Smoking dependence across the levels of cigarette smoking in a multiethnic sample

Psychometric Properties of the FTCD and Brief WISDM: Support for Validity in a Legal-System-Involved Sample

INTRODUCTION

The Fagerström test for cigarette dependence (FTCD) and Brief Wisconsin index of smoking dependence motives (WISDM) are widely used measures of smoking dependence. The FTCD was previously found to have 1-factor and 2-factor structures and Brief WISDM has been found to have an 11-factor and 11-factor hierarchical structure. As such, the current study sought to further investigate the psychometric properties of the FTCD and Brief WISDM with a novel criminal-legal system-involved sample using both a factor-analytic and an item response theory (IRT) approach.

AIMS AND METHODS

Data from 517 criminal-legal system-involved adults (ie, 18 years of age or older) who smoke from Alabama, USA were analyzed. Confirmatory factor analyses (CFA) were conducted on 1-factor and 2-factor structures of the FTCD and 1-factor, 11-factor, and 11-factor hierarchical structures of the Brief WISDM. IRT analyses investigating item discrimination and threshold parameters were also conducted on the brief WISDM.

RESULTS

The CFA showed poor fit for a single-factor structure and mixed results for two 2-factor results for the FTCD. CFA also showed poor fit for a single-factor and mixed results for the 11-factor model. Initial IRT investigations using the 11-factor model showed strong item discrimination, but non-ordered threshold parameters.

CONCLUSIONS

Two-factor structures for the FTCD and the 11-factor model for the Brief WISDM were partially supported in a criminal-legal population, suggesting continued support for the multidimensional structure of the measures. Additionally, exploratory IRT analyses suggested good discrimination across the use spectrum for the Brief WISDM.

IMPLICATIONS

The Fagerström Test of Cigarette Dependence (FTCD) and Brief Wisconsin index of smoking dependence motives (WISDM) are two widely used measures of nicotine dependence, though previous research has shown mixed results for their internal consistency and factor structure. The current study used a unique sample of criminal-legal-involved participants who generally have moderate to high levels of nicotine dependence. The current study found that the FTCD displayed poor internal consistency, a poor fit for a single-factor model, but mixed support for two two-factor models. The Brief-WISDM was found to have strong internal consistency, a poor fit for a single-factor model, but mixed fit for an 11-factor model and good item discrimination.

Pain and Menthol Use Are Related to Greater Nicotine Dependence Among Black Adults Who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study

Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.

Dependence motives and use contexts that predicted smoking cessation and vaping cessation: A two-year longitudinal study with 13 waves

INTRODUCTION

Prior studies examining the impact of e-cigarette use, dependence, cessation motivation/goals, and environmental restriction on smoking cessation were based on cross-sectional or shorter-term longitudinal data with binary outcomes. There is also a critical knowledge gap in corresponding impact on vaping cessation. This study aims to fill in these gaps by investigating these factors' effects on speed of progression to smoking and vaping cessation.

METHODS

This study conducted secondary analysis of data from 13 waves of assessment of adult cigarette users in Wisconsin from October 2015 through July 2019. Cox regression was employed to examine baseline predictors' effects on speed of progression to smoking cessation (past-month abstinence) among 405 exclusive combustible cigarette users and dual users of combustible and electronic cigarettes, as well as progression to vaping cession among 178 dual users.

RESULTS

Dual use of e-cigarettes with cigarettes, lower primary dependence motives of smoking, higher secondary dependence motives of smoking, higher motivation to quit smoking, more ambitious future goals to quit smoking, and more restrictive environment for smoking all contributed to quicker progression to smoking cessation. Dual users with higher secondary dependence motives of smoking or with lower primary dependence motives of vaping progressed faster to vaping cessation.

CONCLUSIONS

The findings support that nicotine dependence is product-specific with two distinct constructs: the primary dependence motives are associated with more difficulty to quit, whereas the secondary dependence motives have the opposite effect. Dual users with strong instrumental reasons for smoking may not find e-cigarettes as an effective substitute for cigarettes.

Association between smoking status and subjective quality of sleep in the South Korean population: a cross-sectional study

PURPOSE

This study aimed to investigate the relationship between smoking and subjective sleep quality in the Korean adult population.

