Impulsivity and the role of smoking-related outcome expectancies among dependent college-aged cigarette smokers

The Independent Contribution of Positive and Negative Metacognitions About Smoking to Urge to Smoke, Withdrawal Symptoms and Dependence in Smoking-Dependent Men

Previous research has indicated that various factors, such as psychological distress, distress intolerance, anhedonia, impulsivity and smoking metacognitions, have been individually linked to the urge to smoke, withdrawal symptoms and dependence. However, these factors have not been collectively examined to determine whether smoking metacognitions independently and significantly contribute to these outcomes. Therefore, the aim of this study was to investigate the impact of distress intolerance, anhedonia, impulsivity and smoking metacognitions on the urge to smoke, withdrawal symptoms and dependency in men who are dependent on smoking. A total of 300 smoking-dependent men completed psychological scales and smoking-related measures. The findings of the study indicated that positive metacognitions about emotion regulation significantly predicted the urge to smoke, even when accounting for other significant predictors such as the number of daily cigarettes smoked, psychological distress, anhedonia and impulsivity. Furthermore, positive metacognitions about cognitive regulation were found to be a significant predictor of withdrawal symptoms, independent of other significant predictors such as psychological distress and the urge to smoke. Smoking dependence was predicted by negative metacognitions about uncontrollability beyond other significant predictors, including the number of daily cigarettes smoked and distress intolerance. These results highlight the role of metacognitions about smoking in both short- and long-term clinical outcomes related to smoking. Consequently, addressing such beliefs during treatment for smoking dependence should be an important therapeutic goal.

Increasing Smoking Cessation Adherence: Do We Need to Consider the Role of Executive Function and Rumination?

Despite the cost and health consequences, a large number of people continue to smoke cigarettes worldwide every day. Notwithstanding, there have been a number of interventions to help people stop smoking but, in general, these have produced only limited success, and better interventions are needed. Accruing evidence affirmed that rumination and executive function play a pivotal role in cigarette smoking behavior, and in this editorial, we describe and discuss the key findings between these constructs and smoking, and argue that an impairment in executive functions does not act alone, but interacts with rumination by directing attention to depressive thoughts, thereby reducing the ability of smokers to engage in constructive behaviors, such as quitting smoking. Finally, we offer a new theory-driven model based on a deep understanding of the interactions between executive functions and rumination and potential moderator effects.

The Impact of a City-Wide Indoor Smoking Ban on Smoking and Drinking Behaviors Across Emerging Adulthood

INTRODUCTION

Almost one-third of college students report recent cigarette use, primarily as "social smoking," and often in conjunction with alcohol use. While city-wide indoor smoking bans effectively reduce the number of social opportunities to smoke (eg, bars and music clubs), little is known about how these bans may impact the smoking behaviors of college students. Furthermore, nothing is known about how indoor smoking bans may impact students' drinking behaviors. The current study aims to determine the impact of a city-wide comprehensive indoor smoking ban on smoking and alcohol behaviors among a longitudinal sample of emerging adults.

METHODS

Data are from a 6-year longitudinal study (10 waves of data collection) that began the summer before college enrollment. Participants (N = 2244; 60% female) reported on their past 3-month smoking and drinking behaviors using Internet-based surveys at each wave. Piecewise linear growth modeling was used to determine how a city-wide comprehensive indoor smoking ban (implemented in the Fall of 2005 between Waves 4 and 5) impacted smoking frequency, cigarette quantity, drinking frequency, and number of binge drinking episodes.

RESULTS

Smoking and alcohol use increased from the summer before college through the semester before implementation of the city-wide smoking ban. While smoking frequency (P < .001) and cigarette quantity (P < .05) declined after the ban, drinking frequency increased (P < .001) and the number of binge drinking episodes remained stable.

CONCLUSIONS

Current findings suggest that comprehensive indoor smoking bans can influence the smoking behaviors of emerging adults, whereas trajectories of drinking are relatively unchanged.

