Patterns of intermittent smoking: An analysis using Ecological Momentary Assessment

Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study

BACKGROUND

Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as "digital natives," since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM's connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps.

OBJECTIVE

This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes.

METHODS

We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non-sexual and gender minority adolescents.

RESULTS

Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024.

CONCLUSIONS

This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50984.

Momentary Influences on Self-Regulation in Two Populations With Health Risk Behaviors: Adults Who Smoke and Adults Who Are Overweight and Have Binge-Eating Disorder

Introduction

Self-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary contexts to a substantial degree. Because most health behaviors (e.g., eating, drinking, smoking) occur in the context of everyday activities, digital technologies may help us better understand and influence these behaviors in real time. Using a momentary self-regulation measure, the current study (which was part of a larger multi-year research project on the science of behavior change) used ecological momentary assessment (EMA) to assess if self-regulation can be engaged and manipulated on a momentary basis in naturalistic, non-laboratory settings.

Methods

This one-arm, open-label exploratory study prospectively collected momentary data for 14 days from 104 participants who smoked regularly and 81 participants who were overweight and had binge-eating disorder. Four times per day, participants were queried about momentary self-regulation, emotional state, and social and environmental context; recent smoking and exposure to smoking cues (smoking sample only); and recent eating, binge eating, and exposure to binge-eating cues (binge-eating sample only). This study used a novel, momentary self-regulation measure comprised of four subscales: momentary perseverance, momentary sensation seeking, momentary self-judgment, and momentary mindfulness. Participants were also instructed to engage with Laddr, a mobile application that provides evidence-based health behavior change tools via an integrated platform. The association between momentary context and momentary self-regulation was explored via mixed-effects models. Exploratory assessments of whether recent Laddr use (defined as use within 12 h of momentary responses) modified the association between momentary context and momentary self-regulation were performed via mixed-effects models.

Results

Participants (mean age 35.2; 78% female) in the smoking and binge-eating samples contributed a total of 3,233 and 3,481 momentary questionnaires, respectively. Momentary self-regulation subscales were associated with several momentary contexts, in the combined as well as smoking and binge-eating samples. For example, in the combined sample momentary perseverance was associated with location, positively associated with positive affect, and negatively associated with negative affect, stress, and tiredness. In the smoking sample, momentary perseverance was positively associated with momentary difficulty in accessing cigarettes, caffeine intake, and momentary restraint in smoking, and negatively associated with temptation and urge to smoke. In the binge-eating sample, momentary perseverance was positively associated with difficulty in accessing food and restraint in eating, and negatively associated with urge to binge eat. While recent Laddr use was not associated directly with momentary self-regulation subscales, it did modify several of the contextual associations, including challenging contexts.

Conclusions

Overall, this study provides preliminary evidence that momentary self-regulation may vary in response to differing momentary contexts in samples from two exemplar populations with risk behaviors. In addition, the Laddr application may modify some of these relationships. These findings demonstrate the possibility of measuring momentary self-regulation in a trans-diagnostic way and assessing the effects of momentary, mobile interventions in context. Health behavior change interventions may consider measuring and targeting momentary self-regulation in addition to trait-level self-regulation to better understand and improve health risk behaviors. This work will be used to inform a later stage of research focused on assessing the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and health outcomes.

Clinical Trial Registration

ClinicalTrials.gov, Identifier: NCT03352713.

COVID-19 Confinement and Health Risk Behaviors in Spain

The World Health Organization (WHO) has declared a world pandemic due to COVID-19. In response, most affected countries have enacted measures involving compulsory confinement and restrictions on free movement, which likely influence citizens' lifestyles. This study investigates changes in health risk behaviors (HRBs) with duration of confinement. An online cross-sectional survey served to collect data about the Spanish adult population regarding health behaviors during the first 3 weeks of confinement. A large sample of participants (N = 2,741) (51.8% women; mean age 34.2 years [SD 13.0]) from all Spanish regions completed the survey. Binomial logistic regressions adjusted for socioeconomic characteristics (i.e., gender, age, civil status, education, and occupation), body mass index (BMI), previous HRBs, and confinement context (i.e., solitude and exposure to COVID-19) were conducted to investigate associations between the number of weeks confined and a set of six HRBs (physical activity, alcohol consumption, fresh fruit and vegetable consumption, smoking, screen exposure, and sleep hours). When adjusted, we observed significantly lower odds of experiencing a higher number of HRBs than before confinement overall in a time-dependent fashion: OR 0.63; 95% CI: 0.49-0.81 for the second and OR 0.47; 95% CI: 0.36-0.61 for the third week of confinement. These results were equally consistent in all age and gender subgroup analyses. The present study indicates that changes toward a higher number of HRBs than before confinement, as well as the prevalence of each HRB except screen exposure, decreased during the first 3 weeks of COVID-19 confinement, and thus the Spanish adult population may have adapted to the new situational context by gradually improving their health behaviors.

Differential patterns of alcohol and nicotine intake: Combined alcohol and nicotine binge consumption behaviors in mice

Late adolescence and young adulthood, corresponding to the high school and college years, are vulnerable periods for increased alcohol and nicotine use. The dramatic increase in the prevalence of electronic cigarette use is particularly concerning in these age groups. Late adolescents and young adults are more likely to engage in cycles of binge drug consumption, and alcohol and nicotine are frequently used together. However, there are few data examining the combination of alcohol and nicotine in binge models in animal models. In this study, our objectives were to determine how voluntary nicotine consumption beginning in late adolescence influenced subsequent binge alcohol consumption in young adulthood, how a combination of alcohol and nicotine binge consumption differed from alcohol-only binge consumption, and whether nicotine would be consumed when presented in a binge procedure. Male C57BL/6J mice voluntarily consumed unsweetened alcohol and nicotine in continuous-access bottle-choice procedures in combination with cycles of drinking-in-the-dark. Our results show that experience with voluntary nicotine consumption in late adolescence did not affect subsequent binge alcohol consumption in early adulthood. However, mice that consumed nicotine in adolescence showed an initial decrease in alcohol preference, and consequently increase in nicotine preference, on the first session of combined ethanol and nicotine binge consumption in adulthood compared with mice that drank only water during late adolescence. Lastly, we found that mice readily consumed unsweetened nicotine when presented in a binge procedure, and the level of consumption exceeded the nicotine consumption observed in the combination alcohol and nicotine binge. Our data show that expansion of the patterns of alcohol and nicotine co-consumption in a mouse models is possible, which will enable us to dissect relevant molecular targets underlying these consumption patterns and better inform drug development efforts.

An electronic, smart lighter to measure cigarette smoking: A pilot study to assess feasibility and initial validity

Understanding variability in smoking patterns may inform smoking cessation interventions. Retrospective reports of cigarettes smoked per day may be biased and typically do not provide temporal precision regarding when cigarettes are smoked. However, real-time, user-initiated tracking, such as logging each time a cigarette is smoked, can be burdensome over long time frames. In this study, adult, non-treatment seeking daily smokers (N = 22) used an electronic, smart lighter to light and timestamp cigarettes for 14 days. Participants reported number of cigarettes smoked per day (CPD) via a mobile device (daily diary) and retrospectively reported CPD at the end of the study using the Timeline Followback (TLFB). Self-reported lighter satisfaction and adherence varied with 68% of participants reporting that they liked using the lighter and participants reporting using the lighter for 92% of cigarettes smoked, on average. Lighter-estimated CPD did not differ from daily diary-estimated CPD, but was significantly lower than TLFB estimates. The lighter resulted in greater day-to-day variability relative to other methods and fewer rounded cigarette counts (digit bias) relative to the TLFB. The lighter appears to be feasible for capturing data on smoking patterns in daily smokers. Though false positive cigarettes are likely low, additional technologies that augment data captured from the lighter may be necessary to reduce false negatives (missed cigarettes) and alternative lighter designs may appeal more to certain smokers.

The Time-Varying Relations Between Risk Factors and Smoking Before and After a Quit Attempt

Introduction

Intensive longitudinal data (ILD) collected with ecological momentary assessments (EMAs) can provide a rich resource for understanding the relations between risk factors and smoking in the time surrounding a cessation attempt.

