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

Personality traits and high cigarette dependence among university students: Insights from Lebanon

PURPOSE

The use of tobacco and cigarette products remains widespread globally, with varying patterns across countries. Understanding the factors influencing cigarette dependence among young adults is crucial for effective smoking prevention and control programs. Personality traits are one of the factors that influence smoking behaviour, yet the evidence on their role in high cigarette dependence among young adults remains inconclusive. This study aims to provide insights and initial evidence on the potential association between personality dimensions, sociodemographic factors, lifestyle habits, and high cigarette dependence among Lebanese university students.

METHODS

A convenient sample of 212 student smokers from one private and one public university in Lebanon participated in an online survey. The survey included measures of personality traits using the Big-Five framework, sociodemographic factors, lifestyle habits, and the Fagerström Test for Cigarette Dependence (FTCD). Logistic regression models and mediation analysis were used to analyze the data.

RESULTS

The results revealed significant associations between personality dimensions and high cigarette dependence among Lebanese university students. Smokers with higher levels of Openness to Experience were more likely to have high cigarette dependence (β = 0.408, p < = 0.015). Conversely, smokers with higher levels of Conscientiousness (β = -0.500, p < 0.001) and Agreeableness (β = -0.491, p < 0.01) were less likely to have high cigarette dependence. Additionally, attending a public university (β = 1.198, p = 0.018), having more close friends who smoke (β = 0.525, p < 0.01), and switching to a cheaper cigarette brand (β = 0.928, p < 0.05) were associated with a higher cigarette dependence.

CONCLUSION

These findings highlight the importance of considering personality dimensions, sociodemographic factors, and lifestyle habits in understanding high cigarette dependence among Lebanese university students. The results can inform the development of targeted interventions to address high cigarette dependence in this population.

Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure

BACKGROUND

Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies.

METHODS

This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants.

RESULTS

Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions.

CONCLUSIONS

This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.

The influence of neuroticism in terms of E-cigarette dependence and beliefs about use and quitting among dual users of combustible and electronic cigarettes

OBJECTIVE

Dual use of combustible and electronic cigarettes (e-cigarettes) is increasing in prevalence and may be related to an increased risk for health problems. Accordingly, dual users represent a particularly vulnerable group. Neuroticism is an individual difference factor that demonstrates robust relations to combustible cigarette use. Yet, no work has examined neuroticism in relation to e-cigarette dependence or cognitions among dual users.

METHODS

To address this limitation, the present study examined neuroticism in relation to e-cigarette dependence, expectancies about the negative effects of e-cigarettes, and perceived barriers for quitting e-cigarettes. The present study analyzed data collected from a cross-sectional survey of 437 dual combustible cigarette and e-cigarette users (49.9% female, M_age = 35.12 years, SD = 10.04).

RESULTS

Results indicated that neuroticism was significantly, positively related to e-cigarette dependence (ΔR² = 0.02, p < .001), expectancies about the negative effects of e-cigarettes (ΔR² = 0.03, p < .001), and perceived barriers for quitting e-cigarettes (ΔR² = 0.10, p < .001).

CONCLUSIONS

These novel findings suggest there may be merit in further exploring the role of neuroticism in the maintenance of concurrent combustible cigarette and e-cigarette use.

Positive psychotherapy for smoking cessation enhanced with text messaging: Protocol for a randomized controlled trial

BACKGROUND

Despite reductions in cigarette smoking in the U.S., improvements in the efficacy of smoking cessation treatments are needed, as rates of sustained abstinence remain disappointingly low. Both low positive affect and high negative affect contribute to smoking relapse and constitute viable targets for smoking cessation interventions. Although some clinical trials have evaluated interventions to address depression as a smoking relapse risk factor, very few have focused on positive affect. Recently, we developed and conducted a preliminary clinical trial of a smoking cessation treatment that targets positive affect and cognitions by incorporating interventions rooted in positive psychology. The current randomized controlled trial will expand upon this preliminary trial to test whether this positive psychology-informed approach results in higher smoking cessation rates compared to a time-matched standard smoking cessation treatment control.

METHODS

Three hundred and forty adult daily smokers will be randomly assigned to either positive psychotherapy for smoking cessation or standard behavioral smoking cessation counseling. Participants will meet weekly with a study counselor for 6 weeks and will receive transdermal nicotine patch and text messaging smoking cessation support. Additionally, text messaging in the positive psychotherapy condition will encourage engagement in positive psychology-specific strategies for boosting mood and staying smoke free. Smoking cessation outcomes will be measured at 12, 26, and 52 weeks following target quit date.

CONCLUSION

Results from this study will provide evidence on whether incorporating positive psychology interventions into smoking cessation treatment can improve smoking cessation outcomes relative to standard behavioral counseling with nicotine patch and text messaging.

