Nicotine dependence and mental disorders among adults in the USA: evaluating the role of the mode of administration

The relationship between smokeless tobacco (snus) and anxiety and depression among adults and elderly people. A comparison to smoking in the Tromsø Study

AIMS

To (i) define the characteristics of snus users compared with non-users and smokers and (ii) define the relationship between snus use and self-reported anxiety and depression and compare it with the relation between smoking and anxiety and depression.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study based on data from the Norwegian population-based survey, the Tromsø Study (2015-16). A total of 32 591 people aged 40 years and older in the municipality of Tromsø were invited to attend. There were 21 083 respondents, giving a 65% attendance rate.

MEASUREMENTS

Tobacco use was assessed by current and previous use of snus or cigarettes. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

FINDINGS

Snus users were more often male, were younger and had higher income and higher alcohol consumption than smokers and non-users of snus. In a linear regression analysis, we found no significant association between current snus use and anxiety and depression after adjusting for background variables. However, there was a positive association between previous snus use and anxiety among males [adjusted beta = 0.258; 99% confidence interval (CI) = 0.023-0.492]. Regarding anxiety, the adjusted beta-coefficients for current smoking were 0.425 (99% CI = 0.184-0.666) for females and 0.303 (99% CI = 0.084-0.522) for males. Concerning depression, the adjusted beta coefficients for current smoking were 0.569 (99% CI = 0.358-0.780) for females and 0.281 (99% CI = 0.060-0.503) for males.

CONCLUSIONS

In Norway, current snus users differ from current smokers by having a higher socio-economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method.

Paranoia and Suicidality: A Cross-Sectional Study in the General Population

Paranoia and suicidality seem to be common traits expressing in the general population to varying degrees. This study aims to explore the association between both and to identify determinants of comorbidity. We interviewed a representative sample of the population in Andalusia (n = 4507) and assessed paranoia and suicidality utilizing the Spanish Green's Paranoid Thoughts Scale (S-GPTS) and the suicidality section of the MINI Neuropsychiatric Interview, respectively. We gathered data on socio-demographics, personality, substance abuse, social support, and environmental distress. We found that paranoia and suicidality were rather common with 6.4% (95% CI: 5.7-7.12) of the sample admitting to some (vs. none) level of suicidality. We also found a robust association between paranoia and suicidality, independent of age and sex (F:298.2; p =.0001; Eta²: .065); 0.5% (95% CI: 0.32-0.76) of the sample (n = 21) presented combinedly high levels of paranoia and some suicidality risk and were considered as having paranoia-suicidality comorbidity (PSC). We identified factors associating with PSC, including poor social support, childhood maltreatment, threatening life-events and increasing personality disorder, and nicotine dependence scores. Paranoia and suicidality are common traits in the general population and their comorbidity seems to associate with low social support, environmental adversity and disordered personality. Suicidality and paranoia are common traits present dimensionally in a representative nonclinical sample. Paranoia strongly and independently associates with suicidality risk in a large population-based study. Paranoia and suicidality comorbidity may be commonly determined by poor social support, disordered personality, previous childhood maltreatment, and exposure to threatening life-events.

The prevalence, odds, predictors, and management of tobacco use disorder or nicotine dependence among people with severe mental illness: Systematic review and meta-analysis

The prevalence, correlates, and management of tobacco use disorder (TUD) or nicotine dependence (ND) among people with severe mental illness (SMI), namely schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD), remain unclear. Therefore, a systematic review and meta-analysis was conducted. Electronic databases were systematically searched from inception to July 12, 2020, for observational studies documenting the prevalence, odds, and correlates of TUD/ND among people with SMI; randomized controlled trials (RCTs) informing the management of TUD/ND in people with SMI were also included. Random-effects meta-analyses were conducted. Sources of heterogeneity were explored. Nineteen observational studies, including 7527 participants with SMI met inclusion criteria. TUD/ND co-occurred in 33.4-65% of people with SMI. Rates were higher among males. While bupropion and varenicline represent promising treatment opportunities for schizophrenia with TUD/ND, non-pharmacological interventions require further research, mainly for people with primary mood disorders. TUD/ND represent prevalent co-occurring conditions among people with SMI. Further well-designed RCTs are warranted to inform their management.

Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.

Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both?

COPD is a chronic lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Furthermore, COPD is often characterized by extrapulmonary manifestations and comorbidities worsening COPD progression and quality of life. A neglected comorbidity in COPD management is mental health impairment defined by anxiety, depression and cognitive problems. This paper summarizes the evidence for impaired mental health in COPD and focuses on current pharmacological intervention strategies. In addition, possible mechanisms in impaired mental health in COPD are discussed with a central role for inflammation. Many comorbidities are associated with multi-organ-associated systemic inflammation in COPD. Considering the accumulative evidence for a major role of systemic inflammation in the development of neurological disorders, it can be hypothesized that COPD-associated systemic inflammation also affects the function of the brain and is an interesting therapeutic target for nutra- and pharmaceuticals.

Self-perceived Mental Health and Population-level Tobacco Use Disparities

Objectives

Poor mental health is associated with increased cigarette smoking, yet whether this extends to alternative tobacco product use remains unknown.

Methods

Wave 1 data from the Population Assessment of Tobacco and Health study assessed relationships between self-perceived mental health (SPMH) and prevalence of and motives for tobacco use among US adults (N = 32,320).

Results

Fair/poor SPMH, as compared to good/excellent SPMH, was associated with increased current cigarette (AOR = 2.91, 95% CI = 2.64, 3.20), e-cigarette (AOR = 1.35, 95% CI = 1.20, 1.53), cigarillo (AOR = 1.38, 95% CI = 1.22, 1.56), filtered cigar (AOR = 1.43, 95% CI = 1.21, 1.70), and smokeless tobacco (AOR = 1.17, 95% CI = 1.01, 1.36), but not traditional cigar use (AOR = 1.04, 95% CI = 0.90, 1.20). Whereas most motives for tobacco use were similar across SPMH rating, those with fair/poor SPMH, as compared to good/excellent SPMH, were more likely to report using traditional cigars due to affordability (AOR = 1.56, 95% CI = 1.23, 1.98) and e-cigarettes (AOR = 1.43, 95% CI = 1.15, 1.79) and smokeless tobacco (AOR = 1.84, 95% CI = 1.19, 2.83) due to appealing advertising.

