Abstinence effects and reactivity to nicotine during 11 days of smoking deprivation

Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study

BACKGROUND

Although cancer patients are generally strongly advised to quit smoking in order to improve treatment efficacy and survival, up to 68 % of patients who were smokers at the time of cancer diagnosis continue smoking. Psychological factors such as depression and anxiety are likely to be associated with smoking behavior following a cancer diagnosis, but the empirical evidence is scarce.

PURPOSE

This observational study aimed at estimating smoking cessation rates and assessing the effect of smoking cessation on psychological symptoms, as well as the predictive role of the same psychological variables on smoking cessation and smoking relapse following cancer surgery.

METHODS

As part of a larger prospective, epidemiological study, smokers (n = 175) with a first diagnosis of nonmetastatic cancer completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, and the Fear of Cancer Recurrence Inventory. Quitters (n = 55) and pair-matched nonquitters (n = 55) were compared on each symptom at pre-quitting, post-quitting, and at a 4-month follow-up. Predictors of smoking cessation and smoking relapse, including psychological variables, were also investigated.

RESULTS

Fifty-five patients (31.4 %) stopped smoking at least on one occasion during the study. Of the 55 quitters, 27 (49.1 %) experienced a relapse. At pre-quitting, quitters had significantly higher levels of anxiety (p = .03) and fear of cancer recurrence (p = .01) than nonquitters, symptoms that significantly diminished at post-quitting and 4 months later in this subgroup of patients. Having breast cancer significantly predicted smoking cessation (relative risk [RR] = 3.08), while depressive symptoms were a significant predictor of smoking relapse (RR = 1.07).

CONCLUSIONS

This study highlights the importance of psychological symptoms in predicting tobacco cessation and relapse among individuals with cancer. Our findings suggest that breast cancer patients are more inclined to stop smoking than patients with other cancers, but future studies should attempt to delineate the effect on smoking cessation of gender and other demographics that characterize this subgroup. This study also suggests that a particular attention should be paid to the early management of depressive symptoms in order to prevent smoking relapse.

Woman focused smoking cessation programming: a qualitative study

BACKGROUND

Several studies of smoking cessation programs in clinical settings have revealed poorer outcomes for women compared to men, including counselling alone or in combination with pharmacotherapy. The objective of the current study was to explore treatment and program structure needs and preferences among female clients in a specialized smoking cessation clinic in an academic mental health and addiction health science centre in order to inform program design so that it meets the needs of female clients.

METHODS

Four focus groups were conducted with current and former female clients (n = 23, mode age range = 50-59 years old, 56.5% were still smoking and 43.5% had quit) who had registered for outpatient smoking cessation treatment. Questions were designed to examine what aspects of the services were helpful and what changes they would like to see to better assist them and other women with quitting smoking. A thematic analysis of the raw data (audio recordings and notes taken during the focus groups) was conducted using a phenomenological theoretical framework.

RESULTS

Themes that emerged indicated that females trying to quit smoking are best supported if they have choice from a variety of services so that treatment can be individualized to meet their specific needs; psychosocial support is provided both one-one-one with health care professionals and by peers in support groups; free pharmacotherapy is available to eliminate financial barriers to use; women-specific educational topics and support groups are offered; the clinic is accessible with evening/weekend hours, options to attend a local clinic, and childcare availability; and communication about clinic services and operation are clear, readily available, and regularly updated.

CONCLUSIONS

An ideal smoking cessation program for women includes a women's centred approach with sufficient variety and choice, free pharmacotherapy, non-judgmental support, accessible services and clear communication of program options and changes. Findings may suggest an actionable list of adaptations that can be adopted by other clinics providing smoking cessation services to women.

