Tobacco dependence among intermittent smokers

Attentional Bias, Pupillometry, and Spontaneous Blink Rate: Eye Characteristic Assessment Within a Translatable Nicotine Cue Virtual Reality Paradigm

Background

Incentive salience processes are important for the development and maintenance of addiction. Eye characteristics such as gaze fixation time, pupil diameter, and spontaneous eyeblink rate (EBR) are theorized to reflect incentive salience and may serve as useful biomarkers. However, conventional cue exposure paradigms have limitations that may impede accurate assessment of these markers.

Objective

This study sought to evaluate the validity of these eye-tracking metrics as indicators of incentive salience within a virtual reality (VR) environment replicating real-world situations of nicotine and tobacco product (NTP) use.

Methods

NTP users from the community were recruited and grouped by NTP use patterns: nondaily (n=33) and daily (n=75) use. Participants underwent the NTP cue VR paradigm and completed measures of nicotine craving, NTP use history, and VR-related assessments. Eye-gaze fixation time (attentional bias) and pupillometry in response to NTP versus control cues and EBR during the active and neutral VR scenes were recorded and analyzed using ANOVA and analysis of covariance models.

Results

Greater subjective craving, as measured by the Tobacco Craving Questionnaire-Short Form, following active versus neutral scenes was observed (F1,106=47.95; P<.001). Greater mean eye-gaze fixation time (F1,106=48.34; P<.001) and pupil diameter (F1,102=5.99; P=.02) in response to NTP versus control cues were also detected. Evidence of NTP use group effects was observed in fixation time and pupillometry analyses, as well as correlations between these metrics, NTP use history, and nicotine craving. No significant associations were observed with EBR.

Conclusions

This study provides additional evidence for attentional bias, as measured via eye-gaze fixation time, and pupillometry as useful biomarkers of incentive salience, and partially supports theories suggesting that incentive salience diminishes as nicotine dependence severity increases.

Switching away from smoking at 12 months among adult JUUL users varying in recent history of quit attempts made with and without smoking cessation medication

Some smokers switch away from smoking using e-cigarettes, but guidelines recommend trying approved medications first. We analyzed switching in adult smokers using JUUL by their recent history of quit attempts and use of smoking cessation medications. Participants were 8511 adult (21+) established smokers (at baseline), in which 50.3% are daily smokers, in a longitudinal observational study who completed a survey 12 months after first purchasing a JUUL Starter Kit. At baseline, participants reported attempts to quit smoking in the prior year and use of pharmacotherapy (nicotine replacement therapy [NRT] or prescription medication) in their most recent attempt. The outcomes were switching (self-reported no past-30-day smoking) and 50%+ reductions in cigarette consumption. Multivariable analyses were adjusted for baseline covariates. Two thirds of the participants had made a quit attempt in the year before purchasing JUUL. Overall, 59% [58%, 60%] had switched at 12 months. Switching was more likely in those who had used NRT and who attempted quitting without medication versus those who used prescription medications or made no quit attempt. In adjusted multivariable analyses, only making a past-year quit attempt (vs. not) was associated with higher odds of switching (OR = 1.15 [1.04, 1.28]). Over 60% of dual users reduced cigarette consumption by ≥50%. These associations were largely similar in daily smokers. Twelve months after purchasing JUUL, almost all smokers reported either switching or reducing their smoking by 50%+, including those who had recently failed to quit smoking with approved pharmacotherapies. E-cigarettes provide an alternative route to abstinence from smoking for smokers with a history of cessation and cessation treatment failure.

Associations Between Food Addiction and Substance-Use Disorders: A Critical Overview of their Overlapping Patterns of Consumption

Purpose of Review

Research on patterns of overconsumption in individuals with food addiction (FA) has focused largely on binge eating. However, compulsive overeating can be varied and dimensional. This review focuses on the similarities between the patterns of consumption in FA and in other clinically established substance-use disorders, such as alcohol and nicotine dependence. It also highlights features that make FA unique to other addiction disorders.

Recent Findings

Overall, there is substantial evidence that binge-like overconsumption is a characteristic of various substance-use and eating disorders. Likewise, it appears that different overeating patterns can reflect addictive-like eating. One pattern may be compulsive grazing — defined as the repetitive inability to resist consumption of small amounts of food.

Summary

This review adds to the increasingly compelling picture that FA and binge-eating disorder are unique conditions, and that FA resembles other substance-use disorders. We conclude that a variety of overeating patterns can reflect addictive eating behaviours in vulnerable individuals, one of which may be compulsive grazing.

Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults

OBJECTIVES

Italy is one of the first countries that imposed a nationwide stay-at-home order during the COVID-19 outbreak, inevitably resulting in changes in lifestyles and addictive behaviours. The aim of this work is to investigate the impact of lockdown restrictions on smoking habits using data collected within the Lost in Italy project.

METHODS

A web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18-74 years. Study subjects were recruited from 27 April to 3 May 2020 and were asked to report changes in smoking habits before the lockdown and at the time of interview.

RESULTS

During the lockdown, 5.5% of the overall sample quit or reduced smoking, but 9.0% of the sample started, relapsed smoking or increased their smoking intensity. In total, the lockdown increased cigarette consumption by 9.1%. An improvement in smoking habits was associated with younger age, occasional smoking and unemployment, whereas a worsening was mainly associated with mental distress. In particular, an increase in cigarette consumption during lockdown was more frequently reported among those with worsening quality of life (OR: 2.05; 95% CI: 1.49 to 2.80), reduction in sleep quantity (OR: 2.29; 95% CI: 1.71 to 3.07) and increased anxiety (OR: 1.83; 95% CI: 1.38 to 2.43) and depressive symptoms (OR: 2.04; 95% CI: 1.54 to 2.71).

CONCLUSIONS

COVID-19 lockdown had a huge impact on smoking consumption of the Italian general population. The main concern is for smokers who increase their cigarette consumption due to an increased mental distress. Providing greater resources for cessation services capable of reducing mental health symptoms in smokers is urgently needed.

Mentioning smoking cessation assistance during healthcare consultations matters: findings from Dutch survey research

Background

Smoking cessation assistance (SCA) can help smokers to successfully quit smoking. It is unclear to what extent hearing about SCA from a healthcare professional is associated with using SCA during a quit attempt.

Methods

We used pooled survey data from the 2016, 2018 and 2020 ‘Module Substance Use’ survey in the Netherlands (N = 5928). Multivariate logistic regression analyses were used to determine the association between having heard about SCA from one or more healthcare professionals in the last year and the use of SCA during the most recent quit attempt in the last year. We used two models: model 1 included any type of assistance; model 2 included assistance typically recommended by treatment guidelines (i.e. counselling and pharmacotherapy).

Results

Hearing about any type of SCA from a healthcare professional in the last year was significantly associated with using any type of SCA during the most recent quit attempt [odds ratio (OR) = 2.96; 95% confidence interval (CI) 2.16–4.06; P < 0.001]. We found the strongest association between hearing about counselling and/or pharmacotherapy and using counselling and/or pharmacotherapy (OR = 5.40; 95% CI 4.11–11.60; P < 0.001). The odds of using SCA was not significantly higher for smokers who had heard about it from two or more healthcare professionals compared to one healthcare professional (OR = 1.38; 95% CI 0.79–2.42; P = 0.26).

Conclusions

Healthcare professionals can play a greater role in stimulating the use of SCA, especially counselling and pharmacotherapy, by mentioning it to smokers during consultations.

Cigarettes smoked among daily and non-daily smokers following CVS Health's tobacco-free pharmacy policy

INTRODUCTION

In September 2014, CVS Health ceased tobacco sales in all of its 7700 pharmacies nationwide. We investigate the impact of the CVS policy on the number of cigarettes smoked per day among metropolitan daily and non-daily smokers, who may respond to the availability of smoking cues in different manners.

METHODS

Data are from the US Census Bureau Tobacco Use Supplement to the Current Population Survey 2014-2015 and the Blue Cross and Blue Shield Institute Community Health Management Hub. Adjusted difference-in-difference (DID) regressions assess changes in the number of cigarettes smoked per day among daily smokers (n=10 759) and non-daily smokers (n=3055), modelling core-based statistical area (CBSA) level CVS pharmacy market share continuously. To assess whether the policy had non-linear effects across the distribution of CVS market share, we also examine market share using tertiles.

RESULTS

CVS's tobacco-free pharmacy policy was associated with a significant reduction in the number of cigarettes smoked by non-daily smokers in the continuous DID (rate ratio=0.985, p=0.022), with a larger reduction observed among non-daily smokers in CBSAs in the highest third of CVS market share compared with those living in CBSAs with no CVS presence (rate ratio=0.706, p=0.027). The policy, however, was not significantly associated with differential changes in the number of cigarettes by daily smokers.

CONCLUSION

The removal of tobacco products from CVS pharmacies was associated with a reduction in the number of cigarettes smoked per day among non-daily smokers in metropolitan CBSAs, particularly those in which CVS had a large pharmacy market share.

Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002-2019

SIGNIFICANCE

Cannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD).

