Gender and stress in predicting depressive symptoms following stroke

BACKGROUND

Post-stroke depression (PSD) is associated with poor clinical and functional outcomes, and women are likely to experience PSD more than men. Although stress is related to depression, and women report greater emotional reactivity to stressful life events, the link between stress and gender is yet to be examined relative to PSD. Further, electronic momentary assessment (EMA), a mobile technology, has not been used to assess stressful life events and PSD in real time and in the natural environments of daily life. The purpose of the current study was to examine gender differences in the relationship of stress and PSD using EMA.

METHODS

Individuals admitted to the Stroke Center at the University of Bordeaux were contacted for participation in a prospective study of symptoms and experiences in daily life using ambulatory monitoring. Forty-three post-stroke patients (47% female) completed electronic assessments of life events, perceived stress, and depressive symptoms (i.e., sad mood, anhedonia, fatigue, concentration difficulties, appetite change, negative thoughts, hopelessness) during their daily life for one week. Patients also completed a clinician-administered standardized depression scale at baseline and three-month follow-up.

RESULTS

Using EMA, participants responded to 83.7% of the electronic interviews for a total of 1,140 observations across diverse daily life contexts. Stressful events of any degree of negativity were reported at over one-third (37.3%) of all EMA assessments. The severity of depressive symptoms as assessed in daily life through EMA was greater in women following stroke than in men. Further, there was a significant association between EMA-assessed depressive symptoms and daily life stress for women, but not men. This association was due primarily to three specific depressive symptoms: sad mood, fatigue, and appetite change. No difference was observed between men and women in standardized depression assessments administered during clinic visits at baseline or three-month follow-up.

CONCLUSIONS

Greater reactivity to stressful life events and a link between stress reactivity and depressive symptoms were found in female as compared to male post-stroke patients. Gender differences in depressive symptoms were identified using EMA data collected during daily life as contrasted with the use of a standard assessment during clinic visits. Mobile technologies may help to identify important real-time behaviors and symptoms that are not observable by standard clinical assessments employed at regular clinic visits. Further, future research should examine the overall and gender-specific benefits of stress-based interventions to reduce the risk of PSD for adults.

Loneliness in HIV-infected smokers

Loneliness is common in persons living with HIV (PLWH). Lonely people smoke at higher rates than the general population, and loneliness is a likely contributor to the ongoing smoking epidemic among PLWH. We explored factors associated with loneliness in a cohort of 272 PLWH smokers enrolled in two separate tobacco treatment trials. Loneliness was independently associated with lack of a spouse or partner, lower educational attainment, "other or unknown" HIV exposure category, depression, anxiety, recent alcohol consumption, and higher daily cigarette consumption. Referral to group therapy reduced loneliness, whereas referral to an individual web-based tobacco treatment did not.

Consideration of sex in clinical trials of transdermal nicotine patch: a systematic review

Transdermal nicotine patch (TNP) is 1 of the most commonly used smoking cessation treatments; however, the efficacy of TNP by sex is not yet clear. The purpose of the current review was to synthesize how sex has been considered in published clinical trials of TNP for smoking cessation. The specific aims of the study were to examine the inclusion of sex in analyses of cessation outcomes, TNP-related variables (compliance, side effects), and quit-related variables (withdrawal, cravings); to review the consideration of sex-related variables (menstrual cycle phase, pregnancy); and to identify needs for future research. Potential articles published through December 31, 2013 were identified through a MEDLINE search of the terms "clinical trial," "nicotine patch," and "smoking cessation." Forty-two studies used all 3 terms and met the inclusion criteria. Approximately half of the studies reported that they considered sex in smoking cessation outcomes, with 15 studies finding no difference by sex and 7 studies finding better outcomes for men versus women. Only 5 studies reported data on outcomes by sex in their publications. No studies reported analysis of TNP compliance or withdrawal by sex. In the 1 study that examined side effects by sex, more women than men reported discontinuing TNP because of skin irritation. No study examined the association of cessation outcomes with menstrual cycle phase. There is a need to include sex in research on TNP, as well as other pharmacological and behavioral smoking treatments, to clarify the picture of treatment efficacy for women compared with men.

Stability of smoking status in the US population: a longitudinal investigation

AIMS

To determine smoking transitions in a representative sample of US adults.

DESIGN

Longitudinal study using data from the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-02; wave 2, 2004-05).

SETTING

The general US adult population.

PARTICIPANTS

A total of 33 309 adults (53.6% female) classified as wave 1 current daily, current non-daily, former daily, former non-daily or never smokers.

MEASUREMENTS

Smoking transitions were determined from waves 1 and 2 data.

FINDINGS

Smoking status remained stable for the majority of current daily (79.8%), former daily (95.8%), former non-daily (96.3%) and never (97.1%) smokers. Among current non-daily smokers, 54.5% quit smoking while 22.5% increased to daily smoking. Current daily smokers who were older [30-44, odds ratio (OR) = 0.62; 95% confidence interval (CI) = 0.49-0.78; 45+, OR = 0.75; 95% CI = 0.61-0.93] and unmarried (OR = 0.80, 95% CI = 0.66-0.96) were less likely to report smoking cessation. Current daily smokers who were Hispanic (OR = 2.15, 95% CI = 1.65-2.81) and college educated (OR = 1.27, 95% CI = 1.05-1.53) were more likely to report smoking cessation. Relapse in former daily smokers was greater in women (OR = 1.44, 95% CI = 1.01-2.06) and lower in older adults (OR = 0.44; 95% CI = 0.27-0.74). Smoking initiation occurred less in women (OR = 0.65; 95% CI = 0.49-0.87) and Hispanic adults (OR = 0.57; 95% CI = 0.36-0.91) and more in unmarried adults (OR = 1.84; 95% CI = 1.37-2.47) and adults with less education (OR = 1.63; 95% CI = 1.09-2.44).

CONCLUSIONS

From 2001 to 2005, smoking status was extremely stable in the US population. Specific gender, race and educational groups need increased prevention and intervention efforts.

Self-efficacy to quit in HIV-infected smokers

INTRODUCTION

Tobacco use is epidemic among persons living with HIV (PLWH), and several studies have shown self-efficacy (SE) to be a predictor of successful cessation. This study examined sociobehavioral correlates of SE and its predictive value for successful cessation in a group of PLWH smokers.

METHODS

The study was conducted on combined patient data from 2 separate randomized controlled trials of tobacco treatment for PLWH smokers. Both trials utilized the same SE scale at the same timepoints, and both had the same smoking cessation endpoint (biochemically confirmed, 7-day, point prevalence abstinence at 3 months). Univariate and multivariate techniques were used to analyze the merged dataset.