Conclusions

Although individuals with poor SPMH are more likely to use alternative tobacco products than those with better SPMH, most motives for use are strikingly similar. These findings highlight the importance of continual monitoring of tobacco use trends among vulnerable populations.

Characteristics of adult smokers presenting to a mind-body medicine clinic

Mind-body interventions can improve vulnerabilities that underlie smoking behavior. The characteristics of smokers who use mind-body medicine have not been explored, preventing the development of targeted interventions. Patients ( N = 593) presenting to a mind-body medicine clinic completed self-report measures. Patients were 67 percent never smokers, 27 percent former smokers, and 6 percent current smokers. Current smokers were younger; more likely to be single, unemployed, or on disability; and report greater depression symptoms, greater pain, and lower social support ( ps < .05).Current smokers who use mind-body medicine have unique psychosocial needs that should be targeted in mind-body smoking cessation interventions.

COPD patients' self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III-IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depression, anxiety and MCI showed significant relations with 6-minute walking test, body mass index (BMI) and GOLD. Depression was related to autonomous long-term oxygen therapy modifications, disease perception, family support and MCI. In the multivariate logistic regression analysis, higher BMI, higher depression and lower anxiety predicted lower adherence to exercise prescriptions (P=0.0004, odds ratio =0.796, 95% CI =0.701, 0.903; P=0.009, odds ratio =0.356, 95% CI =0.165, 0.770; and P=0.05, odds ratio =2.361, 95% CI =0.995, 5.627 respectively). In COPD patients, focusing on pharmacological and nonpharmacological adherence enhance the possibility of tailored pulmonary rehabilitation programs.

A two-site, two-arm, 34-week, double-blind, parallel-group, randomized controlled trial of reduced nicotine cigarettes in smokers with mood and/or anxiety disorders: trial design and protocol

BACKGROUND

The U.S. Food and Drug Administration can set standards for cigarettes that could include reducing their nicotine content. Such a standard should improve public health without causing unintended serious consequences for sub-populations. This study evaluates the effect of progressive nicotine reduction in cigarettes on smoking behavior, toxicant exposure, and psychiatric symptoms in smokers with comorbid mood and/or anxiety disorders using a two-site, two-arm, double-blind, parallel group, randomized controlled trial (RCT) in four phases over 34 weeks.

METHODS

Adult smokers (N = 200) of 5 or more cigarettes per day will be randomized across two sites (Penn State and Massachusetts General). Participants must have not had a quit attempt in the prior month, nor be planning to quit in the next 6 months, meet criteria for a current or lifetime unipolar mood and/or anxiety disorder based on the structured Mini-International Neuropsychiatric Interview, and must not have an unstable medical or psychiatric condition. After a week of smoking their own cigarettes, participants receive two weeks of Spectrum research cigarettes with usual nicotine content (11.6 mg). After this baseline period, participants will be randomly assigned to continue smoking Spectrum research cigarettes that contain either (a) Usual Nicotine Content (11.6 mg); or (b) Reduced Nicotine Content: the nicotine content per cigarette is progressively reduced from approximately 11.6 mg to 0.2 mg in five steps over 18 weeks. At the end of the randomization phase, participants will be offered the choice to either (a) quit smoking with assistance, (b) continue smoking free research cigarettes, or (c) return to purchasing their own cigarettes, for the final 12 weeks of the study. The primary outcome measure is blood cotinine; key secondary outcomes are: exhaled carbon monoxide, urinary total NNAL- 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and 1-hydroxypyrene, oxidative stress biomarkers including 8-isoprostanes, measures of psychiatric symptoms (e.g., depression, anxiety), smoking behavior and dependence (e.g., cigarette consumption, quit attempts), and health effects (e.g., blood pressure, respiratory symptoms).

DISCUSSION

Results from this study will inform FDA on the potential effects of regulating the nicotine content of cigarettes and help determine whether smokers with mood and/or anxiety disorders can safely transition to significantly reduced nicotine content cigarettes.

TRIAL REGISTRATION

TRN: NCT01928758 , registered August 21, 2013.

Cigarette Smoking and Risk of Alcohol Use Relapse Among Adults in Recovery from Alcohol Use Disorders

BACKGROUND

Individuals in recovery from alcohol use disorders (AUDs) frequently continue to smoke cigarettes. The purpose of this study was to examine the relationship between cigarette smoking status and risk of AUD relapse in adults with remitted AUDs among adults in the United States.

METHODS

Data were drawn from Wave 1 (2001 to 2002) and Wave 2 (2004 to 2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Analyses included the subsample of respondents who completed both waves of data collection reported a history of alcohol abuse and/or dependence prior to Wave 1 (N = 9,134). Relationships between Wave 1 cigarette smoking status (nonsmoker, daily cigarette smoker, and nondaily cigarette smoker) and Wave 2 alcohol use, abuse, and dependence were examined using logistic regression analyses. Analyses were adjusted for Wave 1 demographics; mood, anxiety, and substance use disorders; nicotine dependence; and AUD severity.

RESULTS

Both daily and nondaily cigarette smoking at Wave 1 were significantly associated with a lower likelihood of alcohol use and a greater likelihood of alcohol abuse and dependence at Wave 2 compared to Wave 1 nonsmoking. These relationships remained significant after adjusting for demographics, psychiatric disorders, substance use disorders, AUD severity, and nicotine dependence.

CONCLUSIONS

Among adults with remitted AUDs, daily and nondaily use of cigarettes was associated with significantly decreased likelihood of alcohol use and increased likelihood of alcohol abuse and alcohol dependence 3 years later. Concurrent treatment of cigarette smoking when treating AUDs may help improve long-term alcohol outcomes and reduce the negative consequences of both substances.

