Smoking cessation in women. Special considerations

To quit or not to quit? estimating the causal effects of Türkiye's indoor smoking ban on the intentions to quit smoking

BACKGROUND

Smoking bans aim to reduce tobacco use, but their long-term effectiveness remains uncertain. This study investigates short- and long-term causal effects of Türkiye's indoor smoking ban policy on the intentions to quit smoking among adults.

METHODS

Using three waves of data (2008, 2012, and 2016) from the Global Adult Tobacco Survey (GATS), we analyse the changes in intentions to quit smoking before and after the implementation of indoor smoking ban policy in July 2009. The analysis includes data from 2008 as the pre-policy period, 2012 as the short post-policy period, and 2016 as a long post-policy period, to observe both initial and sustained effects.

RESULTS

Results indicate a modest positive effect shortly after the ban's implementation, with a 2% increase in the log odds of intention to quit smoking in 2012 among the individuals exposed to the ban. However, by 2016, the effect appears to vanish, with a 11% decrease in the log odds of intention to quit smoking among those exposed to the ban over a prolonged period.

CONCLUSIONS

Overall, the study suggests that while the smoking ban initially encouraged quitting intentions, its effect did not sustain over time, emphasizing the need for the controls of society compliance and of policy implementations.

Reasons for cigarette and tobacco product use, dual use, and poly use among university students

INTRODUCTION

Tobacco use remains a significant public health issue worldwide, causing over 7 million deaths annually. Polytobacco use has become a common phenomenon. This study aims to analyze reasons for cigarette and tobacco product use, dual use and poly use among university students by sex, in China and Cyprus, selected owing to their still high consumption rates.

METHODS

An online survey was conducted among 589 university students (55% women) with a mean age of 24.2 years from Guangzhou, China, and the Republic of Cyprus. Participants reported their use of cigarettes, e-cigarettes, and waterpipes, as well as their reasons for using these products. Statistical analyses included chi-squared tests, and effect sizes were computed using the phi (φ) coefficient.

RESULTS

The Chinese participants gave as reasons for using cigarettes: 'because of the taste', 'because it looks cool', 'to get high' and 'because friends and family use them'. These were less frequently given by the Cypriots who opted more for 'to relax and relieve tension'. Compared to the Cypriot participants, the more frequent reasons given for consuming e-cigarettes and waterpipes among Chinese students were: 'due to boredom', 'because it looks cool', 'to get high', 'because I am hooked', 'because friends or family members use them', 'because they are less harmful than regular cigarettes' and 'because friends of family members allow their use more'. Dual or poly users felt more addicted than those who practiced single use. Among e-cigarette users, dual users and poly users valued the taste of the product more than single users. In general, men found more reasons for tobacco use than women did.

CONCLUSIONS

This study shows substantial differences in the motivation for using these products according to the product type, number of tobacco/nicotine products used, country, and sex. Understanding the reasons for tobacco use can inform targeted interventions aimed at reducing tobacco consumption among young adults.

Reprint of: Sex differences in appeal, reward, and sensory experience of E-cigarette flavors among adults who smoke cigarettes

OBJECTIVE

Flavors enhance nicotine e-cigarette appeal by altering sensory experience. Females may be more sensitive to tobacco-associated cues and uniquely affected by flavor. The current study is an exploratory analysis to examine differences by sex on reward, appeal, and sensory experience of popular e-cigarette flavors.

METHODS

Adults (N = 121) who use cigarettes (≥1 cigarette/day) were enrolled in a laboratory study in which they vaped four e-cigarette flavors (tobacco, cherry, menthol, vanilla; in separate lab sessions) in one of two freebase nicotine concentrations (6 mg/ml,18 mg/ml). Following exposures, participants rated e-cigarette reward using the Drug Effects Questionnaire (DEQ), flavor and overall e-cigarette appeal using Labeled Hedonic Scales (LHS), and intensity of flavor, irritation, coolness, fruitiness, and sweetness using Generalized Labeled Magnitude Scales (gLMS). Linear mixed models were conducted for outcomes to analyze effects of sex, flavor, and sex x flavor interaction.

RESULTS

For DEQ ratings, there was a trend (p = .08) toward a sex x flavor interaction, in which menthol flavor produced more reward than other flavors for females, but not males. For LHS ratings, there was a significant sex x flavor interaction (p = .03) for overall e-cigarette experience with females but not males rating menthol higher than other flavors. All gLMS scales but irritation showed that females generally had greater differences between flavors compared to males (ps ≤ 0.03).

CONCLUSION

Menthol in e-cigarettes may play an important role in mediating appeal and/or reward among females. This may be due in part to their ability to better detect sensory effects of e-cigarettes.

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.

Sex-specific predictive factors of smoking cessation in subjects at high cardiovascular risk

Smoking is a major risk factor for cardiovascular diseases (CVD), in particular in women, but smoking cessation (SC) reduces or even cancels the risk for both sexes. Using a nationwide SC services database, we aimed to determine the predictive factors of SC in men and women smokers with CV risk factors (CVRF) or CVD. A retrospective study from the French CDTnet database was conducted. Inclusion criteria were age ≥18years, and≥1 CVRF (Body Mass Index ≥25kg/m2, hypertension, diabetes, hypercholesterolemia) or CVD (myocardial infarction (MI) or angina pectoris, stroke, peripheral arterial disease [PAD]). Self-reported smoking abstinence (≥28 consecutive days) was confirmed by exhaled carbon monoxide<10ppm. Logistic regression analysis assessed the association between SC and sociodemographic, medical characteristics, and smoking profile. Among the 36,864 smokers at high CV risk, abstinence rate was slightly lower in women than in men, (52.6% [n=8,102] vs 55.0% [n=11,848], P<0.001). For both sexes, factors associated with the lowest abstinence rates were diabetes, respiratory and psychiatric diseases, anxiolytic/antidepressant use, and cannabis consumption. In women, the factors associated with smoking abstinence were suffering from MI or angina and taking contraceptive pill and the factors associated with persistent smoking were alcohol disorder and high cigarette consumption. In men, there was a positive relationship between overweight and abstinence while being dual users of cigarettes and electronic cigarettes at first visit, having tobacco-related diseases (cancer and PAD) and taking opioid substitution treatment were associated with persistent smoking. Finally, in both sexes, the factors associated with abstinence were: age≥65years, having a diploma, being employed, self-referred or encouraged by entourage, ≥1 previous quit attempt, ≤20 cigarettes per day consumption, benefiting from SC medication prescription and ≥4 follow-up visits. In conclusion, our results suggest the relevance of SC intensive management in smokers at high CV risk, based on sociodemographic, medical, and smoking behaviour characteristics, as well as a gender-specific SC approach.

Sex differences in appeal, reward, and sensory experience of E-cigarette flavors among adults who smoke cigarettes

OBJECTIVE

Flavors enhance nicotine e-cigarette appeal by altering sensory experience. Females may be more sensitive to tobacco-associated cues and uniquely affected by flavor. The current study is an exploratory analysis to examine differences by sex on reward, appeal, and sensory experience of popular e-cigarette flavors.

METHODS

Adults (N = 121) who use cigarettes (≥1 cigarette/day) were enrolled in a laboratory study in which they vaped four e-cigarette flavors (tobacco, cherry, menthol, vanilla; in separate lab sessions) in one of two freebase nicotine concentrations (6 mg/ml,18 mg/ml). Following exposures, participants rated e-cigarette reward using the Drug Effects Questionnaire (DEQ), flavor and overall e-cigarette appeal using Labeled Hedonic Scales (LHS), and intensity of flavor, irritation, coolness, fruitiness, and sweetness using Generalized Labeled Magnitude Scales (gLMS). Linear mixed models were conducted for outcomes to analyze effects of sex, flavor, and sex x flavor interaction.

RESULTS

For DEQ ratings, there was a trend (p = .08) toward a sex x flavor interaction, in which menthol flavor produced more reward than other flavors for females, but not males. For LHS ratings, there was a significant sex x flavor interaction (p = .03) for overall e-cigarette experience with females but not males rating menthol higher than other flavors. All gLMS scales but irritation showed that females generally had greater differences between flavors compared to males (ps ≤ 0.03).

CONCLUSION

Menthol in e-cigarettes may play an important role in mediating appeal and/or reward among females. This may be due in part to their ability to better detect sensory effects of e-cigarettes.

