Characterizing early cigarette use episodes in novice smokers

Pathways to the persistence of drug use despite its adverse consequences

The persistence of drug taking despite its adverse consequences plays a central role in the presentation, diagnosis, and impacts of addiction. Eventual recognition and appraisal of these adverse consequences is central to decisions to reduce or cease use. However, the most appropriate ways of conceptualizing persistence in the face of adverse consequences remain unclear. Here we review evidence that there are at least three pathways to persistent use despite the negative consequences of that use. A cognitive pathway for recognition of adverse consequences, a motivational pathway for valuation of these consequences, and a behavioral pathway for responding to these adverse consequences. These pathways are dynamic, not linear, with multiple possible trajectories between them, and each is sufficient to produce persistence. We describe these pathways, their characteristics, brain cellular and circuit substrates, and we highlight their relevance to different pathways to self- and treatment-guided behavior change.

Where should I start? A scoping review about the publications on clove cigarettes

INTRODUCTION

The general lack of knowledge about the composition of clove cigarettes and the large number of terms that can be used to define different types of cigarettes that contain cloves makes it difficult to find scientific articles focused on the subject. We reviewed the publications that cited clove cigarettes to assess their relevance.

METHODS

We searched publications on Scopus, ScienceDirect, PubMed, and Portal CAPES during the first semester of 2021, without date restrictions. Through a quality assessment, the studies found were assorted in ten different categories.

RESULTS

Indonesian clove cigarettes-also known as kretek-are a mixture of tobacco and cloves rolled in a cigarette and sprayed with oils, plant extract, and food flavorings, in an unknown quantity and composition, different from each brand, which is usually kept in secret. Due to the relatively low prevalence of use in the general population, most publications on tobacco products tend to ignore clove cigarettes or place them in an existing category. Clove cigarettes can be hand-rolled, machine-made, filtered, unfiltered, and each form can be named differently. The interchangeable use of each term, sometimes grouping conventional cigarettes in the mix, can lead the researcher to consider a publication that should be excluded.

CONCLUSION

The existing regulations on flavored cigarettes, although well-intentioned, are still somewhat vague and broad, leaving possible loopholes that can be exploited by the tobacco industries. Fully understanding the precise effects caused by clove cigarettes can be an important tool in future discussions about tobacco control.

Social facilitation of alcohol subjective effects in adolescents: Associations with subsequent alcohol use

RATIONALE

Laboratory research in adults indicates that alcohol-related subjective effects are enhanced under some social conditions. However, it is unknown whether this "social facilitation" of alcohol effects occurs in adolescents and is associated with alcohol use in the natural ecology.

OBJECTIVES

We examined associations of social facilitation of alcohol-related subjective effects with subsequent alcohol use among a relatively high-risk group of adolescents who reported drinking alcohol both with friends and alone.

METHODS

Los Angeles high school students from a prospective study (N = 142; 51% female; 10th graders) completed a baseline survey that assessed alcohol-related "positive" and "negative" subjective effects in two contexts: social (alcohol with friends) and solitary (alcohol alone); social facilitation was calculated as the difference between social and solitary. Students then completed five semi-annual surveys spanning 30 months (2014-2017) assessing 30-day alcohol use (days used, number of drinks, binge drinking).

RESULTS

Greater social facilitation of positive effects was significantly associated with greater number of alcohol use days (RR [95% CI] = 1.48 [1.19, 1.82]; p < .001), greater number of drinks (RR [95% CI] = 1.38 [1.14, 1.66]; p = .001), and greater odds of binge drinking (OR [95% CI] = 1.75 [1.20, 2.57]; p = .004). Similar associations were found with social positive effects. There were no significant associations between solitary positive effects-or any negative effects-and alcohol use outcomes.

CONCLUSIONS

Social facilitation can be measured outside of the laboratory. Relatively high-risk drinking adolescents who are more susceptible to the social facilitation of subjective alcohol effects are more likely to use more alcohol and binge drink.