Demographic, psychosocial, and genetic risk associated with smokeless tobacco use among Mexican heritage youth

BACKGROUND

Despite well-established negative health consequences of smokeless tobacco use (STU), the number and variety of alternative non-combustible tobacco products on the market have increased tremendously over the last 10 years, as has the market share of these products relative to cigarettes. While STU among non-Hispanic white youth has decreased over the last 10 years, the prevalence has remained constant among Hispanic youth. Here we examine demographic, psychosocial, and genetic risk associated with STU among Mexican heritage youth.

METHODS

Participants (50.5 % girls) reported on psychosocial risk factors in 2008-09 (n = 1,087, mean age = 14.3 years), and smokeless tobacco use in 2010-11 (mean age = 16.7 years). Participants provided a saliva sample that was genotyped for genes in the dopamine, serotonin and opioid pathways.

RESULTS

Overall 62 (5.7 %) participants reported lifetime STU. We identified five single nucleotide polymorphisms that increased the risk for lifetime use. Specifically, rs2023902 on SERGEF (OR = 1.93; 95 % CI: 1.05-3.53), rs16941667 on ALDH2 (OR = 3.14; 95 % CI: 1.65-5.94), and rs17721739 on TPH1 (OR = 1.71; 95 % CI: 1.00-2.91) in the dopamine pathway, rs514912 on TRH-DE (OR = 1.84; 95 % CI: 1.25-2.71) in the serotonin pathway, and rs42451417 on the serotonin transporter gene, SLC6A4 (OR = 3.53; 95 % CI: 1.56-7.97). After controlling for genetic risk, being male (OR = 1.86; 95 % CI: 1.02-3.41), obesity status (OR = 2.22; 95 % CI: 1.21-4.09), and both higher levels of anxiety (OR = 1.04; 95 % CI: 1.01-1.08) and social disinhibition (OR = 1.26; 95 % CI: 1.07-1.48) were associated with increased use. High subjective social status (OR = 0.78; 95 % CI: 0.64-0.93) was protective against use, while higher parental education (OR = 2.01; 95 % CI: 1.03-3.93) was associated with increased use.

CONCLUSIONS

These data suggest that use of genetic risk, along with psychosocial, demographic, and behavioral risk factors may increase our ability to identify youth at increased risk for STU, which in turn may improve our ability to effectively target prevention messages to Mexican heritage youth.

Tobacco use pattern among a national firefighter cohort

INTRODUCTION

To date, there have been no large-scale, national epidemiological studies of tobacco use patterns among firefighters, particularly with a focus on smokeless tobacco (SLT) and dual use with cigarettes. While rates of firefighters' smoking are relatively low compared to the general population, SLT use typically is substantially higher than the populations they protect. In the current study, we systemically examine tobacco use, including SLT and dual use, and the health-related profiles of various tobacco use groups in a national sample of career firefighters.

METHODS

Data are from a national cohort study of career departments (N = 20) comprised of 947 male firefighters.

RESULTS

Among 947 participants, 197 (21%) were tobacco users, of which, 34.5% used cigarettes, 53.2% used SLT, and 12.2% used both cigarettes and SLT. Adjusted rates of smoking, SLT use, and dual use were 13.2%, 10.5%, and 12.2%, respectively. Tobacco users of all types were significantly younger and had served fewer years in fire service and were significantly more likely to engage in heavy and binge drinking, as well as more likely to show signs of depressive symptoms compared to nontobacco users.

CONCLUSIONS

Detailed information on tobacco use pattern will aid in better understanding what factors are contributing to the high rates of SLT and dual use among firefighters in order to guide and develop an appropriate treatment program for the fire service.

Emotional disorders and smoking: relations to quit attempts and cessation strategies among treatment-seeking smokers

The cross-sectional associations between lifetime emotional disorder status (anxiety/depressive disorders) among smokers in relation to historical quit processes were examined. Adult treatment-seeking daily cigarette smokers (n=472) received structured psychiatric interviews and completed a survey that included in-depth questions on cessation history. Having a lifetime emotional disorder was significantly associated with a greater number of prior quit attempts and cessation strategies used, including increased use of both non-pharmacological and pharmacological quit methods. These smokers may still require complimentary specialty care to address their specific affective vulnerabilities given that their use of commonly-applied strategies did not result in lifetime abstinence.

Tobacco smoking among male and female alcohol treatment-seekers: clinical complexities, treatment length of stay, and goal achievement

BACKGROUND

Literature suggests that tobacco smoking among clients in alcohol treatment has important clinical implications, including poorer treatment outcome. Much of this literature, however, has been derived from research-based treatment samples that utilized stringent inclusion and exclusion criteria, limiting generalizability of findings.

OBJECTIVE

In order to further our understanding of the correlates of smoking among clients with alcohol problems, the present research examines tobacco smoking status at admission for 21,128 adult treatment seekers from 253 community outpatient substance abuse clinics across New York State.

METHODS

This sample includes tobacco smokers at admission (62%) and women (25%). Clinical complexities at admission (unemployment, lack of high school diploma/GED, criminal justice involvement, mental illness, polysubstance abuse) and length of treatment stay and alcohol-related goal achievement at discharge were assessed by clinic staff.

RESULTS

Mixed models revealed that tobacco smoking was significantly associated with all five clinical complexities; interactions with gender indicated that this association was stronger for women with regard to criminal justice involvement and polysubstance abuse. Also, these smokers evidenced shorter substance disorder treatment duration and were less likely to achieve alcohol-related treatment goals relative to their nonsmoking counterparts.

CONCLUSIONS

Admission tobacco smoking status of alcohol treatment seekers is an important client characteristic with regard to clinical presentation and treatment outcome. Our findings underscore the need to further our understanding of the complexities associated with smoking and especially as it pertains to female smokers.