The social networks of smokers attempting to quit: An empirically derived and validated classification

Social relationships play an important role in the uptake, maintenance, and cessation of smoking behavior. However, little is known about the natural co-occurrence of social network features in adult smokers' networks and how multidimensional features of the network may connect to abstinence outcomes. The current investigation examined whether qualitatively distinct subgroups defined by multiple characteristics of the social network could be empirically identified within a sample of smokers initiating a quit attempt. Egocentric social network data were collected from 1571 smokers (58% female, 83% white) engaged in a 3-year smoking cessation clinical trial. Using nine indicator variables reflecting both risk and protective network features, finite mixture models identified five social network subgroups: High Stress/High Contact, Large and Supportive, Socially Disconnected, Risky Friends and Low Contact, and High Contact with Smokers and Light Drinkers. External variables supported the validity of the identified subgroups and the subgroups were meaningfully associated with baseline demographic, psychiatric, and tobacco measures. The Socially Disconnected subgroup was characterized by little social interaction, low levels of stress, and low exposure to social environmental smoking cues, and had the highest probability of successful cessation at 1 week compared with all other social network subgroups. At 6 months posttreatment its members had higher abstinence rates than members of the High Stress/High Contact subgroup and the Risky Friends and Low Contact subgroup. The present study highlights the heterogeneity of smokers' social milieus and suggests that network features, especially those entailing exposure to smoking cues and contexts, heighten risk for smoking cessation failure. (PsycINFO Database Record

Striatal Dopamine D2/D3 Receptor Availability Varies Across Smoking Status

To assess how tobacco smoking status affects baseline dopamine D2/D3 (D2R) receptor availability and methylphenidate-induced dopamine (DA) release, we retrospectively analyzed D2R availability measures of 8 current smokers, 10 ex-smokers, and 18 nonsmokers who were scanned with positron emission tomography and [11C]raclopride, after administration of an injection of placebo or 0.5 mg/kg i.v. methylphenidate. There was a significant effect of smoking status on baseline striatal D2R availability; with current smokers showing lower striatal D2R availability compared with nonsmokers (caudate, putamen, and ventral striatum) and with ex-smokers (caudate and putamen). Baseline striatal D2R did not differ between nonsmokers and ex-smokers. The effect of smoking status on methylphenidate-induced DA release tended to be lower in smokers but the difference was not significant (p=0.08). For behavioral measures, current smokers showed significantly higher aggression scores compared with both nonsmokers and ex-smokers. These results suggest that with abstinence ex-smokers may recover from low striatal D2R availability and from increased behavioral aggression seen in active smokers. However, longitudinal studies are needed to assess this within abstaining smokers.

Relationship between Personality Traits and Nicotine Dependence in Male and Female Smokers of African-American and European-American Samples

AIMS

Personality characteristics are linked to nicotine dependence (ND). It remains unclear whether these factors differ across African-American (AA) and European-American (EA) male and female smokers. This study was aimed to determine the relationship between personality traits and smoking status, as well as the degree of ND, in AA and EA male and female samples.

METHODS

A total of 5,040 participants (AA: N = 3,737, female = 54.31%; EA: N = 1,313, female = 64.51%) were included in this study, with 2,474 smokers and 2,566 non-smokers. The measures used in this study included five dimensions of personality by the NEO-personality inventory-revised (neuroticism, extraversion, agreeableness, openness to experience, and conscientiousness), Fagerström test for ND, and drive subscale of the ND Syndrome Scale (NDSS).

RESULTS

In the AA sample, neuroticism was significantly associated with a higher risk of smoking [odds ratio (OR) = 1.057; 95% confidence interval (CI) 1.032, 1.083; p < 0.0001], and conscientiousness was significantly associated with decreased risk of smoking (OR = 0.936; 95% CI 0.912, 0.961; p < 0.0001). In the EA sample, higher neuroticism was associated with increased risk of being a current smoker (OR = 1.058; 95% CI 1.013, 1.104; p = 0.0105). Furthermore, we found that a lower level of neuroticism and higher level of conscientiousness were associated with the severity of ND in both the AA and EA samples and a broader range of personality factors were involved in predicting the severity of ND in the AA samples. However, no differential association was detected between male and female smokers of both AA and EA samples.

CONCLUSION

There exist differential relationships between personality traits and the severity of ND in the AA and EA samples.

