Determinants of tobacco use and renaming the FTND to the Fagerstrom Test for Cigarette Dependence

The effects of switching to the standardized research electronic cigarette in people with HIV who smoke in the United States

OBJECTIVE

People with HIV (PWH) who smoke and report ambivalence about quitting may benefit from switching to non-combusted nicotine products. This pilot study examined the effects of providing the NIDA standardized research electronic cigarette (SREC) on smoking behaviors and inflammatory biomarkers in PWH.

METHODS

Thirty-five participants in the United States were enrolled from April 2022 to January 2024 (Mean age 54.4 [13.2] years, 30.1 % female, 62.9 % White) and randomized to SREC provision (n = 17) or usual brand control (n = 18). SREC participants were asked to substitute tobacco-flavor pod-type SRECs for their combustible cigarettes. SREC use and cigarette use were assessed weekly for 6 weeks. Serum inflammatory biomarkers were measured at baseline and week 6.

RESULTS

The effect of condition on cigarettes per day (CPD) during the 6-week period was significant, B = -5.68, 95 % CI = -10.25, -1.11: CPD were reduced by 42.7 % in the SREC condition versus 17.3 % in the control condition. Participants in the SREC condition reported significantly lower urge to smoke at week 6 compared to those in control, (B = -17.05, 95 % CI = -27.15, -6.95). One (5.9 %) participant reported that they transitioned completely from CCs to SREC at week 6. Significant decreases in inflammatory biomarkers were not observed.

CONCLUSIONS

Participants who were provided the SREC, compared to those in the control condition, smoked fewer CPD and had reduced urge to smoke. However, dual use was the most common outcome, indicating that additional support may be needed to improve the likelihood of complete transition from CCs to noncombustible products.

Reducing tobacco and nicotine use among women in treatment for substance use disorder: evaluation of the knit to quit program

INTRODUCTION

Tobacco and nicotine use are prevalent in residential substance use disorder (SUD) treatment programs that serve pregnant and parenting women. This study evaluated a group intervention that integrates knitting instruction, psychoeducation, and social support to improve readiness to quit and reduce tobacco and nicotine use among this population.

METHODS

Clients and staff in four residential SUD treatment programs were assigned to a six-week group intervention or a wait-list control group. Intervention implementation and preliminary effectiveness were assessed using surveys, interviews, and observational measures.

RESULTS

From pre- to post-test, knowledge related to tobacco and nicotine use increased and number of cigarettes smoked per day and nicotine dependence decreased, on average. Additionally, the intervention group reported lower levels of nicotine dependence relative to the control group. Participants described knitting as an enjoyable replacement for smoking and a strategy to regulate stress and emotions.

CONCLUSIONS

Smoking cessation interventions that include knitting are promising and warrant further testing.

Disposable e-cigarettes and their nicotine delivery, usage pattern, and subjective effects in occasionally smoking adults

New disposable e-cigarettes are popular, especially among young people. This study aimed to assess their addictive potential by examining puffing behaviors, subjective effects, and conducting laboratory investigations in an experimental setting. Single-center, four-arm, crossover study. Laboratory setting in Munich (LMU-University Hospital), Germany. Eighteen occasionally cigarette-smoking adults aged 19-28. Two disposable e-cigarettes of the same brand (strawberry-kiwi/ tobacco flavored) were tested with a cigarette and a conventional pod e-cigarette as comparators. Usage was ad libitum for 5 min (or the duration of smoking one cigarette) while puffing topography was recorded. Distributed over 30 min blood samples for nicotine plasma concentrations were drawn and hemodynamic parameters and subjective effects assessed. Nicotine delivery of disposable e-cigarettes (Cmax strawberry-kiwi: 7.1 ng/ml, tobacco: 6.9 ng/ml) was similar to the cigarette (8.1 ng/ml) and higher than for the pod e-cigarette (3.1 ng/ml). The nicotine plasma increase in the first minute was the fastest for disposable e-cigarettes. Tmax for the disposable e-cigarettes (strawberry-kiwi: 5 min, tobacco: 6 min) was reached faster than for the cigarette (8 min). Compared to the pod e-cigarette (6 min), tmax was reached faster with the disposable e-cigarette tobacco. Total nicotine uptake was the lowest for the pod e-cigarette. Puffing behavior differed between e-cigarettes and the cigarette and slightly between both disposable e-cigarettes. Satisfaction and motivation to consume the product again were higher for disposables with a slight preference for strawberry-kiwi flavor. New disposable e-cigarettes hold great addictive potential for young people unestablished in smoking. Besides conducting further research, it is crucial to observe usage trends and strengthen regulations.Trial registration number: DRKS00030978. Date of registration: 21.02.2023.

Smoking cessation support preferences among people released from smoke-free prisons in Queensland, Australia

PURPOSE

This study aims to investigate previous use, awareness and preferences for various forms of cessation support among a sample of people recently released from smoke-free prisons in Queensland, Australia.

DESIGN/METHODOLOGY/APPROACH

A total of 114 people who were released from prison in the previous two months and reported daily tobacco use upon prison entry were recruited from 12 Probation and Parole offices across South-East Queensland to complete a survey measuring use, awareness and preferences for various forms of smoking cessation support before, during and after incarceration. Data were analysed with descriptive statistics.

FINDINGS

In total, 32% of participants had used nicotine replacement therapy (NRT) or cessation medications prior to prison, and 26% reported NRT use while in prison. Only 3% of participants accessed free Quitline telephone counselling while in prison. The development of a peer smoking cessation support group was the most favoured form of smoking cessation support both within prison (42%) and after release (52%). Despite high awareness of the availability of subsidised products upon release (76%), unsupported abstinence ("cold turkey") was slightly preferred as a helpful post-release cessation method (28%), compared to NRT products (24%).

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first study to investigate preferences for smoking cessation support among people released from smoke-free prisons. Findings suggest that implementing prison- and community-based peer support cessation programs and facilitating widespread provision of NRT in prison and post-release should be a priority to reduce high levels of smoking-related morbidity and mortality among this population.

Acute Effects of Nicotine on Non-Drug-Related Reward in Smokers and Non-Smokers

INTRODUCTION

Nicotine increases the reward value of non-drug-related stimuli in animals and dependent smokers; however, research on people who are not dependent on nicotine is limited. This study aimed to explore whether nicotine delivered by oral spray can enhance responding to self-selected sensory rewards in both smokers and non-smokers.

AIMS AND METHODS

Minimally abstinent smokers (n = 30) and non-smokers (n = 31) completed subjective ratings of nicotine withdrawal, and received either 2 mg nicotine or placebo oral spray and visual analogue scales to measure the perceived effects of the spray. An operant conditioning task (Applepicker) that required button clicks to find apples was completed twice, with and without a reward of 30 seconds of pre-prepared music for each reinforcer earned. Measures taken were the number of apples found (reinforcers), number of clicks (responses), and time spent on the task (in seconds).

RESULTS

There were no differences between smokers and non-smokers on ratings of nicotine withdrawal or effects of the spray. All participants spent longer searching for apples, earned more reinforcers, and produced more responses when listening to music. Nicotine administration led to a higher number of reinforcers earned and, when music was playing, an increase in a number of responses. A three-way interaction revealed that non-smokers who had received nicotine spent the longest searching for apples.

CONCLUSIONS

Nicotinic enhancement of sensory rewards was seen in non-smokers only which cannot be accounted for by learned associations with nicotine or reversal of withdrawal effects. Smokers, however, may require higher doses of nicotine to achieve the same effect.

IMPLICATIONS

Nicotinic enhancement of sensory rewards was demonstrated in non-smokers, but not in everyday smokers, suggesting it is unlikely to be related to nicotine dependence or learned associations between nicotine and pleasure. The absence of this effect in smokers suggests that higher levels of nicotine than those obtained from 2 mg oral sprays may be required to achieve enhancement of reward in people who regularly consume nicotine. For nicotine replacement (including e-cigarettes) to become more effective at reducing anhedonia during quit attempts, smokers may require nicotine doses that more closely replicate levels achieved through smoking.

Can We Predict Who Will Experience Adverse Events While Using Smoking Cessation Pharmacotherapy? A Secondary Analysis of the EAGLES Clinical Trial

INTRODUCTION

Concerns about potential side effects remain a barrier to uptake of Food and Drug Administration-approved smoking cessation pharmacotherapy (ie, varenicline, bupropion, nicotine replacement therapy [NRT]). However, use of pharmacotherapy can double the odds of successful quitting. Knowledge of an individual's likelihood of side effects while taking smoking cessation pharmacotherapy could influence treatment planning discussions and monitoring.

METHODS

We conducted a secondary, post hoc analysis to predict an individual's likelihood of adverse events (AEs) using the Evaluating Adverse Events in a Global Smoking Cessation Study data from 4209 adults in the United States who smoked. Participants were randomized to receive 12 weeks of treatment with varenicline, bupropion, NRT patch, or placebo. Our models predicted the likelihood of moderate to severe psychiatric and nonpsychiatric AEs during treatment.

RESULTS

Using pretreatment demographic and clinical data, multivariable logistic regression models yielded acceptable areas under the receiver operating characteristic curve for an individual's likelihood of moderate to severe (1) psychiatric AEs for bupropion and NRT and (2) nonpsychiatric AEs for varenicline and bupropion. Once we adjusted for demographic and baseline characteristics, medication was not associated with psychiatric AEs. Varenicline differed from placebo with regards to nonpsychiatric AEs.