Methods

Participants (N = 142) were smokers seeking treatment at a safety-net hospital smoking cessation clinic who were randomly assigned to receive standard clinic care (ie, counseling and cessation medications) or standard care plus small financial incentives for biochemically confirmed smoking abstinence. Participants completed EMAs via study provided smartphones several times per day for 14 days (1 week prequit through 1 week postquit). EMAs assessed current contextual factors including environmental (eg, easy access to cigarettes, being around others smoking), cognitive (eg, urge to smoke, stress, coping expectancies, cessation motivation, cessation self-efficacy, restlessness), behavioral (ie, recent smoking and alcohol consumption), and affective variables. Temporal relations between risk factors and smoking were assessed using a logistic time-varying effect model.

Results

Participants were primarily female (57.8%) and Black (71.8%), with an annual household income of <$20000 per year (71.8%), who smoked 17.6 cigarettes per day (SD = 8.8). Individuals assigned to the financial incentives group had decreased odds of smoking compared with those assigned to usual care beginning 3 days before the quit attempt and continuing throughout the first week postquit. Environmental, cognitive, affective, and behavioral variables had complex time-varying impacts on smoking before and after the scheduled quit attempt.

Conclusions

Knowledge of time-varying effects may facilitate the development of interventions that target specific psychosocial and behavioral variables at critical moments in the weeks surrounding a quit attempt.

Implications

Previous research has examined time-varying relations between smoking and negative affect, urge to smoke, smoking dependence, and certain smoking cessation therapies. We extend this work using ILD of unexplored variables in a socioeconomically disadvantaged sample of smokers seeking cessation treatment. These findings could be used to inform ecological momentary interventions that deliver treatment resources (eg, video- or text-based content) to individuals based upon critical variables surrounding their attempt.

Ecological momentary assessment of smoking behaviors in native and converted intermittent smokers

BACKGROUND AND OBJECTIVES

About 22% of adult smokers in the U.S. are intermittent cigarette smokers (ITS). ITS can be further classified as native ITS who never smoked daily and converted ITS who formerly smoked daily but reduced to intermittent smoking. Ecological momentary assessment (EMA) was conducted to determine the behaviors and experiences that are associated with the decision to smoke.

METHODS

The study included 24 native ITS and 36 converted ITS (N = 60) from the Pennsylvania Adult Smoking Study. A baseline questionnaire, daily log, and an EMA smoking log that assessed emotions, activities, and smoking urges was filled out with each cigarette for 1 week to capture 574 smoking sessions.

RESULTS

Both groups had very low levels of cigarette dependence. Both groups were more tempted to smoke in positive or negative situations than situations associated with habituation. EMA showed that the most common emotional state during smoking sessions was positive (47%), followed by negative (32%), neutral (16%), and mixed (5%) emotions. Smokers were more likely to smoke during activities of leisure (48%) than during performative duties (29%), social (16%) or interactive occasions (7%). Converted ITS were more likely to smoke alone compared to native ITS (p < .001).

DISCUSSION AND CONCLUSIONS

ITS report minimal levels of dependence when captured on traditional scales of nicotine dependence, yet experience loss of autonomy and difficulty quitting. The majority of the ITS reported positive emotions and leisure activities while smoking, and smoked during the evening.

SCIENTIFIC SIGNIFICANCE

The current paper identifies environmental and behavioral factors that are associated with smoking among ITS in real time. (Am J Addict 2018;27:131-138).

Ecological momentary assessment of various tobacco product use among young adults

INTRODUCTION

Young adults are at high risk for using traditional and novel tobacco products. However, little is known about daily/weekly use patterns or psychosocial triggers for using various tobacco products.

METHODS

This ecological momentary assessment (EMA) study examined timing, tobacco cravings, affect, social context, and other substance use (alcohol, marijuana) in relation to use of cigarettes, electronic nicotine delivery systems (ENDS), and any tobacco product (i.e., cigarettes, ENDS, cigars, hookah), respectively. We also examined interactions between these predictors, sex, and race/ethnicity. From a longitudinal study of 3418 18-25 year-olds from seven Georgia colleges/universities, we recruited 72 reporting current tobacco use to participate in the 21-day EMA study; 43 participated, of which 31 completed ≥66% assessments and were analyzed. Cravings, affect, social context, and substance use were assessed daily across four four-hour windows.

RESULTS

Of the 31 participants, average age was 21.10 years (SD = 1.95), 45.2% were female, and 71.0% non-Hispanic White; 71.0% used cigarettes, 58.1% ENDS, 38.7% cigars, and 25.8% hookah (25.6% used one product, 46.5% two, 27.9% ≥ three). Predictors of cigarette use included higher anxiety, greater odds of marijuana and alcohol use, and higher boredom levels among women. Predictors of ENDS use included being non-White and greater odds of marijuana use, as well as higher tobacco cravings among women and higher boredom among men. Predictors of any tobacco product use included being non-White, higher boredom levels, and greater odds of marijuana and alcohol use.

CONCLUSIONS

Distinct interventions may be needed to address use of differing tobacco products among young adults.

Cigarette Smoking Detection with An Inertial Sensor and A Smart Lighter

In recent years, a number of wearable approaches have been introduced for objective monitoring of cigarette smoking based on monitoring of hand gestures, breathing or cigarette lighting events. However, non-reactive, objective and accurate measurement of everyday cigarette consumption in the wild remains a challenge. This study utilizes a wearable sensor system (Personal Automatic Cigarette Tracker 2.0, PACT2.0) and proposes a method that integrates information from an instrumented lighter and a 6-axis Inertial Measurement Unit (IMU) on the wrist for accurate detection of smoking events. The PACT2.0 was utilized in a study of 35 moderate to heavy smokers in both controlled (1.5–2 h) and unconstrained free-living conditions (~24 h). The collected dataset contained approximately 871 h of IMU data, 463 lighting events, and 443 cigarettes. The proposed method identified smoking events from the cigarette lighter data and estimated puff counts by detecting hand-to-mouth gestures (HMG) in the IMU data by a Support Vector Machine (SVM) classifier. The leave-one-subject-out (LOSO) cross-validation on the data from the controlled portion of the study achieved high accuracy and F1-score of smoking event detection and estimation of puff counts (97%/98% and 93%/86%, respectively). The results of validation in free-living demonstrate 84.9% agreement with self-reported cigarettes. These results suggest that an IMU and instrumented lighter may potentially be used in studies of smoking behavior under natural conditions.

Feasibility of Using Ecological Momentary Assessment to Study Unaided Smoking Cessation in Couples

Introduction

Ecological momentary assessment (EMA) is a valuable method for studying smoking cessation, but feasibility has not been examined in committed couples. The current study examines the feasibility of conducting an EMA study of unaided smoking cessation in single-smoker couples.

Methods

Participants were 62 single-smoker couples recruited to participate in a 21-day study of unaided smoking cessation. Quitters and Partners were given instructions to complete one morning report, three signaled reports, and one evening report per day, as well as lapse reports when necessary. They also completed a series of questionnaires at baseline and follow-up. This article examines predictors of compliance with the reporting instructions.

Results

Compliance with scheduled reporting was reasonable (Quitters: 76%, Partners: 79%). Compliance with "on-time" lapse reporting (vs. make-up reporting) was poor (Quitters: 62%, Partners: 43%). Quitters' compliance with lapse reporting was strongly associated with an orientation toward quitting. Partners' compliance with lapse reporting was associated with relationship motivation. Quitter compliance plummeted when Partners were noncompliant. Self-regulation and emotional instability were not associated with compliance but were associated with time to complete reports. Quitters' and Partners' experiences completing the study provide some insight into the dynamics of completing an EMA study as part of a dyad.

Conclusions

Overall, this study suggests it is feasible and effective to collect EMA data on smoking cessation from couples. However, compliance with lapse reporting was poor, especially for Partners. Researchers could provide remuneration on a different schedule, provide shorter lapse reports, or omit Partner lapse reports altogether.

Implications

This article examined compliance with scheduled and lapse reporting in single-smoker couples during an unaided quit attempt. Compliance with scheduled reporting was acceptable, but compliance with lapse reporting was poor, especially for Partners. Quitters' compliance with lapse reporting was heavily influenced by an orientation toward quitting, suggesting that improved screening for motivation to quit might improve compliance rates. Quitter compliance also plummeted when Partners were noncompliant. Partner demographics and relationship motivation were the best predictors of compliance. To enhance compliance, researchers might provide remuneration on a different scale, dramatically shorten lapse reports, or even omit Partner lapse reports.

