The Sociopharmacology of Tobacco Addiction: Implications for Understanding Health Disparities

Individual variations in motives for nicotine self-administration in male rats: evidence in support for a precision psychopharmacology

The significant heterogeneity in smoking behavior among smokers, coupled with the inconsistent efficacy of approved smoking cessation therapies, supports the presence of individual variations in the mechanisms underlying smoking. This emphasizes the need to shift from standardized to personalized smoking cessation therapies. However, informed precision medicine demands precision fundamental research. Tobacco smoking is influenced and sustained by diverse psychopharmacological interactions between nicotine and environmental stimuli. In the classical experimental rodent model for studying tobacco dependence, namely intravenous self-administration of nicotine, seeking behavior is reinforced by the combined delivery of nicotine and a discrete cue (nicotine+cue). Whether self-administration behavior is driven by the same psychopharmacological mechanisms across individual rats remains unknown and unexplored. To address this, we employed behavioral pharmacology and unbiased cluster analysis to investigate individual differences in the mechanisms supporting classical intravenous nicotine self-administration (0.04 mg/kg/infusion) in male outbred Sprague-Dawley rats. Our analysis identified two clusters: one subset of rats sought nicotine primarily for its reinforcing effects, while the second subset sought nicotine to enhance the reinforcing effects of the discrete cue. Varenicline (1 mg/kg i.p.) reduced seeking behavior in the former group, whereas it tended to increase in the latter group. Crucially, despite this fundamental qualitative difference revealed by behavioral manipulation, the two clusters exhibited quantitatively identical nicotine+cue self-administration behavior. The traditional application of rodent models to study the reinforcing and addictive effects of nicotine may mask individual variability in the underlying motivational mechanisms. Accounting for this variability could significantly enhance the predictive validity of translational research.

Nicotine deprivation amplifies attentional bias toward racial discrimination stimuli in African American adults who smoke cigarettes

High smoking prevalence and low quit smoking rates among African American adults are well-documented, but poorly understood. We tested a transdisciplinary theoretical model of psychopharmacological-social mechanisms underlying smoking among African American adults. This model proposes that nicotine's acute attention-filtering effects may enhance smoking's addictiveness in populations unduly exposed to discrimination, like African American adults, because nicotine reduces the extent to which discrimination-related stimuli capture attention, and in turn, generate distress. During nicotine deprivation, attentional biases toward discrimination may be unmasked and exacerbated, which may induce distress and perpetuate smoking. To test this model, this within-subject laboratory experiment determined whether attentional bias toward racial discrimination stimuli was amplified by nicotine deprivation in African American adults who smoked daily. Participants (N = 344) completed a computerized modified Stroop task assessing attentional interference from racial discrimination-related words during two counterbalanced sessions (nicotine sated vs. overnight nicotine deprived). The task required participants to quickly name the color of discrimination and matched neutral words. Word Type (Discrimination vs. Neutral) × Pharmacological State (Nicotine Deprived vs. Sated) effects on color naming reaction times were examined. Attentional bias toward racial discrimination-related stimuli was amplified in nicotine deprived (reaction time to discrimination minus neutral stimuli: M [95%CI] = 34.69 [29.62, 39.76] ms; d = 0.15) compared to sated (M [95%CI] = 24.88 [19.84, 29.91] ms; d = 0.11) conditions (Word Type × Pharmacological State, p < .0001). The impact of nicotine deprivation on attentional processes in the context of adverse societal conditions merit consideration in future science and intervention addressing smoking in African American adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences

We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.

Multiple Tobacco Product Use Conceptual Framework: A 2021 Update on Evidence

INTRODUCTION

One-third of adults in the United States who use tobacco regularly use two or more types of tobacco products. As the use of e-cigarettes and other noncombusted tobacco products increases-making multiple tobacco product (MTP) use increasingly common-it is essential to evaluate the complex factors that affect product use.

AIMS AND METHODS

In this update to our 2019 conceptual framework, we review and evaluate recent literature and expand the model to include ways in which MTP use may be affected by market factors such as the introduction of new products and socioenvironmental factors like marketing and advertising.