RESULTS

Baseline SE data were available for 272 subjects. The Self-Efficacy/Temptations Scale-Long Form demonstrated good internal reliability with overall and subscale Cronbach's alpha of .77-.92. Younger age, HIV risk other than injection drug use, recent alcohol use, and higher scores for anxiety, depression, loneliness, and nicotine dependence were all significantly correlated with lower baseline SE. Posttreatment SE was significantly predictive of successful cessation, whereas baseline SE was not. Subjects randomized to the treatment interventions were significantly more likely to quit (AOR = 2.99 [1.26-7.01], p = .01), and logistic regression suggested a possible mediating effect of posttreatment SE.

CONCLUSIONS

SE is tightly correlated with a number of modifiable affective and behavioral factors in PLWH smokers, and measures aimed at increasing the SE to abstain in such individuals may enhance the effect of targeted tobacco treatment strategies.

Cigarette smoking among intimate partner violence perpetrators and victims: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND OBJECTIVES

Cigarette smoking and intimate partner violence (IPV) are preventable, major public health issues that result in severe physical and psychological consequences. The primary aim of the current study was to examine the consistency and strength of the association between these highly variable behaviors using a nationally representative sample.

METHODS

Self-reported IPV perpetration, victimization, and smoking data were collected from 25,515 adults (54% female) through the National Epidemiologic Survey on Alcohol and Related Conditions. Multinomial logistic regression models were constructed to determine the relationships among smoking status (current daily, intermittent, former, and never smoker) and IPV (minor and sever victimization as well as perpetration).

RESULTS

Results indicated a robust relationship between IPV and smoking among both victims and perpetrators. The odds for current daily and intermittent smoking were significantly elevated among those who reported both minor and severe IPV relative to their non-violent counterparts. Mood and anxiety disorders were significant comorbid conditions in the interpretation of the relationship between severe IPV and smoking.

CONCLUSIONS

The current study provides strong evidence for a robust relationship between IPV and smoking across current smoking patterns, IPV severity levels, and IPV experience patterns.

SCIENTIFIC SIGNIFICANCE

Findings emphasize the need to better understand the mechanisms by which smoking and IPV are associated and how this interdependence may impact approaches to treatment. Specifically, research is required to assess the efficacy of integrated smoking cessation and IPV treatment or recovery programs over more traditional, exclusive approaches.

Symptoms of alcohol dependence and smoking initiation and persistence: a longitudinal study among US adults

BACKGROUND

A large number of adults report symptoms of, but do not meet diagnostic criteria for, an alcohol use disorder. Yet, little is known about the relationship between symptoms of alcohol use disorders and the initiation and persistence of smoking. This study prospectively examines the relationship between having 1-2 symptoms of alcohol dependence (without abuse) and smoking initiation and persistence as well as nicotine dependence over a 3-year period among adults in the United States.

METHODS

Data were drawn from Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Relationships between Wave 1 symptoms of alcohol dependence, alcohol abuse, and alcohol dependence and initiation and persistence of cigarette smoking and nicotine dependence at Wave 2 were examined using logistic regression analyses. Analyses were adjusted for demographics, mood and anxiety disorders.

RESULTS

Symptoms of alcohol dependence were associated with smoking initiation at Wave 2. There was no association between symptoms of alcohol dependence and smoking persistence. Symptoms of alcohol dependence predicted incident and persistent nicotine dependence. Findings persisted after adjusting for demographic characteristics and mood/anxiety disorders.

CONCLUSIONS

Even 1-2 symptoms of alcohol dependence are associated with increased vulnerability to smoking initiation and onset and persistence of nicotine dependence at a similar strength as alcohol use disorders. Efforts at smoking cessation must address problematic alcohol use, even at the subclinical level, in order to improve efficacy.

Changes in smoking for adults with and without alcohol and drug use disorders: longitudinal evaluation in the US population

BACKGROUND

Little is known about the smoking cessation and smoking relapse behavior of adults with alcohol use disorders (AUDs) and drug use disorders (DUDs).

OBJECTIVE

The current study used longitudinal data from a representative sample of the US adult population to examine changes in smoking over 3 years for men and women with and without AUD and DUD diagnoses.

METHODS

Participants were current or former daily cigarette smokers at Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions who completed the Wave 2 assessment 3 years later (n = 11,973; 46% female). Analyses examined the main and gender-specific effects of AUD and DUD diagnoses on smoking cessation and smoking relapse.

RESULTS

Wave 1 current daily smokers with a current AUD (OR = .70, 95% CI = .55, .89), past AUD (OR = .73, 95% CI = .60, .89), current DUD (OR = .48, 95% CI = .31, .76), and past DUD (OR = .62, 95% CI = .49, .79) were less likely to have quit smoking at Wave 2 than those with no AUD or DUD diagnosis. Wave 1 former daily smokers with a current AUD (OR = 2.26, 95% CI = 1.36, 3.73), current DUD (OR = 7.97, 95% CI = 2.51, 25.34), and past DUD (OR = 2.69, 95% CI = 1.84, 3.95) were more likely to have relapsed to smoking at Wave 2 than those with no AUD or DUD diagnosis. The gender by diagnosis interactions were not significant.

CONCLUSION

Current and past AUDs and DUDs were associated with a decreased likelihood of quitting smoking, while current AUDs, current DUDs, and past DUDs were associated with an increased likelihood of smoking relapse.

Intimate partner violence victimization and cigarette smoking: a meta-analytic review

The current meta-analytic review represents the first comprehensive empirical evaluation of the strength of the relationship between intimate partner violence (IPV) victimization and cigarette smoking. Thirty-nine effect sizes, drawn from 31 peer-reviewed publications, determined the existence of a small to medium composite effect size for the victimization-smoking relationship (d = .41, 95% confidence interval = [.35, .47]). Results indicate that victims of IPV are at greater smoking risk than nonvictims. Subsequent moderator analyses indicated that the association between victimization and smoking is moderately stronger among pregnant compared to nonpregnant victims. The strength of the victimization-smoking relationship did not differ by relationship type or ethnicity. More research is needed on the smoking behavior of male victims, victims of psychological violence, and victims who identify as Latino/Latina. It would be useful for professionals working with IPV victims to assess for smoking and incorporate smoking prevention and cessation skills in intervention settings.

Two decades of smoking cessation treatment research on smokers with depression: 1990-2010

INTRODUCTION

Adults with depression smoke at higher rates than other adults leaving a large segment of this population, who already incur increased health-related risks, vulnerable to the enormous harmful consequences of smoking. Yet, the impact that depression has on smoking cessation is not clear due to the mixed results of past research. The primary aims of this review were to synthesize the research examining the relationship of depression to smoking cessation outcomes over a 20-year period, to examine the gender and racial composition of these studies, and to identify directions for future research.