Mediating effect of anxiety and depression on the relationship between Attention-deficit/hyperactivity disorder symptoms and smoking/drinking

Attention-deficit/hyperactivity disorder (ADHD) has been often found to be comorbid with other disorders, including anxiety, depression, and unhealthy behaviors such as drinking alcohol and smoking. These factors were often discussed separately, and the mediating effects of mental health on substance use are unknown. To study the mediating effects of anxiety and depression on the relationship between ADHD and drinking/smoking behaviors, we conducted a cross-sectional study of 1870 college students from Shanghai, China. The Adult ADHD Self-Report Scale (ASRS-v1.1) and Wender Utah Rating Scale (WURS) were used to identify the current and past ADHD. Structural Equation Modeling was carried out to clarify the mediating effect of anxiety and depression on the relationship between core ADHD symptoms and smoking/drinking behaviors. We found that inattention as one of the core symptoms of ADHD was associated with an increased risk of depression as a direct effect, as well as slightly increased risk of smoking/drinking behaviors by an indirect effect of depression. Hyperactivity-impulsivity, as another core symptom of ADHD had a robust impact on smoking and drinking behaviors, while being mediated by anxiety and depression. In conclusion, anxiety and depression was associated with further increased risk behaviors of smoking/drinking alcohol among those students with ADHD.

Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults

OBJECTIVES

According to a recent national survey, tobacco use is a critical public health issue in China, with more than two-thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS).

METHODS

Male adults (n = 12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking.

RESULTS

After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex-, or current smokers (p < 0.05).

CONCLUSIONS

Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.

Detrimental effects of acute nicotine on the response-withholding performance of spontaneously hypertensive and Wistar Kyoto rats

RATIONALE

Attention-deficit hyperactivity disorder (ADHD) is associated with a higher prevalence of smoking, which may be related to potential therapeutic effects of nicotine on ADHD symptoms. Whereas nicotine offers robust improvements in sustained attention, the effects of nicotine on impulsivity are unclear.

OBJECTIVES

The present study examined the effects of nicotine on the response inhibition capacity of spontaneously hypertensive rats (SHR), an animal model of ADHD, compared to that of a normotensive control Wistar Kyoto (WKY), using the fixed minimum interval (FMI) schedule of reinforcement.

METHODS

Tests were conducted following acute injections of subcutaneous nicotine (0.1-0.6 mg/kg). On each FMI trial, the first lever press initiated an inter-response time (IRT); a head entry into a food receptacle terminated the IRT. IRTs longer than 6 s were intermittently reinforced with sucrose.

RESULTS

A model that assumes that only a proportion of IRTs are sensitive to the timing contingencies of the FMI provided a close fit to the data, regardless of strain or treatment. No baseline difference in FMI performance was observed between SHR and WKY. Nicotine reduced the duration of timed IRTs and the duration of latencies to the IRT-initiating lever press similarly for both strains. Nicotine dose-dependently increased the proportion of timed IRTs; the dose-response curve was shifted leftwards in SHR relative to WKY.

CONCLUSIONS

These results suggest that nicotine (a) reduces response-inhibition capacity, (b) enhances the reinforcing efficacy of sucrose, and (c) dose-dependently enhances attention-like sensitivity to contingencies of reinforcement, through mechanisms that are yet unknown.

Symptoms of depression and smoking behaviors following treatment with transdermal nicotine patch

Subscales from the Center for Epidemiologic Studies depression scale (CESD), assessed prior to treatment, were examined as predictors of withdrawal, craving, and affect during the first week of abstinence, as well as smoking abstinence during the first week of abstinence and at the end of treatment. The negative affect and somatic features CESD subscales were related to higher levels of nicotine withdrawal. The relationship between the interpersonal disturbance CESD subscale and nicotine withdrawal approached significance. This study suggests the need to examine novel psychological mechanisms that may account for the relationship between depression symptoms and smoking cessation.

A randomised placebo-controlled trial of oral hydrocortisone for treating tobacco withdrawal symptoms

RATIONALE

Many smokers experience a decline in cortisol to sub-normal levels during the first days of smoking cessation. A greater decline in cortisol is associated with more intense cigarette withdrawal symptoms, urge to smoke and relapse to smoking. Findings from an uncontrolled study suggest that glucocorticoids could ameliorate cigarette withdrawal.

OBJECTIVES

We investigated whether taking oral hydrocortisone would reduce withdrawal symptoms and the desire to smoke on the first day of temporary smoking abstinence compared with placebo.

METHODS

Using a double-blind within-subject randomised crossover design, 48 smokers took a single dose of 40 mg hydrocortisone, 20 mg hydrocortisone or placebo following overnight smoking abstinence. Abstinence was maintained through the afternoon, and withdrawal symptoms and the desire to smoke were rated across the morning. Salivary cortisol was assessed in the afternoon prior to abstinence (baseline) and while abstinent after each treatment.