RESULTS AND CONCLUSIONS

MTP use patterns are complex, dynamic, and multiply determined by factors at the level of individuals, products, situations or contexts, and marketplace. Substitution, or using one product with the intent of decreasing use of another, and complementarity, or using multiple products for different reasons or purposes, explain patterns in MTP use. Moreover, substitution and complementarity may inform our understanding of how market changes targeted at one product, for instance, new product standards, bans, product pricing, and taxation, affect consumption of other tobacco products. New data from natural experiments and novel laboratory-based techniques add additional data and expand the framework.

IMPLICATIONS

A substantial proportion of people who use tobacco use more than one product. This review synthesizes and evaluates recent evidence on the diverse factors that affect MTP use in addition to expanding our framework. Our review is accompanied by suggested research questions that can guide future study.

At the Origins of Tobacco-Smoking and Tea Consumption in a Virgin Population (Yakutia, 1650–1900 A.D.): Comparison of Pharmacological, Histological, Economic and Cultural Data

(1) Background: The way tobacco and tea spread among virgin populations is of major interest our understanding of how ancient economic and cultural practices could have influenced current habits. (2) Methods: hair concentrations of theobromine, theophylline, caffeine, nicotine, and cotinine were measured in hair samples from 47 frozen bodies of people from eastern Siberia, dated from the contact with Europeans to the assimilation of people into Russian society. (3) Results: hair concentration of theobromine, theophylline, and caffeine vary with the type of beverage consumed: green, black, or local herbal teas. Shortly after the first contacts, a few heavy consumers of tobacco were found among light or passive consumers. Tobacco-related co-morbidities began to be recorded one century after and heavy tea users were only found from the 19th century (4) Conclusions: Economic factors and social and family contacts seem to have played a decisive role in tobacco consumption very early on. Behavioral evolution governed the process of substance integration into Siberian culture and was a determinant for the continuity of its use across long periods of time. Analyzing the respective contributions of social and economic processes in the use of these substances opens avenues of investigation for today’s public health.

Temporal trends in smoking and nicotine dependence in relation to co-occurring substance use in the United States, 2005-2016

BACKGROUND

Despite an overall decline in tobacco use in the United States, secular trends of smoking and nicotine dependence with co-occurring substance use are not well characterized.

METHODS

We examined self-reported tobacco and other substance use in 22,245 participants age 21-59 in the United States from six waves of the National Health and Nutrition Examination Survey (NHANES). Using Joinpoint regression, we assessed secular trends of smoking and nicotine dependence as a function of co-occurring use of alcohol, prescription opioids, marijuana/hashish, cocaine/heroin/methamphetamine, or other injection drug use. Multivariable logistic regressions were fitted to identify the potential risk factors.

RESULTS

During 2005-2016, the prevalence of current smoking decreased (without co-occurring substance use: 17.0 %-12.7 %; with co-occurring use of one substance: 35.3 % to 24.6 %; with co-occurring use of two or more substances: 53.8 %-42.2 %), and moderate-to-severe nicotine dependence decreased as well (8.0 %-4.2 %, 16.0 %-8.8 %, and 23.9 %-15.7 %, respectively). Smoking and nicotine dependence were more likely in those with co-occurring use of one substance (current smoking: odds ratio [OR] = 2.22, 95 % confidence interval [CI] = 2.01-2.45); nicotine dependence: OR = 1.88, 95 % CI = 1.63-2.17) and in those with co-occurring use of two or more substances (current smoking: OR = 5.25, 95 % CI = 4.63-5.95; nicotine dependence: OR = 3.24, 95 % CI = 2.72-3.87).

CONCLUSIONS

Co-occurring substance use was associated with smaller reductions in tobacco use, over time, and with increased odds of nicotine dependence. This suggests that co-occurring substance users should be regarded as a tobacco-related disparity group and prioritized for tobacco control interventions.

Association of frequency of perceived exposure to discrimination with tobacco withdrawal symptoms and smoking lapse behavior in African Americans

BACKGROUND AND AIMS

Frequent experiences of discrimination could increase vulnerability to tobacco withdrawal and smoking lapse in populations subject to tobacco-related health disparities. This laboratory study (2013-17) examined whether individual differences in perceived exposure to discrimination in one's daily life predicted tobacco withdrawal symptoms and smoking lapse behavior following acute tobacco deprivation in African American smokers.

DESIGN

Mixed design with the between-subjects continuous variable of perceived discrimination crossed with the within-subject variable of tobacco deprivation status (deprived versus non-deprived).