Psychiatric correlates of snuff and chewing tobacco use

Compared to the association between cigarette smoking and psychiatric disorders, relatively little is known about the relationship between smokeless tobacco use and psychiatric disorders. To identify the psychiatric correlates of smokeless tobacco use, the analysis used a national representative sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1. Smokeless tobacco use was classified as exclusive snuff use, exclusive chewing tobacco, and dual use of both snuff and chewing tobacco at some time in the smokeless tobacco user's life. Lifetime psychiatric disorders were obtained via structured diagnostic interviews. The results show that the prevalence of lifetime exclusive snuff use, exclusive chewing tobacco, and dual use of both snuff and chewing tobacco was 2.16%, 2.52%, and 2.79%, respectively. After controlling for sociodemographic variables and cigarette smoking, the odds of exclusive chewing tobacco in persons with panic disorder and specific phobia were 1.53 and 1.41 times the odds in persons without those disorders, respectively. The odds of exclusive snuff use, exclusive chewing tobacco, and dual use of both products for individuals with alcohol use disorder were 1.97, 2.01, and 2.99 times the odds for those without alcohol use disorder, respectively. Respondents with cannabis use disorder were 1.44 times more likely to use snuff exclusively than those without cannabis use disorder. Respondents with inhalant/solvent use disorder were associated with 3.33 times the odds of exclusive chewing tobacco. In conclusion, this study highlights the specific links of anxiety disorder, alcohol, cannabis, and inhalant/solvent use disorders with different types of smokeless tobacco use.

Dysphoria and smoking among treatment seeking smokers: the role of smoking-related inflexibility/avoidance

BACKGROUND

Emerging data suggest that dysphoria is one facet of depression that is especially related to various aspects of cigarette smoking. However, it is presently unknown what emotional processes may account for these relations.

OBJECTIVES

In the current cross-sectional study, the impact of avoidance and inflexibility to smoking (AIS), a smoking-specific form of experiential avoidance, was tested on the relationship of dysphoria to four specific smoking processes that are key factors in cessation: perceived barriers to cessation, severity of problems during prior quit attempts, negative reinforcement smoking expectancies, and motivation to quit smoking.

METHODS

Participants (n = 465) were treatment-seeking adult daily smokers. Relative indirect effects were subjected to bootstrap analyses to test direct and indirect effects of dysphoria on smoking processes.

RESULTS

After controlling for gender, nicotine dependence severity, drinking problems, cannabis use, negative affectivity, tobacco-related medical problems, and AIS, dysphoria remained directly, positively related to perceived barriers and cessation problems. Additionally, dysphoria was indirectly, positively related to perceived barriers, cessation problems, negative reinforcement smoking expectancies, and motivation to quit indirectly through higher levels of AIS.

CONCLUSION

In the context of dysphoria, AIS may explain a wide range of clinically-relevant smoking processes.

Examining vulnerability to smokeless tobacco use among adolescents and adults meeting diagnostic criteria for major depressive disorder

Smoking prevalence is unevenly distributed in the U.S. population, with those with mental illness, other substance use disorders, and lower socioeconomic status being especially vulnerable. Less research has been conducted on the association between these same vulnerabilities and smokeless tobacco (ST) use. The present study examined cigarette and ST use among adolescents and adults who met diagnostic criteria for major depressive disorder in the National Survey on Drug Use and Health (NSDUH). Utilizing the most recent (2011) NSDUH, we compared odds for current cigarette smoking and ST use among adolescents and adults meeting criteria for past-year major depressive disorder to the general population, after adjusting for potential confounding influences of sociodemographic and other substance use characteristics. Analyses were conducted to examine sex as a moderator of the relation between major depressive disorder and tobacco use. Odds for current cigarette smoking among those classified with major depressive disorder were increased among adolescents (OR = 1.33, 95% CI [1.05, 1.69], p = .021) and adults (OR = 1.70, 95% CI [1.47, 1.97], p < .0005), and odds for current ST use did not differ among adolescents (OR = 0.90, 95% CI [0.54, 1.49], p = .678) and were lower among adults (OR = 0.68, 95% CI [0.51, 0.91], p = .010). Sex was not a significant moderator in adolescents or adults. Major depressive disorder is associated with increased risk for smoking but not ST use among adolescents and adults further demonstrating heterogeneity in predictors of vulnerability to use of different tobacco products.

Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990-2001

PURPOSE

The present study investigated whether the prevalence of mood and anxiety disorders has increased over time among current smokers and whether these trends differ by gender and in comparison with nonsmokers.

METHODS

Data were drawn from the National Comorbidity Survey (1990) and the National Comorbidity Survey-Replication (2001), representative samples of the US adult population. Binomial regression analyses were used to determine differences between mood and anxiety disorders among current smokers in 1990 and 2001 and whether these differed by gender and in comparison with those who were former or never current smokers.

RESULTS

Any anxiety disorder, panic attacks, panic disorder, social anxiety disorder and dysthymia were all significantly more common among current smokers in 2001 compared with 1990 and except for social anxiety disorder these increases were significantly greater than any trend found in non-smokers. Increases in panic attacks, social anxiety disorder, and dysthymia were more pronounced in female than in male smokers. Major depressive disorder and generalized anxiety disorder were not found to increase over time among smokers.

CONCLUSIONS

The prevalence of several anxiety disorders and dysthymia among current smokers appears to have increased from 1990 to 2001. Future studies are needed to determine whether these trends have continued. If so, interventions aimed at moving the prevalence lower may have limited success if treatment of mental health problems such as anxiety disorders and certain mood disorders are not considered in the development and dissemination of tobacco control programs.

Evidence of sex differences in the relationship between current tobacco use and past-year serious psychological distress: 2005-2008 National Survey on Drug Use and Health

PURPOSE

Cigarette use is highly prevalent in psychiatric populations. Studies suggest that smokeless tobacco use is not significantly associated with past-year psychiatric morbidity, with evidence that tobacco use differ among sexes. The relationships between current tobacco use and past-year serious psychological distress, major depressive episode and anxiety disorder were therefore examined. Sex differences in the aforementioned relationship were also examined.

