The effects of stress and relaxation in the presence of stress on urinary pH and smoking behaviors

A Multifaceted Hypnosis Smoking-Cessation Program: Enhancing Motivation and Goal Attainment

Smoking cessation remains a major health priority. Despite public campaigns against smoking and widespread availability of smoking-cessation treatments, many people continue to smoke. The authors argue that the "problem of motivation," that is, suboptimal or fluctuating motivation to resist smoking urges and to comply with the demands of treatment, commonly undermines treatment seeking and adherence, appreciably reducing the success rates of smoking-cessation programs. The authors describe the history of the Winning Edge smoking-cessation program and discuss ways to enhance motivation before, during, and after formal treatment. They illustrate how hypnotic suggestions, administered in the context of their program, can promote cognitive, behavioral, and emotional commitment to treatment and enhance motivation to live a smoke-free life.

Cigarette smoking and drinking behavior of migrant adolescents and young adults in Hanoi, Vietnam

PURPOSE

There has been a large migration from rural to urban areas in much of the developing world. In the past, this was less true in Vietnam, which remains largely agricultural; however, since the 1990s, economic reforms and loosening of government policies that had previously limited movement have led to a large increase in this rural to urban population movement. Risky health behaviors have been found among migrants in many other settings. The purpose of this research was to determine whether migrant adolescents and young adults in the city of Hanoi are more or less likely than local ones to engage in cigarette smoking and alcohol drinking health risk behaviors, to identify factors associated with these behaviors, and to suggest interventions to reduce these health risk behaviors among the study population.

METHODS

A cross-sectional survey of 4,550 adolescents and young adults aged 15-24 years was conducted in urban Hanoi in 2006. This study examines current use of cigarettes and alcohol by migration status using multivariate logistic regressions.

RESULTS

Cigarette smoking and drinking alcohol are male phenomena. The prevalence of cigarette smoking and alcohol drinking is high among adolescents and young adults in Hanoi and is more common among migrants who came from rural areas of other provinces than nonmigrants in the city. However, multivariate analysis revealed that migrants were neither more likely to smoke cigarettes nor drink alcohol than nonmigrants after controlling for other factors, such as age, full-time worker status, depression, and having close friends who smoke and/or drink.

CONCLUSIONS

The results suggest that interventions aiming at smoking and/or drinking reduction should pay more attention to adolescents, especially males, changing health risk behaviors at school and at work, and peer influence than their migration status.

Triggers of heavier and lighter cigarette smoking in college students

This preliminary study examined the relationship between cigarette smoking and several environmental and psychological cues to smoke in college students who were lighter (2-8 cigarettes per day) and heavier (greater than 10 cigarettes per day) smokers. Nineteen lighter and 16 heavier smokers monitored their smoking behavior and certain smoking cues, and reported this information daily to an interactive voice response (IVR) system over a 13-day period. Results indicated the lighter smokers consumed a significantly greater proportion of cigarettes when drinking alcohol and during the evening hours compared to heavier smokers. No differences were found between groups on smoking in the presence of negative affect or coffee, although heavier smokers smoked a greater proportion of cigarettes when experiencing low energy positive affect (e.g., calm). If a replication of this study produces similar results, there could be implications for public policy, particularly the regulation of smoking in venues where alcohol is served.

Subjective and Reinforcing Effects of Smoking During Negative Mood Induction

Two notions strongly held by many smokers are that negative mood increases smoking behavior and that this increase is due to the ability of smoking to alleviate negative affect. This study used a modified mood induction procedure to examine both the impact of smoking on induced mood, as well as the effect of induced mood on actual smoking behavior. Forty-eight smokers were randomly assigned to a smoking or a water-drinking comparison group. Each participant attended 3 sessions during which 1 of 3 mood states (positive, negative, or neutral) was induced. Contrary to expectation, smoking did not attenuate negative affect. However, negative mood induction subsequently quickened latency to smoke and increased number of puffs consumed ad lib.