SETTING

Academic medical center in Los Angeles, CA, USA.

PARTICIPANTS

African American non-treatment seeking daily cigarette smokers (n = 607, ≥ 10 cig/day).

MEASUREMENTS

At a baseline visit, self-reported frequency of perceived exposure to discrimination in one's daily life was measured [everyday discrimination scale (EDDS)]. At two subsequent counterbalanced experimental visits (16-hour tobacco deprivation versus ad-libitum smoking), self-report assessments of various tobacco withdrawal symptom domains [Brief Questionnaire of Smoking Urges), Wisconsin Smoking Withdrawal Scale (WSWS), Profile of Mood States (POMS), Snaith-Hamilton Pleasure Scale (SHAPS) and Current Impulsivity Scale (CIS)) and a behavioral smoking lapse analogue task were measured.

FINDINGS

Adjusted models demonstrated that greater frequency of perceived exposure to discrimination was associated with larger deprivation-induced increases in acute urges to smoke to alleviate negative mood, several negative mood states and subjective cognitive functioning-effect sizes were small in magnitude (βs = 0.09-0.13; Ps < 0.02). Data were inconclusive for associations between perceived exposure to discrimination and deprivation-induced changes in cravings, urges to smoke for pleasure, positive mood reduction, other symptoms or smoking reinstatement behavior.

CONCLUSIONS

Frequency of perceived exposure to discrimination appears to be modestly associated with increased severity of some deprivation-induced tobacco withdrawal symptoms in African American smokers.

Gender differences within the barriers to smoking cessation and the preferences for interventions in primary care a qualitative study using focus groups in The Hague, The Netherlands

OBJECTIVES

This research aimed to provide a deeper insight into the gender-specific barriers to smoking cessation and gender-specific preferences for interventions in primary care, in order to contribute to better aligned cessation care for women.

DESIGN

Qualitative study using focus groups.

SETTING

Regularly smoking female and male adults were recruited from four different general practices in The Hague (The Netherlands).

PARTICIPANTS

A total of 11 women and nine men participated. Participants included were regular smokers with a minimum age of 18 and sufficient command of the Dutch language, who were willing to talk about smoking cessation. Inclusion ended when saturation was reached for both women and men. Participants were selected by means of purposeful sampling, whereby looking at age, educational level and experience with quitting.

RESULTS

The main barriers to smoking cessation in women were psychological factors, such as emotion and stress, compared with environmental factors in men. Women indicated they were in need of support and positivity, and both women and men expressed the desire for assistance without judgement. Contrary to men, women were not drawn to restrictions and (dis)incentives.

CONCLUSION

When counselling smokers, in women the focus should be on perceived internal problems, as opposed to more external obstacles in men. Contrary to men, female smokers seem to prefer non-coercive interventions, such as a group intervention offering support and positivity. Future research should focus on these gender differences, and how they could improve treatment in primary care.

Evaluating the effect of retail marijuana legalization on parent marijuana use frequency and norms in U.S. States with retail marijuana legalization

OBJECTIVES

To examine post-retail marijuana legalization (RML) change in marijuana use frequency and pro-marijuana norms among parents.

METHODS

The Intergenerational Study, a longitudinal panel of parents (N = 668) and children, followed participants from 2002 to 2018, when parents were 27 and 43 years old, respectively. Three quarters of participants (74%) lived in an RML state and 142 (21%) had used marijuana in the 8 years prior to RML. Piecewise growth modelling compared pre- and post-RML slopes of use frequency and pro-marijuana norms.

RESULTS

Frequency of use and pro-marijuana norms increased following legalization in both RML and non-RML states, though norms rose significantly faster in RML states. Growth in use was primarily driven by new users of marijuana. There were no differences in frequency of marijuana use or pro-marijuana norms by race/ethnicity, gender, or education.

CONCLUSIONS

An increase in marijuana use frequency associated with RML among parents poses risk to both parents' well-being and the health of their children. A faster pace of increase in pro-marijuana norms in RML states may signal continued increases in use in the future.

