Predicting smoking cessation and major depression in nicotine-dependent smokers

Multi-ancestral genome-wide association study of clinically defined nicotine dependence reveals strong genetic correlations with other substance use disorders and health-related traits

Genetic research on nicotine dependence has utilized multiple assessments that are in weak agreement. We conducted a genome-wide association study of nicotine dependence defined using the Diagnostic and Statistical Manual of Mental Disorders (DSM-NicDep) in 61,861 individuals (47,884 of European ancestry, 10,231 of African ancestry, 3,746 of East Asian ancestry) and compared the results to other nicotine-related phenotypes. We replicated the well-known association at the CHRNA5 locus (lead SNP: rs147144681, p =1.27E-11 in European ancestry; lead SNP = rs2036527, p = 6.49e-13 in cross-ancestry analysis). DSM-NicDep showed strong positive genetic correlations with cannabis use disorder, opioid use disorder, problematic alcohol use, lung cancer, material deprivation, and several psychiatric disorders, and negative correlations with respiratory function and educational attainment. A polygenic score of DSM-NicDep predicted DSM-5 tobacco use disorder and 6 of 11 individual diagnostic criteria, but none of the Fagerström Test for Nicotine Dependence (FTND) items, in the independent NESARC-III sample. In genomic structural equation models, DSM-NicDep loaded more strongly on a previously identified factor of general addiction liability than did a "problematic tobacco use" factor (a combination of cigarettes per day and nicotine dependence defined by the FTND). Finally, DSM-NicDep was strongly genetically correlated with a GWAS of tobacco use disorder as defined in electronic health records, suggesting that combining the wide availability of diagnostic EHR data with nuanced criterion-level analyses of DSM tobacco use disorder may produce new insights into the genetics of this disorder.

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.

Predictors of quitting smoking behavior: evidence from Pakistan

This study attempts to identify factors that significantly encourage the cessation of smoking in the context of Pakistan. The study distributes a modified questionnaire among 421 respondents (current as well as former smokers) in the capital city of Pakistan, Islamabad. The binary regression method was employed to data for analyzing predictors of making quit attempts and successful smoking cessation. The result indicates that respondents having strong intentions to quit, high socioeconomic status, low nicotine dependency, and past quit attempts, and those having no-smoking friends, are more likely to quit cigarette smoking successfully. On the other hand, factors like social pressure to quit smoking, religious information against smoking, intention to quit smoking, and public regulation on smoking are more likely to encourage smokers to make quit attempts. The study calls for community and school-wide smoking cessation campaigns involving officials, peers and parents, religious leaders, and other influential individuals to inform people about the dangers of smoking. In addition, religious leaders should be encouraged to issue rulings against smoking especially during "Friday Prayer." Furthermore, the government should pronounce more strict and comprehensive regulations on smoking by properly monitoring its implementation to encourage cessation of cigarette smoking.

Association of nicotine dependence and gut microbiota: a bidirectional two-sample Mendelian randomization study

Background

Nicotine dependence is a key factor influencing the diversity of gut microbiota, and targeting gut microbiota may become a new approach for the prevention and treatment of nicotine dependence. However, the causal relationship between the two is still unclear. This study aims to investigate the causal relationship between nicotine dependence and gut microbiota.

Methods

A two-sample bidirectional Mendelian randomization (MR) study was conducted using the largest existing gut microbiota and nicotine dependence genome-wide association studies (GWAS). Causal relationships between genetically predicted nicotine dependence and gut microbiota abundance were examined using inverse variance weighted, MR-Egger, weighted median, simple mode, weighted mode, and MR-PRESSO approaches. Cochrane's Q test, MR-Egger intercept test, and leave-one-out analysis were performed as sensitivity analyses to assess the robustness of the results. Multivariable Mendelian randomization analysis was also conducted to eliminate the interference of smoking-related phenotypes. Reverse Mendelian randomization analysis was then performed to determine the causal relationship between genetically predicted gut microbiota abundance and nicotine dependence.

Results

Genetically predicted nicotine dependence had a causal effect on Christensenellaceae (β: -0.52, 95% CI: -0.934-0.106, P = 0.014). The Eubacterium xylanophilum group (OR: 1.106, 95% CI: 1.004-1.218), Lachnoclostridium (OR: 1.118, 95% CI: 1.001-1.249) and Holdemania (OR: 1.08, 95% CI: 1.001-1.167) were risk factors for nicotine dependence. Peptostreptococcaceae (OR: 0.905, 95% CI: 0.837-0.977), Desulfovibrio (OR: 0.014, 95% CI: 0.819-0.977), Dorea (OR: 0.841, 95% CI. 0.731-0.968), Faecalibacterium (OR: 0.831, 95% CI: 0.735-0.939) and Sutterella (OR: 0.838, 95% CI: 0.739-0.951) were protective factor for nicotine dependence. The sensitivity analysis showed consistent results.

Conclusion

The Mendelian randomization study confirmed the causal link between genetically predicted risk of nicotine dependence and genetically predicted abundance of gut microbiota. Gut microbiota may serve as a biomarker and offer insights for addressing nicotine dependence.

Neurobiological associations between smoking and internalizing disorders

People with severe mental disorders have a higher mortality rate due to preventable conditions like cardiovascular diseases and respiratory diseases. Nicotine addiction is a preventable risk factor, with tobacco use being twice as high in people with mental disorders. An integrative model that divides mental disorders into externalising, internalising, and thought disorders could be useful for identifying common causalities and risk factors. This review aims to examine the interface between smoking and internalising disorders, specifically schizophrenia, depressive disorders, and anxiety disorders. The review finds that there is a clear association between smoking behaviour and these disorders. Schizophrenia is associated with polymorphisms that result in an imbalance between glutamate and GABA release and abnormalities of dopaminergic pathways. Nicotine improves dopaminergic signalling and balances glutamatergic and GABAergic pathways, improving symptoms and increasing the risk of nicotine dependence. In depressive disorders, smoking is associated with functional changes in brain regions affected by smoking and self-medication. In anxiety disorders, there is a bidirectional relationship with smoking, involving the amygdala and changes in dopaminergic pathways and cortisol production. Smoking poses a threat to people living with psychiatric disorders and calls for further research to assess the interactions between nicotine dependence and internalising and thought disorders.

Assessing the Evidence on the Differential Impact of Menthol versus Non-menthol Cigarette Use on Smoking Dependence in the US Population: A Systematic Review and Meta-analysis

Background: Menthol's effect on cigarette smoking behaviors is an intensely scrutinized US public health issue. This systematic review and meta-analysis examined the question: Does menthol cigarette use have a differential impact on smoking dependence compared with non-menthol cigarette use? Methods: We consulted 6 databases from inception to October 15, 2021. We included articles comparing menthol versus non-menthol cigarette smokers against predefined smoking dependence outcomes. Risk of bias was assessed using the AHRQ Evidence-Based Practice Center approach. We applied a random-effects model to pool adjusted odds ratios. Results: We synthesized 37 demographically adjusted studies. Meta-analytic results suggested non-menthol smokers were equally/more likely to report daily versus non-daily smoking; menthol use was associated with needing a cigarette within one hour; cigarettes per day was not associated with menthol use; menthol use was associated with a low (vs high) Heaviness of Smoking Index score; and results were either non-significant or associated menthol use with lower TTFC. Conclusions: Despite consistently good or fair quality adjusted studies across several measures, results were discordant depending on measures used and means of measurement. Overall, the evidence is insufficient to draw clear conclusions on a differential association between menthol (vs non-menthol) cigarette use and smoking dependence.

The Use of Psychoactive Substances in Germany

BACKGROUND

Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences.

METHODS

The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18-64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451).

RESULTS

Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million).

CONCLUSION

The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.