Factors Associated with the Initial Sensations of Smoking among Smokers with Mental Illness

People with mental illnesses (MI) have a disproportionate smoking prevalence and associated disease burden. Smoking initiation among people with MI is poorly understood. However, the sensations experienced during smoking initiation predict continued smoking and nicotine dependence. Yet, few studies have examined the initial experiences of smoking among people with MI. Thus, the aim of this study was to explore factors associated with the initial sensations of smoking in people with MI. Smokers in an inpatient psychiatric facility (n = 123) were surveyed. Data obtained included information on demographics, smoking and secondhand smoke (SHS) exposure, psychiatric diagnoses, and sensations of initial smoking. Spearman correlations explored associations among initial smoking sensation variables; and binary logistic regression analyses examined the associations between study variables and groupings derived from initial sensations (i.e., "pleasant + buzz," "unpleasant + buzz," and "all" sensations). The most frequently reported initial smoking sensation was feeling dizzy (87%) and there were low to moderate correlations between unpleasant (e.g., cough, sick, nervous) and pleasant (e.g., good, relaxed) sensations. In logistic regression analyses, having higher perceived SHS exposure was significantly associated with the "pleasant + buzz" sensation grouping; and lower past week SHS exposure was associated with the "unpleasant + buzz" sensation grouping; but, no variables were associated with "all" sensation group. Initial smoking sensations are an uncharted avenue of exploration in understanding smoking initiation among people with MI. SHS exposure may be an important factor associated with the report of both unpleasant and pleasant initial sensations. Future studies are needed to further explore initial sensations in relation to the context of smoking initiation among people with MI.

Adolescent dual-product users: Acquisition and situational use of cigarettes and cigars

BACKGROUND

Little is known about how adolescents who smoke both cigarettes and cigar products obtain and use these products. This study sought to explore cigarette and cigar acquisition and situational use among high school smokers.

METHODS

Data are drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Analysis was limited to youth who smoke cigarettes as well as cigars, cigarillos, and little cigars (CCLC) in the past month (N = 649). Consumption of both products was calculated and used to create four subtypes of users based on high or low use of each product (Dual High, Dual Low, High CCLC/Low Cigarette, and Low CCLC/High Cigarette users). Current users were asked to identify situations in which they use cigarettes and CCLCs and ways in which they obtain these products. Data were analyzed overall and by user subtype.

RESULTS

Youth reported acquiring cigarettes and CCLC in similar ways, although youth were more likely to take cigarettes from family members than CCLC (11.1% vs. 4.8%). Several differences were observed between cigarettes and CCLC for situational use. While both products are frequently used in social situations (e.g., with friends), cigarettes were more likely to be used in solitary situations (e.g., before bed). Further, significant differences were observed among the four user subtypes.

CONCLUSIONS

Study results highlight important, nuanced differences regarding how young multi-tobacco users obtain and the situational use of such products. Importantly, these findings vary by user subtype, informing future interventions to prevent and reduce smoking among the most vulnerable subgroups of youth.

Mixed methods research in tobacco control with youth and young adults: A methodological review of current strategies

INTRODUCTION

Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology.

METHODS

Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research.

RESULTS

We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs.

CONCLUSIONS

The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.

Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars:: A Cross-sectional Study

INTRODUCTION

Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them.

METHODS

Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014.

RESULTS

Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only.

CONCLUSIONS

These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.

The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents

INTRODUCTION

Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong.

METHODS

We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7-12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days.

RESULTS

Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61-7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00-2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35-3.19).

CONCLUSIONS

Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.

Booze and butts: A content analysis of the presence of alcohol in tobacco industry's lifestyle magazines

Background

Advertising influences people's health behaviors. Tobacco companies have linked tobacco and alcohol in their marketing activities. We examined how depictions of alcohol were placed in lifestyle magazines produced by tobacco companies, and if these references differed depending on the magazine’s orientation, if it was towards men, women, or if it was unisex.