METHODS

Potential articles published between January 1, 1990 and December 31, 2010 were identified through a MEDLINE search of the terms "clinical trial," "depression," and "smoking cessation." 68 studies used all three terms and met the inclusion criteria.

RESULTS

The majority of studies examined either a past diagnosis of major depression or current depression symptoms. Within the few studies that examined the interaction of gender and depression on smoking cessation, depression had a greater impact on treatment outcomes for women than men. No study reported examining the interactive impact of race and depression on treatment outcomes.

CONCLUSIONS

Although attention to the relationship of depression and smoking cessation outcomes has increased over the past 20 years, little information exists to inform a treatment approach for smokers with Current Major Depressive Disorder, Dysthymia, and Minor Depression and few studies report gender and racial differences in the relationship of depression and smoking cessation outcomes, thus suggesting major areas for targeted research.

The Association of Tobacco Use and Gender to Cardiac Rehabilitation Outcomes: A Preliminary Investigation

INTRODUCTION

Cardiac rehabilitation (CR) outcomes are measured in terms of cardiovascular disease (CVD) risk factor reductions, and these predict long-term cardiac status. This report examines whether reported tobacco use has differential effects on successful cardiovascular risk factor modification, especially for women who have greater smoking-related CVD consequences than men.

METHODS

A retrospective cohort analysis was conducted on 1138 adults (74% male) with diagnosed CVD who participated in ≥7 weeks of a comprehensive CR program. Eleven CVD risk factors were assessed at CR entry and completion. Tobacco use was assessed by self-report at CR entry. The primary outcomes were attainment of goal levels for each risk factor.

RESULTS

Fewer current and former tobacco users reached the preset goal for Maximal Exercise Capacity. Fewer women than men reached the preset goal for HDL. Women who were current or former tobacco users were less likely to meet the target goals for Triglycerides and more likely to meet target goals for Total Cholesterol and Non-HDL Cholesterol.

CONCLUSIONS

This preliminary study suggests the importance of identifying the effect of tobacco use and gender on CR outcomes and the need to evaluate modification of key cardiovascular risk factors for subgroups of cardiac patients.

The relationship of dysthymia, minor depression, and gender to changes in smoking for current and former smokers: longitudinal evaluation in the U.S. population

BACKGROUND

Although data clearly link major depression and smoking, little is known about the association between dysthymia and minor depression and smoking behavior. The current study examined changes in smoking over 3 years for current and former smokers with and without dysthymia and minor depression.

METHODS

Participants who were current or former daily cigarette smokers at Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions and completed the Wave 2 assessment were included in these analyses (n=11,973; 46% female). Analyses examined the main and gender-specific effects of current dysthymia, lifetime dysthymia, and minor depression (a single diagnostic category that denoted current and/or lifetime prevalence) on continued smoking for Wave 1 current daily smokers and continued abstinence for Wave 1 former daily smokers.

RESULTS

Wave 1 current daily smokers with current dysthymia (OR=2.13, 95% CI=1.23, 3.70) or minor depression (OR=1.53, 95% CI=1.07, 2.18) were more likely than smokers without the respective diagnosis to report continued smoking at Wave 2. Wave 1 former daily smokers with current dysthymia (OR=0.44, 95% CI=0.20, 0.96) and lifetime dysthymia (OR=0.37, 95% CI=0.15, 0.91) were less likely than those without the diagnosis to remain abstinent from smoking at Wave 2. The gender-by-diagnosis interactions were not significant, suggesting that the impact of dysthymia and minor depression on smoking behavior is similar among men and women.

CONCLUSIONS

Current dysthymia and minor depression are associated with a greater likelihood of continued smoking; current and lifetime dysthymia are associated with a decreased likelihood of continued smoking abstinence.

Inclusion of women and gender-specific analyses in randomized clinical trials of treatments for depression

BACKGROUND

The higher prevalence and cost of depression for women compared with men and the possible gender differences in treatment response demand the inclusion of women in clinical trials of depression treatments. The 1993 National Institutes of Health (NIH) Revitalization Act set a new standard, requiring investigators to consider the inclusion of women and analyze outcomes by gender, yet compliance with these standards in depression research has not been examined systematically. The purpose of this study is to examine the inclusion of women and gender-specific analyses in recent randomized clinical trials (RCTs) for depression.

METHODS

RCTs were identified through a MEDLINE search for trials published between January 1 and December 31, 2007, and a Clinicaltrials.gov search of self-identified interventional studies to treat depression.

RESULTS

Of the 150 RCTs for depression published in 2007, 15% did not report the gender composition of their sample, 50% of studies did not analyze outcomes by gender, and 12% controlled for gender but did not analyze for gender differences. Of the 768 trials reviewed on Clinicaltrials.gov, 89% reported recruiting male and female participants, yet <1% reported an intention to analyze results by gender.

CONCLUSIONS

Many recent studies of depression treatments include women but do not examine outcomes by gender. Understanding how women differ from men in response to treatment is critical for enhancing treatment efficacy for the greatest number of adults with depression.

Mood and smoking behavior: the role of expectancy accessibility and gender

Little is known about overall or gender-specific factors that may influence the relationship between negative affect and smoking behavior such as smoking expectancies. This paper presents a secondary analysis from a laboratory studying gender differences in smoking behavior following a musical mood induction [Weinberger, A.H., & McKee, S.A., 2012, Gender differences in smoking following an implicit mood induction. Nicotine & Tobacco Research, 14(5), 621-625]. The current analyses examine the role of expectancies (endorsement and accessibility) in the relationship of gender, affect, and smoking. Ninety adult smokers (50% female) were randomly assigned to a negative mood induction, positive mood induction, or neutral condition while completing a single laboratory session. Expectancy endorsement, expectancy accessibility, affect, and smoking topography were assessed following the mood induction. Female smokers with faster accessibility of negative reinforcement expectancies smoked more cigarettes, had longer puff durations, and had shorter inter-puff intervals. Women with faster expectancy accessibility were also more likely to endorse negative reinforcement smoking expectancies. This study was the first to demonstrate links among gender, mood, and accessibility of smoking-related beliefs. Information about the role of expectancy accessibility in smoking behavior can lead to both a better understanding of gender-specific mechanisms of smoking behavior and new directions for smoking treatment development.

How can we use our knowledge of alcohol-tobacco interactions to reduce alcohol use?

Currently, 8.5% of the US population meets criteria for alcohol use disorders, with a total cost to the US economy estimated at $234 billion per year. Alcohol and tobacco use share a high degree of comorbidity and interact across many levels of analysis. This review begins by highlighting alcohol and tobacco comorbidity and presenting evidence that tobacco increases the risk for alcohol misuse and likely has a causal role in this relationship. We then discuss how knowledge of alcohol and tobacco interactions can be used to reduce alcohol use, focusing on whether (a) smoking status can be used as a clinical indicator for alcohol misuse, (b) tobacco policies reduce alcohol use, and (c) nicotinic-based medications can be used to treat alcohol use disorders.