Tobacco cigarette smokers who endorse greater intolerance for nicotine withdrawal also report more severe insomnia symptoms

It has been suggested that nighttime nicotine withdrawal may help to explain why tobacco cigarette smokers are more likely than nonsmokers to experience clinically significant insomnia. There is also reason to believe that intolerance for withdrawal symptoms could play a role in withdrawal-related sleep disturbance. However, we are not aware of any previous research that examined whether smokers who endorse greater intolerance for smoking abstinence also report greater difficulty initiating and/or maintaining sleep. To address this question, 224 adult cigarette smokers (42.9% female, Mcigarettes per day = 21.3) completed the baseline portion of an experimental study that included assessment of current/historical smoking behavior, perceived intolerance for smoking abstinence, and insomnia severity and impact on functioning. The results indicated that, after accounting for general distress intolerance and sociodemographic factors, smokers who endorsed greater intolerance for nicotine withdrawal also reported greater insomnia severity and impact. Logistic regression further revealed that, for every 1-point increase in nicotine withdrawal intolerance scores, smokers were nearly twice as likely to score above threshold for clinically significant insomnia (p = .001). Collectively, these initial findings suggest that intolerance for nicotine withdrawal may warrant consideration as a potentially modifiable mechanistic factor in comorbid insomnia and nicotine/tobacco dependence. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use

BACKGROUND

DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis.

METHODS

The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses.

RESULTS

DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner.

CONCLUSION

DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.

Analysis of E-mental health research: mapping the relationship between information technology and mental healthcare

BACKGROUND

E-mental healthcare is the convergence of digital technologies with mental health services. It has been developed to fill a gap in healthcare for people who need mental wellbeing support that may not otherwise receive psychological treatment. With an increasing number of e-mental healthcare and research, this study aimed to investigate the trends of an e-mental health research field that integrates interdisciplinary fields and to examine the information technologies is being used in mental healthcare. To achieve the research objectives, bibliometric analysis, information extraction, and network analysis were applied to analyze e-mental health research data.

METHODS

E-mental health research data were obtained from 3663 bibliographic records from the Web of Science (WoS) and 3172 full-text articles from PubMed Central (PMC). The text mining techniques used for this study included bibliometric analysis, information extraction, and visualization.

RESULTS

The e-mental health research topic trends primarily involved e-health care services and medical informatics research. The clusters of research comprised 16 clusters, which refer to mental sickness, e-health, diseases, information technology (IT), and self-management. The information extraction analysis revealed a triple relation with IT and biomedical domains. Betweenness centrality was used as a measure of network graph centrality, based on the shortest path to rank the important entities and triple relation; nodes with higher betweenness centrality had greater control over the network because more information passes through that node. The IT entity-relations of "mobile" had the highest score at 0.043466. The top pairs were related to depression, mobile health, and text message.

CONCLUSIONS

E-mental related publications were associated with various research fields, such as nursing, psychology, medical informatics, computer science, telecommunication, and healthcare innovation. We found that trends in e-mental health research are continually rising. These trends were related to the internet of things (IoT) and mobile applications (Apps), which were applied for mental healthcare services. Moreover, producing AI and machine learning for e-mental healthcare were being studied. This work supports the appropriate approaches and methods of e-mental health research that can help the researcher to identify important themes and choose the best fit with their own survey work.

Psychometric properties of Fagerstrom Test of Nicotine Dependence: A systematic review

The Fagerstrom test for nicotine dependence (FTND) is a widely used test for assessing physical nicotine dependence. However, there is a need to assess the psychometric properties of FTND to assess its role in treatment outcome studies. The aim of the present investigation was to review the psychometric properties of the FTND. A broad systematic literature search was performed from Pubmed and PsycINFO from 2000 to 2019. The publication language was limited to English. Two review authors performed the study selection and extracted the data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Rayyan software used to screen relevant studies. A total of 1471 articles retrieved from the search, of which 33 studies fulfilled the inclusion criteria. Eleven studies related to testing the reliability of the FTND were analyzed. Twenty-five studies evaluated the Cronbach alpha of the test. Analysis of the studies revealed the questionable psychometric qualities of the adapted versions of the test across different cultures and ethnicity. It also suggested that it may not tap the appropriate constructs that would predict smoking patterns in light smokers, e-cigarette smokers, and smokeless tobacco users. Thus, further research must focus on improving the psychometric properties of FTND to enhance the measurement of nicotine dependence.

Translational Research in Nicotine Addiction

While commendable strides have been made in reducing smoking initiation and improving smoking cessation rates, current available smoking cessation treatment options are still only mildly efficacious and show substantial interindividual variability in their therapeutic responses. Therefore, the primary goal of preclinical research has been to further the understanding of the neural substrates and genetic influences involved in nicotine's effects and reassess potential drug targets. Pronounced advances have been made by investing in new translational approaches and placing more emphasis on bridging the gap between human and rodent models of dependence. Functional neuroimaging studies have identified key brain structures involved with nicotine-dependence phenotypes such as craving, impulsivity, withdrawal symptoms, and smoking cessation outcomes. Following up with these findings, rodent-modeling techniques have made it possible to dissect the neural circuits involved in these motivated behaviors and ascertain mechanisms underlying nicotine's interactive effects on brain structure and function. Likewise, translational studies investigating single-nucleotide polymorphisms (SNPs) within the cholinergic, dopaminergic, and opioid systems have found high levels of involvement of these neurotransmitter systems in regulating the reinforcing aspects of nicotine in both humans and mouse models. These findings and coordinated efforts between human and rodent studies pave the way for future work determining gene by drug interactions and tailoring treatment options to each individual smoker.

Success Factors for Tobacco Smoking Cessation Among Korean Female College Student Smokers

The purpose of this study was to identify factors that successfully influence to quit smoking in female college students. The study was conducted from September 1, 2015 to December 31, 2017. Participants included 477 female student smokers, the average age was 20.87 years. The participants received smoking cessation counseling over the course of nine visits and via telephone calls for a period of 6 months. Follow-up assessments were conducted at 4, 6, 12, and 24 weeks. The factors significantly associated with successful smoking cessation included the average number of cigarettes smoked per day, age of first smoking experience, nicotine dependency, number of counseling sessions, confidence, and readiness. The most influential factor was the number of counseling sessions. Hence, this study suggested to promote continuous counseling and to introduce counseling programs tailored to female students, which might increase their success rate of quitting.

Reciprocal influences of tobacco use on illicit opioid and alcohol use during the first six-months of specialist addiction treatment

BACKGROUND

This is the first national study of lagged reciprocal associations between tobacco smoking frequency and change in illicit opioid or alcohol use frequency within six-months of treatment.

METHODS

All adults admitted to publicly-funded specialist addiction treatment in England in 2018/19 and enrolled for at least six months for either opioid use disorder (OUD; n = 22,046; 82.4 % of those eligible) or alcohol use disorder (AUD; n = 15,251; 78.8 % of those eligible). Two cross-lagged panel models estimated, separately for OUD and AUD patients, the relationships between smoking at admission and change in main drug over six months, and between main drug use at admission and change in smoking over six months.

RESULTS

Within the OUD cohort, illicit opioid use frequency reduced from 17.7 days to 8.0 days and smoking tobacco remained at 18.8 days. After controlling for available covariates, higher smoking frequency at admission was associated with a relative increase in illicit opioid use at six-months (0.02 days [95 % CI 0.00-0.03]). Within the AUD cohort, alcohol use frequency reduced from 21.2 days to 14.4 days while smoking tobacco reduced from 12.6 days to 11.5 days. Higher smoking frequency at admission was associated with a relative increase in alcohol use at six-months (0.03 days [95 % CI 0.02-0.04]) and higher alcohol use frequency at admission was associated with a relative increase in smoking at six-months (0.04 [95 % CI 0.02-0.06]), controlling for available covariates.

CONCLUSIONS

Higher smoking frequency at admission is associated with higher illicit opioid and alcohol use frequency after six-months of specialist addiction treatment.

