The present study investigated the interaction of smoking and affect on food intake in 60 women, 18-25 years old, who were identified as restrainers. The study consisted of smokers and nonsmokers who viewed a domestic violence or comedy film segment, followed by exposure to snacks. Emotional arousal, regardless of valence, did not result in a difference in food consumption between smokers and nonsmokers. Furthermore, smokers showed similar levels of nicotine craving after both films. Self-report of mood changed only in the domestic violence condition, indicating the difficulty of positive mood induction. Limitations to the study and suggestions for further research are discussed.

Immediate antecedents of cigarette smoking: an analysis from ecological momentary assessment

The authors assessed the association between smoking and situational cues, including affect, in real-world contexts. Using ecological momentary assessment, 304 smokers monitored ad-lib smoking for 1 week, recording each cigarette on palm-top computers. Generalized estimating equations contrasted 10,084 smoking and 11,155 nonsmoking situations. After controlling for smoking restrictions, smoking was strongly related to smoking urges and modestly related to consumption of coffee and food, the presence of other smokers, and several activities. Smoking was unrelated to negative or positive affect or to arousal, although it was associated with restlessness. Thus, in daily life, affect appears to exert little influence over ad-lib smoking in heavy smoking adults.

Evidence that transient nicotine lowers the body weight set point

OBJECTIVE

Smokers usually gain weight when they quit smoking. The present work explores the hypothesis according to which such a rise is a behavioral response to a raised body weight set point taking place when nicotine is eliminated from the body.

RESEARCH METHODS AND PROCEDURES

The human body weight set point was assessed with classical behavioral and psychophysical methods, from the delay to experience negative alliesthesia when repeatedly ingesting sweet stimuli. Seven habitual smokers were tested once before lunch, after smoking (nonabstinent) as usual and once again after refraining from smoking (abstinent). Three additional nicotine-naive subjects were tested under the same procedure after receiving at 0730 h in the morning a transdermal nicotine patch (14 mg) or a placebo patch. Two of the subjects also received nicotine (7 mg) for a third session.

RESULTS

Oral and transdermal administration of nicotine did not decrease the initial pleasure or modify the initial palatability of eating sweet stimuli, but significantly accelerated the following onset of self-reported displeasure (negative alliesthesia) aroused by repeated ingestion of sweet stimuli.

DISCUSSION

These results are understood as an acute lowering of the body weight set point by nicotine. The body weight gain taking place after quitting smoking may, therefore, be explained by the removal of the lowering of the body weight set point induced by nicotine.

Cigarette use during adolescence: effects on nutritional status

Despite numerous anti-tobacco campaigns, smoking among adolescents continues to be a predominant public health issue. This report details the interrelationships between adolescence, smoking, and nutrition and health. Current data indicate that most smokers become nicotine-dependent as adolescents, which places them at risk for chronic diseases associated with continuous oxidative damage. Additionally, nicotine has antidepressant and hypermetabolic effects, which may be of particular importance during adolescence because nicotine use leads to increased dependence on tobacco, contributes to difficulty in smoking cessation, and promotes weight gain following smoking cessation.

Gender differences in the pharmacology of nicotine addiction

Smoking rates have declined in recent years less rapidly in women than in men. More adolescent girls than boys are currently smoking. Quitting smoking is reported in many studies to be more difficult in women than in men. These observations suggest that there may be gender differences in the nature of nicotine addiction. Gender differences in various pharmacological processes involved in nicotine addiction are reviewed. Women take in less nicotine from smoking per cigarette than men but, because of slower metabolism, nicotine levels in the body for a given number of cigarettes per day are similar in male and female smokers. Women tend to be less sensitive to the discriminative effects of nicotine and tend to regulate nicotine intake less precisely than men. On the other hand, women appear to be more sensitive to the effects of nicotine in reducing negative affect and reducing body weight. There is a strong association between depression and smoking, and this association appears to be stronger in women than in men. Women tend to respond more to environmental cues associated with smoking than do men. Thus, several lines of evidence suggest that nicotine addiction is different in women than in men. Understanding the basis for gender differences may be of utility in individualizing and optimizing smoking cessation therapy.