The Influence of Racial/Ethnic Discrimination Experiences on Cigarette Craving for African American and Hispanic Smokers

BACKGROUND

Despite African Americans and Hispanics smoking equal or fewer cigarettes than White smokers, they experience more smoking-related diseases and have lower cessation rates, possibly due to cultural stress. This study examined the influence of racial/ethnic discrimination experiences in comparison to a general negative affect experience on cigarette craving among African American and Hispanic smokers.

METHODS

African American and Hispanic smokers (N = 34) completed two writing tasks: one to elicit distressing experiences of racial/ethnic discrimination and another to elicit distressing experiences of academic/job-related failure. Participants completed both tasks after being randomized into two groups to counterbalance order of tasks. Participants completed pre- and post-task measurements of cigarette craving and negative affect and were asked to retrospectively rate the level of distress produced by each experience about which they wrote. A series of ANOVAs were computed to assess differences in each condition.

RESULTS

Cigarette craving significantly increased from baseline to post racial/ethnic discrimination task and post academic/job failure task (ps < 0.05). Negative affect did not increase from baseline to post-task for either group (ps > 0.05). The post academic/job-related failure writing task cigarette craving was significantly related to the distress rating of this task when controlling for negative affect (p < 0.05) but not the racial/ethnic discrimination task.

CONCLUSIONS

Results suggest recollection of racial/ethnic discrimination experiences has a similar impact on cigarette craving as recollection of academic/job-related failure experiences. It is important to examine cultural experiences linked to cigarette use among racial/ethnic minorities and continue experimental research among racial/ethnic minority smokers.

Gender Differences in Negative Affect During Acute Tobacco Abstinence Differ Between African American and White Adult Cigarette Smokers

INTRODUCTION

Prior studies have found heightened negative affect following tobacco abstinence in women compared to men. However, experimental work addressing whether these findings generalize across racial groups is scarce. This study investigated whether race (non-Hispanic White vs. non-Hispanic African American) moderated gender differences in abstinence-induced negative affect and smoking behavior.

METHODS

Data were collected from 2010 to 2017 from two separate laboratory studies investigating experimentally manipulated tobacco abstinence. Following a baseline session, adult daily smokers (≥10 cigarettes/day; women: n = 297, 83.8% non-Hispanic African American; men: n = 492, 86.2% non-Hispanic African American) attended two counterbalanced lab sessions (16 hours abstinent vs. non-abstinent) and completed self-report measures of negative affect followed by a laboratory analogue smoking reinstatement task.

RESULTS

We found a gender × race interaction for several negative affect states and composite negative affect (βs = -.12 to -.16, Ps < .05). Analyses stratified by race showed that non-Hispanic White women compared to non-Hispanic White men exhibited greater abstinence-induced increases in anger, anxiety, and composite negative affect (βs = -.20 to -.29, Ps < .05). No significant gender differences in abstinence-induced negative affect were found for non-Hispanic African American smokers (βs = .00 to - .04, Ps > .05).

CONCLUSION

These findings suggest that negative affect during acute tobacco abstinence may be a clinically important and intervenable factor that can inform cessation interventions specifically for non-Hispanic White women smokers. Further empirical exploration of mechanisms underlying interactions of gender and race in tobacco addiction may benefit smoking cessation efforts in non-Hispanic African American women smokers.

IMPLICATIONS

This study contributes to a scant body of research examining the intersectional influence of race and gender on abstinence-induced negative affect-a central, motivationally prepotent feature of tobacco withdrawal. Using a laboratory-based design to experimentally manipulate abstinence, we provide evidence of a gender × race interaction on negative affect-related withdrawal. Our findings suggest that gender differences in abstinence-induced negative affect observed among non-Hispanic White smokers may not generalize to non-Hispanic African American smokers, highlighting the need for future work to address potential mechanisms underlying the racially discrepant impact of gender on affective tobacco withdrawal.

Lifetime Smoking Patterns and Preferences for Smoking Cessation Among Women Veterans Receiving Veterans Health Administration Care

The objective of this study was to identify common themes among women veterans who smoke or recently quit and had used smoking cessation treatment within the Veterans Health Administration (VHA). The study built upon previous research by utilizing in-depth interviews to encourage disclosure of potentially stigmatized topics. Twenty women veterans enrolled in VHA care engaged in a quality improvement project focused on improving smoking cessation services. Qualitative analysis of de-identified interviews used a combination of content analysis and thematic analysis within the sociopharmacological model of tobacco addiction. Findings revealed that participants' smoking was influenced by woman veteran identity and by several gender-related contextual factors, including military sexual trauma and gender discrimination. Findings also highlighted other contextual factors, such as personal autonomy, emotional smoking triggers, and chronic mental health concerns. Findings are interpreted within the context of cultural power imbalances, and recommendations are provided for VHA smoking cessation for women veterans.