Expanding the genetic architecture of nicotine dependence and its shared genetics with multiple traits

Cigarette smoking is the leading cause of preventable morbidity and mortality. Genetic variation contributes to initiation, regular smoking, nicotine dependence, and cessation. We present a Fagerström Test for Nicotine Dependence (FTND)-based genome-wide association study in 58,000 European or African ancestry smokers. We observe five genome-wide significant loci, including previously unreported loci MAGI2/GNAI1 (rs2714700) and TENM2 (rs1862416), and extend loci reported for other smoking traits to nicotine dependence. Using the heaviness of smoking index from UK Biobank (N = 33,791), rs2714700 is consistently associated; rs1862416 is not associated, likely reflecting nicotine dependence features not captured by the heaviness of smoking index. Both variants influence nearby gene expression (rs2714700/MAGI2-AS3 in hippocampus; rs1862416/TENM2 in lung), and expression of genes spanning nicotine dependence-associated variants is enriched in cerebellum. Nicotine dependence (SNP-based heritability = 8.6%) is genetically correlated with 18 other smoking traits (rg = 0.40-1.09) and co-morbidities. Our results highlight nicotine dependence-specific loci, emphasizing the FTND as a composite phenotype that expands genetic knowledge of smoking.

Association between health-related quality of life and sense of coherence among health professionals working in primary health centers consuming tobacco in Jaipur, India

Background:

Health-related quality of life (HRQOL) and senses of coherence (SoC) can be affected by the use of tobacco. Hence, the aim of the present study was to explore the association between HRQOL and SoC among health professionals working in primary health centers (PHCs) consuming Tobacco.

Materials and Methods:

It was a cross-sectional descriptive study where sampling technique used was systematic stratified random sampling. Jaipur District has 37 PHCs retrieved from site of NRHM Rajasthan. A close-ended questionnaire was prepared to conduct the interview.

Results:

Majority of study participants (57; 37.01%) were of 36–40 years of age. Males respondents (86; 55.85%) consuming tobacco were more in number than female respondents. Majority of study subjects (91; 59.09%) consumed smoked kind of tobacco, in which most contributed were nurses (49; 62.82%). On applying a linear regression model, it was determined that all subscale of SF-36 was significantly (P ≤ 0.000) associated with SoC.

Conclusion:

From above, it was concluded that there was a strong association between HRQOL and SoC among health professionals working in primary health centers consuming tobacco.

Variants in the CHRNA5-CHRNA3-CHRNB4 Region of Chromosome 15 Predict Gastrointestinal Adverse Events in the Transdisciplinary Tobacco Use Research Center Smoking Cessation Trial

INTRODUCTION

Reducing adverse events from pharmacologic treatment is an important goal of precision medicine and identifying genetic predictors of adverse events is a step toward this goal. In 2012, King et al. reported associations between genetic variants and adverse events in a placebo-controlled smoking cessation trial of varenicline and bupropion. Strong associations were found between gastrointestinal adverse events and 11 variants in the CHRNA5-CHRNA3-CHRNB4 region of chromosome 15, a region repeatedly associated with smoking-related phenotypes. Our goal was to replicate, in an independent sample, the impact of variants in the CHRNA5-CHRNA3-CHRNB4 region on gastrointestinal adverse events and to extend the analyses to adherence and smoking cessation.

METHODS

The University of Wisconsin Transdisciplinary Tobacco Use Research Center (TTURC) conducted a multiarmed, placebo-controlled smoking cessation trial of bupropion and nicotine replacement therapy that included 985 genotyped European-ancestry participants. We evaluated relationships between our key variables using logistic regression.

RESULTS

Gastrointestinal adverse events were experienced by 31.6% TTURC participants. Each of the CHRNA5-CHRNA3-CHRNB4 associations from the King et al. study was found in TTURC, with the same direction of effect. Neither these variants nor the gastrointestinal adverse events themselves were associated with adherence to medication or successful smoking cessation.

CONCLUSIONS

Variants in the CHRNA5-CHRNA3-CHRNB4 region of chromosome 15 are associated with gastrointestinal adverse events in smoking cessation. Additional independent variants in this region strengthen the association. The consistency between the results of these two independent studies supports the conclusion that these findings reflect biological response to the use of smoking cessation medication.

IMPLICATIONS

The fact that our findings from the TTURC smoking cessation trial support the independent findings of King et al. suggest that associations of variants in the CHRNA5-CHRNA3-CHRNB4 region of chromosome 15 with gastrointestinal adverse events while taking medications for smoking cessation reflect biology. However, although adherence to medication was a strong predictor of successful smoking cessation in TTURC, neither adverse events nor the genetic variants associated with them predicted either adherence or successful cessation in this study. Thus, although we should strive to minimize adverse events during treatment, we should not expect that to increase successful smoking cessation substantially.

Associations between child maltreatment, cigarette smoking, and nicotine dependence in young adults with a history of regular smoking

PURPOSE

The purpose of this study was to evaluate whether childhood maltreatment is associated with smoking behaviors and lifetime nicotine dependence and if associations are moderated by sex. We examined these associations among individuals who ever reported being regular smokers.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined relationships between retrospectively self-reported child maltreatment (parent/caregiver-perpetrated emotional, physical, sexual abuse, and neglect; and non-parent/caregiver-perpetrated sexual abuse) and self-reported smoking behaviors among individuals with a history of regular smoking. Outcomes were any current smoking in early adulthood (mean age = 28 years), current smoking in adolescent study waves only, adulthood only, and adolescence and adulthood (n = 3581); and lifetime history of nicotine dependence (n = 3594) per the Fagerstrom scale.

RESULTS

Poly-maltreatment (aRR for 2+ vs. 0 exposures = 1.20, 95% CI: 1.08, 1.34) was associated with lifetime nicotine dependence; associations between nicotine dependence and neglect and non-parent/caregiver sexual abuse by force were only present in women. Neglect and non-parent/caregiver sexual abuse by nonphysical threat were associated with continued smoking, and an association between non-parent/caregiver sexual abuse by physical force and continued smoking was also noted in women only. Women who experienced poly-maltreatment were less likely to report current smoking in adolescence but not adulthood.

CONCLUSIONS

These data suggest in a nationally representative sample of ever regular smokers, child maltreatment is associated with outcomes that suggest an inability to quit smoking and some associations may vary by sex.

Translational Molecular Approaches in Substance Abuse Research

Excessive abuse of psychoactive substances is one of the leading contributors to morbidity and mortality worldwide. In this book chapter, we review translational research strategies that are applied in the pursuit of new and more effective therapeutics for substance use disorder (SUD). The complex, multidimensional nature of psychiatric disorders like SUD presents difficult challenges to investigators. While animal models are critical for outlining the mechanistic relationships between defined behaviors and genetic and/or molecular changes, the heterogeneous pathophysiology of brain diseases is uniquely human, necessitating the use of human studies and translational research schemes. Translational research describes a cross-species approach in which findings from human patient-based data can be used to guide molecular genetic investigations in preclinical animal models in order to delineate the mechanisms of reward circuitry changes in the addicted state. Results from animal studies can then inform clinical investigations toward the development of novel treatments for SUD. Here we describe the strategies that are used to identify and functionally validate genetic variants in the human genome which may contribute to increased risk for SUD, starting from early candidate gene approaches to more recent genome-wide association studies. We will next examine studies aimed at understanding how transcriptional and epigenetic dysregulation in SUD can persistently alter cellular function in the disease state. In our discussion, we then focus on examples from the literature illustrating molecular genetic methodologies that have been applied to studies of different substances of abuse - from alcohol and nicotine to stimulants and opioids - in order to exemplify how these approaches can both delineate the underlying molecular systems driving drug addiction and provide insights into the genetic basis of SUD.

Comparisons of early and delayed abstainers and its effects on long-term smoking cessation in Taiwan

Background

Different quitting trajectories may reflect the stages of behavior change among smokers. The nature of quitting patterns could help the public health sector to design appropriate cessation plans. This study compared demographic, health, and behavioral characteristics and the effects of long-term abstinence between early and delayed abstainers.

