Motivational Influences on Cigarette Smoking

Effects of smoking social cues on brand perception and smoking: an event-related potential study

Introduction

Smokers' dependence on tobacco products stems not only from substance addiction but also from social influences. While prior research has explored the impact of smoking action cues, it has largely overlooked smoking social cues and their role in shaping brand perception and smokers' willingness to pay (WTP), leaving a gap in understanding their interaction. This study addresses the gap by analyzing event-related potentials (ERPs) and behavioral decisions in response to smoking social and action cues.

Methods

Using a 2×2 design (social cues: present vs. absent; action cues: present vs. absent), we assessed brand perception, WTP, and N1 and P3 ERP amplitudes in 22 smokers (18 males, mean age 23.14 ± 1.60 years).

Results

Results showed that smoking social cues increased brand perception and WTP while reducing N1 amplitudes, indicating that the presence of smoking social cues interfere with the processing of smoking action stimuli.

Discussion

These findings highlights the importance of avoiding the simultaneous inclusion of social and action cues in anti-smoking advertisements, which also provide valuable insights for smoking cessation research.

Secondhand Smoke Exposure and Smoking Attitudes and Behaviors Among Adolescents in the Gaza Strip: Findings From the 2019 Global Youth Tobacco Survey

Background

Secondhand smoke (SHS) exposure remains a critical public health concern, especially for adolescents, who are more susceptible to its harmful effects and may initiate smoking as a result. SHS, comprising both mainstream and sidestream smoke, contains over 7000 chemicals, many of which are carcinogenic. Adolescents exposed to SHS are more likely to experiment with smoking due to environmental influences, peer pressure, and familial smoking behavior.

Objective

This study aims to examine the relationship between SHS exposure and smoking attitudes and behaviors among adolescents aged 13-15 in the Gaza Strip, where SHS exposure and tobacco use remain prevalent.

Methods

Data were obtained from the 2019 Global Youth Tobacco Survey (GYTS), a cross-sectional, school-based survey targeting students in Gaza. The study employed a two-stage cluster sampling design to ensure a representative sample. SHS exposure was assessed in multiple contexts, including home, public enclosed spaces, and outdoor areas. Smoking attitudes, initiation behaviors, and demographic variables were also analyzed using descriptive statistics, Chi-square tests, and multivariable logistic regression to identify predictors of smoking behaviors.

Results

Of the 1536 adolescents surveyed, 62.3% reported SHS exposure at home, and 53.9% reported exposure in enclosed public spaces. Adolescents exposed to SHS were significantly more likely to experiment with smoking, with curiosity (62.2%) and peer influence being key motivators. Additionally, SHS exposure in both indoor and outdoor environments was associated with a higher likelihood of shisha experimentation. Females reported higher SHS exposure rates than males across all environments (P < .001).

Conclusion

SHS exposure significantly increases the risk of smoking initiation among adolescents in the Gaza Strip. These findings emphasize the need for targeted public health interventions, including stricter smoke-free legislation, parental education, and awareness campaigns aimed at reducing SHS exposure and preventing smoking uptake in youth.

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.

The Indirect Effects of Negative Affect Reduction Motives on the Relationship Between Sex and Severity of Problems When Trying to Quit Among Black Adults Who Smoke

BACKGROUND

African American/Black (hereafter referred to as Black) persons who smoke constitute a tobacco disparities group in the United States. Within the Black population, female smokers experience a disproportionate percentage of these disparities and are less likely to quit cigarettes than their male counterparts. Two factors implicated in female smokers' relatively worse quit success are (1) motives to smoke to reduce negative affect and (2) expectancies that smoking will reduce negative affect.

OBJECTIVES

The present study sought to test sex differences in these two clinically relevant cognitive constructs and evaluate the indirect effects of sex and severity of problems when trying to quit via smoking motives and expectancies for negative affect reduction among Black adults who smoke. Participants included 103 Black adults who smoke daily (72% male; Mage = 44.5 years, SD = 11.5 years).

RESULTS

Results revealed sex differences in both negative affect reduction motives and expectancies, as well as a partial indirect effect for sex on the severity of problems when trying to quit through negative affect reduction motives (a1b1 = 0.18, 95% CI [0.04, 0.38]) but not negative affect reduction expectancies (a2b2 = -0.01, 95% CI [-0.11, 0.09]) in a simultaneous model of indirect effects.

CONCLUSIONS

These findings shed light on the complex relationship between race, sex, and severity of problems when trying to quit, particularly when complicated by smoking motives and expectancies. Current data should be considered when developing sex-specific, tailored smoking cessation interventions for Black women.

Transcranial direct current stimulation combined with a brief intervention for smoking cessation: a randomized double-blind clinical trial

Non-invasive brain stimulation methods are currently being evaluated for treatment of addictive disorders. Some evidence indicates that modulating left and right prefrontal brain activity by transcranial direct current stimulation (tDCS) can reduce craving and relapse rates in tobacco addiction. Therefore, this study investigated the effects of active and sham tDCS as an add-on treatment to a standardized brief intervention for smoking cessation. This randomized, double-blind study included 36 participants (22 women and 14 men) with nicotine dependence according to ICD-10 criteria. At five visits on alternate days, participants underwent a 20-min active or sham tDCS over the left dorsolateral prefrontal cortex and subsequently participated in a 10-min brief intervention for smoking cessation. Patients were followed up after 3 months. On each treatment day and at follow-up, abstinence was assessed as the smoking status nonsmoker and craving was assessed with the German version of the Questionnaire on Smoking Urges. At each visit, the number of cigarettes smoked per day was recorded and carbon monoxide in expired air and cotinine in saliva were measured. At follow-up, a study-specific questionnaire was used to assess tobacco use. All 36 participants completed the treatment sessions, but one participant in each group was lost to follow-up. Abstinence rates were not significantly different between the groups at any of the study visits, but craving was significantly lower in the active group at tDCS session 5 compared with session 1. tDCS combined with a brief intervention may support smoking cessation, but studies need to evaluate whether longer and more intensive treatment can achieve significant, sustainable effects.

Cigarette craving in virtual reality cue exposure in abstainers and relapsed smokers

Cue exposure therapy (CET) in substance-use disorders aims to reduce craving and ultimately relapse rates. Applying CET in virtual reality (VR) was proposed to increase its efficacy, as VR enables the presentation of social and environmental cues along with substance-related stimuli. However, limited success has been reported so far when applying VR-CET for smoking cessation. Understanding if effects of VR-CET differ between future abstainers and relapsing smokers may help to improve VR-CET. Data from 102 participants allocated to the intervention arm (VR-CET) of a recent RCT comparing VR-CET to relaxation in the context of smoking cessation was analyzed with respect to tolerability, presence, and craving during VR-CET. Cue exposure was conducted in four VR contexts (Loneliness/Rumination, Party, Stress, Café), each presented twice. Relapsed smokers compared to abstainers experienced higher craving during VR-CET and stronger craving responses especially during the Stress scenario. Furthermore, lower mean craving during VR-CET positively predicted abstinence at 6-month follow-up. Attempts to improve smoking cessation outcomes of VR-CET should aim to identify smokers who are more at risk of relapse based on high craving levels during VR-CET. Specifically measuring craving responses during social stress seems to be well suited to mark relapse. We propose to investigate individualized treatment approaches accordingly.

Ethnicity, Coronavirus Disease-Related Stress, and E-cigarette Use and Cigarette Smoking Among Young Adults: A Longitudinal Study

INTRODUCTION

Research has rarely examined ethnic differences in exposure to coronavirus disease (COVID)-related stress in relation to smoking and e-cigarette use.

AIMS AND METHODS

Using pre- and post-COVID data from a sample of predominantly Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) young adults, this study aimed to test the effects of ethnicity on cigarette smoking and e-cigarette use through exposure to COVID-related stress. Young adults from Hawaii who provided pre-COVID data in or before January 2020 were followed up with in March-May 2021. N = 1907 (mean age = 24.9 [SD = 2.9], 56% women) provided complete data relevant to the current analysis at both waves of data collection. Structural equation modeling was used to test the effects of ethnicity (white, Asian [eg, Japanese, Chinese], Filipino, NHPI, and other) on pre- to post-COVID changes in cigarette and e-cigarette use via effects on COVID-related stress.