Commentary: Educational and Clinical Training for Addressing Tobacco-Related Cancer Health Disparities

In the United States, tobacco use is a leading contributor to inequities in cancer health among individuals for many ethnic, racial, sexual minority, and other minority groups as well as individuals in lower socioeconomic groups and other underserved populations. Despite remarkable decreases in tobacco use prevalence rates in the United States over the past 50 years, the benefits of tobacco control efforts are not equitably distributed. Tobacco-related disparities include higher prevalence rates of smoking, lower rates of quitting, less robust responses to standard evidence-based treatments, substandard tobacco treatment delivery by health care providers, and an increased burden of tobacco-related cancers and other diseases. Among the multiple critical barriers to achieving progress in reducing tobacco treatment-related disparities, there are several educational barriers including a unidimensional or essentialist conceptualizations of the disparities; a tobacco treatment workforce unprepared to address the needs of tobacco users from underserved groups; and known research-to-practice gaps in understanding, assessing, and treating tobacco use among underserved groups. We propose the development of competency-based curricula that: 1) use intersectionality as an organizing framework for relevant knowledge; 2) teach interpersonal skills, such as expressing sociocultural respect, a lack of cultural superiority, and empathy as well as skills for developing other-oriented therapeutic relations; and 3) are grounded in the science of the evidence-based treatments for tobacco dependence. These curricula could be disseminated nationally in multiple venues and would represent significant progress toward addressing tobacco-related disparities.

Smoking policies in the home have less influence on cigarettes per day and nicotine dependence level among African American than White smokers: A cross-sectional analysis

BACKGROUND

African American smokers suffer disproportionately from tobacco-related disease caused, in part, by lower rates of smoking cessation. We examined whether smoke-free home policies and delay discounting were differentially associated with cigarettes smoked per day (CPD) and nicotine dependence (ND) among African Americans and Whites.

METHODS

Secondary data analysis was conducted using data from 65 African American (n = 40) and White (n = 25) smokers who completed measures of CPD, ND, tobacco craving, stress, depression, home smoking policy, and delay discounting.

RESULTS

A significant interaction was found between race and home smoking policy on CPD (B = -11.21, p = 0.002) and ND (B = -3.42, p = 0.004). Smoke-free policies in the home were associated with fewer CPD and lower ND levels among Whites, but not among African Americans. Whites who allowed smoking in their homes had significantly greater mean CPD and higher mean ND than their counterparts who did not allow smoking in the home. Among African American smokers, there were no differences in CPD and ND among those who allowed smoking in their home versus those who did not.

CONCLUSIONS

The findings extend the scientific literature by suggesting that a malleable environmental factor (home smoking policy) commonly associated with cessation among Whites does not have the same influence on cessation among African American.

Association of Cumulative Socioeconomic and Health-Related Disadvantage With Disparities in Smoking Prevalence in the United States, 2008 to 2017

IMPORTANCE

Understanding emerging patterns of smoking disparities among disadvantaged populations can guide tobacco control policy.

OBJECTIVE

To estimate disparities in smoking prevalence associated with the number of socioeconomic and health-related disadvantages faced by a population among US adults from 2008 to 2017.

DESIGN, SETTING, AND PARTICIPANTS

Nationally representative cross-sectional annual household-based probability sample of US noninstitutionalized residents. Polytomous regression estimated associations of disadvantage variables, survey year, and their interaction with the following 3 pairwise contrasts: current vs never smoking (estimate of overall disparities), current vs former smoking (unique contribution of disparities in smoking cessation), and former vs never smoking (unique contribution of disparities in smoking initiation). The setting was in-home face-to-face interviews. Participants were respondents in 2008 to 2017 survey years who were aged 25 years or older (N = 279 559).

EXPOSURES

Self-reported past-year unemployment, income below the federal poverty line, absence of high school diploma, disability/limitation interfering with daily functions, serious psychological distress on the Kessler 6-item screen, and at least 60 past-year heavy drinking days, each coded yes or no. These indicators were summed in a cumulative disadvantage index (0, 1, 2, 3, 4, or 5 or 6).