A review of the effects of nicotine on social functioning

Many smokers are aware that smoking is a dangerous health behavior and eventually try to quit smoking. Unfortunately, most quit attempts end in failure. Traditionally, the addictive nature of smoking has been attributed to the pharmacologic effects of nicotine. In an effort to offer a more comprehensive, biobehavioral analysis of smoking behavior and motivation, some researchers have begun to consider the role of social factors in smoking. In line with recent recommendations to integrate social and pharmacological analyses of smoking, we reviewed the experimental literature examining the effects of nicotine and nicotine withdrawal on social functioning. The review identified 13 studies that experimentally manipulated nicotine and assessed social functioning, 12 of which found support for nicotine's enhancement of social functioning. Although few experiments have investigated social functioning, they nevertheless offer compelling evidence that nicotine enhances social functioning in smokers and suggest that nicotine deprivation may hamper social functioning in those dependent on nicotine. Future directions for investigating social outcomes and context in those who use nicotine products are discussed with a focus on leveraging advances in social and developmental psychology, animal research, sociology, and neuroimaging to more comprehensively understand smoking behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

An Ecological Momentary Assessment of Cigarette and Cigar Dual Use Among African American Young Adults

Introduction

The dual use of cigarettes and cigars among African American young adults is a significant public health issue. Patterns of and reasons for dual use are difficult to capture using traditional self-report methods. This study used ecological momentary assessment (EMA) to characterize patterns of dual smoking and examine the personal and environmental predictors of cigarette and cigar smoking among African American young adult dual users (ages 18-29) in real-time.

Methods

For 14 days, 64 participants smoked ad libitum and were prompted four times daily to record their smoking, craving, emotions, social smoking, and environment via text message on their mobile phones. The odds of single product and dual use were examined using adjusted generalized estimating equations.

Results

Participants smoked an average of 7.9 cigarettes and 4.2 cigars per day. Cigarettes and cigars were smoked as frequently during periods of dual use as they were during periods of single product use. Cigarette craving was positively associated with cigarette-only smoking (OR: 1.07), whereas cigar craving was positively associated with cigar-only smoking (OR: 1.43) and dual use (OR: 1.08). Cigars had the greatest odds of dual use when with others (OR: 4.69) and in others' homes (OR: 4.33). Cigarettes had the greatest odds of being smoked while alone (OR: 1.57).

Conclusions

EMA was useful for capturing variable smoking patterns and predictors. In this study population, cigarettes and cigars appeared to be smoked additively, and cigars smoked socially. These findings can inform future interventions addressing dual use in this high priority population.

Implications

This is the first study to use EMA to examine naturalistic patterns and predictors of multiple tobacco use in real-time. African American young adults smoked cigarettes and cigars during periods of dual use as frequently as during periods of single product use. This suggests that most use was additive (one product smoked in addition to another) and less often as substitution (one product smoked instead of another). Social smoking and craving were strongly associated with cigar smoking in single and dual use periods. This study suggests the need for cessation messaging specifically targeted to reduce dual use in this population.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Extending the Balloon Analogue Risk Task to Assess Naturalistic Risk Taking via a Mobile Platform

The Balloon Analogue Risk Task (BART) is a behavioral measure that is commonly used to assess risk taking propensity. The primary goal of the present study was to introduce a mobile version of the BART (mBART) that can be included within ambulatory assessment protocols to assess risk taking in daily life. Study 1 compared common BART indices (i.e., total money earned, adjusted average pumps, balloon explosions, and coefficient of variability [CV]) on a single administration of the laboratory BART on a computer and the mBART on a smartphone (n = 78). Results revealed generally consistent relationships between indices of risk taking propensity in both the laboratory BART and mBART. Study 2 administered the mBART as part of a 7-day ecological momentary assessment (EMA) protocol in a population of nondaily smokers (n = 51). Using multi-level models, results suggest that males have greater adjusted average pumps (p = .03), and that a participant's average CV is negatively related to trait sensation seeking (p = .03) and positively associated with trait positive urgency (p = .04). There were within-person effects of study day (p = .05) and environment (p = .02) with respect to adjusted average pumps such that individuals took greater risks as the study progressed and were riskier when alone compared to with others. Inclusion of the mBART in EMA did not appear to significantly increase participant burden and demonstrated acceptable levels of compliance. These results offer initial evidence supporting the feasibility and utility of the mBART for ambulatory research designs.

Identifying "social smoking" U.S. young adults using an empirically-driven approach

The phenomenon of "social smoking" emerged in the past decade as an important area of research, largely due to its high prevalence in young adults. The purpose of this study was to identify classes of young adult ever smokers based on measures of social and contextual influences on tobacco use. Latent class models were developed using social smoking measures, and not the frequency or quantity of tobacco use. Data come from a national sample of young adult ever smokers aged 18-24 (Truth Initiative Young Adult Cohort Study, N=1564). The optimal models identified three latent classes: Class 1 - nonsmokers (52%); Class 2 - social smokers (18%); and Class 3 - smokers (30%). Nearly 60% of the "social smoker" class self-identified as a social smoker, 30% as an ex-smoker/tried smoking, and 12% as a non-smoker. The "social smoker" class was most likely to report using tobacco mainly or only with others. Past 30-day cigarette use was highest in the "smoker" class. Hookah use was highest in the "social smoker" class. Other tobacco and e-cigarette use was similar in the "social smoker" and "smoker" classes. Past 30-day tobacco and e-cigarette use was present for all products in the "non-smoker" class. Young adult social smokers emerge empirically as a sizable, distinct class from other smokers, even without accounting for tobacco use frequency or intensity. The prevalence of hookah use in "social smokers" indicates a group for which the social aspect of tobacco use could drive experimentation and progression to regular use.

Comparison of Ecological Momentary Assessment Versus Direct Measurement of E-Cigarette Use With a Bluetooth-Enabled E-Cigarette: A Pilot Study

BACKGROUND

Assessing the frequency and intensity of e-cigarette use presents special challenges beyond those posed by cigarette use. Accurate measurement of e-cigarette consumption, puff duration, and the stability of these measures over time will be informative for estimating the behavioral and health effects of e-cigarette use.

OBJECTIVE

The purpose of this pilot study was to compare the accuracy of self-reported e-cigarette puff counts collected via ecological momentary assessment (EMA) to objective puff count data collected by a Bluetooth-enabled e-cigarette device and to examine the feasibility and acceptability of using a second-generation e-cigarette among adult smokers.

METHODS

A total of 5 adult smokers were enrolled in a longitudinal parent study assessing how e-cigarette use affects cigarette use among e-cigarette-naïve smokers. Using a text message-based EMA system, participants reported e-cigarette puffs for 2 weeks. Participants were also given a Bluetooth-enabled e-cigarette (Smokio) that passively collected puff counts and puff duration. Comparisons between mean reports of Smokio (device-report) and EMA (self-report) use were evaluated using paired t tests. Correlation and agreement between device- and self-reports were evaluated using Pearson correlation and the concordance correlation coefficient (CCC), respectively. A linear mixed effect model was used to determine the fixed effect of timing and Smokio-reported daily puffs on report accuracy. We examined the relationship between time of day and reporting accuracy using Tukey's test for multiple pairwise comparisons.

RESULTS

A total of 5 African American participants, 4 men and 1 woman, who ranged in age from 24 to 59 years completed the study, resulting in 5180 observations (device-report) of e-cigarette use. At baseline, participants reported smoking for 5 to 25 years and consumed a mean of 7 to 13 cigarettes per day (CPD); 4 smoked within 30 minutes of waking. At the 30-day follow-up, CPD range decreased to 1 to 3 cigarettes; 4 participants reported past 7-day e-cigarette use, and 1 participant reported no cigarette smoking in the past 7 days. Over 2 weeks of e-cigarette use, participants took an average of 1074 e-cigarette (SD 779.0) puffs per person as captured by the device reports. Each participant took a mean of 75.0 (SD 58.8) puffs per day, with each puff lasting an average of 3.6 (SD 2.4) seconds. Device reports captured an average of 33.3 (SD 47.8) more puffs per person per day than the self-reported e-cigarette puffs. In 87% of days, participants underestimated the number of puffs they had taken on the Smokio. There was significant moderate correlation (r=.47, P<.001) but poor agreement (p_c=0.31, 95% CI 0.15-0.46) between the device- and self-reported data. Reporting accuracy was affected by amount and timing of e-cigarette use.