Motivational Influences on Cigarette Smoking

Cigarette smoking is a leading cause of mortality and morbidity and a particularly common and intractable addictive disorder. Research shows that nicotine is a sine qua non of tobacco addiction and that it produces the hallmark effects of addictive drugs: sensitization, tolerance, physical dependence, and euphoria/elation. Research on the development of smoking reveals that although smoking prevalence has declined from a peak in the mid-1990s, close to 30% of twelfth graders still smoke. Smoking in adolescents is related to development of physical dependence, ethnicity, impulsivity, affective disorder, and peer influences. However, which of these exerts the greatest causal effects is unknown, and their influence no doubt varies across individuals and across development. Once dependence on tobacco smoking is established, evidence suggests that tobacco motivation is strongly influenced by a reduction in withdrawal symptoms, an expectation of stress reduction, and conditioned reinforcement. Nicotine motivation may also be influenced by modulation in stimulus incentive value.

Immediate antecedents of cigarette smoking: an analysis from ecological momentary assessment

The authors assessed the association between smoking and situational cues, including affect, in real-world contexts. Using ecological momentary assessment, 304 smokers monitored ad-lib smoking for 1 week, recording each cigarette on palm-top computers. Generalized estimating equations contrasted 10,084 smoking and 11,155 nonsmoking situations. After controlling for smoking restrictions, smoking was strongly related to smoking urges and modestly related to consumption of coffee and food, the presence of other smokers, and several activities. Smoking was unrelated to negative or positive affect or to arousal, although it was associated with restlessness. Thus, in daily life, affect appears to exert little influence over ad-lib smoking in heavy smoking adults.

Response to social stress, urge to smoke, and smoking cessation

Motivational theories of drug use have assigned negative affect a central role in determining drug urges and drug relapse. The purpose of this study was to examine the effects of social stress on smoking urges in a controlled laboratory setting, and the relation of these responses to short-term (3-month) smoking cessation outcomes. Prior to a clinic-based smoking cessation program, 76 (64% female) smokers were assessed for their affective, cognitive, and physiological responses during the Borkovec social anxiety induction procedure. These responses were used to predict smoking urges immediately after the procedure and to predict abstinence at 3-month follow-up posttreatment. As expected, during the induction, urge to smoke was positively associated with anxiety ratings and negatively associated with self-efficacy to resist smoking. However, only heart rate increase and behavioral social skill (observed by independent judges) predicted smoking abstinence at 3 months. These results suggest that subjective affective and efficacy responses during a stressful social encounter are associated with smoking urges; however, urges and these responses may be related in different ways to the probability of smoking cessation.

Cigarette smoking and chewing gum: response to a laboratory-induced stressor

The current study examined the anxiolytic effects of cigarette smoking and chewing gum on urge to smoke, withdrawal, and anxiety in response to a public speaking task in 45 undergraduate smokers. Participants were asked to smoke, chew gum, or do nothing in response to the stressor. Participants completed measures of anxiety, withdrawal symptoms, and urge to smoke pre- and poststressor. The smoke group reported fewer urges to smoke pre- and poststressor than the other groups. The smoke and gum groups reported fewer withdrawal symptoms than did the control group poststressor. Chewing gum was helpful in managing levels of withdrawal symptoms compared with the control group. Groups did not differ on measures of anxiety. Results suggest that smoking in response to a stressor may not reduce levels of affective stress. Furthermore, chewing gum may be helpful in managing withdrawal symptoms in response to a stressor.

Gender differences in the pharmacology of nicotine addiction

Smoking rates have declined in recent years less rapidly in women than in men. More adolescent girls than boys are currently smoking. Quitting smoking is reported in many studies to be more difficult in women than in men. These observations suggest that there may be gender differences in the nature of nicotine addiction. Gender differences in various pharmacological processes involved in nicotine addiction are reviewed. Women take in less nicotine from smoking per cigarette than men but, because of slower metabolism, nicotine levels in the body for a given number of cigarettes per day are similar in male and female smokers. Women tend to be less sensitive to the discriminative effects of nicotine and tend to regulate nicotine intake less precisely than men. On the other hand, women appear to be more sensitive to the effects of nicotine in reducing negative affect and reducing body weight. There is a strong association between depression and smoking, and this association appears to be stronger in women than in men. Women tend to respond more to environmental cues associated with smoking than do men. Thus, several lines of evidence suggest that nicotine addiction is different in women than in men. Understanding the basis for gender differences may be of utility in individualizing and optimizing smoking cessation therapy.