Hostility and telomere shortening among U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Chronic disorders of aging are critical concerns for the U.S. veteran population, which is, on average, two decades older than the non-veteran population. Characterization of risk factors that may accelerate biological aging is important in identifying targets for prevention and intervention. In the current study, we analyzed data from a contemporary, and nationally representative sample of U.S. veterans to evaluate the relationship between a broad range of sociodemographic, military, and clinical variables, and peripheral telomere length, which is an indicator of biological age and linked to risk for aging-related disorders and mortality. Data from 468U.S. military veterans who participated in the National Health and Resilience in Veterans Study were analyzed. Telomere length was assessed from cells isolated from saliva using quantitative polymerase chain reaction methods. A multivariable binary logistic regression analysis was conducted to evaluate the relations between hostility and telomere length, while controlling for sociodemographic, military, and clinical variables. Greater scores on a measure of hostility were independently associated with telomere shortening, even after adjustment for a broad range of other variables (odds ratio [OR]=1.58, 95% confidence interval [CI]=1.15-2.18). Secondary analyses revealed that this association was driven by difficulties controlling anger (OR=1.72, 95%CI=1.14-2.61), which reflect the external manifestation of hostility, rather than aggressive urges or impulses. Hostility, particularly difficulties controlling anger, is associated with peripheral telomere shortening in U.S. military veterans. Prevention and treatment efforts designed to reduce hostility may help mitigate risk for accelerated cellular aging in this growing segment of the U.S.

The Epidemiology of DSM-5 Nicotine Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III

OBJECTIVE

To present nationally representative information on the prevalence, correlates, psychiatric comorbidity, and treatment of DSM-5 nicotine use disorder (NUD) and the public health burden of US cigarette consumption among adults with NUD and other psychiatric disorders.

METHODS

Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309), we conducted weighted cross-tabulations and multivariate logistic regression analyses to estimate prevalences and examine comorbidity of NUD.

RESULTS

Prevalences of 12-month and lifetime DSM-5 NUD were 20.0% and 27.9%, respectively. Nicotine use disorder was more frequent among men, non-Hispanic whites, younger individuals, the previously married, those with less education and lower incomes, and those residing in rural areas. Adjusting for sociodemographic characteristics and additional psychiatric comorbidity, 12-month NUD and lifetime NUD were significantly associated with other substance use and antisocial personality disorders (odds ratios [ORs] = 1.5-5.1, 12-month; 1.5-5.6, lifetime). Twelve-month severe NUD was generally associated with major depressive, bipolar I, bipolar II, panic, generalized anxiety, posttraumatic stress, and schizotypal, borderline, and antisocial personality disorders (ORs = 1.3-2.5). Individuals with current NUD and at least 1 psychiatric disorder comprised 11.1% of US adults but smoked 53.6% of total cigarettes consumed. Treatment was utilized by 20.3% of respondents with 12-month and 18.8% with lifetime NUD.

CONCLUSIONS

Findings underscore the need to address nicotine use in clinical settings. Recognition of psychiatrically vulnerable subpopulations may inform etiologic research, prevention, and treatment of NUD.

Big five personality factors and cigarette smoking: a 10-year study among US adults

The present study examined the relation between the big five personality traits and any lifetime cigarette use, progression to daily smoking, and smoking persistence among adults in the United States (US) over a ten-year period. Data were drawn from the Midlife Development in the US (MIDUS) I and II (N = 2101). Logistic regression was used to examine the relationship between continuously measured personality factors and any lifetime cigarette use, smoking progression, and smoking persistence at baseline (1995-1996) and at follow-up (2004-2006). The results revealed that higher levels of openness to experience and neuroticism were each significantly associated with increased risk of any lifetime cigarette use. Neuroticism also was associated with increased risk of progression from ever smoking to daily smoking and persistent daily smoking over a ten-year period. In contrast, conscientiousness was associated with decreased risk of lifetime cigarette use, progression to daily smoking, and smoking persistence. Most, but not all, associations between smoking and personality persisted after adjusting for demographic characteristics, depression, anxiety disorders, and substance use problems. The findings suggest that openness to experience and neuroticism may be involved in any lifetime cigarette use and smoking progression, and that conscientiousness appears to protect against smoking progression and persistence. These data add to a growing literature suggesting that certain personality factors--most consistently neuroticism--are important to assess and perhaps target during intervention programs for smoking behavior.

Time perspective as a determinant of smoking cessation in four countries: Direct and mediated effects from the International Tobacco Control (ITC) 4-Country Surveys

BACKGROUND

Future oriented time perspective predicts a number of important health behaviors and outcomes, including smoking cessation. However, it is not known how future orientation exerts its effects on such outcomes, and no large scale cross-national studies have examined the question prospectively. The aim of the current investigation was to examine the relationship between time perspective and success in smoking cessation, and social cognitive mediators of the association.

METHODS

The ITC-4 is a multi-wave, four country survey (Australia, Canada, United States, United Kingdom) of current smokers (N=9772); the survey includes baseline measurements of time perspective, intentions, quit attempts, and self-reported quit status at follow-up over 8 years. We examined the predictive power of time perspective for smoking cessation, as mediated through strength of quit intentions and prior history of quit attempts.

RESULTS

Findings indicated that those smokers with a stronger future orientation at baseline were more likely to have successfully quit at follow-up. This effect was partially explained by intention-mediated effects of future orientation on quit attempts.