CONCLUSIONS

Compared to self-reported e-cigarette use, the Bluetooth-enabled device captured significantly more e-cigarette use and allowed for examination of puff duration in addition to puff counts. A Bluetooth-enabled e-cigarette is a powerful and feasible tool for objective collection of e-cigarette use behavior in the real world.

Higher BMI is associated with stronger effects of social cues on everyday snacking behaviour

Discretionary food choices (snacks) contribute up to a third of the daily energy intake and potentially contribute to energy imbalance and weight gain. Individual snack intake behaviour is guided by internal and external cues, with social cues (seeing others eat, being alone) consistently showing large effects. A wide body of (mainly laboratory-based) research suggests marked differences in people's response to eating cues based on BMI. Here, we show that these BMI differences in cue responsiveness also pertain to everyday snacking behaviour. In two combined ecological momentary assessment studies, 122 participants with BMIs ranging from 18.34 to 45.71 kg/m² logged their everyday snacking behaviour in real-time over two weeks along with the presence or absence of social cues. Random-effects modelling showed that people with higher BMI were more likely to consume high-energy snacks when alone, and were more likely to consume low-energy snacks in the presence of others eating. This suggests BMI differences in cue responsiveness that are in line with impression management theory and underlines the importance of social cues for snacking behaviour and provides avenues for both theory and intervention development.

Using Ecological Momentary Assessment to Identify Common Smoking Situations Among Korean American Emerging Adults

The present study provides detailed contextual information about smoking habits among young Korean American smokers with the goal of characterizing situations where they are most at risk for smoking. Relevant situational factors included location, social context, concurrent activities, time of day, affective states, and food and beverage consumption. Using ecological momentary assessment (EMA) over 7 days, participants (N = 78) were instructed to respond to smoking prompts (n = 2614) and non-smoking prompts (n = 2136) randomly scheduled throughout the day. At each prompt, participants completed a short survey about immediate contextual factors. We used multilevel models to evaluate the association between contextual factors and smoking and further explored the distribution of smoking locations and concurrent activities across each social context and reason for smoking. Compared to non-smoking events, smoking events were associated with being outside, the presence of Korean friends, socializing, consuming alcohol, and experiencing more stress relative to one's average stress level (all ps < .01). Further analyses involving only smoking events showed that when participants smoked alone, they were most commonly at home (50 %) and most often studying/working (28 %). When smoking with Korean friends, participants were most often outside (38 %) and socializing (54 %). When smoking to reduce craving, participants were most often at home (39 %) and studying/working (25 %). To our knowledge, this is the first study to provide detailed descriptions of real-time smoking contexts among young Korean American smokers. Information with this level of granularity is needed to develop effective just-in-time adaptive interventions (JITAIs) for smoking cessation.

Social contexts of momentary craving to smoke among Korean American emerging adults

INTRODUCTION

Korean American emerging adult (KAEA) smokers represent a culturally and developmentally unique population constituted of primarily light, intermittent smokers. Sociocultural contexts might play an important role in contributing to instances of acute cigarette craving and motivation to smoke in this population; yet, research testing such hypotheses is scant. The current study tests whether and how social contexts are associated with the craving among KAEA smokers.

METHODS

Seventy-eight daily KAEA smokers, who smoke 4+ cigs/day, participated in a 7-day ecological momentary assessment (EMA), in which participants responded to both signal-contingent (random) and event-contingent (smoking) prompts to answer surveys on their mobile phones (prompt-level n=1377; 603 random +774 smoking prompts). Nicotine dependence was measured at baseline; cigarette craving, negative affect, presence of others smoking, social contexts were measured with EMA.

RESULTS

Modeling of within-participant variation and covariation showed that being with Korean friends (vs. alone) was associated with increased levels of momentary craving. This association between Korean friends and craving disappeared when adjusted for presence of others smoking, which was a strong predictor of momentary craving. The positive association between Korean friends and craving was amplified immediately prior to smoking (vs. non-smoking random) instances.

CONCLUSIONS

Being with Korean friends might serve as a culturally-specific salient smoking cue, which might have been learned throughout their smoking history. Our data also showed that increased craving associated with Korean friends may represent social settings that primarily involve cigarette smoking. Given our findings on cigarette use among KAEA's social network, addressing cigarette use as a group behavior might be a fruitful intervention strategy.

Resting-state EEG, impulsiveness, and personality in daily and nondaily smokers

OBJECTIVES

Resting EEG is sensitive to transient, acute effects of nicotine administration and abstinence, but the chronic effects of smoking on EEG are poorly characterized. This study measures the resting EEG profile of chronic smokers in a non-deprived, non-peak state to test whether differences in smoking behavior and personality traits affect pharmaco-EEG response.

METHODS

Resting EEG, impulsiveness, and personality measures were collected from daily smokers (n=22), nondaily smokers (n=31), and non-smokers (n=30).

RESULTS

Daily smokers had reduced resting delta and alpha EEG power and higher impulsiveness (Barratt Impulsiveness Scale) compared to nondaily smokers and non-smokers. Both daily and nondaily smokers discounted delayed rewards more steeply, reported lower conscientiousness (NEO-FFI), and reported greater disinhibition and experience seeking (Sensation Seeking Scale) than non-smokers. Nondaily smokers reported greater sensory hedonia than nonsmokers.

CONCLUSIONS

Altered resting EEG power in daily smokers demonstrates differences in neural signaling that correlated with greater smoking behavior and dependence. Although nondaily smokers share some characteristics with daily smokers that may predict smoking initiation and maintenance, they differ on measures of impulsiveness and resting EEG power.

SIGNIFICANCE

Resting EEG in non-deprived chronic smokers provides a standard for comparison to peak and trough nicotine states and may serve as a biomarker for nicotine dependence, relapse risk, and recovery.

Review of hookah tobacco smoking among college students: policy implications and research recommendations

BACKGROUND

About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco.

OBJECTIVE

Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy.

METHODS

PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy".

RESULTS

Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking.

CONCLUSION

Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.

Utilizing mHealth methods to identify patterns of high risk illicit drug use

INTRODUCTION

We assessed patterns of illicit drug use using mobile health (mHealth) methods and subsequent health care indicators among drug users in Baltimore, MD.

METHODS

Participants of the EXposure Assessment in Current Time (EXACT) study were provided a mobile device for assessment of their daily drug use (heroin, cocaine or both), mood and social context for 30 days from November 2008 through May 2013. Real-time, self-reported drug use events were summed for individuals by day. Drug use risk was assessed through growth mixture modeling. Latent class regression examined the association of mHealth-defined risk groups with indicators of healthcare access and utilization.

RESULTS

109 participants were a median of 48.5 years old, 90% African American, 52% male and 59% HIV-infected. Growth mixture modeling identified three distinct classes: low intensity drug use (25%), moderate intensity drug use (65%) and high intensity drug use (10%). Compared to low intensity drug users, high intensity users were younger, injected greater than once per day, and shared needles. At the subsequent study visit, high intensity drug users were nine times less likely to be medically insured (adjusted OR: 0.10, 95%CI: 0.01-0.88) and at greater risk for failing to attend any outpatient appointments (aOR: 0.13, 95%CI: 0.02-0.85) relative to low intensity drug users.

CONCLUSIONS

Real-time assessment of drug use and novel methods of describing sub-classes of drug users uncovered individuals with higher-risk behavior who were poorly utilizing healthcare services. mHealth holds promise for identifying individuals engaging in high-risk behaviors and delivering real-time interventions to improve care outcomes.

Impulsivity and cigarette craving among adolescent daily and occasional smokers

INTRODUCTION

Impulsivity is a multi-dimensional construct that is robustly related to cigarette smoking. While underlying factors that account for this relation are not well understood, craving has been proposed as a central mechanism linking impulsivity to smoking. In order to further refine our understanding of associations between impulsivity and cigarette craving, the current study examined the association between impulsivity and tonic and cue-elicited craving among a sample of adolescent smokers. We expected trait impulsivity would be positively associated with both tonic and cue-elicited craving, and that this relationship would be stronger among daily vs. occasional smokers.