RESULTS

Relative to Asian young adults, members of all other ethnic groups (NHPI, Filipino, white, and other) indicated greater exposure to COVID-related stress. Higher levels of COVID-related stress were associated with increased dual-use status and increased current e-cigarette and cigarette use frequencies. Higher COVID-related stress mediated the effects of NHPI, Filipino, and other ethnicity on increased dual-use status.

CONCLUSIONS

The current data indicate that young adults of vulnerable ethnic groups who experience higher COVID-related stress are at increased risk for dual use of cigarettes and e-cigarettes.

IMPLICATIONS

The findings imply that tobacco use prevention and treatment efforts may need to pay increased attention to racial or ethnic groups that have experienced greater adverse impact of the COVID-19 pandemic.

The dynamics of smoking quit motivation in daily life: Associations with momentary self-regulation and nightly quit intentions

Due to prior work suggesting dynamic fluctuations in quit motivation over time, the current study used ecological momentary assessment (EMA) to examine contextual predictors of momentary quit motivation, most notably perceived self-regulation. The sample (n = 84) intentionally excluded smokers actively trying to quit and those who plan to never quit, focusing on the group of smokers who are interested in but not yet committed to quitting. Participants completed one week of EMA, where they responded to random prompts 7x/day and logged each cigarette. At each prompt, they completed measures assessing cigarette craving, affect (positive and negative), quit motivation, and perceived momentary self-regulation (i.e., willpower self-efficacy, distress intolerance, craving uncontrollability). Participants also completed a nightly prompt where they reported their quit intentions. Results revealed that the newly developed 4-item index of quit motivation had strong psychometric properties, and demonstrated fluctuations over time and across situations. Quit motivation was higher when craving was ideographically lower than usual, and when willpower was higher than usual. People with higher distress intolerance reported higher quit motivation. In addition, stronger quit motivation and less variability in quit motivation was associated with higher quit intentions. The current study suggests that quit motivation does shift dynamically and speaks to the potential importance of targeting craving and willpower self-efficacy to enhance people's motivation to quit.

Measuring attentional bias in smokers during and after psychosocial stress induction with a Trier Social Stress Test in virtual reality via eye tracking

Introduction

Attentional bias (AB) is considered an important factor not only in the etiology of addiction, but also with respect to relapse. However, evidence for the predictive ability of AB for relapse is not robust. One reason for this might be fluctuations of AB due to stress. Therefore, the current study investigated whether AB was present during and after stress induction and whether AB was enhanced by stress induction.

Methods

A Virtual Reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) was used to induce psychosocial stress in smokers (n = 34) and non-smokers (n = 37) followed by a novel free-viewing task in VR. Eye tracking data was recorded to examine gaze behavior to smoking-related and neutral stimuli presented in the VR-TSST and the free-viewing task.

Results

Stress ratings increased significantly from baseline to post VR-TSST in smokers and non-smokers. During the VR-TSST we observed, more frequent, longer, and earlier fixations on smoke-related compared with neutral stimuli without significant group differences. However, in the free-viewing task following the stress induction, a specific AB of smokers in terms of earlier and longer fixations on smoke stimuli was found.

Conclusion

Results indicate that AB is not a persistent trait in smokers, but is context dependent. It is suggested that emotional learning processes such as smoking in the context of relief after stress may contribute to changes of AB both in terms of increased initial attention and deeper stimulus processing. Additionally, the potential of the VR-TSST to induce psychosocial stress could be replicated.

Factors influencing adolescent experimental and current smoking behaviors based on social cognitive theory: A cross-sectional study in Xiamen

Introduction

China has the largest youth population in the world. To better implement the Smoke-free School Initiative, this study aims to examine the protective and risk factors for different smoking behaviors (never smoked, experimental smoking, and current smoking) among school adolescents based on social cognitive theory.

Methods

This research was a secondary analysis of a cross-sectional survey of middle schools in Huli District of Xiamen, China. The final sample consisted of 1937 participants with an average age of 15.41 (SD = 1.64). Descriptive statistics were used to summarize the sociodemographic characteristics of the sample. Multivariate multinomial logistic regression analysis was performed using four models.

Results

Of the respondents, 1685 (86.99%) were never smokers, 210 (10.84%) were experimental smokers, and 42 (2.17%) were current smokers. Social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies were associated with adolescents' smoking behaviors. The number of smoking family members, classmates smoking, the perception that smoking is cool and attractive, and attitudes toward control tobacco policies were the predictors of current smoking behavior (p < 0.05). In contrast, friends smoking and individual and social relationship motivation were associated with only experimental smoking (p < 0.05).

Discussion

The relationship of social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies varied across smoking behaviors. Family, school, society and the government need to cooperate in prevention and intervention programs for adolescent smoking. The relationships between these factors and adolescents' different smoking behaviors needs to be further verified.

[Previous and current use profile of psychiatric and general population]

OBJETIVE

To describe and to compare the previous and the current tobacco use profile between psychiatric population of secondary and tertiary levels of care and general population of basic health care.

METHODS

Descriptive epidemiological/analytical cross sectional study with 378 participants from three Brazilian health services: a) Basic Unity of Health (BUH); b) Mental Health Ambulatory (MHA); c) Psychiatric Hospital (PH). The answers provided during individual interviews were registred in mobile device. Data were submitted to descriptive statistics, Fischer's exact test, analysis of variance and Kruskal-Wallis test.

RESULTS

In the PH all were daily smokers, noticing lower prevalence in MHA (94.1%) and in BUH (91.7%). Among the products utilized has highlighted manufactured cigarettes (98%), followed by roll-your-own cigarettes (39%). The average of cigarettes smoked per day (MHA=19,3, PH=25,3, BUH=17,2) and the percentage of multiple tobacco products users (MHA=28.1%, PH=55.3%, BUH=9.1%) were higher in PH. 73% of smokers exceed ≥ 4% of familiar income with tobacco. In PH were identified higher commitment. Smokers of PH were less advised to stop smoking (MHA=50%, PH=39.5%, BUH=50%).

CONCLUSION

The current tobacco use profile by psychiatric hospital smokers differs from the others. Besides higher tobacco dependency, they smoked a higher amount of cigarettes per day, compromised higher perceptual of personal income to buy tobacco and used multiples tobacco products as well as received less support to stop smoking.

A novel stress-based intervention reduces cigarette use in non-treatment seeking smokers

Tobacco use is the leading cause of preventable mortality worldwide. Since current smoking cessation aids show only modest efficacy, new interventions are needed. Given the evidence that stress is a potent trigger for smoking, the present randomized clinical trial tested whether stress could augment the effects of a memory updating (retrieval-extinction) intervention. Non-treatment seeking smokers (n = 76) were assigned to one of four conditions composed of either a stressful or non-stressful psychosocial challenge followed by either smoking or neutral cues. Ten minutes after this manipulation, all underwent a 60-minute extinction procedure during which they viewed smoking-related videos and images and manipulated smoking paraphernalia. Compared to participants who were not exposed to the laboratory stressor, the stressor-exposed groups exhibited greater psychophysiological responses during their intervention and greater decreases in cigarette use at two- and six-weeks follow-up independent of smoking cue exposure. Together, these findings suggest that the ability of stress to activate cigarette seeking processes can be exploited to decrease cigarette use. With replication, the stress-based intervention could become a novel strategy for decreasing cigarette use in non-treatment seeking smokers.Clinicaltrials.gov identifier: NCT04843969.

Momentary Associations Among Minority Stress, Craving, Affect, and Nicotine Use Among Sexual Minority Youth

OBJECTIVES

Sexual minority youth are more likely to use nicotine relative to heterosexual youth. The minority stress model posits these disparities are partly due to unique stress (i.e., minority stress) specific to their stigmatized identities. However, there is a dearth of research exploring the fine-grained dynamic interplay between minority stressors, mediating processes, and nicotine use in sexual minority youth's daily lives and natural environment. We leveraged ecological momentary assessment over a 30-day monitoring period to test the mediating effects of craving and negative and positive affect on the momentary associations between minority stressors and subsequent nicotine use among sexual minority youth who were active nicotine users and recruited from the community.

METHODS

Participants were 85 nicotine users, ages 15-19 years old (M age = 17.96, SD = 1.10; 56.6% cisgender female; 56.6% bisexual; 73.5% non-Hispanic White) and half (51.8%) were daily nicotine users.