CONCLUSIONS

It is possible to predict person-specific likelihood of moderate to severe psychiatric and nonpsychiatric AEs during smoking cessation treatment, though the probability of psychiatric AEs did not differ by medication. Future work should consider factors related to implementation in clinical settings, including determining whether lower burden assessment protocols can be equally accurate for AE prediction.

IMPLICATIONS

Using data from a large dataset people who smoke in the United States, it is possible to predict an individual's likelihood of psychiatric and nonpsychiatric AEs during smoking cessation treatment prior to initiating treatment. These predictive models provide a starting point for future work addressing how best to modify and integrate such clinical decision support algorithms into treatment for smoking cessation.

Double Jeopardy: Does Intersectional Discrimination Moderate the Relationship Between Acculturation and Cigarette Dependence Among Latinx Sexual Minority Men Current Smokers?

INTRODUCTION

The Double Jeopardy Hypothesis posits that sexual minority people of color may have a greater risk of substance use because of dealing with heterosexism and racism. We sought to test this hypothesis by examining whether appraisal of intersectional forms of discrimination predict greater cigarette dependence and whether acculturation attenuates that relationship among Latinx sexual minority men (SMM) who smoke.

METHODS

Participants were 258 Latinx SMM who identified as current smokers recruited via Amazon Mechanical Turk (MTurk). OLS regressions tested (1) the relationship between appraisal of intersectional forms of discrimination (total and subscales) and Hispanic/non-Hispanic acculturation on cigarette dependence, and (2) the moderating effects of appraisal of intersectional discrimination (total and subscales) on the relationship between Hispanic/non-Hispanic acculturation and cigarette dependence.

RESULTS

In line with our hypotheses, non-Hispanic acculturation was associated with lower cigarette dependence. Appraisal of intersectional discrimination and subscales moderated the relationship between non-Hispanic acculturation and cigarette dependence. Simple slopes tests showed that the effects of non-Hispanic acculturation on cigarette dependence were strongest for those who experience lower intersectional discrimination.

CONCLUSION

Our findings suggest that Latinx SMM may have resilience that helps them deal with the negative effects of discrimination on cigarette dependence, especially for those who are more acculturated to the U.S. These findings may point to Latinx SMM taking on U.S. negative views towards smoking. However, future studies should use a more nuanced assessment of acculturation that does not rely on a language-based acculturation measure.

Brief computer MI to motivate sustained tobacco cessation following psychiatric hospital discharge: Study protocol for a randomized controlled trial

BACKGROUND

Individuals with serious mental illness (SMI) smoke at disproportionately higher rates than those without SMI. We demonstrated, in a randomized controlled trial (RCT) of 342 adult smokers receiving inpatient psychiatric care, that an in-person, motivational interviewing (MI)-based, Sustained Care (SusC) intervention vs. Usual Care (UC) resulted in significantly higher rates of confirmed smoking abstinence at 6-months post-hospital discharge and significantly increased smoking cessation treatment utilization. While successful, this SusC intervention would be challenging to implement broadly in psychiatric hospitals. The current efficacy trial will develop and test an MI-based Sustained Care intervention delivered as a mobile app for iPad and will determine whether this approach can produce higher cessation rates compared to usual care for smokers admitted to a psychiatric inpatient unit.

METHODS

A total of 250 eligible patients hospitalized for psychiatric illness will be randomized to: Tablet-delivered Sustained Care (T-SusC) or Usual Care (UC), and will be followed for six months after discharge. Participants assigned to UC will receive brief, in-hospital tobacco education. Those assigned to T-SusC will receive the brief tobacco education, plus a 40-min, in-hospital MI intervention delivered via a mobile application (app) for iPad use. They will also receive up to 8 weeks of free nicotine patches and a referral to the Texas Tobacco Quitline. Smoking cessation outcomes will be measured at 1-, 3- and 6-months post hospital discharge.

CONCLUSION

Results from this efficacy trial may add to our understanding of acceptable and effective smoking cessation approaches for patients hospitalized with SMI.

Refer2Quit: A pilot referral approach to promote treatment for parents who smoke tobacco through pediatric primary care

Objective

Evidence-based tobacco treatments are rarely provided to household members who smoke but do not attend a child's pediatric visit. This pilot study evaluated an electronic health record (EHR)-linked intervention leveraging pediatric visits to identify and engage household members who smoke tobacco in treatment remotely.

Methods

We conducted a single-arm prospective study with household members who smoke at a high-volume pediatric primary care practice. During preventive visits, the EHR system screened parents for tobacco use, automated treatment connections, and prompted referrals for household members who smoke. Referred household members were contacted, consented, and offered nicotine replacement therapy (NRT), quitline counseling, and/or SmokefreeTXT. Outcomes included feasibility (referral rate), effectiveness (treatment acceptance), and acceptability (satisfaction). A 1-month follow-up survey assessed treatment use and smoking cessation (7-day abstinence from combustible tobacco).

Results

Between April 2022 and August 2024, 3478 pediatric patients had additional household members who smoke. Of 352 (10.1 %) referred individuals, 350 were contacted; 91 (25.9 %) accepted treatment. Among these, 82 (90 %) chose NRT, 58 (64 %) chose quitline, and 64 (70 %) chose SmokefreeTXT. All participants found the referral approach acceptable. At follow-up, 54 (59 %) completed the survey; 42 (46 %) reported treatment use, and 12 (13 %) reported smoking cessation.

Conclusions

This EHR-linked intervention effectively identifies and engages household members who use tobacco in treatment, demonstrating feasibility, acceptability, and promising outcomes. These findings warrant more rigorous evaluation.

Alcohol use in Early Midlife: Findings from the Age 37 Follow-Up Assessment of the FinnTwin12 Cohort

This paper provides an overview of the most recent assessment, collected in early midlife, of the FinnTwin12 cohort, a population-based study of Finnish twins born in 1983-1987. The twins were invited to complete an online survey assessing a range of variables, including physical and mental health, alcohol use and problems, other substance use, and early midlife environments (e.g., parenthood). In total, 2,085 individuals (~ 40% of the original sample) completed the survey (551 complete twin pairs, 58.7% female, 37.3% monozygotic, Mage = 37.2 years, SD = 1.47 years, age range = 34-39 years). Individuals who participated were more likely to be female, monozygotic, and have higher parental education and less hyperactivity/impulsivity and aggression at age 12 when compared to individuals who were invited but did not participate. Parental alcohol misuse and the twins' alcohol use and misuse at age 14 were not related to study retention. Alcohol misuse in early midlife was positively associated with nicotine dependence, lifetime use of cannabis and other drugs, trauma exposure, and depressive symptoms, and negatively associated with physical health and having biological children. These new data expand upon the wealth of measures collected as part of previous assessments, expanding the scope of work on the etiology and correlates of alcohol misuse within a longitudinal, genetically-informed framework. In addition to these new survey measures, we are planning an in-person assessment to collect physiological measurements and conduct additional in-depth phenotyping on a subset of twins who have been more intensively studied over the years.

Effects of very low nicotine cigarettes, e-cigarettes, and nicotine patches on daily own-cigarette abstinence in a randomized controlled switching trial

INTRODUCTION

This research investigated the extent to which three nicotine products promote day-level cigarette substitution during a 1-week switch attempt METHODS: Adults who smoked daily but were not motivated to quit were randomized to 4 weeks using: 1) very low nicotine cigarettes (VLNCs), 2) e-cigarettes, or 3) no product. During two separate switch weeks, participants were instructed to abstain from their own cigarettes and switch to using their study product (if assigned one). Participants were also assigned to use active nicotine patches during one switch week and placebo patches during the other. Nightly smartphone surveys assessed use of participants' own-brand cigarettes. Average marginal effects from a logistic regression model characterized effects of trial design variables on day-level own-cigarette abstinence.

RESULTS

Participants (N = 196) recorded 4998 evening reports. Switch weeks were associated with an average marginal increase in abstinence rate by 27.9 percentage points (p < .001). The switch week effect was significantly larger in the VLNC (35.9 percentage points), and e-cigarette (31.2) groups compared to the no product group (16.4; ps < .05). Use of active patches during the first switch week increased abstinence by 6.9 percentage points on average (p = .010), but use of active patches during the second switch week decreased abstinence probability by 9.6 percentage points (p = .032, difference p = .010) CONCLUSIONS: VLNCs and e-cigarettes meaningfully and equivalently increase the probability of day-level abstinence from one's own cigarettes. Transdermal nicotine promotes cigarette substitution, but only when provided early in the switching process.

Chatting your way to quitting: A longitudinal exploration of smokers' interaction with a cessation chatbot

Background

Cigarette smoking poses a major public health risk, requiring scalable and accessible interventions. Chatbots offer a promising solution, given their potential in providing personalized, long-term interactions. Despite their promise, limited research has examined their efficacy and the intertwined relationship between user experience and effectiveness over an extended period of time.

Methods

In this prospective, single-arm study, we developed and evaluated Roby, a 5-session chatbot intervention incorporating motivational interviewing and cognitive behavioral therapy to help smokers quit. Roby engaged Dutch adult smokers (N = 102) in conversations covering topics such as setting a quit date, managing withdrawal and cravings, and relapse prevention. The primary outcome was the continuous abstinence rate at the end of the intervention, and secondary outcomes included 7-day point prevalence abstinence, self-efficacy, and cravings. User engagement, therapeutic alliance, and interaction satisfaction were measured weekly, and the trajectory was analyzed using Linear Mixed Models.