The role of β-Nicotyrine in E-Cigarette abuse liability I: Drug Discrimination

Background

β-Nicotyrine (β-Nic) is a unique minor alkaloid constituent in electronic nicotine delivery systems (ENDS) that is derived from nicotine (Nic) degradation and can reach 25% of Nic concentrations in ENDS aerosol. β-Nic slows Nic metabolism and prolongs systemic Nic exposure, which may alter the discriminability of Nic. The present study sought to examine β-Nic has interoceptive effects itself, and if it alters the subjective effects ENDS products within a drug-discrimination paradigm.

Methods

The pharmacodynamics of β-Nic were examined in vitro, and a nicotine discrimination paradigm was used to determine if β-Nic (0 - 5.0 mg/kg) shares discriminative stimulus properties with Nic (0.2 mg/kg) in male (n = 13) and female (n = 14) rats after 10- & 60-min β-Nic pretreatment delays. A second group of rats was trained to discriminate β-Nic and Nornicotine (Nornic) from saline to determine if β-Nic alone has interoceptive properties and whether they are similar to Nornic.

Results

β-Nic had similar binding affinity and efficacy at the α4β2 nicotinic receptor subtype as Nornic, ~50% of Nic efficacy. However, β-Nic only weakly substituted for Nic during substitution testing in female rats, but not males, whereas Nornic fully substituted for Nic. Combination testing at the 10 and 60-min pretreatment intervals showed that β-Nic dose-dependently increased the duration of nicotine's discriminative stimulus effects, especially at the 60-min delay. Drug naïve rats could reliably discriminate Nornic, but not β-Nic, from Sal.

Conclusion

β-Nic increased and prolonged the interoceptive stimulus properties of Nic, suggesting it may alter to the abuse liability of ENDS through its ability to slow Nic metabolism.

Targeting GLP-1 receptors to reduce nicotine use disorder: Preclinical and clinical evidence

Nicotine use disorder (NUD) remains a leading cause of preventable death in the U.S. Unfortunately, current FDA-approved pharmacotherapies for smoking cessation have limited efficacy and are associated with high rates of relapse. One major barrier to long-term smoking abstinence is body weight gain during withdrawal. Nicotine withdrawal-induced body weight gain can also lead to development of chronic disease states like obesity and type II diabetes mellitus. Therefore, it is critical to identify novel pharmacotherapies for NUD that decrease relapse and nicotine withdrawal symptoms including body weight gain. Recent studies demonstrate that glucagon-like peptide-1 receptor (GLP-1R) agonists attenuate voluntary nicotine taking and seeking and prevent withdrawal-induced hyperphagia and body weight gain. Emerging evidence also suggests that GLP-1R agonists improve cognitive deficits, as well as depressive- and anxiety-like behaviors, which contribute to smoking relapse during withdrawal. While further studies are necessary to fully characterize the effects of GLP-1R agonists on NUD and understand the mechanisms by which GLP-1R agonists decrease nicotine withdrawal-mediated behaviors, the current literature supports GLP-1R-based approaches to treating NUD.

Adolescent nicotine exposure induces long-term, sex-specific disturbances in mood and anxiety-related behavioral, neuronal and molecular phenotypes in the mesocorticolimbic system

The majority of lifetime smokers begin using nicotine during adolescence, a critical period of brain development wherein neural circuits critical for mood, affect and cognition are vulnerable to drug-related insults. Specifically, brain regions such as the medial prefrontal cortex (mPFC), the ventral tegmental area (VTA), nucleus accumbens (NAc) and hippocampus, are implicated in both nicotine dependence and pathological phenotypes linked to mood and anxiety disorders. Clinical studies report that females experience higher rates of mood/anxiety disorders and are more resistant to smoking cessation therapies, suggesting potential sex-specific responses to nicotine exposure and later-life neuropsychiatric risk. However, the potential neural and molecular mechanisms underlying such sex differences are not clear. In the present study, we compared the impacts of adolescent nicotine exposure in male vs. female rat cohorts. We performed a combination of behavioral, electrophysiological and targeted protein expression analyses along with matrix assisted laser deionization imaging (MALDI) immediately post-adolescent exposure and later in early adulthood. We report that adolescent nicotine exposure induced long-lasting anxiety/depressive-like behaviors, disrupted neuronal activity patterns in the mPFC-VTA network and molecular alterations in various neural regions linked to affect, anxiety and cognition. Remarkably, these phenotypes were only observed in males and/or were expressed in the opposite direction in females. These findings identify a series of novel, sex-selective biomarkers for adolescent nicotine-induced neuropsychiatric risk, persisting into adulthood.

Evaluating the Impact of Chronic Care Model on Smoking Cessation: An Interventional Study

BACKGROUND

This study aims to assess the effectiveness of the chronic care model (CCM) in helping primary healthcare workers quit smoking. The intervention involves implementing the CCM, which includes six key elements: the healthcare system, clinical care planning, clinical management information, self-management guidance, community resources, and decision-making.

MATERIAL AND METHODS

The study is based on a population of 60 primary healthcare workers who smoke. The main outcome measure is smoking cessation, determined by cotinine levels in urine at the baseline, and at 6 and 12 months after the intervention. Other potential results include alterations in smoking-related behaviors and attitudes. Data analysis involves using descriptive statistics and inferential tests to determine the intervention's effectiveness in smoking cessation among primary healthcare workers.

RESULTS

 The CCM is expected to have contributed to a substantial decrease in the smoking rate among primary healthcare workers. It is also seen that there is a great reduction in urine cotinine levels during the 12-month intervention period. Moreover, a positive shift in the smoking-related behaviors and attitudes of the participants is expected.

CONCLUSION

 This study provides key data about the effectiveness of the CCM in helping primary healthcare workers stop smoking. This statement emphasizes the importance of considering socioeconomic factors in the design and implementation of smoking cessation interventions. This ensures that people of different incomes and social statuses have equal access to quitting smoking and achieve similar results.

Real-Life Effectiveness of Smoking Cessation Delivery Modes: A Comparison Against Telephone Counseling and the Role of Individual Characteristics and Health Conditions in Quit Success

INTRODUCTION

Professional behavioral counseling for smoking cessation can be delivered in many forms, which may not work equally well for everyone. We aim to explore in a real-world setting whether different delivery modes yield different rates of quit success and whether quit success varies based on gender, age, educational level, and being treated for a health condition.

AIMS AND METHODS

We used monitoring data (n = 13 747) from a smoking cessation counseling provider in the Netherlands (September 2018 to August 2021) to compare differences in quit success immediately after the end of counseling and at 12-month follow-up between telephone and other modes of counseling. Participants chose which mode of counseling they received. At the 12-month follow-up, we also examined differences in quit success based on demographic characteristics and whether one is being treated for various health conditions.

RESULTS

Participants of in-person group counseling and online in-company group counseling were significantly more likely to have quit immediately after the counseling compared with telephone counseling (OR = 1.25, 95% CI = 1.08-1.44; OR = 1.63, 95% CI = 1.18-2.24). Analyses revealed no significant differences in quit success between telephone and other modes of counseling after 12 months. Those treated for a respiratory or psychological condition were less likely to have maintained quit success, as were women, and participants with a lower educational level.

CONCLUSIONS

When chosen by oneself, the mode of smoking cessation counseling received does not appear to be important for long-term quit success. However, certain groups warrant extra support to prevent excessive program attrition and unsuccessful quit attempts.

IMPLICATIONS

Our findings suggest that when chosen by oneself, the delivery mode of smoking cessation counseling does not appear to be important for long-term quit success. This finding is of particular relevance for those who are unable to attend in-person cessation counseling due to, for instance, reduced accessibility or mobility. We also found that women, lower educated, and younger participants were more likely to dropout of the cessation program or to not have maintained a quit attempt, signaling that disparities in smoking cessation persist when standardized counseling is given, and therefore more tailored counseling may be necessary for these groups.

Acceptability of Hormonal Contraceptives as a Smoking Cessation Aid for Women of Reproductive Age: A Web-Based Cross-Sectional Survey

Introduction

Cigarette smoking is the most common cause of preventable cancers and other premature morbidity and mortality. Modifying hormonal patterns using hormonal contraceptives (HCs) may lead to improved smoking cessation outcomes in women, though the acceptability of this is unknown. Therefore, we explored the willingness of reproductive-age women who smoke to use HC for cessation.