Methods

Content analysis of 6 different tobacco industry lifestyle magazines (73 issues), including 73 magazine covers, 1558 articles, 444 tobacco ads, and 695 non-tobacco ads.

Results

14 of 73 (19%) magazine covers featured alcohol; 581 of 1558 (37%) magazine articles mentioned alcohol; 119 of 444 (27%) tobacco ads showed alcohol images; and 57 of 695 (8%) non-tobacco ads portrayed alcohol. Male-oriented magazines (Unlimited, CML, and Real Edge) contained the most alcohol references, and the references were mainly beer, mixed drinks, and liquor or spirits. Female-oriented magazines (All Woman and Flair) contained the fewest alcohol references, and wine and mixed drinks were the major types of alcoholic beverage portrayed. For the unisex magazine (P.S.), the frequency of alcohol references fell between the male- and female-oriented magazines, and the magazine most frequently mentioned mixed drinks.

Conclusions

Frequent depictions of smoking and drinking in tobacco industry lifestyle magazines might have reinforced norms about paired use of tobacco and alcohol among young adults. The pairing of tobacco and alcohol may particularly target young men. Anti-tobacco interventions need to address the co-use of tobacco and alcohol, change the social acceptability of smoking in social settings, and tailor anti-tobacco messaging by gender.

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Tobacco companies frequently portrayed alcohol in their lifestyle magazines.

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More alcohol references appeared in male-oriented magazines than female-oriented magazines.

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Frequent depictions of smoking and drinking may reinforce co-use norms.

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Interventions should reduce the social acceptability of tobacco and alcohol co-use.

Drug effects on responses to emotional facial expressions: recent findings

Many psychoactive drugs increase social behavior and enhance social interactions, which may, in turn, increase their attractiveness to users. Although the psychological mechanisms by which drugs affect social behavior are not fully understood, there is some evidence that drugs alter the perception of emotions in others. Drugs can affect the ability to detect, attend to, and respond to emotional facial expressions, which in turn may influence their use in social settings. Either increased reactivity to positive expressions or decreased response to negative expressions may facilitate social interaction. This article reviews evidence that psychoactive drugs alter the processing of emotional facial expressions using subjective, behavioral, and physiological measures. The findings lay the groundwork for better understanding how drugs alter social processing and social behavior more generally.

Does the Relationship Between Cigarette Smoking and Other Key Health Behaviors Vary by Geographic Area Among US Young Adults? A Multilevel Analysis

BACKGROUND

Although researchers and practitioners have long been aware of interdependence among health behaviors, they tend to compartmentalize health behaviors in research and practice. This kind of approach often fails to acknowledge the syndemic nature of health behaviors.

PURPOSE

This study investigated differences in the relationship between cigarette smoking and other key health behaviors, such as vigorous physical activity, fruit and vegetable consumption, and binge drinking among young adults (ages 18 to 30 years) across 180 metropolitan and micropolitan statistical areas (MMSAs) in the USA.

METHOD

A total of 19,027 young adults in the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using multilevel logistic regression models.

RESULTS

Both vigorous physical activity and fruit and vegetable consumption were negatively associated with cigarette smoking, whereas binge drinking was positively associated with smoking. There were significant differences in the relation of smoking with vigorous physical activity, fruit and vegetable consumption, and binge drinking across the 180 MMSAs. These differences were associated with the prevalence of cigarette smoking and binge drinking for each MMSA.

CONCLUSION

As indicated by the social learning theory, geographic area-specific prevalence of health behaviors appears to reflect group norms regarding those behaviors which, in turn, affect the clustering of health behaviors in the respective area.

Binge drinking: Burden of liver disease and beyond

The consumption of alcoholic beverages is harmful to human health. In recent years, consumption patterns of alcoholic beverages have changed in our society, and binge drinking has generalized. It is considered to be a socio-sanitary problem with few known consequences in terms of individual and third-party social impacts (in the form of violence or traffic accidents) and its organic impact (affects the liver and other organs and systems, such as the nervous and cardiovascular systems) and represents an important financial burden due to its increasing economic impact. This review provides a global approach to binge drinking and emphasizes its epidemiological character, the effect of this type of consumption and the possible management of a problem with an increasing tendency in our society.