Results

Following an intention-to-treat principle, 18.6 % of participants achieved continuous abstinence, and 37.3 % achieved 7-day point prevalence abstinence. Self-efficacy significantly improved over the intervention, and cravings decreased over time. A slight decreasing trend was observed in engagement and satisfaction, likely due to a novelty effect. However, the decrease did not affect the intervention's outcomes.

Conclusion

This study demonstrates the feasibility and initial usefulness of Roby, highlighting the potential for chatbots in long-term cessation support. Future research should further validate these findings with randomized controlled trials. Additional efforts should focus on monitoring and maintaining user experience in the long term to enhance effectiveness.

Incorporating technology in smoking cessation interventions: In-person vs. Video-call formats

INTRODUCTION

The use of video calls to provide health-related interventions has grown significantly, showing positive results in a broad range of psychological interventions. Scarce research has examined video-call use in smoking cessation treatments. The purpose of this study was to compare two randomised controlled trials conducting a cognitive-behavioral intervention to quit smoking in-person versus using video calls.

MATERIAL AND METHODS

This study is a secondary analysis of two randomised controlled trial studies (RCTs) conducted using two delivery formats: in-person vs. video calls. The sample comprised 498 adults seeking smoking cessation treatment. We analysed smoking cessation, cigarette reduction, and treatment satisfaction outcomes according to delivery format.

RESULTS

No significant differences were found in sex, age, and baseline smoking-related variables. A significantly higher proportion of participants in the video-call format had university studies, were actively working, and had a history of depression compared to the in-person format. No significant differences were found in cessation, smoking reduction, and satisfaction with treatment. Predictive variables of 12-month abstinence were: baseline number of cigarettes smoked per day (OR = 0.93) in the case of the in-person format; and being a woman (OR = 0.53), cigarette dependence (OR = 0.46), and last year quit attempt (OR = 0.52) in the video-call format.

CONCLUSIONS

Both delivery formats showed similar abstinence rates at 12 months and satisfaction with the intervention. Therefore, in-person and video calls could be used to deliver smoking cessation treatments. Given that predictors of long-term abstinence differed across these delivery formats, further research is needed.

TRIALS REGISTRATION

ClinicalTrials.gov IDs: NCT02844595: NCT04765813.

The Efficacy of the SinHumo App Combined With a Psychological Treatment to Quit Smoking: A Randomized Clinical Trial

INTRODUCTION

This study assessed the efficacy of the SinHumo App combined with a cognitive-behavioral smoking cessation treatment on 12-month follow-up abstinence, compared with the same smoking cessation treatment and a control App.

AIMS AND METHODS

A sample of 288 treatment-seeking people who smoke were randomized: SinHumo App plus smoking cessation treatment (n = 140) and control App plus smoking cessation treatment (n = 148). The primary outcome was 7-day point prevalence abstinence (PPA) at the 12-month follow-up. Secondary outcomes were abstinence rates at the end of the intervention and 3- and 6-month follow-ups, cigarette per day (CPD) reduction over the 12-month follow-up, intervention engagement, and satisfaction.

RESULTS

Intention-to-treat analyses showed nonsignificant differences in self-reported 7-day PPA at the 12-month follow-up (37.1 and 42.6%, respectively; OR = 0.80). No significant differences were found in abstinence at the end of the treatment (68.6 vs. 62.8%) nor on 7-day PPA at 3- (35.7 vs. 45.9%) and 6-month (35.0 vs. 41.2%) follow-up. Complete case and multiple imputation analyses yielded similar results for abstinence outcomes. A significant reduction in CPD across the 12-month follow-up in the subsample of participants who smoked was observed, but nonsignificant differences between conditions were found. Higher engagement with the SinHumo App was a significant predictor of 12-month abstinence. Satisfaction with the intervention was high and similar in both groups.

CONCLUSIONS

High abstinence rates over the 12-month follow-up and satisfaction were found in both conditions. The inclusion of the SinHumo App did not improve abstinence rates in the intervention.

IMPLICATIONS

Scarce research has examined the long-term efficacy of smoking cessation treatments, including Apps, to support the quitting process. The present randomized controlled trial contributes to the existing literature about including information and communication technologies in behavior change interventions. The development of effective smoking cessation apps and information and communication technologies-based interventions is crucial for reducing the prevalence of smoking, as these interventions have the potential to reach a large number of people who smoke and reduce access-related barriers to treatment.

Intersensory attention deficits in schizophrenia relate to ongoing sensorimotor beta oscillations

This study tested whether intersensory attention deficits in people with schizophrenia (SZ) relate to aberrant ongoing oscillations in sensory cortices. Electroencephalography (EEG) was recorded while individuals with schizophrenia (N = 27) and healthy controls (HC; N = 27) performed a visual-tactile target detection task. Ongoing alpha (8-12 Hz) and lower beta (13-20 Hz) band oscillations in visual and sensorimotor cortices were examined. Behavioral data suggested an intersensory attention deficit in patients. EEG data revealed stronger alpha-band oscillations for tactile vs. visual attention conditions in the visual cortex of both study groups. In the sensorimotor cortex contralateral to the tactile stimulation site, patients showed an additional intersensory attention effect in ongoing beta-band oscillations, which was negatively related to cognitive and positive symptoms of the PANSS. Our findings extend previous results from unisensory attention research and suggest that deficits in intersensory attention and alterations in sensorimotor beta oscillations are related to schizophrenia symptomatology.

Efficacy and working mechanisms of a Go/No-Go task-based inhibition training in smoking: A randomized-controlled trial

OBJECTIVE

Deficits in inhibitory control contribute to smoking behavior. Inhibitory control training (ICT), which involves repeatedly inhibiting responses to general or substance-related stimuli, shows promise in reducing problematic substance use. This preregistered randomized-controlled trial is the first to investigate the efficacy of general and smoking-specific Go/No-Go task-based ICT on smoking behavior compared to control groups receiving no ICT. Three potential working mechanisms were examined: inhibitory enhancement, automatic stimulus-stop associations, and stimulus devaluation.

METHOD

Individuals who smoke (N = 122) were randomly assigned to complete 28 sessions of smoking-specific Go/No-Go, general Go/No-Go, Sham training, or to a Waitlist control condition. Clinical outcomes included daily cigarettes (primary outcome), carbon monoxide levels, tobacco dependence severity, and craving, assessed at post-intervention and 3-month follow-up.

RESULTS

Go/No-Go training resulted in a significantly greater reduction in tobacco dependence (β = -0.88, p = .004) and craving (β = -4.31, p = .012) post-intervention compared to both control groups. The greater reduction in craving remained significant when compared to the Sham training group only (β = -4.64, p = .026). No significant effects of group were observed on daily cigarette consumption (β = -1.97, p = .093) or carbon monoxide levels (β = 2.16, p = .818) post-intervention. At the 3-month follow-up, no significant effects of group emerged (all ps > .794). Smoking-specific Go/No-Go training did not outperform general Go/No-Go training (all ps > .075). No working mechanism for clinical outcome improvements was identified.

CONCLUSIONS

Preliminary evidence suggests that (smoking-specific) GNG training reduces tobacco dependence severity and craving post-intervention in individuals who smoke compared to non-ICT-based control conditions. Its efficacy as an add-on in smoking cessation needs to be investigated.

CLINICAL TRIAL REGISTRATION NUMBER

DRKS00014652.

Effects of Varenicline, Bupropion, Nicotine Patch, and Placebo on Treating Smoking Among Persons With Current or Past Major Depressive Disorder: Secondary Analysis of a Double-Blind, Randomized, Placebo-Controlled Trial

OBJECTIVE

The aim of this study was to compare the safety and efficacy of the leading smoking cessation medications among individuals with current versus past major depressive disorder (MDD).

METHODS

This was a secondary analysis of a randomized, double-blind trial over 12 weeks with varenicline or bupropion, followed by a 12-week assessment, in participants ages 18-75 with past (N=2,174) or current (N=451) MDD or without psychiatric disorders (N=4,028). Interventions included 12 weeks of pharmacotherapy with placebo, nicotine replacement therapy (NRT; nicotine patch), bupropion, or varenicline, and brief counseling. The primary safety outcome was occurrence of one or more moderate to severe neuropsychiatric adverse events. Efficacy was assessed as biochemically verified continuous abstinence during weeks 9-12.

RESULTS

Among all 6,653 participants, the risk of neuropsychiatric adverse events did not differ by medication within the past-MDD, current-MDD, or nonpsychiatric cohorts. The MDD cohorts had higher risk difference (p<0.001) for neuropsychiatric adverse events compared with the nonpsychiatric cohort (past-MDD cohort, risk difference=-0.03, 95% CI=-0.05, -0.02; current-MDD cohort, risk difference=-0.02, 95% CI=-0.05, 0.00). Within the past-MDD cohort, the odds ratios compared with placebo were 3.0 (95% CI=2.0, 4.5) for varenicline, 2.1 (95% CI=1.6, 2.7) for bupropion, and 2.1 (95% CI=1.4, 3.2) for NRT. Within the current-MDD cohort, varenicline differed from placebo (odds ratio=2.67, 95% CI=1.2, 6.15) and NRT (odds ratio=2.93, 95% CI=1.2, 7.2).