RESULTS

There was a significant dose-response relation between dose of hydrocortisone and reduction in depression and anxiety ratings while abstinent, but there were no other statistically significant associations with dose. Overall, the decline in cortisol following smoking cessation (placebo only) was not significant. Cortisol level on the afternoon of smoking abstinence was not significantly associated with symptom ratings.

CONCLUSIONS

Supplements of hydrocortisone do not reduce the desire to smoke but may ameliorate withdrawal-related depression and anxiety, although the clinical benefit is slight.

Tabakrauchen und Alkoholkonsum bei Patienten mit Kehlkopfteilresektion fünf Jahre nach der Diagnose Kehlkopfkrebs

Zusammenfassung. Tabak- und Alkoholkonsum sind Hauptrisikofaktoren für die Entstehung von Kehlkopfkrebs. Post-operativ fortgesetztes Risikoverhalten kann negative gesundheitliche Auswirkungen haben. Ziel der Arbeit waren die Beschreibung des Alkohol- und Tabakkonsums von Patienten nach krebsbedingter Kehlkopfteilresektion und die Identifizierung von Bedingungen, die die Wahrscheinlichkeit gesundheitlichen Risikoverhaltens beeinflussen. Es wurden 151 Kehlkopfkrebspatienten nach Larynxteilresektion befragt. Untersucht wurden postoperativer Alkohol- und Tabakkonsum sowie soziodemografische, medizinische und psychosoziale Parameter: Depressivität, Ängstlichkeit, erlebte soziale Unterstützung, Progredienzangst, Geschlecht, soziale Schicht, Alter und Tumorstadium. Binär logistische Regressionsanalysen wurden zur Schätzung gesundheitlichen Risikoverhaltens eingesetzt. Zum Zeitpunkt der Befragung waren 22% Raucher. Personen, die kaum soziale Unterstützung erhielten, hatten im Vergleich zu Personen mit guter Unterstützung eine höhere Chance (OR = 8,67) weiterhin zu rauchen. Der Alkoholkonsum war bei 28% der Männer gesundheitsschädigend hoch. Nur zwei der Befragten brachten ihren Alkoholkonsum mit der Krankheitsentstehung in Zusammenhang und 44% mit dem Rauchen. Anders als beim Rauchen bedingte hohe soziale Unterstützung postoperativen Alkoholkonsum (OR = 11,20). Gesundheitliches Risikoverhalten wird nicht selten nach einer Erkrankung an Kehlkopfkrebs aufrechterhalten. Während den Betroffenen die Schädlichkeit des Rauchens weitgehend bekannt erscheint, ist sie hinsichtlich des Alkohols deutlich weniger bewusst. Dies könnte sich auch in dem Umstand widerspiegeln, dass gute soziale Unterstützungssysteme einerseits den Alkoholkonsum stimulieren und andererseits den Tabakkonsum verhindern helfen. Ein Bedarf an professioneller Aufklärung und Unterstützung scheint in Anbetracht der Studienergebnisse angezeigt.

Nicotine withdrawal and reward responsivity in a card-sorting task

RATIONALE

Animal studies have demonstrated decreased reward responsivity during nicotine withdrawal (e.g., Epping-Jordan et al., Nature 393:76-79, 1998) and the Card Arranging Reward Responsivity Objective Test (CARROT) has recently been used to study the effect of nicotine withdrawal on reward responsivity in humans (e.g., Al-Adawi and Powell, Addiction 92:1773-1782, 1997; Powell et al., Biol Psychiatry 51:151-163, 2002). We investigated a suggestion that nicotine withdrawal may have additional reward-related effects apart from the reward responsivity effects already observed.

OBJECTIVE

The objective of this study was to determine whether or not nicotine withdrawal results in slower improvements in performance on a card-sorting task over a series of trials.

METHOD

We carried out two experiments using a modified version of the CARROT, the mCARROT, to compare the performance of human participants in nicotine withdrawal with those who were satiated.

