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Weinberger AH, Platt JM, Smith PH, Goodwin RD. Racial/Ethnic Differences in Self-reported Withdrawal Symptoms and Quitting Smoking Three Years Later: A Prospective, Longitudinal Examination of US Adults. Nicotine Tob Res 2017; 19:373-378. [PMID: 27613908 DOI: 10.1093/ntr/ntw221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/26/2016] [Indexed: 12/16/2022]
Abstract
Introduction Racial/ethnic groups appear to differ on quit success and withdrawal is a key factor in cessation failure, yet little is known about racial/ethnic differences in withdrawal symptoms. This study of US adults examined racial/ethnic differences in current smokers' report of withdrawal symptoms and the relationship between withdrawal symptoms and quitting smoking 3 years later. Methods Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2001; Wave 2, 2004-2005), analyses were conducted on participants who identified as non-Hispanic White, non-Hispanic Black, or Hispanic; reported current cigarette smoking at Wave 1; and provided smoking status information at Wave 2 (n = 7981). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Results Among Wave 1 current smoking adults, non-Hispanic White respondents were more likely than non-Hispanic Black and Hispanic respondents to report experiencing at least one withdrawal symptom, seven out of eight withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related distress (ps < .0001). While withdrawal symptoms were associated with a lower odds of quitting smoking for all groups, a stronger relationship between number of symptoms and lower odds of quitting was evident among non-Hispanic White compared to non-Hispanic Black respondents (interaction β = 0.065, p = .0001). For non-Hispanic White participants, each additional withdrawal symptom was associated with a 6% decrease in the odds of quitting. Conclusions Withdrawal symptoms were more commonly reported by non-Hispanic White adults than non-Hispanic Black and Hispanic adults and appeared to have a greater impact on failure to quit smoking for non-Hispanic White compared to non-Hispanic Black adults. Implications To our knowledge, this is the first study to use prospective, longitudinal data to examine the relationship between race and withdrawal symptoms and the impact of withdrawal symptoms on quitting smoking among adults in the United States. Non-Hispanic White adults were more likely to report withdrawal symptoms and there was a stronger relationship between greater number of withdrawal symptoms and lower odds of quitting for non-Hispanic White adults compared to non-Hispanic Black adults. Developing a better understanding of racial/ethnic differences in withdrawal and cessation can help to tailor efforts to improve outcomes for smokers in various racial/ethnic groups.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan M Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
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Towns S, DiFranza JR, Jayasuriya G, Marshall T, Shah S. Smoking Cessation in Adolescents: targeted approaches that work. Paediatr Respir Rev 2017; 22:11-22. [PMID: 26187717 DOI: 10.1016/j.prrv.2015.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 01/06/2023]
Abstract
Smoking Cessation in adolescents can be considered in a developmental context to enable the clinician to individualise the appropriate assessment and management of the young person they are seeing whether it is in a primary or tertiary care setting. Adolescence is a time of rapid neurocognitive and hormonal change with these factors affected by personality and behavioural factors as well as family, cultural and psychosocial context. Adolescents are uniquely vulnerable to smoking initiation and nicotine addiction throughout these years. Increased awareness of the risks of smoking and using opportunities to assess and intervene regarding smoking cessation are integral to clinical practice for all clinicians seeing young people. This review will discuss the demographics of adolescent smoking, risk factors, assessing smoking and nicotine addiction, the importance of brief interventions, the evidence base for appropriate interventions, particularly in high risk groups and will emphasise innovative training for health professionals in adolescent smoking cessation.