Endogenous opioids and smoking: a review of progress and problems

The present report examines efforts to elucidate the role of opioid mechanisms in the reinforcement of smoking. A number of approaches have been used to evaluate nicotine-opioid interactions. Opiate agonists such as heroin or methadone have been found to increase cigarette smoking reliably in humans, and morphine has been shown to increase the potency and efficacy of nicotine in rats. There is also an extensive literature documenting the nicotine-stimulated release of endogenous opioids in various brain regions involved in the mediation of opiate reinforcement. Blockade studies using opioid antagonists have not been as conclusive. Although animal models have demonstrated commonalities between nicotine withdrawal and the opiate abstinence syndrome, including reversibility by morphine, and although the impact of nicotine on certain response systems such as respiratory reflexes has clearly been shown to involve opioid mediation, attempts to demonstrate opioid modulation for the key indicators of smoking reinforcement--cigarette consumption and nicotine self-administration--have been fraught with difficulty. Resolution of the apparent contradictions will require taking into account: (a) the biphasic properties of nicotine-opioid effects at higher doses and anti-opioid effects at lower doses; (b) the contributions of the opioid receptor populations--mu, kappa, sigma--stimulated at various dose levels; (c) the possibility that endogenous-opioid activity is entrained primarily during the acquisition or re-acquisition of nicotine self-administration; (d) the possibility that the endogenous opioid response does contribute to nicotine reinforcement but only as a delimited component of the neuroregulatory cascade of nicotine; and (e) the possibility that opioids contribute primarily to nicotine reinforcement under special conditions such as stress. Taking these considerations into account should allow studies on endogenous opioid effects to begin to do justice to the complexity of both smoking behavior and the actions of nicotine.

Reactivity to smoking cues: mediating roles of nicotine dependence and duration of deprivation

This study examined the roles of nicotine dependence and duration of smoking deprivation as mediators of smoking cue reactivity in 117 individuals enrolled in treatment. Participants were randomly assigned to 15, 90, or 180 min of deprivation; all were exposed to smoking cues (observing a research assistant smoke a cigarette) while a variety of self-report, behavioral, and psychophysiological measurements were obtained. Results indicated that in general, psychophysiological reactivity to smoking-relevant cues was greater with increasing deprivation; heart rate analysis revealed an interaction between nicotine dependence and duration of deprivation. Smoking desire, negative affect, physical withdrawal symptoms, and other ratings were interrelated during cue exposure, and generally demonstrated predicted relationships with the independent variables. Multiple regression analysis revealed that desire to smoke during cue exposure was predicted by a combination of psychophysiological, self-report, and demographic variables. These findings have implications for methodological considerations and theoretical underpinnings of smoking cue reactivity research.

Smoking withdrawal symptoms in response to a trauma-related stressor among Vietnam combat veterans with posttraumatic stress disorder

This study investigated the relationship between a trauma-related stressor and smoking withdrawal symptoms in 25 male Vietnam combat veterans with posttraumatic stress disorder (PTSD) using a within-subjects design. All subjects were smokers. The stressor involved a modified Stroop task, in which the veterans color-named either anxiety-related or neutral control words. Anxiety-related words produced more withdrawal symptoms than neutral control words, including increased craving, negative affect symptoms, somatic symptoms, and lack of alertness.

Research on stress and smoking: progress and problems

Despite evidence that smoking behaviour increases in the context of stress, there has yet to be a clear-cut demonstration that nicotine intake is similarly enhanced. Although nicotine intake has been shown to reduce reported anxiety in the context of stress, the controlling conditions (type of stressor, intensity, temporal relationships, etc.) need further exploration. Recent findings involving nicotine's effects on the hypophyseal-adrenal axis provide a new perspective on these issues, in that increased nicotine intake during exposure to a stressor may represent, at least in part, behavioral compensation for diminished sensitivity to nicotine brought about by nicotine-stimulated corticosteroid release. Corticosteroids may decrease central nervous system excitability in a way that could account for anxiety reduction; on the other hand, anxiety reduction may be an epiphenomenon with respect to the reinforcement of smoking behaviour. The integration of behavioural, physiological, and biochemical research exemplified by the above approach should lead to a better understanding of stress and smoking.

