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

Anger, anxiety, and depressive affect as predictors of stress-induced cortisol production in khat and tobacco users

INTRODUCTION

Glucocorticoid activity is disrupted in substance users including khat chewers who also use tobacco. Anger, dysphoria, and anxiety can mediate this relationship. The aim of this study was to contrast emotion dysregulation and substance use variables as predictors of post-stress cortisol output.

MATERIALS AND METHODS

Comparable numbers of males (n = 90) and females (n = 85) including controls, khat only, and concurrent khat and tobacco users participated in a stress study. Depressive affect, anxiety, anger, substance use patterns, and saliva samples were collected following a standardized laboratory stress manipulation.

RESULTS

Regression analysis showed that high depression and low anxiety was associated with high post-stress cortisol, but only in co-users of tobacco and khat. Males, but not females, showed a significant association between co-use of khat and tobacco and cortisol, which appears to be mediated by frequency of use. The link between anxiety and post-stress cortisol in the co-users remained significant after controlling for nicotine dependence and substance use frequency.

CONCLUSION

Anxiety predicted the neuroendocrine consequences of concurrent use of tobacco and khat above and beyond sex, nicotine dependence, anger, and substance use frequency. Sex differences, however, are related to differences in nicotine dependence.

Optimizing follow-up and study retention in the 21st century: Advances from the front line in alcohol and tobacco research

AIMS

Longitudinal studies are integral in addiction research but retention of participants over time can be challenging. While statistical algorithms for missing data have advanced, they remain less desirable than collecting actual data with high retention rates. An update to methodological primers with consideration of evolving technology and privacy concerns is needed for 21st century researchers.

METHODS

Comprehensive follow-up methodological strategies were conducted in four concurrent laboratory- and intervention-based studies across N=697 drinker and smokers enrolled in studies at the Clinical Addictions Research Laboratory at the University of Chicago. The methods of three key longitudinal research themes and their outcomes are outlined, including: a) mindset of the research team starting at study enrollment, b) modalities with a particular focus on advances in technological strategies in follow-up, and c) mitigating difficult to reach and challenging participants.

RESULTS

The techniques described herein produced follow-up rates of 95% and 99% in two laboratory-based studies with follow-ups of 1- and 6-years, respectively and 94% and 97% in two intervention studies with follow-ups of 6- and 12- months. Adapting incentive strategies more than tripled on-time follow-up, from 18% to 68% of the sample, switching to more advanced technologies decreased participant burden and time by 30% from traditional telephone interviews, and difficult-to-reach participants averaged 47 contact attempts.

CONCLUSIONS

The methods presented produced exceptional follow-up retention across four studies. The principles and methodologies discussed may be modified across a range of studies to target various sub-populations in the addiction field.

Tobacco Use Among Siblings of Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study

BACKGROUND

Having a brother or sister with childhood cancer may influence health behaviors during adulthood. The aim of this study was to compare tobacco use in siblings of survivors with peers and to identify factors associated with sibling tobacco use.

PROCEDURES

A retrospective cohort study was conducted using adult siblings (N = 1,974) of 5+ year cancer survivors in the Childhood Cancer Survivor Study (CCSS) and participants (N = 24,105, weighted to match CCSS) in the 2007 National Health Interview Survey. Self-reported tobacco use, sociodemographic, and cancer-related risk factors were analyzed.

RESULTS

Siblings were equally likely to have ever smoked compared to their peers (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.12). Siblings were less likely to be current smokers (OR 0.83, 95%CI 0.73-0.94), but more likely to be former smokers (OR 1.21, 95%CI 1.08-1.35). Siblings with low education were more likely to ever smoke (OR 1.51, 95%CI 1.15-2.00) and be current smokers (OR 1.67, 95%CI 1.24-2.26) compared to their peers. Among siblings, risk factors for current tobacco use included the following: low income <$20,000 (OR 1.66, 95%CI 1.09-2.54), low education (OR 6.68, 95%CI 4.07-10.97), psychological distress (OR 5.36, 95%CI 2.21-13.02), and heavy alcohol use (OR 3.68, 95%CI 2.50-5.41).

CONCLUSIONS

Siblings of survivors take up smoking at similar rates to their peers, but are more likely to quit. Efforts are needed to address disparities by providing greater psychosocial support and education for the lowest socioeconomic status families facing childhood cancer.

Stress modulates illness-course of substance use disorders: a translational review

Childhood trauma and post-childhood chronic/repeated stress could increase the risk of a substance use disorder by affecting five stages of addiction illness-course: (a) initial experimentation with substances; (b) shifting from experimental to regular use; (c) escalation from regular use to abuse or dependence; (d) motivation to quit; and (e) risk of (re-)lapse. We reviewed the human literature on relationships between stress and addiction illness-course. We explored per illness-course stage: (i) whether childhood trauma and post-childhood chronic/repeated stress have comparable effects and (ii) whether effects cut across classes of substances of abuse. We further discuss potential underlying mechanisms by which stressors may affect illness-course stages for which we relied on evidence from studies in animals and humans. Stress and substances of abuse both activate stress and dopaminergic motivation systems, and childhood trauma and post-childhood stressful events are more chronic and occur more frequently in people who use substances. Stressors increase risk to initiate early use potentially by affecting trait-like factors of risk-taking, decision making, and behavioral control. Stressors also accelerate transition to regular use potentially due to prior effects of stress on sensitization of dopaminergic motivation systems, cross-sensitizing with substances of abuse, especially in people with high trait impulsivity who are more prone to sensitization. Finally, stressors increase risk for abuse and dependence, attenuate motivation to quit, and increase relapse risk potentially by intensified sensitization of motivational systems, by a shift from positive to negative reinforcement due to sensitization of the amygdala by corticotropin releasing factor, and by increased sensitization of noradrenergic systems. Stress generally affects addiction illness-course across stressor types and across classes of substances of abuse.