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Affiliation(s)
- Susan Towns
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Faculty Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Joseph R DiFranza
- Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Tracey Marshall
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Smita Shah
- Primary Health Care Education and Research Unit, Western Sydney Local Health District, NSW, Australia
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Rodriquez EJ, Stoecklin-Marois MT, Hennessy-Burt TE, Tancredi DJ, Schenker MB. Acculturation-related predictors of very light smoking among Latinos in California and nationwide. J Immigr Minor Health 2016; 17:181-91. [PMID: 23942990 DOI: 10.1007/s10903-013-9896-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The prevalence of light smoking has increased among Latinos. The purpose of this study was to identify demographic and acculturation-related factors associated with very light smoking, defined as smoking 1-5 cigarettes per day (CPD), among Latinos in California and nationwide. Latino smokers in the 2007-2008 National Health and Nutrition Examination Survey (NHANES) or the 2009 California Health Interview Survey (CHIS) were analyzed. Logistic regression assessed factors associated with very light smoking. Among NHANES smokers, those born in Mexico or who lived fewer years in the US were more likely to be very light smokers than 6+ CPD smokers. Among CHIS smokers, those born in Mexico, in another Spanish speaking country, or who spent smaller percentages of their life in the US were more likely to be very light smokers. Findings from this study can be used to design tobacco control media campaigns that include very light smokers.
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Affiliation(s)
- Erik J Rodriquez
- Center for Tobacco Control Research and Education, University of California, 530 Parnassus Ave, Ste 366, Box 1390, San Francisco, CA, 94143-1390, USA,
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Soyster P, Anzai NE, Fromont SC, Prochaska JJ. Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization. Prev Med 2016; 92:176-182. [PMID: 26892910 PMCID: PMC5108455 DOI: 10.1016/j.ypmed.2016.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N=754) were enrolled between 2009 and 2013, and averaged 17 (SD=10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470]=23.03 p<0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.
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Affiliation(s)
- Peter Soyster
- University of California, Berkeley, Department of Psychology. Room 3210, Tolman Hall #1650, Berkeley, CA 94720, USA.
| | - Nicole E Anzai
- Stanford Prevention Research Center, Department of Medicine, Stanford University. 1265 Welch Road, Palo Alto, CA 94305, USA.
| | - Sebastien C Fromont
- Affiliated with Alta Bates Medical Center at the time the study was conducted. 2001 Dwight Way, Berkeley, CA 94704, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University. 1265 Welch Road, Palo Alto, CA 94305, USA.
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Bello MS, Pang RD, Cropsey KL, Zvolensky MJ, Reitzel LR, Huh J, Leventhal AM. Tobacco Withdrawal Amongst African American, Hispanic, and White Smokers. Nicotine Tob Res 2015; 18:1479-87. [PMID: 26482061 DOI: 10.1093/ntr/ntv231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/01/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Persistent tobacco use among racial and ethnic minority populations in the United States is a critical public health concern. Yet, potential sources of racial/ethnic disparities in tobacco use remain unclear. The present study examined racial/ethnic differences in tobacco withdrawal-a clinically-relevant underpinning of tobacco use that has received sparse attention in the disparities literature-utilizing a controlled laboratory design. METHODS Daily smokers (non-Hispanic African American [n = 178], non-Hispanic white [n = 118], and Hispanic [n = 28]) attended two counterbalanced sessions (non-abstinent vs. 16-hour abstinent). At both sessions, self-report measures of urge, nicotine withdrawal, and affect were administered and performance on an objective behavioral task that assessed motivation to reinstate smoking was recorded. Abstinence-induced changes (abstinent scores vs. non-abstinent scores) were analyzed as a function of race/ethnicity. RESULTS Non-Hispanic African American smokers reported greater abstinence-induced declines in several positive affect states in comparison to other racial/ethnic groups. Relative to Hispanic smokers, non-Hispanic African American and non-Hispanic white smokers displayed larger abstinence-provoked increases in urges to smoke. No racial/ethnic differences were detected for a composite measure of nicotine withdrawal symptomatology, negative affect states, and motivation to reinstate smoking behavior. CONCLUSIONS These results suggest qualitative differences in the expression of some components of tobacco withdrawal across three racial/ethnic groups. This research helps shed light on bio-behavioral sources of tobacco-related health disparities, informs the application of smoking cessation interventions across racial/ethnic groups, and may ultimately aid the overall effort towards reducing the public health burden of tobacco addiction in minority populations. IMPLICATIONS The current study provides some initial evidence that there may be qualitative differences in the types of tobacco withdrawal symptoms experienced among non-Hispanic African American, Hispanic, and non-Hispanic white smokers. Extending this line of inquiry may elucidate mechanisms involved in tobacco-related health disparities and ultimately aid in reducing the public health burden of smoking in racial/ethnic minority populations.
