Psychosocial predictors of nicotine dependence in Black and Puerto Rican adults: a longitudinal study

Public versus internal conceptions of addiction: An analysis of internal Philip Morris documents

BACKGROUND

Tobacco addiction is a complex, multicomponent phenomenon stemming from nicotine's pharmacology and the user's biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine's addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.

METHODS AND FINDINGS

We analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris's move from public denial to public affirmation of nicotine's addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government's filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine's (IoM's) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris's public statements reinforce the idea that nicotine's pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.

CONCLUSIONS

Philip Morris's research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine's pharmacology, the industry's continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.

The Association of Cigarette Smoking With Depression and Anxiety: A Systematic Review

BACKGROUND

Many studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We therefore conducted a systematic review evaluating the association of smoking and depression and/or anxiety in longitudinal studies.

METHODS

Studies were identified by searching PubMed, Scopus, and Web of Science and were included if they: (1) used human participants, (2) were longitudinal, (3) reported primary data, (4) had smoking as an exposure and depression and/or anxiety as an outcome, or (5) had depression and/or anxiety as the exposure and smoking as an outcome.

RESULTS

Outcomes from 148 studies were categorized into: smoking onset, smoking status, smoking heaviness, tobacco dependence, and smoking trajectory. The results for each category varied substantially, with evidence for positive associations in both directions (smoking to later mental health and mental health to later smoking) as well as null findings. Overall, nearly half the studies reported that baseline depression/anxiety was associated with some type of later smoking behavior, while over a third found evidence that a smoking exposure was associated with later depression/anxiety. However, there were few studies directly supporting a bidirectional model of smoking and anxiety, and very few studies reporting null results.

CONCLUSIONS

The literature on the prospective association between smoking and depression and anxiety is inconsistent in terms of the direction of association most strongly supported. This suggests the need for future studies that employ different methodologies, such as Mendelian randomization (MR), which will allow us to draw stronger causal inferences.

IMPLICATIONS

We systematically reviewed longitudinal studies on the association of different aspects of smoking behavior with depression and anxiety. The results varied considerably, with evidence for smoking both associated with subsequent depression and anxiety, and vice versa. Few studies supported a bidirectional relationship, or reported null results, and no clear patterns by gender, ethnicity, clinical status, length to follow-up, or diagnostic test. Suggesting that despite advantages of longitudinal studies, they cannot alone provide strong evidence of causality. Therefore, future studies investigating this association should employ different methods allowing for stronger causal inferences to be made, such as MR.

Impact of conjoint trajectories of body mass index and marijuana use on short sleep duration

BACKGROUND AND OBJECTIVES

We examined the association between the conjoint developmental trajectories of body mass index (BMI) and marijuana use from age 24 to age 32 and short sleep duration.

METHODS

The participants included 158 African American male, 267 African American female, 166 Puerto Rican male, and 225 Puerto Rican female young adults (N=816). Using Mplus, we obtained the conjoint trajectories of BMI and marijuana use. Logistic regression analyses examined the association between the conjoint trajectories and short sleep duration.

RESULTS

Five conjoint trajectory groups were extracted: normal BMI and no or low marijuana use, obese and no or low marijuana use, morbidly obese and some marijuana use, normal BMI and high marijuana use, and obese and high marijuana use. Those in the obese and no or low marijuana use group, the morbidly obese and some marijuana use group, and the obese and high marijuana use group were more likely to report shorter sleep duration than those with normal BMI and no or low marijuana use group.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

This study highlights the significance of examining joint trajectories over several developmental stages. In treating short sleep duration, we propose focusing on treating obesity, and also treating marijuana use if applicable.

A randomized study of contingency management and spirometric lung age for motivating smoking cessation among injection drug users

Background

Even after quitting illicit drugs, tobacco abuse remains a major cause of morbidity and mortality in former injection drug users. An important unmet need in this population is to have effective interventions that can be used in the context of community based care. Contingency management, where a patient receives a monetary incentive for healthy behavior choices, and incorporation of individual counseling regarding spirometric “lung age” (the age of an average healthy individual with similar spirometry) have been shown to improve cessation rates in some populations. The efficacy of these interventions on improving smoking cessation rates has not been studied among current and former injection drug users.

