Predictors of persistent nicotine dependence among adults in the United States

Emotional dysregulation among English-speaking Hispanic persons who smoke living in the United states

Hispanic/Latinx (hereafter Hispanic) individuals in the United States (US) experience serious tobacco-related disparities and factors contributing to such disparities need to be adequately identified and clinically addressed. Emotion dysregulation is a key transdiagnostic relevant to smoking. The present cross-sectional investigation sought to test if emotion dysregulation was related to more severe problems during smoking quit attempts (e.g., irritability, weight gain), perceptions of difficulty about quitting, as well as negative and positive beliefs about smoking abstinence in a sample of English-speaking Hispanic adults residing in the US who smoke. Participants included 332 Hispanic adults who engaged in daily cigarette smoking (35.46 years old, 37 % identified as female). Emotion dysregulation was significantly related to more severe problems when quitting and perceived barriers for quitting, as well as negative beliefs about smoking abstinence. Additionally, emotion dysregulation was significantly and negatively related to positive outcomes about smoking abstinence. The amount of change in the various smoking criterion variables accounted for by emotion dysregulation was small (sr2 range: 0.028-0.085), but evident in adjusted models that accounted for a wide range of factors (e.g., depression, drug use severity). Overall, this investigation found consistent empirical evidence that individual differences in emotion dysregulation in Hispanic individuals were associated with several clinically significant smoking processes, suggesting this construct may represent an important factor involved in the maintenance and relapse of smoking among this ethnic population.

Evaluating Alcohol Use Severity in Terms of Cigarette Smoking-Related Processes and Anxiety/Depression Among Adult Latinx Smokers

OBJECTIVE

Although empirical work focused on smoking-drinking comorbidity among Latinx persons is growing, no work has explored the relation between alcohol use severity in terms of co-occurring smoking processes and mental health. Therefore, the present investigation aimed to explore the prevalence and role of alcohol use severity in relation to clinically significant tobacco and mental health problems among English-speaking Latinx adults who smoke cigarettes.

METHODS

Participants included 338 English-speaking Latinx adults who smoked cigarettes daily (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female).

RESULTS

Results indicated that approximately 68% of male and 61% of female smokers scored above established clinical cutoffs for hazardous and harmful alcohol use and possible alcohol dependence. Moreover, alcohol use severity was associated with increased risk for cigarette dependence, perceived barriers for quitting, and more problematic symptoms when trying to quit. Alcohol use severity was also related to more severe anxiety and depressive symptoms.

CONCLUSIONS

Overall, the current findings suggest that intervening to reduce alcohol use severity may be important to improving smoking cessation and mental health among Latinx persons who smoke.

Differences in smoking behavior and beliefs about abstinence among Latinx individuals with and without depression who smoke cigarettes

There is a well-established relation between depression and smoking in the general population. However, past work focused on Latinx persons who smoke in relation to depressed affect has yielded inconsistent findings. The present investigation aimed to build on past research and evaluate differences among English-speaking Latinx adults who smoke combustible cigarettes with and without probable depression in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The current sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) that were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with probable depression (compared to those without) demonstrated higher levels of cigarette dependence, more severe problems when trying to quit, greater perceived barriers for quitting, and increased negative abstinence expectancies after adjusting for sociodemographic and concurrent substance use variables. Future work could build from this research to elucidate the role of depression in the maintenance and relapse of smoking among the Latinx population.

Alcohol use severity in relation to pain severity and interference among latinx adults with current pain who smoke cigarettes

Limited research has focused expressly on dual tobacco-alcohol use among the Latinx population. Latinx individuals who smoke represent a tobacco health disparities group and evince elevated rates of pain problems and symptoms. Prior research has consistently linked pain problems and severity to smoking and alcohol prevalence, maintenance, and behavior. Accordingly, the current study sought to build from the limited work that exists among Latinx persons who smoke and evaluate the role of alcohol use severity in terms of pain severity and interference. The current sample consisted of 228 adult Latinx daily cigarette smokers (Mage = 34.95 years; SD = 8.58; 39.0% female) who endorsed current pain. Results indicated that elevated alcohol use problems were associated with greater levels of pain severity (R2 = 0.06) and interference (R2 = 0.06). The present findings suggest that there may be utility in clinical screening for alcohol use problems among Latinx persons who smoke to offset pain problems among this high-risk group.

Are C-reactive protein concentrations affected by smoking status and physical activity levels? A longitudinal study

BACKGROUND AND OBJECTIVE

To compare high-sensitivity C-reactive protein (hsCRP) levels according to smoking status and physical activity (PA) changes in adults.

METHODS

The sample consisted of 6028 participants (4833 men) who underwent a voluntary routine health evaluation at the Preventive Medicine Center at the Hospital Israelita Albert Einstein, Sao Paulo, Brazil, from January 2007 to December 2013. Data were collected at baseline and follow-up (2.7±1.6 years). Plasma hsCRP (in mg/L) was analyzed in both moments. Smoking status was obtained through a self-reported questionnaire, being participants classified as non-smokers, once smokers (report smoking at baseline or follow-up), and persistently smokers (reported smoking at both baseline and follow-up). PA was assessed by questionnaire in both moments, being participants classified as persistently inactive, became inactive, became active, and persistently active. The Rank Analysis of Covariance was used to compare hsCRP follow-up values according to smoking and physical activity status.

RESULTS

Persistently smokers showed significantly higher median values of hsCRP at follow-up (1.3 mg/L, IQR:0.6-2.8) than once smokers (1.1 mg/L, IQR: 0.6-2.4) and non-smokers (1.0 mg/L, IQR: 0.5-2.2), even considering covariates (p<0.001). Persistently actives had lower levels of hsCRP at follow-up when compared to persistently inactive in the three smoking status groups (non-smokers p<0.001, once smokers p = 0.001, and persistently smokers p = 0.037).

CONCLUSION

Persistently active participants had lower hsCRP values at follow-up than those persistently inactive in all the smoking status groups. Regular practice of PA is an important strategy for facing low-grade inflammation, even among smokers.

A Nationally Representative Study of the Hardening Hypothesis Among Educational Groups Over Four Decades

INTRODUCTION

As smoking prevalence has decreased, there has been debate about "hardening" (smokers are more resistant to established tobacco control measures) or "softening" (smokers are more responsive to interventions) of the remaining smoking population. Despite growing evidence to reject the "hardening" hypothesis, there is lack of long-term population-based studies to test this hypothesis by educational level.

AIMS AND METHODS

Repeated cross-sectional population-based surveys during 1978-2014 and in 2018 were utilized. The target population consisted of ~5000 25-64-year-old Finns annually. The data included 109 257 respondents of which 53 351 ever-smoking individuals were included in the analyses. Response rates varied between 84% and 43%. Five hardening indicators considering smoking frequency, intensity and smoking cessation were used as the dependent variables. The main independent variable was study year (time). Statistical analyses were based on regression models using restricted cubic splines by educational level.

RESULTS

Contrary to the hardening hypothesis, hardening indicators showed softening over time among all educational groups. However, educational groups differed from each other. Compared with the highly educated, the quit ratio was lower, number of cigarettes per day (CPD) was higher, the proportions of daily smokers among current smokers and heavy smokers among daily smokers were higher among the less educated.

CONCLUSIONS

In accordance with growing evidence, also the Finnish smoking population has "softened" over time. Although the change has been predominantly in the same direction for all educational groups, the rate of change has been stronger among the highly educated, highlighting the continued burden of smoking among the less educated.

IMPLICATIONS

Even though "softening" of smoking has occurred, lighter smoking also poses health risks. Therefore, tobacco control policies and cessation services should be developed and targeted to a greater extent also for people who smoke less than daily and for those who smoke fewer CPD. Furthermore, interventions should focus on special requirements of the lower educational groups to promote health equity.