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Affiliation(s)
- Mariel S Bello
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Karen L Cropsey
- Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA; Department of Psychology, University of Southern California, Los Angeles, CA;
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Kleinjan M, Engels RCME, DiFranza JR. Parental smoke exposure and the development of nicotine craving in adolescent novice smokers: the roles of DRD2, DRD4, and OPRM1 genotypes. BMC Pulm Med 2015; 15:115. [PMID: 26449981 PMCID: PMC4599744 DOI: 10.1186/s12890-015-0114-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among adolescent novice smokers, craving is often the first, and is the most reported, symptom of nicotine dependence. Until now, little has been known about the development of craving symptoms in novice smokers. The aim of this study was to identify specific genetic (i.e., DRD2 Taq1A, DRD4 48 bp VNTR, and OPRM1 A118G polymorphisms) and environmental mechanisms that underlie the emergence of both cue-induced and cognitive craving among adolescent novice smokers. METHOD A five-wave longitudinal, genetically-informed survey study was conducted with intervals of four months. The sample included 376 early adolescent smokers (12-13 years of age at baseline). Self-report questionnaires were completed regarding smoking behavior, observed parental smoking behavior, and both cue-induced and cognitive craving. RESULTS Data were analyzed with a latent growth curve approach. For both cue-induced and cognitive craving, significant interaction effects were found for DRD2 Taq1A with parental smoke exposure. A1-allele carriers did not seem to be influenced by the environment with regard to craving development. Adolescents who are homozygous for the A2-allele and who are more exposed to parental smoking experience the highest levels of both types of craving over time. No significant interaction effects were found between parental smoke exposure and DRD4 48 bp VNTR or OPRM1 A118G. CONCLUSIONS Previous studies identified DRD2 Taq1A A1-allele carriers as vulnerable to developing nicotine dependence. However, this study showed that parental smoking increased the chances of developing dependence more rapidly for early adolescents who are considered to be less sensitive to the rewarding effects of nicotine according to their DRD2 Taq1A genotype. It is thus especially important that these young people not be exposed to smoking in their social environment.
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Affiliation(s)
- Marloes Kleinjan
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
| | - Rutger C M E Engels
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.
| | - Joseph R DiFranza
- University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA.
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Hendricks PS, Westmaas JL, Park VMT, Thorne CB, Wood SB, Baker MR, Lawler RM, Hooper MW, Delucchi KL, Hall SM. Smoking abstinence-related expectancies among American Indians, African Americans, and women: potential mechanisms of tobacco-related disparities. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:193-205. [PMID: 23528192 PMCID: PMC4103623 DOI: 10.1037/a0031938] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has documented tobacco-related health disparities by race and gender. Prior research, however, has not examined expectancies about the smoking cessation process (i.e., abstinence-related expectancies) as potential contributors to tobacco-related disparities in special populations. This cross-sectional study compared abstinence-related expectancies between American Indian (n = 87), African American (n = 151), and White (n = 185) smokers, and between women (n = 231) and men (n = 270) smokers. Abstinence-related expectancies also were examined as mediators of race and gender relationships with motivation to quit and abstinence self efficacy. Results indicated that American Indians and African Americans were less likely than Whites to expect withdrawal effects, and more likely to expect that quitting would be unproblematic. African Americans also were less likely than Whites to expect smoking cessation interventions to be effective. Compared with men, women were more likely to expect withdrawal effects and weight gain. These expectancy differences mediated race and gender relationships with motivation to quit and abstinence self-efficacy. Findings emphasize potential mechanisms underlying tobacco-related health disparities among American Indians, African Americans, and women and suggest a number of specific approaches for targeting tobacco dependence interventions to these populations.