METHODS

A total of 133,221 adults from four successive independent samples of the 2005-2008 National Survey on Drug Use and Health were included. Prevalence odds ratios and 95 % confidence intervals were calculated using multivariable logistic regression adjusting for demographic factors, survey year, pregnancy (women only), past-year medical morbidity, past-year psychiatric comorbidity, and past-year substance use disorders.

RESULTS

No associations were demonstrated among smokeless tobacco users. Statistically significant sex differences were found for current tobacco use and serious psychological distress (p < 0.001). Both male and female smokers were significantly more likely to have serious psychological distress and anxiety disorder compared to never users, while only female smokers were more likely to have major depressive episode. The strongest associations were found for anxiety disorder among all adults as well as both sexes.

CONCLUSIONS

The null associations for both sexes for smokeless tobacco may support a reduced risk profile. Female cigarette smokers may be more vulnerable to subclinical distress and depression than males. Studies using other nationally representative samples are needed to confirm these data.

Mental disorders and smoking trajectories: a 10-year prospective study among adolescents and young adults in the community

BACKGROUND

Numerous studies have documented an association between mental disorders and onset of cigarette smoking. Yet, there is little understanding of the potential impact of mental disorders on trajectories of smoking over time. The objective of this study was to investigate this relationship among adolescents over a 10-year span.

METHODS

Data were drawn from the Early Developmental Stages of Psychopathology Study, a 10-year prospective investigation of youth in Germany. Growth mixture modeling was used to identify smoking trajectories and logistic regression analyses were used to examine relationships between mental disorders and subsequent trajectories.

RESULTS

Four trajectories were identified: non-users; increasing use; decreasing use; persistent use. Alcohol/drug use disorders, stress disorders, anxiety disorders, somatoform disorder and nicotine dependence were associated with nicotine use (as compared to the non-smoker class). However, comparisons between trajectories of nicotine use showed that any stress disorder predicted only decreasing use compared to the other two trajectories; nicotine dependence, alcohol/illicit drug use disorders as well as panic disorder and somatoform disorders were inversely associated with increasing use; nicotine dependence and alcohol/drug use disorders were associated with persistent use.

CONCLUSIONS

Several mental disorders appear to be non-specific markers of the range of smoking trajectories while others predict specific trajectories. Numerous disorders (e.g., alcohol/drug use disorders) do not appear to occur only prior to and predict increased smoking trajectory as had been previously suggested, but rather they also occur concurrently, with high levels of smoking and in some cases smoking persists at a steady level over time.

Cigarette smoking and onset of mood and anxiety disorders

OBJECTIVES

We examined the association between regular cigarette smoking and new onset of mood and anxiety disorders.

METHODS

We used logistic regression analysis to detect associations between regular smoking and new-onset disorders during the 3-year follow-up among 34 653 participants in the longitudinal US National Epidemiologic Survey on Alcohol and Related Conditions (2001-2005). We used instrumental variable methods to assess the appropriateness of these models.

RESULTS

Regular smoking was associated with an increased risk of new onset of mood and anxiety disorders in multivariable analyses (Fdf = 5,61 = 11.73; P < .001). Participants who smoked a larger number of cigarettes daily displayed a trend toward greater likelihood of new-onset disorders. Age moderated the association of smoking with most new-onset disorders. The association was mostly statistically significant and generally stronger in participants aged 18 to 49 years but was smaller and mostly nonsignificant in older adults.

CONCLUSIONS

Our finding of a stronger association between regular cigarette smoking and increased risk of new-onset mood and anxiety disorders among younger adults suggest the need for vigorous antismoking campaigns and policy initiatives targeting this age group.

Nicotine dependence and comorbid psychiatric disorders: examination of specific genetic variants in the CHRNA5-A3-B4 nicotinic receptor genes

BACKGROUND

The associations between nicotine dependence and specific variants in the nicotinic receptor CHRNA5-A3-B4 subunit genes are irrefutable with replications in many studies. The relationship between the newly identified genetic risk variants for nicotine dependence and comorbid psychiatric disorders is unclear. We examined whether these genetic variants were associated with comorbid disorders and whether comorbid psychiatric disorders modified the genetic risk of nicotine dependence.

METHODS

In a case control study of nicotine dependence with 2032 subjects of European descent, we used logistic regression models to examine the pleiotropy and risk moderation. Comorbid disorders examined were alcohol dependence, cannabis dependence, major depressive disorder, panic attack, social phobia, posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), conduct disorder, and antisocial personality disorder (ASPD).

RESULTS

Nicotine dependence was associated with every examined comorbid psychiatric disorders, with odds ratio varying from 1.75 to 3.33. No evidence supported the associations between the genetic variants and the comorbid disorders (pleiotropy). No evidence suggested that the risks for nicotine dependence associated with the genetic variants vary with comorbid psychiatric disorders in general, but the power was limited in detecting interactions.

CONCLUSIONS

The genetic risks of nicotine dependence associated with the CHRNA5-A3-B4 subunit genes are specific, and not shared among commonly comorbid psychiatric disorders. The risks for nicotine dependence associated with these genetic variants are not modified by comorbid psychiatric disorders such as major depressive disorder or alcohol dependence. However, the power is an important limitation in studying the interplay of comorbidity and genetic variants.

Does current versus former smoking play a role in the relationship between anxiety and mood disorders and nicotine dependence?

OBJECTIVE

Research suggests an association between nicotine dependence and anxiety/mood disorders. Yet, less is known about the role of current versus former smoking in the association between nicotine dependence and these psychiatric disorders. The purpose of the present study was to investigate the relations between anxiety/mood disorders and 1) nicotine dependence and 2) current versus former smoking.

METHOD

Data were drawn from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative sample of over 43,000 adults in the United States. Analyses examined whether dependent versus non-dependent smoking and current versus former smoking were associated with anxiety/mood disorders.