METHODS

Data were drawn from the 2002-2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1-5 CPD; moderate, 6-15 CPD; heavy, 16+ CPD).

RESULTS

Across all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use.

CONCLUSIONS

US individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.

Motives for Substance Use in Daily Life: A Systematic Review of Studies Using Ecological Momentary Assessment

The motivational model of substance use posits four motive subtypes (coping, enhancement, social, conformity) dynamically interact with contextual factors to impact decisions about substance use. Yet, prior studies assessing the motivational model have relied on between-person, cross-sectional evaluations of trait motives. We systematically reviewed ecological momentary assessments (EMA) studies (N=64) on motives for substance use to examine: methodological features of EMA studies examining the motivational model, support for the motivational model between and within individuals, and associations between trait motives and daily processes. Results of the reviewed studies provide equivocal support for the motivational model, and suggest that EMA measures and trait measures of motives might not reflect the same construct. The reviewed body of research indicates most studies have not examined the momentary and dynamic nature of the motivational model and more research is needed to inform interventions that address heterogeneous reasons for substance use in daily life.

Characterizing nicotine exposure among a community sample of non-daily smokers in the United States

Background

Over one-quarter of all smokers in the United States identify as non-daily smokers and this number is projected to rise. Unlike daily smokers who typically maintain consistent levels of nicotine exposure with regular smoking, non-daily smokers have variable patterns of smoking that likely result in high intraindividual variability in nicotine intake. The current study aimed to characterize the weekly intraindividual variability in cotinine and identify smoking-related predictors in nondaily smokers.

Methods

An ecological momentary assessment of 60 non-daily smokers ages 24–57 years was conducted over a consecutive 7-day at-home protocol to log each smoking session, assessments of mood and social activity during smoking, and collection of daily saliva samples in a convenience sample from Pennsylvania, USA. Hierarchical linear regression analyses were conducted to determine the effects of smoking characteristics on total cotinine exposure measured by pharmacokinetic area under the curve and the range, maximum, and minimum cotinine values during the week controlling for demographic variables.

Results

The mean daily cotinine level was 119.2 ng/ml (SD = 168.9) with individual values that ranged from nondetectable to 949.6 ng/ml. Menthol predicted increased total cotinine levels (P < 0.05). Shorter time to the first cigarette of the day predicted significantly higher minimum (P < 0.05), maximum (P < 0.05), and total cotinine values (P < 0.05) after controlling for covariates. Negative emotions and social interactions with others were also significantly associated with higher cotinine metrics. There was no significant effect of the nicotine metabolite ratio.

Conclusions

Our findings highlight the variability in nicotine exposure across days among non-daily smokers and point to the role of smoking context in nicotine exposure. The findings suggest the need to develop better assessment methods to determine health and dependence risk and personalized cessation interventions for this heterogeneous and growing group of smokers.

Internet-based intervention compared to brief intervention for smoking cessation in Brazil: a pilot study (Preprint)

Background

Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop.

Objective

This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians.

Methods

Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants’ characteristics, and the intention to treat was calculated.

Results

A total of 49 smokers were enrolled in this study (n=25, 51% in the brief intervention group; n=24, 49% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2%), had elementary school (n=22, 44.9%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71%) participants answered follow-up 1, and 19 (39%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups.

Conclusions

The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size.

Comparison of Nicotine Dependence and Biomarker Levels among Traditional Cigarette, Heat-Not-Burn Cigarette, and Liquid E-Cigarette Users: Results from the Think Study

This study aimed to compare Korean smokers' smoking-related biomarker levels by tobacco product type, including heat-not-burn cigarettes (HNBC), liquid e-cigarettes (EC), and traditional cigarettes (TC). Nicotine dependence levels were evaluated in Korean adult study participants including TC-, EC-, HNBC-only users and nonsmokers (n = 1586) from March 2019 to July 2019 in Seoul and Cheonan/Asan South Korea using the Fagerström Test Score. Additionally, urine samples (n = 832) were collected for the measurement of urinary nicotine, cotinine, OH-cotinine, NNAL(4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), CYMA(N-acetyl-S-(2-cyanoehtyl)-L-cysteine), or CEMA (2-cyanoethylmercapturic acid) using LC-MS/MS. The median(interquartile range) nicotine dependence level was not different among the three types of smokers, being 3.0 (2.0-5.0) for TC- (n = 726), 3.0 (1.0-4.0) for EC- (n = 316), and 3.0 (2.0-4.0) for HNBC- (n = 377) only users. HNBC-only users presented similar biomarker levels compared to TC-only users, except for NNAL (HNBC: 14.5 (4.0-58.8) pg/mL, TC: 32.0 (4.0-69.6) pg/mL; p = 0.0106) and CEMA (HNBC: 60.4 (10.0-232.0) ng/mL, TC: 166.1 (25.3-532.1) ng/mL; p = 0.0007). TC and HNBC users showed increased urinary cotinine levels as early as the time after the first smoke of the day. EC users' biomarker levels were possibly lower than TC or HNBC users' but higher than those of non-smokers.

Effectiveness of nicotine gum in preventing lapses in the face of temptation to smoke among non-daily smokers: a secondary analysis

BACKGROUND AND AIMS

Non-daily smokers (NDS) comprise a large fraction of US smokers. Despite little or no dependence, as typically assessed, intermittent smokers (ITS) have difficulty quitting smoking. A randomized clinical trial comparing the effect of nicotine gum with placebo on quitting smoking in non-daily smokers did not find an effect on overall abstinence. We undertook an analysis to assess whether using nicotine gum versus placebo when tempted to smoke could reduce incidence of lapses in those situations.

DESIGN

Within a 6-week randomized, placebo-controlled clinical trial of nicotine gum, analyses contrasted the outcome of temptation episodes where gum was or was not used.

SETTING

Smoking cessation research clinic in Pittsburgh, PA, USA.

PARTICIPANTS

A total of 255 adult ITS (131 nicotine gum, 124 placebo) seeking help for smoking cessation.

INTERVENTION

Nicotine gum (2 mg) versus placebo for up to 8 weeks, with as-needed dosing instructions.

MEASUREMENTS

Outcome was lapsing in temptation episodes, as reported by participants via ecological momentary assessment (EMA). Propensity scores predicting gum use from situational factors (e.g. mood, social setting, smoking cues) served as a control variable.

FINDINGS

Participants reported 2713 temptation episodes, 46.0% (1248) of which resulted in smoking (lapsing). There was a significant gum use × active treatment interaction (P = 0.0009). Using nicotine gum decreased the odds of lapsing by 55% compared with using placebo [odds ratio (OR) = 0.45; 0.22-0.94]; when gum was not used, the assigned gum condition made no significant difference (OR = 1.53; 0.78-3.01; Bayes factor = 0.14). The nicotine effect was not reliably different when participants were trying to achieve abstinence versus when trying to maintain abstinence (OR = 0.44; 0.10, 2.03; P = 0.294; Bayes factor = 0.11), for men and women (OR = 1.68; 0.58, 4.87; P = 0.343; Bayes factor = 0.10), or for participants with some or no dependence (OR = 0.88; 0.30, 2.59; P = 0.811; Bayes factor = 0.06).

CONCLUSIONS

When used in response to temptation to smoke, 2 mg nicotine gum can help to prevent lapses among non-daily smokers.

Heterogeneity in past-year smoking, current tobacco use, and smoking cessation behaviors among light and/or non-daily smokers

INTRODUCTION

Prevalence of light daily smoking, <10 cigarettes per day (CPD), and non-daily smoking has increased in the US population. This analysis examined the heterogeneity in past-year smoking behavior, current tobacco use behaviors, and smoking cessation behaviors among light and/or non-daily smokers.

METHODS

Current adult (≥18 years old) smokers (N=26196) participated in the 2010–2011 US Current Population Survey – Tobacco Use Supplement, which reported current (T1) and past 12-month (T0) smoking behaviors. Responses were categorized by intensity (light ≤10 CPD vs heavy >10 CPD) and frequency (non-daily vs daily). Combinations of T0 and T1 smoking behaviors resulted in 15 smoking trajectories ending in light/non-daily smoking and a 16th category of heavy daily smokers at T1. Differences in demographics, tobacco use, and smoking cessation behaviors were assessed by using weighted multivariable regression models.

RESULTS

Overall, 46.1% of US smokers were heavy smokers, 24.6% remained light daily smokers and 12.5% remained light non-daily smokers between T0 and T1. Current cigar, smokeless tobacco, and pipe use differed by smoking trajectories (p<0.05). All light and/or non-daily smokers were more likely than heavy daily smokers to have made a quit attempt (p<0.05) but use of cessation treatments varied. Smokers in many light and/or non-daily smoking trajectories were less likely than heavy daily smokers to be aided by healthcare providers for smoking cessation (p<0.05).

CONCLUSIONS

Among heavy daily smokers who became light non-daily smokers, the mismatch between intent to quit (80.9%) and receiving advice to set a quit date (33.7%) is one example of a potential opportunity for a clinical intervention.