Methods

A cross-sectional online survey was conducted with a convenience sample of reproductive-age women living in the United States who self-reported smoking combustible cigarettes. Questions covered smoking history, previous HC use, and willingness to use various HC methods (i.e., injectable, oral, patch, vaginal insert) for cessation. Chi-squared tests and logistic regression were conducted using StataBE 17.1.

Results

Of 358 eligible respondents, n = 312 (86.9%) reported previous HC use. Average age of those with HC use history was 32.1 ± 6.1 years compared with 27.8 ± 6.7 years for those without history of HC use (p = 0.001). Of respondents who reported previous HC use, 75.6% reported willingness to use HCs, compared with 60.9% of those without a history of HC use. Overall, willingness to use various types of HC ranged from 22.6% for the vaginal insert to 59.2% willing to use an oral contraceptive.

Discussion

These observations indicate that most women who smoke cigarettes are willing to use HC for a smoking cessation aid, especially if they have a history of HC use and with an oral form of HC. To improve the rate of smoking cessation for women of reproductive age, future interventions should explore how to incorporate HC for cessation.

Society for Research on Nicotine and Tobacco as an Outgrowth of the 1988 Surgeon General's Report on Nicotine Addiction: Reflections of the Early Presidents

INTRODUCTION

The Society for Research on Nicotine and Tobacco began in the United States as a scientific organization "to stimulate the generation and dissemination of new knowledge concerning nicotine and tobacco in all its manifestations." Now in its 30th year, the Society is taking on new challenges in tobacco control, nicotine vaping, product regulation, and public policy.

AIMS AND METHODS

This Review describes the formative years of the Society from the perspective of researchers who were in leadership positions during that time, documenting how biobehavioral and clinical research in the first 10 years was a continuation of the scientific mission of the 1988 United States Surgeon General's Report on Nicotine Addiction and summarizing organizational innovations during each president's term of office.

CONCLUSIONS

The Society's promotion of scientific research served as a catalyst for funding, policy, and regulation, setting the stage for its influence and credibility.

IMPLICATIONS

This Commentary provides context and an overview of the scientific research and the organizational innovations that occurred during the early years of the Society for Research on Nicotine and Tobacco using publications and available documentation. The Society was able to thrive because biobehavioral research on nicotine addiction provided the scientific underpinnings for the tobacco control enterprise as a whole. The objective of this Commentary is to describe formative events in the Society's history based on the accomplishments of its early leaders.

Characterization of trajectories of physical activity and cigarette smoking from early adolescence to adulthood

BACKGROUND

Cigarette smoking and physical inactivity are two critical risk factors for noncommunicable diseases and all-cause mortality. However, few studies have compared the long-term trajectories of both behaviors, as well as multilevel factors associated with trajectory patterns. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave I through V survey data, this study characterized distinct subgroups of the population sharing similar behavioral patterns from adolescence to adulthood, as well as predictors of subgroup membership for physical activity (PA) and cigarette smoking behavior respectively.

METHODS

Using the Add Health Wave I through V survey data, we identified the optimal number of latent classes and class-specific trajectories of PA and cigarette smoking from early adolescence to adulthood, fitting latent growth mixture models with standardized PA score and past 30-day cigarette smoking intensity as outcome measures and age as a continuous time variable. Associations of baseline sociodemographic factors, neighborhood characteristics, and sociopsychological factors with trajectory class membership were assessed using multinomial logistic regression.

RESULTS

We identified three distinct subgroups of non-linear PA trajectories in the study population: moderately active group (N = 1067, 5%), persistently inactive group (N = 14,257, 69%) and worsening activity group (N = 5410, 26%). Foror cigarette smoking, we identified three distinct non-linear trajectory subgroups: persistent non-smoker (N = 14,939, 72%), gradual quitter (N = 2357, 11%), and progressing smoker (N = 3393, 16%). Sex, race/ethnicity, neighborhood environment and perceived peer support during adolescence were significant predictors of both physical activity and cigarette smoking trajectory subgroup membership from early adolescence to adulthood.

CONCLUSIONS

There are three distinct subgroups of individuals sharing similar PA and cigarette smoking behavioral profile respectively from adolescence to adulthood in the Add Health study population. Behavioral interventions that focus on neighborhood environment (e.g. establish community-based activity center) and relationship to peers during adolescence (e.g. peer counseling) could be key to long-term PA promotion and cigarette smoking cessation.

Association between having a meal together with family and smoking: a cross-sectional nationwide survey

BACKGROUND

Smoking is a major risk factor that significantly affects public health. Although the South Korean government spends significant money on smoking cessation services, the smoking rate remains stagnant. Families influence health-conscious decisions, and family meals can positively affect smoking suppression and health behaviors. Therefore, this study investigated whether family meals are correlated with adults' smoking behaviors.

METHODS

This study used data from the 2019-2021 Korean National Health and Nutrition Examination Survey. Having a meal together with family was defined as "yes" for those who have at least one meal with their family each day and "no" for those who do not. Current smoking status was classified as having smoked at least 5 packs of cigarettes (100 cigarettes) in one's lifetime and having used either conventional cigarettes or e-cigarettes in the last 30 days. Multiple logistic regression analyses were used to examine the association between eating together, smoking, and weight application.

RESULTS

When comparing the group that ate with their family compared to the group that did not, the odds ratio for current smoking status was 1.27 (95% confidence interval [CI]: 1.05-1.54) for male participants and 1.90 (95% CI: 1.33-2.71) for female participants. This showed a dose-dependent effect according to the frequency of family meals. Those who smoked conventional cigarettes had a strong association (men: OR 1.28, 95% CI 1.00-1.67; women: OR 2.22, 95% CI 1.42-3.46). However, those who only vaped e-cigarettes or used both conventional cigarettes and e-cigarettes had no statistically significant correlations.

CONCLUSION

This study provides evidence suggesting that eating meals as a family is related to smoking behavior and can positively affect smoking cessation intentions in adults. Consequently, a smoking cessation program can be developed that uses social support, such as encouraging family meals.

Adverse physiological effects of smoking cessation on the gastrointestinal tract: A review

Smoking cessation is known to have numerous health benefits, but it can also induce adverse physiological effects, including those affecting the gastrointestinal tract (GIT). Understanding the adverse physiological effects of smoking cessation on the GIT is critical for healthcare professionals and smokers attempting to quit, as it enables them to anticipate and manage potential challenges during the smoking cessation process. Although the detrimental effects of smoking on the GIT have been well established, there is a gap in the literature regarding the specific physiological reactions that may occur upon smoking cessation. This mini-review summarizes the current literature on the predisposing factors, pathophysiology, clinical presentation, and treatment options for adverse physiological effects of smoking cessation on the GIT. We aimed to raise awareness among busy clinical professionals about these adverse effects, empowering them to effectively support individuals striving to quit smoking and maintain their cessation. By consolidating the existing knowledge in this field, this review offers practical implications for smokers, healthcare providers, and policymakers to optimize smoking cessation interventions and support strategies to improve health outcomes.

Treatment adherence in a smoking cessation clinical trial for individuals with current or past major depressive disorder: Predictors and association with cessation

INTRODUCTION

Individuals with major depressive disorder (MDD) exhibit high rates of tobacco use and lower responsiveness to tobacco cessation treatments. Treatment adherence is a strong predictor of treatment outcomes in the general population but has not been evaluated in this under-served community of smokers with MDD.

METHODS

We used data from a randomized clinical trial on smoking cessation treatment among 300 smokers with MDD to examine the rate of adherence (medication and counseling), the association of adherence with cessation outcomes, and factors associated with adherence, including demographic and smoking characteristics, psychiatric characteristics, smoking cessation processes (e.g., withdrawal, reinforcers), and treatment-related side effects (e.g., nausea).

RESULTS

Overall, 43.7% of participants were adherent with medication and 63.0% were adherent with counseling. Medication adherence was significantly associated with cessation, with 32.1% of adherent vs. 13.0% of non-adherent participants quitting smoking at EOT. Counseling adherence was also significantly associated with cessation, with 32.3% of adherent vs. 2.7% of non-adherent participants quitting smoking. Multivariate regression models showed that medication adherence was associated with higher engagement in complementary reinforcers and higher baseline smoking reward, while counseling adherence was associated with identifying as female, lower alcohol use and nicotine dependence, higher baseline smoking reward, and higher engagement in substitute and complementary reinforcers within the first weeks of medication use.

CONCLUSIONS

As with the general population of smokers, non-adherence to treatment in smokers experiencing depression is widespread and a significant barrier to cessation. Interventions that target reinforcers may improve rates of treatment adherence.