Weight gain after smoking cessation in women: the impact of dieting status

OBJECTIVE

The fear of weight gain appears to be a barrier to quitting in some smokers, particularly in women. However, not all female smokers have the same concerns about weight, and not all quitters are equally susceptible to gaining weight after cessation. We hypothesized that among females, dieters, compared to nondieters, would report more weight gain after smoking cessation and would tend to smoke more for weight control purpose.

METHOD

Undergraduate college students were surveyed to assess their smoking status, dieting status, postcessation weight gain, and their motivations to smoke.

RESULTS

Among former smokers, dieters reported considerably more weight gain than nondieters. Dieters were more likely to have started, and to have continued smoking in order to control their weight, and among current smokers, dieters reported having had shorter quit attempts.

DISCUSSION

The dieters/former smokers' comparatively high weight gain after smoking cessation is discussed in terms of possible changes in dietary intake, metabolic rate, and physical activity.

Interaction of stress, smoking, and dietary restraint in women

Smoking cessation often results in weight gain but certain subtypes of smokers may be more likely than others to gain weight. Women high in dietary restraint ("restrainers") increase food intake and gain more weight than nonrestrainers during smoking cessation. Restrainers have also been reported to increase food intake following laboratory stressors. Therefore, the present study was designed to measure the influence of stress on food intake and subjective distress during acute smoking abstinence in restrained and nonrestrained women. Participants were 48 women, 18-40 years old, comprising six groups (n = 8 per group) in a 2 x 3 x 2 design. Groups consisted of two levels of restraint (restrained and nonrestrained) and three levels of smoking (ad lib. smokers, abstinent smokers, and nonsmokers), whereas the within-participant manipulation involved two sessions differing in stress (stress and control). Snack foods were available for consumption. Results showed that distress, measured by the Stress-Arousal Checklist and visual analogue measures of tension and anxiety, was higher in the stress session for all groups except for restrainers who smoked ad lib. Furthermore, distress was significantly higher in smoke-abstinent restrainers during the stress session than all other conditions. However, despite differences in distress, no effect was observed for food intake. Desire for a cigarette showed a sharper increase over the stress session for restrainers compared with nonrestrainers but did not differ in the control session. These data suggest that restrainers may use smoking to reduce distress and may increase smoking, but not eating, during stress.

Effects of monoamine receptor antagonists on nicotine-induced hypophagia in the rat

(--)-Nicotine, in doses of 0.2-0.6 mg/kg intraperitoneally (i.p.), induced a dose-dependent anorexia 1 h, 2 h and 4 h after food presentation in 20-h food-restricted male rats. The anorectic response of nicotine (0.4 mg/kg, 30 min before the test) was prevented by pretreatment with the central nicotine receptor antagonist mecamylamine (0.5 and 1 mg/kg). The peripheral nicotine receptor antagonist hexamethonium (5 and 10 mg/kg), the muscarinic receptor antagonist atropine (5 and 10 mg/kg), the dopamine D2 receptor antagonist pimozide (0.5 and 1 mg/kg), the dopamine D1 receptor antagonist SCH23390 (R-(+)-8-chloro-2, 3, 4, 5-tetrahydro-3-methyl-5-phenyl-1 H-3-benzazepine-7ol maleate; 0.05 and 0.1 mg/kg), the alpha-adrenoceptor antagonist phenoxybenzamine (5 and 10 mg/kg), and the beta-adrenoceptor antagonist propranolol (5 and 10 mg/kg) amplified the nicotine response while promoting anorexia by themselves. The dopamine D2 receptor antagonist sulpiride (25, 50 and 100 mg/kg) increased food intake and amplified the anorectic effect of nicotine. The 5-HT receptor antagonists metergoline (0.5 and 1 mg/kg) and mianserin (1 and 2 mg/kg) increased the nicotine effect. When the antagonists were used alone, metergoline did not change food intake, while mianserin increased food intake. It can be concluded that part of nicotine-induced anorexia is mediated through central nicotinic receptors.