Using Nicotine Gum to Assist Nondaily Smokers in Quitting: A Randomized Clinical Trial

INTRODUCTION

Non-daily intermittent smokers (ITS) comprise 30% of US adult smokers. ITS smoke for nicotine and have trouble quitting, but tend to smoke in particular situations. This study tested the effect of nicotine gum, used to prevent or react to situational temptations, for helping ITS quit.

METHODS

ITS (smoking 4-27 days/month) seeking help quitting were randomized to 2 mg nicotine gum (n = 181) or placebo (n = 188), to be used to anticipate or react to temptations to smoke, for 8 weeks. Participants received up to six sessions of behavioral counseling. The primary outcome was 6-month biochemically verified continuous abstinence; analyses also examined 14-day point-prevalence abstinence at multiple time points, and used event-history analyses to assess progression to abstinence, lapsing, and relapsing. Analyses adjusted for group differences in age and baseline smoking, and considered several potential moderators of treatment effects.

RESULTS

Nicotine gum did not significantly improve outcomes on any measure. Biochemically verified 6-month continuous abstinence rates were 7.2% for active gum and 5.3% for placebo (AOR = 1.39, 0.58-3.29, p > .25). ITS with any degree of dependence (Fagerstrom Test of Nicotine Dependence scores >0) showed poorer outcomes on multiple endpoints, and did more poorly on active gum on some outcomes. Gum use was low, starting at 1 gum per day on average and declining over time.

CONCLUSIONS

Nicotine gum (2 mg), used intermittently, did not improve cessation rates among ITS, including those demonstrating some degree of dependence.

IMPLICATIONS

Nicotine replacement has been extensively tested with daily smokers, especially those who smoke relatively heavily. Nondaily smoking is now common, creating a need for treatment for ITS. Despite evidence that ITS' smoking is motivated by nicotine-seeking, a theoretically and empirically derived situational approach to using acute nicotine replacement was not successful at helping ITS quit. Gum use was low; whether higher or more frequent dosing is needed, or whether an entirely different approach is needed, is not clear. Effective treatment options are needed for ITS, especially those with some degree of dependence.

Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences

AIM

To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England.

METHODS

Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies.

RESULTS

There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant.

CONCLUSION

Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact.

IMPLICATIONS

This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.

Ecological momentary assessment of temptations and lapses in non-daily smokers

RATIONALE

Little is known about relapse among non-daily, intermittent smokers (ITS), who have difficulty quitting, despite a lack of dependence.

OBJECTIVES

To analyze situations associated with temptations to smoke and smoking lapses among ITS trying to maintain abstinence.

METHODS

Participants were 130 initially abstinent ITS in the placebo arm of a smoking cessation study. EMA data captured participants' situations and states in temptations (n = 976), including those that eventuated in lapses (n = 147), for up to 6 weeks. Randomly timed assessments assessed background states (n = 11,446). Participants also reported coping performed to prevent lapses. Multilevel analyses compared temptations to background situations, and lapse episodes to resolved temptations.

RESULTS

Temptations were marked by exposure to smoking cues, including others smoking, lax smoking restrictions, and alcohol consumption, as well as more negative affect. Lapses did not differ from resolved temptations in craving intensity, but were more often associated with smoking cues and availability of cigarettes, alcohol consumption, and worse affect, and were more often attributed to good moods. Both behavioral and cognitive coping responses were associated with avoiding lapsing, but behavioral coping had much larger effects. The effects of affective distress on lapse risk were mediated by its effects on coping.

CONCLUSIONS

Smoking cues play a major role in ITS' temptations and lapses, perhaps indicating a degree of behavioral dependence. Affective distress also played a role in ITS lapses, undermining the idea that the affective distress seen in daily smokers' lapses is due to nicotine withdrawal. The data reinforce the important role of coping in preventing lapses.

Changes in smoker characteristics in England between 2008 and 2017

AIMS

At a time of declining smoking prevalence in England, it is useful to document any changes in the characteristics of smokers. This has implications for targeting tobacco control policies and interventions. This study compared the characteristics of smokers from 2008 to 2017 to assess changes in smoking and quitting patterns and socio-demographic profile.

DESIGN AND SETTING

Analysis of annual trends in results from repeated cross-sectional surveys of representative samples of the population in England from 2008 to 2017.

PARTICIPANTS

The study included 208 813 adults aged 16+.

MEASUREMENTS

Information was gathered on age, sex, social grade and region, cigarette consumption, cigarette dependence as measured by time to first cigarette of the day, daily smoking, smoking roll-your-own cigarettes, attempts to cut down, use of an e-cigarette or nicotine replacement therapy, attempts to cut down or quit, use of support in quit attempts and whether the quit attempt was abrupt.

FINDINGS

During the period, mean daily cigarette consumption [B = -0.30, 95% confidence interval (CI) = -0.33 to -0.27] and the time to first cigarette score decreased (B = -0.03, 95% CI = -0.03 to -0.02). The proportion of smokers attempting to cut down or quit decreased (odds ratio (OR) range = 0.96-0.97, 95% CI range = 0.95-0.97). Use of behavioural support [odds ratio (OR) = 0.89, 95% CI = 0.86-0.92] or no support decreased (OR = 0.98, 95% CI = 0.96-0.99), while use of pharmacological support, including e-cigarettes, increased (OR = 1.04, 95% CI = 1.02-1.05). There was no significant change in the difference in social grade between smokers and non-smokers comparing 2008 with 2017. Changes in smoking and quitting behaviour were independent of changes in socio-demographic characteristics.

CONCLUSIONS

Between 2008 and 2017 in England, smokers appear to have become less dependent on cigarettes but less likely to try to quit or cut down. Of those who tried to quit, fewer used behavioural support and more used pharmacological support. The proportion from more disadvantaged backgrounds did not change significantly.

The association between gender roles and smoking initiation among women and adolescent girls

Smoking cigarettes is a leading global cause of preventable death and disease. Men historically smoke more than women, but the prevalence of smoking among women in low and middle-income countries is increasing at an alarming rate. Understanding the factors that influence smoking initiation among women and girls is needed to address the growing epidemic of women smokers and the looming impact on women's health worldwide. We assume that smoking initiation is embedded in socio-culturally influenced gendered context and use a social cognitive model with a gendered lens as a framework for organizing and synthesizing the research. Guided by this framework, we identified gaps in the literature and make recommendations for future research in this review paper. The results suggest that psychological and environmental determinants are rooted in fluctuating cultural influences and values, but few research studies provide a gendered analysis or systematically examine these factors in the context of gender and culture. Sex/gender is a significant construct through which women and girls experience the psychological, environmental, and other influences on smoking initiation. Much more research is needed to understand the psychological and environmental influences as well as the intersection of gender roles and other social categories on female smoking initiation.

Intent to quit, quit attempts, and perceived health risk reduction among African American, Latino, and White nondaily and daily smokers in the United States

Objective: Ethnic and racial differences in smoking patterns and behaviors have been well documented and most African American and Latino smokers are nondaily or light smokers. However, differences within smoking levels are understudied. Our primary aim was to determine whether there are racial and ethnic differences among African American, Latino, and White nondaily, light daily, and moderate to heavy daily smokers on (1) perceived health risk reduction, (2) intentions to quit, and (3) past year quit attempts. Design: Smokers were recruited through an online research panel for a cross-sectional survey (n = 2376). Sampling quotas were used to obtain equal numbers of African American, Latino, and White nondaily and daily smokers. Results: African American (59.6%) and Latino (54%) nondaily smokers were more likely than White nondaily smokers (45%) to currently limit their cigarettes per day (cpd) as a perceived health risk reduction strategy (p < 0.05). African American nondaily smokers were more likely than Latino and White nondaily smokers (p < 0.05) to limit their smoking in the past year as a perceived health risk reduction strategy (range: 0 'never' to 5 'always'; Means = 3.2, 2.9, 3.0, standard deviations [SD] = 1.1, 1.1, 1.2, respectively). African American nondaily smokers (15%) were more likely than either Latinos (7.8%) or Whites (8.5%) to intend to quit in the next 30 days (p < 0.01). African American (61.6%) and Latino (60.3%) nondaily smokers were more likely than Whites (49%) to have made a quit attempt in the past year (p < 0.01). Fewer racial and ethnic differences were found among daily smokers. Conclusions: Racial and ethnic group differences were more pronounced among nondaily smokers compared to light daily smoker and moderate to heavy daily smokers. Smoking level is an important consideration in understanding racial and ethnic variation in perceived health risk reduction and cessation-related behaviors.

Sociological and Psychological Factors on Prohibited Substances Abuse in Rehabilitation Centre of Medan City, Indonesia

INTRODUCTION:

Prohibited substances issue and their abuse have become a scourge for people in Indonesia. This situation creates concern for every level of society since this is very influential to damage and can even eliminate generations at a later time.

AIM:

This study aims to determine the characteristics of age, education, psychological and social problems related to substance dependence experienced by individuals with substance disorders who undergo rehabilitation in Medan, Indonesia.