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8
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Neuroadaptation in nicotine addiction: update on the sensitization-homeostasis model. Brain Sci 2012; 2:523-52. [PMID: 24961259 PMCID: PMC4061804 DOI: 10.3390/brainsci2040523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/05/2012] [Accepted: 09/25/2012] [Indexed: 01/24/2023] Open
Abstract
The role of neuronal plasticity in supporting the addictive state has generated much research and some conceptual theories. One such theory, the sensitization-homeostasis (SH) model, postulates that nicotine suppresses craving circuits, and this triggers the development of homeostatic adaptations that autonomously support craving. Based on clinical studies, the SH model predicts the existence of three distinct forms of neuroplasticity that are responsible for withdrawal, tolerance and the resolution of withdrawal. Over the past decade, many controversial aspects of the SH model have become well established by the literature, while some details have been disproven. Here we update the model based on new studies showing that nicotine dependence develops through a set sequence of symptoms in all smokers, and that the latency to withdrawal, the time it takes for withdrawal symptoms to appear during abstinence, is initially very long but shortens by several orders of magnitude over time. We conclude by outlining directions for future research based on the updated model, and commenting on how new experimental studies can gain from the framework put forth in the SH model.
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Kiviniemi MT, Orom H, Giovino GA. Psychological distress and smoking behavior: the nature of the relation differs by race/ethnicity. Nicotine Tob Res 2010; 13:113-9. [PMID: 21159784 DOI: 10.1093/ntr/ntq218] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We explored how the relation between psychological distress and smoking behavior differed as a function of race/ethnicity of respondents to a representative national survey. METHODS Data from the 2007 Health Information National Trends Survey were analyzed. Participants reported experiences of psychological distress in the past 30 days, race/ethnicity, current smoking status (smoker/nonsmoker), and number of cigarettes smoked per day. Logistic regression and linear regression analyses were used to examine the influence of race, distress, and their interaction on smoking behavior using survey weighting techniques to account for sampling strategy and nonresponse. RESULTS For current smoking status, there was a significant interaction between race and psychological distress. Follow-up analyses indicated that psychological distress was related to smoking status for White but not for Black or Hispanic respondents. Similar results were found for number of cigarettes smoked per day among current smokers. CONCLUSIONS The results suggest that the often-reported association between psychological distress and smoking is relatively specific to White individuals. The relation does not appear to characterize either Black or Hispanic individuals.
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Affiliation(s)
- Marc T Kiviniemi
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 314 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, USA.
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Difranza JR. Thwarting science by protecting the received wisdom on tobacco addiction from the scientific method. Harm Reduct J 2010; 7:26. [PMID: 21050440 PMCID: PMC2992487 DOI: 10.1186/1477-7517-7-26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 11/04/2010] [Indexed: 01/03/2023] Open
Abstract
In their commentary, Dar and Frenk call into question the validity of all published data that describe the onset of nicotine addiction. They argue that the data that describe the early onset of nicotine addiction is so different from the conventional wisdom that it is irrelevant. In this rebuttal, the author argues that the conventional wisdom cannot withstand an application of the scientific method that requires that theories be tested and discarded when they are contradicted by data. The author examines the origins of the threshold theory that has represented the conventional wisdom concerning the onset of nicotine addiction for 4 decades. The major tenets of the threshold theory are presented as hypotheses followed by an examination of the relevant literature. Every tenet of the threshold theory is contradicted by all available relevant data and yet it remains the conventional wisdom. The author provides an evidence-based account of the natural history of nicotine addiction, including its onset and development as revealed by case histories, focus groups, and surveys involving tens of thousands of smokers. These peer-reviewed and replicated studies are the work of independent researchers from around the world using a variety of measures, and they provide a consistent and coherent clinical picture. The author argues that the scientific method demands that the fanciful conventional wisdom be discarded and replaced with the evidence-based description of nicotine addiction that is backed by data. The author charges that in their attempt to defend the conventional wisdom in the face of overwhelming data to the contrary, Dar and Frenk attempt to destroy the credibility of all who have produced these data. Dar and Frenk accuse other researchers of committing methodological errors and showing bias in the analysis of data when in fact Dar and Frenk commit several errors and reveal their bias by using a few outlying data points to misrepresent an entire body of research, and by grossly and consistently mischaracterizing the claims of those whose research they attack.