METHODS

106 smokers (ages 16-20) completed the questionnaires and reported their cigarette craving prior to and immediately following presentation of each of three counterbalanced cue types: (a) in vivo smoking, (b) alcohol, and (c) neutral cue.

RESULTS

Impulsivity was positively associated with tonic craving for daily smokers (β=.38; p=.005), but not occasional smokers (β=.01; p=.95), with a significant impulsivity x smoker group interaction (β=1.31; p=.03). Impulsivity was unrelated to craving following smoking or alcohol cue, regardless of smoker group (all p's>.16).

CONCLUSIONS

Results suggest a moderated effect in which impulsivity is positively associated with tonic craving for daily smokers, but not occasional smokers. Tonic craving may serve as a mechanism linking impulsivity, smoking persistence, and nicotine dependence among daily smokers.

Development of the PROMIS coping expectancies of smoking item banks

OBJECTIVE

Smoking is a coping strategy for many smokers who then have difficulty finding new ways to cope with negative affect when they quit. This paper describes analyses conducted to develop and evaluate item banks for assessing the coping expectancies of smoking for daily and nondaily smokers.

METHODS

Using data from a large sample of daily (N = 4,201) and nondaily (N = 1,183) smokers, we conducted a series of item factor analyses, item response theory analyses, and differential item functioning (DIF) analyses (according to gender, age, and ethnicity) to arrive at a unidimensional set of items for daily and nondaily smokers. We also evaluated performance of short forms (SFs) and computer adaptive tests (CATs) for assessing coping expectancies of smoking.

RESULTS

For both daily and nondaily smokers, the unidimensional Coping Expectancies item banks (21 items) are relatively DIF free and are highly reliable (0.96 and 0.97, respectively). A common 4-item SF for daily and nondaily smokers also showed good reliability (0.85). Adaptive tests required an average of 4.3 and 3.7 items for simulated daily and nondaily respondents, respectively, and achieved reliabilities of 0.91 for both when the maximum test length was 10 items.

CONCLUSIONS

This research provides a new set of items that can be used to reliably assess coping expectancies of smoking, through a SF, CAT, or a tailored set selected for a specific research purpose.

Development of the PROMIS positive emotional and sensory expectancies of smoking item banks

INTRODUCTION

The positive emotional and sensory expectancies of cigarette smoking include improved cognitive abilities, positive affective states, and pleasurable sensorimotor sensations. This paper describes development of Positive Emotional and Sensory Expectancies of Smoking item banks that will serve to standardize the assessment of this construct among daily and nondaily cigarette smokers.

METHODS

Data came from daily (N = 4,201) and nondaily (N =1,183) smokers who completed an online survey. To identify a unidimensional set of items, we conducted item factor analyses, item response theory analyses, and differential item functioning analyses. Additionally, we evaluated the performance of fixed-item short forms (SFs) and computer adaptive tests (CATs) to efficiently assess the construct.

RESULTS

Eighteen items were included in the item banks (15 common across daily and nondaily smokers, 1 unique to daily, 2 unique to nondaily). The item banks are strongly unidimensional, highly reliable (reliability = 0.95 for both), and perform similarly across gender, age, and race/ethnicity groups. A SF common to daily and nondaily smokers consists of 6 items (reliability = 0.86). Results from simulated CATs indicated that, on average, less than 8 items are needed to assess the construct with adequate precision using the item banks.

CONCLUSIONS

These analyses identified a new set of items that can assess the positive emotional and sensory expectancies of smoking in a reliable and standardized manner. Considerable efficiency in assessing this construct can be achieved by using the item bank SF, employing computer adaptive tests, or selecting subsets of items tailored to specific research or clinical purposes.

A Qualitative Study of Smoker Identity Among College Student Smokers

BACKGROUND

This research was motivated by findings that college students who smoke cigarettes often self-categorize as nonsmokers, that is, they reject the social identity of "smoker."

OBJECTIVES

The goal of the present study was to shed light on college students' smoker identities beyond the smoker/nonsmoker dichotomy.

METHODS

Focus groups were conducted to investigate how college students categorize their own smoking patterns and to identify what behaviors and attitudes are associated with these different categories of smoker identities. Forty-one students from a western university participated in this study in November 2011.

RESULTS

The focus group results indicated that there were five distinct smoker identities on campus. Light and regular smokers were the daily smoker identities present, while stress, social, and drunk smokers were the occasional smoker identities. Moreover, each of these smoker identities was defined by a unique pattern of smoking behavior, attitudes, and motives.

CONCLUSIONS/IMPORTANCE

These findings support the notion that there are different types of smokers, both daily and occasional, in the college population. We suggest that researchers, healthcare providers, and prevention/intervention programs may all benefit from distinguishing between these different types of smokers.

Affective motives for smoking among early stage smokers

BACKGROUND

As most smokers initiate smoking during adolescence, assessment of smoking motives that underlie trajectories of dependence is critical for both prevention and cessation efforts. In the current study, we expected participants with higher nicotine dependence would smoke (a) less for positive reinforcement (PR) and (b) more for negative reinforcement (NR) motives. We secondarily assessed the relative contribution of PR to NR motives across levels of dependence.

METHODS

Data were drawn from a study on cue-elicited craving among occasional versus daily adolescent smokers aged 16-20 years (N = 111). Smoking motives were assessed in relation to 3 commonly used measures of nicotine dependence: (a) Fagerström Test for Nicotine Dependence (FTND), (b) Autonomy over Smoking Scale (AUTOS), and (c) Nicotine Dependence Syndrome Scale (NDSS).

RESULTS

Compared to occasional smokers, daily smokers had significantly higher scores on each dependence measure and endorsed more prominent NR smoking motives. Each measure of nicotine dependence was strongly associated with NR motives for smoking, although measures differed in their association with PR motives. As expected, the FTND, AUTOS, and NDSS each significantly predicted smoking motive difference score (PR - NR), such that higher dependence was associated with more prominent NR motives for smoking.

CONCLUSIONS

Results are consistent with our understanding of dependence and provide further support for 3 common measures of nicotine dependence among early stage smokers.

Nicotine interactions with low-dose alcohol: pharmacological influences on smoking and drinking motivation

An extensive literature documents a close association between cigarette and alcohol use. The joint pharmacological effects of alcohol and nicotine on smoking and drinking motivation may help explain this relationship. This experiment was designed to test the separate and combined pharmacological effects of nicotine and a low dose of alcohol (equivalent to 1-2 standard drinks) on substance use motivation using a double-blind and fully crossed within-subjects design. Participants (N = 87) with a wide range of smoking and drinking patterns completed 4 counterbalanced experimental sessions during which they consumed an alcohol (male: 0.3g/kg; female: 0.27g/kg) or placebo beverage and smoked a nicotine (.6 mg) or placebo cigarette. Outcome measures assessed the impact of drug administration (alcohol or nicotine) on craving to smoke, craving to drink, affect, and liking of the beverage and cigarette. Results indicated that combined administration produced higher cravings to smoke for the entire sample, as well as higher cravings to drink among women and lighter drinkers. Heavier users of either alcohol or cigarettes also exhibited enhanced sensitivity to the effects of either drug in isolation. Separate, but not interactive, effects of alcohol and nicotine on mood were observed as well as both same-drug and cross-drug effects on beverage and cigarette liking. Together, these findings support the notion that the interactive pharmacological effects of nicotine and low doses of alcohol play an important role in motivating contemporaneous use and suggest roles for cross-reinforcement and cross-tolerance in the development and maintenance of alcohol and nicotine use and dependence.

Reasons for smoking among tri-ethnic daily and nondaily smokers

INTRODUCTION

Nondaily smokers experience adverse effects from tobacco use, yet they have been understudied compared to daily smokers. Understanding how reasons for smoking (RS) differ by smoking level, gender, and race/ethnicity could inform tailored interventions.

METHODS

A cross-sectional survey was administered through an online panel survey service to 2,376 current smokers who were at least 25 years of age. The sample was stratified to obtain equal numbers of 3 racial/ethnic groups (African American [AA], Latino, and White) across smoking level (native nondaily, converted nondaily, daily light, and daily moderate/heavy).