Treatment of tobacco dependence in people with mental health and addictive disorders

People with mental health and addictive disorders (MHADs) have higher rates of cigarette smoking, and less success in quitting smoking compared with the general population. Moreover, tobacco-related medical illness may be the leading cause of death in the MHAD population. We discuss the scope of this comorbidity, and approaches to the treatment of tobacco dependence in people with MHAD, including schizophrenia, mood disorders, anxiety disorders, and alcohol and substance use disorders. Finally, at the level of health systems, we emphasize the importance of integrated treatment of tobacco dependence in MHADs.

The relationship of major depressive disorder and gender to changes in smoking for current and former smokers: longitudinal evaluation in the US population

AIMS

Although depression and smoking are correlated highly, the relationship of major depressive disorder (MDD) to smoking cessation and relapse remains unclear. This study compared changes in smoking for current and former smokers with and without current and life-time MDD over a 3-year period.

DESIGN

Analysis of two waves of longitudinal data from the National Institute on Alcohol Abuse and Alcoholism's National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-02; wave 2, 2004-05).

SETTING

Data were collected through face-to-face interviews from non-institutionalized United States civilians, aged 18 years and older, in 50 states and the District of Columbia.

PARTICIPANTS

A total of 11 973 adults (54% male) classified as current or former daily smokers at wave 1 and completed wave 2.

MEASUREMENTS

Classification as current or former smokers at wave 1 and wave 2.

FINDINGS

Smoking status remained stable for most participants. Wave 1 current daily smokers with current MDD [odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.03, 1.85] and life-time MDD (OR = 1.52, 95% CI: 1.15, 2.01) were more likely than those without the respective diagnosis to report continued smoking at wave 2. Wave 1 former daily smokers with current MDD (OR = 0.44, 95% CI: 0.26, 0.76) were less likely to report continued abstinence at wave 2. None of the gender × MDD diagnosis interactions were significant. Patterns of results remained similar when analyses were limited to smokers with nicotine dependence.

CONCLUSIONS

Current and life-time major depressive disorders are associated with a lower likelihood of quitting smoking and current major depressive disorder is associated with greater likelihood of smoking relapse.

Smoking cue reactivity in adult smokers with and without depression: a pilot study

Little is known about the relationship between Major Depressive Disorder (MDD) and smoking-related behaviors such as cue-induced urges to smoke. The purpose of this pilot study was to examine: (1) differences in smoking cue reactivity by MDD history and (2) the association of a diagnosis of MDD, current depressive symptoms, and smoking variables to cue-induced urges to smoke. Participants (N = 52) were n = 31 smokers with no MDD history and n = 21 smokers with past MDD. Participants completed a 2-hour laboratory session during which they were exposed to neutral (eg, pencils) and smoking cues (eg, cigarettes) after smoking one of their preferred brand cigarettes (Satiated Condition) and when it had been 1 hour since they smoked (Brief Deprivation Condition). Cue-induced urges increased with exposure to smoking cues and this increase did not significantly differ by diagnosis group. Current symptoms of depression, but not a diagnosis of MDD, were significantly and positively related to cue-induced cravings in satiated adult smokers. The association between depression symptoms and smoking urges was not significant in the Brief Deprivation Condition. Smoking cue reactivity may be a useful procedure for studying aspects of smoking behavior in adults with depression.

Developing and validating a human laboratory model to screen medications for smoking cessation

INTRODUCTION

To facilitate translational work in medications development for smoking cessation, we have developed a human laboratory analogue of smoking lapse behavior. Our paradigm models 2 critical features of smoking lapse: the ability to resist the first cigarette and subsequent ad libitum smoking. In this paper we present the results of 2 studies designed to develop and validate the effect of nicotine deprivation on smoking lapse behavior.

METHODS

Study 1 (n = 30) was designed to develop the model parameters by examining varying levels of nicotine deprivation (1, 6, and 18 hr; within-subject) and identifying optimum levels of monetary reinforcement to provide while modeling the ability to resist smoking. Study 2 was designed to validate the model by screening smoking cessation medications with known clinical efficacy. Subjects (n = 62) were randomized to either varenicline 2 mg/day, bupropion 300 mg/day, or placebo, and we then modeled their ability to resist smoking and subsequent ad libitum smoking.

RESULTS

In Study 1, increasing levels of nicotine deprivation and decreasing levels of monetary reinforcement decreased the ability to resist smoking. In Study 2, the lapse model was found to be sensitive to medication effects among smokers who demonstrated a pattern of heavy, uninterrupted, and automated smoking (i.e., smoked within 5 min of waking). Ratings of craving, mood, withdrawal, and subjective cigarette effects are presented as secondary outcomes with results mirroring clinical findings.

CONCLUSIONS

Our smoking lapse model demonstrates promise as a translational tool to screen novel smoking cessation medications. Next steps in this line of research will focus on evaluating predictive validity.

A Review of Smoking Cessation in Bipolar Disorder: Implications for Future Research

Tobacco smoking is common in people with bipolar disorder, and rates of smoking cessation are lower than in the general population. A literature review found eleven clinical research publications on bipolar disorder and tobacco, including only one smoking cessation pharmacotherapy trial. This article will review these findings and discuss possible reasons for the high rates of tobacco addiction among persons with bipolar disorder, as well as specific vulnerability factors that may contribute to tobacco treatment failure. An approach to the clinical assessment and treatment of tobacco dependence is described for this sub-group of smokers. Finally, recommendations are made for planning future treatment studies in persons with bipolar disorder and nicotine dependence.

The role of smoking expectancies in the relationship between PTSD symptoms and smoking behavior among women exposed to intimate partner violence

Intimate partner violence (IPV) is a public health problem associated with negative health consequences, including higher rates of tobacco smoking. Smoking expectancies are related to motivation to quit and relapse. IPV-exposed women endorse higher rates of PTSD symptoms, which are related to smoking and smoking expectancies. The present study sought to examine the relationship among smoking behavior, smoking expectancies, and PTSD symptoms among IPV-exposed women. Participants were 83 women who reported experiencing IPV within the last month, smoked an average of 12 cigarettes per day, and reported moderate levels of nicotine dependence (FTND mean=4.4). Participants completed baseline and follow-up interviews. Multiple regression analyses assessed the relationships among smoking expectancies and PTSD symptoms to cigarettes smoked per day and nicotine dependence. Findings demonstrated that Stimulation/State Enhancement expectancies were positively related to cigarettes per day, whereas PTSD arousal symptoms were negatively related to cigarettes per day, p's<.05. Neither smoking expectancies nor PTSD symptoms were significantly related to nicotine dependence. Supplemental analyses revealed that PTSD re-experiencing symptoms were negatively related and PTSD avoidance/numbing symptoms were positively related to Stimulation/State Enhancement expectancies, p's<.05. This study extends findings regarding the association between PTSD symptoms and smoking among an understudied population - IPV-exposed women. The relationship between PTSD symptoms and smoking differed across PTSD symptom clusters and expectancy scales, which may have implications for treatment development. The fact that expectancies and PTSD symptoms are related to smoking behavior among IPV-exposed women may be important for enhancing prevention and intervention efforts.