Considerations of Sex and Gender in FDA Tobacco Regulation

This Viewpoint discusses how sex and gender subpopulations may be differentially affected by tobacco products and suggests that the FDA formulate regulations in clinically meaningful ways.

CHRNA5-A3-B4 and DRD2 Genes and Smoking Cessation Throughout Adulthood: A Longitudinal Study of Women

INTRODUCTION

Smoking cessation is more than 50% heritable. Genetic studies of smoking cessation have been limited by short-term follow-up or cross-sectional design.

AIMS AND METHODS

This study tests single nucleotide polymorphism (SNP) associations with cessation during long-term follow-up throughout adulthood in women. The secondary aim tests whether genetic associations differ by smoking intensity. Associations between 10 SNPs in CHRNA5, CHRNA3, CHRNB2, CHRNB4, DRD2, and COMT and the probability of smoking cessation over time were evaluated in two longitudinal cohort studies of female nurses, the Nurses' Health Study (NHS) (n = 10 017) and NHS-2 (n = 2793). Participant follow-up ranged from 2 to 38 years with data collected every 2 years.

RESULTS

Women with the minor allele of either CHRNA5 SNP rs16969968 or CHRNA3 SNP rs1051730 had lower odds of cessation throughout adulthood [OR = 0.93, p-value = .003]. Women had increased odds of cessation if they had the minor allele of CHRNA3 SNP rs578776 [OR = 1.17, p-value = .002]. The minor allele of DRD2 SNP rs1800497 was associated with lower odds of cessation in moderate-to-heavy smokers [OR = 0.92, p-value = .0183] but increased odds in light smokers [OR = 1.24, p-value = .096].

CONCLUSIONS

Some SNP associations with short-term smoking abstinence observed in prior studies were shown in the present study to persist throughout adulthood over decades of follow-up. Other SNP associations with short-term abstinence did not persist long-term. The secondary aim findings suggest genetic associations may differ by smoking intensity.

IMPLICATIONS

The results of the present study expand on previous studies of SNP associations in relation to short-term smoking cessation to demonstrate some of these SNPs were associated with smoking cessation throughout decades of follow-up, whereas other SNP associations with short-term abstinence did not persist long-term. The rate of relapse to smoking remains high for several years after quitting smoking, and many smokers experience multiple quit attempts and relapse episodes throughout adulthood. Understanding genetic associations with long-term cessation has potential importance for precision medicine approaches to long-term cessation management.

Impact of tobacco flavoring on oral nicotine consumption in C57BL/6J mice

BACKGROUND

The continued use of flavors in tobacco products has been a prominent factor in their popularity, yet little is known regarding their role in nicotine dependence. This study aimed to investigate the impact of tobacco flavoring on oral nicotine consumption in mice using the two-bottle choice (2BC) test and assessed the potential impact of age and sex in their interactions.

METHODS

Adolescent and adult male and female C57BL/6J mice were used. First, voluntary consumption of tobacco flavor concentrate from a commercial electronic cigarette liquid vendor (Avail Vapor LLC) was measured; then, the effects of tobacco flavoring in combination with nicotine were examined. In one approach, tobacco flavor concentration was kept constant while nicotine concentration varied, and in the second, nicotine was kept constant while the tobacco flavor concentration varied.

RESULTS

Overall, tobacco flavoring decreased oral nicotine consumption in mice, and its effects were sex- and age-dependent. Although females consumed the tobacco-flavored solution at a slightly higher rate than males, male mice were more sensitive to the effects of the combination (nicotine + tobacco). Furthermore, adolescent mice showed a starker reduction in nicotine consumption in the presence of tobacco flavoring compared to adult mice. This attenuation was most likely due to a basal aversion to the tobacco flavoring itself, thus, creating a negative synergistic effect with nicotine.

CONCLUSIONS

Tobacco flavoring increases aversion to nicotine in the 2BC test in C57BL6J mice, suggesting that some flavors may diminish rather than enhance oral nicotine consumption in rodents.

Relapse to cotinine seeking in rats: differential effects of sex

Relapse is a defining feature of smoking and a significant challenge in cessation management. Elucidation of novel factors underlying relapse may inform future treatments. Cotinine, the major metabolite of nicotine, has been shown to support intravenous self-administration in rats, implicating it as one potential factor contributing to nicotine reinforcement. However, it remains unknown whether cotinine would induce relapse-like behaviors. The current study investigated relapse to cotinine seeking in two relapse models, the reinstatement of drug seeking and incubation of drug craving models. In the reinstatement model, rats were trained to self-administer cotinine, underwent extinction of cotinine-associated responses, and were tested for cue-, drug-, or stress-induced reinstatement. Conditioned cues associated with cotinine self-administration, cotinine (1-2 mg/kg), or the pharmacological stressor yohimbine (1.25-2.5 mg/kg) induced reinstatement of cotinine seeking. Female rats displayed more pronounced cue-induced, but not drug- or stress-induced reinstatement than male rats. In the incubation of the craving model, rats were trained to self-administer cotinine and underwent forced withdrawal in home cages. Rats were tested for cue-induced cotinine-seeking on both withdrawal day 1 and withdrawal day 18. Rats exhibited greater cue-induced cotinine-seeking on withdrawal day 18 compared to withdrawal day 1, with no difference between male and female rats. These findings indicate that cotinine induces sex-specific relapse to drug seeking in rats, suggesting that cotinine may contribute to relapse.

Associations of tobacco cigarette use and dependence with substance use disorder treatment completion by sex/gender and race/ethnicity

INTRODUCTION

Individuals with substance use disorders (SUD) are approximately five times more likely to smoke cigarettes than the general population. Individuals who smoke cigarettes have greater odds of SUD relapse compared to individuals who do not smoke cigarettes, but we know little about how cigarette use is related to SUD treatment completion overall by sex/gender or race/ethnicity.

METHODS

This study examined 2855 adults (71.98 % male; >70 % racial/ethnic minority) in outpatient and residential SUD treatment at a New York-based treatment agency over a six-month period in 2018.

RESULTS

Overall, approximately three-fourths of SUD treatment-seeking participants smoked cigarettes, with high rates across sex/gender and racial/ethnic groups. Nicotine dependence did not differ by sex/gender, and White Non-Hispanic adults had the highest levels of nicotine dependence across racial/ethnic groups. Those who smoked cigarettes were significantly less likely to complete treatment compared to those who did not smoke cigarettes (OR = 0.69; 95 % CI: 0.58, 0.82). The study found no overall differences in SUD treatment completion and length of stay by sex/gender or race/ethnicity.

CONCLUSIONS

Given the high prevalence of cigarette smoking and lower odds of completing SUD treatment, the current system of care for SUD treatment may be enhanced by addressing cigarette smoking from onset of treatment.

Need for mindfulness-based relapse prevention strategies for postpartum smoking relapse prevention

The health concerns for women are varied from that of men and are of higher concern. To increase this concern, women have recorded higher smoking relapse rates than men were an alarming 60% to 90% of the women who have attempted to quit relapse within their first year. Women who quit during pregnancy are seen to have higher rates of relapse than others. Such postpartum relapse has detrimental effects on the mother as well as the newborn. Mindfulness-based interventions have seen benefits in the areas of substance abuse and relapse prevention. Although research in the area of mindfulness and its benefits on smoking cessation has been limited, literature shows positive outcomes. This brief article examines the need for mindfulness-based relapse prevention strategies for women who are undergoing postpartum smoking relapses so that they could benefit from the same.

Effects of excessive alcohol drinking on nicotine biotransformation in rats

Alcohol and nicotine (tobacco smoke) are often used together, and taking both addictive substances is associated with an increased risk of certain diseases. It is extremely important to understand the pharmacodynamic and pharmacokinetic mechanisms of the interaction between nicotine and ethanol, which are still not fully understood. The study aimed to evaluate the influence of chronic alcohol consumption on nicotine biotransformation in ethanol-preferring and non-preferring male and female rats. Rats were divided into four groups depending on their alcohol preferences and gender. Nicotine, nornicotine, nicotine N-oxide, cotinine, trans-3'-hydroxycotinine, and cotinine N-oxide in rats plasma were determined by LC-MS/MS after five days of exposure to tobacco smoke. A non-compartmental analysis of nicotine and its metabolites was used for pharmacokinetic parameters calculation. Our experimental results showed that the rate of nicotine elimination depends on gender, regardless of alcohol preferences (significantly slower in females than in males). Mean residence timeof nornicotine, cotinine, and trans-3'-hydroxycotinine were significantly higher in alcohol-preferring male rats than in alcohol preferring female rats. In non-alcohol preferring female rats compared to ethanol-preferring female rats, significantly more nicotine N-oxide (fivefold) and trans-3'-hydroxycotinine (twofold) reached the general circulation unchanged. Drinking ethanol influenced the elimination of nornicotine and cotinine in male rats. Ethanol consumption was identified as a modifier of nicotine pharmacokinetics and this was gender-dependent.