CONCLUSIONS

All medications were generally safe in both MDD cohorts. NRT and bupropion were not more effective than placebo for those with current MDD. Varenicline plus counseling may be the best treatment for individuals with past or current MDD, given its greater efficacy, similar risk of adverse events, and, for those with current depression, reductions in anxiety and depression while trying to quit smoking.

Sex differences in dorsal striatal volume and interest in quitting smoking

AIMS

Over the recent decades, smoking among women has become an increasingly pressing public health challenge. Mounting evidence suggests that, compared to men, women's smoking is more strongly influenced by habitual responses to sensorimotor cues. To understand the brain mechanisms underlying the cessation challenges commonly reported by women who smoke, the present study used voxel-based morphometry (VBM) to investigate sex-related volumetric differences in the dorsal striatum, a region implicated in habitual substance use behavior, and their associations with self-reported quit interest among daily smoking adults.

METHODS

Structural magnetic resonance imaging (MRI) data were collected from 41 women and 52 men (30.1 ± 7.5 years) who reported smoking an average of 15-40 cigarettes per day for at least past 24 months. Multiple regression analyses were carried out with sex and average gray matter volumes (GMV) of predetermined brain regions of interest (ROIs; bilateral caudate, putamen) and control regions (bilateral nucleus accumbens, thalamus) as predictors of self-reported interest in quitting smoking.

FINDINGS

Women displayed greater striatal GMV and lower current quit interest than men. ROI-based analyses revealed an interaction between sex and putamen GMV, wherein putamen GMV was more strongly and negatively linked to quit interest in women than men.

CONCLUSIONS

Greater GMV in the putamen could be linked to an attenuated desire to stop smoking among women. This may serve as a neuroanatomical mechanism underlying the higher prevalence of habit-driven smoking behavior observed in women as compared to men.

Pain Interference and Intensity in Relation to Abstinence Outcomes Following a One-Session Personalized Feedback Smoking Cessation Digital-Intervention

Background: Pain is a highly common and costly health problem that is strongly linked to cigarette smoking. Pain interference, the degree to which pain impedes physical, occupational, recreational, and social functioning, may have an important role in terms of smoking cessation. However, no study has examined the role of pain interference as a predictor of relapse following a quit attempt in a smoking cessation trial. Objectives: The current study examined the role of pain interference, above the effects of pain intensity, on relapse following a quit attempt. Participants were 121 treatment-seeking adult cigarette smokers (29% female; Mage = 29.32, SD = 7.52) who attended a randomized-controlled trial (RCT) testing the effect of a digital single-session personalized feedback intervention (PFI) for distress tolerance and cigarette smoking behavior. Multiple logistic regressions were conducted to examine pain intensity and pain interference scores as predictors of 7-day point prevalence abstinence (PPA) at 2 weeks and 4 weeks following the 1-session intervention. Models controlled for sex, baseline cigarette dependence, treatment condition, and baseline distress tolerance. Results: Pain interference was associated with higher odds of reporting relapse at 4-week post intervention (OR: 1.54, 95% CI [1.06, 2.25]).), while pain intensity only showed a non-significant association with higher odds of reporting relapse at 2-week (OR: 1.40, 95% CI [0.67, 2.94]). Conclusions: This prospective study highlights the effect of pain interference on later-stage relapse outcomes following participation in a cigarette smoking cessation program.

E-liquid flavors and nicotine concentration choices over 6 months after a smoking cessation attempt with ENDS: Secondary analyses of a randomized controlled trial

INTRODUCTION

Many tobacco smokers try to quit with electronic nicotine delivery systems (ENDS or e-cigarettes). We aimed to describe e-liquid flavors and nicotine concentration use over 6 months in a prospective cohort of smokers willing to quit with ENDS.

METHODS

We included 622 participants from the intervention group of the Efficacy, Safety and Toxicology of ENDS randomized controlled trial. Participants were adult smokers smoking at least five cigarettes a day. They received free ENDS and a choice of 6 e-liquid flavors in 4 nicotine concentrations and smoking cessation counseling. We tracked flavor choice and nicotine concentration at 1, 2, 4, and 8 weeks, and at 6 months, after the target quit date, comparing participants who reported only vaping (exclusive e-cigarette users) to those who vaped and smoked (dual users) over the last 7 days. We applied multivariable regression models to compute adjusted risk ratios (ARR).

RESULTS

At Week 1, 66% (n=409) were exclusive e-cigarette users, and 21% (n=129) were dual users. At Month 6, 43% (n=266) were exclusive e-cigarette users, and 16% (n=102) were dual users. While flavor choices were similar at Week 1, at 6 months, exclusive e-cigarette users reported using more fruity flavors than dual users (31% vs 22%, ARR=2.10; 95% CI: 1.21-3.66). The nicotine concentration used initially was similar in both groups and diminished over time. At 6 months, exclusive e-cigarette users used a lower mean nicotine concentration than dual users (6.3 vs 8.2 mg/mL, difference= -1.55; 95% CI: -2.84 - -0.25 mg/mL).

CONCLUSIONS

After 6 months, exclusive e-cigarette users used more fruity-flavored e-liquids and chose a lower mean nicotine concentration than dual users.

Smoking as a Marker of Comorbid Vulnerability Among Persons with Probable Posttraumatic Stress Disorder Who Engage in Hazardous Drinking

Background: Persons with posttraumatic stress disorder (PTSD) compared to those without evince high rates of hazardous drinking, or patterns of alcohol consumption that increase the risk for harmful consequences. One potential marker of vulnerability for PTSD-hazardous drinking comorbidity may be smoking behavior. Individuals with PTSD have a higher prevalence of smoking and smoke at higher rates. Smokers, compared to nonsmokers, are more apt to engage in hazardous alcohol use. Notably, there is a need to expand research on smoking in the context of PTSD and hazardous drinking to inform treatment of these morbidities. Objective: The present cross-sectional investigation sought to examine smoking status as a marker of risk among persons with probable PTSD who engage in hazardous drinking (N = 647; Mage = 38.90 years, SD = 10.71; 51.2% female). Results: Results indicated that trauma-exposed smokers, compared to non-smokers, evinced greater severity of PTSD symptoms, depression, emotion regulation difficulties, hazardous drinking, and substance use problems, with small effect sizes. No statistically significant group differences were found for anxiety symptom severity. Secondary analyses among only smokers supported an interrelation between cigarette dependence and each of the criterion variables that demonstrated statistically significant group differences. Specifically, cigarette dependence was statistically significantly and incrementally related to PTSD symptom severity, depression, emotion regulation difficulties, more severe hazardous drinking, and a greater degree of substance use problems. Conclusions: Overall, the current investigation found that smoking status among persons with probable PTSD who engaged in hazardous drinking was associated with numerous indicators of mental health and substance use vulnerability.

Weaning From Tobacco with Nicotine or Varenicline in Severe and Mild Tobacco Dependence—Findings of a Meta-Analysis

BACKGROUND

Systematic reviews have documented the beneficial effects of bupropion, cytisine, nicotine, and varenicline as aids to permanent smoking cessation. We investigated the question whether the effect of treatment depends on the severity of tobacco dependence.

METHODS

We systematically searched for relevant publications in bibliographic databases and trial registries, made inquiries to manufacturers, and consulted additional sources of information (last search on 1 September 2022). The smokers included in the present study were classified as mildly or severely tobacco-dependent on the basis of their scores on the Fagerström Test for Nicotine Dependence, with variable cut-off values (FTND score 4, 5, or 6). In this meta-analysis, we determined the results with respect to the endpoint of sustained smoking cessation at 6 and 12 months in each of the two subgroups and investigated the heterogeneity between them.

RESULTS

No subgroup analyses that could enable us to answer the question posed in this meta-analysis were available for either bupropion or cytisine. Subgroup analyses were available for varenicline in 12 studies, involving a total of 9723 smokers, and for nicotine in 23, involving 15 003 smokers. No statistically significant heterogeneity (p > 0.05) between mildly and severely tobacco-dependent smokers was found for the effect of either drug on the endpoint sustained smoking cessation (at 6 and 12 months), and this was so independently of the FTND cut-off value that was used.

CONCLUSION

The benefit of varenicline and nicotine as aids to smoking cessation is independent of the severity of tobacco dependence.

Boredom and affective temperaments as factors hindering smoking cessation: An exploration within an Italian sample

Background

Smoking cessation presents challenges influenced by neurological adaptations and psychological factors, potentially exacerbated by susceptibility to boredom and affective temperaments.

Methods

This study enrolled 409 participants via an online survey distributed among the Italian population through mailing lists, social networks, and messaging apps. Specific questions assessed cigarette smoking, while the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) and Boredom Proneness Scale (BPS) explored affective temperaments and susceptibility to boredom, respectively.

Results

Results indicated smokers exhibited higher cyclothymic temperament scores compared to no-smokers and ex-smokers, suggesting a connection between this temperament and smoking behavior. Furthermore, the analysis demonstrated variable influences of specific temperaments on boredom proneness.

Conclusions

These findings emphasize the significance of incorporating affective temperaments and boredom proneness into smoking cessation interventions. Understanding the interplay between affective temperaments and boredom proneness can guide the development of innovative and personalized cessation strategies. Further research is warranted to delve deeper into these relationships and their implications for intervention approaches.

Survival Outcomes of an Early Intervention Smoking Cessation Treatment After a Cancer Diagnosis

Importance

Smoking after a cancer diagnosis increases mortality and risk for a second cancer.