Association between tobacco and alcohol use among young adult bar patrons: a cross-sectional study in three cities

BACKGROUND

Bars and nightclubs are key public venues where young adults congregate and use both tobacco and alcohol, and young adult bar patrons are at high risk for substance use. This study examined the association between cigarette smoking and alcohol use among a random sample of young adult bar patrons from three different cities in the USA.

METHODS

Cross-sectional data was collected from a random sample of young adult bar patrons aged 18-29 in San Diego, CA (N = 1,150), Portland, ME (N = 1,019), and Tulsa, OK (N = 1,106) from 2007-2010 (response rate 88%) using randomized time location sampling. Respondents reported the number of days they smoked cigarettes, drank alcohol, and binge drank in the past 30 days. Multinomial logistic regression was used to analyze the association between smoking (nonsmoker, occasional smoker, and regular smoker) and drinking and binge drinking for each city controlling for age, gender, race/ethnicity, and education. Predicted probabilities of each smoking category were calculated by drinking and binge drinking status. The association between smoking and drinking and binge drinking among combined samples was also analyzed, controlling for demographic variables and city.

RESULTS

Respondents reported high current smoking rates, ranging from 51% in Portland to 58% in Tulsa. Respondents in Tulsa were more likely to report regular smoking than those in San Diego and Portland, with demographic variables being controlled. Young adult bar patrons also exhibited a strong association between smoking and drinking. In general, as the frequency of drinking and binge drinking increased, the predicted probability of being a smoker, especially a regular smoker, increased in each city.

CONCLUSIONS

Young adult bar patrons consistently reported a high smoking rate and a strong relationship between smoking and drinking, regardless of the different bar cultures and tobacco control contexts in each of the three cities. While smoke-free bar policies were negatively associated with regular smoking, these policies alone may not be enough to influence the association between smoking and drinking, particularly if tobacco marketing continues in these venues, or in the absence of programs specifically addressing the co-use of tobacco and alcohol.

A cross-sectional study examining youth smoking rates and correlates in Tbilisi, Georgia

Georgia has high smoking rates; however, little is known about the prevalence and correlates of youth smoking. We conducted a secondary data analysis of a 2010 cross-sectional survey of 1,879 secondary and postsecondary school students aged 15 to 24 years in Tbilisi, Georgia, examining substance use, perceived risk, and recreational activities in relation to lifetime and current (past 30 days) smoking. Lifetime and current smoking prevalence was 46.1% and 22.6%, respectively. In secondary schools, lifetime smoking correlates included being male, consuming alcohol, lifetime marijuana use, and lower perceived risk (P's ≤ .001). Correlates of current smoking among lifetime smokers included being male, consuming alcohol, lifetime marijuana use, lower perceived risk, less frequently exercise, and more often going out (P's < .05). In postsecondary schools, lifetime smoking correlates included being male, consuming alcohol, lifetime marijuana use, lower perceived risk, more often going out, and recreational internet use (P's < .0). Correlates of current smoking among lifetime smokers included being male (P's = .04), consuming alcohol, marijuana use, lower perceived risk, and more often going out (P's < .05). Tobacco control interventions might target these correlates to reduce smoking prevalence in Georgian youth.

Social facilitation expectancies for smoking: psychometric properties of a new measure

OBJECTIVE

Expectancies about social outcomes for smoking are relevant to college student smokers, who frequently report "social smoking." A new measure, the Social Facilitation Expectancies (SFE) scale, was developed to assess these beliefs.

PARTICIPANTS

The SFE was administered to undergraduate college student smokers (N = 1,096; study completed in May 2011).

METHODS

Items were scored on a 5-point scale with a summed total score. The sample was randomly split and principle axis factoring and confirmatory factor analysis applied to determine scale structure. The structure was tested across sex and smoking groups and validation analyses were conducted.