The association between hormonal contraceptive use and smoking, negative affect, and cessation attempts in college females

Exogenous and endogenous female hormones influence nicotine use and cessation, potentially through mechanisms such as anxiety and negative affect. In the present study, college females using all types of hormonal contraceptives (HC) were compared to those not using HC to determine the potential influence on current smoking, negative affect, and current and past cessation attempts. Differences between progestin-only and combination HC were also examined. Of the 1,431 participants, 53.2% (n = 761) reported current HC use, and 12.3% (n = 176) of participants endorsed current smoking. Women currently using HC were significantly more likely to smoke (13.5%; n = 103) compared to women not using HC (10.9%; n = 73), p = .04. There was a significant main effect of HC use being associated with lower anxiety levels (p = .005), as well as a significant HC use by smoking status interaction, such that women who smoke using HC reported the lowest levels of anxiety among participants (p = .01). Participants using HC were more likely to be making a current attempt to quit smoking than those not using HC (p = .04) and were more likely to have made past quit attempts (p = .04). No significant differences were observed across women using progestin-only, combined estrogen and progestin, and women not using HC. These findings provide evidence that exogenous hormones may be an advantageous treatment target and that they warrant additional study.

Characterization of salivary progesterone in female smokers

INTRODUCTION

Fluctuations in ovarian hormones have been associated with changes in cigarette smoking behavior, which can be measured through both serum or less invasive salivary procedures. The primary aim of this exploratory study is to characterize the progesterone profiles of salivary progesterone measurements and to compare that with the profiles estimated from a previously measured serum sample.

METHODS

Non-treatment seeking, cigarette smoking women (n=82; ages 18-45) provided daily salivary hormone samples every morning for 14 consecutive days. Time dependent random effects functions were used to approximate daily salivary progesterone (ng/ml) levels over the course of a standardized menstrual cycle. Serum measures of progesterone from a previous study of female cigarette smokers were examined for consistency with established profiles and compared to the salivary profile using the same methodology.

RESULTS

The salivary model fit exhibits relative stability during the follicular phase and a clear unimodal peak during the luteal phase. Parameter estimates from the non-linear function show correspondence to serum data. Although the profiles estimated from salivary and serum data agree in functional form, we observed larger between-subject heterogeneity both in the follicular level and the peak luteal level in salivary measures.

CONCLUSIONS

The pattern of salivary and serum progesterone measured across the menstrual cycle is similar in form, which is noteworthy given that the saliva and serum samples were drawn from independent sample of female smokers. Inter- and intra-individual variation in salivary measures may be greater than in serum measures.

IMPLICATIONS

Measuring progesterone level variation across the menstrual cycle via saliva samples has several benefits relative to serum sampling methods in that they are easily obtained, non-invasive and low-cost. Inter- and intra-individual variation in measurements may be greater than those in serum measurements. However, the functional form of the salivary progesterone profile is isomorphic to serum progesterone.

The Effects of Menstrual Cycle Hormones on Responses to Varenicline and Naltrexone Among Female Heavy Drinking Smokers

Aims

Women often experience poorer smoking cessation outcomes in comparison to men. Menstrual cycle phase and sex hormones may influence smoking behavior and alter response to opioid antagonist medications. Less is known about the effects of sex hormones in response to pharmacotherapy for female heavy drinking smokers.

Methods

This study is a secondary analysis of premenopausal female heavy drinking smokers who completed a 12-week randomized clinical trial comparing varenicline plus placebo versus varenicline plus naltrexone for smoking cessation and drinking reduction. Participants (n = 26; total observations = 66) provided saliva samples for assays of progesterone (P4) and estradiol (E2) post-randomization at Weeks 4, 8 and 12. We examined the effects of P4/E2 ratio and medication on smoking and drinking outcomes.

Results

For drinking outcomes, there was a significant interaction for percent days abstinent (b = 0.017, P = 0.05), suggesting that greater P4/E2 ratio is associated with greater percent days abstinent for women assigned to the varenicline plus naltrexone condition. There were no interaction effects for the remaining drinking outcomes (P’s ≥ 0.12). Results found no significant interaction effect of P4/E2 ratio and medication on smoking abstinence (P = 0.19).

Conclusion

Our results imply that when women show a greater P4/E2 ratio, typically observed during the luteal phase of the menstrual cycle, they experience an added benefit of naltrexone, versus placebo, for drinking outcomes as shown by greater percent days abstinent. Additional studies in larger samples are warranted as sex hormones offer important information above and beyond comparing women versus men.

Effect of smoking reduction, cessation, and resumption on cancer risk: A nationwide cohort study

BACKGROUND

The objective of this study was to investigate the effects of reduction, cessation, and resumption of smoking on cancer development.

METHODS

The authors identified 893,582 participants who currently smoked, had undergone a health screening in 2009, and had a follow-up screening in 2011. Among them, 682,996 participated in a third screening in 2013. Participants were categorized as quitters, reducers I (≥50% reduction), reducers II (<50% reduction), sustainers (referent), or increasers (≥20% increase). Outcome data were obtained through December 31, 2018.

RESULTS

Reducers I exhibited a decreased risk of all cancers (adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.93-0.99), smoking-related cancers (aHR, 0.95; 95% CI, 0.92-0.99), and lung cancer (aHR, 0.83; 95% CI, 0.77-0.88). Quitters had the lowest risk of all cancers (aHR, 0.94; 95% CI, 0.92-0.96), smoking-related cancers (aHR, 0.91; 95% CI, 0.89-0.93), and lung cancer (aHR, 0.79; 95% CI, 0.76-0.83). In further analysis with 3 consecutive screenings, additional smoking reduction (from reducers II to reducers I) lowered the risk of lung cancer (aHR, 0.74; 95% CI, 0.58-0.94) in comparison with sustainers. Quitting among reducers I further decreased the risk of all cancers (aHR, 0.90; 95% CI, 0.80-1.00), smoking-related cancers (aHR, 0.81; 95% CI, 0.81-0.92), and lung cancer (aHR, 0.66; 95% CI, 0.52-0.84) in comparison with sustainers. Smoking resumption after quitting, even at a lower level, increased the risk of smoking-related cancers (aHR, 1.19; 95% CI, 1.06-1.33) and lung cancer (aHR, 1.48; 95% CI, 1.21-1.80) in comparison with sustained quitting.

CONCLUSIONS

Smoking cessation and, to a lesser extent, smoking reduction decreased the risks of cancer. Smoking resumption increased cancer risks in comparison with sustained quitting.

LAY SUMMARY

Worldwide, tobacco use is the single leading preventable risk factor for cancer and cancer death. This study examined the effects of reduction, cessation, and resumption of smoking on cancer development by measuring smoking behavior repetitively. Although smoking reduction has a substantial cancer prevention benefit for those who cannot quit, cessation should be encouraged whenever possible. Quitters should be monitored to ensure that they do not resume smoking.

Nicotine and the developing brain: Insights from preclinical models

Use of tobacco products during pregnancy is associated with increased risk for neurodevelopmental disorders in the offspring. Preclinical models of developmental nicotine exposure have offered valuable insights into the neurobiology of nicotine's effects on the developing brain and demonstrated lasting effects of developmental nicotine exposure on brain structure, neurotransmitter signaling and behavior. These models have facilitated discovery of novel compounds as candidate treatments for attention deficit hyperactivity disorder, a neurodevelopmental disorder associated with prenatal nicotine exposure. Using these models the significance of heritability of behavioral phenotypes from the nicotine-exposed pregnant female or adult male to multiple generations of descendants has been demonstrated. Finally, research using the preclinical models has demonstrated synergistic interactions between developmental nicotine exposure and repetitive mild traumatic brain injury that contribute to "worse" outcomes from the injury in individuals with attention deficit hyperactivity disorder associated with developmental nicotine exposure.