METHODS:

This study is a cross-sectional analytic, in which the sample of this study was individuals who underwent rehabilitation in the Rehabilitation Center in Medan City who fulfilled the inclusion and exclusion criteria. A structured interview was carried out with the MINI ICD-10 on part M. disorders related to psychoactive substances. Furthermore, to see the level of dependence, WHO ASSIST questionnaire (The Alcohol, Smoking and Substance Involvement Screening Test) was used.

RESULTS:

This study discovered that subjects with age above 21 years were the most dominant of the prohibited substance users group as many as 87 people (69%), Batak tribe with 73 people (57.9%), residence originating from outside the city with 70 people (55.6%), Unmarried with 87 people (70.2%), education level is medium (junior high school) with 117 people (92.9%) and work as many as 77 people (61.1%). The study also found that the most dominant number of prohibited substances users were single users of methamphetamine and a combination of two substances, each of which was 49 people (38.9%). There is no relationship between social factors and patterns of prohibited substance use. Also, the most dominant users of prohibited substances who undergo rehabilitation are those based on family and police (involuntary admission). Finally, as many as 70 people used methamphetamine require intensive intervention.

CONCLUSION:

This study shows that social and demographic factors are not related to the pattern of prohibited substance use.

Increases in Cigarette Consumption and Decreases in Smoking Intensity When Nondaily Smokers Are Provided With Free Cigarettes

Introduction

Studies testing novel tobacco products often provide participants with free product and assess consumption. Some, but not all, studies find that providing free cigarettes increases smoking. We tested changes in smoking when free cigarettes were provided to nondaily, intermittent smokers, who constitute one-third of US adult smokers.

Methods

Cigarette consumption was assessed by Time-Line Follow-Back in 235 intermittent smokers for two 2-week periods: when providing their own cigarettes and when provided own-brand cigarettes for free. Smoking topography and carbon monoxide boost were assessed for one cigarette at the end of each period.

Results

Cigarette consumption increased significantly, by 66% (from 1.98 to 3.28 cigarettes per day), when cigarettes were available for free; both the number of days the subjects smoked and the number of cigarettes on those days increased. The increases were significantly greater among African Americans, those Fagerström Tobacco Nicotine Dependence scores >0, those with incomes less than US $25,000 per year, those who engaged in greater conscious restraint of smoking, and for smokers of menthol cigarettes, or "longs." Smoking intensity (smoke volume, by topography) and carbon monoxide boost decreased significantly when cigarettes were provided for free.

Conclusions

Providing intermittent smokers with free cigarettes substantially increased their smoking while decreasing smoking intensity. The increases in smoking varied according to multiple individual and cigarette-type differences. These phenomena may complicate interpretation of studies that compare consumption of a free test product with cigarette consumption or constituent exposure when smokers are providing their own cigarettes. They also suggest that cigarette cost and variations in low-level dependence and in smoking restraint are factors in nondaily smoking.

Implications

The study shows that providing nondaily smokers with free cigarettes increases cigarette consumption, but does differentially for different subgroups and cigarette types, while also decreasing smoking intensity. This suggests the value of using free-cigarette baseline data in studies where interventions provide free cigarettes.

Infrequent and Frequent Nondaily Smokers and Daily Smokers: Their Characteristics and Other Tobacco Use Patterns

Introduction

The proportion of smokers who do not smoke daily has increased over time, but nondaily smokers are a heterogeneous group. We compare characteristics and other tobacco product use of infrequent nondaily, frequent nondaily, and daily US adult smokers.

Methods

We analyzed data from the 1998, 2000, 2005, and 2010 National Health Interview Surveys. Current smokers were categorized as daily, infrequent nondaily (smoked 1-12 days in the past 30 days), and frequent nondaily (smoked 13-29 days in the past 30 days) smokers. Multinomial logistic regression analysis was used to analyze the correlates of infrequent nondaily, frequent nondaily, and daily smoking.

Results

Among current smokers, 8.3% were infrequent nondaily, 8.1% were frequent nondaily, and 83.6% were daily smokers. The prevalence of infrequent versus daily smoking increased over time, with a smaller increase among non-Hispanic Blacks than non-Hispanic Whites. The adjusted odds of both infrequent and frequent smoking versus daily smoking differed by age, race/ethnicity, education, poverty status, marital status, region, quit attempts in the past 12 months, and binge drinking. Snuff users (vs. non-snuff users) were 2.4 times as likely to be infrequent than daily smokers. There were also differences in race/ethnicity, education, marital status, region, quit attempts, and snuff use between infrequent versus frequent smokers.

Conclusion

Infrequent smokers differ from both frequent and daily smokers in socio-demographics, quit attempts, and snuff use. The heterogeneity of nondaily smokers should be considered in developing targeted tobacco control and smoking cessation programs.

Implications

Infrequent and frequent nondaily smokers were found to differ from daily smokers in age, race/ethnicity, education, poverty status, marital status, region, and quit attempts and they were different from each other in race/ethnicity, education, marital status, region, and quit attempts. Binge drinkers were more likely to be infrequent smokers and frequent smokers versus daily smokers. Current snuff users were found to have increased odds of infrequent smoking versus daily smoking and versus frequent smoking. These results highlight the importance of acknowledging the differences among nondaily smokers in smoking frequency in developing targeted tobacco control and smoking cessation programs.

Heterogeneity of intermittent smokers in a Hispanic college student sample

Hispanics are more likely to be daily light smokers (DLS) and intermittent smokers (ITS) than non-Hispanic whites. Although daily light (≤10 cigarettes per day [CPD]) and intermittent (nondaily) smoking have increased in recent years, few studies have compared DLS and ITS, especially within a Hispanic sample. The primary aims of this study were to investigate differences between DLS and ITS, and within ITS, differences between converted ITS (CITS; previously smoked daily for ≥6 months) and native ITS (NITS; never smoked daily) in a Hispanic college student sample (M_age = 23.74, SD = 5.17; 58.1% male). Analyses were conducted using baseline data from a larger study that evaluated attitudes toward tobacco free campus policies in a U.S. university on the border with México. This study included data from 45 DLS and 216 ITS (CITS: n = 77, NITS: n = 139; N = 261). Compared to DLS, ITS were younger (on average), less likely to identify as smokers, smoked on fewer days in the past month, smoked fewer cigarettes on smoking days, and reported less nicotine dependence. Compared to CITS, NITS were younger, less likely to self-identify as smokers, smoked on fewer days in the past month, smoked fewer CPD on smoking days, and were less dependent on nicotine. Given the similarities between current and past findings (suggesting that CITS are in between DLS and NITS-regarding smoking behavior), these data suggest a similar pattern likely exists also among Hispanic smokers. Additionally, the absence of some previously observed differences is relevant in characterizing this particular Hispanic college sample. These findings provide further insight for the tailoring of interventions that target Hispanic DLS, CITS and NITS).

Ecological momentary assessment of smoking behaviors in native and converted intermittent smokers

BACKGROUND AND OBJECTIVES

About 22% of adult smokers in the U.S. are intermittent cigarette smokers (ITS). ITS can be further classified as native ITS who never smoked daily and converted ITS who formerly smoked daily but reduced to intermittent smoking. Ecological momentary assessment (EMA) was conducted to determine the behaviors and experiences that are associated with the decision to smoke.

METHODS

The study included 24 native ITS and 36 converted ITS (N = 60) from the Pennsylvania Adult Smoking Study. A baseline questionnaire, daily log, and an EMA smoking log that assessed emotions, activities, and smoking urges was filled out with each cigarette for 1 week to capture 574 smoking sessions.

RESULTS

Both groups had very low levels of cigarette dependence. Both groups were more tempted to smoke in positive or negative situations than situations associated with habituation. EMA showed that the most common emotional state during smoking sessions was positive (47%), followed by negative (32%), neutral (16%), and mixed (5%) emotions. Smokers were more likely to smoke during activities of leisure (48%) than during performative duties (29%), social (16%) or interactive occasions (7%). Converted ITS were more likely to smoke alone compared to native ITS (p < .001).

DISCUSSION AND CONCLUSIONS

ITS report minimal levels of dependence when captured on traditional scales of nicotine dependence, yet experience loss of autonomy and difficulty quitting. The majority of the ITS reported positive emotions and leisure activities while smoking, and smoked during the evening.

SCIENTIFIC SIGNIFICANCE

The current paper identifies environmental and behavioral factors that are associated with smoking among ITS in real time. (Am J Addict 2018;27:131-138).

Very-low-nicotine-content cigarettes and dependence among non-daily smokers

BACKGROUND

The US Food and Drug Administration is considering reductions in the nicotine content of cigarettes to reduce smoking and tobacco dependence. A randomized study showed that even non-daily, intermittent smokers (ITS) reduced their cigarette consumption when switched to very-low-nicotine-content cigarettes (VLNCCs). This paper assesses whether switching ITS to VLNCCs results in decreased dependence and whether subsequent cigarette consumption is mediated by decreased dependence.