CONCLUSIONS

Future orientation predicts smoking cessation across four English-speaking countries; the cessation-facilitating effects of future orientation may be primarily due to future oriented individuals' motivated and sustained involvement in the quit cycle over time.

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.

Cigarette smoking and completed suicide: results from 3 prospective cohorts of American adults

BACKGROUND

Prior reports have indicated a potential dose-response relationship between smoking and suicide. However, this relationship is controversial.

METHODS

This study evaluated the association between smoking and risk of death from suicide in three large-scale cohorts of U.S. men and women (n=253,033). Suicides were identified from death certificates among 43,816 men enrolled in the Health Professionals Follow-up Study (HPFS) between 1986 and 2008, 116,566 women in the Nurses' Health Study (NHS) between 1976 and 2008, and 92,651 women in the NHS II between 1989 and 2007. Information on smoking was obtained at baseline and updated every 2 years. Relative risks (RRs) of suicide were estimated using Cox proportional hazards regression models. Cohort specific RRs were pooled using random-effects models. Suicide deaths were determined by physician review of death certificates.

RESULTS

A total of 457 deaths from suicide were documented. Compared to never smokers, the pooled multivariate RR (95% confidence interval [CI]) of suicide was 1.15 (0.91-1.45) for former smokers and 2.69 (2.11-3.42) for current smokers. A nonmonotonic dose-response relationship was noted between the number of cigarettes smoked per day (CPD) and suicide risk (P trend<0.001). Compared to never smokers, the pooled multivariate RR (95% CI) was 2.59 (1.77-3.79) for those with 1-14 CPD, 2.03 (1.39-2.94) for those with 15-24 CPD, and 4.13 (2.96-5.78) for those with ≥ 25 CPD.

LIMITATIONS

Smoking was self-reported and had some degree of measurement error. Participants were not a representative sample of the U.S. population.

CONCLUSIONS

Results from three large cohorts suggest a nonmonotonic dose-response association between smoking and suicide risk.

Hostility as a predictor of affective changes during acute tobacco withdrawal

INTRODUCTION

Hostility--a personality trait reflective of cynical attitudes and a general mistrust of others--is associated with smoking status and relapse risk. Yet, the mechanisms linking hostility and smoking are not entirely clear. In this lab study, we tested a socioaffective model that purports that high-hostility individuals smoke to cope with maladaptive social mood states (i.e., anger and low friendliness), which become expressed and exacerbated during acute tobacco withdrawal.

METHODS

Following a baseline visit at which trait hostility was assessed, adult smokers (n = 153, ≥10 cig/day) attended two counterbalanced lab visits: a deprived session following 16 hr of deprivation, and a nondeprived session. At both lab visits, affect and withdrawal symptoms were assessed at a single time point.

RESULTS

Higher trait hostility predicted larger deprivation-induced increases in several forms of negative affect (anxiety, depression, confusion; βs ≥ .20, ps ≤ .01) and a composite tobacco withdrawal symptom index (β = .16, p = .04) but did not predict changes in positive emotions. These effects persisted after statistically controlling for gender, nicotine dependence, and depression. Other aspects of trait aggression (i.e., verbal aggression, physical aggression, anger) did not predict deprivation-induced changes in affect and withdrawal other than state anger.

DISCUSSION

High-hostility individuals appear to experience generalized exacerbations in several negative affective states during acute tobacco withdrawal. Increases in negative affect during tobacco withdrawal may motivate negative reinforcement-mediated smoking and could underlie tobacco addiction in high-hostility smokers.

A transdisciplinary approach to protocol development for tobacco control research: a case study

The increasing complexity of scientific problems related to lifestyle risk factors has prompted substantial investments in transdisciplinary or team science initiatives at the biological, psychosocial, and population levels of analysis. To date, the actual process of conducting team science from the perspectives of investigators engaged in it has not been well documented. We describe the experience of developing and implementing data collection protocols using the principles of transdisciplinary science. The New England Family Study Transdisciplinary Tobacco Use Research Center was a 10-year collaboration involving more than 85 investigators and consultants from more than 20 disciplines as well as more than 50 research staff. We used a two-phase process in which all the study personnel participated in the developing and testing of 160 instruments. These instruments were used in 4,378 assessments with 3,501 participants. With substantial effort, it is possible to build a team of scientists from diverse backgrounds that can develop a set of instruments using a shared conceptual approach, despite limited or no experience working together previously.