RESULTS

A 9-item, 1-factor scale was replicated within each group. Higher SFE scores were observed among those with greater smoking experience and higher scores were associated with greater endorsement of other smoking-related beliefs.

CONCLUSIONS

These preliminary findings provide support for the sound psychometric properties of this measure for use with young adult college students.

In the company of others: social factors alter acute alcohol effects

RATIONALE

Alcohol is usually consumed in social contexts. However, the drug has been studied mainly under socially isolated conditions, and our understanding of how social setting affects response to alcohol is limited.

OBJECTIVES

The current study compared the subjective, physiological, and behavioral effects of a moderate dose of alcohol in moderate social drinkers who were tested in either a social or an isolated context and in the presence of others who had or had not consumed alcohol.

METHODS

Healthy men and women were randomly assigned to either a social group tested in pairs (SOC; N = 24), or an isolated group tested individually (ISO; N = 20). They participated in four sessions, in which they received oral alcohol (0.8 g/kg) or placebo on two sessions each, in quasi-randomized order under double-blind conditions. In the SOC condition, the drug conditions of the co-participants were varied systematically: on two sessions, both participants received the same substance (placebo or alcohol) and on the other two sessions one received alcohol while the other received placebo. Cardiovascular measures, breath alcohol levels, and mood were assessed at regular intervals, and measures of social interaction were obtained in the SOC group.

RESULTS

Alcohol produced greater effects on certain subjective measures in the SOC condition compared with the ISO condition, including feelings of intoxication and stimulation, but not on other measures such as feeling sedated or high, or on cardiovascular measures. Within the SOC condition, participants rated themselves as more intoxicated when their partner received alcohol, and paired subjects interacted more when at least one participant received alcohol.

CONCLUSIONS

The presence of others enhances some of the subjective and behavioral effects of alcohol, especially the presence of another intoxicated individual. This enhancement of alcohol effects may explain, in part, why it is used in a social context.

Impact of alcohol use and bar attendance on smoking and quit attempts among young adult bar patrons

OBJECTIVES

We examined cigarette smoking and quit attempts in the context of alcohol use and bar attendance among young adult bar patrons with different smoking patterns. Methods. We used randomized time location sampling to collect data among adult bar patrons aged 21 to 26 years in San Diego, California (n = 1235; response rate = 73%). We used multinomial and multivariate logistic regression models to analyze the association between smoking and quit attempts and both drinking and binge drinking among occasional, regular, very light, and heavier smokers, controlling for age, gender, race/ethnicity, and education.

RESULTS

Young adult bar patrons reported high rates of smoking and co-use of cigarettes and alcohol. Binge drinking predicted smoking status, especially occasional and very light smoking. All types of smokers reported alcohol use, and bar attendance made it harder to quit. Alcohol use was negatively associated with quit attempts for very light smokers, but positively associated with quitting among heavier smokers.

CONCLUSIONS

Smoking and co-use of cigarettes and alcohol are common among young adult bar patrons, but there are important differences by smoking patterns. Tobacco interventions for young adults should prioritize bars and address alcohol use.

Applying anthropology to eliminate tobacco-related health disparities

INTRODUCTION

Disparities in tobacco's harm persist. Declines in smoking among the general population have not been experienced to the same extent by vulnerable populations. Innovative strategies are required to diminish disparities in tobacco's harm. As novel tools, anthropological concepts and methods may be applied to improve the design and outcomes of tobacco cessation interventions.

METHODS

We reviewed over 60 articles published in peer-reviewed journals since 1995 for content on anthropology and smoking cessation. The specific questions framing the review were: (a) "How can lessons learned from anthropological studies of smoking improve the design and effectiveness of smoking cessation interventions?" (b) How can anthropology be applied to diminish disparities in smoking cessation? and (c) How can qualitative methods be used most effectively in smoking cessation intervention research?