RESULTS

Results indicated that exposure to a minority stressor was associated with momentary elevations in nicotine craving and negative affect and decreases in positive affect. Nicotine craving and positive affect were also associated with greater probability of subsequent nicotine use. The associations between minority stressors and subsequent nicotine use were mediated through craving and positive, but not negative affect.

CONCLUSIONS

Our findings provide the first ecological momentary assessment evidence of these associations among sexual minority youth and help support and advance both addictions and sexual minority-specific models (e.g., minority stress) of nicotine use among youth.

Brief Sensations Seeking Scale (BSSS): Validity Evidence in Mexican Adolescents

Sensation seeking is a construct associated with risky behaviors over a wide age range, but validation studies in Mexico are lacking. The aim of this study was to investigate the validity of two versions of the Brief Sensation Seeking Scale (the BSSS-8 and BSSS-4) in young Mexican individuals. The sample consisted of 2884 students (age: M = 16.6, SD = 1.5) from five preparatory schools in Morelos, Mexico. The internal structure of the BSSS was evaluated according to the structural equation modeling (SEM) parameterization, including measurement invariance (compared to the factor loadings obtained in the meta-analysis); conditional reliability; and equivalence between versions. The unidimensionality and measurement invariance (configurational, factor loadings, thresholds, intercepts, and residuals) across sex and age groups were satisfactory, and the factor loadings were highly congruent with those obtained in the meta-analysis. Reliability was suitably high (greater than 0.80), especially near the mean scores, but was lower for extreme scores. Thus, the instrument was concluded to be optimal for defining the construct of sensation seeking, consistent with the findings of previous studies.

[Self-determination and forensic addiction treatment : Reflections on the tension between patient autonomy and the preventive function of Sect. 64 of the German Criminal Code (StGB) from a psychiatric, ethical and normative perspective]

BACKGROUND

Among the current proposals for the upcoming reform of forensic addiction treatment according to Sect. 64 of the German Criminal Code (StGB), that of the DGPPN stands out as the most far-reaching. Among other things, it calls for making the ordering of the measure dependent on the consent of the defendant and the regular and voluntary demonstration of the willingness to undergo treatment. Prior to treatment in a forensic addiction facility, those affected should reliably participate in addiction-specific treatment offers in the prison setting.

AIMS

A critical reflection on the key assumptions and implications of this reform proposal with respect to treatment motivation and the right or ability to self-determination.

MATERIAL AND METHODS

These assumptions are analyzed and discussed from psychiatric, medical-ethical and legal-normative perspectives.

RESULTS AND DISCUSSION

Neither the setting nor the resources of a prison seem to make it a suitable place for the motivationally critical phases of (probationary) addiction treatment. The approach that only those who have previously demonstrated therapy motivation in word and deed should have the "advantage" of forensic withdrawal therapy, would not do justice to the complexity of substance use disorders and would lead to an overestimation of the already elusive concept of therapy motivation in the context of this disorder. Also, from an ethical perspective, self-determination in forensic addiction patients appears too understudied, both conceptually and empirically, to justify such a far-reaching approach. On a normative level, the new approach would remove an effective special prevention instrument from the hand and create an imbalance in the structure of sanctions.

The Effects of Immediate vs Gradual Reduction in Nicotine Content of Cigarettes on Smoking Behavior: An Ecological Momentary Assessment Study

BACKGROUND

In recent years, much research has examined the effects of various interventions and treatments for smoking cessation. The results suggest that interventions targeting changes of nicotine content can help smokers reduce tobacco use or quit smoking. A number of clinical studies show that smokers who received an immediate reduction in nicotine content to very low levels have significantly greater reductions in the number of cigarettes smoked and toxic substance exposure compared to those with gradual reductions. However, from the perspective of smoking craving, whether the immediate and gradual reduction in nicotine content reduce smoking by reducing cravings needs further investigation.

METHODS

74 eligible Participants were randomly allocated to one of the two experimental conditions: (1) immediate reduction to 0.1 mg of nicotine per cigarette (n = 40); (2) gradual reduction from 1.0 (0.8 g ~ 1.2 mg) to 0.1 mg of nicotine per cigarette (n = 34). All participants completed 1-week baseline period during which they smoked their usual cigarette, followed by 16-week of interventions. The primary outcomes included cigarette cravings and number of cigarettes smoked per day (CPD); secondary outcomes included the number of cigarette-free day and emotional states.

RESULTS

Among the 52 participants [51 (98.1%) men; mean (SD) age, 33.44 (6.71) years; mean (SD) CPD, 16.83 (9.94)] who completed the trial, significantly lower cravings for cigarettes were observed in the immediate (n = 25) vs. gradual nicotine reduction group (n = 27) in the morning (t = -2.072, p = 0.039) and after dinner (t = -2.056, p = 0.041). Compared with the baseline daily smoking, the number of cigarettes smoked per day was significantly reduced at the beginning of week 12 in the immediate nicotine reduction group (p = 0.001) and at week 16 in the gradual nicotine reduction group (p < 0.001). The number of participants with any cigarette-free day was not significantly different between the groups (p = 0.198). The number of cigarette-free days was significantly more in the immediate vs. gradual nicotine reduction group (p = 0.027).

CONCLUSIONS

The significantly lower cravings were observed in the immediate vs. gradual nicotine reduction group, and led to faster reduction in the number of CPD, and a significant increase in the number of cigarette-free days. These findings add to the evidence base for reduced nicotine content in cigarettes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier: ChiCTR2100048216.

Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study

BACKGROUND

Successful long-term recovery from opioid use disorder (OUD) requires continuous lapse risk monitoring and appropriate use and adaptation of recovery-supportive behaviors as lapse risk changes. Available treatments often fail to support long-term recovery by failing to account for the dynamic nature of long-term recovery.

OBJECTIVE

The aim of this protocol paper is to describe research that aims to develop a highly contextualized lapse risk prediction model that forecasts the ongoing probability of lapse.

METHODS

The participants will include 480 US adults in their first year of recovery from OUD. Participants will report lapses and provide data relevant to lapse risk for a year with a digital therapeutic smartphone app through both self-report and passive personal sensing methods (eg, cellular communications and geolocation). The lapse risk prediction model will be developed using contemporary rigorous machine learning methods that optimize prediction in new data.

RESULTS

The National Institute of Drug Abuse funded this project (R01DA047315) on July 18, 2019 with a funding period from August 1, 2019 to June 30, 2024. The University of Wisconsin-Madison Health Sciences Institutional Review Board approved this project on July 9, 2019. Pilot enrollment began on April 16, 2021. Full enrollment began in September 2021.

CONCLUSIONS

The model that will be developed in this project could support long-term recovery from OUD-for example, by enabling just-in-time interventions within digital therapeutics.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29563.

Rewarding Effects of Nicotine Self-administration Increase Over Time in Male and Female Rats

INTRODUCTION

Smoking and the use of other nicotine-containing products is rewarding in humans. The self-administration of nicotine is also rewarding in male rats. However, it is unknown if there are sex differences in the reward-enhancing effects of nicotine self-administration and if the rewarding effects of nicotine change over time.

METHODS

Rats were prepared with catheters and intracranial self-stimulation (ICSS) electrodes to investigate the effects of nicotine and saline self-administration on reward function. A decrease in thresholds in the ICSS procedure reflects an enhancement of reward function. The ICSS parameters were determined before and after the self-administration sessions from days 1 to 10, and after the self-administration sessions from days 11 to 15.

RESULTS

During the first 10 days, there was no sex difference in nicotine intake, but during the last 5 days, the females took more nicotine than the males. During the first 10 days, nicotine self-administration did not lower the brain reward thresholds but decreased the response latencies. During the last 5 days, nicotine lowered the reward thresholds and decreased the response latencies. An analysis with the 5-day averages (days 1-5, 6-10, and 11-15) showed that the reward enhancing and stimulatory effects of nicotine increased over time. There were no sex differences in the reward-enhancing and stimulatory effects of nicotine. The nicotinic receptor antagonist mecamylamine diminished the reward-enhancing and stimulatory effects of nicotine.

CONCLUSION

These findings indicate that the rewarding effects of nicotine self-administration increase over time, and there are no sex differences in the reward-enhancing effects of nicotine self-administration in rats.