METHODS

ITS randomized to VLNCCs (n = 118) or normal nicotine content cigarettes (n = 120) completed multiple measures of dependence (Fagerstrom Test of Nicotine Dependence [FTND], Nicotine Dependence Syndrome Scale [NDSS], Wisconsin Inventory of Smoking Dependence Motives [WISDM], and Hooked on Nicotine Checklist [HONC]) at Baseline and 2, 6, and 10 weeks after randomization. A principal component factor score captured common variance among these measures (except FTND). Cigarettes per day (CPD) was assessed by three convergent methods.

RESULTS

Switching ITS to VLNCCs reduced dependence on all measures except the WISDM Secondary Dependence Motives and HONC. Except for the effects on the factor score, these effects of VLNCCs could be accounted for by contemporaneous CPD. Week-2 dependence measures did not prospectively predict weeks 3-4 CPD, once antecedent dependence and CPD were accounted for. "Cheating" among participants who appear to have smoked conventional cigarettes did not affect the findings.

DISCUSSION

Among ITS, switching to VLNCCs results in reduced tobacco dependence. However, the reductions in dependence appear to be secondary to effects on cigarette consumption, and do not appear to be an independent predictor or cause of reduced cigarette consumption.

Trajectories of Tobacco and Nicotine Use Across Young Adulthood, Texas, 2014-2017

OBJECTIVES

To examine intraindividual change in polytobacco and individual tobacco and nicotine product use across young adulthood.

METHOD

Participants were 2711 students from 24 Texas colleges participating in a 6-wave online study, with 6 months between each wave. Participants were aged 18 to 25 years at baseline in fall 2014 or spring 2015 and aged 20 to 28 years at wave 6. We used growth curve modeling for an accelerated longitudinal design to examine change from ages 18 to 28 years in polytobacco use (use of 2 or more products) and in use of 5 individual products (cigarettes, smokeless tobacco or snus, large cigars, cigarillos, or little cigars, hookah, and electronic nicotine delivery systems [ENDS]).

RESULTS

There was a statistically significant decline in polytobacco use from ages 18 to 28 years. There were also statistically significant declines in ENDS, hookah, and cigar use but not in smokeless tobacco use, for which use was negligible, or in cigarette use. Importantly, cigarettes were the most used product at virtually all ages.

CONCLUSIONS

Young adults may mature out of polytobacco use with increasing age, but they may continue to use some products, most notably cigarettes, potentially the most toxic and addictive tobacco and nicotine product.

Using the text-messaging program SmokefreeTXT to support smoking cessation for nondaily smokers

INTRODUCTION

Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers.

METHODS

Adult nondaily smokers (N = 32; mean age = 35 ± 12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12 weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day.

RESULTS

Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as "neutral" to "helpful." Within-person change was observed in theorized mechanisms, with less craving (p < 0.01), increased abstinence self-efficacy (external: p < 0.01; internal: p < 0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p < 0.01, pleasure p < 0.01; and pros: p < 0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N = 17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR = 2.21[1.21-3.72]), and less likely to occur to socialize (OR = 0.06[0.01-0.24]), between 19:00 and 23:00 (OR = 0.34[0.17-0.66]), and on Saturdays (OR = 0.59[0.35-0.99]) than prior to quitting.

CONCLUSIONS

While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.

A randomized clinical trial of counseling and nicotine replacement therapy for treatment of African American non-daily smokers: Design, accrual, and baseline characteristics

BACKGROUND

Non-daily smokers (NDS) who smoke on some but not all days are a growing subset of United States (US) tobacco users. Racial/ethnic minorities are more likely to be NDS. African American NDS have strikingly high levels of nicotine and carcinogen exposure, making treatment of this high risk group a priority.

METHODS

The current study is one of three ongoing federally-funded clinical trials of NDS and, to our knowledge the only RCT focused on racial/ethnic minority NDS. The design has been guided by input from Patient and Stakeholder Advisory Panels who helped develop the research questions, design the intervention, and select the outcomes. The objective is to compare the effectiveness of smoking cessation counseling alone (C) or smoking cessation counseling plus participant's choice of nicotine replacement therapy (NRT; C + NRT) for African American NDS. Two-hundred seventy-eight African American NDS will be randomized in a 2:1 fashion to C + NRT or C. All participants receive five sessions of smoking cessation counseling; those randomized to C + NRT receive their choice of nicotine gum, patch, and/or lozenge. Treatment in both groups lasts for 12 weeks. We hypothesize that C + NRT will be more effective than C on the primary outcome of biochemically-confirmed abstinence from smoking at week 12. Secondary aims will compare C + NRT and C on patient- and provider-desired outcomes including abstinence from smoking at week 26, change in biochemically-verified nicotine and carcinogen exposure, days abstinent, and treatment process measures (e.g., NRT use and side effects). Predictors of abstinence will also be explored.

DISCUSSION

Findings will illuminate effective treatment options for African American NDS and contribute to development of evidence-based guidelines for treating the 8.9 million US adult NDS for whom no guidelines currently exist.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT02244918.

Interaction between ethnicity and smoker type with dependence: A comparison of daily and intermittent African American and Caucasian smokers

Ethnic differences in smoking patterns and dependence have been observed between Caucasian and African American smokers: African Americans who smoke are more likely to be intermittent smokers (ITS), and daily smokers (DS) consume fewer cigarettes yet report more dependence. Participants' (N = 482, 67% Caucasian, 54% ITS) dependence was assessed by primary and secondary dependence subscales of the Wisconsin Inventory of Smoking Dependence Motives, the Nicotine Dependence Syndrome Scale, the Hooked on Nicotine Checklist, the Fagerström Test of Nicotine Dependence, and time to first cigarette after waking. We tested associations with dependence for ethnicity, smoker type, and an Ethnicity × Smoker Type interaction, using multivariable linear regression, with adjustment for age, sex, and education. Additional models adjusted for cigarettes per day and history of daily smoking. There was a significant interaction between ethnicity and smoker type for 5 of 6 measures of dependence (each scale assessed separately), such that African American ITS reported more dependence than Caucasian ITS, whereas dependence did not differ by ethnicity among DS. African American ITS smoked more cigarettes per day and were more likely to have a history of daily smoking than Caucasian ITS; after further adjustments for these differences, there were no significant interactions of ethnicity and smoker type for any measure. Among DS, dependence did not differ by race. African American ITS were more dependent than Caucasian ITS; this difference was explained by higher cigarette consumption and a higher proportion converted from DS to ITS among African Americans versus Caucasians. (PsycINFO Database Record

Smiling Instead of Smoking: Development of a Positive Psychology Smoking Cessation Smartphone App for Non-daily Smokers

PURPOSE

The usefulness of mobile technology in supporting smoking cessation has been demonstrated, but little is known about how smartphone apps could best be leveraged. The purpose of this paper is to describe the program of research that led to the creation of a smoking cessation app for non-daily smokers, so as to stimulate further ideas to create "smart" smartphone apps to support health behavior change.

METHOD

Literature reviews to evaluate the appropriateness of the proposed app, content analyses of existing apps, and smoking cessation sessions with non-daily smokers (n = 38) to inform the design of the app.

RESULTS

The literature reviews showed that (1) smoking cessation apps are sought after by smokers, (2) positive affect plays an important role in smoking cessation, (3) short, self-administered exercises consistently bring about enduring positive affect enhancements, and (4) low treatment-seeking rates of non-daily smokers despite high motivation to quit indicate a need for novel smoking cessation support. Directed content analyses of existing apps indicated that tailoring, two-way interactions, and proactive features are under-utilized in existing apps, despite the popularity of such features. Conventional content analyses of audio-recorded session tapes suggested that difficulty in quitting was generally linked to specific, readily identifiable occasions, and that social support was considered important but not consistently sought out.

CONCLUSION

The "Smiling Instead of Smoking" (SIS) app is an Android app that is designed to act as a behavioral, in-the-pocket coach to enhance quitting success in non-daily smokers. It provides proactive, tailored behavioral coaching, interactive tools (e.g., enlisting social support), daily positive psychology exercises, and smoking self-monitoring.

Intermittent and daily smokers' subjective responses to smoking

RATIONALE

One third of US smokers are intermittent smokers (ITS) who do not smoke daily. Unlike daily smokers (DS), whose smoking is negatively reinforced by withdrawal relief, ITS may be motivated by immediate positive reinforcement. In contrast, incentive salience theory posits hypothesis that "liking" of drug effects fades in established users, such as DS.

OBJECTIVE

This study aims to compare ITS' and DS' hedonic responses to smoking.

METHODS

Participants were 109 ITS (smoking 4-27 days/month) and 52 DS (smoking daily 5-25 cigarettes/day), aged ≥21, smoking ≥3 years, and not quitting smoking. For 3 weeks, participants engaged in ecological momentary assessment, carrying an electronic diary that asked them to rate their most recent smoking experience on 0-100 visual analog scales (satisfaction, enjoyment [averaged as "pleasure"], feeling sick, feeling a "rush," enjoying upper respiratory sensations, and immediate craving relief). Hierarchical random effect regression analyzed 4476 ratings.