Developmental nicotine exposure and masculinization of the rat preoptic area

Nicotine is a neuroteratogenic component of tobacco smoke, e-cigarettes, and other products and can exert sex-specific effects in the developing brain, likely mediated through sex hormones. Estradiol modulates expression of nicotinic acetylcholine receptors in rats, and plays critical roles in neurodevelopmental processes, including sexual differentiation of the brain. Here, we examined the effects of developmental nicotine exposure on the sexual differentiation of the preoptic area (POA), a brain region that normally displays robust structural sexual dimorphisms and controls adult mating behavior in rodents. Using a rat model of gestational exposure, developing pups were exposed to nicotine (2 mg/kg/day) via maternal osmotic minipump (subcutaneously, sc) throughout the critical window for brain sexual differentiation. At postnatal day (PND) 4, a subset of offspring was analyzed for epigenetic effects in the POA. At PND40, all offspring were gonadectomized, implanted with a testosterone-releasing capsule (sc), and assessed for male sexual behavior at PND60. Following sexual behavior assessment, the area of the sexually dimorphic nucleus of the POA (SDN-POA) was measured using immunofluorescent staining techniques. In adults, normal sex differences in male sexual behavior and in the SDN-POA area were eliminated in nicotine-treated animals. Using novel analytical approaches to evaluate overall masculinization of the adult POA, we identified significant masculinization of the nicotine-treated female POA. In neonates (PND4), nicotine exposure induced trending alterations in methylation-dependent masculinizing gene expression and DNA methylation levels at sexually-dimorphic differentially methylated regions, suggesting that developmental nicotine exposure is capable of triggering masculinization of the rat POA via epigenetic mechanisms.

Biological determinants impact the neurovascular toxicity of nicotine and tobacco smoke: A pharmacokinetic and pharmacodynamics perspective

Accumulating evidence suggests that the detrimental effect of nicotine and tobacco smoke on the central nervous system (CNS) is caused by the neurotoxic role of nicotine on blood-brain barrier (BBB) permeability, nicotinic acetylcholine receptor expression, and the dopaminergic system. The ultimate consequence of these nicotine associated neurotoxicities can lead to cerebrovascular dysfunction, altered behavioral outcomes (hyperactivity and cognitive dysfunction) as well as future drug abuse and addiction. The severity of these detrimental effects can be associated with several biological determinants. Sex and age are two important biological determinants which can affect the pharmacokinetics and pharmacodynamics of several systemically available substances, including nicotine. With regard to sex, the availability of gonadal hormone is impacted by the pregnancy status and menstrual cycle resulting in altered metabolism rate of nicotine. Additionally, the observed lower smoking cessation rate in females compared to males is a consequence of differential effects of sex on pharmacokinetics and pharmacodynamics of nicotine. Similarly, age-dependent alterations in the pharmacokinetics and pharmacodynamics of nicotine have also been observed. One such example is related to severe vulnerability of adolescence towards addiction and long-term behavioral changes which may continue through adulthood. Considering the possible neurotoxic effects of nicotine on the central nervous system and the deterministic role of sex as well as age on these neurotoxic effects of smoking, it has become important to consider sex and age to study nicotine induced neurotoxicity and development of treatment strategies for combating possible harmful effects of nicotine. In the future, understanding the role of sex and age on the neurotoxic actions of nicotine can facilitate the individualization and optimization of treatment(s) to mitigate nicotine induced neurotoxicity as well as smoking cessation therapy. Unfortunately, however, no such comprehensive study is available which has considered both the sex- and age-dependent neurotoxicity of nicotine, as of today. Hence, the overreaching goal of this review article is to analyze and summarize the impact of sex and age on pharmacokinetics and pharmacodynamics of nicotine and possible neurotoxic consequences associated with nicotine in order to emphasize the importance of including these biological factors for such studies.

Understanding the stimulus effects of nicotine and bupropion in a drug-drug discriminated goal-tracking task

RATIONALE

Bupropion is a non-nicotine medication for smoking cessation that has overlapping stimulus effects with nicotine as demonstrated in drug discrimination studies. Whether these shared stimulus effects will alter acquisition or maintenance of a discrimination between nicotine and bupropion is unknown.

OBJECTIVE

We sought to test this possibility using the drug discriminated goal-tracking (DGT) task and whether discrimination training history affected generalization and substitution tests.

METHODS

Sixty adult Sprague-Dawley rats (30M/30F) were equally split into three discrimination training groups: SAL-0.4NIC, 10BUP-0.4NIC, and 20BUP-0.4NIC. On nicotine days, all rats were administered subcutaneously 0.4 mg/kg nicotine and had intermittent access to liquid sucrose. On intermixed non-reinforced days, rats were administered intraperitoneally saline, 10 or 20 mg/kg bupropion. Upon completion, a range of nicotine and bupropion doses were assessed before substitution tests with varenicline and sazetidine-A were conducted.

RESULTS

The SAL-0.4NIC and 10BUP-0.4NIC groups readily discriminated by session 8, as evidenced by increased dipper entries (goal-tracking) on nicotine days. The 20BUP-0.4NIC group was slower to acquire the discrimination. Female rats, regardless of group, had higher conditioned responding evoked by the lowest dose of nicotine (0.025 mg/kg) in the dose-effect curve. The discrimination required rats to learn to withhold responding to the training dose of bupropion. This withholding of excitatory dipper entries generalized to other doses. Varenicline and sazetidine-A partially substituted for the nicotine stimulus, and this pattern did not differ with training history.

CONCLUSIONS

We are the first to study a drug-drug discrimination using the DGT task. Females appeared to have a lower discrimination threshold for nicotine that was not impacted by the learning history. Further work on the importance of sex as a biological variable and how the complex interoceptive stimulus effects of nicotine can vary with training histories is needed.

Ongoing tobacco use in women who experience homelessness and unstable housing: A prospective study to inform tobacco cessation interventions and policies

BACKGROUND

Tobacco use is common in people who experience homelessness. However, despite biological differences in use by sex and lower quit rates in women, research in homeless and unstably housed (HUH) women is sparse. We identified correlates of use specific to this population, with the goal of informing tobacco cessation programs tailored for HUH women.

METHODS

We conducted a prospective study among HUH women recruited from San Francisco homeless shelters, street encampments, free meal programs and low-income hotels. Between June 2016 and January 2019, study participants completed six monthly interviews to examine factors associated with tobacco use, defined as urinary cotinine >10 pg/mL or self-reported prior 30-day use.

RESULTS

Among 245 participants, 40% were Black, the median age was 53, 75% currently used tobacco and 89% had ≥one 24-hour quit attempt in the prior year. Tobacco use was more common in women with PTSD (66% vs. 48%) and depression (54% vs. 35%) compared to women without these conditions. Adjusted odds of tobacco use decreased significantly with increasing age (OR_{/5 yrs}: 0.81; 95% CI:0.68, 0.96) and increased with an increasing number of additional substances used (OR: 2.52; 95% CI: 1.88, 3.39).

CONCLUSION

Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.

Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Results of a pilot randomized control trial

INTRODUCTION

Menstrual phase influences cigarette smoking-related outcomes. Telephone-based cessation programs (e.g., quitlines) may incorporate the role of the menstrual cycle in an effort to tailor interventions for women.

PURPOSE

The goal of this preliminary randomized clinical trial was to examine the feasibility and acceptability of timing quit date to menstrual phase in women in a quitline setting.

METHODS

We recruited treatment-seeking women with regular menstrual cycles between the ages of 18-40 years. Participants were randomized to the follicular phase (FP; quit date set 6-8 days post onset of menses) or standard of care (SC; no menstrual timing of quit date). All participants received four weeks of nicotine replacement therapy transdermal patch concurrent with six weeks of telephone-based counseling. We explored self-reported and biochemically-verified seven-day point prevalence abstinence at end-of-treatment and three-month follow-up.

RESULTS

Participants (n = 119; FP: n = 58, SC: n = 61) were, on average, 33.4 years old and smoked 13.6 cigarettes/day. The median number of counseling sessions completed was 6 out of 6 available, and 66% of participants completed the intervention. Over 90% of participants reported they would recommend this study to friends/family. Cessation rates did not significantly vary by randomization.

CONCLUSIONS

Results of this preliminary trial indicate that timing quit date to FP is an acceptable and feasible approach to address smoking cessation in women of reproductive age. While we observed similar smoking cessation rates between groups, this preliminary study was not fully powered to determine efficacy. Therefore, the feasibility and acceptability results indicate that a fully-powered efficacy trial is warranted.