RESULTS

A 7-factor structure of a 20-item Modified Reasons for Smoking Scale (MRSS) was confirmed (each subscale alpha > 0.80). Each factor of the MRSS varied by smoking level, with nondaily smokers endorsing all RS less frequently than daily smokers (p < .0001). The 4 smoker subgroups incrementally differed from one another (p < .05) with several exceptions between converted nondaily and daily light smokers. Males reported stronger RS on 5 out of 7 reasons (p < .05). Females had higher scores on tension reduction/relaxation (p < .0001). Latinos reported stronger RS than Whites and AAs on all reasons (p < .05) except for tension reduction/relaxation (p > .05). AAs and Whites were comparable on all RS (p > .05).

CONCLUSIONS

The present study highlights considerable variability across smoking level, gender, and race/ethnicity in strength of RS. Addressing subgroup differences in RS may contribute to more sensitive and effective prevention and treatment efforts.

Craving in intermittent and daily smokers during ad libitum smoking

INTRODUCTION

This study aimed to assess average and peak craving intensity among nondaily intermittent smokers (ITS) in smoking episodes and when not smoking compared to that of daily smokers (DS).

METHODS

Two hundred and twelve ITS and 194 DS monitored their smoking and craving for 3 weeks using Ecological Momentary Assessment methods. Craving was assessed (0-100 scale) when subjects lit a cigarette and at random times when not smoking; 48,469 observations were analyzed using generalized estimating equations.

RESULTS

ITS experienced craving, including intense craving; their 95th percentile intensity averaged 77.7 ± 22.5 out of 100 (higher among DS: 89.1 ± 14.5). ITS reported lower craving than DS, both when smoking and when not smoking. In both groups, craving was less intense when not smoking (DS: 71.1 ± 20.7 vs. 59.83 ± 21.97; ITS: 59.91 ± 23.03 vs. 26.63 ± 19.87), but the difference was significantly greater among ITS. Among ITS, the probability of smoking rose continuously as craving increased over the full range of the scale. In contrast, among DS the probability of smoking rose until the midpoint of the scale, after which the relationship flattened. Findings were mostly similar for ITS with and without a history of past daily smoking.

CONCLUSIONS

ITS do experience craving, including intense craving. The relationship between craving and smoking is stronger among ITS because DS experience moderate craving even between cigarettes. In contrast, ITS appear to experience craving in limited situations associated with smoking, suggesting that their craving and smoking may be driven by transient cues rather than endogenous needs.

Smoking patterns and stimulus control in intermittent and daily smokers

Intermittent smokers (ITS) – who smoke less than daily – comprise an increasing proportion of adult smokers. Their smoking patterns challenge theoretical models of smoking motivation, which emphasize regular and frequent smoking to maintain nicotine levels and avoid withdrawal, but yet have gone largely unexamined. We characterized smoking patterns among 212 ITS (smoking 4–27 days per month) compared to 194 daily smokers (DS; smoking 5–30 cigarettes daily) who monitored situational antecedents of smoking using ecological momentary assessment. Subjects recorded each cigarette on an electronic diary, and situational variables were assessed in a random subset (n = 21,539 smoking episodes); parallel assessments were obtained by beeping subjects at random when they were not smoking (n = 26,930 non-smoking occasions). Compared to DS, ITS' smoking was more strongly associated with being away from home, being in a bar, drinking alcohol, socializing, being with friends and acquaintances, and when others were smoking. Mood had only modest effects in either group. DS' and ITS' smoking were substantially and equally suppressed by smoking restrictions, although ITS more often cited self-imposed restrictions. ITS' smoking was consistently more associated with environmental cues and contexts, especially those associated with positive or “indulgent” smoking situations. Stimulus control may be an important influence in maintaining smoking and making quitting difficult among ITS.

Smokers who report smoking but do not consider themselves smokers: a phenomenon in need of further attention

BACKGROUND

Heightened stigma surrounding the action of smoking may decrease the likelihood that individuals who engage in smoking identify with the label 'smoker'. Non-identifying smokers (NIS) may undermine accurate smoking prevalence estimates and can be overlooked by tobacco control efforts.

OBJECTIVE

We sought to characterise NIS in a cross-sectional study using a sample representative of the population of adults (>18 years) in California who reported smoking at least 100 cigarettes in their lifetime, smoking at least some days and at least once in the last 30 days (n=1698). Individuals were considered NIS if they met the above criteria and answered 'no' when asked if they 'considered themselves a smoker'.

RESULTS

We estimate that 395 928 (SD=54 126) NIS were living in California in 2011 (a prevalence of 12.3% of all smokers in California). The odds of being NIS were higher among non-daily smokers who were previously daily smokers (adjusted OR (AOR)=7.63, 95% CI 2.67 to 21.8) or were never previously daily smokers (AOR=7.14, CI 2.78 to 18.3) compared with daily smokers. The odds of being an NIS were also higher among those who did not believe they were addicted to cigarettes (AOR=3.84, CI 1.68 to 9.22), were older than 65 years (vs less than 45 years) (AOR=3.35, CI 1.16 to 9.75) or were from ethnic minorities including Black and Asian (vs non-Hispanic white) (AOR=3.16, CI 1.19 to 8.49).

CONCLUSIONS

Smoking surveillance should restructure selection criteria to more accurately account for NIS in areas with high stigma toward smokers. Targeted interventions may be needed for NIS including educating healthcare providers to enquire more deeply into smoking habits.

I am your smartphone, and I know you are about to smoke: the application of mobile sensing and computing approaches to smoking research and treatment

Much is known about the immediate and predictive antecedents of smoking lapse, which include situations (e.g., presence of other smokers), activities (e.g., alcohol consumption), and contexts (e.g., outside). This commentary suggests smartphone-based systems could be used to infer these predictive antecedents in real time and provide the smoker with just-in-time intervention. The smartphone of today is equipped with an array of sensors, including GPS, cameras, light sensors, barometers, accelerometers, and so forth, that provide information regarding physical location, human movement, ambient sounds, and visual imagery. We propose that libraries of algorithms to infer these antecedents can be developed and then incorporated into diverse mobile research and personalized treatment applications. While a number of challenges to the development and implementation of such applications are recognized, our field benefits from a database of known antecedents to a problem behavior, and further research and development in this exciting area are warranted.

Methodology for developing and evaluating the PROMIS smoking item banks

INTRODUCTION

This article describes the procedures used in the PROMIS Smoking Initiative for the development and evaluation of item banks, short forms (SFs), and computerized adaptive tests (CATs) for the assessment of 6 constructs related to cigarette smoking: nicotine dependence, coping expectancies, emotional and sensory expectancies, health expectancies, psychosocial expectancies, and social motivations for smoking.

METHODS

Analyses were conducted using response data from a large national sample of smokers. Items related to each construct were subjected to extensive item factor analyses and evaluation of differential item functioning (DIF). Final item banks were calibrated, and SF assessments were developed for each construct. The performance of the SFs and the potential use of the item banks for CAT administration were examined through simulation study.

RESULTS

Item selection based on dimensionality assessment and DIF analyses produced item banks that were essentially unidimensional in structure and free of bias. Simulation studies demonstrated that the constructs could be accurately measured with a relatively small number of carefully selected items, either through fixed SFs or CAT-based assessment. Illustrative results are presented, and subsequent articles provide detailed discussion of each item bank in turn.

CONCLUSIONS

The development of the PROMIS smoking item banks provides researchers with new tools for measuring smoking-related constructs. The use of the calibrated item banks and suggested SF assessments will enhance the quality of score estimates, thus advancing smoking research. Moreover, the methods used in the current study, including innovative approaches to item selection and SF construction, may have general relevance to item bank development and evaluation.

Cue reactivity in non-daily smokers: effects on craving and on smoking behavior

RATIONALE

Non-daily, or intermittent smokers (ITS), are increasingly prevalent. Their smoking may be more situational than that of daily smokers (DS), and thus is hypothesized to be more influenced by cues.

OBJECTIVES

To assess ITS' response to cues, and compare it to that of DS.

METHODS

Samples of 239 ITS and 207 DS (previously reported in Shiffman et al. 2012a) were studied in 2,586 laboratory cue-reactivity sessions. Craving (Questionnaire of Smoking Urges) and smoking (probability, latency, puff parameters, and carbon monoxide increases) in response to cues was assessed following exposure to neutral cues and cues related to smoking, alcohol, negative affect, positive affect, and smoking prohibitions. Mixed effects models, generalized estimating equations and random-effects survival analyses were used to assess response to cues and differences between DS and ITS.