RESULTS

Although withdrawal produced no direct effect on the mCARROT measure of reward responsivity, the overall sorting rate was lower, and the increase in sorting rate across successive trials was slower during nicotine withdrawal than during satiation.

CONCLUSIONS

These data indicate that nicotine withdrawal impacted on task performance independently of the introduction of a performance contingent reward, suggesting a novel reward-related effect of nicotine withdrawal.

An fMRI investigation of the impact of withdrawal on regional brain activity during nicotine anticipation

Previous research indicates that drug motivational systems are instantiated in structures that process information related to incentive, motivational drive, memorial, motor/habit, craving, and cognitive control processing. The present research tests the hypothesis that activity in such systems will be powerfully affected by the combination of drug anticipation and drug withdrawal. Event-related fMRI was used to examine activation in response to a preinfusion warning cue in two experimental sessions that manipulated withdrawal status. Significant cue-induced effects were seen in the caudate, ventral anterior nucleus of the thalamus, the insula, subcallosal gyrus, nucleus accumbens, and anterior cingulate. These results suggest that withdrawal and nicotine anticipation produce (1) different motor preparatory and inhibitory response processing and (2) different craving related processing.

Posttraumatic stress disorder and smoking relapse: A theoretical model

Posttraumatic stress disorder (PTSD) is associated with a high prevalence of cigarette smoking, heavy cigarette consumption, and low cessation rates. To date, little is known about mechanisms impeding smoking cessation among this recalcitrant group of smokers. An important first step in improving smoking cessation treatment efficacy is the assessment of knowledge about mechanisms pertinent to relapse. This theoretical study addresses the gap in the literature regarding factors potentially influencing smoking relapse among individuals with PTSD. Mechanisms reviewed that may be particularly relevant to smoking relapse among PTSD smokers include negative affect, positive affect, attention, anxiety sensitivity, distress tolerance, and self-efficacy. Treatment implications as well as methodological advances that may be relevant to examining the proposed relapse model are discussed.

Acute psychomotor, subjective and physiological responses to smoking in depressed outpatient smokers and matched controls

RATIONALE

Cigarette smoking is highly prevalent in people diagnosed with depression, and depressed smokers are less likely to quit. Examining depressed smokers' responses to smoking will help determine the role of depression in maintaining cigarette smoking.

OBJECTIVES

To determine the psychomotor, subjective and physiological effects of cigarette smoking in currently depressed smokers versus matched controls.

MATERIALS AND METHODS

Fourteen currently depressed smokers and 14 never-depressed smokers, matched in age, gender, nicotine dependence and daily cigarette consumption, smoked three cigarettes at half-hourly intervals. All smokers were non-deprived. Self-reported mood and craving for cigarettes, performance on a simple reaction time task, expired-air carbon monoxide, heart rate and blood pressure were assessed before and after smoking each cigarette. Smoking topography was also assessed.

RESULTS

Depressives and controls did not differ in terms of dependence on cigarettes or expired-air carbon monoxide. Topographic and cardiovascular measures were similar in depressed and control participants, suggesting that they smoke cigarettes in a similar manner. However, depressives displayed enhanced reaction time performance after the first cigarette. Positively reinforced craving was reduced after smoking each cigarette but returned to baseline levels within 30 min in depressed but not in control smokers. Depressed smokers also displayed higher levels of negatively reinforced craving. Both depressives and controls reported improved positive mood after smoking.

CONCLUSIONS

Cigarette smoking in non-deprived depressed smokers enhances psychomotor performance and the reduction of positively reinforced craving in depressed smokers after smoking is transient, suggesting that enhanced craving may play a role in the maintenance of smoking in depression.

The early time course of smoking withdrawal effects

RATIONALE

There has been little study of the very early time course of the smoking withdrawal syndrome, despite its relevance to the maintenance of both smoking and postcessation abstinence. The literature contains a range of estimates about the early appearance of withdrawal symptoms, but without reference to empirical data.

OBJECTIVES

The study aim was to conduct a comprehensive, multimodal assessment of the early time course of the symptoms associated with smoking withdrawal among cigarette smokers.