METHODS

We designed a cross-sectional survey using data from the 2018 Korean Community Health Service Conditions Survey and selected smoking status as our variable of interest. We divided the participants into people who currently, never, and formerly smoked, those who smoked < 20 cigarettes/day, and those who smoked > 20 cigarettes/day. Subjective sleep quality was analyzed using the Pittsburgh Sleep Quality Index. Multiple logistic regression analysis was performed for statistical analysis.

RESULTS

A total of 174,665 participants were enrolled. People who formerly and currently smoked were found to have poorer subjective sleep quality than those who never smoked. The odds of poor subjective sleep quality in people who smoked > 20 cigarettes/day were 1.15 times (95% confidence interval: 1.09-1.21) for men and 1.51 times (95% confidence interval: 1.22-1.86) for women, compared with men and women who never smoked.

CONCLUSIONS

Smoking was negatively associated with subjective sleep quality. Smoking cessation programs and lifestyle improvement education may be justifiable to improve the quality of sleep in Korean adults.

Effect of Varenicline Added to Counseling on Smoking Cessation Among African American Daily Smokers: The Kick It at Swope IV Randomized Clinical Trial

IMPORTANCE

African American smokers have among the highest rates of tobacco-attributable morbidity and mortality in the US, and effective treatment is needed for all smoking levels.

OBJECTIVES

To evaluate the efficacy of varenicline vs placebo among African American adults who are light, moderate, and heavy daily smokers.

DESIGN, SETTING, AND PARTICIPANTS

The Kick It at Swope IV (KIS-IV) trial was a randomized, double-blind, placebo-controlled clinical trial conducted at a federally qualified health center in Kansas City. A total of 500 African American adults who were daily smokers of all smoking levels were enrolled from June 2015 to December 2017; final follow-up was completed in June 2018.

INTERVENTIONS

Participants were provided 6 sessions of culturally relevant individualized counseling and were randomized (in a 3:2 ratio) to receive varenicline (1 mg twice daily; n = 300) or placebo (n = 200) for 12 weeks. Randomization was stratified by sex and smoking level (1-10 cigarettes/d [light smokers] or >10 cigarettes/d [moderate to heavy smokers]).

MAIN OUTCOMES AND MEASURES

The primary outcome was salivary cotinine-verified 7-day point prevalence smoking abstinence at week 26. The secondary outcome was 7-day point prevalence smoking abstinence at week 12, with subgroup analyses for light smokers (1-10 cigarettes/d) and moderate to heavy smokers (>10 cigarettes/d).

RESULTS

Among 500 participants who were randomized and completed the baseline visit (mean age, 52 years; 262 [52%] women; 260 [52%] light smokers; 429 [86%] menthol users), 441 (88%) completed the trial. Treating those lost to follow-up as smokers, participants receiving varenicline were significantly more likely than those receiving placebo to be abstinent at week 26 (15.7% vs 6.5%; difference, 9.2% [95% CI, 3.8%-14.5%]; odds ratio [OR], 2.7 [95% CI, 1.4-5.1]; P = .002). The varenicline group also demonstrated greater abstinence than the placebo group at the end of treatment week 12 (18.7% vs 7.0%; difference, 11.7% [95% CI, 6.0%-17.7%]; OR, 3.0 [95% CI, 1.7-5.6]; P < .001). Smoking abstinence at week 12 was significantly greater for individuals receiving varenicline compared with placebo among light smokers (22.1% vs 8.5%; difference, 13.6% [95% CI, 5.2%-22.0%]; OR, 3.0 [95% CI, 1.4-6.7]; P = .004) and among moderate to heavy smokers (15.1% vs 5.3%; difference, 9.8% [95% CI, 2.4%-17.2%]; OR, 3.1 [95% CI, 1.1-8.6]; P = .02), with no significant smoking level × treatment interaction (P = .96). Medication adverse events were generally comparable between treatment groups, with nausea reported more frequently in the varenicline group (163 of 293 [55.6%]) than the placebo group (90 of 196 [45.9%]).

CONCLUSIONS AND RELEVANCE

Among African American adults who are daily smokers, varenicline added to counseling resulted in a statistically significant improvement in the rates of 7-day point prevalence smoking abstinence at week 26 compared with counseling and placebo. The findings support the use of varenicline in addition to counseling for tobacco use treatment among African American adults who are daily smokers.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02360631.