IMPLICATIONS

This study investigated the rewarding effect of nicotine and saline self-administration in male and female rats. The self-administration of nicotine, but not saline, enhanced brain reward function and had stimulatory effects. The rewarding effects of nicotine increased over time in the males and the females. Despite that the females had a higher level of nicotine intake than the males, the reward-enhancing effects of nicotine self-administration were the same. These findings suggest that in new tobacco and e-cigarette users, nicotine's rewarding effects might increase quickly, and a higher level of nicotine use in females might not translate into greater rewarding effects.

Reactions to reduced nicotine content cigarettes in a sample of young adult, low-frequency smokers

RATIONALE

Reducing nicotine content in cigarettes to ≤ 2.4 mg per g of tobacco [mg/g] reduces smoking behavior and toxicant exposure among adult daily smokers. However, cigarettes with similar nicotine content could support continued experimentation and smoking progression among young adults who smoke infrequently.

OBJECTIVES

This study evaluated the threshold for nicotine in cigarettes that produces reactions associated with smoking progression in a sample of young adults who smoke infrequently.

METHODS

Young adults (n = 87, 18-25 years, 49% female) using tobacco products ≤ 15 days per month completed three counterbalanced, double-blinded sessions, each measuring positive and negative subjective reactions to fixed doses of smoke from investigational cigarettes containing one of three different nicotine contents: normal (NNC; 15.8 mg/g); very low (VLNC; 0.4 mg/g); and intermediate (INC; 2.4 mg/g). In a final session, participants chose one of the cigarettes to self-administer.

RESULTS

Post-cigarette breath carbon monoxide was greater for VLNC than for NNC (p < 0.001). Positive reactions were greater for NNC than INC (p < 0.001) and for INC than VLNC (p = 0.001). Negative reactions were greater for NNC than INC and VLNC (both p < 0.001); INC and VLNC did not differ. Cigarette choices did not differ from an even distribution (43% NNC, 25% INC, 32% VLNC), but choice for NNC or INC was associated with higher ratio of positive to negative reactions during the NNC and INC fixed dose sessions, respectively (p < 0.001).

CONCLUSIONS

Reducing nicotine content will likely lower the abuse liability of cigarettes for most young, low-frequency smokers. Additional work is needed to determine if compensatory smoking may lead to increased toxicant exposure, and if a subset of individuals choosing lower nicotine cigarettes may continue to smoke regardless of nicotine content.

Smoke signals: A study of the neurophysiological reaction of smokers and non-smokers to smoking cues inserted into antismoking public service announcements

Tobacco addiction is one of the biggest health emergencies in the world, Antismoking Public Service Announcements (PSAs) represent the main public tool against smoking; however, smoking-related cues (SCs) often included in PSAs can trigger ambiguous cerebral reactions that could impact the persuasiveness and efficacy of the antismoking message. This study aimed to investigate the electroencephalographic (EEG) response in adult smokers and non-smokers during the exposure to SCs presented in antismoking PSAs video, in order to identify eventual neurophysiological features of SCs' 'boomerang effect' elicited in smokers. EEG frontal Alpha asymmetry and frontal Theta were analyzed in 92 adults (30 no smokers, 31 low smokers, 31 high smokers) from EEG recorded during the vision of 3 antismoking PSAs, statistical analysis was conducted using ANOVA. Main results showed a significant interaction between smoking cue condition (Pre and Post) and smoking habit (in particular for female heavy smokers) for the frontal Alpha asymmetry. Since the relative higher right frontal Alpha activity is associated with approach towards a stimulus, it is suggested that the relative left frontal Alpha increase in response to SCs might reflect an appetitive approach in response to it. In the light of the Incentive Sensitization Theory, this pattern can be interpreted as a neurophysiological signal in response to SCs that could undermine the message's effectiveness contributing to the maintenance of the addiction.

Targeted smoking cessation for dual users of combustible and electronic cigarettes: a randomised controlled trial

Background

Although many smokers use electronic cigarettes (e-cigarettes) to quit smoking, most continue to smoke while vaping. This dual use might delay cessation and increase toxicant exposure. We aimed to test the efficacy of a self-help intervention designed to help dual users to quit smoking.

Methods

In this three-arm randomised controlled trial we recruited individuals in the USA using Facebook and multimedia advertisements. Included participants were 18 years or older, smoked at least weekly in the preceding year, and vaped at least weekly in the preceding month. We used computer generated randomisation with balanced-permuted blocks (block size 10, with 2–4-4 ratio) to allocate participants to assessment only (ASSESS group), generic smoking cessation self-help booklets (GENERIC group), or booklets targeting dual users (eTARGET group). Individuals in the generic or targeted intervention groups received monthly cessation materials for 18 months, with assessments every 3 months for 24 months. The main outcome was self-reported 7-day point-prevalence smoking abstinence at each assessment point. All randomly allocated participants were included in primary analyses using generalised estimating equations for each of 20 datasets created by multiple imputation. Analysis of the χ²s produced an F test. The trial is registered with ClinicalTrials.gov, NCT02416011, and is now closed.

Findings

Between July 12, 2016, and June 30, 2017, we randomly assigned 2896 dual users (575 to assessment, 1154 to generic intervention, and 1167 to targeted self-help). 7-day point-prevalence smoking abstinence increased from 14% at 3 months to 42% at 24 months (F_7,541·7=67·1, p<0·0001) in the overall sample. Targeted self-help resulted in higher smoking abstinence than did assessment alone throughout the treatment period (F_1,973·8=10·20, p=0·0014 [α=0·017]). The generic intervention group had abstinence rates between those of the assessment and targeted groups, but did not significantly differ from either when adjusted for multiple comparisons (GENERIC vs eTARGET F_1,1102·5=1·79, p=0·18 [α=0·05]; GENERIC vs ASSESS F_1,676·7=4·29, p=0·039 [α=0·025]). Differences between study groups attenuated after the interventions ended.

Interpretation

A targeted self-help intervention with high potential for dissemination could be efficacious in promoting smoking cessation among dual users of combustible cigarettes and e-cigarettes.

Dynamic associations between anxiety, depression, and tobacco use in older adults: Results from The Irish Longitudinal Study on Ageing

Evidence supports moderate-to-large reductions in anxiety, depression, and perceived stress after smoking cessation; however, much of the available evidence has focused on young adults. Therefore, this study quantified associations between smoking and smoking cessation on prevalent and incident generalised anxiety disorder (GAD) and major depression (MDD) in a nationally representative sample of Irish older adults. Participants (n = 6201) were community dwelling adults aged ≥50 years resident in Ireland. Smoking status and self-reported doctor diagnosis of anxiety or depression prior to baseline were assessed at baseline (i.e., Wave 2). At baseline and 2-, 4-, and 6-year follow-up (i.e., Waves 3-5), GAD and MDD were assessed by the Composite International Diagnostic Interview Short-Form. Logistic regression quantified cross-sectional and prospective associations (odds ratios (ORs) and 95% confidence intervals (95%CIs)) between smoking status and mental health. Prevalence and incidence of GAD was 9.1% (n = 566) and 2.8% (n = 148), respectively. Prevalence and incidence of depression was 11.1% (n = 686) and 6.4% (n = 342), respectively. Following full adjustment, current smokers had higher odds of prevalent GAD (OR = 1.729, 1.332-2.449; p < 0.001) and MDD (OR = 1.967, 1.548-2.499; p < 0.001) than non-smokers. Former smokers had higher odds of prevalent GAD than non-smokers (OR = 1.276, 1.008-1.616; p < 0.001). Current smokers did not have higher odds of incident MDD (OR = 1.399, 0.984-1.990; p = 0.065) or GAD than non-smokers (1.039, 0.624-1.730; p = 0.881). Findings may have important implications for interventions designed to curb tobacco abuse, which tend to be less successful among those with anxiety and depression.

Emotional symptoms and sensation seeking: Implications for tobacco interventions for youth and young adults

INTRODUCTION

Although emotional symptoms and sensation seeking are recognized as important risk factors for tobacco use among youth and young adults, to date, their joint influence on tobacco use has not been examined.

METHODS

Data used in this study are from the Texas Adolescent Tobacco and Marketing Surveillance study, a population-based cohort. At baseline, in 2014, participants were in the 10th grade. Mixed-effects logistic regression models examined associations between emotional symptoms and sensation seeking in 2014 and odds of past 30-day cigarette and e-cigarette use in 2018. Interactions between emotional symptoms and sensation seeking were examined to assess whether one modifies the effect of the other on cigarette and e-cigarette use.