Prenatal tobacco smoke exposure, risk of schizophrenia, and severity of positive/negative symptoms

Prenatal exposure to cigarette smoke causes chronic fetal hypoxia, dysregulation of endocrine equilibrium, and disruption of fetal neurodevelopment associated with brain malfunction, all of which potentially could induce vulnerability to schizophrenia. A total of 212 schizophrenia patients aged 14-30years, and 212 matched controls were studied. Prenatal tobacco smoke exposure of the schizophrenia patients was compared to that of the normal controls by applying logistic regression analysis and controlling for several confounding factors. The outcomes of interest were comparison of the frequency of maternal and paternal smoking between patients and controls, as well as the severity of positive and negative symptoms between the offspring of smoking and nonsmoking parents. Among the mothers of schizophrenia patients and controls, 92 (43.4%) and 46 (21.7%) smoked, respectively. Maternal smoking during pregnancy had a significant unique contribution on increasing the risk for development of schizophrenia (p=0.001), and a greater severity of negative symptoms (p=0.023). Paternal smoking did not have a significant effect on the risk of schizophrenia, or severity of negative symptoms. The findings suggest that maternal smoking during pregnancy puts offspring at an increased risk for later schizophrenia, with increased severity of negative symptoms. Given the wide practice of smoking during pregnancy, fetal exposure to tobacco smoke could be a major preventable neurodevelopmental factor that increases vulnerability to schizophrenia.

Depression and smoking: a 5-year prospective study of patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) and smoking are major public health problems and epidemiologically strongly associated. However, the relationship between smoking and depression and whether this is influenced by common confounding factors remain unclear, in part due to limited longitudinal data on covariation.

METHODS

In the Vantaa Depression Study, psychiatric out- and inpatients with DSM-IV MDD and aged 20-59 years at were followed from baseline to 6 months, 18 months, and 5 years. We investigated course of depression, smoking, and comorbid alcohol-use disorders among the 214 patients (79.6% of 269) participating at least three time points; differences between smoking versus nonsmoking patients, and covariation of MDD, smoking, and alcohol-use disorders.

RESULTS

Overall, 31.3% of the patients smoked regularly, 41.1% intermittently, and 27.6% never. Smokers were younger, had more alcohol-use disorders and Cluster B and C personality disorder symptoms, a higher frequency of lifetime suicide attempts, higher neuroticism, smaller social networks, and lower perceived social support than never smokers. Smoking and depression had limited longitudinal covariation. Depression, smoking, and alcohol-use disorders all exhibited strong autoregressive tendencies.

CONCLUSIONS

Among adult psychiatric MDD patients, smoking is strongly associated with substance-use and personality disorders, which may confound research on the impact of smoking. Rather than depression or smoking covarying or predicting each other, depression, smoking, and alcohol-use disorders each have strong autoregressive tendencies. These findings are more consistent with common factors causing their association than either of the conditions strongly predisposing to the other.

An Association between Emotional Responsiveness and Smoking Behavior

Introduction. Emotional responsiveness (ER) has been theorized to play a protective role in pathways to tobacco initiation, regular use, and dependence, yet a possible association between ER and smoking behavior has not been studied. Our aim was to test whether measuring ER to a neutral stimulus was associated with decreased odds of current smoking. Methods. We measured ER and smoking status (current, former, and never) in two datasets: a cross-sectional dataset of persons with diabetes (n = 127) and a prospective dataset of depressed patients (n = 107) from an urban primary care system. Because there were few former smokers in the datasets, smoking status was dichotomized (current versus former/never) and measured at baseline (cross-sectional dataset) or at 36 weeks after-baseline (prospective dataset). ER was ascertained with response to a neutral facial expression (any ER versus none). Results. Compared to their nonresponsive counterparts, adjusted odds of current smoking were lower among participants endorsing emotional responsiveness in both the cross-sectional and prospective datasets (ORs = .29 and .32, P's <.02, resp.). Discussion. ER may be protective against current smoking behavior. Further research investigating the association between ER and decreased smoking may hold potential to inform treatment approaches to improve smoking prevalence.

Do time perspective and sensation-seeking predict quitting activity among smokers? Findings from the International Tobacco Control (ITC) Four Country Survey

Personality factors such as time perspective and sensation-seeking have been shown to predict smoking uptake. However, little is known about the influences of these variables on quitting behavior, and no prior studies have examined the association cross-nationally in a large probability sample. In the current study it was hypothesized that future time perspective would enhance - while sensation-seeking would inhibit - quitting activity among smokers. It was anticipated that the effects would be similar across English speaking countries. Using a prospective cohort design, this cross-national study of adult smokers (N=8845) examined the associations among time perspective, sensation-seeking and quitting activity using the first three waves of data gathered from the International Tobacco Control Four Country Survey (ITC-4), a random digit dialed telephone survey of adult smokers from the United Kingdom, United States, Canada and Australia. Findings revealed that future time perspective (but not sensation-seeking) was a significant predictor of quitting attempts over the 8-month follow-up after adjusting for socio-demographic variables, factors known to inhibit quitting (e.g., perceived addiction, enjoyment of smoking, and perceived value of smoking), and factors known to enhance quitting (e.g., quit intention strength, perceived benefit of quitting, concerns about health effects of smoking). The latter, particularly intention, were significant mediators of the effect of time perspective on quitting activity. The effects of time perspective on quitting activity were similar across all four English speaking countries sampled. If these associations are causal in nature, it may be the case that interventions and health communications that enhance future-orientation may foster more quit attempts among current smokers.