Acute thermogenic effects of nicotine and alcohol in healthy male and female smokers

Nicotine intake is associated with lower body weight in both women and men. Despite its energy content, alcohol consumption is also associated with lower body weight in women but not in men. Each drug may reduce weight by acutely increasing thermogenesis. During four sessions, nicotine (20 micrograms/kg per dosing) or placebo was given to male and female smokers (n = 9 each) via measured-dose nasal spray every 30 min for 2 h after consumption of diet tonic water with or without alcohol (0.5 g/kg). Each nicotine/placebo dosing was followed by assessment of energy expenditure by indirect calorimetry. Alcohol alone induced no significant effect in men or women, whereas nicotine alone and combined with alcohol induced a significant thermogenic effect in men but not women. These results are consistent with other research suggesting a reduced thermogenic responsiveness to drugs in women and indicate that nicotine must act via appetite suppression to reduce body weight in women. Similarly, these findings do not support the notion that alcohol is inversely related to body weight in women because of excessive acute thermogenesis.

Physiological and subjective responses to food cues as a function of smoking abstinence and dietary restraint

Dietary restraint is a characteristic associated with greater increase in food intake after smoking cessation, and salivation is a marker of physiological responsiveness to food that may be influenced by cessation. The present study examined the effect of brief smoking abstinence (16 h) vs. no abstinence on salivary and subjective responses to food taste cues in women smokers high vs. low in dietary restraint (n = 10 each). On each of two days (smoking abstinence vs. nonabstinence), salivary volume was assessed during each of 10 trials involving presentation of a small sample of strawberry yogurt. Decline in salivation over trials is indicative of habituation, or reduction in physiological responsiveness to taste cues, and may be a marker of satiety. Subjects also completed self-report measures of hunger, taste liking, desire for cigarette, and emotional arousal during each trial. A 10-min period of ad lib consumption of yogurt ended each session. Results showed significantly elevated salivary response to the first trial of taste exposure in high vs. low restraint women, especially on the smoking day. Moreover, salivary habituation was significantly disrupted by smoking abstinence, especially over the first 5 trials, in high restraint but not low restraint women. High restraint women also reported increasing desire for cigarette and emotional arousal across food taste trials on both days, while low restraint women reported no change in each over trials. There were no differences in ad lib yogurt consumption. These results indicate that brief smoking abstinence attenuates salivary habituation to taste in high restraint women, suggesting a marker for processes responsible for increased food intake after quitting smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Individual variability in responses to nicotine

Individual variability in acute responses to nicotine, which may be defined as variable magnitude of effects following controlled dosing, is generally attributed to stable characteristics of tobacco users such as genetic/constitutional factors or to chronic behavioral factors (e.g., long-term use of other drugs). Often overlooked, however, is that such variability may also be due to the transient influence of the situational factors in which people consume nicotine, such as acute stress or physical activity. Results of selected studies from the author's laboratory provide examples of each of these sources of variability in nicotine responding on subjective, behavioral, and physiological measures. All studies used a nasal spray method of nicotine dosing or controlled smoking (paced puffing) to control acute nicotine exposure, an essential methodological feature of any research on individual differences in acute responses to nicotine. As an example of genetic/constitutional factors, gender differences in nicotine responding have begun to receive some attention, with few differences emerging. However, females may be more responsive than males to nonnicotine stimuli associated with smoking (e.g., sight and taste of smoke). In terms of chronic behavioral factors, long-term use of nicotine produces attenuation of most subjective and some behavioral effects of nicotine, reflecting chronic tolerance, and the possibility that chronic use of other drugs may alter responses to nicotine (i.e., cross-tolerance or cross-sensitization) deserves greater study. Of particular emphasis in this review is the modulating influence of acute situational factors on nicotine responding. Human studies have shown that magnitude of nicotine's subjective effects may depend on the predrug subjective state, level of physical activity vs. rest, and concurrent acute intake of other drugs, among other situational factors. Proper consideration of these situational factors may reveal the greatest source of individual variability in responding to nicotine and clarify the impact of more stable genetic/constitutional or chronic environmental factors.