Examining antidepressant drug response by smoking status: why is it important and how often is it done?

Despite an increasingly recognized relationship between depression and smoking, little is known about the degree to which treatment studies for depression consider the impact of smoking on outcomes. The aim of this study is to examine the extent to which smoking is considered in current antidepressant treatment research. We conducted a MEDLINE search of recent randomized clinical trials of pharmacotherapy for depression published between 1 January and 31 December 2007, and a search of current pharmacological intervention studies for depression using www.ClinicalTrials.gov. Only 5% of the 107 pharmacological trials for depression published in 2007 reported the smoking status of their samples. Two studies (1.9%) controlled for smoking in the analyses and no studies analyzed outcomes by smoking status. Excluding the eight studies of combined treatment for depression and nicotine dependence, no other study on www.ClinicalTrials.gov (total n = 920) reported an intention to analyze outcomes by smoking status. Emerging data link smoking and depression, however, little attention has been directed toward the effects of smoking on antidepressant treatment outcomes. Conducting research to understand how nicotine and smoking affect responsiveness to antidepressants would advance our understanding of the neurobiology of depression and the development of new and targeted treatments.

Gender differences in smoking following an implicit mood induction

INTRODUCTION

Smoking is significantly associated with negative affect, which may play an especially important role in the smoking behavior of women. The purpose of this laboratory study was to examine the role of gender in the relationship of negative mood and smoking maintenance for male and female smokers following an implicit mood induction using music.

METHODS

Ninety adult smokers (50% female) completed a laboratory session during which they were randomly assigned to a negative mood induction, a positive mood induction, or a neutral mood condition. Latency to smoke and number of cigarettes smoked were assessed during an ad libitumsmoking period following the mood induction.

RESULTS

Female smokers began smoking more quickly following the negative mood induction when compared with males. There were no gender differences in the number of cigarettes smoked or for cravings to smoke by mood condition.

CONCLUSIONS

This study demonstrated gender differences in the relationship between negative affect and smoking behavior following an implicit and subtle mood manipulation. A better understanding of gender differences in smoking behavior can provide valuable information about mechanisms that maintain smoking behavior and guide treatment development to help adults quit smoking.

Stress decreases the ability to resist smoking and potentiates smoking intensity and reward

We have developed a novel human laboratory model to examine two primary aspects of stress-precipitated tobacco relapse: (1) Does stress reduce the ability to resist the first cigarette? (2) Once the first cigarette is initiated, does stress facilitate subsequent smoking? Using a within-subject design, daily smokers (n = 37) who were nicotine deprived overnight received a personalized imagery induction (stress or neutral) on two separate days, and then had the option of initiating a tobacco self-administration session or delaying initiation for up to 50 min in exchange for three levels of monetary reinforcement. Subsequently, the tobacco self-administration session entailed a 1-hour period in which subjects could choose to smoke using a smoking topography system. Following the stress induction, subjects were less able to resist smoking, smoked more intensely (increased puffs, shorter inter-puff interval, and greater peak puff velocity), and perceived greater satisfaction and reward from smoking. Stress significantly increased hypothalamus-pituitary-adrenal (HPA) axis reactivity, tobacco craving, negative emotion, and physiologic reactivity relative to the neutral condition. In addition, increased cortisol, ACTH, and tobacco craving were associated with reduced ability to resist smoking following stress. These findings have implications for understanding the impact of stress on smoking relapse and model development to assess smoking lapse behavior.

Differences in smoking expectancies in smokers with and without a history of major depression

Adults with depression evidence higher rates of smoking and lower quit rates than adults without depression. Little is known about the relationship between depression and smoking beliefs which are associated with both smoking and smoking cessation behavior. The primary aim of this study was to examine whether adult smokers with and without a history of major depressive disorder (MDD) differ in their endorsement of smoking expectancies. The secondary aim of the study was to examine whether there were interactions of depression and gender on the endorsement of expectancies. Adult cigarette smokers participating in a clinical trial of Selegiline hydrochloride for smoking cessation were classified as having a history of depression (MDD+, n=26) or no history of depression (MDD-, n=75). History of depression and smoking expectancies were assessed prior to randomization into the clinical trial. There was a main effect of depression on 7 out of 10 of the assessed beliefs. MDD+ smokers, compared to MDD- smokers, more strongly endorsed beliefs that smoking reduces negative affect, boredom, and cravings; smoking increases stimulation and social facilitation; smoking helps to manage cravings and weight; and that the taste is enjoyable. The main effect of gender and the interactive effect of depression and gender were not significant. Incorporating expectancies into cognitive-behavioral treatments for smoking cessation may be useful for smokers with a history of depression.

A tobacco reconceptualization in psychiatry: toward the development of tobacco-free psychiatric facilities

Tobacco dependence is the leading cause of death in persons with psychiatric and substance use disorders. This has lead to interest in the development of pharmacological and behavioral treatments for tobacco dependence in this subset of smokers. However, there has been little attention paid to the development of tobacco-free environments in psychiatric institutions despite the creation of smoke-free psychiatric hospitals mandated by the Joint Commission for Accreditation of Health Organizations (JCAHO) in 1992. This review article addresses the reasons why tobacco should be excluded from psychiatric and addictions treatment settings, and strategies that can be employed to initiate and maintain tobacco-free psychiatric settings. Finally, questions for further research in this field are delineated. This Tobacco Reconceptualization in Psychiatry is long overdue, given the clear and compelling benefits of tobacco-free environments in psychiatric institutions.

Perceived Risks and Benefits of Quitting Smoking in Non-Treatment Seekers

Little is known about beliefs about quitting and treatment motivation in non-treatment seeking smokers. One hundred eight-eight daily cigarette smokers not currently motivated to quit smoking completed measures of perceived risks and benefits of quitting and motivation to quit. Self esteem related to quitting was positively related to desire to quit, expected success at quitting, confidence in quitting, and motivation to quit. Greater perceived risks of cravings were related to greater expected difficulty of remaining abstinent, and greater perceived risk of increased negative affect was related to decreased expectation of success at quitting, confidence for quitting, and increased expectation for difficulty remaining abstinent. Greater perceived risk of weight gain was related to being less likely to have a goal of complete abstinence. There were no gender, ethnicity, age, or education differences in the relationship of perceived risks and benefits of quitting and motivation. Knowing the risks and benefits that relate to motivation to quit for non-treatment seeking smokers provides the foundation for targeting this group in campaigns to increase quit motivation.

