Exercise facilitates smoking cessation indirectly via improvements in smoking-specific self-efficacy: Prospective cohort study among a national sample of young smokers

Acute effects of outdoor and indoor walking on cigarette cravings, withdrawal symptoms and affective response during temporary smoking abstinence

RATIONALE

Cigarette smoking is one of the leading preventable causes of premature death worldwide. There is evidence in the literature that brief exercise units indoors can improve well-being in temporarily abstinent smokers and reduce cigarette cravings and withdrawal symptoms.

OBJECTIVE

Because exercise in natural environments showed enhanced psychological effects, the aim of our study was to examine the acute effects of outdoor exercise compared with indoor exercise on craving, withdrawal symptoms and affective response in temporarily abstinent smokers.

METHODS

In a randomized controlled within-subject-design, temporarily abstinent smokers (N = 16) participated in three interventions lasting 10 min: outdoor walking (OUT-EX), indoor walking (IN-EX) and a sedentary control condition (CC). Self-reported cigarette craving, withdrawal symptoms and affective response were assessed pre-, mid-, post-interventions and at follow-up.

RESULTS

In contrast to CC, OUT-EX and IN-EX significantly reduced cigarette cravings during and at the end of the intervention compared to pre-intervention, but not at 20 min follow-up. Cigarette withdrawal symptoms decreased significantly over time in all three groups, but no significant group differences were found. OUT-EX and IN-EX, but not CC, showed significantly improved affective valence at the end of the intervention and at follow-ups. Outdoor walking resulted in significantly lower cigarette cravings than indoor walking at the end of the intervention.

CONCLUSION

The study adds to existing evidence that short bouts of indoor or outdoor exercise can help reduce cigarette cravings and increase well-being in abstinent smokers. Further studies are needed to address the potential additional effect of outdoor exercise on craving, affective states and smoking cessation.

Does Aerobic Exercise Facilitate Vaping and Smoking Cessation: A Systematic Review of Randomized Controlled Trials with Meta-Analysis

Cigarette smokers try to quit using several strategies including electronic cigarette use (vaping). An alternative, easy and cheap method is exercise. However, little is known about the efficacy of aerobic exercise (AE) to augment smoking and vaping cessation. This study aimed to systematically review and discuss the reported effects of AE on long-term vaping and smoking cessation in randomized control trials (RCTs). RCTs were searched on different databases. The outcome measures included long-term vaping or smoking cessation and maximal or peak oxygen uptake (VO2max/peak) after vaping- or smoking cessation. Meta-analysis was conducted to examine the effects of AE on long-term vaping and smoking cessation, and the effects of AE on VO2max/peak. Cochrane Risk of Bias tool 2 was used to assess trials quality. Thirteen trials were included (5 high, 2 moderate and 6 low quality). Although two high quality trials revealed that 3 vigorous supervised AE sessions a week for 12 to 15 weeks increased the number of long-term successful quitters, the meta-analysis including the other trials showed that AE did not significantly increase success rate of long-term quitters. However, VO2max/peak was improved at the end of treatment. There were no trials on AE and vaping cessation. No evidence was found that AE promotes long-term smoking cessation. Nevertheless, AE improved VO2max and/or VO2peak in quitters.

Aerobic exercise as a promising nonpharmacological therapy for the treatment of substance use disorders

Despite the prevalence and public health impact of substance use disorders (SUDs), effective long-term treatments remain elusive. Aerobic exercise is a promising, nonpharmacological treatment currently under investigation as a strategy for preventing drug relapse. Aerobic exercise could be incorporated into the comprehensive treatment regimens for people with substance abuse disorders. Preclinical studies of SUD with animal models have shown that aerobic exercise diminishes drug-seeking behavior, which leads to relapse, in both male and female rats. Nevertheless, little is known regarding the effects of substance abuse-induced cellular and physiological adaptations believed to be responsible for drug-seeking behavior. Accordingly, the overall goal of this review is to provide a summary and an assessment of findings to date, highlighting evidence of the molecular and neurological effects of exercise on adaptations associated with SUD.

Predictors of Cigarette Smoking Cessation in Adolescents: A Systematic Review

PURPOSE

To update a systematic review published in 2012 that identified predictors of cigarette smoking cessation among adolescents.

METHODS

The PubMed and Web of Science databases were searched for relevant articles published between September 2010 and January 2018, using the following keywords: smoking OR tobacco OR cessation; quit OR stop; longitudinal OR prospective OR cohort. Our search identified 3,399 articles. Inclusion criteria included longitudinal studies (intervention and cohort studies) evaluating cigarette smoking cessation in young people (aged 10-24 years). After screening, in total, 34 articles were included in the review.