RESULTS

ITS' craving increased following exposure to smoking and alcohol cues and decreased following positive affect cues, but cues had little effect on smoking behaviors. Cue reactivity was similar in ITS and DS. Among ITS, craving intensity predicted smoking probability, latency, and intensity, and the effects on latency were stronger among ITS than DS.

CONCLUSIONS

Contrary to hypotheses, ITS were not more responsive to laboratory cues than DS. Results show that ITS do experience craving and craving increases that are then associated with smoking.

The relationship between impulsivity, risk-taking propensity and nicotine dependence among older adolescent smokers

Impulsivity and risk-taking propensity are neurobehavioral traits that reliably distinguish between smoking and non-smoking adults. However, how these traits relate to smoking quantity and nicotine dependence among older adolescent smokers is unclear. The current study examined impulsivity and risk-taking propensity in relation to smoking behavior and nicotine dependence among current older adolescent smokers (age 16-20 years; N=107). Participants completed the Barratt Impulsiveness Scale-11 (BIS-11), the Balloon Analogue Risk Task (BART), and self-report measures of smoking behavior and nicotine dependence. Results indicated a significant positive relationship between nicotine dependence and the Attention subscale (β=.20, t=2.07, p<.05) and the Non-planning subscale (β=.19, t=1.92, p<.06) of the BIS-11. Contrary to expectation, the results also indicated a significant negative relationship between performance on the BART and nicotine dependence (β=-.19, t=-2.18, p<.05), such that greater risk-taking propensity was associated with less dependence. These data suggest that impulsivity and risk-taking propensity are related to older adolescent smoking but are separable traits with distinguishable associations with nicotine dependence among adolescents. These findings support the notion that impulsivity is related to heightened nicotine dependence, but suggest that the relationship between risk-taking propensity and nicotine dependence is more ambiguous and warrants further investigation.

Relationship of self-reported and acute stress to smoking in emerging adult smokers

OBJECTIVE

In the current study, we examined subjective and objective measures of stress and their relationship to baseline and future cigarette smoking behaviors over a 1-year follow-up in young adult experimental smokers.

METHOD

Participants (N = 56) completed two laboratory sessions to determine subjective and objective responses to a controlled laboratory stressor versus a control task. Baseline measures included drug use and smoking histories and a self-report measure of habitual stress (i.e., daily hassles). They were re-contacted 1 year after the laboratory sessions to determine smoking status.

RESULTS

There was wide variability in smoking trajectories, with 34% of participants increasing their smoking over the course of the year. Contrary to predictions, neither daily hassles nor stress reactivity was related to smoking at baseline or change over the year.

CONCLUSIONS

These preliminary findings suggest that daily stress or responses to acute social stress are not strong predictors of progression in emerging adult smokers.

Validation of smoking-related virtual environments for cue exposure therapy

Craving is considered one of the main factors responsible for relapse after smoking cessation. Cue exposure therapy (CET) consists of controlled and repeated exposure to drug-related stimuli in order to extinguish associated responses. The main objective of this study was to assess the validity of 7 virtual reality environments for producing craving in smokers that can be used within the CET paradigm. Forty-six smokers and 44 never-smokers were exposed to 7 complex virtual environments with smoking-related cues that reproduce typical situations in which people smoke, and to a neutral virtual environment without smoking cues. Self-reported subjective craving and psychophysiological measures were recorded during the exposure. All virtual environments with smoking-related cues were able to generate subjective craving in smokers, while no increase was observed for the neutral environment. The most sensitive psychophysiological variable to craving increases was heart rate. The findings provide evidence of the utility of virtual reality for simulating real situations capable of eliciting craving. We also discuss how CET for smoking cessation can be improved through these virtual tools.

Exploring the next frontier for tobacco control: Nondaily smoking among New York City adults

Objective. Among current smokers, the proportion of Nondaily smokers is increasing. A better understanding of the characteristics and smoking behaviors of Nondaily smokers is needed. Methods. We analyzed data from the New York City (NYC) Community Health Survey to explore Nondaily smoking among NYC adults. Univariate analyses assessed changes in Nondaily smoking over time (2002–2010) and identified unique characteristics of Nondaily smokers; multivariable logistic regression analysis identified correlates of Nondaily smoking in 2010. Results. The proportion of smokers who engage in Nondaily smoking significantly increased between 2002 and 2010, from 31% to 36% (P = 0.05). A larger proportion of Nondaily smokers in 2010 were low income and made tax-avoidant cigarette purchases compared to 2002. Smoking behaviors significantly associated with Nondaily smoking in 2010 included smoking more than one hour after waking (AOR = 8.8, 95% CI (5.38–14.27)); buying “loosies” (AOR = 3.5, 95% CI (1.72–7.08)); attempting to quit (AOR = 2.3, 95% CI (1.36–3.96)). Conclusion. Nondaily smokers have changed over time and have characteristics distinct from daily smokers. Tobacco control efforts should be targeted towards “ready to quit” Nondaily smokers.

Measuring exposure to protobacco marketing and media: a field study using ecological momentary assessment

INTRODUCTION

The aims of this study were to validate ecological momentary assessment (EMA) as a method for measuring exposure to tobacco-related marketing and media and to use this method to provide detailed descriptive data on college students' exposure to protobacco marketing and media.

METHODS

College students (n = 134; ages 18-24 years) recorded their exposures to protobacco marketing and media on handheld devices for 21 consecutive days. Participants also recalled exposures to various types of protobacco marketing and media at the end of the study period.

RESULTS

Retrospectively recalled and EMA-based estimates of protobacco marketing exposure captured different information. The correlation between retrospectively recalled and EMA-logged exposures to tobacco marketing and media was moderate (r = .37, p < .001), and EMA-logged exposures were marginally associated with the intention to smoke at the end of the study, whereas retrospective recall of exposure was not. EMA data showed that college students were exposed to protobacco marketing through multiple channels in a relatively short period: Exposures (M = 8.24, SD = 7.85) occurred primarily in the afternoon (42%), on weekends (35%), and at point-of-purchase locations (68%) or in movies/TV (20%), and exposures to Marlboro, Newport, and Camel represented 56% of all exposures combined and 70% of branded exposures.

CONCLUSIONS

Findings support the validity of EMA as a method for capturing detailed information about youth exposure to protobacco marketing and media that are not captured through other existing methods. Such data have the potential to highlight areas for policy change and prevention in order to reduce the impact of tobacco marketing on youth.

Why two smoking cessation agents work better than one: role of craving suppression

OBJECTIVE

This research examined why smokers receiving combination medication for smoking cessation are more likely to quit smoking than are those who receive either single agent (monotherapy) or placebo.

METHOD

Data were collected from 1,504 current smokers (58.2% women, 83.9% White; mean age = 44.67 years, SD = 11.08) participating in a cessation clinical trial who were randomized to 1 of 6 cessation pharmacotherapy conditions (placebo, nicotine patch, nicotine lozenge, bupropion, nicotine patch + nicotine lozenge, and bupropion + nicotine lozenge). Participants completed ecological momentary assessments 4 times a day, concerning 5 hypothesized mediators (negative affect, positive affect, craving, smoking expectations, and withdrawal) of pharmacotherapy effects. Medications were provided for 8-12 weeks post-quit along with 6 individual counseling sessions. Mediational paths were estimated via a novel Bayesian approach with estimation of multiple mediator models.

RESULTS

Biochemically confirmed 8-week abstinence was the outcome variable, with the monotherapy and combination pharmacotherapy composites producing 45% (n = 689) and 54% (n = 478) abstinence rates, respectively. The univariate models suggested that the combination treatments produced higher abstinence rates than the monotherapies because of greater suppression of withdrawal, craving, and smoking expectations. However, multiple mediator models showed that the suppression of craving on the quit day produced the strongest mediational effects and could account for the mediational effects of other tested variables.

CONCLUSION

Suppression of craving on the quit day significantly mediates the clinical effects of monotherapies and combination smoking pharmacotherapies, and the higher abstinence rates for combination therapy versus monotherapies appear primarily due to greater craving suppression.

Occasional smoking in college: who, what, when and why?

INTRODUCTION

The majority of college students who smoke do so on an occasional basis and generally do not define themselves as smokers. This represents a considerable challenge for public health efforts to prevent escalation of use and to promote cessation. Strengthening such efforts will require further examination of the motivations behind occasional smoking within this vulnerable group.