Exposure to smoking-relevant cues: effects on desire to smoke and topographical components of smoking behavior

The effects of exposure to two classes of smoking-relevant cues (environmental; negative affect) on desire to smoke and smoking topography were evaluated. Sixty chronic smokers were randomly assigned to one of six groups in a two-way ANOVA design in which the salience of environmental cues and presence of negative affective cues were manipulated. This was followed by a 20-minute interval during which ad libitum smoking was videotaped in an unobtrusive manner. Results indicated that the experimental manipulations differentially influenced ratings of desire and topographical components of smoking behavior. Implications are raised regarding the role of cue reactivity in the maintenance of smoking behavior.

Anxiolytic effects of smoking associated with four stressors

There is a widespread belief that cigarette smoking alleviates stress. The literature reveals conflicting results on the anxiolytic effects of smoking. This study was designed to replicate a report that smoking (a) reduced subjective anxiety induced by stressful anagrams and (b) increased pain threshold for a cold pain task. This study (N = 15) included two other stressors: white noise and an auditory vigilance task. A significant Time x Condition (smoking vs. deprived) interaction was found for Spielberger State Anxiety Inventory scores in the anagram task. A borderline significant interaction effect was found for the cold pain task. No significant effects were found with the two other tasks. These results provide partial support for the popular notion that smoking mitigates stress-induced anxiety. No difference was found between the smoking and deprived conditions for either pain threshold or pain endurance.

Job stress, cigarette smoking and cessation: the conditioning effects of peer support

Relationships between questionnaire measures of job stress and smoking intensity (SI) and cessation were studied among 560 disease-free smoking males and 310 quitters all members of 22 kibbutzim. The main-effect hypothesis that stress is positively related to SI and negatively to cessation received some support in correlational and multiple regression analyses for the entire sample. Hours of work, work addiction, lack of influence, intrinsic impoverishment and lack of support were positively associated with SI. Conflict, responsibility, hours of work, low status, lack of influence and harsh working conditions were negatively associated with cessation. When peer support was dichotomized into low and high, we found that persons reporting low support smoked significantly more than those who reported high support. Seeking effects of both hours of work and support on SI, we found additive main effects but no interaction effect. The average number of cigarettes smoked by people who worked less than 8 hours and reported high support was 17, whereas people who worked more than 8 hours and reported low support smoked an average of 22 cigarettes a day. The buffering effect of support on the relationship between stress and both SI and cessation of smoking was examined by means of interaction analysis. No buffer effect was evident for SI. However, for respondents reporting low support more job stressors were negatively related to cessation than among those reporting high support, confirming the support-buffer hypothesis. Suggestions regarding better measurement of support are discussed. We conclude with the hypothesis that social support may be detrimental to the smoker, depending on the smoking attitudes and behaviors of the 'supportive' others.

Social-environmental factors among light and heavy cigarette smokers: a controlled comparison with nonsmokers

Support for the importance of psychosocial influences on smoking is limited because the evidence is primarily based on intervention studies which deal with self-selected and thus unrepresentative samples of smokers. There have been few comparisons with nonsmokers on these factors. In this study, we examine the role of psychosocial factors among a representative community sample of smokers and nonsmokers. Heavy smokers were distinguished from nonsmokers by only slightly higher levels of environmental stressors, less supportive social resources, and poorer psychological functioning. Light smokers did not differ from nonsmokers on these factors. Although stressors and resources were correlated with psychological functioning across all respondents, such relationships were not significantly stronger for either heavy or light smokers. These results suggest that psychosocial influences may have differential relevance during the different phases of smoking behavior such as initiation, maintenance, and cessation.