Methods

We retrospectively sampled 142 abstainers from smoking cessation clinic participants for a study conducted from January 1 to December 31, 2017. Baseline information was obtained at the first clinic visit, and phone interviews were conducted 2 weeks, 3 months, and 6 months later. The 7-day point prevalence abstinence was employed for measuring their quitting status. We defined early abstainers as those who attained abstinence by second week and delayed abstainers as those who had done so by the third month. We compared their characteristics and 6-month quit rates and examined potential predictors between the two quitting patterns.

Results

One hundred forty-two participants were included with 87 (61.3%) early abstainers and 55 (38.7%) delayed abstainers. Early abstainers were older with more comorbidities, presenting longer smoking duration, higher exhaled carbon monoxide (CO) concentration and Fagerstrom Test of Cigarette Dependence (FTCD) scores. The 6-month abstinence rate was high for both quitting patterns with no significant difference (83.9% versus 81.8%, p = 0.7462). Higher FTCD scores and exhaled CO concentration were potential predictors for early abstainers with adjusted odds ratio 1.16 (95% confidence interval [CI], 1.01–1.33) and 1.04 (95% CI, 1.00–1.08) respectively.

Conclusions

Our results associated early abstainers with older age, more comorbidities and higher nicotine dependence. Both groups achieved good long-term abstinence maintenance. Although early abstainers may achieve earlier reduction of health risks, smokers could still benefit from long-term abstinence if they can manage to quit smoking even at later phases of cessation courses.

Nicotine and alcohol: the role of midbrain dopaminergic neurons in drug reinforcement

Nicotine and alcohol addiction are leading causes of preventable death worldwide and continue to constitute a huge socio-economic burden. Both nicotine and alcohol perturb the brain's mesocorticolimbic system. Dopamine (DA) neurons projecting from the ventral tegmental area (VTA) to multiple downstream structures, including the nucleus accumbens, prefrontal cortex, and amygdala, are highly involved in the maintenance of healthy brain function. VTA DA neurons play a crucial role in associative learning and reinforcement. Nicotine and alcohol usurp these functions, promoting reinforcement of drug taking behaviors. In this review, we will first describe how nicotine and alcohol individually affect VTA DA neurons by examining how drug exposure alters the heterogeneous VTA microcircuit and network-wide projections. We will also examine how coadministration or previous exposure to nicotine or alcohol may augment the reinforcing effects of the other. Additionally, this review briefly summarizes the role of VTA DA neurons in nicotine, alcohol, and their synergistic effects in reinforcement and also addresses the remaining questions related to the circuit-function specificity of the dopaminergic system in mediating nicotine/alcohol reinforcement and comorbidity.

Not all smokers appear to seek nicotine for the same reasons: implications for preclinical research in nicotine dependence

Tobacco use leads to 6 million deaths every year due to severe long-lasting diseases. The main component of tobacco, nicotine, is recognized as one of the most addictive drugs, making smoking cessation difficult, even when 70 percent of smokers wish to do so. Clinical and preclinical studies have demonstrated consistently that nicotine seeking is a complex behavior involving various psychopharmacological mechanisms. Evidence supports that the population of smokers is heterogeneous, particularly as regards the breadth of motives that determine the urge to smoke. Here, we review converging psychological, genetic and neurobiological data from clinical and preclinical studies supporting that the mechanisms controlling nicotine seeking may vary from individual to individual. It appears timely that basic neuroscience integrates this heterogeneity to refine our understanding of the neurobiology of nicotine seeking, as tremendous progress has been made in modeling the various psychopharmacological mechanisms driving nicotine seeking in rodents. For a better understanding of the mechanisms that drive nicotine seeking, we emphasize the need for individual-based research strategies in which nicotine seeking, and eventually treatment efficacy, are determined while taking into account individual variations in the mechanisms of nicotine seeking.

Validation of a brief behavioral economic assessment of demand among cigarette smokers

Basic and clinical addiction research use demand measures and analysis extensively to characterize drug use motivations. Hence, obtaining an accurate and brief measurement of demand that can be easily utilized in different settings is highly valued. In the current study, 2 versions of a breakpoint measure, designed to capture cigarette demand, were investigated in 119 smokers who were recruited from an online crowdsourcing platform. The first version determines the maximum price a smoker is willing to pay for one cigarette received right now when paid out of pocket, and the second determines the maximum price when paid using a hypothetical $100 gift card received for free. The breakpoint measures were administered along with the Cigarette Purchase Task (CPT), Fagerström Test for Cigarette Dependence (FTCD), and The Questionnaire of Smoking Urges (QSU-brief). Both single-item breakpoint versions were significantly correlated with CPT-derived demand measures loaded on the persistence factor (i.e., elasticity of demand, breakpoint, Pmax, and Omax), but not with those loaded on the amplitude factor (i.e., intensity of demand). In addition, both single-item measures were associated with metrics of tobacco dependence (e.g., FTCD, QSU) with effect sizes that are similar to the ones found between CPT-derived breakpoint and those same metrics. These findings suggest that the single-item breakpoint measure is a viable method for measuring demand that may provide a useful and efficient tool to capture crucial and distinct aspects of smoking. In addition, the breakpoint measures may help increase the utility of behavioral demand measures in novel research and clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cross-Sectional Study to Characterise Nicotine Dependence in Central Vietnamese Men

Tobacco is legally permitted for adults, easily available, and the prevalence of smoking is high. Tobacco use is the largest preventable risk factor for human disease. To reduce smoking, many countries have introduced public policy to restrict the distribution of tobacco. The aim of this study was to analyse tobacco smoking and nicotine dependence in Central Vietnamese men around Hue and Da Nang cities. Nicotine dependence was measured using the Fagerström Test for Nicotine Dependence (FTND) score. The cohort contained total of 1822 Central Vietnamese men from Hue and Da Nang: 1453 smokers and 369 non-smokers. Individuals completed a questionnaire and factors such as smoking initiation, quitting behaviour, and success in quitting were also recorded. In the smoking group, the average amount of time in which the individual had smoked was 26.4 years. Average FTND value was 4.02, median was 4, the first quartile was 2, and the third quartile was 6. In all, 431 smokers (30%) had an FTND score of 6 or higher; an FTND score of this value is considered to equate to an individual having high nicotine dependence. Therefore, it could be noted that high nicotine dependence is very common in Central Vietnam. High nicotine dependence was significantly correlated with years of smoking. The longer the smoking period, the higher the FTND score. A high FTND score correlated with the individual being less likely to successfully quit smoking. The results of the questionnaire demonstrate that even when there is no restriction in public policy concerning the distribution of tobacco, individuals still wish to quit smoking. This study identified a high prevalence of severe nicotine dependence in Central Vietnamese men and the majority smokers wished to quit smoking. Consequently, the results of this study highlight the acute need for a specific programme to aid smokers in Central Vietnam to quit smoking.

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

INTRODUCTION

Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.

METHODS

The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.

RESULTS

Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day.

CONCLUSIONS

Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.