Changes in smoking expectancies in abstinent, reducing, and non-abstinent participants during a pharmacological trial for smoking cessation

INTRODUCTION

Smoking expectancies are related to smoking consumption and predict smoking cessation. Little is known about whether expectancies change during smoking treatments, consistent with changes in smoking behavior. This study examined reported changes in smoking beliefs during an 8-week smoking cessation trial, which evaluated the safety and efficacy of the monoamine oxidase B inhibitor selegiline hydrochloride versus placebo.

METHODS

Participants were classified as "Quit" (n = 18), "Reduced" (n = 34), or "Not Quit" (n = 49) by 7-day point prevalence abstinence at the end of treatment. Expectancies were assessed at randomization, 1 week after the target quit date, and at the end of treatment.

RESULTS

Beliefs about smoking assessed prior to the quit attempt were not associated with cessation outcomes. Participants who quit smoking reported a reduction in expectations that smoking would reduce negative affect, boredom, and cravings, and facilitate social interactions, while participants who did not quit smoking reported an increase in Negative Social Impression beliefs. There were gender differences in beliefs related to Negative Affect Reduction, Negative Physical Feelings, Social Facilitation, and Cravings and significant Gender X Smoking Status interactions for Health Risk and Weight Control beliefs. There were no significant effects of medication on expectancies.

DISCUSSION

Baseline expectancies were not associated with abstinence outcomes; however, expectancies changed over time with changes in smoking, and the greatest changes were seen with smoking abstinence. Information about the relationship between smoking beliefs and behaviors may be used to enhance or tailor smoking cessation treatments.

Nicotine withdrawal in U.S. smokers with current mood, anxiety, alcohol use, and substance use disorders

BACKGROUND

The current study examined tobacco withdrawal symptoms and withdrawal-related discomfort and relapse in smokers with and without current mood disorders, anxiety disorders, alcohol use disorders (AUD), and substance use disorders (SUD).

METHODS

The subsample of current daily smokers (n=8213) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, Wave 1, 2001-2002, full sample n=43,093) were included in these analyses. Cross-sectional data compared smokers with and without current psychiatric disorders on withdrawal symptoms using logistic regression models. The effects of having a co-morbid psychiatric disorder and AUD/SUD compared to a psychiatric disorder alone on nicotine withdrawal were also examined.

RESULTS

Participants with a current mood disorder, anxiety disorder, AUD, or SUD were more likely to report withdrawal symptoms and reported more withdrawal symptoms than those without current disorders. Having a current mood disorder, anxiety disorder, or SUD was also associated with increased likelihood of withdrawal-related discomfort and relapse. There were no significant interactions between psychiatric disorders and AUDs/SUDs on withdrawal symptoms or behavior.

CONCLUSIONS

Participants with a current Axis I disorder were more likely to experience tobacco withdrawal symptoms and withdrawal-related discomfort and relapse. Having a co-morbid psychiatric disorder and AUD/SUD did not synergistically increase the experience of withdrawal-related symptoms or relapse. It is important to identify Axis I disorders in smokers and provide these smokers with more intensive and/or longer treatments to help them cope with withdrawal symptoms and prevent relapse.

A double-blind, placebo-controlled, randomized clinical trial of oral selegiline hydrochloride for smoking cessation in nicotine-dependent cigarette smokers

AIM

The primary aim of this study was to determine the safety and efficacy of the monoamine oxidase-B (MAO-B) inhibitor selegiline hydrochloride (SEL, l-Deprenyl; Eldepryl) as an aid for smoking cessation in cigarette smokers.

METHODS

One hundred and one nicotine-dependent adult cigarette smokers without current psychiatric or substance use disorders participated in this 8-week randomized, double-blind, placebo-controlled trial. Participants received either SEL (5mg bid, n=51) or placebo (PLO, n=50), in combination with brief (<10 min) manualized smoking cessation counseling. The main smoking outcome measures were 7-day point prevalence abstinence at end of trial (EOT), 4-week continuous smoking abstinence at end of trial (CA), and 7-day point prevalence abstinence at 6-month follow-up (6MFU). Abstinence was determined by an absence of self-reported cigarette smoking and biochemically verified by expired breath carbon monoxide and plasma cotinine levels.

RESULTS

Rates of smoking abstinence did not differ by medication group (EOT: SEL=16%, PLO=20%, p=0.57; CA: SEL=14%, PLO=18%, p=0.56; 6MFU: SEL=12%, PLO=16%, p=0.54). Adverse events were modest and comparable between medication groups. Participants receiving SEL were more likely than those receiving PLO to report dry mouth (25.5% versus 8.2%, p<0.05).

CONCLUSIONS

Our results suggest that SEL was safe and well-tolerated by adult cigarette smokers, but did not improve smoking abstinence rates compared to PLO.

Effects of the nicotinic receptor antagonist mecamylamine on ad-lib smoking behavior, topography, and nicotine levels in smokers with and without schizophrenia: a preliminary study

Individuals with schizophrenia have higher plasma nicotine levels in comparison to non-psychiatric smokers, even when differences in smoking are equated. This difference may be related to how intensely cigarettes are smoked but this has not been well studied. Mecamylamine (MEC), a non-competitive nicotinic acetylcholine receptor (nAChR) antagonist, which has been shown to increase ad-lib smoking and to affect smoking topography, was used in the current study as a pharmacological probe to increase our understanding of smoking behavior, smoking topography, and resulting nicotine levels in smokers with schizophrenia. This preliminary study used a within-subject, placebo-controlled design in smokers with schizophrenia (n=6) and healthy control smokers (n=8) to examine the effects of MEC (10mg/day) on ad-lib smoking behavior, topography, nicotine levels, and tobacco craving across two smoking deprivation conditions (no deprivation and 12-h deprivation). MEC, compared to placebo, increased the number of cigarettes smoked and plasma nicotine levels. MEC increased smoking intensity and resulted in greater plasma nicotine levels in smokers with schizophrenia compared to controls, although these results were not consistent across deprivation conditions. MEC also increased tobacco craving in smokers with schizophrenia but not in control smokers. Our results suggest that antagonism of high-affinity nAChRs in smokers with schizophrenia may prompt compensatory smoking, increasing the intensity of smoking and nicotine exposure without alleviating craving. Further work is needed to assess whether nicotine levels are directly mediated by how intensely the cigarettes are smoked, and to confirm whether this effect is more pronounced in smokers with schizophrenia.