METHODS

Participants were 50 smokers randomly assigned to either abstain or smoke at their own pace during 4 h in the laboratory. Dependent measures included resting heart rate, sustained attention (Rapid Visual Information Processing task; RVIP), selective attention to smoking stimuli (an emotional Stroop task), and self-report (Wisconsin Smoking Withdrawal Scale; WSWS). After baseline assessment, participants were assigned to the two conditions and the dependent measures were collected every 30 min.

RESULTS

Generalized estimating equations revealed that abstaining participants displayed greater withdrawal than smoking participants on all measures with the exception of the Stroop task. Statistically significant differences in withdrawal were found within 60 min on heart rate, within 30 min on the RVIP, and between 30 and 180 min postcessation on the various subscales of the WSWS.

CONCLUSIONS

These findings provide the first evidence of the early time course of smoking withdrawal symptoms, although further research is needed to distinguish withdrawal from drug offset effects. Implications for understanding the maintenance of daily smoking and for the treatment of tobacco dependence are discussed.

Reduction in cortisol after smoking cessation among users of nicotine patches

OBJECTIVE

Cortisol has been shown to decline after stopping smoking and this decline has been associated with smoking relapse and with reports of increased withdrawal severity and distress. We examined whether a decrease in cortisol is evident in smokers trying to quit using nicotine patches and whether cortisol is related to withdrawal symptoms, smoking urges, subjective stress, nicotine dependence, and smoking relapse.

METHODS

Among 112 smokers trying to quit using 15-mg patches, salivary cortisol and reports of stress, withdrawal, and urges were measured before quitting smoking and up to 6 weeks of abstinence among abstinent smokers using 15-mg nicotine patches. Thirty participants both remained abstinent and provided cortisol samples at all measurement times.

RESULTS

Relative to preabstinence, there was a significant decline in cortisol after abstinence of 1 day, and after 1, 2, and 6 weeks (p < .05). The decline in cortisol on the first day of abstinence was positively associated with reported cigarette consumption (p < .01) and tended (nonsignificant) to be associated with smoking relapse at 6 weeks (p = .07). A lower absolute level of cortisol, but not the change in cortisol, on the first day of abstinence was significantly associated with increased reports of urges, withdrawal symptoms, and stress (p < .05), independently of reported cigarette consumption.

CONCLUSIONS

Smokers using 15-mg nicotine patches are likely to experience a decline in cortisol on stopping smoking. This decline is likely to be greater among heavier smokers and may predict relapse to smoking. Those with lower cortisol after cessation may experience increased withdrawal symptoms, urges to smoke, and subjective stress.

Smoking and panic attacks, panic disorder, and agoraphobia: a review of the empirical literature

The empirical literature regarding panic-spectrum problems (i.e., panic attacks, panic disorder, and agoraphobia) and cigarette smoking is reviewed. In the first section of the paper, empirical studies that document the prevalence of smoking and panic-related problems are presented and discussed. In the second section of the paper, studies pertaining to the role cigarette smoking may play in the onset and maintenance of panic-related problems are critically reviewed. In the third section of the paper, studies related to the association between panic vulnerability factors and the nature of smoking behavior are presented. In the fourth section of the paper, specific areas not otherwise covered in the review are presented to stimulate further development in these areas (e.g., specialized treatment development).

Smoking, cortisol and nicotine

Cigarette smoking is associated acutely with elevated cortisol levels. However, the results of comparisons of cortisol levels in smokers and non-smokers have been inconsistent, and the significance of cortisol responses in smoking cessation is unclear. Here we describe one study comparing the cortisol profiles of smokers and nonsmokers over the day, and a second investigation in which cortisol was monitored during smoking cessation. In the first study, we collected saliva samples from 196 middle-aged men and women on working and weekend days repeatedly through the day. On both working and weekend days, cortisol levels were significantly higher in smokers after adjustment for age, gender and grade of employment. Cortisol responses to waking (the increase between waking and 30 min) were also greater in smokers. The elevation in cortisol among smokers is generally attributed to nicotine exposure. Nicotine replacement therapy substantially improves abstinence rates, and has become a standard component of smoking cessation treatments, but the effects of nicotine replacement on cortisol are not known. In the second study, cortisol was monitored over 6 weeks of abstinence in 112 smokers treated with behavioural support and 15 mg nicotine patches. Smoking cessation was accompanied by an abrupt decrease in salivary cortisol, and this was sustained over the abstinence period. There was a marginal association between the decrease in cortisol and smoking relapse rates. These results suggest that the nicotine supplied through patches was not sufficient to block the cortisol reduction following smoking cessation. The contribution of these findings to understanding the role of neuroendocrine function in smoking is described.