Objective

To determine the association between time of entry into a smoking cessation intervention following a cancer diagnosis and survival outcomes.

Design, Setting, and Participants

Using a prospective cohort study design, patients with cancer who smoked and received cessation treatment were assessed at 3 months, 6 months, and 9 months following tobacco treatment onset. Survival outcomes of tobacco treatment were measured and compared among patients at the MD Anderson Cancer Center Tobacco Research and Treatment Program. Treatment occurred between January 1, 2006, and March 3, 2022. Patients were excluded if they died before the tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information. The data analysis took place from September 2023 to May 2024.

Interventions

Cessation treatment consisted of 6 to 8 personalized counseling visits and 10 to 12 weeks of pharmacotherapy. More than 95% of visits were provided via telemedicine.

Main Outcomes and Measures

The primary outcomes were survival as recorded in the MD Anderson Cancer Center tumor registry and 7-day point prevalence abstinence at each follow-up.

Results

The main analytical sample consisted of 4526 currently smoking patients diagnosed with cancer and receiving cessation treatment (2254 [49.8%] female; median [IQR] age, 55 [47-62] years). Survival over 15 years increased for those quitting smoking at 3 months (adjusted hazard ratio [aHR], 0.75 [95% CI, 0.67-0.83]), 6 months (aHR, 0.79 [95% CI, 0.71-0.88]), and 9 months (aHR, 0.85 [95% CI, 0.76-0.95]) of follow-up. The optimal survival outcomes were observed for patients who received tobacco treatment within 6 months of a cancer diagnosis. At the 75th percentile, their survival increased from 2.1 years (95% CI, 1.8-2.4 years) among continuing smokers (nonabstainers) vs 3.9 years (95% CI, 3.2-4.6 years) for patients who quit (abstainers). Similar but less pronounced outcomes were noted when tobacco treatment began within 6 months to 5 years following diagnosis, with survival at the 75th percentile of 4.8 years (95% CI, 4.3-5.3 years) for nonabstainers vs 6.0 years (95% CI, 5.1-7.2 years) for abstainers.

Conclusions and Relevance

The results of this prospective cohort study suggest that evidence-based smoking cessation treatment within 6 months following a cancer diagnosis maximizes survival benefit. This study supports smoking cessation as an important early clinical intervention for patients after being diagnosed with cancer.

Establishment of a Quantitative Method for the Extraction of Nicotine and Cotinine in Gingival Tissue and Relationship Between Gingival Intoxication With Conventional Smoking Biomarkers: A Pilot Study

OBJECTIVES

Smoking is considered a major risk factor for periodontitis genesis and progression. In clinical studies, specific indicators have been used to characterize the smoking status of the patient as the number of cigarettes consumed (NCC), the pack-years (PY), or Fagerström Test for Nicotine Dependence (FTND). However, available literature is missing on the relationship between cotinine gingival intoxication and smoking indicators. First, the development of a quantitative method for the extraction of nicotine and cotinine in gingival tissue. Second, to investigate the relationship between gingival intoxication and conventional smoking biomarkers.

MATERIAL AND METHODS

Fourteen smoker patients were included in the study. After clinical data collection, salivary and gingival samples collection, toxicological analyses were performed using liquid extraction after enzymatic digestion (subtilisin) and ultra-performance liquid chromatography coupled to mass spectrometry (UPLC-MS/MS).

RESULTS

Gingival cotinine quantification was successfully performed in 14 samples (100%) with a mean of 0.280 ng/mg (range = 0.094-0.505). Only FTND was statistically associated with gingival cotinine levels (p = 0.0072; r² = 0.60). Gingival nicotine quantification was achieved in 12 of the 14 gingival samples (86%) with a mean of 0.384 ± 1.00 ng/mg (range = 0.03-3.84). Gingival nicotine was statistically associated with NCC (p = 0.032; r² = 0.55), PY (p = 0.0011; r² = 0.76), and FTND (p = 0.016; r² = 0.60). Salivary nicotine and cotinine levels were statistically associated with, respectively, NCC (p = 0.030; r² = 0.34), and NCC (p = 0.0094; r² = 0.63) + PY (p = 0.0078; r² = 0.64).

CONCLUSIONS

This pilot study established a quantitative extraction method for nicotine and cotinine from human gingival samples. Additionally, FTND was associated with gingival cotinine. However, further large-scale studies are needed to confirm the relationship between nicotine dependence and gingival intoxication.

Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6

OBJECTIVE

The aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample.

METHODS

We used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors.

RESULTS

Among people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16-2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications.

CONCLUSION

Our findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.

Ecological momentary assessment of delay discounting, reward valuation, and craving in very light cigarette users

Heightened delay discounting has been linked to adverse smoking cessation outcomes, including among light cigarette users. Few studies have evaluated delay discounting's proposed mechanism, preference reversal (concurrent increases in valuation of/craving for desired objects), and none have done so in naturalistic settings. We examined how person-level delay discounting moderated the within-person association between cigarette valuation and craving among very light daily cigarette users who were financially incentivized to abstain. Forty participants completed a baseline delay-discounting task and intermittent ratings of cigarette valuation and craving during the incentivized abstinence attempt. Subjects earned monetary rewards for abstinence on a descending schedule (e.g., $20 on Days 1 and 2 and $2.50 on Days 9 and 10). Consistent with preference reversals, there was a positive association between cigarette valuation and craving. This relation was moderated by delay discounting (stronger among those with low discounting rates) and by monetary reinforcement amount (stronger on days with low reinforcement). Additionally, subjects were more likely to report stronger cravings on days with high monetary reinforcement, with this effect moderated by delay discounting (stronger among those with low discounting rates). The results suggest that heightened delay discounting may not confer risk for preference reversal among very light daily cigarette users who are attempting abstinence.

Experience with reduced-nicotine cigarettes and whether this decreases smoking and substitution for full-nicotine cigarettes

Studies suggest that reduced-nicotine cigarettes decrease nicotine intake and dependence. However, questions remain about reduced-nicotine cigarette abuse liability, whether reduced-nicotine cigarette exposure lowers reduced- and full-nicotine cigarette use, and whether reduced-nicotine cigarettes substitute for full-nicotine cigarettes. This randomized, double-blind laboratory study used operant behavioral economics to examine abuse liability of cigarettes with varying nicotine content. Non-treatment-seeking smokers (N = 43) self-administered reduced- (5.2, 2.4, or 1.3 mg/g) and full-nicotine (15.8 mg/g) cigarettes before and after 3 weeks of at-home exposure. Participants were randomized to full-nicotine or one of the reduced-nicotine cigarettes to determine the effect of exposure on abuse liability and substitutability. Abuse liability was assessed in single-commodity sessions, and substitutability was measured in concurrent-commodity sessions. In the self-administration sessions, concurrently available reduced-nicotine cigarettes attenuated full-nicotine cigarette demand and rendered reduced-nicotine cigarettes partial substitutes for full-nicotine cigarettes. Exposure to study cigarettes for 3 weeks marginally reduced demand for reduced- and full-nicotine cigarettes irrespective of nicotine content. Results suggest a limited influence of nicotine content on smoking behavior in established smokers and highlight the role of nonpharmacological factors (e.g., taste/smell) on the maintenance of smoking. These results should be considered in determining whether a nicotine-reduction standard is a feasible path for reducing cigarette demand.

Comparing the Fagerström Test and Heaviness of Smoking Index in Predicting Smoking Abstinence in Cancer Patients

INTRODUCTION

People with cancer who smoke exhibit greater cigarette dependence than people without cancer who smoke, a crucial factor in smoking cessation. Research is limited on the predictive potential of the Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) on smoking abstinence in cancer patients undergoing smoking cessation treatment.

AIMS AND METHODS

We analyzed data from 5934 cancer patients seeking smoking cessation treatment at The University of Texas MD Anderson Cancer Center (female 52.08%; Mean age = 55.52, SD = 11.17). We evaluated the predictive accuracy of FTCD and HSI on abstinence at 3, 6, and 9 months from the first consultation, and assessed the concordance between these tools in measuring cigarette dependence using Cohen's kappa test and different correlation and regression models. We also analyzed variations across sex at birth and race/ethnicity.

RESULTS

Both the FTCD and the HSI demonstrated comparable predictive accuracy for smoking cessation at all follow-ups, with neither showing high accuracy (Areas Under the Curve scores around 0.6). Concordance analysis revealed substantial agreement between FTCD and HSI scores (Cohen's kappa ~ 0.7), particularly at lower levels of dependence. However, this agreement varied by race, with reduced concordance observed in non-Hispanic Blacks.

CONCLUSIONS

Our results indicate that both the FTCD and HSI are effective tools for predicting smoking cessation in cancer patients, with the HSI offering a less burdensome assessment option. Nevertheless, the findings suggest the need for tailored approaches in assessing cigarette dependence that could predict smoking cessation more accurately, considering racial differences.

IMPLICATIONS

The burden of assessing cigarette dependence in cancer care settings can be reduced by using the HSI instead of the FTCD. In addition, both instruments could be substantially interchanged and used for meta-analytic studies examining dependence and abstinence, but race/ethnicity should be considered.