The Role of Perceived Neighborhood Cohesion in the Association between Depressive Symptoms and Cigarette Smoking

BACKGROUND

Greater depression has been linked to increased smoking rates. However, the mechanisms underlying this association are not fully understood. It is possible that high perceived neighborhood cohesion may serve as one such mechanism given its associations with decreased depression and smoking. Having increased levels of depression likely impacts one's perceptions of neighborhood cohesion, which could lead to further increases in depression and a need to manage these symptoms via cigarette smoking. As a first test of this theory, the current study examined the effect of neighborhood cohesion on the association between depressive symptoms and smoking frequency and quantity among past 30-day cigarette smokers.

METHODS

Participants were 201 combustible cigarette smokers (Mage = 48.33, SD = 11.64; 63.2% female; 68.2% White) who completed self-report measures as part of a larger study of environmental influences on cardiac health.

RESULTS

Greater depressive symptoms were associated with lower levels of perceived neighborhood cohesion, and there was a significant indirect effect of greater depressive symptoms on heavier smoking through decreased neighborhood cohesion (b = .07, SE = .04, 95% CI [.003, .15]). There was no significant indirect effect for daily smoking.

CONCLUSION

These results suggest that neighborhood cohesion is an important contextual factor that serves as one explanatory mechanism for the well-established relationship between depression and smoking quantity. Thus, there may be utility in implementing interventions focused on increasing neighborhood cohesion as a way to decrease smoking behavior.

Perceived racial/ethnic discrimination in relation to smoking abstinence expectancies among adult Latinx smokers in the United States

INTRODUCTION

Hispanic/Latinx (hereafter Latinx) individuals in the United States (US) face unique smoking-related health disparities, including limited access to care and health insurance for smoking treatment. Social determinants of health (SDoH) have received increased recognition in their role of smoking behavior and cessation. However, research on SDoH in Latinx smoking populations has been limited. Past research on non-Latinx white individuals has found smoking abstinence expectancies to be an integral cognitive process related to multiple aspects of smoking behavior, and its role has also been understudied in Latinx individuals. Perceived racial/ethnic discrimination is one SDoH, but its role in relation to abstinence expectancies among Latinx smokers has not been explored. Therefore, the present investigation sought to evaluate perceived racial/ethnic discrimination in terms of smoking abstinence expectancies among Latinx smokers living in the US.

METHODS

Participants included 338 English-speaking Latinx adult daily cigarette smokers (M_age = 35.5 years; SD = 8.65; age range 18-61; 37.3 % female) recruited nationally throughout the US using Qualtrics Panels.

RESULTS

Results supported statistically significant main effects for perceived racial/ethnic discrimination in relation to increased smoking abstinence expectancies of negative mood, somatic symptoms, harmful consequences, and positive consequences (p's < 0.001).

DISCUSSION

Overall, the results of the present investigation build from a limited body of work on perceived racial/ethnic discrimination and smoking and provide novel evidence of consistent and moderate incremental associations between perceived racial/ethnic discrimination and negative and positive smoking abstinence expectancies among Latinx smokers.

Latinx Individuals Who Smoke Daily with and without a Probable Anxiety Disorder: Differences in Smoking Behavior and Beliefs about Abstinence

There is a well-established relation between anxiety psychopathology and smoking in the general population. However, little work focuses on Latinx/Hispanic (hereafter Latinx) persons who smoke from this comorbidity perspective. The present investigation aimed to explore differences among English-speaking Latinx adults who live in the United States (US) and smoke cigarettes with and without a probable anxiety disorder in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) who identified as Latinx and were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with a probable anxiety disorder (compared to those without) were more likely to demonstrate higher levels of cigarette dependence, severity of problems when trying to quit, perceived barriers for quitting, and negative abstinence expectancies after adjusting for key variables linked to smoking and anxiety (e.g., hazardous drinking, education). The current findings are the first to document probable anxiety disorder status as a clinically relevant factor for a wide range of smoking variables and beliefs about abstinence among Latinx persons who smoke.

Perceived Racial/Ethnic Discrimination and Smoking Outcome Expectancies among Adult Latinx Smokers Living in the United States

Background: Smoking-related health disparities are prevalent in the Latinx community in the United States (US). Although Social Determinants of Health (SDoH) are known to contribute to a myriad of health problems among the Latinx population, there is relatively limited work expressly aimed at elucidating SDoH among Latinx smokers. Perceived racial/ethnic discrimination is one SDoH construct that may be especially relevant to understanding smoking-related cognition for Latinx smokers in the US. Smoking outcome expectancies, reflecting beliefs about the consequences of smoking, are established cognitive processes that have been linked to the maintenance and relapse of smoking. The purpose of the present work is to investigate perceived racial/ethnic discrimination in relation to smoking outcome expectancies amongst Latinx smokers in the US. Method: Participants included 338 English-speaking Latinx adult daily cigarette smokers from the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female). Results: Results indicated that perceived racial/ethnic discrimination was related to greater levels of negative reinforcement, positive reinforcement, and appetite-weight control expectancies, but not negative consequences expectancies. Discussion: Overall, the current findings provide novel insight into the relationship between perceived racial/ethnic discrimination and smoking outcome expectancies amongst English-speaking Latinx cigarette users in the US.

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%-3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%-3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.

Epidemiology of tobacco use and nicotine dependence in truck drivers

OBJECTIVE

To investigate the epidemiology of tobacco use and nicotine dependence in a sample of truck drivers in Brazil.

METHODS

Between 2015 and 2016, a cross-sectional study was conducted on 624 truck drivers who operate on the BR-050 highway in Brazil. Participants were interviewed about sociodemographic data, occupational characteristics, mental health, behavioral data, and tobacco use. Then, the Fagerstrom test for nicotine dependence (FTND) was used to verify nicotine dependence in smoking truck drivers. Logistic regression and linear regression were also used to verify factors associated with tobacco use in the previous 30 days and nicotine dependence scores, respectively.

RESULTS

The prevalence of tobacco use among truck drivers was 21.1% (n = 132;95%CI: 18.1-24.5). Of the total number of smokers who responded to the FTND (n = 118; 89.4%), most had high/very high nicotinic dependence (68.6%; 95%CI: 59.8-76.3). Tobacco use was associated with absence of religion (adjusted odds ratio [AOR]: 2.60; 95%CI: 1.35-5.01), employment relationship of the contract (AOR = 1.98; 95%CI: 1.26-3.13); > 12 hours daily working time (AOR = 1.80; 95%CI: 1.09-2.98) and alcohol use in the previous 30 days (AOR = 2.92; 95%CI: 1.86-4.57). Irregular physical activity was associated with higher scores of nicotine dependence (β = 1.87; 95%CI: 0.55-3.19).

CONCLUSION

The results showed a high prevalence of tobacco use and high/very high nicotine dependence among the truck drivers.

The pattern in prevalence and sociodemographic factors of smoking in Malaysia, 2011–2019: Findings from national surveys

INTRODUCTION

Smoking is a major contributor to morbidity and mortality worldwide, with Malaysia no exception. Through the Ministry of Health and other ministries in the government of Malaysia, numerous anti-smoking measures have been introduced to prevent and control smoking in the country. Continuous monitoring of smoking prevalence in the community is essential in order to evaluate the effectiveness of anti-smoking policies. This study aims to update the sociodemographic factors associated with smoking in the past decade in Malaysia.