Genome-wide association study across European and African American ancestries identifies a SNP in DNMT3B contributing to nicotine dependence

Cigarette smoking is a leading cause of preventable mortality worldwide. Nicotine dependence, which reduces the likelihood of quitting smoking, is a heritable trait with firmly established associations with sequence variants in nicotine acetylcholine receptor genes and at other loci. To search for additional loci, we conducted a genome-wide association study (GWAS) meta-analysis of nicotine dependence, totaling 38,602 smokers (28,677 Europeans/European Americans and 9925 African Americans) across 15 studies. In this largest-ever GWAS meta-analysis for nicotine dependence and the largest-ever cross-ancestry GWAS meta-analysis for any smoking phenotype, we reconfirmed the well-known CHRNA5-CHRNA3-CHRNB4 genes and further yielded a novel association in the DNA methyltransferase gene DNMT3B. The intronic DNMT3B rs910083-C allele (frequency=44-77%) was associated with increased risk of nicotine dependence at P=3.7 × 10-8 (odds ratio (OR)=1.06 and 95% confidence interval (CI)=1.04-1.07 for severe vs mild dependence). The association was independently confirmed in the UK Biobank (N=48,931) using heavy vs never smoking as a proxy phenotype (P=3.6 × 10-4, OR=1.05, and 95% CI=1.02-1.08). Rs910083-C is also associated with increased risk of squamous cell lung carcinoma in the International Lung Cancer Consortium (N=60,586, meta-analysis P=0.0095, OR=1.05, and 95% CI=1.01-1.09). Moreover, rs910083-C was implicated as a cis-methylation quantitative trait locus (QTL) variant associated with higher DNMT3B methylation in fetal brain (N=166, P=2.3 × 10-26) and a cis-expression QTL variant associated with higher DNMT3B expression in adult cerebellum from the Genotype-Tissue Expression project (N=103, P=3.0 × 10-6) and the independent Brain eQTL Almanac (N=134, P=0.028). This novel DNMT3B cis-acting QTL variant highlights the importance of genetically influenced regulation in brain on the risks of nicotine dependence, heavy smoking and consequent lung cancer.

Comorbid Cannabis and Tobacco Use Disorders in Hospitalized Patients with Psychotic-Spectrum Disorders

OBJECTIVE

Individuals with psychotic-spectrum disorders use tobacco and cannabis at higher rates than the general population and individuals with other psychiatric disorders, which may contribute to increased rates of medical problems and mortality. The present study examined whether individuals with psychosis and comorbid tobacco and/or cannabis use disorders exhibit differing clinical characteristics in terms of their sociodemographic, mental health, substance use, physical health, and medication use patterns. Elucidation of these profiles, and determining their relative severity, has important implications for treatment, including offering more targeted interventions based on type of comorbidity pattern.

METHODS

We examined the electronic medical records of 829 patients with psychotic-spectrum disorders admitted to a psychiatric hospital and categorized them as having: (1) cannabis use disorder (CUD); (2) tobacco use disorder (TUD); (3) comorbid cannabis and tobacco use disorders (CUD + TUD); or (4) neither disorder (no CUD/TUD). Multinomial logistic regression was used to compare the aforementioned groups on multiple variables controlling for age and sex.

RESULTS

Alcohol and stimulant use disorder diagnoses were each related to higher odds of having a CUD and CUD + TUD, relative to no CUD/TUD. Stimulant and polysubstance use disorder diagnoses were each related to higher odds of having a TUD compared to no CUD/TUD. Greater number of prescribed psychotropic medications was related to higher odds of a TUD compared to no CUD/TUD.

CONCLUSIONS

Although several differences between groups were accounted for by age of cannabis versus tobacco users, findings point to the importance of considering comorbid alcohol and substance use disorders among those with psychosis and CUD/TUD, as these comorbidities have important implications for screening and treatment selection during and following acute hospitalization.

Lifetime Depression, Other Mental Illness, and Smoking Cessation

Objectives In this study, we attempt to elucidate the relationship between lifetime mental illness (LMI), particularly a depression diagnosis, and smoking cessation. Methods Data were drawn from a previous study and include LMI, demographics, mood, and smoking cessation outcomes. We evaluated the relationship between multiple LMIs and smoking cessation at 7 months post-intervention, and depression in combination with another LMI. Results At 7 months, the adjusted odds of cessation for those with one LMI, including depression, were 0.74 (p = .102), and for those with 2+ LMIs, 0.69 (p = .037), both in comparison with participants who reported no history of LMI. Among those with 2+ LMIs, the adjusted odds of cessation for those with a depression diagnosis were 0.34 (p = .007) compared to those whose multiple LMIs did not include depression. Conclusions Among smokers seeking cessation treatment, those who had 2+ LMIs were at greater risk of relapse, an effect particularly marked in smokers with depression. This study adds to the literature examining the potential impact of LMI on smokers' ability to quit by considering the potential impact of 2+ LMIs and highlights the potential impact of depression as a risk factor for continued smoking.

Nicotinic receptors mediate stress-nicotine detrimental interplay via dopamine cells' activity

Epidemiological studies report strong association between mood disorders and tobacco addiction. This high comorbidity requires adequate treatment but the underlying mechanisms are unknown. We demonstrate that nicotine exposure, independent of drug withdrawal effects, increases stress sensitivity, a major risk factor in mood disorders. Nicotine and stress concur to induce long-lasting cellular adaptations within the dopamine (DA) system. This interplay is underpinned by marked remodeling of nicotinic systems, causing increased ventral tegmental area (VTA) DA neurons' activity and stress-related behaviors, such as social aversion. Blocking β2 or α7 nicotinic acetylcholine receptors (nAChRs) prevents, respectively, the development and the expression of social stress-induced neuroadaptations; conversely, facilitating α7 nAChRs activation specifically in the VTA promotes stress-induced cellular and behavioral maladaptations. Our work unravels a complex nicotine-stress bidirectional interplay and identifies α7 nAChRs as a promising therapeutic target for stress-related psychiatric disorders.

Factors Correlated with Success Rate of Outpatient Smoking Cessation Services in Taiwan

Smoking is the leading cause of preventable death. The purpose of this study was to explore the patient’s and physician’s factors that are correlated with smoking cessation success rate. A total of 877 smokers who visited the outpatient smoking cessation services at a medical center in Northern Taiwan were recruited for the study. Phone interviews were carried out six months after the initial visit to evaluate the success rate of smoking cessation. The result showed that the abstinence rate at six-month was 37.7%. By the multivariate logistic regression model, the predictive factors of abstinence were smokers who had a lower Fagerström test for cigarette dependence (FTCD), lower exhaled carbon monoxide (CO) concentration, or who smoked less than 20 cigarettes per day at the first visit. Smokers who had more than one smoking cessation outpatient visit or seen by physicians who, on average, delivered more than one smoking cessation consultations per week also led to a higher success rate. Therefore, we suggest that physicians should put more efforts and encourage follow-up visits for some smokers by knowing their characteristics at the first visit. Furthermore, physicians with more experience in smoking cessation consultation seemed to be more likely to help patients to quit smoking successfully.

The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder

INTRODUCTION

People with chronic opioid use disorder often present to treatment with individual and structural vulnerabilities and remain at risk of reporting adverse health outcomes. This risk is greatly compounded by tobacco smoking, which is highly prevalent among people with chronic opioid use disorder. Despite the known burden of tobacco smoking on health, the relationship between nicotine dependence and health has not been studied among those receiving injectable opioid agonist treatment. As such, the present study aims to explore the association between nicotine dependence and physical health among participants of the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) at baseline and six-months.

METHODS

SALOME was a double-blind phase III clinical trial testing the non-inferiority of injectable hydromorphone to injectable diacetylmorphine for chronic opioid use disorder. Participants reporting tobacco smoking were included in a linear regression analysis of physical health at baseline (before receiving treatment) and at six-months.

RESULTS

At baseline, nicotine dependence score, lifetime history of emotional, physical, or sexual abuse and prior month safe injection site access were independently and significantly associated with physical health. At six-months nicotine dependence score was the only variable that maintained this significant and independent association with physical health.

CONCLUSIONS

Findings indicate that after six-months, the injectable treatment effectively brought equity to patients' physical health status, yet the association with nicotine dependence remained. Findings could inform whether the provision of treatment for nicotine dependence should be made a priority in settings where injectable opioid agonist treatment is delivered to achieve improvements in overall physical health in this population.

Associations between opioid and nicotine dependence in nationally representative samples of United States adult daily smokers

INTRODUCTION

Smoking prevalence among adults with opioid dependence far exceeds that of the general population, and cessation outcomes in this group are one-fourth that of smokers without a substance use disorder. Understanding the reasons underlying these poor outcomes is critical for developing more effective smoking interventions in this group. Elevated baseline severity of nicotine dependence is associated with lower rates of smoking cessation over time. We examined whether nicotine dependence severity among smokers may vary as a function of opioid dependence status using nationally representative samples of adult smokers.