Prefrontal cognitive dysfunction is associated with tobacco dependence treatment failure in smokers with schizophrenia

BACKGROUND

Patients with schizophrenia have higher rates of smoking (58-88%) than in the general population ( approximately 22%), and are more refractory to smoking cessation. These patients also exhibit numerous neurocognitive deficits, some of which may be ameliorated by cigarette smoking. The neurocognitive benefits derived from nicotine may, in turn, contribute to elevated rates of smoking and smoking persistence in schizophrenia. The present study examined the relationship between neurocognitive function and smoking cessation in schizophrenia.

METHODS

Treatment-seeking smokers with schizophrenia (N=58) participated in a 10-week placebo-controlled trial of sustained-release (SR) bupropion plus transdermal nicotine patch. Neuropsychological performance was evaluated in a subset of patients (n=31), prior to pharmacological treatment, using a neurocognitive battery.

RESULTS

Subjects were compared as a function of endpoint smoking status (Quit versus Not Quit), assessed by end of trial 7-day point prevalence abstinence, confirmed by CO level (< 10 ppm) on demographic traits, smoking, and clinical outcomes. While there were no significant baseline differences between quitters and non-quitters, non-quitters exhibited significantly greater deficits in performance on Trail Making Test, Part B (p=0.01) and on Digit Span backwards (p=0.04) compared to quitters. No associations were found between quit status and performance on other neuropsychological measures.

CONCLUSIONS

Our findings extend results of previous studies which suggest deficits in frontal executive function are associated with smoking cessation failure in schizophrenia. This may have implications for the development of tailored smoking cessation treatments in this population.

Gender differences in associations between lifetime alcohol, depression, panic disorder, and posttraumatic stress disorder and tobacco withdrawal

This study examined the interaction of gender and lifetime psychiatric status on the experience of nicotine withdrawal using retrospective data from the National Comorbidity Survey (NCS; N = 816). Multiple regression analyses were performed to examine the main and interactive effects of gender and major depression, alcohol abuse/dependence, panic disorder, and PTSD on indices of withdrawal. Major depression and alcohol abuse/dependence were associated with longer duration of withdrawal symptoms in women. Women also showed stronger associations between major depression and recurrent withdrawal symptoms and PTSD and smoking relapse to alleviate withdrawal. Men showed a stronger association between alcohol abuse/dependence and smoking relapse to alleviate withdrawal. When developing and providing smoking cessation interventions, it is important to consider the gender-specific effects of lifetime psychiatric status on withdrawal.

The impact of cigarette smoking on stimulant addiction

OBJECTIVES

Stimulant users smoke cigarettes at high rates; however, little is known about the relationship between tobacco and stimulants.

METHODS

Our goal in this article is to synthesize a growing literature on the role of cigarette smoking in stimulant addiction.

RESULTS

Early nicotine exposure may influence the development of stimulant addiction. Preclinical and clinical studies suggest a facilitatory role of nicotinic agonists for stimulant addiction. Smoking appears to be associated with more severe stimulant use and poorer treatment outcomes.

CONCLUSIONS

It is important to assess smoking and smoking-related variables within stimulant research studies to more fully understand the comorbidity. Integrating smoking cessation into stimulant treatment may improve nicotine and stimulant treatment outcomes.

Relationship of perceived risks of smoking cessation to symptoms of withdrawal, craving, and depression during short-term smoking abstinence

The current study examined the relationship between perceived risks of quitting smoking and the self-reported experience of risks (e.g., cravings) during short-term abstinence. Participants (n=55) were daily smokers enrolled in a study of contingency management for smoking cessation with biochemically confirmed abstinence for 1 week. Participants were divided into groups of higher and lower perceived risk of quitting. There were no differences by risk group in demographics or baseline smoking, nicotine dependence, cravings, withdrawal, and depression. Although participants with higher levels of perceived risks reported a similar pattern of cravings and withdrawal symptoms during abstinence, they experienced higher levels of cravings, withdrawal symptoms, and depression than participants with lower risk beliefs. There were no differences in the relationship of risk to withdrawal symptoms by gender. Smokers with higher levels of perceived risk may find it more difficult to quit and remain abstinent due to higher levels of anticipated or experienced withdrawal symptoms and may benefit from targeted behavioral interventions with regard to risk perception and enhanced coping with withdrawal and other effects of smoking cessation.

Nicotinic antagonist augmentation of selective serotonin reuptake inhibitor-refractory major depressive disorder: a preliminary study

BACKGROUND

There is evidence for nicotinic hypercholinergic mechanisms in depression. Clinical relationships between tobacco use and depression suggest important effects of nicotine in major depressive disorder (MDD). It has been hypothesized that cigarette smoking may exert antidepressant effects, presumably mediated through stimulation of nicotinic acetylcholine receptor systems. We compared the nicotinic antagonist, mecamylamine hydrochloride (MEC), with placebo as an augmentation strategy for patients with MDD who were refractory to selective serotonin reuptake inhibitor (SSRI) treatment.

METHODS

Twenty-one SSRI-treated subjects with MDD were randomized to MEC (up to 10 mg/d; n = 11) or placebo (PLO group; n = 10) during an 8-week trial. The primary outcome measure was the change in depressive symptoms assessed using the 17-item Hamilton Depression Rating Scale during the 8-week trial.

RESULTS

There was a significant reduction in 17-item Hamilton Depression Rating Scale scores in the MEC versus PLO groups, as evidenced by a significant medication x time interaction (F1,19 = 6.47, P < 0.05). Five (45.5%) of 11 subjects in the active study medication group demonstrated a 50% or more decrease in depressive symptoms from baseline as compared with 1 (10%) of 10 subjects assigned to placebo medication, but this difference was not significant (P = 0.15; Fisher exact test). The primary side effects of MEC were constipation and orthostatic hypotension.

CONCLUSIONS

These preliminary findings suggest that the nicotinic acetylcholine receptor antagonist, MEC, may have utility as an augmentation strategy for patients with SSRI-refractory MDD.

A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia

BACKGROUND

Individuals with schizophrenia smoke at higher rates (58%-88%) than the general population (approximately 22%), and have difficulty quitting. We determined whether the combination of sustained-release (SR) bupropion (BUP) with the transdermal nicotine patch (TNP) was well-tolerated and superior to placebo (PLO)+TNP for smoking cessation in schizophrenia.

METHODS

A 10-week, double-blind, placebo-controlled trial of BUP (300 mg/day) in combination with TNP (21 mg/24h) for 58 outpatient smokers with schizophrenia was conducted. Primary outcome measures were continuous smoking abstinence in the last 4 weeks of the trial (Days 43-70) and 7-day point prevalence abstinence at 6 months post-target quit date (TQD) (week 26).