METHODS

The study utilized data from three national household surveys in Malaysia, namely the Global Adult Tobacco Survey (GATS) 2011, the National Health and Morbidity Survey (NHMS) 2015 and the National Health and Morbidity Survey (NHMS) 2019. These surveys adopted a multistage stratified sampling design that represents the population in Malaysia. Smoking status was determined based on the GATS protocol and definitions. Complex sample design estimates and complex multivariable logistic regression were used in the analysis.

RESULTS

A total of 4250, 21410 and 11111 respondents aged ≥15 years participated in GATS 2011, NHMS 2015 and NHMS 2019, respectively, with a response rate between 85% and 87%. The prevalence of smoking was 23.1% (95% CI: 21.2–25.2) in 2011, 22.8% (95% CI: 21.9–23.8) in 2015 and 21.3% (95% CI: 19.9–22.8) in 2019. The prevalence was consistently higher in males (40.5–43.9%), adults aged 25–44 years (25.4–29.0%), Malay (22.6–24.7%), other ethnicities (30.0–35.0%), and the self-employed (33.7–44.6%). Multiple logistic regression analysis showed that the adjusted odds ratio (AOR) of smoking was higher in males, in younger and middle age groups, Malays, and those with lower education level.

CONCLUSIONS

There were slight changes in the sociodemographic factors of smoking in the past decade in Malaysia. Stern measures and more aggressive strategies are needed to address all the risk factors in controlling smoking behavior in the country.

Associations of tobacco cigarette use and dependence with substance use disorder treatment completion by sex/gender and race/ethnicity

INTRODUCTION

Individuals with substance use disorders (SUD) are approximately five times more likely to smoke cigarettes than the general population. Individuals who smoke cigarettes have greater odds of SUD relapse compared to individuals who do not smoke cigarettes, but we know little about how cigarette use is related to SUD treatment completion overall by sex/gender or race/ethnicity.

METHODS

This study examined 2855 adults (71.98 % male; >70 % racial/ethnic minority) in outpatient and residential SUD treatment at a New York-based treatment agency over a six-month period in 2018.

RESULTS

Overall, approximately three-fourths of SUD treatment-seeking participants smoked cigarettes, with high rates across sex/gender and racial/ethnic groups. Nicotine dependence did not differ by sex/gender, and White Non-Hispanic adults had the highest levels of nicotine dependence across racial/ethnic groups. Those who smoked cigarettes were significantly less likely to complete treatment compared to those who did not smoke cigarettes (OR = 0.69; 95 % CI: 0.58, 0.82). The study found no overall differences in SUD treatment completion and length of stay by sex/gender or race/ethnicity.

CONCLUSIONS

Given the high prevalence of cigarette smoking and lower odds of completing SUD treatment, the current system of care for SUD treatment may be enhanced by addressing cigarette smoking from onset of treatment.

Prevalence of tobacco dependence and associated factors in China: Findings from nationwide China Health Literacy Survey during 2018–19

Background

Tobacco dependence is the key barrier to successful smoking cessation. However, little is known about its prevalence, sociodemographic characteristics and determinants. We aimed to estimate the prevalence, associated factors and burden of tobacco dependence in China.

Methods

During 2018–2019, the nationally representative 2018 China Health Literacy Survey (2018 CHLS) invited 87,708 participants to participate using a multistage stratified sampling method from 31 provinces (or equivalent) in mainland China, and 84,839 participants aged 20–69 with valid data were included in the analysis. We diagnosed tobacco dependence based on international criteria (ICD-10, DSM-4) and tailored to Chinese population according to China Clinical Guideline for Tobacco Cessation (2015 version). The prevalence of tobacco dependence was estimated overall and by sociodemographic factors. The Logistic regression was conducted to estimate odds ratios (OR) and 95% confidence intervals (CIs) for tobacco dependence and success of smoking cessation (being ex-smokers), with different levels of adjustment. These were used to estimate the total number of adults who were tobacco dependent in China.

Findings

In China, the estimated prevalence of current smoking was 25.1%, significantly higher in men than in women (47.6% vs 1.9%). The prevalence of current smoking varied approximately 3-fold (12.9% to 37.9%) across 31 provinces of China. Among general population aged 20–69 years, the prevalence of tobacco dependence was 13.1% (95% CI:12.2–14.1). Among current smokers, the prevalence of tobacco dependence was 49.7% (46.5–52.9%), with no difference between men and women (49.7% vs 50.8%). The prevalence of tobacco dependence was associated significantly with smoking intensity, defined by pack-years (1.62 [1.54–1.70] per 10 pack-years), cigarettes smoked per day (2.01 [1.78, 2.27] per 10 cigarettes), and smoking starting age (0.93 [0.90, 0.97] per 5 years). Given smoking intensity, the prevalence of tobacco dependence also varied by age, gender, certain socioeconomic status and regions. Compared with those without tobacco dependence, ever smokers with tobacco dependence were less likely to be ex-smokers (2.88, 2.59–3.21). In China, 183.5 (170.4–197.4) million adults (177.5 million were men) were tobacco dependent in 2018.

Interpretation

In China, tobacco dependence is highly prevalent, with approximately half of current smokers being addictive, highlighting the need for coordinated effort to improve awareness, diagnosis and treatment of tobacco dependence.

Funding

Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), National Key R&D Program of China (grant no 2017YFC1309400), and National Natural Science Foundation of China (grant no 81720108001).

Note

Chinese translation of abstract is available in appendix section.

The effects of varenicline, bupropion, nicotine patch, and placebo on smoking cessation among smokers with major depression: A randomized clinical trial

IMPORTANCE

Improving treatment outcomes for smokers with major depressive disorder (MDD) can have significant public health implications.

OBJECTIVE

To evaluate the safety and efficacy of smoking cessation pharmacotherapy among smokers with MDD.

DESIGN

Secondary analysis of a randomized, double-blind, active- (nicotine patch) and placebo-controlled trial of 12 weeks of either varenicline or bupropion with a 12-week follow-up.

PARTICIPANTS

Community volunteers 18-75 years of age; smoke 10+ cigarettes/day; with clinically stable MDD (N = 2635) or no psychiatric disorder (N = 4028), from 140 sites in 16 countries.

INTERVENTION

Twelve weeks of pharmacotherapy (placebo [PLA], nicotine replacement therapy [NRT], bupropion [BUP], varenicline [VAR]) plus brief cessation counseling.

MEASURE(S)

Primary safety outcome: the occurrence of ≥1 treatment-emergent, moderate to severe neuropsychiatric adverse event (NPSAE). Primary efficacy outcome: biochemically confirmed continuous abstinence (CA) during the final 4 weeks of treatment (Weeks 9-12).

RESULTS

A total of 6653 participants (56% female; 39% MDD) ~47 years old. Risk of NPSAEs did not differ by medication for MDD. MDD had higher risk (p < .0001) for NPSAEs than the NPC. Efficacy (6653; intent-to-treat): CA rates for MDD versus NPC respectively were 31.2% versus 38.0% VAR; 23.0% versus 26.1% BUP; 22.6% versus 26.4% NRT; and 13.4% versus 13.7% PLA but no differential treatment effect was noted within the cohorts. All active treatments differed from PLA but VAR showed the largest effect.

CONCLUSIONS

Results suggest that for MDD smokers, inclusive of those with recurrent episode, varenicline plus counseling may be the best pharmacological option for the treatment of smoking given its greater efficacy effect size and similar risk of NPSAEs.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01456936. https://clinicaltrials.gov/ct2/show/NCT01456936.

Tobacco and nicotine use

Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide. More than a billion people smoke, and without major increases in cessation, at least half will die prematurely from tobacco-related complications. In addition, people who smoke have a significant reduction in their quality of life. Neurobiological findings have identified the mechanisms by which nicotine in tobacco affects the brain reward system and causes addiction. These brain changes contribute to the maintenance of nicotine or tobacco use despite knowledge of its negative consequences, a hallmark of addiction. Effective approaches to screen, prevent and treat tobacco use can be widely implemented to limit tobacco's effect on individuals and society. The effectiveness of psychosocial and pharmacological interventions in helping people quit smoking has been demonstrated. As the majority of people who smoke ultimately relapse, it is important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.

Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology

Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviors such as smoking. Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence. The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e., current, former, never). Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers. Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of Negative Emotion on Abstinence Induced Change in Urge to Vape and Measures of Vaping Dependence

INTRODUCTION

Negative emotion and craving to smoke are established factors driving the maintenance of combustible cigarette use and dependence. The current study aimed to examine whether these findings extend to e-cigarette use. Toward that aim, change in vaping urge following abstinence was examined as a function of negative emotion. Additionally, a mediation model which previously demonstrated relationships between negative emotion, craving, and combustible cigarette dependence was tested in e-cigarette users.

METHOD

Daily e-cigarette users (N = 32, M_age = 21 years, SD_age = 7 years; 78% white) completed a battery of psychological, behavioral, and smoking-related measures in a human laboratory setting. Using their personal devices, participants completed a 5-minute ad-libitum vaping session, a baseline measure of vaping urge, followed by a 2-hour observed abstinence period and a final assessment of vaping urge.

RESULTS

Multivariate regression and two mediation models were utilized to examine factors associated with vaping dependence. The results of these models indicated that negative affect predicted vaping urge following observed abstinence. The relationship between negative affect and measures of vaping dependence and habit, respectively, were significantly mediated by changes in urge during the abstinence period.

CONCLUSIONS

These preliminary results indicate that psychological constructs underlying vaping dependence are similar to those previously found to be associated with combustible cigarette dependence. Further research examining whether these constructs, namely negative affect and change in urge following abstinence, will be important variables to target for vaping cessation treatments is needed.

Remission from nicotine dependence among people with severe mental illness who received help/services for tobacco/nicotine use

OBJECTIVES

A growing body of evidence supports pharmacological interventions to assist smoking cessation in people with severe mental illness (SMI); that is, lifetime major depressive disorder, bipolar disorders, or schizophrenia. Little is known about whether behavioral services are also associated with high probability of remission from nicotine dependence as compared to other types of help/services received (pharmacological, behavioral, or both).

METHODS

A sample of 726 American lifetime adult smokers with SMI and a history of nicotine dependence, who received help/services for tobacco/nicotine use, were identified. These data came from a limited public use dataset, the 2012-2013 NESARC-III. Survival analysis was used to compare the probability of remission from nicotine dependence and the time needed for full remission from nicotine dependence by type of help/services received for tobacco/nicotine use.

RESULTS

Remission was more frequent among those who received behavioral services. In addition, the average time from onset of nicotine dependence until full remission from nicotine dependence was shorter among those who received behavioral services.

CONCLUSIONS

The current study suggests a clinical need for behavioral interventions to promote the probability of remission from nicotine dependence among smokers with SMI. Health care providers could play a role in educating and encouraging smokers with SMI to seek and utilize behavioral services.

Marriage and reductions in men's alcohol, tobacco, and cannabis use

BACKGROUND

Psychoactive substance use is lower among married compared to divorced or unmarried men; yet, the nature of this effect remains unclear because becoming and staying married is potentially confounded with substance-related background familial and individual factors, like parental divorce and personality. The authors investigated the associations between marital status and substance use; how substance use changed across the transition to marriage; and whether marriage effects were likely to be causal.

METHOD

The sample included 1790 adults from male-male twin pairs from a population-based registry. Measures of marital status and alcohol, tobacco, and cannabis use came from Life History Calendars. Data were analyzed using regression, co-twin comparison, and within-person models. The latter models are tools for quasi-causal inference that control for familial and individual-level confounders.

RESULTS

Married men used less alcohol, tobacco, and cannabis than men who were divorced/separated or single. In analyses of substance use across the transition to marriage, men reduced their alcohol and cannabis use both before and after marriage, but their tobacco use only after marriage. These effects were largely robust in co-twin and within-person analyses.

CONCLUSIONS

Marriage was associated with substantial reductions in substance use compared to being divorced/separated or single, and these reductions began prior to marriage. The co-twin comparison and within-person models ruled out the alternative explanation that marriage effects were due to confounding background familial and individual factors. These results provide strong evidence that the social role expectations associated with marriage reduce psychoactive substance use.

Longitudinal and Reciprocal Relationships Between Psychological Well-Being and Smoking

INTRODUCTION

Smoking cessation treatments currently succeed at a rate of approximately 20%-30%, underscoring the importance of exploring factors that might increase intervention effectiveness. Although negative affect has been studied extensively in relation to smoking cessation, psychological well-being (PWB; eg, life satisfaction, optimism, positive affect, purpose in life) has received little attention. This study tested longitudinal and reciprocal relationships between PWB and smoking status in older adults.

METHODS

Panel data were obtained from the biennial, longitudinal Health and Retirement Study. Using structural equation modeling, we developed cross-lagged models to examine the relationships of PWB in 2006 with smoking status in 2010 and of smoking status in 2006 with PWB in 2010 while controlling for covariates (Ns = 2939-4230, 55% women, 89% white, mean age = 64 years, mean years of education = 13, 25% smokers in 2006 and 21% smokers in 2010). Separate cross-lagged models were developed for each of the PWB variables: life satisfaction, optimism, positive affect, and purpose in life.

RESULTS

Greater life satisfaction (standardized path coefficient = -0.04), optimism (standardized path coefficient = -0.07), and positive affect (standardized path coefficient = -0.08) in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction (standardized path coefficient = -0.25), optimism (standardized path coefficient = -0.10), positive affect (standardized path coefficient = -0.10), and purpose in life (standardized path coefficient = -0.13) in 2010.

CONCLUSIONS

Findings warrant further exploration of the relationships between PWB and smoking, and support the incorporation of PWB-boosting components into existing treatments.

IMPLICATIONS

Given the relatively low success rate of current smoking cessation treatments, the present results suggest that increasing PWB might promote abstinence and therefore warrant consideration as a focus of future cessation treatment research. Moreover, these results suggest that smoking might inhibit PWB, illuminating a negative consequence of smoking not previously identified. Helping smokers increase their PWB may benefit them beyond promoting cessation and contribute to a flourishing society. These results warrant further investigation of PWB and smoking, and support the continued evaluation of PWB-boosting components in smoking cessation treatments.

Clinical trial recruitment of adult African American smokers from economically disadvantaged urban communities

This investigation evaluated the effectiveness and challenges of multiple recruitment methods, described as proactive, reactive, and combination methods, among adult African American smokers (N = 527) from economically disadvantaged urban communities enrolled to test progressively reduced nicotine content investigational cigarettes. The study evaluated success using descriptive statistics to measure the volume of phone calls and percentage of eligible participants per method. Reactive and combination strategies effectively prompted participants to call about the study. Combination methods yielded the highest eligibility rates. Findings demonstrate the unique recruitment successes within this population across a range of recruitment methods and may inform improved methods to recruit and engage African Americans in clinical trials.

Determinants of mental health and abuse of psychoactive substances associated with tobacco use. A case-control study

This study aimed to estimate the strength of association among smokers with variables regarding mental health, family functionality, and use of other psychoactive substances. This is a case-control observational study developed from March to November 2016. The study was conducted in a Brazilian Midwest municipality with 646 subjects, of which 323 were cases. In the model, the case group comprised subjects with a certain degree of tobacco dependence. The control group included subjects that were not exposed to tobacco. Concerning tobacco use time, the mean exposure of the case group was 25.65 years. In the multiple logistic regression analysis model the following were positively associated: non-white skin color (p = 0.002); years of study ≤ 8 (p < 0.001); having children (p < 0.001); informal work (p = 0.024); not having a health plan (p < 0.001); high family dysfunction (p = 0.007); AUDIT ≥ 8 (p < 0.001); depression (p < 0.001); having illicit drug in lifetime (p < 0.001); living with other people (p = 0.003) and no religion (p = 0.001). This study reinforces the vulnerability of smokers, associating variables correlated to the field of mental health, and innovates by discussing the influence of family relationships on nicotinic dependence.