RESULTS

After adjusting for age, sex, race/ethnicity, school type, and ever use of cigarettes or e-cigarettes at baseline, adolescents with high emotional symptoms (AOR_cig=1.97; 95% CI:1.07–3.60, and AOR_e-cig=1.68; 95% CI: 1.06–2.66) and with high sensation seeking tendencies (AOR_cig=2.05; 95% CI: 1.03–4.10, and AOR_e-cig=1.68; 95% CI: 1.02–2.76) had significantly higher odds of past 30-day cigarette and e-cigarette use four years later compared to adolescents with low emotional symptoms and low sensation seeking tendencies. The interaction was significant (p=0.01) for e-cigarette use only; among low sensation seekers, adolescents who reported high levels of emotional symptoms were at increased risk for past 30-day use (AOR_e-cig=3.43; 95% CI: 1.38–8.51), and among adolescents with low emotional symptoms, high sensation seekers were at increased for risk for past 30-day use (AOR_e-cig=3.50; 95% CI: 1.54–7.91).

CONCLUSIONS

It is important for tobacco use prevention programs to consider both behavioral risk factors – sensation seeking and emotional symptoms – in an integrative way, to target high risk subgroups and thereby increase the efficacy of existing effective intervention strategies in order to curb tobacco use among youth and young adults.

Self-control and smoking in a sample of adults living with HIV/AIDS: A cross-sectional survey

INTRODUCTION

Cigarette smoking prevalences are very high in persons living with HIV (PLWH). Identifying variables among PLWH that are linked to smoking in community samples (e.g., self-control) can inform smoking treatments for PLWH. The current study examined the association of self-reported self-control and smoking (e.g., smoking status, cigarette dependence) in a sample of PLWH.

METHODS

Adult PLWH were recruited from the Center for Positive Living (Montefiore Medical Center, Bronx, New York, US). All participants completed measures of demographics, cigarette smoking, and self-control. Participants who reported current cigarette smoking completed measures of cigarette dependence; intolerance for smoking abstinence; and motivation, confidence, and desire to quit smoking.

RESULTS

The overall sample included 285 PLWH (49.1% cigarette users, 55.4% male, 52.7% Black race, 54.8% Latino/a ethnicity). PLWH with current cigarette smoking reported lower self-control than PLWH with no current cigarette smoking (M = 116.88, SD = 17.07 versus M = 127.39, SD = 20.32; t = -4.15, df = 211, p < 0.001). Among PLWH with current cigarette smoking, lower self-control was associated with greater cigarette dependence (ρ = -0.272, p < 0.01), and lower confidence in quitting smoking cigarettes (ρ = 0.214, p < 0.05). Lower self-control was associated with greater overall smoking abstinence intolerance (ρ = -0.221, p < 0.05) and withdrawal intolerance (ρ = -0.264, p < 0.01).

DISCUSSION

Among a sample of PLWH, lower self-control was related to cigarette smoking (versus no smoking), greater cigarette dependence, lower confidence in quitting smoking, and greater intolerance for smoking abstinence. It may be useful to target self-control among PLWH to increase confidence in quitting and abstinence intolerance with the goal of improving smoking cessation outcomes.

Time-varying effects of 'optimized smoking treatment' on craving, negative affect and anhedonia

AIMS

To identify when smoking cessation treatments affect craving, negative affect and anhedonia, and how these symptoms relate to abstinence, to help evaluate the effects of particular intervention components in multi-component treatments and accelerate treatment refinement.

DESIGN

Secondary analysis of data from a two-arm randomized controlled trial.

SETTING

Seven primary care clinics in Wisconsin, United States.

PARTICIPANTS

Adult primary care patients who smoked daily (n = 574).

INTERVENTION AND COMPARATOR

Intervention was abstinence-optimized treatment (A-OT, n = 276) comprising 3 weeks of nicotine mini-lozenges pre-target quit day (TQD), 26 weeks of combination nicotine patch and mini-lozenges post-TQD and extensive psychosocial support. The comparator was recommended usual care (RUC, n = 298), comprising brief counseling and 8 weeks of nicotine patch post-TQD.

MEASUREMENTS

Time-varying effect models examined dynamic effects of A-OT (versus RUC) on the primary outcomes of nightly cigarette craving, negative affect and anhedonia from 1 week pre- to 2 weeks post-TQD. Exploratory models examined within-person relations between nicotine medication use and same-day symptom ratings. Secondary logistic regression analyses examined associations between post-TQD craving, negative affect and anhedonia and 1-month post-TQD abstinence.

FINDINGS

A-OT significantly suppressed pre- and post-TQD craving (β = -0.27 to -0.46 across days) and post-TQD anhedonia (β = -0.24 to -0.38 across days), relative to RUC. Within individuals, using patches was associated with lower negative affect in RUC (β = -0.42 to -0.52), but not in A-OT. Using more mini-lozenges was associated with greater craving (β = 0.04-0.07) and negative affect (β = 0.03-0.05) early, and with lower anhedonia (β = -0.06 to -0.12) later. Greater post-TQD craving (OR = 0.68) and anhedonia (OR = 0.85) predicted lower odds of abstinence 1 month post-TQD.

CONCLUSION

Time-varying effect models showed that a multi-component treatment intervention for smoking cessation suppressed significant withdrawal symptoms more effectively than recommended usual care among daily adult smokers motivated to quit. The intervention reduced craving pre- and post-target quit day (TQD) and anhedonia post-TQD.

Negative affect among daily smokers: A systematic review and meta-analysis

BACKGROUND

Negative Affect (NA), as a personality trait is a tendency towards experiencing a more negative emotion. The body of research suggests that NA encourages smoking relapse and smoking as a reason for NA reduction, though. The likelihood of this connection does not seem to be bright yet. The present study critically reviews researches to synthesize the existing literature to determine the strength of this linkage.

METHODS

Key-word related research was systematically searched in PubMed, PsychINFO, Science Direct and Google Scholar for studies conducted from 1980 to 2019, followed by, the assessment and selection of retrieved studies based on defined inclusion criteria. A random-effects meta-analysis model was used to examine the prospective relationship between NA and smoking. Meta-regression was also used to dig for possible explanations of heterogeneity. Furthermore a multi-moderators model and sub-group analyses examined the moderating factors.

RESULTS

Forty effect-sizes comprising 12 cross-sectional studies, 28 longitudinal studies and 24,913 participants were included in the meta-analysis. The forest plot of the pooled correlation effect size in the random model indicates a significant effect size of the relationship between NA and smoking (r = 0.11; 95%CI 0.071-0.15, P = 0.001) in the meta-analysis with high heterogeneity (Q = 473.916; df=39; P = 0.001; I2=91.77%). Also, the pooled effect size was obtained as 0.143 (95%CI 0.071-0.214) for light-to-moderate and 0.112 (95%CI 0.057-0.166) for moderate-to-heavy smokers, with the effect size ranging from 0.061 to 0.195 which was significant among all subtypes, though this trend seem higher among adolescents, males, and longitudinal studies than in adults, females, and cross-sectional studies.

LIMITATIONS

The review was limited to English articles, and the heterogeneity of the studies were high.

CONCLUSION

These results support the notion that NA was positively and weakly linked to smoking and this linkage is stronger in light-to-moderate smokers, males, and adolescents. Theoretical and clinical implications are discussed with the aim of extending future directions on NA and smoking.

Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders

This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.

Perceived Stress Mediates the Association between Deployment Sexual Trauma and Nicotine Dependence in Women Veterans

BACKGROUND

Rates of smoking and related health consequences are higher for women veterans as compared with their civilian counterparts, and trauma is a known risk factor associated with smoking. Military sexual trauma is prevalent among women veterans and associated with deleterious health outcomes, including tobacco use. However, research has not examined variables that may explain this association. The purpose of the present study was to examine the association between deployment sexual trauma (DST; military sexual trauma that occurs during deployment) and nicotine dependence, and whether perceived stress is a potential explanatory variable (i.e., mediator) in this relationship.

METHODS

Cross-sectional associations and Hayes mediation models were examined using baseline interview data from the Survey of Experiences of Returning Veterans sample (352 recently returned women veterans).