METHODS

Data were derived from multiple years of the National Survey on Drug Use and Health (NSDUH, 2006-2014; n = 58,971). Nicotine dependence was measured by the Nicotine Dependence Syndrome Scale (NDSS) and the first item (i.e., time to first cigarette) of the Fagerström Test for Nicotine Dependence (FTND). Opioid dependence was assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria.

RESULTS

Opioid-dependent smokers exhibited greater severity of nicotine dependence compared to non-opioid dependent smokers, as evidenced by higher mean NDSS scores (p < 0.05). On both NDSS and FTND measures of nicotine dependence, opioid-dependent smokers were also approximately twice as likely to be dependent on nicotine than those not dependent on opioids (p's < 0.05).

CONCLUSIONS

Opioid dependence is associated with increased severity and prevalence of nicotine dependence among smokers. Considering the disproportionate societal and economic burdens of smoking and smoking-related consequences in this vulnerable population, continued investigations are needed to better understand opioid-dependent individuals' poor cessation outcomes.

Pathways to precision medicine in smoking cessation treatments

Cigarette smoking is highly addictive and modern genetic research has identified robust genetic influences on nicotine dependence. An important step in translating these genetic findings to clinical practice is identifying the genetic factors affecting smoking cessation in order to enhance current smoking cessation treatments. We reviewed the significant genetic variants that predict nicotine dependence, smoking cessation, and response to cessation pharmacotherapy. These data suggest that genetic risks can predict smoking cessation outcomes and moderate the effect of pharmacological treatments. Some pharmacogenetic findings have been replicated in meta-analyses or in multiple smoking cessation trials. The variation in efficacy between smokers with different genetic markers supports the notion that personalized smoking cessation intervention based upon genotype could maximize the efficiency of such treatment while minimizing side effects, thus influencing the number needed to treat (NNT) and the number needed to harm. In summary, as precision medicine is revolutionizing healthcare, smoking cessation may be one of the first areas where genetic variants may identify individuals at increased risk. Current evidence strongly suggests that genetic variants predict cessation failure and that cessation pharmacotherapy effectiveness is modulated by biomarkers such as nicotinic cholinergic receptor α5 subunit (CHRNA5) genotypes or nicotine metabolism ratio (NMR). These findings strengthen the case for the development and rigorous testing of treatments that target patients with different biological risk profiles.

Preparing the Way: Exploiting Genomic Medicine to Stop Smoking

Clinical medicine of the future is poised to use an individual's genomic data to predict disease risk and guide clinical care. The treatment of cigarette smoking and tobacco use disorder represents a prime area for genomics implementation. The genes CHRNA5 and CYP2A6 are strong genomic contributors that alter the risk of heaviness of smoking, tobacco use disorder, and smoking-related diseases in humans. These biomarkers have proven analytical and clinical validity, and evidence for their clinical utility continues to grow. We propose that these biomarkers harbor the potential of enabling the identification of elevated disease risk in smokers, personalizing smoking cessation treatments, and motivating behavioral changes. We must prepare for the integration of genomic applications into clinical care of patients who smoke.

[Not Available]

Zusammenfassung. Diese Empfehlungen sollen dazu dienen, Fachpersonen das Wissen über die aktuelle Evidenz von Diagnostik und Therapie der Depression im Alter zur Verfügung zu stellen und damit zur frühzeitigen Erkennung und evidenzbasierten Behandlung beizutragen. Da für einige Behandlungsansätze nur rudimentär kontrollierte Studien vorliegen, wird auch das klinische Expertenwissen in die Beurteilung einbezogen. Im diagnostischen Vorgehen wird die besondere Symptomatik der Depression im Alter beleuchtet, auf die Suizidalität eingegangen und werden die häufig vorkommenden somatischen Komorbiditäten hervorgehoben. Auch Hypothesen zur Pathogenese, wie Neuroendokrinologie, Neurodegeneration und vaskuläre Faktoren, werden erläutert. In der Behandlung gilt heute ein integrierter biopsychosozialer Ansatz mit gezielten psychosozialen Interventionen, spezifischer Psychotherapie und einer antidepressiven Pharmakotherapie bei schweren Depressionen als sinnvoll. Daneben kommen auch chronobiologische oder Neurostimulationsverfahren zum Einsatz.

Effects of lorcaserin (Belviq®) on nicotine- and food-maintained responding in non-human primates

BACKGROUND

Accumulating evidence suggests that the FDA-approved serotonin 5-HT2C receptor agonist, lorcaserin (Belviq®), may be a promising candidate for the management of substance use disorders, including nicotine addiction. The present study was conducted to determine the efficacy and selectivity of acute or continuous lorcaserin treatment for decreasing the reinforcing effects of nicotine in a primate species.

METHODS

Adult rhesus monkeys (n=4) with a history of nicotine self-administration (>2years) responded for injections of nicotine (0.32-100μg/kg IV) or food pellets under a fixed-ratio schedule of reinforcement during daily 100-min sessions. When responding was stable, lorcaserin was administered either as an acute pretreatment (0.1-1.0mg/kg, IM) or by continuous infusion (0.1mg/kg/hr, SC for 3-5days). Daily activity patterns were also monitored immediately following experimental sessions.

RESULTS

Results indicate that acute lorcaserin pretreatment produced significant and dose-dependent decreases in nicotine-maintained responding across a >100-fold range of self-administered nicotine doses. Continuous lorcaserin treatment decreased intake of 10μg/kg/inj nicotine to about 50% of baseline values. Food-maintained responding was only moderately decreased in 3 of 4 subjects after acute administration and unaffected in all subjects during continuous treatment. Daily activity also was significantly decreased-to ≤50% of control values-following experimental sessions in which acute lorcaserin was administered.

CONCLUSIONS

These data indicate that lorcaserin reduces IV self-administration of nicotine at a dose that decreases motoric activity but less consistently disrupts food-maintained responding. Further research into lorcaserin's potential utility for the management of nicotine dependence is warranted.

Cigarette dependence and depressive symptoms as predictors of smoking status at five-year follow-up after a workplace smoking cessation program

Workplace smoking cessation interventions increase quit rates compared to no treatment or minimal interventions. However, most studies report data up to one year. This study aims to evaluate long-term effects of a worksite smoking cessation intervention based on cognitive behavioral cessation groups combined with first-line medications, and determine to what extent cigarette dependence (FTCD) and depressive symptoms may influence results at five-year follow-up. Participants were invited to answer a short survey five years after starting the program. A total of 90.4% (n=227) of those who had attended at least one treatment session and were alive, completed the survey. At the five-year follow-up, 29.5% participants reported continuous abstinence. Low scores in the FTCD and low depressive symptoms at baseline predicted continuous abstinence. Three out of four continuous abstainers at twelve months remained abstinent at the five-year follow-up. The study shows that workplace smoking cessation interventions have long-term effects and supports the traditional one-year follow-up period to assess smoking cessation.

Prenatal tobacco exposure, maternal postnatal nicotine dependence and adolescent risk for nicotine dependence: Birth cohort study

AIMS

The goals of this study are to determine if there is (a) a threshold effect for prenatal tobacco exposure (PTE) on adolescent risk for nicotine dependence, and (b) an additive effect of PTE and maternal postnatal nicotine dependence on adolescent risk for nicotine dependence.

METHODS

Pregnant women were recruited in their 4th or 5th gestational month and asked about cigarette use during the first trimester. Mothers reported on third trimester cigarette use at delivery. Sixteen years post-partum, mothers and offspring reported on current levels of cigarette use (N=784). Nicotine dependence was assessed in both using a modified Fagerström questionnaire.