RESULTS

Current dependent, but not non-dependent, smoking was associated with significantly increased odds of anxiety/mood disorders. There was no association between anxiety/mood disorders and former dependent smoking, compared with never smoking. However, compared with never smoking, former non-dependent smoking was associated with significantly decreased odds of current anxiety/mood disorders.

CONCLUSIONS

Current dependent smoking was positively associated with current anxiety/mood disorders, and former non-dependent smoking was negatively associated with current anxiety/mood disorders. The present research is important for understanding the relation between nicotine dependence and anxiety/mood disorders, and why it may be difficult for people with these disorders to quit smoking. The results from this study indicate that greater clinical attention could be directed toward the role of anxiety/mood disorders in smoking cessation.

Accelerating discovery for complex neurological and behavioral disorders through systems genetics and integrative genomics in the laboratory mouse

Recent advances in systems genetics and integrative functional genomics have greatly improved the study of complex neurological and behavioral traits. The methods developed for the integrated characterization of new, high-resolution mouse genetic reference populations and systems genetics enable behavioral geneticists an unprecedented opportunity to address questions of the molecular basis of neurological and psychiatric disorders and their comorbidities. Integrative genomics augment these strategies by enabling rapid informatics-assisted candidate gene prioritization, cross-species translation, and mechanistic comparison across related disorders from a wealth of existing data in mouse and other model organisms. Ultimately, through these complementary approaches, finding the mechanisms and sources of genetic variation underlying complex neurobehavioral disease related traits is becoming tractable. Furthermore, these methods enable categorization of neurobehavioral disorders through their underlying biological basis. Together, these model organism-based approaches can lead to a refinement of diagnostic categories and targeted treatment of neurological and psychiatric disease.

Smokeless tobacco use and its relation to panic disorder, major depression, and posttraumatic stress disorder in American Indians

INTRODUCTION

Rates of nicotine use are high in American Indians. Anxiety and depression tend to be associated with cigarette use, but the association of anxiety and depression with smokeless tobacco (ST) is less clear. We asked if panic disorder, major depression, and posttraumatic stress disorder (PTSD) are related to lifetime ST use in 2 American Indian tribes.

METHODS

Logistic regression analyses examined the association between lifetime panic disorder, major depression, and PTSD and the odds of lifetime ST use status after controlling for sociodemographic characteristics, smoking status, and alcohol use disorders in 1,506 Northern Plains and 1,268 Southwest tribal members.

RESULTS

Odds of lifetime ST use was 1.6 times higher in Northern Plains tribal members with a lifetime history of PTSD after controlling for sociodemographic variables and smoking (95% CI: 1.1, 2.3; p = .01). This association remained significant after further adjustment for panic disorder and major depression (odds ratio [OR] = 1.5; 95% CI: 1.0, 2.2; p = .04) but was diminished after accounting for alcohol use (OR = 1.3; 95% CI: 0.9, 1.9; p = .23). In the Southwest, lifetime psychiatric disorders were not associated with lifetime ST use status. Increasing psychiatric comorbidity was significantly linked to increased odds of ST use in both tribes.

CONCLUSIONS

This study is the first to examine psychiatric conditions and lifetime ST use in a large, geographically diverse American Indian community sample. Although approximately 30% of tribal members were lifetime users of ST, the association with lifetime psychiatric disorders was not as strong as those observed with cigarette smoking. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation.

Anxiety, Health Risk Factors, and Chronic Disease

Anxiety disorders are the most common mental health condition and frequently co-occur with a variety of health risk factors, such as physical inactivity, cigarette smoking, and alcohol consumption. As such, untreated anxiety and increased risk for engagement in these health risk habits can further increase risk for later-onset chronic disease and complications in disease management. Contemporary studies have identified unique temporal relationships between the onset of specific anxiety disorders with smoking and alcohol use disorders. Incorporating exercise with evidence-based treatments for anxiety is emerging and promising in enhancing treatments for anxiety-related conditions. Likewise, substance use treatment programs may benefit from the detection and management of anxiety. Collaborative care models for anxiety may provide the needed systems-based approach for treating anxiety more effectively in primary and specialty care medical settings. Based on a qualitative review of the literature, this article summarizes the current research on the associations between anxiety, health risk factors, and the risk for chronic diseases. The authors also offer suggestions for future research that would help in better understanding the complex relationships between the role anxiety plays in the vulnerability for and management of physical inactivity and substance use.

Socio-demographic, lifestyle and health characteristics among snus users and dual tobacco users in Stockholm County, Sweden

BACKGROUND

Socio-demographic and lifestyle characteristics of snus users have not been systematically described. Such knowledge is pivotal for tobacco control efforts and for the assessment of health effects of snus use.

METHODS

A cross-sectional study was conducted, based on the Stockholm Public Health Survey, including a population-based sample of 34,707 men and women aged 18-84 years. We examined how socio-demographic, lifestyle and health-related characteristics were associated with the prevalence of current daily snus use, smoking and dual tobacco use. Logistic regression was used to calculate odds ratios of prevalence (ORs) and 95% confidence intervals (CIs).

RESULTS

Low educational level (OR = 1.60, CI = 1.41-1.81 and OR = 1.49, CI = 1.17-1.89, for men and women respectively), as well as occupational class and low income were associated with snus use. Some unfavourable lifestyle characteristics, including risky alcohol consumption (males: OR = 1.81, CI = 1.63-2.02; females: OR = 1.79, CI = 1.45-2.20), binge drinking and low consumption of fruit and vegetables were also associated with snus use. In contrast, physical inactivity and overweight/obesity were not, nor was perceived health. The prevalence of smoking followed steeper gradients for social as well as lifestyle characteristics. Overweight and obese men were however less often smokers. Perceived poor general health and psychological distress were highly related to smoking. Social disadvantage, as well as unhealthy lifestyle and self-reported poor health were strongly associated with dual use. There were limited differences between men and women.