Recollections of Childhood Religious Identity and Behavior as a Function of Adult Religiousness

People have a strong motivation to maintain a self-concept that is coherent and consistent over time. Religion is an central source of social identity for many people, but its importance is prone to dramatic change across the life course. To maintain a consistent perception of self, recollections of one's own past religiousness may shift to better fit with the present. This study examined changes between early and middle adulthood in retrospective perceptions of religious behavior and identity in childhood. Data from a population-based birth cohort sample were matched with data from individuals who participated in at least two of three adult follow-up studies, at intervals of approximately 10 years. Logistic regression was used to analyze the association of final recollections of childhood behavior and identity with previous recollections and current religious characteristics. Consistent with the predictions of temporal self-appraisal theory, participants' perception of their religious identity as children tended to change over time to match their adult religious identity. Recollections of childhood religious behavior were more stable than recollections of religious identity, and change was unrelated to adult behavior. These results have implications for studying religious characteristics using retrospective measures, regarding their accuracy and their independence from contemporary measures.

Characteristics of alcoholic smokers, nonsmokers, and former smokers: personality, negative affect, alcohol involvement, and treatment participation

INTRODUCTION

Previous research has indicated that smoking behavior in the general population is linked to personality traits such as behavioral undercontrol and negative emotionality, but it is unknown whether these traits pertain to alcoholic smokers. Further, prior research has not established whether alcoholic smokers differ from their nonsmoking counterparts in terms of alcohol involvement severity and treatment participation. Exploration of these associations is important, given the high prevalence of cigarette smoking among alcoholics.

METHODS

Treatment-seeking alcoholics were categorized into daily cigarette smokers (n = 76), nonsmokers (n = 34), and former smokers (n = 33). These groups were compared on personality traits, negative affect, alcohol involvement, and alcohol outpatient treatment participation.

RESULTS

All three groups scored similarly on a variety of personality traits (e.g., extraversion and neuroticism), and on most aspects of negative affect, with the exception of anxiety (smokers scored higher than nonsmokers and former smokers). In terms of alcohol involvement, alcoholic smokers reported greater negative drinking consequences and alcohol physical dependence relative to former smokers, even considering that alcoholic smokers had relatively more abstinent days. Finally, alcoholic smokers attended considerably fewer alcohol outpatient treatment sessions relative to both nonsmokers and former smokers.

CONCLUSIONS

Common risk factors for both alcoholism and smoking behavior, such as personality traits and negative affect, may obscure personality differences between smokers and nonsmokers in an alcohol treatment sample. Furthermore, findings suggest that current nicotine use among alcoholics is associated with greater anxiety and severity of alcoholism than among their former-smoking counterparts.

Religious service attendance and major depression: a case of reverse causality?

Although previous studies have found a protective association between attendance at religious services and depression, the extent to which this association is driven by depressed persons' dropping out of religious activities is not clear. The authors examined whether early onset of a major depressive episode (MDE) predicted a subsequent decrease in religious service attendance. Data came from 3 follow-up studies of the National Collaborative Perinatal Project birth cohort (mean age = 37 years at last follow-up; n = 2,097; 1959-2001). The generalized estimating equations method was used to calculate the impact of an early MDE diagnosis (before age 18 years) on the likelihood of change in level of religious service attendance from childhood to adulthood. Twenty-seven percent of study participants met the criteria for lifetime MDE (n = 567), of whom 31% had their first onset prior to age 18 years. Women with early MDE onset were 1.42 times more likely (95% confidence interval: 1.19, 1.70) than women with adult-onset MDE or no lifetime MDE to stop attending religious services by the time of the first adult follow-up wave. No significant associations were observed among men. These findings suggest that women are more likely to stop attending religious services after onset of depression. Selection out of religious activities could be a significant contributor to previously observed inverse correlations between religious service attendance and psychopathology during adulthood.

High Hostility Among Smokers Predicts Slower Recognition of Positive Facial Emotion

High levels of trait hostility are associated with wide-ranging interpersonal deficits and heightened physiological response to social stressors. These deficits may be attributable in part to individual differences in the perception of social cues. The present study evaluated the ability to recognize facial emotion among 48 high hostile (HH) and 48 low hostile (LH) smokers and whether experimentally-manipulated acute nicotine deprivation moderated relations between hostility and facial emotion recognition. A computer program presented series of pictures of faces that morphed from a neutral emotion into increasing intensities of happiness, sadness, fear, or anger, and participants were asked to identify the emotion displayed as quickly as possible. Results indicated that HH smokers, relative to LH smokers, required a significantly greater intensity of emotion expression to recognize happiness. No differences were found for other emotions across HH and LH individuals, nor did nicotine deprivation moderate relations between hostility and emotion recognition. This is the first study to show that HH individuals are slower to recognize happy facial expressions and that this occurs regardless of recent tobacco abstinence. Difficulty recognizing happiness in others may impact the degree to which HH individuals are able to identify social approach signals and to receive social reinforcement.