Household Smoking Status and Heavy Metal Concentrations in Toenails of Children

There is limited evidence on the distribution of heavy metals and its association with secondhand smoking (SHS) within Pacific Island children living in New Zealand. Certain heavy metals such as cadmium (Cd), lead (Pb), and aluminum (Al) bioaccumulates in the body and can deteriorate health in both children and adults. Others, such as chromium (Cr) and nickel (Ni) in trace amounts are necessary but become toxic at high levels. Exposure routes of these elements include food, water, and air. The purpose of this study was to identify the distribution of toxic metal concentrations and its possible correlation with SHS within the Pacific Island children. A sub-sample of children within Pacific Island families longitudinal study, at the nine-year phase, who were living in the New Zealand city of Auckland were invited to participate, (n = 278). Toenails were used as a biomarker to determine Cr, Pb, Cd, Cu, Ni, and Al concentration using inductively coupled plasma mass spectrometry. Reliable and validated questionnaires were used for demographics, lifestyle, and health outcome variables. Significant differences between household smoking status and ethnicity, as well as parents' marital status, were observed (p < 0.05). There was no statistical difference in heavy metal concentrations in smoking versus non-smoking households. However, Cr, Pb, Cd, Cu, and Ni concentrations were all higher than the required optimal health value in both groups. A high concentration of heavy metals was observed in these children that exceeded the value required for optimal health, although no significant difference in heavy metals with regards to secondhand smoking was observed. SHS was associated with children's ethnicity and parental marital status, but not with household income levels or maternal education.

Increasing Depression and Substance Use Among Former Smokers in the United States, 2002-2016

INTRODUCTION

Mental health and substance use problems are associated with smoking relapse among former smokers. Yet, little is known about the prevalence of mental health and substance use among former smokers in the U.S. In addition, it is unknown whether the prevalence of these conditions has changed over time as former U.S. smokers have grown to outnumber current U.S. smokers. This study, which was conducted in 2018 and 2019, examined the prevalence and trends over time in depression (2005-2016), marijuana use (2002-2016), and alcohol use problems (2002-2016) among former U.S. smokers.

METHODS

The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study. Data from U.S. individuals who were aged ≥18 years in 2002-2016 were included. Former smokers were defined as having smoked ≥100 lifetime cigarettes and no past-year cigarettes.

RESULTS

From 2005 to 2016, the prevalence of major depression increased from 4.88% to 6.04% (AOR=1.01, 95% CI=1.00, 1.03, p=0.04). From 2002 to 2016, past-year marijuana use rose from 5.35% to 10.09% (AOR=1.08, 95% CI=1.07, 1.09, p<0.001) among former smokers. Past-month binge alcohol use also increased from 17.22% to 22.33% (AOR=1.03, 95% CI=1.02, 1.04, p<0.001), although the prevalence of past-year alcohol abuse or dependence did not change.

CONCLUSIONS

Depression and substance use, which are factors associated with increased risk for cigarette use relapse, appear to be increasing over time among former U.S. smokers. Increased awareness of these trends may be important for clinical and public health efforts to direct attention to conditions potentially threatening sustained abstinence among former smokers.

Smoking relapse risk is increased among individuals in recovery

BACKGROUND

The prevalence of cigarette smoking among individuals with a history of substance use disorders (SUDs) remains up to four times higher than those without a history of SUDs. More than half of individuals who attain sustained remission from SUDs will die of tobacco-related diseases. The aim of this secondary data analysis was to compare the risk for smoking relapse among smokers with no history of SUDs and smokers in recovery from SUDs after multi-component, cognitive-behavioral treatment for tobacco dependence.

METHODS

Participants were randomized to receive 6 sessions of multicomponent cognitive-behavioral therapy (adapted for lower socioeconomic groups or standard), 8 weeks of nicotine patches, and were followed for 6 months in the parent randomized clinical trial. Participants passed a urine drug test prior to enrollment. Recovery was assessed at baseline by self-report to the question, "Do consider yourself in recovery from drugs or alcohol?" Relapse was defined as any smoking for 7 consecutive days.

RESULTS

Participants were primarily lower SES and identified as racial and/or ethnic minorities. Cox proportional hazards models revealed that the risk of smoking relapse following tobacco dependence treatment was greater among smokers in long-term (HR: 1.44; 95% CI: 1.01, 2.05) and short-term (HR: 1.98; 95% CI: 1.30, 3.03) recovery than for smokers with no history of SUDs.

CONCLUSIONS

Our findings indicate that smokers in recovery from SUDs have 1.5-2 times the risk of relapse than smokers with no history of SUDs. More effective relapse prevention interventions are needed for this vulnerable, high-risk group of smokers.

Trends in Illicit Drug Use Among Smokers and Nonsmokers in the United States, 2002-2014

OBJECTIVE

Cigarette smoking has declined in the United States. Still, identifying prevalent and modifiable barriers to quitting can help inform the next steps for tobacco control. Illicit drug use, which may be increasingly common in the United States, could be one such factor. We investigated the relationship between past-month illicit drug use and cigarette smoking status and estimated trends in the prevalence of past-month illicit drug use by cigarette smoking status from 2002 to 2014 in the United States.

METHODS

The 2002-2014 National Survey on Drug Use and Health was used to obtain nationally representative data on past-month illicit drug use.

RESULTS

From 2002 to 2014, past-month illicit drug use (for all drugs considered) was nearly 5 times more common among current smokers than among never smokers (adjusted odds ratio = 4.79) and nearly twice as prevalent in former smokers as in never smokers (adjusted odds ratio = 1.99). Illicit drug use increased linearly over time from 2002 to 2014 in the entire general population (ie, across and within current smokers, former smokers, and never smokers). This increasing trend in drug use was most rapid among former smokers (relative to current smokers and never smokers) and was largely, but not entirely, driven by increases in cannabis use.

CONCLUSIONS

Illicit drug use is most prevalent among current cigarette smokers. Yet, the rate of increase in illicit drug use prevalence was most rapid among former smokers. Because former smokers outnumber current smokers in the general population, it may be important to monitor former smokers into the future for potential negative drug-related outcomes.

Do current smokers use more cigarettes and become more dependent on nicotine because of psychological distress after a natural disaster?

Natural disasters increase nicotine dependence and cigarette consumption, but the exact mechanisms and conditions responsible for this increase are relatively unclear. This study explored whether posttraumatic stress and depressive symptoms were pathways to increased nicotine dependence and cigarette consumption after disaster exposure using a representative sample of current smokers who were living in New Orleans at the time Hurricane Katrina struck (n = 175), and a comparison sample of smokers from Memphis (n = 222) who were not directly impacted by Hurricane Katrina. We assessed whether nicotine dependence and daily cigarette consumption differed by city and evaluated potential mediators and moderators of this association using conditional process analysis. Results showed that though nicotine dependence (B = 0.46, SE = 0.20, p = .02) and average daily cigarette consumption (B = 2.19, SE = 0.80, p = .01) were higher among New Orleans than Memphis smokers 27 months after Hurricane Katrina, hurricane exposure did not indirectly affect nicotine dependence and average daily cigarette consumption through increases in posttraumatic stress and depressive symptoms. Smokers who are exposed to disasters may not be increasing their cigarette use and their dependency on nicotine because of post-disaster psychological distress. Future studies should investigate other mechanisms and conditions to explain post-disaster changes in smoking behavior.