Methods

In a randomized, factorial design study, we recruited 100 active smokers from an ongoing cohort study of current and former injection drug users to assess the impact of contingency management and spirometric lung age on smoking cessation. The primary outcome was 6-month biologically-confirmed smoking cessation comparing contingency management, spirometric lung age or both to usual care. Secondary outcomes included differences in self-reported and biologically-confirmed cessation at interim visits, number of visits attended and quit attempts, smoking rates at interim visits, and changes in Fagerstrom score and self-efficacy.

Results

Six-month biologically-confirmed smoking cessations rates were 4% usual care, 0% lung age, 14% contingency management and 0% for combined lung age and contingency management (p = 0.13). There were no differences in secondary endpoints comparing the four interventions or when pooling the lung age groups. Comparing contingency management to non-contingency management, 6-month cessation rates were not different (7% vs. 2%; p = 0.36), but total number of visits with exhaled carbon monoxide-confirmed abstinence were higher for contingency management than non-contingency management participants (0.38 vs. 0.06; p = 0.03), and more contingency management participants showed reduction in their Fagerstrom score from baseline to follow-up (39% vs. 18%; p = 0.03).

Conclusions

While lung age appeared ineffective, contingency management was associated with more short-term abstinence and lowered nicotine addiction. Contingency management may be a useful tool in development of effective tobacco cessation strategies among current and former injection drug users.

Trial registration

Clinicaltrials.gov NCT01334736 (April 12, 2011).

Triple comorbid trajectories of tobacco, alcohol, and marijuana use as predictors of antisocial personality disorder and generalized anxiety disorder among urban adults

OBJECTIVES

We modeled triple trajectories of tobacco, alcohol, and marijuana use from adolescence to adulthood as predictors of antisocial personality disorder (ASPD) and generalized anxiety disorder (GAD).

METHODS

We assessed urban African American and Puerto Rican participants (n = 816) in the Harlem Longitudinal Development Study, a psychosocial investigation, at 4 time waves (mean ages = 19, 24, 29, and 32 years). We used Mplus to obtain the 3 variable trajectories of tobacco, alcohol, and marijuana use from time 2 to time 5 and then conducted logistic regression analyses.

RESULTS

A 5-trajectory group model, ranging from the use of all 3 substances (23%) to a nonuse group (9%), best fit the data. Membership in the trajectory group that used all 3 substances was associated with an increased likelihood of both ASPD (adjusted odds ratio [AOR] = 6.83; 95% CI = 1.14, 40.74; P < .05) and GAD (AOR = 4.35; 95% CI = 1.63, 11.63; P < .001) in adulthood, as compared with the nonuse group, with control for earlier proxies of these conditions.

CONCLUSIONS

Adults with comorbid tobacco, alcohol, and marijuana use should be evaluated for use of other substances and for ASPD, GAD, and other psychiatric disorders. Treatment programs should address the use of all 3 substances to decrease the likelihood of comorbid psychopathology.

Personality characteristics in the mid-forties predict women's smoking cessation in their mid-sixties

This study examined whether personality characteristics measured when a woman is in her mid-40s can predict success in sustained smoking cessation 22 years later, when the woman is in her mid-60s. Multivariate logistic regression analyses were conducted on data from a sample of 195 women (M ages 43 and 65, respectively), who were regular smokers and participated in a longitudinal study from 1983 to 2009. The results suggest that women who exhibited low self-control, high resistance to rules, impulsivity, and sensation seeking in their mid-40s were significantly less likely to succeed in quitting smoking for a period of 5 years or more by the time they reached their mid-60s. Addressing some personal characteristics in smoking cessation programs might enhance their effectiveness and success.

The Association of Externalizing Behavior and Parent-Child Relationships: An Intergenerational Study

We investigated the influence of the child's behavior on the quality of the mutual parent-child attachment relationships across three generations. We did so using a prospective longitudinal study which spanned 20 years from adolescence through adulthood. Study participants completed in-class questionnaires as students in the East Harlem area of New York City at the first wave and provided follow-up data at 4 additional points in time. 390 participants were included in these analyses; 59% female, 45% African American, and 55% Puerto Rican. Using structural equation modeling, we determined that externalizing behavior in the child was negatively related to the mutual parent-child attachment relationship for two generations of children. We also found continuity in externalizing behavior for the participant over time and from the participant to his/her child. Additionally, we found continuity in the quality of the mutual attachment relationship from the participant's relationship with his/her parents to the participant's relationship with his/her child. Finally, the mutual attachment relationship of the participant with his/her parents had a negative association with the participant's externalizing behavior in adulthood. Based on these results, we propose that family interventions should focus on the role of the child's externalizing behavior in the context of the parent-child attachment relationship. Furthermore, we suggest that prevention programs should address externalizing behavior as early as possible, as the effects of externalizing behavior in adolescence can persist into adulthood and extend to the next generation.