Increasing digital equity to promote online smoking cessation program engagement among rural adults: a randomized controlled pilot trial

BACKGROUND

Cigarette smoking prevalence is higher for rural than urban adults, yet digital access to cessation programming is reduced. We aim to investigate digital access interventions to promote engagement with an online evidence-based cessation treatment (EBCT) program among rural adults.

METHODS

This pilot trial used a pragmatic, three-arm, randomized, parallel-group design (ClinicalTrials.gov: NCT05209451). Inclusion criteria included being aged ≥18, Mayo Clinic Midwest patient, rural residency, and currently smokes cigarettes. All participants received an online, 12-week EBCT program and were randomized to receive one of three digital access interventions: print materials (control, n = 30); print materials + loaner iPad device with data plan coverage (n = 30); or print materials + loaner device + up to six, 15-20-minute motivational interviewing-based coaching calls to support technology needs (n = 30). A composite score of trial engagement (primary outcome) and self-reported smoking abstinence and use of EBCT resources (secondary outcomes) were assessed online at 4 and 12 weeks. Qualitative interviews were used to assess patient experience. Neither participants nor outcome assessors were blinded to group assignment.

RESULTS

Results are reported for all 30 participants in each group. The average age of participants is 51.0 years and 61% are women. We show no significant arm differences for the trial engagement composite score (p = 0.30). We also find coaching support is significantly (p < 0.05) associated with enhanced smoking-related treatment response, including cigarette abstinence and use of EBCT resources, and participants reported positive experiences with the intervention.

CONCLUSIONS

The coaching intervention to support technology needs is acceptable and shows preliminary evidence of its efficacy in smoking-related treatment response. Further studies could refine and implement the coaching intervention for trial engagement and long-term cessation.

Unveiling the psychological mechanisms of mutual help groups for addiction recovery: The role of social identity factors

The effectiveness of mutual help groups (MHGs) in promoting addiction recovery has been widely acknowledged. However, the psychological mechanisms underlying the impact of MHGs remain somewhat uncertain. Drawing on a social identity perspective, this study investigated a sequential mediation model in which social support is posited as a driving factor that enhances abstinence maintenance through group identification, recovery identity, and self-efficacy. A sample of 820 smokers, participating in a 6-month collective smoking cessation programme which included access to an online help group, completed measures of social support, group identification, smoker/ex-smoker identity, and self-efficacy at the programme's outset. Smoking abstinence was assessed 6 and 9 months later. The findings supported the proposed model, indicating that social support was positively associated with MHG identification, which, in turn, was related to a stronger recovery identity. Subsequently, recovery identity was associated with increased self-efficacy, and indirectly, with smoking abstinence at both measurement times. Additional analyses testing alternative mediation models further supported the validity of the proposed model. These findings suggest that social identity factors play significant roles in accounting for the effectiveness of MHGs for addiction recovery.

A multicomponent smoking cessation program for adults with Type 2 Diabetes Mellitus (DiMe-SALUD2 project): A study protocol of a randomized controlled trial

Background

Tobacco use represents a significant public health burden, being especially harmful for smokers with Type 2 Diabetes Mellitus (T2DM). Effective smoking cessation interventions are required for this vulnerable population. The goal is to describe a study protocol of a randomized controlled trial (RCT) aimed at analyzing the effectiveness and efficiency of a multicomponent smoking cessation intervention for T2DM smokers, including a training protocol on healthy lifestyle habits and self-management of T2DM (DiMe-SALUD2 project).

Methods

This RCT will assign participants to: (1) Control Group (n = 30), including a brief psychoeducation advice about smoking cessation; (2) Cognitive-behavioral treatment (CBT) for smoking cessation (n = 30), based on a multicomponent program implemented in group-based sessions over an eight-week period; and (3) CBT plus DiMeSALUD2 protocol (n = 30), which will develop an additional psychoeducational protocol specifically designed to improve healthy lifestyle habits. Participants will be assessed at baseline, post-treatment and several follow-ups (1-, 6- and 12-months). Primary outcomes will include smoking abstinence (24-h point prevalence abstinence at post-treatment and 7-day point prevalence at follow-ups) and smoking continuous abstinence. Secondary outcomes will include treatment retention, changes in smoking patterns and nicotine dependence, as well as the impact on T2DM clinical variables, mental health, and quality of life.

Discussion

The DiMeSALUD2 program could assist T2DM smokers in quitting tobacco use and improving their overall quality of life. This project will help incorporating improvements in routine clinical practice with T2DM patients, offering a smoking cessation program adapted to their specific needs.

Trial registration

ClinicalTrials.gov. Identifier: NCT05885659. Date of registration: June 2nd, 2023.

Anxiety sensitivity in relation to smoking dependence motives among Latinx persons who smoke

Hispanic/Latinx (hereafter Latinx) persons are an established tobacco disparities population in the United States (US). Past work has suggested that individual differences in anxiety sensitivity, or the fear of arousal-based sensations, is one important cognitive construct for smoking maintenance and relapse among Latinx persons who smoke. However, previous research has not examined if anxiety sensitivity is associated with motivational facets of smoking dependence among this tobacco disparities population. In the current study, anxiety sensitivity was explored in terms of smoking motives for primary, secondary, and overall cigarette dependence. Participants included 336 English-speaking Latinx adults in the US who smoked cigarettes daily (Mage = 35.53, SD = 8.65, 37.3% Female). Results indicated that anxiety sensitivity was statistically significantly and positively related to higher primary and secondary dependence motives and marginally statistically significant to cigarette dependence; findings were evident after adjusting for numerous theoretically relevant variables (e.g., depression). Overall, the current study is the first to document linkages between anxiety sensitivity and numerous motivational bases of tobacco dependence among Latinx persons who smoke from the US.

Do tobacco regulatory and economic factors influence smoking cessation outcomes? A post-hoc analysis of the multinational EAGLES randomised controlled trial

INTRODUCTION

We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes.

METHODS

EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment.

RESULTS

In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)).

CONCLUSIONS

Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a country's GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT01456936.

Associations between compliance with very low nicotine content (VLNC) cigarettes, abstinence self-efficacy, and quit outcomes in a pilot smoking cessation trial

BACKGROUND

Switching to Very Low Nicotine Content (VLNC) cigarettes reduces toxicant exposure and nicotine dependence, and may improve smoking cessation. However, non-compliance with VLNCs is often high, which may reduce their effectiveness. Here, we conducted secondary analyses of a pilot smoking cessation trial utilizing VLNCs to examine associations between pre-cessation VLNC compliance and changes in smoking rate, dependence, and abstinence self-efficacy, as well as quit outcomes.

METHODS

People who smoke daily (n=35) engaged in a 4-week pre-cessation intervention including VLNCs, transdermal nicotine patch, and behavioral counseling. After quit date, participants received 8 weeks of nicotine replacement therapy and 4 additional behavioral sessions, and were followed for 10 weeks to assess abstinence. Compliance with VLNCs was assessed biweekly during pre-cessation using timeline follow-back. Statistical analyses examined associations between VLNC compliance and a) changes in smoking rate, dependence and abstinence self-efficacy over the course of study cigarette use; and b) time to relapse, controlling for other smoking variables.

RESULTS

Greater compliance during the second half of study cigarette use was associated with subsequent improvement in self-efficacy (p<.05). Increased self-efficacy and VLNC compliance both predicted lower likelihood of relapse. Nicotine dependence and cigarettes per day both decreased following study cigarette use, but were unrelated to compliance or relapse.

CONCLUSIONS

Compliance with VLNCs prior to quitting increased abstinence self-efficacy and predicted better quit outcomes above and beyond baseline smoking characteristics. Although preliminary, these findings suggest that identifying strategies to promote exclusive use of VLNCs during a brief pre-cessation window may be beneficial.

Multimodal 7T imaging reveals enhanced functional coupling between salience and frontoparietal networks in young adult tobacco cigarette smokers

Tobacco cigarette smoking is associated with disrupted brain network dynamics in resting brain networks including the Salience (SN) and Fronto parietal (FPN). Unified multimodal methods [Resting state connectivity analysis, Diffusion Tensor Imaging (DTI), neurite orientation dispersion and density imaging (NODDI), and cortical thickness analysis] were employed to test the hypothesis that the impact of cigarette smoking on the balance among these networks is due to alterations in white matter connectivity, microstructural architecture, functional connectivity and cortical thickness (CT) and that these metrics define fundamental differences between people who smoke and nonsmokers. Multimodal analyses of previously collected 7 Tesla MRI data via the Human Connectome Project were performed on 22 people who smoke (average number of daily cigarettes was 10 ± 5) and 22 age- and sex-matched nonsmoking controls. First, functional connectivity analysis was used to examine SN-FPN-DMN interactions between people who smoke and nonsmokers. The anatomy of these networks was then assessed using DTI and CT analyses while microstructural architecture of WM was analyzed using the NODDI toolbox. Seed-based connectivity analysis revealed significantly enhanced within network [p = 0.001 FDR corrected] and between network functional coupling of the salience and R-frontoparietal networks in people who smoke [p = 0.004 FDR corrected]. The network connectivity was lateralized to the right hemisphere. Whole brain diffusion analysis revealed no significant differences between people who smoke and nonsmokers in Fractional Anisotropy, Mean diffusivity and in neurite orienting and density. There were also no significant differences in CT in the hubs of these networks. Our results demonstrate that tobacco cigarette smoking is associated with enhanced functional connectivity, but anatomy is largely intact in young adults. Whether this enhanced connectivity is pre-existing, transient or permanent is not known. The observed enhanced connectivity in resting state networks may contribute to the maintenance of smoking frequency.