The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study

Introduction. Previous studies have examined the association between specific mental disorders, particularly mood and anxiety disorders, and substance-related disorders; but the temporal link between them remains unclear. This study aimed to examine whether individuals with specific mental disorders, including affective psychoses, neurotic disorders, schizophrenia, personality disorders, and adjustment reaction, have higher risks for subsequently developing substance-related disorders compared to those without. Methods. A large-scale study with longitudinal data was conducted using the Taiwan National Health Insurance Research Database (NHIRD) consisting of 2,000,118 patients' medical records from 2000 to 2009. A total of 124,423 people diagnosed with selected mental disorders and the same number of people without the diagnoses of the selected disorders were identified between January 1, 2001, and December 31, 2006, and followed up for the diagnoses of substance-related disorders till the end of 2009. We estimated the risk for subsequently developing substance-related disorders among patients with the selected mental disorders compared to those without by using Cox proportional hazard models. The cumulative incidence of substance-related disorders was calculated using the Kaplan-Meier method. Results. The risk for developing substance-related disorders in patients with selected mental disorders is about 5 times (HR=5.09, 95% CI: 4.74-5.48) higher than those without after adjusting for potential confounding variables. From the multivariate analyses of subsamples stratified by age, sex, and urban and income levels, we found all adjusted hazard ratios were significantly higher than 1.0, ranging from 2.12 (95% CI: 1.72-2.62) to 14.55 (95% CI: 7.89-26.83). For children and adolescents aged 10-19 years, those with specific mental disorders had 14.55-fold higher risk for developing substance-related disorders in later life compared to their counterparts. Furthermore, patients with personality disorders had the highest risk (HR=25.05). Conclusions. The earlier onset of the selected mental disorders is a potential risk for developing substance-related disorders in later life, particularly for personality disorders. Health professionals should pay more attention to this at-risk population, especially to adolescents with mental disorders.

Adherence to Pharmacological Smoking Cessation Interventions: A Literature Review and Synthesis of Correlates and Barriers

Introduction

Efficacious pharmacological interventions for smoking cessation are available, but poor adherence to these treatments may limit these interventions overall impact. To improve adherence to smoking cessation interventions, it is first necessary to identify and understand smoker-level characteristics that drive nonadherence (ie, nonconformance with a provider's recommendation of timing, dosage, or frequency of medication-taking during the prescribed length of time).

Methods

We present a literature review of studies examining correlates of, or self-reported reasons for, nonadherence to smoking cessation pharmacotherapies. Studies were identified through PubMed-using MeSH terms, Embase-using Emtree terms, and ISI Web of Science.

Results and Conclusions

This literature review included 50 studies that examined nonpreventable (eg, sociodemographics) and preventable (eg, forgetfulness) factors associated with adherence to smoking cessation medication and suggestions for overcoming some of the identified barriers. Systematic study of this topic would be facilitated by consistent reporting of adherence and correlates thereof in the literature, development of consistent definitions of medication adherence across studies, utilization of more objective measures of adherence (eg, blood plasma levels vs. self-report) in addition to reliance on self-reported adherence.

Implications

This article provides the most comprehensive review to date on correlates of adherence to pharmacological smoking cessation interventions. Challenges and specific gaps in the literature that should be a priority for future research are discussed. Future priorities include additional research, particularly among vulnerable populations of smokers, developing standardized definitions of adherence and methods for measuring adherence, regular assessment of cessation pharmacotherapy adherence in the context of research and clinical practice, and development of novel treatments aimed at preventable barriers to medication adherence.

Prevention and Treatment of Tobacco Use: JACC Health Promotion Series

Tobacco use is the leading preventable cause of death worldwide and is a major risk factor for cardiovascular disease (CVD). Both prevention of smoking initiation among youth and smoking cessation among established smokers are key for reducing smoking prevalence and the associated negative health consequences. Proven tobacco cessation treatment includes pharmacotherapy and behavioral support, which are most effective when provided together. First-line medications (varenicline, bupropion, and nicotine replacement) are effective and safe for patients with CVD. Clinicians who care for patients with CVD should give as high a priority to treating tobacco use as to managing other CVD risk factors. Broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns, and restrict tobacco marketing enhance clinicians' actions working with individual smokers.

Probability and correlates of nicotine dependence among smokers with and without major depressive disorder: Results from the national epidemiology survey on alcohol and related conditions

PURPOSE

This study aims to use data from a nationally representative survey to examine the correlates of nicotine dependence among smokers with and without major depressive disorder.

METHODS

Data were drawn from the Wave 1 of the National Epidemiology Survey on Alcohol and Related Conditions (NESARC, 2001-2002). Logistic regression analyses taking into account the complex sampling design were used to examine the correlates of nicotine dependence.

RESULTS

The typical correlates of nicotine dependence (odds > 1.44 or 1/1.44, effect size (d) > .2) were age, race, employment, weight, and the interaction effects of gender with age of first use, age at onset of daily smoking, and quantity of smoking.

CONCLUSION AND PRACTICE IMPLICATIONS

This study will increase psychiatric nurses' understanding and awareness regarding the correlates of nicotine dependence.

Compared characteristics of current vs. past smokers at the time of diagnosis of a first-time lung or head and neck cancer: a cross-sectional study

Background

Active smoking at the time of diagnosis of a first head & neck (H&N) or lung cancer is associated with a worse cancer outcome and increased mortality. However, the compared characteristics of active vs. former smokers at cancer diagnosis are poorly known.

Methods

In 371 subjects with a first H&N or lung cancer, we assessed: 1) socio-demographic features; 2) lifelong types of smoking; 3) alcohol use disorder identification test (AUDIT); 4) cannabis abuse screening test (CAST); and 5) Mini International Neuropsychiatric Interview (MINI). Using a multivariable regression model, we compared the profile of current smokers and past smokers.

Results

Current smokers more frequently exhibited H&N cancer (OR 3.91; 95% CI [2.00–6.51]; p <  0.0001) and ever smoking of hand-rolled cigarettes (OR 2.2; 95% CI [1.25–3.88]; p = 0.007). Among subjects with lung cancer (n = 177), current smoking was primarily associated with ever smoking of hand-rolled cigarettes (OR 2.88; 95% CI [1.32–6.30]; p = 0.008) and negatively associated with age (OR 0.92; 95% CI [0.89–0.96]; p <  0.001). Among subjects with H&N cancer (n = 163), current smokers exhibited a significantly greater AUDIT score (OR = 1.08; 95% CI [1.01–1.16]; p = 0.03).

Conclusion

At the time of diagnosis of the first lung or H&N cancer, current smoking is highly associated with previous type of smoking and alcohol drinking patterns.

Trial registration

NCT01647425; Registration date: July 23, 2012.

Evaluation of menthol per se on acute perceptions and behavioral choice of cigarettes differing in nicotine content

Subjective perceptions and self-administration of cigarettes are each influenced by nicotine. Yet, differences specifically due to menthol in perceptions and choice of cigarettes varying in nicotine, and the association between these responses, have not been directly tested. Using a mixed between- and within-subjects design, acute responses to each of two menthol or non-menthol Spectrum research cigarettes, moderate (16-17 mg/g) versus very low (0.4 mg/g) in nicotine contents, were compared following brief abstinence in adult smokers preferring menthol ( n=44) or non-menthol ( n=29) brands. To ensure reliable perceptions, they experienced five exposures to each cigarette, then chose between them. All perceptions and choices were greater for moderate vs very low nicotine, as expected, and the magnitude of difference in four of six perceptions was associated with subsequently greater choice of the moderate nicotine cigarette. Importantly, virtually no differences were found between menthol and non-menthol, as nearly all perceptions, cigarette choices, and the association between perceptions and choice were not moderated by menthol or the interaction of nicotine by menthol. Our results indicate perceptions and reinforcement from cigarettes do not differ due to menthol when nicotine content and smoking topography are carefully controlled. Thus, regardless of menthol, smoking perceptions directly predict self-administration behavior.