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Affiliation(s)
- Joseph R Difranza
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
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DiFranza JR, Ursprung WWSA. The latency to the onset of nicotine withdrawal: a test of the sensitization-homeostasis theory. Addict Behav 2008; 33:1148-53. [PMID: 18547736 DOI: 10.1016/j.addbeh.2008.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 04/03/2008] [Accepted: 04/29/2008] [Indexed: 11/30/2022]
Abstract
The latency to withdrawal (LTW) is the expired time between the last cigarette and when the smoker feels the need to smoke again. The sensitization-homeostasis theory predicts that the LTW is inversely related to the frequency and duration of smoking such that more frequent cigarette consumption and a longer history of tobacco use will be associated with a shorter LTW. An anonymous cross-sectional survey of 1055 10th and 11th grade students of mixed ethnicity was conducted in two schools using self-completed questionnaires. Participants were asked "After you have smoked a cigarette, how long can you go before you feel you need to smoke again?" Of 162 current smokers, 73.5% reported a regular need to smoke and a LTW. Reported values for the LTW ranged from .05 h to "3 weeks or more." Monthly cigarette consumption ranged from 1 to 895. The LTW correlated inversely with monthly cigarette consumption (Kendall's tau b=-.53, P<.001) and the duration of smoking (Kendall's tau b=-.25, P<.001) as predicted by the sensitization-homeostasis theory.
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Affiliation(s)
- Joseph R DiFranza
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Smith AE, Cavallo DA, Dahl T, Wu R, George TP, Krishnan-Sarin S. Effects of acute tobacco abstinence in adolescent smokers compared with nonsmokers. J Adolesc Health 2008; 43:46-54. [PMID: 18565437 PMCID: PMC2527725 DOI: 10.1016/j.jadohealth.2007.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 11/29/2007] [Accepted: 12/01/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE Abstinence effects such as nicotine withdrawal and mood changes contribute to the maintenance of cigarette smoking in adult smokers, and emerging reports on adolescent smokers suggest they may experience similar subjective effects when deprived. This study aimed to prospectively document tobacco abstinence-induced changes during the first 48 hours of abstinence in adolescent smokers compared with nonsmokers, to distinguish effects distinct from typical adolescent lability. METHODS Fifty-seven adolescent smokers and 44 adolescent nonsmokers were assessed during a 48-hour inpatient session. Characteristic nicotine withdrawal symptoms, cravings for cigarettes, and mood symptoms were measured at 13 time points following initiation of abstinence. RESULTS The only abstinence-related effects observed were changes in craving for tobacco and feelings of anger. Tobacco craving increased and peaked quickly following initiation of abstinence and displayed a slight decrease toward the end of the 48-hour abstinence period, while anger symptoms peaked after a more prolonged abstinence. Overall, smokers' symptoms and cravings were positively associated with amount of daily smoking but not with reports of dependence or biological measures of extent of use. CONCLUSIONS We observed that among adolescent smokers, the primary effects associated with abstinence from cigarettes are relatively minimal, and include a heightened and persistent craving to smoke and increases in anger. Although smokers had greater negative mood symptoms compared with nonsmokers, the presence and severity of most of these symptoms appear to be minimally altered by abstinence and not associated with dependency or biological indicators of amount of tobacco use.