RESULTS

Based on the results of a threshold analysis for PTE, four groups were created: threshold PTE only (10+ cigarettes per day), maternal nicotine postnatal dependence with no-low PTE (0-<10 cigarettes per day), threshold PTE+maternal postnatal nicotine dependence, and a referent group with no-low PTE and no maternal postnatal nicotine dependence. Adolescents in the PTE-only group and the PTE+maternal postnatal nicotine dependence group were significantly more likely to be at risk for nicotine dependence than the offspring from the referent group. However, there was no evidence for an additive effect of maternal postnatal nicotine dependence, and maternal nicotine dependence was not a significant predictor of adolescent risk for nicotine dependence in regression models including prenatal tobacco exposure.

CONCLUSIONS

Bivariate analysis revealed a threshold effect for PTE of 10 cigarettes per day. In multivariate analysis, PTE remained significantly related to risk for offspring nicotine dependence, after controlling for maternal postnatal nicotine dependence and other covariates associated with adolescent cigarette use.

Increased Risk of Major Depression With Early Age of Exposure to Cigarettes

INTRODUCTION

This study examined the association between age of initiation of cigarette use and increased risk of lifetime major depressive episode.

METHODS

This study utilized publicly available data from the 2013 National Survey on Drug Use and Health involving a nationally representative sample of interviews of 55,160 randomly selected people aged ≥12 years. Analysis was conducted in 2016. Age of initiation of cigarette use was divided into four groups (≤12 years, 13-14 years, 15-18 years, and >18 years). Eligible participants included adults aged ≥18 years who had ever smoked a cigarette and had non-missing data for all analytic variables (n=23,906). Associations between lifetime major depressive episode and covariates were assessed using chi-square tests. Logistic regression was used to calculate crude ORs and AORs with 95% CIs.

RESULTS

About half of participants reported starting cigarette use when they were aged 15-18 years. Compared with the group that initiated cigarette use at age ≤12 years, all other age groups were from 25% to almost 50% less likely to report a lifetime major depressive episode.

CONCLUSIONS

Early age of onset of cigarette use is associated with increased likelihood of experiencing a lifetime major depressive episode. Further research is needed to elucidate the mechanisms driving this association.

Substanzkonsum in der Allgemeinbevölkerung in Deutschland

Zusammenfassung. Ziel: Die Verbreitung des Substanzkonsums in der erwachsenen Allgemeinbevölkerung Deutschlands soll anhand aktueller Daten dargestellt werden. Methodik: Datengrundlage bildete der Epidemiologische Suchtsurvey 2015, eine bundesweite Befragung in der Wohnbevölkerung von 18 bis 64 Jahren (n = 9,204; Rücklaufquote: 52.2 %). Probanden wurden zum Gebrauch von Tabak, Alkohol, illegalen Drogen und Medikamenten befragt. Ergebnisse: In den letzten 30 Tagen hatten 28.7 % der Befragten Tabakprodukte genutzt. Den Konsum von Alkohol in diesem Zeitraum berichteten 72.8 %. Hinweise auf klinisch relevanten Konsum in den letzten 12 Monaten wiesen 28.3 % (Männer) bzw. 9.6 % (Frauen) auf. Die 12-Monats-Prävalenz illegaler Drogen lag bei 6.1 % für Cannabis und bei maximal 1 % für alle anderen Substanzen. Unter Medikamenten hatten Schmerzmittel die höchste Gebrauchsprävalenz (47.1 %) sowie die geringste Prävalenz täglichen Gebrauchs unter Nutzern (8.6 %). Schlussfolgerungen: Die Ergebnisse belegen die nach wie vor hohe Verbreitung des Substanzkonsums in der Allgemeinbevölkerung. Konsumprävalenz sowie Hinweise auf klinisch relevanten Konsum sind in Bezug auf legale Substanzen, die eine hohe Verfügbarkeit charakterisiert, am häufigsten. Hinweise auf klinisch relevanten Konsum illegaler Drogen bestanden bei deutlich weniger Personen. Da es sich dabei jedoch um eine besondere Risikogruppe handelt, ist deren Erreichung durch adäquate Angebote sicherzustellen.

Zeitliche Entwicklungen im Substanzkonsum in der deutschen Allgemeinbevölkerung

Zusammenfassung. Ziel: Ziel der Studie ist die Analyse von Trends des (klinisch relevanten) Konsums von Tabak, Alkohol, Cannabis und anderen illegalen Drogen sowie der Einnahme von Medikamenten zwischen 1995 und 2015. Methodik: Datengrundlage bilden acht Erhebungswellen des Epidemiologischen Suchtsurveys (ESA) aus den Jahren 1995 bis 2015. Die Befragungen erfolgten schriftlich, telefonisch oder online. Eine einheitliche Darstellung zeitlicher Trends ist für den Altersbereich 18 bis 59 Jahre möglich. Ergebnisse: Der Tabakkonsum hat in den letzten 20 Jahren abgenommen. Trenddaten des Alkoholkonsums zeigen sinkende Konsumwerte für Männer und stabile Werte für Frauen. Die Prävalenz des Rauschtrinkens ist bei Frauen seit dem Jahr 2009 angestiegen. Der Cannabiskonsum hat zwischen 2012 und 2015 bei beiden Geschlechtern zugenommen. Der wöchentliche Gebrauch von Schmerzmitteln ist angestiegen, während bei Schlaf-/Beruhigungsmitteln ein Rückgang zu verzeichnen ist. Indikatoren eines klinisch relevanten Konsums zeigen für Cannabis keine Änderungen, für Tabak einen Rückgang und für Medikamente einen Anstieg. Hinweise auf klinisch relevanten Alkoholkonsum sind bei Männern konstant geblieben und bei Frauen angestiegen. Schlussfolgerungen: Die weite Verbreitung insbesondere der legalen Substanzen legt einen dringenden Handlungsbedarf für Prävention und Intervention nahe. Als besondere Zielgruppe wurden Frauen identifiziert, bei denen der klinisch relevante Konsum von Alkohol und Medikamenten zugenommen hat.

Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial

AIMS

To examine the ability of different common measures of cigarette dependence to predict smoking cessation during pregnancy.

DESIGN

Secondary analysis of data from a parallel-group randomized controlled trial of physical activity for smoking cessation. The outcomes were biochemically validated smoking abstinence at 4 weeks post-quit and end-of-pregnancy.

SETTING

Women identified as smokers in antenatal clinics in 13 hospital trusts predominantly in southern England, who were recruited to a smoking cessation trial.

PARTICIPANTS

Of 789 pregnant smokers recruited, 784 were included in the analysis.

MEASUREMENTS

Using random-effect logistic regression models, we analysed the effects of baseline measures of cigarette dependence, including numbers of cigarettes smoked daily, Fagerström Test of Cigarette Dependence (FTCD) score, the two FTCD subscales of Heaviness of Smoking Index (HSI) and non-Heaviness of Smoking Index (non-HSI), expired carbon monoxide (CO) level and urges to smoke (strength and frequency) on smoking cessation. Associations were adjusted for significant socio-demographic/health behaviour predictors and trial variables, and area under the receiver operating characteristic (ROC) curve was used to determine the predictive ability of the model for each measure of dependence.

FINDINGS

All the dependence variables predicted abstinence at 4 weeks and end-of-pregnancy. At 4 weeks, the adjusted odds ratio (OR) (95% confidence interval) for a unit standard deviation increase in FTCD was 0.59 (0.47-0.74), expired CO = 0.54 (0.41-0.71), number of cigarettes smoked per day 0.65 (0.51-0.84) and frequency of urges to smoke 0.79 (0.63-0.98); at end-of-pregnancy they were: 0.60 (0.45-0.81), 0.55 (0.37-0.80), 0.70 (0.49-0.98) and 0.69 (0.51-0.94), respectively. HSI and non-HSI exhibited similar results to the full FTCD.