METHODS

Based within a priori identified content areas, we conducted eight focus groups of occasional smokers (N=53) at two demographically diverse colleges in the southeastern U.S.

RESULTS

Few participants self-identified as a smoker and few had immediate desire to quit. Most identified extrinsic motivations for future quitting, including college graduation and parenthood. Although participants acknowledged smoking-related health risks, they minimized them as being personally irrelevant. Participants highlighted social (i.e., alcohol and other smokers) and stress-related smoking triggers. They also described how they carefully managed the situations in which they would, and would not smoke in order to preserve their identity.

CONCLUSIONS

College students who smoke occasionally appear to engage in impression management, taking effort to shape their personal image to not appear as a smoker. They use smoking mainly as a social engagement tool, but also to alleviate negative emotions. They express minimal desire to quit and believe they are immune to the health risks of smoking. Public health messages should address this common pattern of smoking among young adults differently than regular smoking patterns by highlighting the social, emotional, and health consequences of occasional smoking before nicotine dependence has fully developed.

Alcohol and tobacco co-use in nondaily smokers: an inevitable phenomenon?

INTRODUCTION AND AIMS

Alcohol use has consistently been associated with smoking among nondaily smokers. However, this may not be an inevitable relationship that extends across all drinking sessions and/or all nondaily smokers. Recently, distinct subgroups of nondaily smokers have been identified, with one subgroup maintaining a stable pattern of nondaily smoking (long-term occasional smokers; LOS), and others transitioning to nondaily smoking either from a non-smoking status (early occasional smokers; EOS) or from a daily smoking status (former daily smokers; FDS). However, little is known about the extent to which these subgroups differ in their alcohol-tobacco co-administration patterns.

DESIGN AND METHODS

183 nondaily smokers (74 LOS; 55 EOS; 54 FDS) completed face-to-face interviews during which they provided details about their lifetime and past-week tobacco and alcohol administration patterns.

RESULTS

EOS were more likely to report having used alcohol at the time of their first-ever cigarette relative to the other subgroups (P ≤ 0.001), but there were no differences in past-week co-administration patterns between the subgroups. Overall, less than one-third of all smoking sessions occurred when drinking, but these accounted for more than half of all cigarettes consumed during the previous week. Moreover, while only 42% of drinking sessions involved tobacco co-administration, when drinking and smoking did co-occur, significantly greater amounts of alcohol were consumed relative to drinking sessions where no tobacco was used (P < 0.01).

DISCUSSION AND CONCLUSIONS

Findings suggest that alcohol use is not invariably related to smoking in EOS, FDS or LOS, but when it is, across all subgroups co-administration is associated with mutual dose escalation.

Effects of dieting status and cigarette deprivation on progressive ratio responding for cigarette puffs by young women smokers

There is evidence from self-report measures which suggests that young women dieters find cigarette smoking less rewarding than non-dieters. We aimed to further elucidate differences between dieters and non-dieters in their evaluation of smoking using a behavioural measure of drug reward. Thirty female undergraduates attended two sessions (cigarette deprived and non-deprived). A computer-based progressive ratio operant procedure was employed to assess the amount of effort that participants were willing to expend to gain a puff on a cigarette. The point at which responding ceased was taken as a measure of drug reward (breakpoint). Self-report measures of sensory/hedonic aspects of smoking were also completed. The breakpoints of both dieters and non-dieters were greater under deprived than non-deprived conditions but the breakpoints of dieters were significantly lower than those of the non-dieting smokers under both conditions. Self-reported enjoyment of smoking was lower for dieters than non-dieters and reports for non-dieters but not dieters were affected by deprivation level. Both behavioural and self-report measures of rewarding aspects of smoking suggest that young women dieters find smoking less rewarding than non-dieters, but self-report measures are more resistant to deprivation effects for dieters. This is consistent with the suggestion that subjective and behavioural measures assess different dimensions of the rewarding effects of smoking.

Using the methods of ecological momentary assessment in substance dependence research--smoking cessation as a case study

Ecological momentary assessment (EMA) is the name applied to any of a range of research methodologies that aim to assess participants in near real time as they go about their regular day-to-day activities. Such methods have particular utility for studying drug use and drug dependence. Using the area of nicotine dependence as a case study, this review highlights how EMA can be used to build upon the findings from more traditional research methods to enhance our understanding of drug use. Particular attention is given to the role that advances in technology have played in the adoption of EMA in drug dependence research.

Light smoking in a predominantly Hispanic college student sample: a 7 day diary assessment

Both Hispanic and college student populations smoke at non trivial rates but less frequently than other smoking groups. Limited information exists about the at risk times for smoking among those who smoke fewer than 10 cigarettes per day, particularly college students. Participants (n=116 young adults) completed a 7 day Tobacco Consumption Diary by recording for each cigarette smoked: time and day, location, number of people present, number of smokers present, mood, and whether alcohol was consumed. Descriptive analyses suggest a variety of psycho-social contexts within which light smoking may occur for a predominantly Hispanic sample of college students. Inferential analyses reveal a somewhat heterogeneous pattern of light smoking. Nevertheless, Thursday, Friday, and Saturday, as well as later hours of each day in particular are associated with an increased likelihood of smoking. Further study of intra-individual patterns of both Hispanic and college student light smoking is needed to identify the ideographic triggers that can be intervened upon to aid light smokers in cessation.

The intersection of gender and race/ethnicity in smoking behaviors among menthol and non-menthol smokers in the United States

AIMS

To determine whether menthol is related to initiation, quantity or quitting, we examined differences in smoking behaviors among menthol and non-menthol smokers, stratified by gender and race/ethnicity, and adjusting for age, income and educational attainment.

DESIGN

Cross-sectional, using data from the 2005 National Health Interview Survey and Cancer Control Supplement.

SETTING

United States.

PARTICIPANTS

Black, Hispanic and white women and men aged 25-64 years.

MEASUREMENTS

For each group, we examined (i) proportion of menthol smokers (comparing current and former smokers); (ii) age of initiation, cigarettes smoked per day and quit attempt in the past year (comparing menthol and non-menthol current smokers); and (iii) time since quitting (comparing menthol and non-menthol former smokers). We calculated predicted values for each demographic group, adjusting for age, income and educational attainment.

FINDINGS

After adjusting for age, income and education, black (compared with Hispanic and white) and female (compared with male) smokers were more likely to choose menthol cigarettes. There was only one statistically significant difference in age of initiation, cigarettes smoked per day, quit attempts or time since quitting between menthol and non-menthol smokers: white women who smoked menthol cigarettes reported longer cessation compared with those who smoked non-menthol cigarettes.

CONCLUSIONS

The results do not support the hypothesis that menthol smokers initiate earlier, smoke more or have a harder time quitting compared with non-menthol smokers. A menthol additive and the marketing of it, given the clear demographic preferences demonstrated here, however, may be responsible for enticing the groups least likely to smoke into this addictive behavior.

Are occasional smokers a heterogeneous group? An exploratory study

BACKGROUND

Occasional smokers represent an important segment of all smokers and have been described to be a heterogeneous group in terms of past experience and likelihood of maintaining nondaily smoking behavior.

METHODS

In the prospective Ontario Tobacco Survey, 408 occasional smokers were followed for a year. Characteristics of subgroups of occasional smokers, as suggested by previous literature, were studied for personal and smoking behavior group differences. Agglomerative hierarchical clustering was also used to empirically identify subgroups of occasional smokers using average linkage. Smoking status at 1-year follow-up was examined overall and by the identified subgroups to determine if any were useful predictors of persistent status as nondaily smoking and likelihood of smoking cessation.

RESULTS

Significant differences were seen among the subgroups of occasional smokers suggested in previous studies including the number of quit attempts, setting a firm quit date, and whether or not participants cared others knew they smoked in descriptive analyses. Exploratory cluster analysis suggested 4 clusters of occasional smokers based on differences in age, perceived addiction, and history of daily smoking. Subgroups based on participants' history of smoking, self-reported addiction level, and empirically identified cluster subgroups resulted in significant differences of smoking status at 1-year follow-up.

CONCLUSIONS

This study suggests that occasional smokers may be a heterogeneous group with different subgroups characterized by age, accumulated smoking experience and smoking pattern, as well as factors associated with the likelihood of quitting altogether, over time, and perceived addiction.