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Affiliation(s)
- Anne E Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA
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Smith AE, Cavallo DA, McFetridge A, Liss T, Krishnan-Sarin S. Preliminary examination of tobacco withdrawal in adolescent smokers during smoking cessation treatment. Nicotine Tob Res 2008; 10:1253-9. [PMID: 18629736 PMCID: PMC3777831 DOI: 10.1080/14622200802219357] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tobacco withdrawal symptoms have been shown to play a significant role in mediating relapse to smoking in adult smokers; however, few prospective studies have examined the course of tobacco withdrawal symptoms over time and their connection to lapse in adolescent smokers. Withdrawal symptoms were assessed weekly for 4 weeks in a sample of adolescent smokers participating in a pilot cessation intervention. Adolescent smokers experienced an exacerbation in overall withdrawal symptoms, particularly of cravings and restlessness, although symptoms were generally mild. The course of symptoms was different for boys and girls: Girls generally experienced a peak and subsequent decline in symptoms early in the establishment of abstinence, whereas boys experienced a constant level of symptoms that did not decline over the 4 weeks. Finally, withdrawal symptoms experienced on quit day were not related to lapse to smoking during the course of treatment for either boys or girls. These results suggest that although withdrawal symptoms may be uncomfortable, they may not be the most salient to a lapse to smoking for adolescent smokers attempting to quit. These findings have direct implications for the design and implementation of treatment of nicotine dependence in adolescent smokers.
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Affiliation(s)
- Anne Emilie Smith
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
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15
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Fernando WWSA, Wellman RJ, Difranza JR. The relationship between level of cigarette consumption and latency to the onset of retrospectively reported withdrawal symptoms. Psychopharmacology (Berl) 2006; 188:335-42. [PMID: 16953390 DOI: 10.1007/s00213-006-0497-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 06/22/2006] [Indexed: 11/25/2022]
Abstract
RATIONALE Subthreshold smokers (who smoke < or =5 cigarettes/day) experience withdrawal symptoms, yet they smoke less than is required to maintain serum nicotine levels. OBJECTIVES For study 1, our aim was to determine (1) if adult subthreshold smokers report withdrawal symptoms; (2) how they rate symptom severity; (3) the length of their latency to withdrawal symptoms; (4) and the relationship between level of cigarette consumption and latency to withdrawal. The aim of study 2 was to attempt to replicate the results of study 1 in a nationally representative sample and to compare subthreshold and threshold (> or =6 cigarettes/day) smokers. METHODS Study 1 was conducted through telephone interviews. Study 2 was conducted through secondary analysis of data from the National Youth Tobacco Survey (self-administered in schools). RESULTS In study 1, all subjects experienced withdrawal symptoms. The mean number of symptoms was 4.3; mean intensity of each symptom was >6 (1-10 scale). A quarter of the subjects could go for > or =2 days before experiencing withdrawal. More frequent smokers had a shorter latency to withdrawal (r=-0.43, p<0.001, n=36). In study 2, 63% of subthreshold smokers reported feeling at least one withdrawal symptom. Median latency to withdrawal was 168 h for subthreshold and 2 h for threshold smokers. A negative correlation between level of cigarette consumption and latency to withdrawal was observed for both groups. CONCLUSIONS Although subthreshold smokers experience significant withdrawal symptoms, they can smoke infrequently because symptoms may not appear for one to several days. Consistent with the sensitization-homeostasis theory, low doses of nicotine can suppress withdrawal symptoms over long periods.
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Affiliation(s)
- W W S A Fernando
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Abstract
Relapse is by far the most likely outcome of any smoking cessation attempt, even those made with the benefit intensive psychosocial treatment and pharmacotherapy. The present article briefly reviews the epidemiology of smoking and self-quitting, the outcome data for major forms of behavioral and pharmacologic smoking cessation treatments, and what is known about the natural history of relapse and recovery among treated smokers. A recent trend in smoking relapse research has been to study the dynamics of key motivational processes, such as withdrawal symptoms, negative affect, and craving, in the laboratory and in smokers' natural environments. This literature is also briefly reviewed, with an emphasis on how such investigations may reveal the limitations of current cessation treatments. Finally, three significant research themes that are likely to be important in future relapse research are highlighted--the possible "hardening" of the smoking population, the potential for developmental research to deepen our understanding of smoking motivation, and the promise of molecular genetic studies for advancing treatment and our understanding of relapse.