CONCLUSIONS

Four common measures of dependence, including number of cigarettes smoked per day, scores for Fagerström Test of Cigarette Dependence and frequency of urges and level of expired CO, all predicted smoking abstinence in the short term during pregnancy and at end-of-pregnancy with very similar predictive validity.

Impact of self-reported lifetime depression or anxiety on effectiveness of mass distribution of nicotine patches

BACKGROUND

Large-scale public health initiatives providing free nicotine replacement therapy have been shown to increase smoking cessation rates; however, their effectiveness among the highly prevalent population of smokers with depression and anxiety disorders has not been explored. The aim of this study was to investigate the influence of lifetime history of depression or anxiety on smoking cessation success following the free distribution of nicotine patches.

METHOD

In the context of a randomised controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomised to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Participants were divided into subgroups based on the presence of self-reported lifetime diagnosis of depression and anxiety.

RESULTS

Irrespective of self-reported lifetime history of depression or anxiety, odds of self-reported cessation at 6 months were significantly greater among groups receiving nicotine patches compared to no intervention control (no history of depression or anxiety: OR 2.20; 95% CI 1.05 to 4.63; history of depression or anxiety present: OR 3.90; 95% CI 1.28 to 11.88). Among nicotine patch recipients only, quit outcomes did not differ between those with and without self-reported lifetime depression or anxiety in models unadjusted and adjusted for differences in demographic and smoking characteristics.

CONCLUSIONS

The mass distribution of free nicotine patches (without behavioural support) is effective among smokers with or without lifetime history of depression or anxiety alike, providing further support for the adoption of similar initiatives as a means of promoting tobacco cessation on a population level.

TRIAL REGISTRATION NUMBER

NCT01429129, Post-results.

Genome-wide single nucleotide polymorphism heritability of nicotine dependence as a multidimensional phenotype

BACKGROUND

Heritability estimates from twin studies of the multi-faceted phenotype of nicotine dependence (ND) range from moderate to high (31-60%), but vary substantially based on the specific ND-related construct examined. The current study estimated the aggregate role of common genetic variants on key ND constructs.

METHOD

Genomic-relationship-matrix restricted maximum likelihood (GREML) was used to decompose phenotypic variance across multiple ND indices using 796 125 polymorphisms from 2346 unrelated 'lifetime ever smokers' of European ancestry. Measures included DSM-IV ND and Fagerström Test for Nicotine Dependence (FTND) summary measures and constituent constructs (e.g. withdrawal severity, tolerance, heaviness of smoking and time spent smoking). Exploratory and confirmatory factor models were used to describe the covariance structure across ND measures; resulting factor(s) were the subject(s) of GREML analyses.

RESULTS

Factor models indicated highly correlated DSM-IV and FTND factors for ND (0.545, 95% confidence interval 0.50-0.60) that could be represented as a higher-order factor (NIC DEP). Additive genetic influence on NIC DEP was 33% (s.e. = 0.14, p = 0.009). Post-hoc analyses indicated moderate genetic effects on the DSM-IV (34%, s.e. = 0.14, p = 0.008) and FTND (26%, s.e. = 0.14, p = 0.032) factors, both of which were influenced by the same genetic effects (r G-SNP = 1.00, s.e. = 0.09, p < 0.00001).

CONCLUSIONS

Overall, common single nucleotide polymorphisms accounted for a large proportion of the genetic influences on ND-related phenotypes that have been observed in twin studies. Genetic contributions across distinct ND scales were largely influenced by shared genetic factors.

Tobacco consumption and positive mental health: an epidemiological study from a positive psychology perspective

Background

Positive mental health (PMH) is much more than the absence of mental illnesses. For example, PMH explains that to be happy or resilient can drive us to live a full life, giving us a perception of well-being and robustness against everyday problems. Moreover, PMH can help people to avoid risky behaviours like tobacco consumption (TC). Our hypothesis was that PMH is negatively associated with TC, and this association differs across rural, urban and migrant populations.

Methods

A cross-sectional study was conducted using the PERU MIGRANT Study’s dataset, including rural population from the Peruvian highlands (n = 201), urban population from the capital city Lima (n = 199) and migrants who were born in highlands but had to migrated because of terrorism (n = 589). We used an adapted version of the 12-item Global Health Questionnaire to measure PMH. The outcome was TC, measured as lifetime and recent TC. Log-Poisson robust regression, performed with a Maximum Likelihood method, was used to estimate crude prevalence ratios (PR) and 95 % confidence intervals (95%CI), adjusted by sex, age, family income and education which were the confounders. The modelling procedure included the use of LR Test, Akaike information criteria (AIC) and Bayesian information criteria (BIC).

Results

Cumulative occurrence of tobacco use (lifetime TC) was 61.7 % in the rural group, 78 % in the urban group and 76.2 % in rural-to-urban migrants. Recent TC was 35.3 % in the rural group, 30.7 % in the urban group and 20.5 % in rural-to-urban migrants. After adjusting for confounders, there was evidence of a negative association between PMH and lifetime TC in the rural group (PR = 0.93; 95%CI: 0.87–0.99), and a positive association between PMH and recent TC in migrants (PR = 1.1; 95%CI: 1.0–1.3).

Conclusions

PMH was negatively associated with TC in rural participants only. Urbans exhibited just a similar trend, while migrants exhibited the opposite one. This evidence represents the first step in the route of knowing the potential of PMH for fighting against TC. For rural populations, this study supplies new information that could support decisions about prevention programmes and psychotherapy for smoking cessation. However, more research in the topic is needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-016-0130-7) contains supplementary material, which is available to authorized users.

A Review of Impact of Tobacco Use on Patients with Co-occurring Psychiatric Disorders

Consumption of tobacco has been a worldwide problem over the past few decades due to the highly prevalent tobacco-attributable complications. Tobacco use has also been found to be more prevalent in patients with psychiatric disorders. Therefore, we conducted this review about the impact of tobacco use on co-occurring psychiatric disorders. Various facets of this interaction between tobacco use among those with co-occurring psychiatric disorders have been explored. It has been found that people with psychiatric disorders have a higher chance of currently smoking tobacco and lesser chance of cessation. Tobacco use and mental disorders continue to share a complex relationship that has been further evolving after the change in the pattern of tobacco use and also the advent of newer modalities of treatment. However, at the same time, it is believed that cessation of smoking may lead to improvement in the symptoms of mental illness.

Smoking cessation and depressive symptoms at 1-, 3-, 6-, and 12-months follow-up

BACKGROUND

The relationship between tobacco and depressive symptoms has been examined. However, there is little information on the evolution of these symptoms when an individual quits. The aim of this study was to analyze the evolution of depressive symptoms over time (pre-, post-treatment, 1-, 3-, 6-, and 12-months follow-up) in relation to smoking status 12 months after having received a psychological treatment for smoking cessation.

METHOD

The sample was made up of 242 adults who received cognitive-behavioral treatment for smoking cessation (64.4% women; mean age=41.71 years). The BDI-II was used to assess depressive symptomatology. Participants were classified into three groups according to smoking status at 12-months follow-up (abstainers, relapsers, and smokers).

RESULTS

There were no significant differences in depressive symptoms among the three groups at pretreatment. At the end of treatment, abstainers and relapsers presented less depressive symptomatology than smokers. At follow-up, abstainers continued to present less depressive symptomatology than smokers, whereas in relapsers, symptoms began to increase as the relapses occurred. Regarding the evolution of depressive symptomatology, the abstainer and relapser groups showed a significant reduction at the end of treatment. Only in the group of abstainers did the decrease continue during 12 months follow-up.

LIMITATIONS

The decrease of the initial sample size from 562 to 242 participants. Variables such as self-esteem and self-efficacy were not assessed.

CONCLUSIONS

Smoking cessation is associated with a decrease in depressive symptomatology, that is maintained over time. In contrast, relapse is associated with an increase of such symptoms. These findings signify the potential importance of addressing depressive symptomatology in smoking cessation treatment.