RESULTS

Three specific disciplinary tools were identified and examined: (a) culture, (b) reflexivity, and (c) qualitative methods. Examining culture as a dynamic influence and understanding the utilities of smoking in a particular group is a precursor to promoting cessation. Reflexivity enables a deeper understanding of how smokers perceive quitting and smoking beyond addiction and individual health consequences. Qualitative methods may be used to elicit in-depth perspectives on quitting, insights to inform existing community-based strategies for making behavior changes, and detailed preferences for cessation treatment or programs.

CONCLUSIONS

Anthropological tools can be used to improve the effectiveness of intervention research studies targeting individuals from vulnerable groups. Synthesized applications of anthropological concepts can be used to facilitate translation of findings into clinical practice for providers addressing tobacco cessation in vulnerable populations.

Reinforcement of smoking and drinking: tobacco marketing strategies linked with alcohol in the United States

OBJECTIVES

We investigated tobacco companies' knowledge about concurrent use of tobacco and alcohol, their marketing strategies linking cigarettes with alcohol, and the benefits tobacco companies sought from these marketing activities.

METHODS

We performed systematic searches on previously secret tobacco industry documents, and we summarized the themes and contexts of relevant search results.

RESULTS

Tobacco company research confirmed the association between tobacco use and alcohol use. Tobacco companies explored promotional strategies linking cigarettes and alcohol, such as jointly sponsoring special events with alcohol companies to lower the cost of sponsorships, increase consumer appeal, reinforce brand identity, and generate increased cigarette sales. They also pursued promotions that tied cigarette sales to alcohol purchases, and cigarette promotional events frequently featured alcohol discounts or encouraged alcohol use.

CONCLUSIONS

Tobacco companies' numerous marketing strategies linking cigarettes with alcohol may have reinforced the use of both substances. Because using tobacco and alcohol together makes it harder to quit smoking, policies prohibiting tobacco sales and promotion in establishments where alcohol is served and sold might mitigate this effect. Smoking cessation programs should address the effect that alcohol consumption has on tobacco use.

Empirical support for a multi-dimensional model of sensations experienced by youth during their initial smoking episodes

AIMS

To examine the dimensionality of sensations experienced during initial tobacco smoking.

DESIGN

Cross-sectional survey.

SETTING

Thirteen secondary schools located in British Columbia, Canada.

PARTICIPANTS

Data from 1187 adolescents who responded 'yes' to the question: 'Have you ever tried cigarette smoking, even one or two puffs?'.

MEASUREMENTS

Participants answered questions about their demographic characteristics, tobacco smoking history and sensations experienced during their initial smoking episodes.

FINDINGS

The sensations appear to represent the following three separate but modestly correlated dimensions: a pleasant dimension defined by feeling good and relaxed; an unpleasant dimension defined by coughing, feeling sick and nervous; and a 'buzz' dimension defined by feeling high and dizzy. The three factors made statistically significant contributions to the prediction of transition to regular smoking (defined as having smoked at least 100 cigarettes in one's life-time) after adjusting for age, sex and age at first puff.

CONCLUSIONS

The results suggest that three relatively distinct physiological systems appear to explain the relationship between initial smoking sensations and probability of becoming a regular smoker. Researchers examining sensations experienced during initial tobacco smoking episodes should consider using a three-dimensional profile of symptoms composed of pleasant, unpleasant and buzz dimensions.

Contextual and subjective antecedents of smoking in a college student sample

INTRODUCTION

College is a time when individuals are at risk for initiating or increasing their smoking behavior. Little is known, however, about the contexts in which college students smoke. Identifying antecedents to smoking would provide insights into motivation and stimulus control of smoking in this population.

METHOD

In a sample of 50 college student smokers, situational, behavioral, and subjective state variables were compared between prompted interviews (N = 2,095) and participant-initiated smoking interviews (N = 865) using electronic handheld diaries.