Hepatitis C and Cigarette Smoking Behavior: Themes From Focus Groups

INTRODUCTION

People with chronic hepatitis C virus (HCV; PWHC) use cigarettes at a much higher prevalence than other individuals, and smoking can exacerbate the harms specifically related to HCV (eg, hepatocellular carcinoma). Little is known about factors related to cigarette use among PWHC.

AIMS AND METHODS

This study examined focus group data to explore beliefs and behaviors related to cigarette use among PWHC. Qualitative data from two focus groups of PWHC reporting current cigarette smoking (n = 15, 60% male) were collected using a semi-structured interview guide. Participants were asked about reasons for smoking, barriers to quitting smoking, and the relationship of HCV to smoking. Focus groups were transcribed verbatim and coded in NVivo 12. Four coders examined themes that arose in the focus groups. Common themes are described and supported with quotes.

RESULTS

Reasons for smoking included addiction to cigarettes, stress, substituting cigarettes for other drugs, and social norms, while reasons for quitting included health and being free from the use of all drugs. Barriers to quitting included concerns about coping with stress, weight gain, and having a lack of support for and education about quitting. Many participants believed there was a link between smoking and HCV and discussed smoking in relation to the stress of an HCV diagnosis.

CONCLUSIONS

Participants identified both HCV-related and non-HCV-related aspects of cigarette smoking and cessation-related behaviors that could be targeted in cessation treatment. More research is needed to identify the best treatment approaches that reduce the significant medical consequences of cigarette use among PWHC.

IMPLICATIONS

People with chronic hepatitis C virus (HCV; PWHC) smoke cigarettes at a high prevalence, yet little is known about their smoking behaviors. Moreover, there are no cessation treatments targeting PWHC. This is the first study to collect focus group data from PWHC who smoke in order to identify reasons for cigarette use (HCV-related and non-HCV-related), and motivators and barriers to quitting cigarettes. PWHC reports using cigarettes to cope with the stress of an HCV diagnosis and to celebrate HCV cure. These findings suggest there are specific times during the HCV care continuum where providers can aid with cessation efforts.

Psychometric Properties of the FTCD and Brief WISDM: Support for Validity in a Legal-System-Involved Sample

INTRODUCTION

The Fagerström test for cigarette dependence (FTCD) and Brief Wisconsin index of smoking dependence motives (WISDM) are widely used measures of smoking dependence. The FTCD was previously found to have 1-factor and 2-factor structures and Brief WISDM has been found to have an 11-factor and 11-factor hierarchical structure. As such, the current study sought to further investigate the psychometric properties of the FTCD and Brief WISDM with a novel criminal-legal system-involved sample using both a factor-analytic and an item response theory (IRT) approach.

AIMS AND METHODS

Data from 517 criminal-legal system-involved adults (ie, 18 years of age or older) who smoke from Alabama, USA were analyzed. Confirmatory factor analyses (CFA) were conducted on 1-factor and 2-factor structures of the FTCD and 1-factor, 11-factor, and 11-factor hierarchical structures of the Brief WISDM. IRT analyses investigating item discrimination and threshold parameters were also conducted on the brief WISDM.

RESULTS

The CFA showed poor fit for a single-factor structure and mixed results for two 2-factor results for the FTCD. CFA also showed poor fit for a single-factor and mixed results for the 11-factor model. Initial IRT investigations using the 11-factor model showed strong item discrimination, but non-ordered threshold parameters.

CONCLUSIONS

Two-factor structures for the FTCD and the 11-factor model for the Brief WISDM were partially supported in a criminal-legal population, suggesting continued support for the multidimensional structure of the measures. Additionally, exploratory IRT analyses suggested good discrimination across the use spectrum for the Brief WISDM.

IMPLICATIONS

The Fagerström Test of Cigarette Dependence (FTCD) and Brief Wisconsin index of smoking dependence motives (WISDM) are two widely used measures of nicotine dependence, though previous research has shown mixed results for their internal consistency and factor structure. The current study used a unique sample of criminal-legal-involved participants who generally have moderate to high levels of nicotine dependence. The current study found that the FTCD displayed poor internal consistency, a poor fit for a single-factor model, but mixed support for two two-factor models. The Brief-WISDM was found to have strong internal consistency, a poor fit for a single-factor model, but mixed fit for an 11-factor model and good item discrimination.

Breaking down barriers: rationalisations and motivation to stop among Chinese male smokers under cigarette dependence

BACKGROUND

Smoking rationalisation beliefs are a huge barrier to quitting smoking. What types of rationalisations should be emphasised in smoking cessation interventions? Although past literature has confirmed the negative relationship between those beliefs and motivation to stop smoking, little is known regarding the importance and performance of those beliefs on motivation with varying cigarette dependence. The study aimed to ascertain rationalisations that are highly important for motivation yet perform poorly in different cigarette dependence groups.

METHODS

The cross-sectional study was conducted from November 19 to December 9, 2023 in Guiyang City, China. Adult male current smokers were enrolled. Partial least squares structural equation modelling was used to test the hypothesis. The multi-group analysis was used to determine the moderating effect of cigarette dependence, and the importance-performance map analysis was utilised to assess the importance and performance of rationalisations.

RESULTS

A total of 616 adult male current smokers were analysed, and they were divided into the low cigarette dependence group (n = 297) and the high cigarette dependence group (n = 319). Except for risk generalisation beliefs, smoking functional beliefs (H1: -β = 0.131, P < 0.01), social acceptability beliefs (H3: β = -0.258, P < 0.001), safe smoking beliefs (H4: β = -0.078, P < 0.05), self-exempting beliefs (H5: β = -0.244, P < 0.001), and quitting is harmful beliefs (H6: β = -0.148, P < 0.01) all had a significant positive influence on motivation. Cigarette dependence moderated the correlation between rationalisations and motivation. In the high-dependence group, the social acceptability beliefs and smoking functional beliefs were located in the "Concentrate Here" area. In the low-dependence group, the social acceptability beliefs were also situated in there.

CONCLUSIONS

Social acceptability beliefs and smoking functional beliefs showed great potential and value for improvement among high-dependence smokers, while only social acceptability beliefs had great potential and value for improvement among low-dependence smokers. Addressing these beliefs will be helpful for smoking cessation. The multi-group analysis and the importance-performance map analysis technique have practical implications and can be expanded to other domains of health education and intervention practice.

Combination Treatment With Varenicline and Nicotine Patch on Smoking Cessation Outcomes in Heavy Drinkers at 26-Week Follow-up

PURPOSE/BACKGROUND

People who smoke cigarettes and drink alcohol heavily are less likely to quit smoking compared with those who do not drink heavily. The current study examined the effects of a 12-week treatment phase of combination varenicline and nicotine patch compared with placebo and nicotine patch on smoking cessation (primary outcome) and alcohol consumption (secondary outcome) in heavy drinking smokers at 26-week follow-up.

METHODS/PROCEDURES

Participants were daily smokers who met heavy drinking criteria. They were randomly assigned to receive either varenicline and nicotine patch (n = 61) or placebo and nicotine patch (n = 61) for 12 weeks. At week 26, self-reports of point prevalence cigarette abstinence were biochemically confirmed, and past-month alcohol drinking days and heavy drinking days were assessed.

FINDINGS/RESULTS

At week 26, smoking quit rates did not differ by treatment group (25% varenicline and 26% placebo). Relative to week 12 outcomes, week 26 quit rates significantly dropped off in the varenicline group but not in the placebo group. Alcohol drinking reductions for the whole sample that were previously observed from baseline to week 12 were sustained at week 26, although they did not differ between treatment groups.

IMPLICATIONS/CONCLUSIONS

In heavy drinking smokers, smoking cessation success was evident in a quarter of the total sample at 3 months postmedication discontinuation. At this time, quit rates were the same between those who received varenicline and nicotine patch and those who received nicotine patch alone. Future research is warranted to examine what may aid in longer-term smoking quit rates in heavy drinking smokers.

A Scoping Review of Behavioural Studies on Heated Tobacco Products

Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.

Problematic Consumption of Alcohol, Cannabis and Cigarettes—a German Nationwide Survey on Psychopathology, Stress, Mindfulness, and Quality of Life

BACKGROUND

Even among minors, the use of psychotropic substances is widespread in Europe. Data on the use of tobacco, alcohol and cannabis are regularly reported in Germany, but data on problematic use are lacking. In the present study, established screening instruments were used to investigate the prevalence of problematic use of cigarettes, alcohol and cannabis among children and adolescents.

METHODS

A survey that was designed to be representative was conducted across Germany in a sample of 4001 persons aged 12-17. The survey consisted of established screening instruments for problematic consumption patterns and related psychosocial aspects. Prevalences were estimated, and bivariate and multivariate associated characteristics were studied.

RESULTS

Among 12- to 17-year-olds in Germany, the prevalence values (with 95% confidence intervals) of problematic use were: for cigarettes, 0.5% [0.3; 0.7]; for alcohol, 11.3% [10.3; 12.3]; and for cannabis, 0.5% [0.3; 0.7]. For the problematic use of cigarettes, alcohol and cannabis, there were both bivariate and multivariate statistically significant associations with greater psychopathology, lower mindfulness, and a lower quality of life. For example, greater psychopathology and stress experience were both associated with an increased risk of problematic cannabis use (odds ratios 1.21 [1.11; 1.31] and 1.59 [1.33; 1.88]).