Joint trajectories of victimization and marijuana use and their health consequences among urban African American and Puerto Rican young men

We examined the joint trajectories of violent victimization and marijuana use from emerging adulthood to the early thirties and their health consequences in the early thirties among urban African American and Puerto Rican men. Data were collected from a community sample of young men (N = 340) when they were 19, 24, 29, and 32 years old. The joint trajectories of violent victimization and marijuana use were extracted using growth mixture modeling. Three distinct joint trajectory groups of violent victimization and marijuana use were identified: high violent victimization/consistently high marijuana use; low violent victimization/increasingly high marijuana use, and low violent victimization/low marijuana use. Group comparisons using regression analyses showed that men who had experienced high levels of violent victimization and were high frequency marijuana over time users experienced the most adverse psychological and physical health outcomes, including more health problems, psychological maladjustment, and substance use disorders.

Developmental trajectories of marijuana use from adolescence to adulthood: personality and social role outcomes

Longitudinal trajectories of marijuana use from adolescence into adulthood were examined for adverse life-course outcomes among African-Americans and Puerto Ricans. Data for marijuana use were analyzed at four points in time and on participants' personality attributes, work functioning, and partner relations in adulthood using growth mixture modeling. Each of the three marijuana-use trajectory groups (maturing-out, late-onset, and chronic marijuana-users) had greater adverse life-course outcomes than a nonuse or low-use trajectory group. The chronic marijuana-use trajectory group was highly associated with criminal behavior and partners' marijuana use in adulthood. Treatment programs for marijuana use should also directly address common adverse life-course outcomes users may already be experiencing.

Developmental associations between externalizing behaviors, peer delinquency, drug use, perceived neighborhood crime, and violent behavior in urban communities

This study examines the precursors of violent behavior among urban, racial/ethnic minority adults. Data are from an on-going study of male and female African Americans and Puerto Ricans, interviewed at four time waves, Time 1-Time 4 (T1-T4), from adolescence to adulthood. Structural Equation Modeling was used to analyze the developmental pathways, beginning in mid-adolescence (T1; age = 14.0 years), to violent behavior in adulthood (T4; age = 29.2 years). The variables assessed were: components of externalizing behaviors (i.e., rebelliousness, delinquency; T1, T3); illicit drug use (T2); peer delinquency (T2); perceived neighborhood crime (T4); and violent behavior (T3, T4). Results showed that the participants' externalizing behaviors (rebelliousness and delinquency) were relatively stable from mid-adolescence (T1; age = 14.0 years) to early adulthood (T3; age = 24.4 years). The participants' externalizing behaviors in mid-adolescence also had a direct pathway to peer delinquency in late adolescence (T2; age = 19.1 years). Peer delinquency, in turn, had a direct pathway to the participants' illicit drug use in late adolescence (T2), and to externalizing behaviors in early adulthood (T3). The participants' illicit drug use (T2; age = 19.1 years) had both direct and indirect paths to violent behavior in adulthood (T4). The participants' externalizing behaviors in early adulthood (T3) were linked with violent behavior at T3, and perceived neighborhood crime (T4), both of which had direct pathways to violent behavior in adulthood (T4). The findings suggest developmental periods during which externalizing behaviors, exposure to delinquent peers, illegal drug use, and neighborhood crime could be targeted by prevention and intervention programs in order to reduce violent behavior.

Adolescent attributes and young adult smoking cessation behavior

This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally supported the hypothesized model. The results indicated that having parents who smoked and having low educational aspirations and expectations were associated with being unconventional, which, in turn, was related to having low emotional control and reporting more internalizing behaviors. Internalizing behaviors were directly associated with a lower likelihood of smoking cessation, as was parental smoking. Research and clinical implications are discussed and the limitations noted.