RESULTS

ITS found smoking pleasurable (mean = 69.7 ± 1.7 [SE]) but significantly less so than DS did (77.6 ± 2.3; p < 0.006). ITS also reported more aversive response (ITS 18.2 ± 1.4, DS 11.6 ± 2.0; p < 0.007). Even though ITS are more likely to smoke at bars/restaurants, when drinking alcohol, or when others were present, they did not report more pleasure in these settings (compared to DS). More extensive smoking experience was unrelated to craving or smoking effects among DS, but predicted greater craving, greater pleasure, and less aversion among ITS.

CONCLUSIONS

The findings were largely inconsistent with incentive-salience models of drug use.

Prevalence and correlates of light and non-daily smoking in Brazil: Results from a nationwide representative survey

BACKGROUND

The research of light (≤10 cigarettes per day) and non-daily smokers in developing countries including Brazil is scarce despite the high prevalence of these groups among smokers and health risks associated to low-level smoking.

OBJECTIVE

To describe health and smoking characteristics of Brazilian adult light and non-daily smokers.

METHODS

We analyzed data from the 2013 Brazilian National Health Research survey (n=48,282).

RESULTS

The prevalence of current manufactured cigarette smoking in the total sample was 12.4%. Among these smokers, 12.8% were non-daily smokers (NDS), 47.4% were light smokers (LS) and 39.8% were moderate/heavy smokers (MHS). Bivariate analysis showed that non-daily smoking was associated with higher odds of poor self-rated health, binge drinking and lung diseases compared to never smokers (ORs=1.2; 5.9 and 1.9). Light smoking was associated with higher odds of poor self-rated health, binge drinking, depression, use of sleeping pills and lung diseases (ORs=1.3; 4.3; 1.4; 1.2 and 2.0). After controlling for sex and age, non-daily smoking was associated with lung disease (OR=2.2) and light smoking with depression and lung diseases (ORs=1.3 and 1.8). Smoking levels were associated with living with same-level smokers in bivariate and multivariate analyses.

CONCLUSION

A large proportion of smokers in Brazil are light and non-daily smokers, carrying substantial health risks related to tobacco use. Longitudinal research is needed to provide further evidence of associations found in this study. Public health policies must take the different smoking patterns into consideration to effectively target all smokers and reduce the harmful consequences of tobacco worldwide.

Factors associated with short-term transitions of non-daily smokers: socio-demographic characteristics and other tobacco product use

AIMS

To examine the transitions in smoking status among non-daily smokers who transitioned to daily or former smokers or remained as non-daily smokers during a 12-month period. We analyzed factors associated with these transitions, including the use of cigars and smokeless tobacco (SLT).

DESIGN

Secondary data analyses using pooled data from the 2003, 2006/07 and 2010/11 Tobacco Use Supplements to the Current Population Survey (TUS-CPS).

SETTING

United States.

PARTICIPANTS

Self-respondents aged 18+ who have smoked for more than 5 years and were non-daily smokers 12 months before the interview (n = 13 673, or 14.5% of current smokers).

MEASUREMENTS

Multinomial logistic regression model to determine the correlates of non-daily to daily, stable non-daily and non-daily to former smoking transitions among non-daily smokers at baseline. The model controlled for socio-demographic factors and the use of cigars and SLT.

FINDINGS

Of the adults in our sample, 2.6% were non-daily smokers at baseline. Among these, 69.7% remained non-daily smokers (stable non-daily smokers), 18.4% became daily smokers (non-daily to daily smokers) and 11.9% quit smoking (non-daily to former smokers) after 12 months. The non-daily to daily versus stable non-daily smoking transition was less likely among those who were aged 65+ (P = 0.018), male (P < 0.001), Hispanic (P < 0.001), with an income of $25 000-49 999 or ≥$75 000 and current users of SLT (P = 0.003), but more likely among those without a college degree compared with the appropriate reference group. The non-daily to former versus stable non-daily smoking transition was less likely among those aged 25+, male (P = 0.013), non-Hispanic Asian (P = 0.032), without a college degree, widowed/divorced/separated (P = 0.013) or never married (P = 0.011) and current users of cigars (P = 0.003) compared with the appropriate reference group.

CONCLUSIONS

While more than two-thirds of non-daily smokers in the United States remain as such after 12 months, others become daily smokers or quit. The likelihood of remaining stable non-daily smokers and of transition from non-daily to daily and non-daily to former smokers is associated with socio-demographic factors and current use of cigars and smokeless tobacco.

Tobacco outlet density and converted versus native non-daily cigarette use in a national US sample

OBJECTIVE

Investigate whether non-daily smokers' (NDS) cigarette price and purchase preferences, recent cessation attempts, and current intentions to quit are associated with the density of the retail cigarette product landscape surrounding their residential address.

PARTICIPANTS

Cross-sectional assessment of N=904 converted NDS (CNDS). who previously smoked every day, and N=297 native NDS (NNDS) who only smoked non-daily, drawn from a national panel.

OUTCOME MEASURES

Kernel density estimation was used to generate a nationwide probability surface of tobacco outlets linked to participants' residential ZIP code. Hierarchically nested log-linear models were compared to evaluate associations between outlet density, non-daily use patterns, price sensitivity and quit intentions.

RESULTS

Overall, NDS in ZIP codes with greater outlet density were less likely than NDS in ZIP codes with lower outlet density to hold 6-month quit intentions when they also reported that price affected use patterns (G2=66.1, p<0.001) and purchase locations (G2=85.2, p<0.001). CNDS were more likely than NNDS to reside in ZIP codes with higher outlet density (G2=322.0, p<0.001). Compared with CNDS in ZIP codes with lower outlet density, CNDS in high-density ZIP codes were more likely to report that price influenced the amount they smoke (G2=43.9, p<0.001), and were more likely to look for better prices (G2=59.3, p<0.001). NDS residing in high-density ZIP codes were not more likely to report that price affected their cigarette brand choice compared with those in ZIP codes with lower density.

CONCLUSIONS

This paper provides initial evidence that the point-of-sale cigarette environment may be differentially associated with the maintenance of CNDS versus NNDS patterns. Future research should investigate how tobacco control efforts can be optimised to both promote cessation and curb the rising tide of non-daily smoking in the USA.

Use of and reasons for using multiple other tobacco products in daily and nondaily smokers: Associations with cigarette consumption and nicotine dependence

BACKGROUND

Use of other tobacco products (OTPs) among smokers is increasing. Little is known about types of OTP used and the reasons for use, and how OTP use and reasons for use correlate with smoking patterns and nicotine dependence in daily and nondaily smokers. This paper addresses these gaps in the literature.

METHODS

656 daily smokers and 203 nondaily smokers provided information on their use of different OTPs (hookah, e-cigarettes, chew/snuff, snus, cigars, dissolvables), and reasons for using OTPs (e.g., "to cut down on smoking"), as well as their cigarette consumption and nicotine dependence. Logistic regression models assessed the association of smoking status with OTP use (ever and current) and reasons for use. Within each smoking group, separate logistic regression models examined the associations of OTP use and reasons for use with cigarette consumption and nicotine dependence.

RESULTS

Compared to daily smokers, nondaily smokers were more likely to use hookah and cigars, less likely to use dissolvables, and less likely to endorse using OTPs to reduce their smoking. Among non-daily smokers, nicotine dependence was associated with a higher likelihood of current OTP use (OR=1.04 [95% CI 1.01-1.07]; p<0.05), whereas cigarette consumption was not.

CONCLUSIONS

Results suggest OTP use in nondaily smokers does not correlate with less frequent smoking, but may correlate with higher nicotine dependence. Use of combustible OTPs among nondaily smokers may offset any potential benefits achieved through less frequent cigarette consumption. Providers should explicitly address OTP use when discussing cigarette cessation and reduction.

Smoking transitions in a sample of Hispanic daily light and intermittent smokers

Few studies have documented the differences between daily light (DLS; ≤10 cigarettes per day) and intermittent (ITS; nondaily) smokers. The primary aim of this study was to assess the potential transitions (i.e., increased/stayed at same level) between baseline and a 3month follow-up of Hispanic DLS and ITS who were randomly assigned to a control group of a brief cessation intervention. Additionally, potential nicotine addiction differences between groups of smokers (e.g., ITS who became DLS vs. those who did not change) were assessed. Participants were 190 Hispanic DLS/ITS (who represent a subsample from a larger dataset, n=370) with complete data (53.7% female; Mage=38.6years, SD=15.1; range=18-74years) randomized to the control arm of a brief cessation intervention. Participants completed sociodemographics, tobacco use history, and the Fagerström Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker and Fagerström, 1991). The majority of participants remained DLS (41.1%) or ITS (21.6%). ANCOVA findings indicated significant group differences regarding FTND scores (F [5114]=6.93, p<0.001). Those who remained DLS had significantly higher FTND scores than those who remained ITS and those who converted from ITS to DLS. Within these DLS/ITS who were randomized to a control group, smoking transitions primarily remained stable over time, particularly among DLS (who demonstrated higher nicotine dependence), suggesting the need for low level cessation interventions to continue and include a focus on dependence symptoms.

Influence of Smoking Consumption and Nicotine Dependence Degree in Cardiac Autonomic Modulation

Background

Smoking consumption alters cardiac autonomic function.