Exposure to Secondhand Smoke in Children is Associated with a Thinner Retinal Nerve Fiber Layer: The Hong Kong Children Eye Study

PURPOSE

We sought to assess the effects of exposure to secondhand smoke (SHS) on peripapillary retinal nerve fiber layer (p-RNFL) thickness in children.

DESIGN

Cross-sectional study.

METHODS

Children 6-8 years of age were consecutively recruited from the population-based Hong Kong Children Eye Study. All participants received comprehensive ophthalmic examinations and p-RNFL thickness was measured by spectral-domain optical coherence tomography. SHS data were derived from a validated questionnaire. Associations between p-RNFL thickness and SHS exposure status, number of smokers in the family, and quantity of smoking in the family were determined by multivariate linear regression after adjusting for potential confounders.

RESULTS

Among the Hong Kong Children Eye Study cohort (n = 3,103), approximately one-third of children were exposed to SHS (35.4%, n = 1,097). Compared to those without exposure to SHS, children exposed to SHS had similar age (P = .83), gender (P = .17), body mass index (P = .44), birth weight (P = .23), and axial length (P = .34), but had lower family income (P < .001) and lower parental education level (P < .001). After adjusting for all the above factors, exposure to SHS was associated with a thinner global p-RNFL by 4.4 μm (P < .001). Reduced p-RNFL was also associated with increased numbers of smokers in the family (β = -3.40, P < .001) and increased quantity of SHS (β = -0.22, P < .001).

CONCLUSIONS

Exposure to SHS in children was associated with a thinner p-RNFL. A thinner p-RNFL may increase the risk of irreversible visual impairment in the future. Our results provide evidence to recommend that children avoid exposure to SHS.

Flavor and product messaging are the two most important drivers of electronic cigarette selection in a choice-based task

Electronic cigarette use-vaping-is increasingly popular. Various product factors may influence an individual's choice of e-cigarette. To provide an evidence base for e-cigarette regulation, a better understanding of the role different product attributes play in product preferences is needed. Here, we used conjoint analysis to quantify different factors that influence e-cigarettes choices, including flavors, nicotine level, customizability, or use of e-cigarettes to manage appetite/food craving. Young adults completed a set of choice-based conjoint tasks online. Choice Based Conjoint analysis (CBC) was used to determine utility scores for each attribute. Young adults (n = 587) who vaped at least once per week were included in analyses; gender differences were explored. Flavor was the most important attribute (48.1%), followed by product messaging (21.0%) and nicotine level (15.3%). Within flavor, confectionery and fruit flavors had the highest utility scores, while classic menthol and tobacco flavors had the lowest. Men and women differed in flavors, nicotine levels, and product messaging that appealed most. Among young adults who vape weekly, flavor is the most important factor in e-cigarette preferences. Gender also factors into e-cigarette preferences, especially for preferred nicotine level. Understanding why individuals choose particular e-cigarette products will help inform public health efforts and policy making.

Very Light Daily Smoking in Young Adults: Relationships Between Nicotine Dependence and Lapse

INTRODUCTION

Very light daily smoking is increasingly common among young adults. Evidence suggests that levels of nicotine dependence vary significantly among young adults who engage in very light daily smoking. However, the links between dependence and clinically relevant outcomes (eg, lapse) in this population remain unclear. The goal of this study was to address this gap by evaluating how well different nicotine dependence scales predict lapse behavior among very light daily smoking young adults.

AIMS AND METHODS

Very light daily smokers (1-5 cigarettes/day) aged 18-25 participated in an initial laboratory session, during which nicotine dependence was assessed using four commonly used measures: the Fagerstrӧm Test for Cigarette Dependence (FTCD), the Hooked On Nicotine Checklist (HONC), the Transdisciplinary Tobacco Use Research Centers (TTURC) Nicotine Dependence Inventory, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). After a baseline period, eligible participants (n = 40) completed a 10-day abstinence incentive period in which they attempted to refrain from smoking to earn monetary rewards. Cox proportional hazards models were used to test whether dependence predicted days to first lapse.