RESULTS

In total, 63 predictors of smoking cessation among adolescents were identified, with 36 new predictors that were not identified in the previous review: nine sociodemographic factors, 13 psychosocial factors, five behavioral factors, 19 social influences factors, eight smoking related variables, six environmental factors, 2 health related variables, and one genetic factor.

CONCLUSIONS

To increase the probability of successful smoking cessation, strategies targeting young smokers should consider both individual and environmental predictors of cessation.

Short Bouts of Physical Activity Are Associated with Reduced Smoking Withdrawal Symptoms, but Perceptions of Intensity May Be the Key

The primary aim of this study was to assess the effectiveness of a short bout (10 min) of moderate-intensity exercise to reduce withdrawal symptomatology, craving and negative affect; while the secondary aim was to assess how the effectiveness of a short bout of moderate exercise can be modulated by the perception of intensity in physically active and low-activity smokers. Fifty low-activity and physically active smokers were recruited (24 male and 26 female) and randomized in three different conditions. Prescribed (objective) moderate intensity (OBJ) and perceived moderate intensity (PER), and passive waiting (PW). After the intervention (T3), smokers reported less desire to smoke in the PER (p < 0.001) and OBJ (p < 0.001) conditions, relative to the PW condition. At T3 smokers in the PER condition reported less negative affect than smokers in the PW condition relative to the baseline (T1) (p < 0.007). Further, smokers in the PER condition reported less negative affect than smokers in the PW condition (p < 0.048). Physically active (PA) smokers perceived less exertion than low-activity (LA) smokers, and the effects were stronger in the PER condition relative to OBJ. Generally, our results suggest that a short bout of moderate exercise helps both LA and PA smokers. These findings provided a novel insight into the psychological mechanisms that affect the efficacy of the exercise in smoking cessation and suggest that exercise should be tailored according to individual perception of intensity.

Long-Term Outcomes of a Preoperative Lung Resection Smoking Cessation Program

BACKGROUND

Smoking cessation programs for patients with cancer suggest 6-mo quit rates between 22% and 40%, and 1-y rates of 33%. We sought to investigate the long-term outcomes of an intensive, preoperative smoking cessation program in patients undergoing lung resection.

MATERIAL AND METHODS

A retrospective analysis of an IRB-approved, prospective database was performed. Elective lung resections between January 1, 2015 and June 30, 2017 were identified. Demographics, smoking status, pack years, occurrence of smoking cessation counseling, complications, and quit date were obtained. Smoking cessation included face-to-face motivational interviewing, choice of nicotine replacement therapy, discussion that surgery may be canceled or delayed without cessation, and follow-up as needed.

RESULTS

A total of 340 patients underwent lung resection. Of these, 82 patients were classified as current smokers. All were advised to quit and encouraged to meet with a certified tobacco treatment specialist. Sixty-three patients met with a tobacco treatment specialist and 19 did not. Overall, 60 patients (73%) were able to quit before surgery. At 2 y postoperatively, 15 (18%) were lost to follow-up and 9 (11%) had died. Excluding deaths and censoring those lost to follow-up, cessation rates at 6, 12, and 24 mo postoperatively were 55.3%, 55.6%, and 51.7%, respectively.

CONCLUSIONS

Implementation of an intensive smoking cessation program in the preoperative period demonstrated high initial, mid-term, and long-term success rates. The preoperative period, particularly one centered around lung cancer, is an effective time for smoking cessation intervention and can lead to a high rate of cessation up to 2 y after surgery.

Exercise interventions for smoking cessation

BACKGROUND

Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain.

OBJECTIVES

To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019.

SELECTION CRITERIA

We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models.

MAIN RESULTS

We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I² = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I² = 0%; 453 participants).

AUTHORS' CONCLUSIONS

There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.

Smoking and Physical Activity Trajectories from Childhood to Midlife

Introduction: Despite substantial interest in the development of health behaviors, there is limited research that has examined the longitudinal relationship between physical activity (PA) and smoking trajectories from youth to adulthood in a Finnish population. This study aimed to identify trajectories of smoking and PA for males and females, and study the relationship between these trajectories from youth to adulthood. Methods: Latent profile analysis (LPA) was used to identify trajectories of smoking and PA separately for males and females among 3355 Finnish adults (52.1% females). Participants' smoking and PA were assessed five to eight times over a 31-year period (3⁻18 years old at the baseline, 34⁻49 years at last follow-up). Multinomial logistic regression analysis was used to study the relationship between the trajectories of smoking and PA. Results: Five smoking trajectories and four to five PA trajectories were identified for males and females. Of the PA trajectory groups, the persistently active group were least likely to follow the trajectories of regular smoking and the inactive and low active groups were least likely to follow non-smoking trajectory group. Likewise, inactive (women only) and low active groups were less likely to belong to the non-smokers group. Conclusions: The study suggests that those who are persistently active or increasingly active have substantially reduced probabilities of being in the highest-risk smoking categories.