Objective

Assess the influence of the intensity of smoking and the nicotine dependence degree in cardiac autonomic modulation evaluated through index of heart rate variability (HRV).

Methods

83 smokers, of both genders, between 50 and 70 years of age and with normal lung function were divided according to the intensity of smoking consumption (moderate and severe) and the nicotine dependency degree (mild, moderate and severe). The indexes of HRV were analyzed in rest condition, in linear methods in the time domain (TD), the frequency domain (FD) and through the Poincaré plot. For the comparison of smoking consumption, unpaired t test or Mann-Whitney was employed. For the analysis between the nicotine dependency degrees, we used the One-way ANOVA test, followed by Tukey's post test or Kruskal-Wallis followed by Dunn's test. The significance level was p < 0,05.

Results

Differences were only found when compared to the different intensities of smoking consumption in the indexes in the FD. LFun (62.89 ± 15.24 vs 75.45 ± 10.28), which corresponds to low frequency spectrum component in normalized units; HFun (37.11 ± 15.24 vs 24.55 ± 10.28), which corresponds to high frequency spectrum component in normalized units and in the LF/HF ratio (2.21 ± 1.47 vs 4.07 ± 2.94). However, in the evaluation of nicotine dependency, significant differences were not observed (p > 0.05).

Conclusion

Only the intensity of smoking consumption had an influence over the cardiac autonomic modulation of the assessed tobacco smokers. Tobacco smokers with severe intensity of smoking consumption presented a lower autonomic modulation than those with moderate intensity.

Social contexts of momentary craving to smoke among Korean American emerging adults

INTRODUCTION

Korean American emerging adult (KAEA) smokers represent a culturally and developmentally unique population constituted of primarily light, intermittent smokers. Sociocultural contexts might play an important role in contributing to instances of acute cigarette craving and motivation to smoke in this population; yet, research testing such hypotheses is scant. The current study tests whether and how social contexts are associated with the craving among KAEA smokers.

METHODS

Seventy-eight daily KAEA smokers, who smoke 4+ cigs/day, participated in a 7-day ecological momentary assessment (EMA), in which participants responded to both signal-contingent (random) and event-contingent (smoking) prompts to answer surveys on their mobile phones (prompt-level n=1377; 603 random +774 smoking prompts). Nicotine dependence was measured at baseline; cigarette craving, negative affect, presence of others smoking, social contexts were measured with EMA.

RESULTS

Modeling of within-participant variation and covariation showed that being with Korean friends (vs. alone) was associated with increased levels of momentary craving. This association between Korean friends and craving disappeared when adjusted for presence of others smoking, which was a strong predictor of momentary craving. The positive association between Korean friends and craving was amplified immediately prior to smoking (vs. non-smoking random) instances.

CONCLUSIONS

Being with Korean friends might serve as a culturally-specific salient smoking cue, which might have been learned throughout their smoking history. Our data also showed that increased craving associated with Korean friends may represent social settings that primarily involve cigarette smoking. Given our findings on cigarette use among KAEA's social network, addressing cigarette use as a group behavior might be a fruitful intervention strategy.

How Do Light and Intermittent Smokers Differ from Heavy Smokers in Young Adulthood: The Role of Smoking Restraint Strategies

Light and intermittent smoking has become a prevalent pattern of use among young adults. Little is known about which factors differentiate light and intermittent smokers (LITS) from heavy smokers (HS) in young adulthood. In this study, we compare young adult LITS with HS with regard to demographic- and smoking-related variables, self-control abilities, and concrete strategies of smoking restraint. The data were collected as part of an Ecological Momentary Assessment (EMA) study with 137 German young adult smokers (M Age = 21.1 years, 46.0% female; 76 HS [≥10 cigarettes/day] and 61 LITS [≤5 cigarettes/day]). Participants were recruited over the Internet and completed a baseline questionnaire online. Several variables differentiated LITS and HS in a multiple logistic regression analysis: LITS reported fewer smoking friends (p < .001) and a higher self-efficacy to resist smoking (p < .01). Further, LITS smoking status was associated with reporting a past quit attempt (p < .05) and the use of smoking restraint strategies (counting, limiting, and purposefully not smoking cigarettes; p < .05). Notably, nicotine dependence and trait self-control abilities did not differentiate between LITS and HS. Our results point to the role of smoking restraint strategies and self-monitoring of smoking to limit the daily number of cigarettes smoked.

Adult Cigarette Smokers at Highest Risk for Concurrent Alternative Tobacco Product Use Among a Racially/Ethnically and Socioeconomically Diverse Sample

INTRODUCTION

Rates of alternative tobacco product use (ATPs; eg, cigars, cigarillos, pipes) among cigarette smokers are on the rise but little is known about the subgroups at highest risk. This study explored interactions between demographic, tobacco, and psychosocial factors to identify cigarette smokers at highest risk for ATP use from a racially/ethnically and socioeconomically diverse sample of adult smokers across the full smoking spectrum (nondaily, daily light, daily heavy).

METHODS

Two-thousand three-hundred seventy-six adult cigarette smokers participated in an online cross-sectional survey. Quotas ensured equal recruitment of African American (AA), white (W), Hispanic/Latino (H) as well as daily and nondaily smokers. Classification and Regression Tree modeling was used to identify subgroups of cigarette smokers at highest risk for ATP use.

RESULTS

51.3% were Cig+ATP smokers. Alcohol for men and age, race/ethnicity, and discrimination for women increased the probability of ATP use. Strikingly, 73.5% of men screening positive for moderate to heavy drinking and 62.2% of younger (≤45 years) African American/Hispanic/Latino women who experienced regular discrimination were Cig+ATP smokers.

CONCLUSIONS

Screening for concurrent ATP use is necessary for the continued success of tobacco cessation efforts especially among male alcohol users and racial/ethnic minority women who are at greatest risk for ATP use.

Higher stimulus control is associated with less cigarette intake in daily smokers

It is well established that environmental stimuli influence smoking in light, and to a lesser degree, heavy smokers. A 2-factor model of dependence suggests that the influence of stimulus control is masked among heavier smokers who primarily smoke for nicotine maintenance. The current study aimed to assess the influence of stimulus control across a range of moderate to heavy daily smokers. Furthermore, as local tobacco control policies may change the role of stimulus control, the study aimed to replicate previous U.S. findings on stimulus control in an Australian setting marked by strong tobacco control policies. In 2 Ecological Momentary Assessment studies, 420 participants monitored antecedents of smoking and nonsmoking situations. In a set of idiographic logistic regression analyses, situational antecedents were used to predict smoking occasions within each individual's data. Linear regression analysis was used to test for the association between stimulus control and smoking rate, and to test for differences between the 2 samples. Daily smokers' smoking was under considerable stimulus control, which was weaker at higher smoking rates. Overall, there was greater stimulus control in the Australian sample. Daily smokers also experience a degree of stimulus control, which is less influential in heavier smokers.

Outcomes of a Tailored Intervention for Cigarette Smoking Cessation Among Latinos Living With HIV/AIDS

INTRODUCTION

Tobacco use has emerged as a leading killer among persons living with HIV, with effective approaches to tobacco treatment still unknown. HIV infection is nearly 3 times as prevalent in Latinos than in non-Latino Whites. This study reports the results of a randomized trial comparing a tailored intervention to brief counseling for smoking cessation among Latino smokers living with HIV (LSLWH).

METHODS

LSLWH (N = 302; 36% female, 10% employed full-time, 49% born in United States) were randomized to 4 in-person sessions of a tailored intervention (Aurora) or 2 in-person sessions of brief advice (enhanced standard care [ESC]). Both groups received 8 weeks of nicotine replacement therapy (NRT) patch. Biochemically validated 6- and 12-month 7-day point-prevalence abstinence (PPA) rates were compared, along with secondary outcomes (e.g., reduction to light smoking, NRT adherence).

RESULTS

Seven-day PPA rates reached 8% versus 11% at 6 months and 6% versus 7% at 12 months, for Aurora and ESC, respectively, with no between-group differences (p values > .40). Significant changes from baseline to 6 and 12 months among intervention targets were noted (percentage reduction in heavy smoking and dependence; increases in knowledge and self-efficacy). Baseline smoking frequency, older age, and higher intensity of patch use during the trial emerged as significant predictors of abstinence at 6 months.

CONCLUSIONS

There was no evidence that the tailored intervention improved cessation rates. Interventions that encourage use of, and adherence to, empirically validated cessation aids require further development to reduce tobacco-related death and disease in this vulnerable population.

Perceived Addiction as a Predictor of Smoking Cessation Among Occasional Smokers

Introduction: Common short screening measures of dependence that use number of cigarettes per day may not be appropriate for use in populations of occasional smokers.

Aims: In this study, we investigate whether perceived addiction (PA) predicts quit attempts and successful cessation among occasional smokers.

Methods: Current occasional smokers (18+) in the Ontario Tobacco Survey (OTS) longitudinal cohort study followed up every six months for up to three years. Respondents rated their self-perceived level of addiction (very vs. somewhat or not very addicted). Generalised Estimating Equation models and proportional hazard models were used to test the predictive ability of PA.