CONCLUSIONS

The social, lifestyle and health profiles of exclusive snus users in Stockholm County are less favourable than those of non-users of tobacco, but more advantageous than those of exclusive smokers. This knowledge should guide tobacco control measures as well as the interpretation of health risks linked to snus use.

Influence of anxiety on health outcomes in COPD

BACKGROUND

Psychological functioning is an important determinant of health outcomes in chronic lung disease. To better define the role of anxiety in chronic obstructive pulmonary disease (COPD), a study was conducted of the inter-relations between anxiety and COPD in a large cohort of subjects with COPD and a matched control group.

METHODS

Data were used from the FLOW (Function, Living, Outcomes, and Work) cohort of patients with COPD (n=1202) and matched controls without COPD (n=302). Anxiety was measured using the Anxiety subscale of the Hospital Anxiety and Depression Scale.

RESULTS

COPD was associated with a greater risk of anxiety in multivariable analysis (OR 1.85; 95% CI 1.072 to 3.18). Among patients with COPD, anxiety was related to poorer health outcomes including worse submaximal exercise performance (less distance walked during the 6-min walk test: -66.3 feet for anxious vs non-anxious groups; 95% CI -127.3 to -5.36) and a greater risk of self-reported functional limitations (OR 2.41; 95% CI 1.71 to 3.41). Subjects with COPD with anxiety had a higher longitudinal risk of COPD exacerbation in Cox proportional hazards analysis after controlling for covariates (HR 1.39; 95% CI 1.007 to 1.90).

CONCLUSION

COPD is associated with a higher risk of anxiety. Once anxiety develops among patients with COPD, it is related to poorer health outcomes. Further research is needed to determine whether systematic screening and treatment of anxiety in COPD will improve health outcomes and prevent functional decline and disability.

Cognitive-affective characteristics of smokers with and without posttraumatic stress disorder and panic psychopathology

The present study evaluated differences among daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), panic attacks (PA), and no axis I psychopathology (past 6 months) in terms of several cognitive-affective variables implicated in both the onset and maintenance of anxiety psychopathology and cigarette smoking. The sample consisted of 123 daily smokers (62% women: M(age)=29.7, SD=11.9). Compared to the PA and no psychopathology groups, the PTSD group reported significantly higher levels of anxiety sensitivity, discomfort intolerance, negative affectivity, anxious arousal, and anhedonic depression; and, the PTSD group reported significantly lower levels of perceived control over anxiety-related events than the PA group. The PD group, compared to those in the PA and no psychopathology groups, reported significantly higher levels of anxiety sensitivity, negative affectivity, and anxious arousal; and significantly lower levels of perceived control over anxiety-related events. No significant differences were evident between the PTSD and PD groups. Theoretical and clinical implications of the present findings are discussed in terms of smoking and emotional vulnerability.

Anxiety sensitivity and panic reactivity to bodily sensations: relation to quit-day (acute) nicotine withdrawal symptom severity among daily smokers making a self-guided quit attempt

The current investigation explored the main and interactive effects of panic attacks in response to laboratory-induced bodily sensations and anxiety sensitivity in predicting acute nicotine withdrawal symptoms among daily smokers making a self-guided quit attempt. Participants were 99 daily smokers (58% women; M(age) = 28.4 years, SD = 11.7) who completed a battery of questionnaires, a voluntary hyperventilation challenge, and a measure of nicotine withdrawal symptoms 12 hr after making a self-guided quit attempt. Results indicated that the interaction of anxiety sensitivity and panic responsivity to the challenge predicted quit-day nicotine withdrawal symptom severity above and beyond the main effects (p < .05). The form of the interaction indicated that the relationship between postchallenge panic attack status and acute nicotine withdrawal was more robust among individuals who were low in anxiety sensitivity. Individuals who did not experience a panic attack posthyperventilation who were also low in anxiety sensitivity reported the lowest levels of nicotine withdrawal. Results suggest that anxiety sensitivity may be less relevant with regard to acute nicotine withdrawal severity among individuals with panic-related problems.

Smoking, nicotine and neuropsychiatric disorders

Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.

Smoking cessation pharmacotherapy

Cigarette smoking remains an important risk factor for premature cardiovascular disease and its many complications. There are clear benefits from treating tobacco dependence on the rate of clinical outcomes. In addition to behavioral therapies, various pharmacologic strategies have been developed to help achieve this goal. First-line therapies include nicotine replacement, bupropion and varenicline, a partial nicotine antagonist. Second-line treatments include clonidine and nortriptyline. Additional treatment strategies with less proven efficacy include monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, opioid receptor antagonists, bromocriptine, anti-anxiety drugs, nicotinic receptor antagonists (e.g. mecamylamine) and glucose tablets. Various approaches under investigation include inhibitors of the hepatic P450 enzyme (e.g. methoxsalen), cannabinoid-1 receptor antagonists (e.g. rimonabant), and nicotine vaccines.

Personality, psychiatric disorders, and smoking in middle-aged adults

INTRODUCTION

A number of personality traits have been associated with cigarette smoking. Current smokers generally show higher levels of negative emotionality and lower levels of behavioral constraint than former smokers and those who never smoked. However, prior investigations have not examined thoroughly whether these smoking-personality associations are unique to smoking status or simply reflect the fact that these personality traits tend to be elevated across numerous forms of psychopathology. Likewise, prior studies have not addressed whether personality shows differential associations with smoking based on the presence or absence of lifetime psychiatric disorders.

METHODS

The present study examined these questions using data from 472 current, 311 former, and 324 never-smokers aged 34-44 years.

RESULTS

Current smokers reported being more reactive to stress, more aggressive, more alienated, and less harm avoidant than both former smokers and never-smokers, whereas former smokers and never-smokers showed similar personality profiles overall. Psychiatric disorder history did not interact with smoking status in predicting personality. Controlling for differences in four major lifetime psychiatric disorders (major depression, alcohol dependence, drug dependence, and conduct disorder) reduced the differences in personality traits associated with smoking status. However, smoking status continued to relate uniquely and significantly to higher levels of negative emotionality and behavioral under control with the most robust effect observed for trait alienation.