RESULTS

FTCD scores significantly predicted days to lapse, as did scores on the FTCD item assessing time to first cigarette of the day (TTFC). No other dependence measures predicted time to lapse. Both the FTCD and TTFC continued to independently predict time to lapse after controlling for smoking frequency and duration.

CONCLUSIONS

The FTCD may be a particularly useful tool for capturing clinically meaningful variability in nicotine dependence among young adults who engage in very light daily smoking.

IMPLICATIONS

This is the first study to directly link self-reported nicotine dependence with the ability to achieve and maintain abstinence among very light daily smoking young adults. The results may aid clinicians in selecting among variable measures of nicotine dependence when assessing and treating this population.

Measures of dependence in menthol and nonmenthol smokers - A comprehensive narrative review

Introduction. More than a decade ago, concerns were raised that menthol in cigarettes might enhance addiction to smoking. This article provides a comprehensive review of published studies examining cigarette dependence among menthol and nonmenthol smokers. The purpose of the review is to evaluate the scientific evidence to determine if menthol increases cigarette dependence. Materials and Methods. The published literature was searched in 2019 for studies that provide evidence on cigarette dependence among menthol compared to nonmenthol smokers. Included in this review are published studies that compare menthol and nonmenthol smokers based on widely accepted and validated measures of dependence, or other established predictors of dependence (age of smoking initiation [first cigarette]/age of progression [regular/daily smoking]) and indicators of dependence (smoking frequency, cigarettes smoked per day, time to first cigarette after waking, night waking to smoke, smoking duration). Results and Conclusion. Based on a review of the available studies, including those with adjusted results and large representative samples, reliable and consistent empirical evidence supports a conclusion that menthol smokers are not more dependent than nonmenthol smokers and thus menthol in cigarettes does not increase dependence.

Behavioral economic demand and delay discounting are differentially associated with cigarette dependence and use in adolescents

INTRODUCTION

The Reinforcer Pathology Model describes how two behavioral economic processes, increased sensitivity to immediate rewards (delay discounting) and excessive reward derived from a substance (demand), both contribute to problematic patterns of substance use. In a novel application of this model, the current cross-sectional study examined how these distinct processes relate to different facets of cigarette use in adolescents.

METHODS

Adolescent daily cigarette smokers ages 15 to 19 (Mean age 17.7, N = 50) completed a laboratory assessment of demand using a Cigarette Purchase Task for their usual brand cigarettes and an adjusting-amount delay discounting task. Demand was conceptualized as two factors (Amplitude and Persistence) and delay discounting was calculated as Area Under the Curve (log AUC). The two factors of demand and discounting AUC were included as statistical predictors of level of cigarette dependence and average number of cigarettes smoked per day in linear regression models.

RESULTS

Amplitude of demand was marginally significant predictor (p = .06) of cigarettes smoked per day whereas neither Persistence of demand nor delay discounting significantly predicted this outcome. Both Amplitude of demand and delay discounting, but not Persistence, were associated with level of cigarette dependence. The effects of amplitude of demand and delay discounting on cigarette dependence or use did not significantly interact.

CONCLUSIONS

Results of this study suggest that amplitude of cigarette demand may be a risk factor for both cigarette consumption and dependence, while discounting - a known risk factor for cigarette initiation - may relate specifically to level of dependence.

A qualitative study exploring cues and other motivators among a racially diverse sample of light and intermittent smokers

Introduction

Light and intermittent smokers (LITS) represent almost 50% of all current smokers. Research is needed to understand smoking motives among adult light smokers.

Aims

To explore smoking cues and motivators among a racially diverse sample of adult LITS (≤10 CPD). In addition, we explored differences between native (always smoked ≤10), and converted (former heavier) LITS.

Methods

We used purposive sampling to recruit participants who were native and converted LITS and to include equal numbers of African Americans, Whites and Latinos. We coded and analyzed transcripts using a stage approach to identify themes.

Results

Four main themes emerged that may be unique to light smokers and suggests potential strategies for intervention: (1) smoking in response to cues and control, (2) identifying as a smoker, (3) concern about health consequences, and (4) other priorities influencing smoking. There were some differences among smoking cues and motivators by race and ethnicity, and differences between native and converted LITS.