RESULTS

DST was associated with postdeployment nicotine dependence and greater perceived stress. Further, perceived stress was a significant mediator between DST and binary nicotine dependence (indirect effect [standard error] of DST on nicotine dependence through perceived stress, 0.04 [0.01]; 95% confidence interval, 0.01-0.07; odds ratio, 1.04; p < .01) when controlling for education.

CONCLUSIONS

Findings suggest that perceived stress may be a clinical target for decreasing nicotine dependence among women veterans who have experienced DST.

Oxytocin Reduces Cigarette Consumption in Daily Smokers

INTRODUCTION

Despite widespread knowledge of the dangers of cigarette consumption, smoking continues to be a public health concern. One compound that has shown potential for treatment in preclinical models is the neuropeptide oxytocin (OT). The purpose of the present study was to examine the effects of intranasal oxytocin on cigarette craving, behavioral economic demand for cigarettes, and cigarette consumption, in regular smokers after 18 hours of abstinence.

METHOD

Otherwise healthy daily smokers (n = 35) completed two sessions where they received OT (40 IU intranasal) or placebo (PBO) and completed measures of craving and cigarette demand, and they were given six opportunities to smoke partial cigarettes in exchange for money.

RESULTS

On average participants smoked few cigarettes after receiving OT than after receiving PBO, and they reported less desire for additional cigarettes during the smoking period. OT did not affect cigarette demand or standardized measures of cigarette craving.

CONCLUSIONS

This study suggests that OT decreases some indices of smoking desire and consumption, providing modest support for the idea that OT might be effective for reducing cigarette smoking.

IMPLICATIONS

This study provides new evidence that oxytocin might have clinical value in the treatment of addictive disorders, in this case tobacco addiction. The study adds to a growing literature suggesting that this neuropeptide, which is mainly known for its role in social bonding and attachment, may also affect mood and motivational states relevant to addiction.

Personal Social Networks in Later-Life Alcohol and Cigarette Use

This study examines the social network factors that influence health risk behaviors - specifically cigarette use and alcohol consumption - over time in a sample of older adults in the United States. Methods: Data are from Waves 1 (2005-2006) and 2 (2010-2011) of the National Social Life, Health, and Aging Project (NSHAP), a longitudinal study on health and social factors of older adults. The final analytic sample used for this study included 1,922 respondents who responded to both waves and who responded to questions concerning drinking and smoking behavior. Results: Using lagged dependent variable models, findings show that personal networks can have protective effects on smoking or drinking; more contact-days with alters lower odds of drinking (OR = 0.935, p < .01), and more alters in the same household lower odds of smoking (OR = 0.679, p < .05). Being able to discuss issues of health with others serves to reduce the adoption of smoking (OR = 0.555, p < .05). However, for current smokers and drinkers, personal networks are not necessarily protective from heavy smoking or drinking; more close ties increase odds of heavy drinking (OR = 1.531, p < .01), while networks have no significant associations with the odds of heavy smoking for current smokers. Conclusion: Context is important when evaluating the influence of social networks on health-compromising behaviors, as social networks can be protective from engaging in smoking/drinking behavior, but for those who currently smoke or drink, it has no relationship or can even be enabling for those who currently drink, making them more likely to be heavy drinkers.

Effectiveness of a brief information, motivation and behavioral skills program on stage transitions and lapse for individuals who use ketamine

OBJECTIVE

Chronic ketamine use is a significant public health and social problem in East and South East Asia and may lead to impairments in health and cognitive functioning. The study evaluated effects of an information, motivation and behavior skills (IMB) program on changes in motivational stage and ketamine use.

METHODS

Ketamine using individuals residing in the City of Taipei were recruited (N = 395): 279 selected an IMB program consisting of a 1-day workshop of six 50-minute interactive sessions provided in small groups. The remaining 116 participants selected an education-as-usual (EAU) program consisting of a 1-day workshop of six 50-minute didactic lectures provided in a large group format. Motivational stage of change and ketamine knowledge were assessed before and after the interventions. Participants were followed one year later to assess their ketamine use status.

RESULTS

No significant difference in knowledge increase between the IMB and EAU groups (p = .59). The proportion of participants who transitioned from the contemplation to preparation motivational stages was greater in the IMB group than in the EAU group (p < .01). A significant difference in the rates of ketamine lapse during a one-year post intervention follow up was observed between the IMB (50%) and EAU (75%) groups (p < .01).

CONCLUSIONS

Interventions based on IMB principles may be more effective in supporting motivational stage transition and in prevention of lapses to ketamine use as compared to currently offered standard drug education programs. Policy makers should consider including IMB interventions in their rehabilitation programs addressing ketamine use problems.

Shifts in momentary motivation to quit smoking based on experimental context and perceptions of motivational instability

BACKGROUND

Smoking quit intentions (i.e., plans or commitments to reduce smoking) are distinct from quit motivation (i.e., desire to quit). Motivation to quit is a dynamic avoidance motivational state, likely subject to frequent fluctuations and shifts based on environmental context, similar to craving (an approach motivational state). Moreover, people's perceptions of motivational instability may influence their momentary quit motivation and beliefs surrounding their abilities to manage the quit process successfully.

METHODS

In the current study, smokers were recruited online. Baseline motivation to quit was examined along with perceptions of motivational instability. Participants who reported some interest in eventually quitting (n = 174; M_age = 45.29, SD = 14.81, 74.1% women) were randomly assigned to negative affect, cigarette or neutral cue conditions and then momentary motivation to quit was assessed, followed by a validated index of quit intentions.

RESULTS

Participants in the negative affect and cigarette cue conditions reported greater momentary motivation to quit than participants in the neutral condition (F = 3.73, p = .03), particularly for people who reported upfront that their motivation did not change from day-to-day (F = 3.97, p = .02). In addition, greater momentary quit motivation predicted stronger quit intentions (B = 0.66, p < .001).

CONCLUSION

Findings from this study suggest that motivation to quit is likely dynamic and influenced by context as well as by self-perceptions. Implications suggest that further efforts to separate motivation from intention may be useful in understanding smokers' desires and plans to quit smoking.

Effect of Depressive Symptoms and Sex on the Relationship Between Loneliness and Cigarette Dependence: A Moderated Mediation

Loneliness is a subjective and emotionally unpleasant experience of perceiving insufficient social relationships. Previous research has revealed that loneliness constitutes a psychosocial risk factor for depression, and is also related to unhealthy behaviors such as smoking. This study aims to examine the relation between loneliness, depression, and cigarette dependence, and to explore the role of sex in this relationship. A total sample of 275 adult treatment-seeking daily smokers (Mage = 45.3; 61.5% females) was used. Our results showed a significant correlation between higher scores of loneliness, depressive symptoms, and cigarette dependence. In addition, mediation analysis showed a significant indirect effect of loneliness on cigarette dependence, via depressive symptoms. Regarding the effect of sex, we found that this variable significantly moderated the relationship between depressive symptoms and cigarette dependence. Results of this study extend previous literature by showing that, in treatment seeking smokers, loneliness is a significant predictor of depressive symptoms, and through this relation, it predicts cigarette dependence. Additionally, sex was a significant moderator of this relation. These findings have several clinical implications, and also contribute to the understanding of cigarette dependence, which is a well-known barrier for smoking cessation.

Racial/ethnic differences in perceived risks and benefits of quitting smoking in a sample of African American and Hispanic adults living with HIV/AIDS: A preliminary study

Persons living with HIV/AIDS (PLWH) report very high prevalences of cigarette smoking, and there are racial/ethnic disparities in smoking consequences and quit outcomes. In this exploratory pilot study, we examined racial/ethnic differences in perceived risks and benefits of quitting cigarette smoking among 97 adult PLWH in the Bronx, New York (Hispanic, 53.6%; African American, 46.4%). Compared to African American PLWH, Hispanic PLWH reported greater endorsement of overall risks and benefits and risks of negative affect, difficulty concentrating, social ostracism, loss of enjoyment, and cravings. It may be useful to incorporate risks and benefits of quitting into smoking treatment for African American and Hispanic PLWH.

Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial

INTRODUCTION

Behavioral Activation is a behavioral-based treatment that has been proposed as suitable for smoking cessation, as it simultaneously addresses reinforcement-related variables and also mood management. The aim of this study was to compare the effects of a cognitive-behavioral smoking cessation treatment with components of behavioral activation (SCBSCT-BA) with a standard cognitive-behavioral treatment (SCBSCT), and a wait-list control group (WL).

METHOD

The sample was comprised of 275 adults smokers (61.4% females, mean age = 45.36, SD = 10.96). After baseline assessment sessions, participants were randomized (ratio: 2.2.1.) to SCBSCT-BA, SCBSCT, or WL. Active groups received 8 weekly 1-hour face-to-face group sessions. Biochemically verified smoking abstinence and depressive symptoms were assessed at the end of treatment, and at 3-, 6-, and 12-month follow-ups.

RESULTS

Significant treatment effects in 7-dayspoint prevalence abstinence rates were found for both active groups at the end of treatment. Abstinence rates at 12-months follow-up were 30% for SCBSCT-BA, and 18% for SCBSCT. Using Multiple Imputation for missing data, regression analysis showed significantly greater ORs for the SCBSCT-BA condition (vs. SCBSCT) at the end of treatment and at 3-months follow-up. At 6-, and 12-months follow-ups, ORs for the SCBSCT-BA condition, although greater, did not reach statistical significance. Multilevel analysis showed that abstinence was related to reductions in depressive symptoms.

CONCLUSIONS

SCBSCT-BA obtained positive results at short and medium term. Participants who quit smoking experienced a significant reduction in depressive symptoms. Findings support the benefit of adding BA to a cognitive-behavioral smoking cessation treatment.

TRIAL REGISTRATION

www.clinicaltrials.gov NCT02844595.

Effect of transcranial direct current stimulation on the number of smoked cigarettes in tobacco smokers

BACKGROUND

Recent studies reported that transcranial direct current stimulation (tDCS) applied over the dorsolateral prefrontal cortex (DLPFC) reduced craving and cigarette smoking. We aimed to evaluate whether 3 sessions of tDCS over the DLPFC modulate cigarette smoking which is a critical factor in tobacco smokers.

METHODS

In a double-blinded, sham-controlled, parallel experimental study, 22 participants who wished to quit smoking received tDCS with the cathodal over the right DLPFC and anodal over the left DLPFC based on the 10-20 EEG international system (F4, F3) at an intensity of 1.5 mA for 20 minutes during three consecutive days. For sham stimulation, the electrodes placement was the same as for the active stimulation.

RESULTS

For the short time interval (8 days after the end of the tDCS regimen), the number of smoked cigarettes was reduced similarly in the active and sham groups (p < 0.001). Also, at the long time-interval (4 months after the end of the tDCS regimen) as compared to pre-tDCS, there was no significant difference in the number of smoked cigarettes in the active (p = 0.806) or the sham (p = 0.573) groups. Overall, there were no statistically significant differences between the active and sham tDCS groups on cigarette smoking.

CONCLUSION

These findings suggested that 3 sessions of tDCS over the right and left DLPFC may reduce number of smoked cigarettes for short-time period but might not be significantly more effective than sham to decrease cigarette smoking.

The link between parental smoking and youth externalizing behaviors: Effects of smoking, psychosocial factors, and family characteristics

This study examined the associations between parental cigarette smoking and youth externalizing behaviors (i.e., oppositional and conduct problems) both concurrently and 1 year later, and tested whether parental smoking predicted youth externalizing over and above parent psychosocial, family, and demographic characteristics linked to smoking and externalizing behaviors. Data were drawn from the Seattle Social Development Project (SSDP) and The Intergenerational Project (TIP), a prospective longitudinal study aimed toward understanding the intergenerational transmission of substance use, mental health, and risky behaviors. The current study used multilevel modeling to examine both concurrent and lagged associations from 325 families, which included parents and youth (Aged 6-19) across seven waves of data. In concurrent analyses, both parental smoking and several family characteristics independently predicted higher levels of child externalizing behaviors, even after controlling for parent age at child birth and demographic correlates of smoking. However, parental depressive symptoms reduced the association between smoking and externalizing behaviors to nonsignificance in concurrent models. In lagged analyses, only harsh parenting, low monitoring, and low parent-child bonding predicted externalizing behaviors 1 year later; parental smoking did not predict externalizing behaviors over time. Results showed that parental smoking, mental health, parenting, and family relationships all are associated with externalizing problems and constitute potential intervention targets in the short term, though poor parenting and parent-child bonding, rather than smoking, predicted externalizing behaviors over time. The robust association between concurrent parental depressive symptoms and youth conduct problems may suggest prioritizing parental mental health (e.g., via mental health screening) for improving both parent and child well-being. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Child and adolescent predictors of smoking involvement in emerging adulthood

OBJECTIVE

This study examined the differential relationship of externalizing behavior, internalizing behavior, social context, and their interactions to three developmental indicators of smoking involvement: onset (age), amount of smoking, and dependence symptomatology.

METHOD

Participants (n = 504, 73% male) from a high-risk community-based longitudinal study were followed from age 12-14 to young adulthood (18-20). Smoking involvement was conceptualized as a process involving differences in (a) age of onset of smoking, (b) amount of smoking at age 18-20, and (c) level of nicotine dependence symptomatology at age 18-20. Survival analysis was used to predict onset of smoking, regression for smoking level, and zero-inflated Poisson regression for nicotine dependence.

RESULTS

Externalizing (teacher report) and internalizing behavior (youth self-report), prior to the onset of smoking, predicted different components of smoking and nicotine dependence in young adulthood. Parental smoking predicted all levels of smoking involvement. Peer smoking was related to early onset of smoking, but not higher levels of smoking involvement. Externalizing and internalizing behavior interacted to predict nicotine dependence level, with higher levels of internalizing behavior predicting higher levels of dependence symptoms, even at low levels of externalizing behavior.

CONCLUSIONS

Externalizing and internalizing behavior and social context are independent and interacting risk factors that come into play at different points in the developmental process occurring between smoking onset and dependence. This study provides important information for theoretical models of smoking progression and shows that different types of risk should be targeted for prevention at different points in smoking progression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A randomized controlled trial of distress tolerance treatment for smoking cessation

We previously developed a distress tolerance (DT)-based treatment that showed promising results for smokers with a history of early lapse. In the current study, we conducted a randomized controlled trial of this DT treatment for a general population of smokers not limited to those with a history of early lapse. We randomized 116 participants (41% female) to DT or standard treatment (ST). Both treatments included 1 individual session during Week 1 followed by 7 group sessions during Weeks 2-9 (quit date at Session 4), two 20-min phone sessions, and 8 weeks of transdermal nicotine patch. Results indicated no significant differences between conditions in the primary outcome of biochemically verified 7-day point prevalence smoking abstinence or in time to 1st lapse. Verified abstinence rates in DT were 38.7%, 38.7%, 46.77%, 40.32%, 20.9%, and 17.7% versus 40.7%, 37.0%, 53.7%, 44.4%, 33.3%, and 22.2% in ST at 1, 2, 4, 8, 13, and 26 weeks postquit, respectively. Additionally, we found no significant moderators of treatment efficacy and few differences in treatment process variables. These findings stand somewhat in contrast to those in our previous study and other recent studies of similar acceptance-based treatments. However, differences in methodology, inclusion of nicotine replacement therapy in both treatment conditions, and strict inclusion-exclusion criteria that excluded many smokers with affective vulnerabilities may underlie this discrepancy. Future research should evaluate the utility of DT and other acceptance-based treatments in populations with affective vulnerabilities who might specifically benefit from a DT-based approach. (PsycINFO Database Record

The effect of parental smoking on preadolescents' implicit and explicit perceptions of smoking-related cues

Children of smokers are significantly more likely to experiment with cigarettes and become habitual smokers than children of nonsmokers. The current study examined the effect of parental smoking on children's implicit and explicit responses toward smoking behavior and smoking-related cues with the goal of identifying potential mechanisms for this relationship. A sample of 8-12-year-old children of smokers (n = 57) and children of nonsmokers (n = 86) completed a dot probe task to assess implicit attentional bias toward smoking cues and the Affect Misattribution Procedure (AMP) to assess implicit affective responses to smoking cues. In addition, children indicated their explicit perceptions of smokers and smoking behavior. Results demonstrated that children of smokers showed more sustained implicit attentional bias toward pictures of smoking stimuli presented alone than children of nonsmokers. Overall, participants showed negative implicit affective responses to smoking stimuli regardless of parental smoking. Children of smokers indicated that smokers would experience fewer negative consequences than children of nonsmokers; these relationships were moderated by age. Together, our findings suggest that parental smoking affects the ways that preadolescent children implicitly process smoking cues and their perceptions about smoking and its consequences. These findings help us understand the environmental mechanisms associated with smoking behavior in this vulnerable population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Individual differences in emotion dysregulation and trajectory of withdrawal symptoms during a quit attempt among treatment-seeking smokers

OBJECTIVE

Cigarette smoking remains the leading preventable cause of death in the United States, and withdrawal symptoms are central to the maintenance of tobacco use. Previous research suggests that individual differences in the propensity to experience negative affect may be related to more severe withdrawal symptoms. However, little research has examined how individual differences in the ability to regulate affect (emotion dysregulation) may impact withdrawal symptoms over time.