RESULTS

The strongest predictors of smoking were recently inhabiting an outside location (odds ratio [OR] = 4.19, p < .001), the presence of others smoking (OR = 3.93, p < .001), and being where smoking was permitted (OR = 3.26, p < .001), indicating situational control over smoking. Less cue control over smoking was found for daily than nondaily smokers. Craving was the most robust subjective antecedent of smoking behavior (OR = 1.32, p < .001).

DISCUSSION

These results suggest that smoking among college students is largely opportunistic, craving is important and may develop early in the progression of smoking, and stimulus control may erode with greater smoking experience.

Subjective effects of transdermal nicotine among nonsmokers

The subjective experience of nicotine, which may be influenced by personality traits as well as environmental factors, may be important for understanding the factors associated with the initiation and maintenance of nicotine dependence. The present study examined the effects of 7 mg transdermal nicotine among a relatively large sample (n = 91; 44 women) of college-aged nonsmokers. Using a placebo controlled, double-blind, within-subjects design, nicotine's effects were examined at rest and again after participants completed a sustained attention task. Sex and personality factors (Behavioral Inhibition and Behavioral Approach; BIS/BAS Scales; Carver & White, 1994) were examined as potential moderators. Overall, the effects of nicotine were generally modest and unpleasant. In the context of the cognitive task, nicotine increased nausea and negative affect but reduced fatigue, relative to placebo. In contrast, effects of nicotine during the initial 4 hr of patch administration, in which participants were in their natural environments, were moderated by individual differences in behavioral approach. Neither behavioral inhibition nor gender reliably moderated any subjective effects of nicotine. The present work suggests transdermal nicotine exerts only modest, mostly negative effects among nonsmokers. Future work should examine both contextual and personality moderators in large samples of participants who are exposed to nicotine through multiple routes of administration.

Smoking and drinking among college students: "it's a package deal"

BACKGROUND

This paper reports on qualitative research on smoking in contexts associated with drinking among college students. Although a plethora of survey research has shown a positive association between smoking and alcohol use, little attention has been given to the utility functions of these co-occurring behaviors.

METHODS

Data are drawn from semi-structured interviews with college freshmen at a large Mid-western university in the U.S. (n=35). In addition, eleven focus groups with fraternity and sorority members were conducted (n=70). Interviews and focus groups focused on a range of issues including current smoking behavior, reasons for smoking, and smoking and drinking.

RESULTS

A review of qualitative responses reveals that smoking served multiple utility functions for this population including (1) facilitating social interaction across gender, (2) allowing one to structure time and space at a party, (3) enabling "party" smokers to smoke with fewer negative side effects, and (4) helping to calm one down when drunk.

CONCLUSIONS

Whereas smoking was stigmatized during the context of one's everyday life as a student, at parties while consuming alcohol, smoking was viewed as normative and socially acceptable. Preventive interventions are needed on college campus that target co-substance use and address widespread misperceptions about the harm of tobacco use and addiction.

Coming to our senses: appreciating the sensorial in medical anthropology

This article supports the call for the sensorially engaged anthropological study of healing modalities, popular health culture, dietary practices, drug foods and pharmaceuticals, and idioms of distress. Six concepts are of central importance to sensorial anthropology: embodiment, the mindful body, mimesis, local biology, somatic idioms of distress, and 'the work of culture'. Fieldwork in South and Southeast Asia and North America illustrates how cultural interpretations associate bodily sensations with passions (strong emotions) and anxiety states, and bodily communication about social relations. Lay interpretations of bodily sensations inform and are informed by local understanding of ethnophysiology, health, illness, and the way medicines act in the body. Bodily states are manipulated by the ingestion of substances ranging from drug foods (e.g., sources of caffeine, nicotine, dietary supplements) to pharmaceuticals that stimulate or suppress sensations concordant with cultural values, work demands, and health concerns. Social relations are articulated at the site of the body through somatic modes of attention that index bodily ways of knowing learned through socialization, bodily memories, and the ability to relate to how another is likely to be feeling in a particular context. Sensorial anthropology can contribute to the study of transformative healing and trajectories of healthcare seeking and patterns of referral in pluralistic healthcare arenas.