Acute nicotine withdrawal symptoms and anxious responding to bodily sensations: A test of incremental predictive validity among young adult regular smokers

Although previous work has found associations between panic and smoking, little research has investigated potential mechanisms by which smoking may contribute to panic problems. The present investigation evaluated the incremental validity of acute nicotine withdrawal symptoms (elicited by an average of 2h of nicotine deprivation) relative to negative affectivity, anxiety sensitivity, and nicotine dependence in predicting anxiety responding to 3-min voluntary hyperventilation. The sample consisted of 90 regular smokers (46 females), as defined by smoking >or= 10 cigarettes per day for at least 1 year, recruited through the general community. Consistent with prediction, greater levels of pre-challenge nicotine withdrawal symptoms uniquely predicted post-challenge intensity of panic symptoms and anxiety relative to other established factors. Findings are discussed in the context of how regular smoking may promote panic symptomotology.

Validation of retrospective reports of early experiences with smoking

Initial sensitivity to the pharmacological effects of a drug may affect patterns of future use and dependence for a wide variety of drugs. Retrospective reports of sensations experienced upon early experimentation, however, may be limited by recall bias based on time elapsed and subsequent experiences. To validate reports of early experiences with nicotine, we studied 34 smokers who had contributed retrospective data on early experiences with smoking. Half had reported experiencing a buzz from smoking their first cigarette (the "yes" group), the other half had not (the "no" group). To simulate initial sensitivity to nicotine, we asked participants to remain abstinent from smoking for 5 days to allow for the dissipation of tolerance. They then participated in a laboratory session in which they were reexposed to nicotine in an unfamiliar form (nicotine nasal spray) and asked to indicate pleasurable responses by depressing a foot pedal if and when they experienced a "pleasurable buzz." Smokers in the "yes" group were marginally more likely to be male. The two groups did not differ significantly on age or race. The "yes" group smoked significantly more cigarettes/day than the "no" group. When the two groups were compared for response to nasal spray following 5 days' abstinence, smokers in the "yes" group were marginally more likely to have signaled experiencing at least one pleasurable buzz and rated "pleasurable sensation from spray" on a 100-mm visual analogue scale administered 10 min after nicotine dosing significantly higher than were those in the "no" group. To the extent that several days' abstinence can serve as a model for initial sensitivity to nicotine, our findings validate retrospective reports of pleasurable sensations upon early smoking experimentation.

An experimental examination of the initial weeks of abstinence in cigarette smokers

Gaining experimental control over abstinence may help define processes that change during abstinence that may be related to the association between initial abstinence and relapse risk often noted in clinical trials. Adult smokers (n = 34) were randomly assigned to receive monetary incentives contingent on abstinence (CO +/- 4 ppm) or noncontingent for 12 days. Carbon monoxide (CO) tests were conducted 3 times per day, saliva samples were collected on Days 5 and 12, and all other measures were collected 1 time per day. In the contingent group, 59% of participants abstained throughout the study versus 0% in the control condition. Abstinence was associated with increases in participant-rated ease of abstaining and confidence in abstinence; nicotine withdrawal severity and craving decreased over time. Results indicate that it is feasible to experimentally manipulate smoking abstinence and that doing so can enhance understanding of the relationship between early abstinence and relapse risk.

Nonclinical panic attack history and smoking cessation: an initial examination

The present study evaluated the association of nonclinical panic attacks among regular smokers with the duration of past quit attempts as well as the type and intensity of DSM-IV smoking withdrawal symptoms. As hypothesized, smokers with a history of panic attacks reported significantly shorter quit attempts compared to their nonpanic counterparts. Additionally, smokers with a history of panic relative to their nonpanic counterparts reported more intense affective reactions during their last quit attempt in regard to anxiety-related but not other types of smoking withdrawal symptomatology. These findings are discussed in regard to the role of negative affect vulnerability factors in smoking cessation with specific reference to panic attacks.