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Affiliation(s)
- Thomas M Piasecki
- Department of Psychological Sciences, 210 McAlester Hall, University of Missouri-Columbia, Columbia, MO 65211, USA.
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17
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Panday S, Reddy SP, Ruiter RAC, Bergström E, de Vries H. Determinants of smoking cessation among adolescents in South Africa. HEALTH EDUCATION RESEARCH 2005; 20:586-599. [PMID: 15772246 DOI: 10.1093/her/cyh020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Data is required on the motivational determinants of smoking cessation among a multi-ethnic sample of adolescents in South Africa. The I-Change Model was used to explore the determinants of smoking cessation among a sample of 1267 Black African, Colored and White Grade 9-11 monthly smokers and former smokers in the Southern Cape-Karoo region. Across the ethnic groups, former smokers displayed a more positive attitude toward non-smoking, were surrounded by a social environment that was more supportive of non-smoking, displayed higher self-efficacy not to smoke in stressful, routine and social situations, and were more positive about their intention not to smoke in the next year. The I-Change Model can be used to address the cognitions of smoking in a multi-ethnic society like South Africa. However, some ethnic tailoring will be required. Black African students will benefit from a focus on attitudinal cognitions and cultural factors that motivate smoking. Colored students require the involvement of their social environment, while White students will benefit from the development of refusal skills in social situations.
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Affiliation(s)
- Saadhna Panday
- Department of Health Education and Health Promotion, Maastricht University, The Netherlands.
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18
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Hanson MJS. An examination of ethnic differences in cigarette smoking intention among female teenagers. ACTA ACUST UNITED AC 2005; 17:149-55. [PMID: 15819640 DOI: 10.1111/j.1041-2972.2005.0023.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe and compare predictors of cigarette smoking intention, as defined by the theory of planned behavior, among African American, Puerto Rican, and non-Hispanic white female teenagers. DATA SOURCES A convenience sample of 430 English-speaking female teenagers (141 African American, 146 Puerto Rican, and 143 non-Hispanic white teenagers), aged 13-19 years, who were patients at family planning clinics in eastern Pennsylvania. The data were obtained through a self-administered questionnaire. CONCLUSIONS Regression analyses demonstrated attitude, subjective norm, and perceived behavioral control predicted 70% of the variance in smoking intention in African American, 69% in Puerto Rican, and 88% in non-Hispanic white teenagers. In addition, ethnic group differences were identified. For African Americans, smoking intention was mediated principally by perceived behavioral control, whereas for Puerto Rican and non-Hispanic white teenagers, attitudes were the greatest predictor of intention to smoke. Moreover, non-Hispanic white smokers had a stronger intention to smoke than either the African American or Puerto Rican smokers. IMPLICATIONS FOR PRACTICE Cigarette smoking is the leading preventable cause of death in the United States, with the majority of smokers initiating the habit in their teen years. Nurse practitioners are in key positions to counsel young women about the dangers of smoking. The identification of cultural-specific predictors of smoking will assist in the development of tailored antismoking messages.
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Robinson LA, Vander Weg MW, Riedel BW, Klesges RC, McLain-Allen B. "Start to stop": results of a randomised controlled trial of a smoking cessation programme for teens. Tob Control 2005; 12 Suppl 4:IV26-33. [PMID: 14645937 PMCID: PMC1766134 DOI: 10.1136/tc.12.suppl_4.iv26] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the feasibility, acceptability, and effectiveness of a school based smoking cessation programme among students caught smoking at school. DESIGN A randomised controlled trial comparing cessation rates among students in a behavioural cessation programme and those receiving self help materials only. SETTING Eighteen schools in the Memphis, Tennessee area. SUBJECTS Two hundred and sixty one adolescent cigarette smokers (166 male, 95 female) averaging 15.8 years of age. INTERVENTION Students assigned to the intervention received a four session behavioural treatment programme administered individually by a health educator. In addition, these students received stage matched intervention in brief phone calls monthly until the one year follow up. MAIN OUTCOME MEASURE Self reported and biochemically verified smoking cessation at post-test and 12 month follow up. RESULTS Recruiting students who were caught smoking at school proved to be highly successful. Participants rated the programme favourably, and retention rates were high. Although treated participants improved more in tobacco related knowledge relative to controls (p = 0.002), there were no group differences in changes in attitudes toward smoking. In addition, treated and control participants demonstrated no significant differences in cessation rates both at post-test and follow up. Comparisons between self reported cessation rates and those obtained under bogus pipeline conditions or with biochemical verification suggested significant falsification of cessation among participants. CONCLUSIONS Our results failed to demonstrate any significant effect of the cessation programme on smoking rates for treated adolescents compared with controls. Our findings also highlight the importance of utilising strong methodology in research on adolescent smoking cessation, including control groups and biochemical verification of smoking status.