METHOD

Therefore, the current study examined the effects of emotion dysregulation on change in tobacco withdrawal symptoms over 12 weeks following a cigarette quit attempt among 188 (M_age = 38.52, SD = 14.00, 46.8% male) treatment seeking smokers.

RESULTS

Results from the study indicated greater emotion dysregulation was associated with greater quit day withdrawal symptoms as well as with as slower decline in withdrawal symptoms over the 12-week period (B = -0.001, SE = 0.001, p = .046).

CONCLUSION

The current study offers novel evidence into the role of emotion dysregulation in relation to withdrawal symptoms during a quit attempt. Assessing and reducing heightened emotion dysregulation prior to a quit attempt may be a potentially important therapeutic tactic for helping smokers achieve greater success in managing tobacco withdrawal.

PUBLIC HEALTH SIGNIFICANCE STATEMENT

This study emphasizes the ways in which emotional dysregulation may affect tobacco withdrawal symptoms. This study can be utilized to further target smoking cessation programs for those attempting to quit smoking.

Never, non-daily, and daily smoking status and progression to daily cigarette smoking as correlates of major depressive episode in a national sample of youth: Results from the National Survey of Drug Use and Health 2013 to 2015

BACKGROUND

Cigarette smoking is associated with depression, and new initiates who progress more quickly to daily smoking may be at enhanced risk. In a nationally representative sample of youth, this study examined the association between daily, non-daily, and never smoking with past-year and lifetime major depressive episode (MDE) and, among daily smokers, whether faster progression to daily smoking was associated with increased MDE risk.

METHODS

Data were from n = 44,921 youth aged 12-17 in the 2013-2015 National Survey on Drug Use and Health. Weighted adjusted multivariable logistic regression models were used to examine the association of smoking status (daily, non-daily, never) with lifetime and past-year MDE, and the association between progression from cigarette trial to daily smoking with MDE outcomes among daily smokers.

RESULTS

Daily and non-daily smokers had similar rates of lifetime and past-year MDE; rates of MDE were approximately 50% lower among never smokers. Compared to never smokers, adjusted models showed that non-daily smokers had a higher risk of past-year and lifetime MDE, while daily smokers had a higher risk of past-year but not lifetime MDE. Daily smoking youth who progressed more quickly from cigarette trial to daily use had an increased risk of both lifetime and past-year MDE.

CONCLUSIONS

Prevention programs should target factors associated with the shift from cigarette experimentation to regular use to curb deleterious consequences of use.

Early life adversity and health-risk behaviors: proposed psychological and neural mechanisms

Early life adversity (ELA) is associated with poorer health in adulthood, an association explained, at least in part, by increased engagement in health-risk behaviors (HRBs). In this review, we make the case that ELA influences brain development in ways that increase the likelihood of engaging in HRBs. We argue that ELA alters neural circuitry underpinning cognitive control as well as emotional processing, including networks involved in processing threat and reward. These neural changes are associated psychologically and behaviorally with heightened emotional reactivity, blunted reward responsivity, poorer emotion regulation, and greater delay discounting. We then demonstrate that these adaptations to ELA are associated with an increased risk of smoking cigarettes, drinking alcohol, and eating high-fat, high-sugar foods. Furthermore, we explore how HRBs affect the brain in ways that reinforce addiction and further explain clustering of HRBs.

Nicotine dependence, internalizing symptoms, mood variability and daily tobacco use among young adult smokers

INTRODUCTION

Cigarette use among young adults continues to rise. As young adults transition to college and assume other adult roles and responsibilities, they are at risk for the development of mental health problems and for the progression of substance use problems. Previous studies suggest that individual differences in negative and positive mood contribute to cigarette use in established college-aged smokers, but less is known whether fluctuations in mood influence daily cigarette use, controlling for trait levels of internalizing symptoms and nicotine dependence.

METHODS

Data for this study came from a sample of college students (N=39, 59% female, mean age 20.4years) who reported regular cigarette use and participated in a 21-day ecological momentary assessment (EMA) study assessing within-individual variation in cigarette use and mood.

RESULTS

A three-level hierarchical linear model accounting for the structure of 1896 occasions of cigarette use nested within days and individuals indicated that within-individual variability in positive mood was associated with cigarette use at each occasion, after taking into account baseline levels of nicotine dependence and internalizing problems.

CONCLUSIONS

Daily shifts in positive moods are importantly associated with consuming cigarettes throughout the day.

Associations between pain intensity and urge to smoke: Testing the role of negative affect and pain catastrophizing

BACKGROUND

Cigarette smokers are more likely to experience pain than nonsmokers, and experimental research indicates that pain is a potent motivator of smoking. Urge to smoke is a predictor of early relapse, yet associations between pain and urge to smoke have yet to be tested among daily smokers. This study aimed to conduct the first crosssectional test of associations between current pain intensity and urge to smoke, and to test the role of negative affect and pain catastrophizing in relations between pain intensity and urge to smoke.

METHODS

Participants (N = 229, 42.4% Female, 38.9% black/African American, Mcpd = 21.9) were recruited for a laboratory study of pain and smoking, and these data were collected at the baseline session. Data were analyzed using a series of regressions and conditional process models.

RESULTS

Current pain intensity was positively associated with urge to smoke, and urge to smoke for the relief of negative affect. There was an indirect association via state negative affect, such that pain intensity was positively associated with negative affect, which in turn was associated with greater urge to smoke. Further, positive associations between pain intensity and urge to smoke were only evident among smokers who endorsed low (vs high) levels of catastrophizing.

CONCLUSIONS

These findings contribute to an emerging literature indicating that pain and related constructs are relevant to the maintenance of tobacco smoking. Future research should examine how painrelevant cognitive-affective factors may influence associations between the experience of pain and motivation to smoke tobacco.

Impulsivity related personality traits and cigarette smoking in adults: A meta-analysis using the UPPS-P model of impulsivity and reward sensitivity

BACKGROUND

Although there is considerable evidence of an association between impulsivity and cigarette smoking, the magnitude of this association varies across studies. Impulsivity comprises several discrete traits that may influence cigarette use in different ways. The present meta-analysis aims to examine the direction and magnitude of relationships between specific impulsivity-related traits, namely lack of premeditation, lack of perseverance, sensation seeking, negative urgency, positive urgency and reward sensitivity and both smoking status and severity of nicotine dependence in adults across studies and to delineate differences in effects across these relationships.

METHODS

Ninety-seven studies were meta-analysed using random-effects models to examine the relationship between impulsivity-related traits and smoking status and severity of nicotine dependence. A number of demographic and methodological variables were also assessed as potential moderators.

RESULTS

Smoking status and severity of nicotine dependence were significantly associated with all impulsivity-related traits except reward sensitivity. Lack of premeditation and positive urgency showed the largest associations with smoking status (r = 0.20, r = 0.24 respectively), while positive urgency showed the largest association with severity of nicotine dependence (r = 0.23). Study design moderated associations between lack of premeditation and lack of perseverance and smoking status, with larger effects found in cross-sectional compared to prospective studies.

CONCLUSIONS

Finding suggest that impulsivity is associated with an increased likelihood of being a smoker and greater nicotine dependence. Specific impulsivity-related traits differentially relate to smoking status and severity of nicotine dependence. Understanding the complexity of impulsivity-related traits in relation to smoking can help to identify potential smokers and could inform cessation treatment.