Results/Findings: Occasional smokers with very high PA had a higher likelihood of reporting a quit attempt (RR: 2.49; 95% CI: 1.88, 3.30) after adjusting for demographics. Given an incident quit attempt, occasional smokers who reported being very addicted were 2.93 times more likely to relapse (95%: 2.01, 4.28). The effect of PA was independent of other predictors of smoking behaviour.

Conclusions: For some, occasional smokers, smoking cessation is a difficult process that may require significant support. Asking occasional smokers about PA is an effective way to predict likely success in quitting smokers that may be easily assessed in population based, as well as in community and clinical, settings.

Stimulus control in intermittent and daily smokers

Many adult smokers are intermittent smokers (ITS) who do not smoke daily. Prior analyses have suggested that, compared with daily smokers (DS), ITS smoking was, on average, more linked to particular situations, such as alcohol consumption. However, such particular associations assessed in common across subjects may underestimate stimulus control over smoking, which may vary across persons, due to different conditioning histories. We quantify such idiographic stimulus control using separate multivariable logistic regressions for each subject to estimate how well the subject's smoking could be predicted from a panel of situational characteristics, without requiring that other subjects respond to the same stimuli. Subjects were 212 ITS (smoking 4-27 days/month) and 194 DS (5-30 cigarettes daily). Using ecological momentary assessment, subjects monitored situational antecedents of smoking for 3 weeks, recording each cigarette in an electronic diary. Situational characteristics were assessed in a random subset of smoking occasions (n = 21,539), and contrasted with assessments of nonsmoking occasions (n = 26,930) obtained by beeping subjects at random. ITS showed significantly stronger stimulus control than DS across all context domains: mood, location, activity, social setting, consumption, smoking context, and time of day. Mood and smoking context showed the strongest influence on ITS smoking; food and alcohol consumption had the least influence. ITS smoking was under very strong stimulus control; significantly more so than DS, but DS smoking also showed considerable stimulus control. Stimulus control may be an important influence on maintaining smoking and making quitting difficult for all smokers, but especially among ITS.

Development and psychometric properties of the Smoking Restraint Questionnaire

Restraint is a component of self-control that focuses on the deliberate reduction of an undesired behavior and is theorized to play a role in smoking reduction and cessation. However, there exists no instrument to assess smoking restraint. This research aimed to develop the Smoking Restraint Questionnaire (SRQ) to meet this need. Participants were 406 smokers (48% female; 52.2% nondaily) with a mean age of 38.83 years (SD = 12.05). They completed a baseline questionnaire designed to assess smoking restraint. They also completed 21 days of ecological momentary assessment (EMA), during which they recorded each cigarette smoked and answered questions related to planned restraint every morning, and restraint attempts every evening. The 4-item questionnaire of smoking restraint was found to fit a single factor (root mean square error of approximation = .038, comparative fit index = .99, Tucker-Lewis index = .99), and the resulting composite was reliable (composite reliability = 0.74). The questionnaire contains items that assess the setting of weekly restraint goals and attempts at not lighting up when tempted to smoke. Participant SRQ scores positively correlated with EMA data on plans to restrain (p < .001) and frequency of restraint attempts (p < .001). These correlations suggest that the SRQ has good predictive validity in relation to the intention and behaviors of smoking reduction. The SRQ is promising as a measure of smoking restraint and may enable further research and insights into smoking reduction and cessation.

Impulsivity and Stress Response in Nondependent Smokers (Tobacco Chippers) in Comparison to Heavy Smokers and Nonsmokers

INTRODUCTION

Tobacco chippers are light smokers with stable patterns of smoking that exhibit lower nicotine dependence severity than heavy smokers. Chippers may provide valuable information about the factors influencing drug dependence. Impulsivity and stress are two factors known to influence smoking. By comparing nondependent smokers (tobacco chippers, n = 25) to dependent smokers (heavy smokers, n = 23) and nonsmokers (n = 25), this study examines the relationship between nicotine dependence, impulsivity, chronic stress, and stress reactivity.

METHODS

A total of 73 adult participants completed a study visit that included questionnaires to measure nicotine dependence, chronic stress, personality, affect, withdrawal, and craving. Impulsivity was measured with the delay discounting task and the flanker task. Stress reactivity was assessed by monitoring respiration, heart rate, and salivary cortisol during performance of a titrated Stroop task. Effects of acute stress on affect and craving were examined.

RESULTS

Tobacco chippers were as impulsive as heavy smokers on the delay discounting task but no different from nonsmokers on the flanker task. Heavy smokers reported higher perceived stress than chippers and nonsmokers. Perceived stress was a significant predictor of discounting only in heavy smokers. Acute stress induced changes in respiration, heart rate, and heart rate variability. Craving and negative affect increased after stress in both smoking groups, but craving was associated with affect only in chippers.

CONCLUSIONS

Tobacco chippers do not differ from heavy smokers in impulsivity, but do differ in perceived stress. One's perception and experience of stress might be associated to nicotine dependence resistance and could inform smoking cessation treatments.

IMPLICATIONS

By examining impulsivity, chronic stress, and stress reactivity in nondependent smokers (tobacco chippers) compared to dependent smokers and nonsmokers, this study contributes to the understanding of nicotine addiction and informs smoking cessation programs.

Gender and stimulus control of smoking behavior

INTRODUCTION

Gender differences in smoking behavior have been proposed to account for poorer outcomes among women attempting to quit. Specifically, it has been suggested that women's smoking behavior is less motivated by nicotine-seeking and more driven by environmental cues. To date, however, few real-world studies have examined the hypothesis that women's smoking is under greater stimulus control.

METHODS

One hundred and ninety four daily smokers (men = 107; women = 87) completed 3 weeks of ecological momentary assessment (EMA) monitoring that provided data on real-world smoking behavior by reporting on situational contexts shown by previous research to influence smoking behavior (including social setting, cigarette availability, alcohol consumption, and mood).

RESULTS

Analyses of particular cues found few gender differences; however, men's smoking increased to a greater extent compared with women's when they were with others who were smoking. Idiographic analyses that allow individual subjects to have different directions of linkage to situational cues also were conducted to assess how predictable subjects' smoking was from a range of contextual characteristics. Compared with women, men's smoking was significantly more closely tied to food/alcohol consumption and tended to be more closely tied to social context. No other gender differences were found.

CONCLUSIONS

EMA analyses suggest that men and women are similarly influenced by cues, including mood. Where there were gender differences, it was men rather than women whose smoking behavior was more influenced by cues. The data contradict the hypothesis that women's smoking is more influenced by cues.

Social smoking among intermittent smokers

BACKGROUND

"Social smoking" - smoking mostly or even only with others - may be an important pattern that implies smoking motivated extrinsically by social influences. Non-daily smokers (intermittent smokers; ITS) are often assumed to be social smokers, with some authors even assuming that all ITS are social smokers (SS+). We sought to identify and characterize social smokers in a sample of ITS.

METHODS

204 adult ITS (smoking 4-27 days/month) recorded the circumstances of smoking in their natural settings using Ecological Momentary Assessment, while also recording their circumstances in nonsmoking moments. SS+ were defined as ITS who were with others when they smoked most of their cigarettes, and who were ≥50% more likely to be with others when smoking than when not.

RESULTS

Only 13% of ITS were SS+. Although defined solely on the basis of presence of others, SS+ showed a distinct pattern of smoking across multiple dimensions: compared to other ITS (who were significantly less likely to smoke when with others), SS+ smoking was more associated with socializing, being with friends and acquaintances, drinking alcohol, weekends, evening or nighttime, being in other people's homes, but not their own home. SS+ smoking was low in the morning and increased in the evening. SS+ smoked fewer days/week and were less dependent, but did not differ demographically.

CONCLUSIONS

Social smoking does constitute a highly distinct smoking pattern, but is not common among adult ITS.

Correlates of Converted and Native Nondaily Smoking

OBJECTIVES

Nondaily smokers represent a growing proportion of current smokers in the United States. However, little is known about which characteristics are important in distinguishing between nondaily smokers who are former daily smokers (converted nondaily) and nondaily smokers who never smoked daily (native nondaily). This study contrasts converted and native nondaily smokers on demographic, psychosocial, tobacco-related characteristics and quit intentions and behaviors in a tri-ethnic sample (Blacks, Whites, and Latinos) of smokers.

METHODS

Smokers were recruited for a web-based survey using an online panel survey company. Participants were 1,201 nondaily smokers (904 converted nondaily smokers and 297 native nondaily smokers). A multivariable logistic regression was conducted to assess the associations between demographic, smoking-related, and psychosocial variables with converted versus native nondaily smoking.

RESULTS

Logistic regression indicated that number of years smoking, years as a nondaily smoker, number of days smoked in a month, smoking dependence, identity as a smoker, and number of smoking cessation methods used were correlates of being converted nondaily smokers versus native nondaily smokers.

CONCLUSIONS

Clinicians and researchers should consider characteristic variations in nondaily smokers when designing and implementing intervention efforts targeting this smoking population.