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Affiliation(s)
- L A Robinson
- The University of Memphis Department of Psychology, 202 Psychology Building, Memphis, TN 38152-3230, USA.
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DiFranza JR, Wellman RJ. A sensitization–homeostasis model of nicotine craving, withdrawal, and tolerance: Integrating the clinical and basic science literature. Nicotine Tob Res 2005; 7:9-26. [PMID: 15804674 DOI: 10.1080/14622200412331328538] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Recent reports suggest that nicotine withdrawal symptoms are common among adolescents after a few weeks of intermittent tobacco use. No current model of nicotine dependence had predicted the rapid development of symptoms of dependence and withdrawal before the development of tolerance. We present a model that integrates neuroscience with clinical observations regarding how nicotine dependence develops, progresses, and resolves in humans. The central tenet of this sensitization-homeostasis model is that nicotine's dependence liability derives from its ability to stimulate neural pathways responsible for the suppression of craving. As a result of sensitization, the craving suppression produced by nicotine is magnified to superphysiological levels. The overinhibition of neurons responsible for craving initiates compensatory homeostatic measures that stimulate the craving pathways and result in craving when nicotine is absent. Separate homeostatic mechanisms are responsible for craving, withdrawal, and tolerance. The sensitization-homeostasis model is unique in its attribution of dependence to craving suppression, its attention to the temporal relationships among clinical features of nicotine dependence, and its extensive integration of clinical observations and basic science. It provides a framework for theory-based research.
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Affiliation(s)
- Joseph R DiFranza
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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21
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Abstract
BACKGROUND African Americans experience disproportionate smoking-related mortality. Because established smoking during youth predisposes to adult smoking and serious health consequences, characterizing ethnic differences in adolescent smokers' self-quit attempts may inform ethnic-specific approaches to youth smoking cessation. METHODS African American and European American teenage smokers applying to a teenage smoking cessation study (2000-2003) provided smoking-related data, including characteristics of previous cessation attempts and prior use of nicotine replacement therapy (NRT). Tobacco dependence was assessed using the Fagerstrom Test of Nicotine Dependence (FTND). RESULTS Of 980 (15.5 +/- 1.3 years, 41.8% African American, 59.9% female) participants, African Americans boys were significantly less likely than European American boys to report a prior quit attempt (OR = 0.35, 95% CI 0.17-0.73, P = 0.0049) or to have used NRT (OR = 0.60, 95% CI 0.36-0.998, P = 0.049) after adjusting for years smoked and FTND score. African American girls were more likely to report a prior request for cessation treatment than European American girls after adjusting for FTND and years smoked (OR = 2.19, 95% CI 1.37-3.48, P = 0.001). CONCLUSIONS While increasing education and outreach to African American boys and enhancing access to formal cessation programs for African American girls who smoke may be beneficial, our findings warrant extension to non-treatment-seeking teenage smokers.
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Affiliation(s)
- Eric T Moolchan
- Department of Health and Human Services, National Institute on Drug Abuse, Intramural Research Program, Clinical Pharmacology and Therapeutics Research Branch, National Institutes of Health, Baltimore, MD 21224, USA.
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