CONCLUSION

A comparison with the few available previous findings implies that problematic alcohol consumption has become more prevalent. There were both similarities and differences across the three substances studied with respect to patterns of problematic consumption, particularly in relation to the experience of stress.

The trajectory of smoking cessation after treatment and its related factors in Taiwan

Smoking has multiple negative effects on health; therefore, the Taiwanese government provides smoking cessation clinics to smokers. This study aimed to explore the trajectory of smoking cessation after smokers received treatment and the variables related to different trajectories. A retrospective longitudinal study was conducted, in which 735 adult smokers who received smoking cessation medications were recruited. The participants' demographic characteristics, chronic diseases, smoking characteristics, and cigarette dependence were collected from chart review. The amount of smoking was collected at baseline, and at 1 week, 1 month, 3 months, and 6 months after treatment. The Proc Traj procedure for group-based modeling and multinomial logistic regression were used for statistical analysis. Three trajectories were identified: early quitters (28.03%), late quitters (11.43%) and reducers (60.54%). Compared with early quitters, reducers were younger and had a higher probability of severe cigarette dependence. Compared with early quitters, late quitters had a higher number of taking smoking cessation medications. The findings revealed that approximately 60% of participants who received smoking cessation treatment could not completely quit smoking, and that age, number of medications taken, and cigarette dependence were significant predictors of different trajectories.

Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity (STEP): Study protocol for a randomized controlled trial

Anxiety sensitivity (AS), reflecting the fear of bodily sensations, is a transdiagnostic vulnerability factor that underpins both affective psychopathology and smoking. Phase II research supports the efficacy of a 15-week community-based intervention (STEP) that combines high-intensity exercise offered by the YMCA with standard smoking cessation treatment (tobacco quitline and nicotine replacement therapy) for sedentary smokers with elevated AS. This Phase III study aims to enroll 360 adults to evaluate whether STEP efficacy for achieving smoking abstinence generalizes to Black and Hispanic smokers with elevated AS.

Evaluation of effectiveness and acceptability of a psychological treatment for smoking cessation combined with a smartphone App: A pilot study

Despite the increasing number of mobile-based interventions to quit smoking over the last years, few studies have investigated the efficacy of smoking cessation interventions blended with smartphone Apps. The present pilot study aims to examine the preliminary effectiveness and acceptability of a cognitive-behavioral treatment combined with a smartphone App, compared to the same psychological treatment without the App. The sample comprised 206 treatment-seeking smokers, who were assigned to: 1) an experimental group receiving a cognitive-behavioral intervention combined with the "Non Fumo" App (n = 102), and 2) a control group receiving only the cognitive-behavioral intervention to quit smoking (n = 104). Results concerning the primary outcomes showed no significant differences between conditions in point-prevalence abstinence rates at 12-month follow-up (35.30 % in the experimental group vs. 31.70 % in the control group) and in treatment acceptability. Regarding the secondary outcomes, both groups obtained similar point-prevalence abstinence rates at the end of treatment (61.80 % vs. 65.40 %), at 3-month (42.20 % vs. 45.20 %, respectively) and 6-month follow-ups (37.30 % vs. 37.50 %). No significant differences were found between conditions in prolonged abstinence rates at 6-month (35.3 % vs. 35.6 %) and 12-month follow-ups (30.4 % vs. 26.9 %). Overall, good abstinence rates and treatment acceptability were obtained, although there were no significant differences between conditions. More research is needed to establish clear conclusions about the efficacy of psychological smoking cessation treatments blended with smartphone Apps.

The imbalance of self-reported wanting and liking is associated with the degree of attentional bias toward smoking-related stimuli in low nicotine dependence smokers

Background and aims

The Incentive Sensitization Theory (IST) offers a comprehensive framework that explains how attentional mechanisms contribute to the maintenance and relapse of addictive behavior. However, the extent to which the underlying neuropsychological mechanisms are consciously accessible for report remains unknown. Thus, the aim of this study was to investigate the association between self-reported wanting and liking among smokers and its relationship with detecting changes in smoking-related stimuli.

Design

An online experiment was designed deploying a flicker paradigm with neutral and smoking-related changes, completed by 422 individuals (mean age = 29.1 years, 214 non-smokers, 123 current smokers, and 85 former smokers). Additionally, the Fagerström Test for Cigarette Dependence and the Imaginative Wanting and Liking Questionnaire were administered.

Findings

Consistent with prior research findings, smokers exhibited faster detection of smoking-related changes compared to non-smokers, while former smokers displayed an intermediate level of attentional bias, falling between the levels observed in smokers and non-smokers. Further, higher levels of nicotine dependence were associated with a greater discrepancy between self-reported wanting and liking, which was associated with better change detection performance for high salience smoking-related stimuli in smokers.

Conclusion

These findings support the predictions of IST and support the notion that attentional bias might develops early in the course of nicotine addiction. Furthermore, the results indicate that the underlying cognitive mechanisms might be partially within conscious awareness, which opens up potential avenues for research design, treatment, and interventions.

Racial/ethnic minority females smoke more cigarettes after social interaction with others who smoke

The present study investigated the effects of social interaction with others who smoke on daily cigarette use among diverse females via ecological momentary assessment methods. Ninety-eight premenopausal females (29.6% White, 70.4% racial/ethnic minority) who smoke daily reported their social interactions and cigarette use over 35-days. Greater than usual levels of social interaction with others who smoke was associated with increased cigarette use that day among racial/ethnic minority females. Future smoking cessation interventions targeting racial/ethnic minority females should consider the impact of social environments on smoking behaviors, such as the frequency of peer interactions with others who smoke.

Development and initial validation of a new self-report measure to assess perceived dependence on tobacco and nicotine products

How nicotine is administered has evolved from cigarettes to various delivery systems. Assessing perceived dependence on nicotine-containing products now requires accounting for product specificity while allowing comparisons across products and users. This study aims to develop a new self-report measure to assess perceived dependence on tobacco and nicotine products (TNPs) among exclusive and poly-TNP users. A draft version of the new measure, the ABOUT-Dependence, was constructed based on literature review, qualitative research, and expert opinion. Data for scale formation and psychometric assessment was obtained through a US-based web survey (n = 2334) that included additional dependence measures for convergent validity assessment. Qualitative research confirmed a preliminary conceptual framework with seven sub-concepts. Following a cognitive debriefing, 19 items were considered to best represent the different sub-concepts. Psychometric findings supported a three-domain structure [i.e., behavioral impact (five items), signs and symptoms (five items), and extent/timing of use (two items)] and an overall total composite score. The data confirmed convergent and known-group validity, as well as test-retest reliability. The ABOUT-Dependence is a 12-item, psychometrically sound, self-report measure that may be used as a tool for research and further understanding of perceived dependence across the spectrum of TNP and TNP users.

The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study

BACKGROUND

Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption.

METHODS

The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks).

RESULTS

We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (β = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV.

CONCLUSIONS

The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step.

TRIAL REGISTRATION

ISRCTN15684371.

Safety of e-cigarettes and nicotine patches as stop-smoking aids in pregnancy: Secondary analysis of the Pregnancy Trial of E-cigarettes and Patches (PREP) randomized controlled trial

AIMS

The aim of this study was to examine the safety of e-cigarettes (EC) and nicotine patches (NRT) when used to help pregnant smokers quit.

DESIGN

A recent trial of EC versus NRT reported safety outcomes in the randomized arms. We conducted a further analysis based on product use.

SETTING

Twenty-three hospitals in England and a stop-smoking service in Scotland took part.

PARTICIPANTS

The participants comprised 1140 pregnant smokers.

INTERVENTIONS

We compared women using and not using EC and NRT regularly during pregnancy.

MEASUREMENTS

Measurements included nicotine intake compared with baseline, birth weight, other pregnancy outcomes, adverse events, maternal respiratory symptoms and relapse in early abstainers.

FINDINGS

Use of EC was more common than use of NRT (47.3% vs 21.6%, P < 0.001). Women who stopped smoking (abstainers) and used EC at the end-of-pregnancy (EOP) reduced their salivary cotinine by 45% [49.3 ng/ml, 95% confidence interval (CI) = -79.8 to -10]. Only one abstainer used NRT at EOP. In dual users, cotinine increased by 19% (24 ng/ml, 95% CI = 3.5-68). In women reporting a reduction of at least 50% in cigarette consumption, cotinine levels increased by 10% in those using nicotine products and by 9% in those who did not. Birth weights in dual users and exclusive smokers were the same (3.1 kg). Birth weight in abstainers using either nicotine product was higher than in smokers [3.3 kg, standard deviation (SD) = 0.7] versus 3.1 kg, SD = 0.6; difference = 0.15 kg, 95% CI = 0.05-0.25) and not different from abstainers not using nicotine products (3.1 kg, SD = 0.8). Abstainers and smokers using nicotine products had no worse pregnancy outcomes or more adverse events than abstainers and smokers not using them. EC users reported more improvements than non-users in cough [adjusted relative risk (aRR) = 0.59, 95% CI = 0.37-0.93] and phlegm (aRR = 0.53, 95% CI = 0.31-0.92), controlling for smoking status. EC or NRT use had no association with relapse.

CONCLUSIONS

Regular use of e-cigarettes or nicotine patches by pregnant smokers does not appear to be associated with any adverse outcomes.