Smoking during pregnancy in the United States, 2005-2014: The role of depression

BACKGROUND

Despite success of public health-oriented tobacco control programs in lowering the smoking prevalence over the past several decades, it is unclear whether similar reductions in smoking have been experienced among pregnant women, especially in vulnerable groups such as those with major depression and/or lower socioeconomic status.

OBJECTIVES

The purpose of this study is to examine the relationship between major depressive episode (MDE) and smoking among pregnant women overall, and by demographics and to estimate changes in the prevalence of cigarette smoking among pregnant women with and without MDE from 2005 to 2014.

STUDY DESIGN

Cigarette use among pregnant women with and without MDE was examined using logistic regression models in the National Survey on Drug Use and Health.

RESULTS

Prenatal smoking is more common among pregnant women with, compared to without, MDE (32.5% vs. 13.0%; (adjusted OR=2.50 (1.85, 3.40)), and greater disparities were revealed when also considering income, education and race. Over time, smoking during pregnancy increased significantly among women with MDE (35.9% to 38.4%; p=0.02)) and showed a decreasing trend among women without MDE (12.5% to 9.1%; p=0.07) from 2005 to 2014.

CONCLUSIONS

Over the past decade, smoking during pregnancy has increased among women experiencing a major depressive episode and is over four times more common among pregnant women with, than without, MDE. Disparities in smoking during pregnancy by MDE status and socioeconomic subgroups appear substantial. Given the multitude of risks associated with both MDE and smoking during the prenatal period, more work targeting this vulnerable and high-risk group is needed.

Depression Among Non-Daily Smokers Compared to Daily Smokers and Never-Smokers in the United States: An Emerging Problem

INTRODUCTION

Depression is strongly associated with daily smoking. Yet, little is known about the association between depression and non-daily smoking. The aim of this study was to investigate the prevalence of past-year depression and changes in past-year depression over time among non-daily smokers, compared to daily smokers and never-smokers, overall and stratified by age, gender, income, nicotine dependence, and cigarettes per day.

METHODS

Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons aged 12 and over (total study population N = 496 805). The prevalence of past-year depression was examined annually among non-daily smokers, daily smokers, and never-smokers from 2005 to 2013 using linear trend analyses.

RESULTS

Past-year depression was common among 10.10% of non-daily smokers, common among 10.78% of daily smokers, and 5.51% of never-smokers in 2013. The prevalence of depression increased from 2005 to 2013 among non-daily smokers (9.06% vs. 10.10%; p = .034) while there was no significant change in depression over time among daily smokers. Increases in depression among non-daily smokers occurred for both men and women and appear most pronounced youth, those smoking fewer cigarettes, and those without nicotine dependence.

CONCLUSIONS

The prevalence of depression among non-daily smokers was equivalent to daily smokers and nearly twice that among nonsmokers. Depression appears to be increasing over time in non-daily smokers especially among youth, those who smoke less, and those without nicotine dependence. More work on the mental health of non-daily smokers is needed as this is an increasing and understudied group.

IMPLICATIONS

This is the first study to investigate changes in the prevalence of depression among non-daily smokers compared to daily smokers and never-smokers over the past decade in a nationally representative sample of the United States. The results suggest an increase in depression among non-daily smokers over time that did not similarly occur for daily smokers. Further, there were several subgroups of non-daily smokers among whom depression has increased more rapidly. This study suggests the need for more information about the relationship between depression and non-daily smoking including the impact of depression on quit attempts and outcomes.

Trends in cigarette consumption and time to first cigarette on awakening from 2002 to 2015 in the USA: new insights into the ongoing tobacco epidemic

OBJECTIVE

The current study estimates trends in the number of cigarettes smoked per day (CPD) and percentage of smokers having their first CPD within 30 min of waking (time to first cigarette (TTFC)<30 min) among smokers from 2002 to 2015 in the USA overall, and adjusting for demographics. Trends in TTFC<30 min were also estimated by varying levels of cigarette consumption.

METHODS

Data were drawn from the National Household Survey on Drug Use, an annual nationally representative cross-sectional study of the US population aged 12 and older (n=54 079-58 397 per year). Linear time trend analyses of CPD and TTFC<30 min were conducted adjusting for age, gender and income; linear time trend analyses of TTFC among those at varying levels of CPD were then performed.

RESULTS

Estimates suggest that CPD declined overall from 2002 to 2015, and that the prevalence of TTFC<30 min declined overall among smokers (p<0.0001). The proportion of smokers consuming fewer (ie, 1-5, 6-15) CPD has increased while the number consuming 16+ CPD has decreased overall. Among those smoking 1-5 (p=0.0006) and 6-15 (p<0.0001) CPD, TTFC<30 min has increased significantly, but TTFC<30 min has remained unchanged among those smoking 16 or more CPD (p=0.5838).

CONCLUSIONS

Findings suggest that smokers today are consuming fewer CPD, yet are increasingly likely to have their first cigarette earlier on awakening than they were a decade ago. Intervention and outreach efforts aimed at moving the prevalence lower may benefit from evaluating and addressing nicotine dependence even among lighter smokers.

Evaluating the role of smokeless tobacco use indices as brief measures of dependence

INTRODUCTION

There is considerable interest in using brief measures of dependence for evaluation and treatment of tobacco dependence. The Heaviness of Smoking Index (HSI) is a validated measure of dependence among cigarette smokers. However, a similar index has not been studied among ST users. The aim of this study is to develop similar ST use indices and evaluate their utility as concise dependence measures. Time to first chew/dip of the day (TTFD), number of cans of ST used per week (CPW), and number of dips/chews per day (DPD) were used to create three ST use indices; heaviness of ST use index (HSTI), ST dependence index (STDI), and ST quantity frequency index (ST-QFI).

METHODS

The study was based on data collected from a community based sample of exclusive ST users living in Oklahoma. Participants completed the self-administered survey which included dependence scales and questionnaires to measure sociodemographic factors and tobacco use characteristics. Saliva samples were obtained to measure cotinine concentration. Method of scoring for TTFD and DPD was similar to the scoring scheme employed for HSI items. DPD was transformed by a series of statistical tests into a three category scoring variable. Concurrent validity and reliability of the ST use indices were evaluated and overall accuracy of ST use indices was assessed. Level of agreement between the ST use indices and Fagerström Test for Nicotine Dependence for ST users (FTND-ST) was calculated to find the extent these indices were equivalent to FTND-ST in measuring dependence.

RESULTS

ST use indices were significantly correlated with FTND-ST. ST users who had higher HSTI or STDI scores were more likely to have Tobacco Dependence Screener (TDS) based dependence diagnosis (OR: 1.50, 95%CI: 1.12, 2.02 and OR: 1.53, 95%CI: 1.16, 2.02, respectively). Study findings showed that all ST use indices were predictors of cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that STDI had acceptable reliability. At the optimal cutoff scores, both HSTI and STDI had good level of agreement with FTND-ST (k=0.81, p<0.0001 and k=0.71, p≤0.0001, respectively).

CONCLUSIONS

Components of physical dependence are interrelated and each ST use item, TTFD, CPW, and DPD, explains a different dependence feature. Significant association of HSTI and STDI with other tobacco dependence measures and FTND-ST suggests that these indices are valuable brief measures of dependence among ST users and can be used as a substitute for FTND-ST, similar to HSI in smoking dependence studies. A concise dependence measure like HSTI or STDI has reduced response burden and is an effective tool in clinical and research setting.