DISCUSSION

These results provide the most comprehensive depiction to date of interrelations among personality, psychopathology, and smoking and suggest an important role of personality in smoking that is not redundant with or conditional upon lifetime psychopathology.

The Role of Mindful Attention in Regard to the Relation Between Negative Affect Reduction Outcome Expectancies and Emotional Vulnerability Among Adult Cigarette Smokers

The present investigation examined the role of mindful attention in regard to the relation between negative affect reduction smoking outcome expectancies and anxious arousal and anhedonic depression symptoms and difficulties with emotion regulation among 174 (46% women; M _age = 25.32 years, SD = 10.51) daily cigarette smokers. As predicted, there was a significant interaction for negative affect reduction smoking outcome expectancies and mindful attention in relation to anxious arousal symptoms and emotion regulation difficulties. Individuals endorsing both higher levels of negative affect reduction outcome expectancies and lower levels of mindful attention reported the greatest anxious arousal symptoms and difficulties with emotion regulation, while those reporting both lower levels of negative affect reduction expectancies and higher levels of mindful attention were associated with lesser anxious arousal symptoms and the least difficulties with emotion regulation. There was no interactive effect for anhedonic depression symptoms. Findings are discussed in relation to better understanding the clinically meaningful interplay between mindful attention and negative affect reduction outcome expectancies among cigarette smokers in terms of affective vulnerability.

Test of the role of nicotine dependence in the relation between posttraumatic stress disorder and panic spectrum problems

Posttraumatic stress disorder (PTSD) frequently co-occurs with panic spectrum problems. Relatively little empirical work has tested possible mechanisms accounting for this association. Nicotine dependence often ensues subsequent to PTSD onset and research suggests smoking high numbers of cigarettes daily may lead to panic problems. The current study tested the hypotheses that nicotine dependence partially mediates the relations between PTSD and both panic attacks and panic disorder within a nationally representative sample of 5,692 (3,020 women; M(Age) = 45, SD = 18) adults from the National Comorbidity Survey-Replication. Results were consistent with hypotheses. These findings support the theory suggesting smoking among people with PTSD may be involved in the development of panic problems.

An evaluation of anxiety sensitivity, emotional dysregulation, and negative affectivity among daily cigarette smokers: relation to smoking motives and barriers to quitting

The present investigation evaluated the relations between anxiety sensitivity and motivational bases of cigarette smoking, as well as barriers to quitting smoking, above and beyond concurrent substance use, negative affectivity, and emotional dysregulation among a community sample of 189 daily cigarette smokers (46% women; M(age)=24.97 years, SD=9.78). Results indicated that anxiety sensitivity was significantly related to coping, addictive, and habitual smoking motives, as well as greater perceived barriers to quitting. These effects were evident above and beyond the variance accounted for by concurrent tobacco, alcohol, and marijuana use and discernable from shared variance with negative affectivity and emotional dysregulation. Emotional dysregulation was significantly related to stimulation, habitual, and sensorimotor smoking motives and greater perceived barriers to quitting, whereas negative affectivity was only significantly related to smoking for relaxation. These findings uniquely add to a growing literature suggesting anxiety sensitivity is an important and unique cognitive factor for better understanding clinically-relevant psychological processes related to cigarette smoking.

Subtypes of nicotinic acetylcholine receptors in nicotine reward, dependence, and withdrawal: evidence from genetically modified mice

Neuronal nicotinic acetylcholine receptors (nAChRs) can regulate the activity of many neurotransmitter pathways throughout the central nervous system and are considered to be important modulators of cognition and emotion. nAChRs are also the primary site of action in the brain for nicotine, the major addictive component of tobacco smoke. nAChRs consist of five membrane-spanning subunits (alpha and beta isoforms) that can associate in various combinations to form functional nAChR ion channels. Owing to a dearth of nAChR subtype-selective ligands, the precise subunit composition of the nAChRs that regulate the rewarding effects of nicotine and the development of nicotine dependence are unknown. The advent of mice with genetic nAChR subunit modifications, however, has provided a useful experimental approach to assess the contribution of individual subunits in vivo. Here, we review data generated from nAChR subunit knockout and genetically modified mice supporting a role for discrete nAChR subunits in nicotine reinforcement and dependence processes. Importantly, the rates of tobacco dependence are far higher in patients suffering from comorbid psychiatric illnesses compared with the general population, which may at least partly reflect disease-associated alterations in nAChR signaling. An understanding of the role of nAChRs in psychiatric disorders associated with high rates of tobacco addiction, therefore, may reveal novel insights into mechanisms of nicotine dependence. Thus, we also briefly review data generated from genetically modified mice to support a role for discrete nAChR subunits in anxiety disorders, depression, and schizophrenia.

Panic reactivity to voluntary hyperventilation challenge predicts distress tolerance to bodily sensations among daily cigarette smokers

The present investigation examined the extent to which panic reactivity to bodily sensations is related to distress tolerance (DT) among daily smokers. It was hypothesized that panic reactivity to an initial voluntary hyperventilation (i.e., whether participants met criteria for a DSM-IV panic attack; PA) would predict the relative degree of task persistence on a second hyperventilation trial (DT) above and beyond the variance accounted for by anxiety sensitivity (AS), negative affectivity (NA), cigarette smoking rate, and self-reported discomfort intolerance (DI). Participants were 95 daily smokers (58% women; M-sub(age) = 29.0, SD = 12.2) who completed a battery of questionnaires and two voluntary hyperventilation procedures. Results indicated PA status significantly predicted DT, above and beyond the theoretically relevant covariates of AS, NA, cigarettes per day, and DI ( p < .05). Such a result is consistent with theoretical models and empirical findings on emotional reactivity that suggest panic responsivity to internal cues may represent a key explanatory construct in terms of level of DT to interoceptive stimuli.