Conclusions

Overall, LITS reported drivers of smoking that were unrelated to symptoms of nicotine withdrawal. Even when experiencing salient cues, our LITS cohort expressed the ability to assert control over smoking by abstaining when situational contexts made smoking inconvenient.

Exposure to passive nicotine vapor in male adolescent rats produces a withdrawal-like state and facilitates nicotine self-administration during adulthood

Electronic cigarette use is particularly prevalent in adolescents, but the effects of secondhand exposure to nicotine vapor in adolescents on the propensity to develop nicotine dependence and increase nicotine self-administration in adulthood are poorly known. The present study explored the effects of nicotine vapor exposure on withdrawal-like states (hyperalgesia, spontaneous withdrawal signs, and locomotor activity) in adolescent rats and the vulnerability to acquire intravenous nicotine self-administration in adulthood. Adolescent (postnatal day 38) rats were exposed to intermittent nicotine vapor (14 h/day) for 7 consecutive days in a range of doses (0, 0.4, and 7 mg/m³). The rats were tested for somatic, emotional, and motivational withdrawal symptoms. When the animals reached adulthood, they were allowed to self-administer nicotine (0.03 mg/kg/0.1 ml) intravenously in operant chambers for 1 h/day for 12 consecutive days. Rats that were exposed to nicotine vapor presented moderate to severe signs of spontaneous withdrawal after the cessation of nicotine vapor. No effect on anxiety-like behavior was observed. Rats that were exposed to high levels of nicotine vapor in adolescence had lower pain thresholds and exhibited faster and higher acquisition of nicotine self-administration in adulthood. Chronic exposure to nicotine vapor in adolescent rats produced a withdrawal-like state and facilitated the acquisition of intravenous nicotine self-administration in adulthood. These results suggest that exposure of adolescents to nicotine vapor may confer higher risk of developing nicotine dependence when they become adults.

Sociological and Psychological Factors on Prohibited Substances Abuse in Rehabilitation Centre of Medan City, Indonesia

INTRODUCTION:

Prohibited substances issue and their abuse have become a scourge for people in Indonesia. This situation creates concern for every level of society since this is very influential to damage and can even eliminate generations at a later time.

AIM:

This study aims to determine the characteristics of age, education, psychological and social problems related to substance dependence experienced by individuals with substance disorders who undergo rehabilitation in Medan, Indonesia.

METHODS:

This study is a cross-sectional analytic, in which the sample of this study was individuals who underwent rehabilitation in the Rehabilitation Center in Medan City who fulfilled the inclusion and exclusion criteria. A structured interview was carried out with the MINI ICD-10 on part M. disorders related to psychoactive substances. Furthermore, to see the level of dependence, WHO ASSIST questionnaire (The Alcohol, Smoking and Substance Involvement Screening Test) was used.

RESULTS:

This study discovered that subjects with age above 21 years were the most dominant of the prohibited substance users group as many as 87 people (69%), Batak tribe with 73 people (57.9%), residence originating from outside the city with 70 people (55.6%), Unmarried with 87 people (70.2%), education level is medium (junior high school) with 117 people (92.9%) and work as many as 77 people (61.1%). The study also found that the most dominant number of prohibited substances users were single users of methamphetamine and a combination of two substances, each of which was 49 people (38.9%). There is no relationship between social factors and patterns of prohibited substance use. Also, the most dominant users of prohibited substances who undergo rehabilitation are those based on family and police (involuntary admission). Finally, as many as 70 people used methamphetamine require intensive intervention.

CONCLUSION:

This study shows that social and demographic factors are not related to the pattern of prohibited substance use.

Not all smokers appear to seek nicotine for the same reasons: implications for preclinical research in nicotine dependence

Tobacco use leads to 6 million deaths every year due to severe long-lasting diseases. The main component of tobacco, nicotine, is recognized as one of the most addictive drugs, making smoking cessation difficult, even when 70 percent of smokers wish to do so. Clinical and preclinical studies have demonstrated consistently that nicotine seeking is a complex behavior involving various psychopharmacological mechanisms. Evidence supports that the population of smokers is heterogeneous, particularly as regards the breadth of motives that determine the urge to smoke. Here, we review converging psychological, genetic and neurobiological data from clinical and preclinical studies supporting that the mechanisms controlling nicotine seeking may vary from individual to individual. It appears timely that basic neuroscience integrates this heterogeneity to refine our understanding of the neurobiology of nicotine seeking, as tremendous progress has been made in modeling the various psychopharmacological mechanisms driving nicotine seeking in rodents. For a better understanding of the mechanisms that drive nicotine seeking, we emphasize the need for individual-based research strategies in which nicotine seeking, and eventually treatment efficacy, are determined while taking into account individual variations in the mechanisms of nicotine seeking.