Childhood impulsive behavior and problem gambling by adulthood: a 30-year prospective community-based study

AIMS

Problem gambling can create major financial, emotional and sometimes criminal problems for an individual. This study prospectively investigated the association between impulsive behavior at age 7 and the development of life-time problem gambling by adulthood. We also examined the specificity of any observed association between impulsive behaviors and problem gambling by conducting parallel analyses examining the link between respondents' shy/depressed behavior in childhood and later problem gambling.

DESIGN, SETTING AND PARTICIPANTS

Cohort study of 958 offspring of mothers enrolled in the Collaborative Perinatal Project who participated in an adult follow-up study at a mean age of 39.2 years.

MEASUREMENTS

Multivariable logistic regression models were fitted to determine associations between psychologist-rated impulsive and shy/depressed behaviors at age 7 and life-time self-reported gambling as measured by the South Oaks Gambling Screen administered during the adult follow-up study.

FINDINGS

Children who exhibited impulsive behaviors at age 7, compared to their non-impulsive counterparts, were 3.09 (95% confidence interval: 1.40-6.82) times as likely to report problem gambling years later. In contrast, we did not find a significant association between childhood shy/depressed behavior and problem gambling by adulthood in adjusted analyses.

CONCLUSIONS

Impulsive behaviors at age 7 are a specific and significant risk factor for later problem gambling.

Smoking in pregnancy and parenting stress: maternal psychological symptoms and socioeconomic status as potential mediating variables

INTRODUCTION

The purpose of this study was to examine the impact of smoking in pregnancy on parenting stress. Maternal psychological symptoms and socioeconomic status (SES) were evaluated as potential mediating factors between prenatal cigarette use and later parenting stress.

METHOD

The sample included 218 mothers who were recruited at the hospital after birth and completed a 6-month visit with their infants at a university laboratory. Based on the mothers' responses to interviews at the hospital on tobacco use during pregnancy, the sample included 77 nonsmokers and 141 smokers. Information on sociodemographic variables, prenatal care, and other substance use during pregnancy was collected at the hospital interview. At the 6-month visit, the mothers completed measures of parenting stress and psychological symptoms. Cotinine levels were assessed at both timepoints.

RESULTS

Regression analysis showed that maternal smoking during pregnancy predicted parenting stress in infancy. Maternal symptoms of psychological distress and SES were evaluated simultaneously to determine whether they functioned as mediating variables between smoking in pregnancy and parenting stress. A multiple mediation analysis (Preacher & Hayes, 2008a) showed that maternal psychological symptoms functioned as a mediating variable but that SES did not.

CONCLUSIONS

Results suggest that mothers who smoke in pregnancy are likely to experience higher levels of psychological symptoms, which, in turn, predict higher levels of parenting stress. Smoking in pregnancy may be a marker for symptoms of psychological distress in mothers.

The relation between nicotine dependence and suicide attempts in the general population

OBJECTIVE

There has been much debate as to whether nicotine is a risk factor for suicidal behaviour. This study sought to examine the relation between nicotine dependence and suicide attempts in a population-based sample of adults.

METHOD

Our study used the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (NESARC; 2004-2005), a large (n = 34,653) nationally representative survey of community-dwelling American adults. Multiple logistic regression analyses examined the relation between suicide attempts and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nicotine dependence, compared with nonusers of nicotine. Associations between suicide attempts and other measures of nicotine use (nicotine cessation, age of first use, frequency, and amount of use) were also examined.

RESULTS

Lifetime (AOR 1.78; 95% CI 1.48 to 2.15) and past-year nicotine dependence (AOR 1.77; 95% CI 1.02 to 3.06) were independently associated with lifetime and past-year suicide attempts, respectively, even after adjusting for sociodemographic factors, other mental disorders, and physical disease. Nicotine dependence cessation was associated with a decreased likelihood of suicide attempt compared with people currently dependent on nicotine (AOR 0.15; 95% CI 0.05 to 0.43). Greater amount of daily cigarette use was associated with suicide attempts in the model that adjusted for sociodemographic factors and other mental disorders (AOR 1.53; 95% CI 1.05 to 2.24).

CONCLUSIONS

Nicotine dependence is associated with suicide attempts, independently of comorbid mental disorders and physical disease. The association attenuates when a person ceases using nicotine, suggesting a state, rather than trait, effect. These findings provide evidence for additional concern regarding the deleterious health effects of tobacco.