Polysubstance Use Patterns Among High Dose Benzodiazepine Users: A Latent Class Analysis and Differences Between Male and Female Use

Benzodiazepines (BZDs) represent one of the most widely used groups of pharmaceuticals, but if used for long periods of time they are associated with dependence and an increased risk of harmful effects. High-dose (HD) BZD dependence is a specific substance use disorder associated with a poor quality of life. It is especially important to pinpoint differences in HD BZD addict subgroups in order to tailor treatment to the individual's specific needs, also considering possible comorbidities with other substance use disorders. We conducted a study to evaluate HD BZD dependence (converted doses to diazepam equivalents, mg) in an Italian sample of 1,354 participants. We also investigated if and to which extent participants co-used other substances (alcohol, tobacco, cannabis/cannabinoids, cocaine, and heroin). We then performed latent class analysis (LCA) to identify the use patterns of these substances, finding three classes: participants in Class 1 (4.3% of the sample) had the highest probability of also using cocaine and alcohol (Polysubstance BZD users); Class 2 comprised subjects with the highest probability of being former heroin, cocaine, THC, and alcohol users (Former polysubstance BZD users); Class 3 represented mono-dependence BZD users (78.5% of the sample) and was the most prevalent among women, while young men were most prevalent in Class 1. The present study underlines different characteristics in HD BZD users both concerning other addictions and sex, and also highlights the need for a stricter control of BZD use, ranging from prescriptions to sales.

Homeless women's perspectives on smoking and smoking cessation programs: A qualitative study

BACKGROUND

Individuals who are unsheltered or experiencing homelessness are more likely to smoke than those in the general population and have a higher prevalence of tobacco-related illnesses. Those who are unhoused make quit attempts at rates similar to the general population, however rates of successful quitting are much lower. Women bear a higher burden of smoking-related diseases and are less successful in their cessation efforts than men. Despite these increased risks and challenges, cessation programs specifically designed to meet the needs of women experiencing homelessness are extremely rare.

METHODS

To examine perceptions of smoking cessation programs among women who are unstably housed, we conducted in-depth, semi-structured interviews with twenty-nine women experiencing homelessness or unstable housing who had histories of tobacco and substance use. Interviews explored the social context of smoking, as well as interest in, barriers to, and facilitators of quitting. We used a grounded theory approach to analyze the transcripts.

RESULTS

Participants reported a number of structural barriers to cessation. They reported obstacles to participating in existing cessation programs, including chronic stress related to experiences of being unsheltered and fear of being exposed to neighborhood violence. These conditions were paired with a strong need to self-isolate in order to maintain personal safety, which runs counter to traditional group-based cessation programs.

CONCLUSION

A dissonance exists between current smoking cessation programs and the needs of women who are unsheltered or unstably housed. Alternative cessation treatment delivery models that address extremely high levels of chronic stress violence, and avoidance of group settings are needed, as are programs that provide options for safe participation.

Nicotine e-cigarette vapor inhalation and self-administration in a rodent model: Sex- and nicotine delivery-specific effects on metabolism and behavior

E-cigarettes, which deliver vaporized nicotine, have dramatically risen in popularity in recent years, despite many unanswered questions about safety, efficacy in reducing dependence, and overall impact on public health. Other factors, such as sex, also play an important role in determining behavioral and neurochemical responses to drugs of abuse. In these studies, we sought to develop a protocol for vaporized e-cigarette nicotine self-administration in rats, as a foundation to better understand the differing effects of nicotine exposure routes on behavior and physiological function. We report a novel method that elicits robust nicotine vapor self-administration in male and female rats. Our findings indicate that 5-mg/ml nicotine vape solution provides a high level of consistency in lever-pressing behavior for both males and females. Moreover, in male rats, we find that such e-cigarette nicotine vapor induces similar blood levels of nicotine's main metabolite, cotinine, as that found with intravenous nicotine self-administration. Therefore, the breathing pattern during vapor exposure in males leads to similar levels of titrated nicotine intake as with intravenous nicotine self-administration. Interestingly, a differential effect was found in the females, in which the same conditions of vapor exposure led to decreased cotinine levels with vapor compared to intravenous self-administration. Finally, differences in nicotine-mediated locomotion provide further support of the physiological effects of e-cigarette vapor inhalation. Taken together, our findings reveal important sex differences in nicotine intake based on the route of exposure, and we further establish a protocol for nicotine vapor self-administration in rats.

Inactivation of posterior but not anterior dorsomedial caudate-putamen impedes learning with self-administered nicotine stimulus in male rats

The rodent caudate-putamen is a large heterogeneous neural structure with distinct anatomical connections that differ in their control of learning processes. Previous research suggests that the anterior and posterior dorsomedial caudate-putamen (a- and p-dmCPu) differentially regulate associative learning with a non-contingent nicotine stimulus. The current study used bilateral NMDA-induced excitotoxic lesions to the a-dmCPu and p-dmCPu to determine the functional involvement of a-dmCPu and p-dmCPu in appetitive learning with contingent nicotine stimulus. Rats with a-dmCPu, p-dmCPu, or sham lesions were trained to lever-press for intravenous nicotine (0.03 mg/kg/inf) followed by access to sucrose 30 s later. After 1, 3, 9, and 20 nicotine-sucrose training sessions, appetitive learning in the form of a goal-tracking response was assessed using a non-contingent nicotine-alone test. All rats acquired nicotine self-administration and learned to retrieve sucrose from a receptacle at equal rates. However, rats with lesions to p-dmCPu demonstrated blunted learning of the nicotine-sucrose association. Our primary findings show that rats with lesions to p-dmCPu had a blunted goal-tracking response to a non-contingent nicotine administration after 20 consecutive days of nicotine-sucrose pairing. Our findings extend previous reports to a contingent model of nicotine self-administration and show that p-dmCPu is involved in associative learning with nicotine stimulus using a paradigm where rats voluntarily self-administer nicotine infusions that are paired with access to sucrose-a paradigm that closely resembles learning processes observed in humans.

Successful Smoking Cessation among Women Smokers Based on Utilizing National Smoking Cessation Service Type in Korea

Background: This study aimed to evaluate the successful smoking cessation across different national smoking cessation services. Methods: This study included data that had been previously entered into the integrated information system for smoking cessation services and comprised 144,688 participants after excluding missing data. These clinics provide face-to-face counseling, phone calls, text messages, and e-mail services for six months and nine sessions. Results: The women-only program had the lowest success rate (11.3%). Compared with the women-only program, the six-month success rate of smoking cessation clinic at public health centers (OR = 3.72, CI = [3.52, 3.92]), visiting-type smoking cessation clinics (OR = 2.97, CI = [2.79, 3.16]), the residential 4 -night 5-day program (OR = 7.79, CI = [6.49, 9.35]), and a program for inpatients (OR = 2.36, CI = [1.89, 2.94]) showed a significant increase. Conclusions: Emotional labor workers who participated in the women-only program had low smoking cessation success rates, while those who participated in the residential 4-night 5-day program had high success rates.

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.

Studying Sex Differences in Rodent Models of Addictive Behavior

Animal models of addictive behaviors are useful for uncovering neural mechanisms involved in the development of dependence and for identifying risk factors for drug abuse. One such risk factor is biological sex, which strongly moderates drug self-administration behavior in rodents. Female rodents are more likely to acquire drug self-administration behaviors, consume higher amounts of drug, and reinstate drug-seeking behavior more readily. Despite this female vulnerability, preclinical addiction research has largely been done in male animals. The study of sex differences in rodent models of addictive behavior is increasing, however, as more investigators are choosing to include both male and female animals in experiments. This commentary is meant to serve as an introductory guide for preclinical investigators new to the study of sex differences in addiction. We provide an overview of self-administration models, a broad view of female versus male self-administration behaviors, and suggestions for study design and implementation. Inclusion of female subjects in preclinical addiction research is timely, as problem drug and alcohol use in women is increasing. With proper attention, design, and analysis, the study of sex differences in addiction has the potential to uncover novel neural mechanisms and lead to greater translational success for addiction research. © 2021 Wiley Periodicals LLC.