Gambling patterns and associated risk and protective factors among Finnish young people

BACKGROUND AND AIMS

In recent years online gambling has become a potential risk for young people. The purpose of this study was to analyse patterns of gambling activities and their association with behavioural risk factors and protective factors.

DATA AND METHOD

A demographically balanced sample of Finnish respondents aged 15-25 years (N = 1200) filled out an online survey in March-April 2017. Principal component analysis was used to reduce the variables on gambling activities to smaller sets of components, and regression analysis was used to analyse whether behavioural risk factors and protective factors were associated with the gambling patterns found.

RESULTS

Two main components were found: online- and skill-based competent gambling and chance-based entertainment gambling. Competent gambling had statistically significant associations with a variety of behavioural problems and risks, including psychological distress, lower social support, lower delay of gratification, hazardous drinking, regular drug use, compulsive Internet use, and problem gambling. Entertainment gambling was associated with lower delay gratification, hazardous drinking, and problem gambling. Entertainment gambling had a negative association with compulsive Internet use and a positive association with social support.

CONCLUSIONS

Online-based competent gambling is a potentially hazardous form of gambling. New forms of online gambling are potential risks for younger generations. Health professionals working with young people should be aware of the role of online gambling and associated activities.

A randomized clinical trial of counseling and nicotine replacement therapy for treatment of African American non-daily smokers: Design, accrual, and baseline characteristics

BACKGROUND

Non-daily smokers (NDS) who smoke on some but not all days are a growing subset of United States (US) tobacco users. Racial/ethnic minorities are more likely to be NDS. African American NDS have strikingly high levels of nicotine and carcinogen exposure, making treatment of this high risk group a priority.

METHODS

The current study is one of three ongoing federally-funded clinical trials of NDS and, to our knowledge the only RCT focused on racial/ethnic minority NDS. The design has been guided by input from Patient and Stakeholder Advisory Panels who helped develop the research questions, design the intervention, and select the outcomes. The objective is to compare the effectiveness of smoking cessation counseling alone (C) or smoking cessation counseling plus participant's choice of nicotine replacement therapy (NRT; C + NRT) for African American NDS. Two-hundred seventy-eight African American NDS will be randomized in a 2:1 fashion to C + NRT or C. All participants receive five sessions of smoking cessation counseling; those randomized to C + NRT receive their choice of nicotine gum, patch, and/or lozenge. Treatment in both groups lasts for 12 weeks. We hypothesize that C + NRT will be more effective than C on the primary outcome of biochemically-confirmed abstinence from smoking at week 12. Secondary aims will compare C + NRT and C on patient- and provider-desired outcomes including abstinence from smoking at week 26, change in biochemically-verified nicotine and carcinogen exposure, days abstinent, and treatment process measures (e.g., NRT use and side effects). Predictors of abstinence will also be explored.

DISCUSSION

Findings will illuminate effective treatment options for African American NDS and contribute to development of evidence-based guidelines for treating the 8.9 million US adult NDS for whom no guidelines currently exist.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT02244918.

WISDM Primary and Secondary Dependence Motives: Associations With Smoking Rate, Craving, and Cigarette Effects in the Natural Environment

Introduction

The Wisconsin Inventory of Smoking Dependence Motives (WISDM) is a multidimensional measure of smoking motives that was developed to facilitate research aiming to refine the nomological network surrounding tobacco dependence. Recent evidence suggests that a composite of four subscales, termed the Primary Dependence Motives (PDM), may represent core features of advanced addiction, while the remaining nine subscales (Secondary Dependence Motives; SDM) represent instrumental motives for cigarette use that may be relevant at any stage of smoking.