Smoking concordance in lung and colorectal cancer patient-caregiver dyads and quality of life

BACKGROUND

Distress may be heightened among members of cancer patient-caregiver dyads that are mismatched on smoking status (either the patient or caregiver smokes, but the other does not), negatively affecting quality of life (QoL). The purpose of this study was to examine associations between patient-caregiver smoking concordance, caregiver psychological adjustment, and caregiver and patient mental and physical QoL.

METHODS

Lung and colorectal patient-caregiver dyads (N = 742) were identified from the Cancer Care Outcomes Research and Surveillance (CanCORS) and CanCORS Caregiver studies. The majority of the cancer patients were male (67.0%) with local (45.6%) or regional (12.9%) disease. The majority of the informal caregivers were females (78.6%), under 65 years of age (69.6%), and often spouses (57.8%) of the patients.

RESULTS

Lung and colorectal cancer caregivers, who were members of dyads where one or both members continued to smoke, reported worse mental health QoL than nonsmoking dyads. For colorectal cancer patients, continuing to smoke when the caregiver did not was associated with worse mental health QoL compared with nonsmoking dyads. Dyad smoking was less strongly associated with physical QoL for both caregivers and patients.

CONCLUSION

Results highlight the importance of assessing smoking in both cancer patients and their caregivers and referring families to appropriate psychosocial and smoking cessation services.

IMPACT

This is the first study to show associations between cancer patient-caregiver smoking status and QoL for both dyad members. Future studies will need to confirm these associations longitudinally and investigate potential mechanisms linking dyad smoking and QoL.

Impulsivity-like traits and smoking behavior in college students

Recent research has deconstructed the concept of impulsivity by identifying five different traits that influence engagement in impulsive behaviors: positive urgency (tendency to act rashly in response to a positive mood), negative urgency (tendency to act rashly in response to a negative mood), sensation seeking, lack of planning, and lack of perseverance. The traits are only moderately related to each other. The aim of this study was to apply this advance to the study of smoking. We tested a two-stage hypothesis: Higher sensation seeking was hypothesized to differentiate current smokers from non-smokers, and negative and positive urgencies were expected to predict concurrent level of nicotine dependence among smokers. As anticipated, greater sensation seeking was associated with a higher odds of being a current smoker (odds ratio=1.51). Greater positive urgency, but not other impulsivity-related traits, was associated with significantly higher levels of nicotine dependence, explaining 29% of the variance in level of nicotine dependence.

Relationships of personality and psychiatric disorders to multiple domains of smoking motives and dependence in middle-aged adults

INTRODUCTION

Individual differences in psychopathology and personality may associate with dependence on smoking for specific motivational reasons. However, the associations among psychopathology, personality, and smoking dependence and motives have not been examined simultaneously in studies to date, leaving it unclear whether specific patterns of affective and behavioral functioning are associated with specific aspects of smoking dependence.

METHODS

The present study examined these associations in 296 current smokers aged 35-43 years. Smoking dependence and motives were assessed with structured interview, the Fagerström Test for Nicotine Dependence, and the Wisconsin Inventory of Smoking Dependence Motives.

RESULTS

Regardless of the measure of smoking dependence tested, a lifetime history of major depression and high levels of trait stress reaction were consistently related to greater current smoking dependence severity. Substance dependence showed significant associations with some measures of smoking dependence but had relatively few effects when entered in models along with depression history and trait stress reaction. In multivariate models, alcohol dependence and conduct disorder history did not show unique significant associations with smoking dependence nor did trait aggression, alienation, control, or harm avoidance.

DISCUSSION

Results indicate little specificity in the associations of particular psychiatric diagnoses or personality traits with specific self-reported facets of smoking dependence. It appears that a general vulnerability to depression and negative emotions is the most robust indicator of vulnerability to high levels of self-reported smoking dependence, regardless of which dimensions of smoking dependence are analyzed.

Hostility, cigarette smoking, and responses to a lab-based social stressor

High-trait hostility is associated with persistent cigarette smoking. To better understand mechanisms that may account for this association, we examined the effects of acute smoking abstinence and delayed versus immediate smoking reinstatement on responses to a social stressor among 48 low hostile (LH) and 48 high hostile (HH) smokers. Participants completed two laboratory sessions, one before which they had smoked ad lib and one before which they had abstained for the prior 12 hr. During each session, participants completed a stressful speaking task and then smoked immediately after the stressor or after a 15-min delay. The effect of immediate versus delayed smoking reinstatement on recovery in negative mood was significantly moderated by hostility. When reinstatement was delayed, HH participants showed significant increases in negative mood over time, whereas LH participants showed little change. When reinstatement was immediate, HH and LH smokers showed similar significant decreases in negative mood. Smoking abstinence did not moderate hostility effects. Cigarette smoking may prevent continuing increases in negative mood after social stress in HH smokers, which may partially explain their low rates of quitting.