A review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders

Persons with alcohol use disorders (AUDs) and substance use disorders (SUDs) appear to be heavily affected by cigarette smoking. In order to address the consequences of smoking in this population, an understanding of the current state of knowledge is needed. Epidemiologic research provides the opportunity to obtain detailed information on smoking behaviors in large community samples. The aim of this paper was to synthesize the epidemiologic evidence on smoking among persons with AUDs/SUDs and suggest directions for future research. Literature searches of Medline and PubMed were used to identify articles and additional articles were elicited from publication reference lists. To be included in the review, papers had to be published in English, analyze epidemiologic data, and examine an aspect of smoking behavior in persons with AUDs/SUDs. Twenty-nine studies met inclusion criteria and were included in the review. In summary, epidemiologic evidence to date suggests greater lifetime and current smoking, nicotine dependence, and non-cigarette tobacco use; lower quitting; and differences in quit attempts and withdrawal symptoms for persons with AUDs/SUDs compared to other people. Most studies examined nationally representative data and were conducted on persons in the United States and Australia. Few publications examined outcomes by demographics (e.g., gender, age) but these studies suggested that specific patterns differ by demographic subgroups. More research is needed on persons with AUDs/SUDs in order to develop the most effective public health and clinical interventions to reduce smoking behaviors, improve cessation outcomes, and reduce the harmful consequences of smoking for those with AUDs/SUDs.

Prevalence and social determinants of smoking in the adult Greek Cypriot population

BACKGROUND

Smoking remains a major public health concern in Europe. In the current study, we investigate the prevalence and socioeconomic factors that contribute to smoking disparities in Greek Cypriot adults.  Material and methods: In 2009, using the Countrywide Integrated Noncommunicable Disease Intervention questionnaire a representative sample of Greek Cypriot adults was surveyed (response rate 100%).  Socioeconomic and demographic data were collected and analyzed.

RESULTS

The prevalence of smoking in Greek Cypriot adults was 50.8 % among men and 21.2 % among women. Sociodemographic disparities in smoking prevalence were identified, characterized by higher prevalence in urban vs rural centers (especially among women), and higher prevalence among employed women vs housewives. Socioeconomic inequalities in prevalent smoking were gender-specific, with occupational social class showing an inverse association among men and a direct among women, with income showing an inverse association (mostly among men), and educational attainment showing a clear inverse gradient among men and a direct gradient among women.

CONCLUSION

Striking gender-specific bidirectional associations between socioeconomic factors and smoking prevalence were identified among Greek Cypriot adults, which may promote targeted intervention programmes aiming at halting and reversing smoking behaviors in Cyprus. Hippokratia 2016, 20(4): 284-291.

The natural history of substance use disorders

PURPOSE OF REVIEW

Illicit drugs, alcohol, and tobacco use disorders contribute substantially to the global burden of disease. Knowledge about the major elements of the natural history of substance use disorders (incidence, remission, persistence, and relapse) is crucial to a broader understanding of the course and outcomes of substance use disorders.

RECENT FINDINGS

Prospective cohort studies in nonclinical samples indicate that externalizing psychopathology in earlier life, including early disordered substance use, delinquency, and personality disorders, are related to substance use disorders later in life and chronic course. Externalizing psychopathology may be initiated by early adverse experiences, for example, childhood maltreatment and stressful life events. After controlling for confounders, 'age at first use' as a causal factor for alcohol use disorder later in life and the 'drug substitution' hypothesis are not supported in general population data.

SUMMARY

Future research should focus on elaborating the causal framework that leads to the development and persistence of severe substance use disorders, with an emphasis on identifying modifiable factors for intervention by policy makers or health professionals. More research is needed on the natural history of substance use disorders in low-income and middle-income countries.

Hospitalization due to drug use did not change after a decade of the Psychiatric Reform

OBJECTIVE

To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil.

METHODS

This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression.

RESULTS

The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds.

CONCLUSIONS

The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform.

Influence of Psychiatric and Personality Disorders on Smoking Cessation Among Individuals in Opiate Dependence Treatment

OBJECTIVE

We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals.

METHODS

Participants (N = 116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory-III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked.

RESULTS

Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall, narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI [0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]).

CONCLUSIONS

Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.

Trajectories of smoking behavior as a function of mood and satisfaction with life: What matters most?

BACKGROUND

Worldwide, tobacco use causes more than 5 million deaths per year. The present study investigated possible preventative factors of nicotine dependence, such as mood and Satisfaction With Life (SWL).

METHODS

Longitudinal Internet survey of 1957 individuals assessed three times at a two week interval (2007-2010).

OUTCOME MEASURES

Cigarette Dependence Scale (CDS), feeling prisoner to cigarettes, smoking cessation, reduction, and relapse.

PREDICTORS

Time (i.e. trajectory of dependence over time), smoking status (daily, occasional or ex-smoker), mood, and SWL. All measures were assessed at each time point.

RESULTS

Both SWL, and mood, respectively were significantly associated with dependence (slopeSWL=-0.03, slopeSWL=-0.11, ps<0.001). With respect to feeling prisoner to cigarettes, mood but not SWL showed a significant association (slopeSWL=-0.14, p<0.001). Occasional, and ex-smokers showed significantly greater decrease in psychological dependence, as mood increased, than daily smokers (slopeoccasional=-0.28, poccasional=0.011; slopeex=-0.27, pex<0.001). Smoking cessation decreased over time, and both mood, as well as SWL had a significant impact on cessation (ORmood=1.43, pmood<0.01, ORSWL=1.15, pSWL=0.042). Reduction in smoking was predicted by SWL only (ORSWL=1.21, p=0.043), whereas relapse was predicted by mood only (ORmood=0.55, p<0.01).

LIMITATIONS

The participants were self-selected. Possible confounding relationships (e.g., medication) have to be further assessed.

CONCLUSIONS

Cigarette dependence, feeling prisoner to cigarettes, cessation, and reduction are significantly influenced by both mood and SWL. Treatments may thus tackle mood regulation, SWL, and nicotine dependence in tandem.

Smoking dependence in 18 European countries: Hard to maintain the hardening hypothesis

OBJECTIVE

When the prevalence of smoking decreases in a population, there is a hypothesis-the so-called "hardening hypothesis"-that the remaining smokers form a subgroup of "hardcore smokers." Our aims were to test the hardening hypothesis and to analyze the determinants of high dependence taking into account both individual and country-level characteristics.

METHOD

Within the Pricing Policies and Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking between January and July 2010 in 18 European countries, including 2882 male and 2254 female smokers with complete information on smoking dependence. The Heaviness of Smoking Index (HSI) was used as a measure of tobacco dependence. We correlated smoking prevalence and dependence using the country as unit of analysis. Moreover, we fitted multilevel logistic regression models.

RESULTS

Country-specific prevalence of smoking was positively, although not significantly, correlated with the proportion of highly tobacco-dependent smokers (overall rsp=0.203, p=0.419), both in men (rsp=0.235, p=0.347) and women (rsp=0.455, p=0.058). Using individual-level analysis, high dependence was positively related to age, and, although not significantly, to smoking prevalence, and inversely related to level of education. The lack of a smoking ban at home was positively related to smoking dependence.

CONCLUSIONS

Using both ecological and individual-level analyses, the relations between smoking prevalence and HSI were not significant, but in the opposite direction as compared to that assumed by the "hardening hypothesis." Therefore, our data provide empirical evidence against this theory, thus supporting the feasibility of an endgame strategy.