Cigarette Cravings, Impulsivity, and the Brain

Craving is a core feature of tobacco use disorder as well as a significant predictor of smoking relapse. Studies have shown that appetitive smoking-related stimuli (e.g., someone smoking) trigger significant cravings in smokers impede their self-control capacities and promote drug seeking behavior. In this review, we begin by an overview of functional magnetic resonance imaging (fMRI) studies investigating the neural correlates of smokers to appetitive smoking cues. The literature reveals a complex and vastly distributed neuronal network underlying smokers' craving response that recruits regions involved in self-referential processing, planning/regulatory processes, emotional responding, attentional biases, and automatic conducts. We then selectively review important factors contributing to the heterogeneity of results that significantly limit the implications of these findings, namely between- (abstinence, smoking expectancies, and self-regulation) and within-studies factors (severity of smoking dependence, sex-differences, motivation to quit, and genetic factors). Remarkably, we found that little to no attention has been devoted to examine the influence of personality traits on the neural correlates of cigarette cravings in fMRI studies. Impulsivity has been linked with craving and relapse in substance and tobacco use, which prompted our research team to examine the influence of impulsivity on cigarette cravings in an fMRI study. We found that the influence of impulsivity on cigarette cravings was mediated by fronto-cingulate mechanisms. Given the high prevalence of cigarette smoking in several psychiatric disorders that are characterized by significant levels of impulsivity, we conclude by identifying psychiatric patients as a target population whose tobacco-smoking habits deserve further behavioral and neuro-imaging investigation.

Emotion-based impulsivity, smoking expectancies, and nicotine dependence in college students

The aim of this study was to enhance our understanding of the relationship between affect-related dispositions to rash action, negative urgency (NU: the tendency to act rashly when in a negative mood), positive urgency (PU: the tendency to act rashly when in a positive mood) and level of nicotine dependence symptoms by examining how the two traits transact with affect-related smoking expectancies. Based on the Acquired Preparedness model of addictive behaviors, we hypothesized that the relationship between PU and level of nicotine dependence would be mediated by positive affect smoking expectancies. We also hypothesized that the relationship between NU and level of nicotine dependence would be mediated by negative affect reduction expectancies. We studied 139 college-aged smokers and found support for this model; positive affect expectancies for smoking mediated the relationship between PU and level of nicotine dependence symptoms. Negative affect reduction smoking expectancies mediated the relationship between NU and level of nicotine dependence. The clinical implications of this research suggest that prevention/intervention programs should include substance-free activities as reinforcement and as ways to deal with extreme positive and negative mood.

Probability and predictors of cannabis use disorders relapse: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

This study aims to estimate the odds and predictors of Cannabis Use Disorders (CUD) relapse among individuals in remission.

METHODS

Analyses were done on the subsample of individuals with lifetime history of a CUD (abuse or dependence) who were in full remission at baseline (Wave 1) of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=2350). Univariate logistic regression models and hierarchical logistic regression model were implemented to estimate odds of relapse and identify predictors of relapse at 3 years follow up (Wave 2).

RESULTS

The relapse rate of CUD was 6.63% over an average of 3.6 year follow-up period. In the multivariable model, the odds of relapse were inversely related to time in remission, whereas having a history of conduct disorder or a major depressive disorder after Wave 1 increased the risk of relapse.

CONCLUSIONS

Our findings suggest that maintenance of remission is the most common outcome for individuals in remission from a CUD. Treatment approaches may improve rates of sustained remission of individuals with CUD and conduct disorder or major depressive disorder.