The Prospective Association Between the Five Factor Personality Model With Health Behaviors and Health Behavior Clusters

To examine the prospective association of personality with individual behavior, multibehavior and clustered health behavior profiles. A prospective study design was employed. Two hundred young adults provided baseline data and 126 (mean age: 21.6 yrs) provide complete data for a 5-month follow-up assessment (63% response rate). Personality and health behaviors (and covariates) were assessed via validated questionnaires. A multibehavior index variable was created ranging from 0-5; two separate health behavior cluster indices were created, including high (4-5 behaviors) vs. low (2 or fewer) behavior adoption and an energy balance cluster (MVPA and diet). When examining MVPA as a continuous variable, the personality trait conscientiousness was prospectively associated with MVPA and a healthy diet. Extraversion was prospectively associated with high (vs. low) behavioral clustering (OR = 1.18; 95% CI: 1.00-1.40) and conscientiousness was prospectively associated with energy balance clustering (OR = 1.09; 95% CI: 1.01-1.17). Extraversion, conscientiousness, openness to experience, and agreeableness were associated with select health-related behaviors. Further, extraversion and conscientiousness were associated with health behavior clustering.

Physical Activity and Cognitive Function among Older Adults with an Elevated Gamma Gap

OBJECTIVE

An elevated gamma gap is indicative of high serum concentrations of globulin proteins, some of which elicit acute inflammatory responses. An impaired cognitive function has been linked to central and peripheral inflammation, while exercise is associated with protective, anti-inflammatory benefits. In this study, we evaluated whether the gamma gap is associated with cognitive function among older adults and whether physical activity is favorably associated with cognitive function among those with an elevated gamma gap.

MATERIALS AND METHODS

Data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) were used to identify 2,352 older adults aged between 60 and 85 years. The gamma gap was evaluated by subtracting albumin from total protein, i.e., gamma gap = total protein (g/dL) - albumin (g/dL). Those at or above 3.1 g/dL (31.0 g/L) were considered to have an elevated gamma gap. The Digit Symbol Substitution Test (DSST) was used to assess cognitive function tasks of pairing and free recall among participants. Participants were asked open-ended questions about participation in leisure-time physical activity over the previous 30 days.

RESULTS

Those with an elevated gamma gap (DSST, 44.8) had a lower cognitive function score when compared to those without an elevated gamma gap (DSST, 50.1) (p < 0.001). After adjustments, and among those with an elevated gamma gap, those meeting the moderate-to-vigorous intensity physical activity (MVPA) guidelines (vs. not meeting them) had a DSST score of 6.42 units higher (β = 6.42, 95% CI 3.85-8.99, p < 0.001).

CONCLUSION

In this national sample of older adults, the gamma gap was associated with cognitive function, and among those with an elevated gamma gap, meeting the physical activity guidelines was associated with a higher cognitive function. Relevant clinical implications are discussed, as the gamma gap may be predictive of the risk for early mortality and reduced quality of life. Experimental work is needed to investigate whether physical activity training programs are effective in reducing an elevated gamma gap and preserving optimal cognitive functioning among at-risk individuals.

The Association between Lower Extremity Muscular Strength and Cognitive Function in a National Sample of Older Adults

Background

We evaluated the association between lower extremity muscular strength and cognition among older adults in the United States.

Methods

Data from the 1999–2002 National Health and Nutrition Examination Survey was used to identify 1508 older adults, between 60–85 years. Muscle strengthening activities were assessed via self-report. Participation in physical activity was determined from self-report data. The DSST was used to assess participant executive cognitive functioning tasks of pairing and free recall. A Kin-Com MP isokinetic dynamometer (Chatanooga Group Inc.) was used to assess lower extremity strength, expressed as absolute strength (N), relative strength (N/body weight in kg), and high (<245.75 N) vs. low (≤245.75 N) absolute strength based on the median levels of strength.

Results

Lower extremity strength (β = 0.01; 95% CI: 0.0008–0.03; p = 0.039) was associated with higher cognitive performance, independent of age, muscle strengthening activities, physical activity and other covariates. In an adjusted multivariate logistic regression model, those with high (vs. low) strength had a 34% reduced odds of having low cognitive function (OR = 0.66; 95% CI: 0.46–0.93; p = 0.02).

Conclusion

In this nationally representative sample of older adults, there was a positive association between elevated lower extremity muscular strength and cognitive functioning.

Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial

Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP), a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American). Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.

Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic

Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.

Exercise Facilitates Smoking Cessation Indirectly via Intention to Quit Smoking: Prospective Cohort Study Among a National Sample of Young Smokers

INTRODUCTION

We evaluated the specific association between exercise and smoking cessation via smoking-mediated intentions to quit smoking among a national sample of young daily smokers in the United States.

DESIGN

Prospective cohort study over a 2-year period, with daily smokers assessed across all 50 states in the United States.

SETTING

Data from the 2003 to 2005 National Youth Smoking Cessation Survey were used.

PARTICIPANTS

A total of 1175 young adult smokers aged between 18 and 24 years.

MEASURES

Baseline exercise and intent to quit smoking were assessed via validated survey measures. Smoking status at the 2-year follow-up period was assessed via survey assessment.

RESULTS

After adjustments, meeting exercise guidelines at baseline was associated with an increased baseline intent to quit smoking among this national sample of daily smokers (OR = 1.49; 95% confidence interval [CI]: 1.07-2.07; P = .01). After adjustments, those with a baseline intent to quit smoking had a 71% increased odds ratio (OR) of being a nonsmoker at the 2-year follow-up (OR = 1.71; 95% CI: 1.20-2.44; P = .003). Baseline exercise was not associated with 2-year follow-up smoking status (OR = 0.87; 95% CI: 0.60-1.28; P = .50).

CONCLUSION

In this nationally representative sample of young daily smokers, there was a positive association between exercise participation and intention to quit smoking. Baseline intent to quit smoking was independently associated with nonsmoking status at a 2-year follow-up. Thus, this indirect link between exercise and smoking status may be partially explained by the influence of exercise engagement on smoking-specific intentions.

Assessing the feasibility, acceptability and potential effectiveness of an integrated approach to smoking cessation for new and expectant fathers: The Dads in Gear study protocol

BACKGROUND

Evidence related to the effects of tobacco exposure in pregnancy and on infant and child health have focused on women's smoking cessation. Less often addressed is men's smoking, which when continued in fatherhood, reduces the chances of female partners' cessation and can negatively impact children's health as well as men's health. Dads in Gear (DIG) is an innovative program designed specifically for new fathers who want to reduce and quit smoking that includes three components: smoking cessation, fathering, and physical activity. The over-arching purpose of this study is to evaluate the feasibility of the DIG program and provide estimates of program efficacy. The purpose of this article is to describe the rationale and protocol for evaluating the DIG program's feasibility, acceptability and potential effectiveness.

METHODS

Using a prospective, non-comparative design, the DIG program will be implemented and evaluated in six communities. The program will be offered by trained facilitators to fathers who currently smoke and want to quit. The RE-AIM framework will guide the evaluation. Open-ended questions in participant surveys, and semi-structured interviews and weekly telephone de-briefs with facilitators will provide data for a process evaluation. Estimates of effectiveness include smoking behavior, fathering and physical activity measures at baseline, end of program, and 3-month follow up.

CONCLUSION

The DIG program could support positive changes with respect to smoking cessation, physical activity and overall health for men. These effects could also promote family health. The program might also provide an effective model for engaging men in other health behavior change.

The association between habitual physical activity and cigarette cravings, and influence of smokers' characteristics in disadvantaged smokers not ready to quit

RATIONALE

Habitual physical activity (PA) may have an important role in suppressing cigarette cravings. Systematic reviews show a strong acute effect of bouts of PA on reducing cigarette cravings, and it may be that these effects accumulate.

OBJECTIVES

The aim was to investigate the relationship between habitual levels of PA and cigarette cravings in disadvantaged smokers not ready to quit by examining baseline cross-sectional data from the Exercise Assisted Reduction then Stop smoking study (EARS).

METHODS

A series of linear regression models were applied to investigate the relationship between habitual PA and cigarette cravings and to identify additional predictors of cigarette cravings. The analyses were extended by including interaction terms with PA to identify potential moderators of the relationship between PA and cravings.

RESULTS

A higher level of moderate intensity PA was associated with lower cravings (p = 0.033). Additional predictors were the mood and physical symptoms scale (p = 0.007; higher scores were associated with higher cravings) and alcohol consumption (p = 0.002; higher consumption was associated with lower cravings). In addition, a moderation effect of alcohol consumption was found; at higher levels of alcohol consumption, higher PA was significantly associated with higher cravings (p = 0.023).

CONCLUSIONS

Overall, participation in regular PA is associated with reduced cigarette cravings; among those with heavy alcohol consumption, this participation is associated with higher cravings. These exploratory analyses suggest that further research into the relationship between PA, alcohol consumption and cigarette cravings is needed.