RESULTS

Smokers assigned to the BUP+TNP group (n = 29) were more likely to achieve continuous smoking abstinence (8/29, 27.6%) than the PLO+TNP group (n = 29, 1/29, 3.4%) [Fisher's Exact Test, p < .05]; at 6-months post-TQD, 4/29 (13.8%) versus 0/29 (0.0%) achieved 7-day point prevalence smoking abstinence (p = .11). Neither bupropion SR nor smoking abstinence significantly altered the positive or negative symptoms of schizophrenia. The combination was well-tolerated in smokers with schizophrenia.

CONCLUSIONS

Combination therapy with bupropion SR+TNP versus placebo+TNP is well-tolerated and significantly improved short-term smoking abstinence in smokers with schizophrenia.

Cigarette smoking and intimate partner violence among men referred to substance abuse treatment

This study examined differences between alcohol-dependent offenders of intimate partner violence (IPV) with and without current daily cigarette smoking. Eighty-five alcohol dependent men arrested for domestic and referred to substance abuse treatment were evaluated. A total of 71% of the participants reported current cigarette smoking. The groups were divided into daily smokers (n = 52) vs. non-daily smokers (n = 21). Daily smokers had significantly more days of alcohol use in the 28 days prior to starting treatment, significantly more ASI alcohol and legal severity, and significantly more participants with a diagnosis of antisocial personality disorder compared to non-daily smoking alcohol dependent offenders of IPV.

Age of onset of smoking among alcohol dependent men attending substance abuse treatment after a domestic violence arrest

This study examined differences between alcohol dependent offenders of intimate partner violence (IPV) with early initiation of cigarette smoking versus alcohol dependent offenders of IPV with later initiation of cigarette smoking. Seventy-eight alcohol dependent men who were arrested for domestic and referred to substance abuse treatment were randomly assigned to manual-guided behavioral therapies (Cognitive Behavioral Therapy or Twelve Step Facilitation). Sixty-two clients reported smoking cigarettes (85%) while 52 reported smoking cigarettes (71%) on a daily basis. Early initiation of smoking was defined as smoking cigarettes before the age of 16 years of age, while later initiation of smoking was defined as smoking cigarettes from 16.5 years and older. Regarding baseline characteristics, participants assigned to the early initiation of smoking condition had significantly more domestic violence arrests and significantly higher anger expression scores at baseline compared to the late smoking initiation group. Despite more severity of substance abuse, legal and violence characteristics at the baseline assessment in the early initiation group, both smoking initiation groups responded equally as well across 12 weeks of manualized behavioral treatments. The implications of these findings are discussed.

Effects of acute abstinence, reinstatement, and mecamylamine on biochemical and behavioral measures of cigarette smoking in schizophrenia

BACKGROUND

Schizophrenics have higher rates of smoking than the general population, and more difficulty with smoking cessation. However, there has been little study of differences between schizophrenics and controls with respect to biochemical and behavioral indices of smoking. We compared smokers with schizophrenia (SS; n=27) and control smokers (CS; n=26) on smoking and psychiatric outcomes at baseline, during acute smoking abstinence and reinstatement, and with pre-treatment using the nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine (MEC) in a human laboratory setting.

METHODS

Biochemical (e.g., plasma nicotine) and behavioral (e.g., craving, withdrawal) outcomes were assessed at baseline, after overnight abstinence, and after smoking reinstatement during three consecutive test weeks. Each week, participants received one of three doses of MEC (0.0, 5.0, or 10.0 mg/dayx3 days) in a randomized, counterbalanced manner.

RESULTS

Compared to CS, SS displayed similar levels of craving and withdrawal, but higher plasma nicotine and cotinine levels, and cotinine/CPD ratio. During reinstatement, SS consumed significantly more cigarettes than CS, but MEC did not significantly alter indices of smoking, psychiatric symptoms, or cigarette consumption during reinstatement.

CONCLUSIONS

1) The reinforcing effects of smoking may be increased in SS versus CS after overnight abstinence; 2) the lack of effects of nAChR antagonism may suggest that non-nicotinic components of cigarettes may contribute to the behavioral effects of smoking in both SS and CS; and 3) consistent with previous studies, SS may exhibit higher baseline levels of nicotine and cotinine, and greater extraction of nicotine per cigarette than CS.

Reliability of the Fagerström Test for Nicotine Dependence, Minnesota Nicotine Withdrawal Scale, and Tiffany Questionnaire for Smoking Urges in smokers with and without schizophrenia

Few studies have examined the psychometrics of smoking-related behavioral measures in schizophrenia and questions have been raised about the applicability to smokers with schizophrenia. We examined the reliability of the Fagerström Test for Nicotine Dependence (FTND), Minnesota Nicotine Withdrawal Scale (M-NWS), and the Tiffany Questionnaire for Smoking Urges (TQSU) for smokers with schizophrenia (SS; n=151) and nonpsychiatric smokers (CS; n=181) recruited into three studies with similar inclusion criteria. SS and CS did not differ on a number of demographic and smoking variables (e.g., age). SS reported higher carbon monoxide (CO) levels, plasma cotinine levels, FTND, M-NWS, and TQSU Factor 1 scores. The internal consistencies (Cronbach's alpha) of the smoking measures were found to be high and comparable between diagnostic groups for the FTND, M-NWS total scores, and TQSU Factor 2 (all alpha's>0.70) but higher for the CS than SS for the TQSU Factor 1 (0.86 versus 0.79). Test-retest correlations were lower for SS than CS on the FTND (0.65 versus 0.82), TQSU Factor 1 (0.65 versus 0.79), and TQSU Factor 2 (0.69 versus 0.81), but did not differ between diagnostic groups for M-NWS (0.58 versus 0.64). Our findings suggest that these measures may be reliable for use in smokers with schizophrenia.

Persistent hyponatremia and inappropriate antidiuretic hormone secretion in children with extensive burns

Three children aged 2 1/2 to 5 1/2 yr, with burns covering 30%--45% of body surface area, developed hyponatremia and serum hypotonicity on the 5th--6th day following the burn injury. The hyponatremia persisted for 10--15 days. During this period, all three passed inappropriately concentrated urines. One child also demonstrated marked and inappropriate thirst. All three children demonstrated persistent respiratory alkalosis, which appeared and disappeared concomitantly with the hyponatremia. There were no signs of dehydration, and plasma volumes, measured in two children, were normal to high. These children are believed to show evidence of inappropriate antidiuretic hormone (ADH) secretion. In the absence of those conditions known to produce this syndrome, it is postulated that in these children it may have resulted from prolonged pain, anxiety, and/or pyrexia.