Association of Stress Management with Success of Smoking Cessation in Korean Female Emotional Labor Workers for Service and Sales

Emotional labor is paid work that involves managing and regulating one’s emotions during the job including evoking and suppressing one’s feelings. This study examined the factors associated with successful smoking cessation through tailored smoking cessation counseling including stress management among female emotional labor workers. The study was conducted from 1 September 2015 to 31 December 2017. A total of 2674 women registered in the Comprehensive Smoking Cessation Service System and were grouped as either emotional labor workers for service and sales (1002) or other occupations (1672) for analysis. The participants received nine sessions of face-to-face and telephone smoking cessation counseling over 6 months, and follow-up assessments were conducted 4, 6, 12, and 24 weeks after counseling. Smoking cessation counseling involved a stress management program comprising stress tests, depression tests, color therapy, and a buddy program including peer support. Factors associated with successful smoking cessation included the number of counseling sessions, motivation rulers (Importance, Confidence, Readiness), average daily smoking amount, expired carbon monoxide (CO), and nicotine dependence. The most associated factor was the number of counseling sessions. Since counseling focused on stress management, it was the most important factor in smoking cessation, and continuous counseling could help those wanting to quit smoking.

Sex differences in COPD management

Introduction: A growing body of evidence indicates that prevalence of chronic obstructive pulmonary disease (COPD) has been increasing more rapidly among women compared to men, but the available data on the differences between the sexes in the responses to the various COPD therapies are still scarce.Areas covered: The aim of this narrative review is to provide an overview of current knowledge on sex differences in COPD management.Expert opinion: There is no solid evidence of sex differences in response to usual COPD treatments but there are sex-related differences in management of patients with a clinical diagnosis of COPD. It is difficult to explain the reason for these differences, but most likely they are due to local prescribing habits, rather than solid scientific reasons. However, there are also signals of different sex-related responses, the qualification and quantification of which is difficult with the information currently available. These signals should lead to the inclusion of more women in clinical trials, but also to the design of prospective clinical studies to assess the possible differences linked to sex in COPD treatment responses, whose identification is an important step toward the definition of personalized COPD therapy.

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey

Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged ⩾30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.

Influence of the natural hormonal milieu on brain and behavior in women who smoke cigarettes: Rationale and methodology

Women experience more severe health consequences from smoking, have greater difficulty quitting, and respond less favorably to nicotine replacement therapy than men. The influence of fluctuating ovarian hormones, specifically estradiol (E) and progesterone (P), on brain and behavioral responses during exposure to smoking reminders (i.e., cues) may be a contributing factor. Results from our laboratory suggest that women in the late follicular phase of their menstrual cycle (MC) have enhanced smoking cue (SC) vulnerabilities and reduced functional connectivity in neurocircuitry underlying cognitive control, potentially placing them at greater risk for continued smoking and relapse. The primary aim of this study is to examine and link hormonal status with brain and behavioral responses to SCs over the course of three monthly MCs in naturally cycling women who are chronic cigarette smokers. This longitudinal, counterbalanced study collects brain and behavioral responses to SCs at three time points during a woman's MC. Participants complete psychological and physical examinations, biochemical hormonal verification visits, and at least three laboratory/neuroimaging scan visits. The scan visits include a 10-min SC task during blood oxygen level-dependent (BOLD) data acquisition and are timed to occur during the early follicular phase (low E and P), late follicular phase (high E, unopposed by P), and mid-luteal phase (high P, high E). The primary outcomes include brain responses to SCs (compared to non-SCs), subjective craving, E and P hormone levels, and behavioral responses to SCs. This study addresses a critical gap in our knowledge: namely, the impact of the natural hormonal milieu on brain and behavioral responses to SCs, a powerful relapse trigger. Additionally, this study will provide a roadmap for human sex differences researchers who are obliged to consider the often confounding cyclic hormonal fluctuations of women.

Comparing participant estimated demand intensity on the cigarette Purchase Task to consumption when usual-brand cigarettes were provided free

Accumulating evidence suggests that the hypothetical Cigarette Purchase Task (CPT), especially its demand Intensity index (i.e., estimated cigarettes participants would smoke if free), is associated with individual differences in smoking risk. Nevertheless, few studies have examined the extent to which hypothetical CPT demand Intensity may differ from consumption when participants are provided with free cigarettes. That topic is the overarching focus of the present study. Participants were 745 adult smokers with co-morbid psychiatric conditions or socioeconomic disadvantage. CPT was administered for usual-brand cigarettes prior to providing participants with seven days of their usual-brand cigarettes free of cost and consumption was recorded daily via an Interactive Voice Response (IVR) System. Demand Intensity was correlated with IVR smoking rate (rs 0.670-0.696, ps < 0.001) but estimates consistently exceeded IVR smoking rates by an average of 4.4 cigarettes per day (ps < 0.001). Importantly, both measures were comparably sensitive to discerning well-established differences in smoking risk, including greater cigarettes per day among men versus women (F(1,732) = 18.74, p < 0.001), those with versus without opioid-dependence (F(1,732) = 168.37, p < 0.001), younger versus older adults (F(2,730) = 32.93, p < 0.001), and those with lower versus greater educational attainment (F(1,732) = 38.26, p < 0.001). Overall, CPT demand Intensity appears to overestimate consumption rates relative to those observed when participants are provided with free cigarettes, but those deviations are systematic (i.e., consistent in magnitude and direction, Fs all <1.63; ps > 0.19 for all interactions with subgroups). This suggests that demand Intensity was sensitive to established group differences in smoking rate, supporting its utility as an important measure of addiction potential.

Estradiol promotes and progesterone reduces anxiety-like behavior produced by nicotine withdrawal in female rats

This study assessed sex differences and the role of ovarian hormones in nicotine withdrawal. Study 1 compared physical signs, anxiety-like behavior, and corticosterone levels in male, intact female, and ovariectomized (OVX) female rats during nicotine withdrawal. Estradiol (E2) and progesterone levels were also assessed in intact females that were tested during different phases of the 4-day estrous cycle. Study 2 assessed the role of ovarian hormones in withdrawal by comparing the same measures in OVX rats that received vehicle, E2, or E2+progesterone prior to testing. Briefly, rats received a sham surgery or an ovariectomy procedure. Fifteen days later, rats were prepared with a pump that delivered nicotine for 14 days. On the test day, rats received saline or the nicotinic receptor antagonist, mecamylamine to precipitate withdrawal. Physical signs and anxiety-like behavior were assessed on the elevated plus maze (EPM) and light-dark transfer (LDT) tests. During withdrawal, intact females displayed greater anxiety-like behavior and increases in corticosterone levels as compared to male and OVX rats. Females tested in the estrus phase (when E2 is relatively low) displayed less anxiety-like behavior and had lower corticosterone levels versus all other phases. Anxiety-like behavior and corticosterone levels were positively correlated with E2 and negatively correlated with progesterone levels. Intact females displaying high E2/low progesterone showed greater anxiety-like behavior and corticosterone levels as compared to females displaying low E2/high progesterone. Lastly, OVX-E2 rats displayed greater anxiety-like behavior than OVX-E2+progesterone rats. These data suggest that E2 promotes and progesterone reduces anxiety-like behavior produced by nicotine withdrawal.

Role of Brain Derived Extracellular Vesicles in Decoding Sex Differences Associated with Nicotine Self-Administration

Smoking remains a significant health and economic concern in the United States. Furthermore, the emerging pattern of nicotine intake between sexes further adds a layer of complexity. Nicotine is a potent psychostimulant with a high addiction liability that can significantly alter brain function. However, the neurobiological mechanisms underlying nicotine’s impact on brain function and behavior remain unclear. Elucidation of these mechanisms is of high clinical importance and may lead to improved therapeutics for smoking cessation. To fill in this critical knowledge gap, our current study focused on identifying sex-specific brain-derived extracellular vesicles (BDEV) signatures in male and female rats post nicotine self-administration. Extracellular vesicles (EVs) are comprised of phospholipid nanovesicles such as apoptotic bodies, microvesicles (MVs), and exosomes based on their origin or size. EVs are garnering significant attention as molecules involved in cell–cell communication and thus regulating the pathophysiology of several diseases. Interestingly, females post nicotine self-administration, showed larger BDEV sizes, along with impaired EV biogenesis compared to males. Next, using quantitative mass spectrometry-based proteomics, we identified BDEV signatures, including distinct molecular pathways, impacted between males and females. In summary, this study has identified sex-specific changes in BDEV biogenesis, protein cargo signatures, and molecular pathways associated with long-term nicotine self-administration.