Neural circuitry of impulsivity in a cigarette craving paradigm

Impulsivity has been shown to play a pivotal role in the onset, pattern of consumption, relapse and, most notably, craving of illicit and licit drugs such as cigarette smoking. The goal of this study was to examine the neurobiological influence of trait impulsivity during cue-induced cigarette craving. Thirty-one chronic smokers passively viewed appetitive smoking-related and neutral images while being scanned and reported their feelings of craving. They completed the Barratt Impulsiveness Scale, a measure of trait impulsivity. We conducted functional connectivity analyses using the psycho-physiological interaction method. During the processing of smoking stimuli, participants presented increased activations in the cingulate and prefrontal cortices. We observed a significant positive relationship between impulsivity scores and reported craving. A negative correlation was observed between the impulsivity score and activity in the posterior cingulate cortex (PCC). The insula, dorsal anterior cingulate cortex (dACC) as well as the dorsolateral prefrontal cortex (DLPFC) presented a negative connectivity with the PCC. Consistent with the view that the PCC is related to the ability to resist cigarette craving, our results suggest that high impulsive smokers have greater difficulty in controlling their cravings, and that this weakness may be mediated by lower PCC activity. Moreover, we argue that the less PCC activity, the greater the probability of a stronger emotional, physiological, and biased attentional response to smoking cues mediated by insula, dACC, and DLPFC activity. This is the first study on this topic, and so, results will need to be replicated in both licit and illicit drug abusers. Our findings also highlight a need for more emphasis on the PCC in drug addiction research, as it is one of the most consistently activated regions in functional magnetic resonance imaging studies examining the neural correlates of cue-induced alcohol, drug, and tobacco cravings.

A prospective study of the Acquired Preparedness Model: the effects of impulsivity and expectancies on smoking initiation in college students

This study reports on a prospective test of the Acquired Preparedness Model, which posits that impulsivity influences cigarette smoking through the formation of more positive and fewer negative expectancies about smoking effects. College freshman never-smokers (n = 400; 45% male) completed a baseline interview and quarterly online follow-up assessments for 15 months after baseline. Structural equation modeling indicated that the effects of the impulsivity components of sensation seeking and negative urgency on risk of smoking initiation were mediated by expectancies for positive and negative reinforcement from smoking, respectively. Expectancies about negative consequences from smoking predicted initiation but did not mediate the effects of sensation seeking or negative urgency. Findings are consistent with the Acquired Preparedness Model and suggest that heightened impulsivity is associated with heightened expectancies for reinforcement from smoking, and thus with greater risk for smoking initiation.

Taking stock of self-control: a meta-analysis of how trait self-control relates to a wide range of behaviors

Given assertions of the theoretical, empirical, and practical importance of self-control, this meta-analytic study sought to review evidence concerning the relationship between dispositional self-control and behavior. The authors provide a brief overview over prominent theories of self-control, identifying implicit assumptions surrounding the effects of self-control that warrant empirical testing. They report the results of a meta-analysis of 102 studies (total N = 32,648) investigating the behavioral effects of self-control using the Self-Control Scale, the Barratt Impulsiveness Scale, and the Low Self-Control Scale. A small to medium positive effect of self-control on behavior was found for the three scales. Only the Self-Control Scale allowed for a fine-grained analysis of conceptual moderators of the self-control behavior relation. Specifically, self-control (measured by the Self-Control Scale) related similarly to the performance of desired behaviors and the inhibition of undesired behaviors, but its effects varied dramatically across life domains (e.g., achievement, adjustment). In addition, the associations between self-control and behavior were significantly stronger for automatic (as compared to controlled) behavior and for imagined (as compared to actual) behavior.

Do expectancies for reinforcement from smoking change after smoking initiation?

Expectancies are important predictors of smoking behavior. Recent research suggests that expectancies are not stable and vary across internal and external states and levels of cigarette consumption. Expectancies may also vary between individuals as a function of temperamental characteristics such as behavioral undercontrol (BU). Although pre-initiation expectancies have been linked to subsequent smoking behaviors, no study has assessed the effect of smoking initiation on expectancies. The present study was designed to test the hypotheses that both positive (PRE) and negative (NRE) reinforcement expectancies would increase following initiation, and that these changes would be moderated by BU. College students were interviewed 12-15 months apart. Those who initiated smoking between assessments (n = 69) were included in the present study. Linear mixed models showed a significant increase in PRE but not NRE from pre- to postinitiation. The relationship between NRE and time was moderated by BU, such that higher BU was associated with significantly larger post-initiation increases in NRE. Findings suggest that PRE and NRE change significantly following experience with smoking. Furthermore, undercontrolled, impulsive individuals may be particularly vulnerable to smoking with the intention of alleviating aversive states.

Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: an application of the acquired preparedness model

This study tests the acquired preparedness model (APM) to explain associations among trait impulsivity, social learning principles, and marijuana use outcomes in a community sample of female marijuana users. The APM states that individuals with high-risk dispositions are more likely to acquire certain types of learning that, in turn, instigate problematic substance use behaviors. In this study, three domains of psychosocial learning were tested: positive and negative marijuana use expectancies, and marijuana refusal self-efficacy. Participants were 332 community-recruited women aged 18-24 enrolled in a study of motivational interviewing for marijuana use reduction. The present analysis is based on participant self-reports of their impulsivity, marijuana use expectancies, marijuana refusal self-efficacy, marijuana use frequency, marijuana use-related problems, and marijuana dependence. In this sample, impulsivity was significantly associated with marijuana use frequency, marijuana-related problems, and marijuana dependence. Results also indicate that the effect of impulsivity on all three marijuana outcomes was fully mediated by the three principles of psychosocial learning tested in the model, namely, positive and negative marijuana expectancies, and marijuana refusal self-efficacy. These findings lend support to the APM as it relates to marijuana use. In particular, they extend the applicability of the theory to include marijuana refusal self-efficacy, suggesting that, among high-impulsives, those who lack appropriate strategies to resist the temptation to use marijuana are more likely to exhibit more frequent marijuana use and use-related negative consequences.

Smoking outcome expectancies mediate the association between sensation seeking, peer smoking, and smoking among young adolescents

BACKGROUND

Sensation seeking is a strong correlate of smoking among adolescents, yet the research on mediators of this association is not well established. The proposed model of the present study includes antecedent variables (sensation seeking), mediators (perceived peer smoking, outcome expectancies including negative consequences, positive reinforcement, negative reinforcement, and appetite-and-weight control), and one outcome variable (smoking cigarettes during the past 30 days).

METHODS

Self-reported data obtained from Hungarian high-school students (ninth grade, N = 2,565, mean age 15.3 years, SD = 0.56) were analyzed with structural equation modeling. Before testing of the main model, the construct validity of mediators (outcome expectancy scales) was supported with confirmatory factor analysis (CFA) and structural equation modeling. The final model was tested with structural equation modeling, and the goodness-of-fit indices and the proportion of direct and indirect effects were analyzed.

RESULTS

Our mediational model had an excellent model fit, and this study supported both the proposed sensation seeking-->positive and negative reinforcement-->smoking behavior pathways and sensation seeking-->perceived peer smoking-->positive and negative reinforcement-->smoking behavior pathways. The total indirect effect explains 76% of sensation seeking and smoking association. Results support the notion that positive and negative reinforcement expectancies mediate between sensation seeking and smoking.

DISCUSSION

Results support the notion that perceived peer smoking, positive and negative reinforcement expectancies mediate between sensation seeking and smoking.

Impulsivity and cigarette craving: differences across subtypes

RATIONALE

Cigarette smoking has been linked to a number of personality characteristics, including impulsivity. Smokers tend to endorse high levels of impulsivity, and more impulsive smokers have greater difficulty quitting, but little is known about potential explanatory mechanisms. Although indirect evidence suggests craving as a candidate mechanism, direct evidence has been mixed.

MATERIALS AND METHODS

This study assessed whether specific aspects of impulsivity (sensation seeking, lack of premeditation, lack of perseverance, and urgency) were associated with cue-induced craving. Regular smokers (n = 60; 50% female) were exposed to a smoking cue and a neutral cue in a repeated measure counter-balanced design.

RESULTS

Mixed effects regression models indicated that smokers who were high in sensation seeking reported greater increases in appetitive craving after smoking cue exposure, whereas, smokers who were high in urgency and lack of perseverance reported greater increases in negative affect craving.

CONCLUSIONS

Findings suggest a complex relationship between impulsivity and cue-induced craving that may be masked by single construct conceptualizations of impulsivity.