Methods

A sample of 255 smokers (all regular alcohol users) participated in an ecological momentary assessment study in which they monitored smoking behavior and related experiences for 21 days. Multilevel regression analyses tested how PDM and SDM predicted daily smoking rate, cigarette craving, and appraisals of pleasure and relief of unpleasant feelings from smoking.

Results

When PDM and SDM were entered simultaneously, only PDM was related to daily cigarette count, and only SDM predicted reports of craving and relief from unpleasant feelings from smoking. SDM was associated with reports of greater pleasure from smoking and PDM was associated with lower pleasure ratings. The Fagerström Test for Nicotine Dependence (FTND) was related to daily smoking rate and craving, but WISDM composites contributed incremental prediction.

Conclusions

The findings confirm that PDM indexes heavier use that is relatively unrelated to immediate consequences of smoking. SDM is not uniquely related to smoking heaviness, but is associated with craving and reports of pleasure and relief of unpleasant feelings derived from smoking during ad lib use.

Implications

This study extends the evidence for the distinction between the WISDM PDM and SDM. PDM scores are associated with heavier smoking and are relatively unrelated to immediate consequences of smoking. SDM is more strongly related to craving and reports of smoking-derived pleasure and relief of unpleasant feelings during ongoing use in daily life.

Chronic Pain Status, Nicotine Withdrawal, and Expectancies for Smoking Cessation Among Lighter Smokers

BACKGROUND

Chronic pain and tobacco smoking are both highly prevalent and comorbid conditions, and chronic pain may pose a barrier to smoking cessation.

PURPOSE

The objective of this study was to test associations between chronic pain status and several smoking-related factors that have previously been shown to predict cessation outcomes.

METHOD

Daily smokers (N = 205) were recruited from the general population to complete an online survey of pain and tobacco smoking.

RESULTS

Results indicated that smokers with chronic pain (vs. no chronic pain) consumed more cigarettes per day, scored higher on an established measure of tobacco dependence, reported having less confidence in their ability to quit, and endorsed expectations for experiencing greater difficulty and more severe nicotine withdrawal during future cessation attempts. Mediation analyses further indicated that the inverse association between chronic pain and abstinence self-efficacy was indirectly influenced by past cessation failures.

CONCLUSIONS

These findings suggest that individuals with chronic pain may constitute an important subgroup of tobacco smokers who tend to experience lower confidence and greater difficulty when attempting to quit. Future research would benefit from replicating these findings among older and more diverse samples of heavier tobacco smokers, and extending this work to the study of prospective relations between chronic pain status and cessation-relevant processes/outcomes over the course of a quit attempt.

Perceived cessation treatment effectiveness, medication preferences, and barriers to quitting among light and moderate/heavy homeless smokers

INTRODUCTION

Homeless individuals smoke at disproportionately high rates and quit at disproportionately low rates relative to domiciled smokers. Targeted research is needed to inform future interventions. Socio-demographic characteristics of homeless adults suggest that light smoking may be prevalent, and the relation between smoking level and treatment-related preferences/needs is unknown. The current study addressed these gaps in a sample of homeless smokers.

METHODS

Participants (N=237) were homeless adult daily light (1-10 cigarettes per day) and moderate/heavy (>10 cigarettes per day) smokers recruited from a single shelter that offered cessation treatment. Survey items assessed perceived treatment effectiveness, pharmacological intervention preferences, and barriers to quitting smoking. Logistic regressions were used to assess differences in treatment-related factors by smoking level.

RESULTS

The prevalence of light smoking (44.7%) was higher than in previously studied samples of domiciled smokers. Relative to moderate/heavy smokers, light smokers smoked for fewer years, had more quit attempts in the last year, and were more likely to smoke menthol cigarettes. They were less likely to believe that medications would give them the greatest chance of quitting and more likely to believe that group counseling would be helpful. Light smokers did not differ from moderate/heavy smokers on specific pharmacological intervention preferences or on perceived barriers to quitting smoking, including craving.

CONCLUSIONS

The promotion of pharmacotherapy to address cravings may be necessary for light smokers, who represent a sizeable proportion of homeless smokers and who may make apt intervention targets given their higher rates of purposeful quit attempts relative to heavier smoking counterparts.