MAIN OUTCOMES AND MEASURES

Self-reported current, former (ever smoked ≥100 cigarettes, had since quit, and not currently smoking), and never (<100 cigarettes) smoking.

RESULTS

Among 278 048 respondents (mean [SD] age, 51.9 [16.8] years; 55.7% female) with data on smoking history (99.5% of the sample), the mean current smoking prevalence across 2008 to 2017 compared with populations without disadvantages was successively higher among populations with 1 disadvantage (21.4% vs 13.8%; current vs never smoking adjusted odds ratio [OR], 2.34; 95% CI, 2.27-2.43), 2 disadvantages (26.6% vs 13.8%; OR, 3.55; 95% CI, 3.39-3.72), 3 disadvantages (35.1% vs 13.8%; OR, 5.35; 95% CI, 5.05-5.66), 4 disadvantages (45.7% vs 13.8%; OR, 8.59; 95% CI, 7.91-9.34), or 5 or 6 disadvantages (58.2% vs 13.8%; OR, 14.70; 95% CI, 12.30-17.50). In current vs former and former vs never smoking status contrasts, ORs were lower but also showed successively greater associations with increasing cumulative disadvantage. Current (vs never) smoking odds significantly declined each year among populations with 0 (OR, 0.95; 95% CI, 0.94-0.96), 1 (OR, 0.96; 95% CI, 0.95-0.97), or 2 (OR, 0.98; 95% CI, 0.97-0.99) disadvantages but did not change across 2008 to 2017 among those with 3 or more disadvantages.

CONCLUSIONS AND RELEVANCE

Results of this study demonstrate that US disparities in smoking prevalence from 2008 to 2017 were successively larger with each additional disadvantage faced, were expressed in higher smoking initiation odds and lower smoking cessation odds, and widened over time.

Not all smokers appear to seek nicotine for the same reasons: implications for preclinical research in nicotine dependence

Tobacco use leads to 6 million deaths every year due to severe long-lasting diseases. The main component of tobacco, nicotine, is recognized as one of the most addictive drugs, making smoking cessation difficult, even when 70 percent of smokers wish to do so. Clinical and preclinical studies have demonstrated consistently that nicotine seeking is a complex behavior involving various psychopharmacological mechanisms. Evidence supports that the population of smokers is heterogeneous, particularly as regards the breadth of motives that determine the urge to smoke. Here, we review converging psychological, genetic and neurobiological data from clinical and preclinical studies supporting that the mechanisms controlling nicotine seeking may vary from individual to individual. It appears timely that basic neuroscience integrates this heterogeneity to refine our understanding of the neurobiology of nicotine seeking, as tremendous progress has been made in modeling the various psychopharmacological mechanisms driving nicotine seeking in rodents. For a better understanding of the mechanisms that drive nicotine seeking, we emphasize the need for individual-based research strategies in which nicotine seeking, and eventually treatment efficacy, are determined while taking into account individual variations in the mechanisms of nicotine seeking.

A review of the effects of nicotine on social functioning

Many smokers are aware that smoking is a dangerous health behavior and eventually try to quit smoking. Unfortunately, most quit attempts end in failure. Traditionally, the addictive nature of smoking has been attributed to the pharmacologic effects of nicotine. In an effort to offer a more comprehensive, biobehavioral analysis of smoking behavior and motivation, some researchers have begun to consider the role of social factors in smoking. In line with recent recommendations to integrate social and pharmacological analyses of smoking, we reviewed the experimental literature examining the effects of nicotine and nicotine withdrawal on social functioning. The review identified 13 studies that experimentally manipulated nicotine and assessed social functioning, 12 of which found support for nicotine's enhancement of social functioning. Although few experiments have investigated social functioning, they nevertheless offer compelling evidence that nicotine enhances social functioning in smokers and suggest that nicotine deprivation may hamper social functioning in those dependent on nicotine. Future directions for investigating social outcomes and context in those who use nicotine products are discussed with a focus on leveraging advances in social and developmental psychology, animal research, sociology, and neuroimaging to more comprehensively understand smoking behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Happiness as a Buffer of the Association Between Dependence and Acute Tobacco Abstinence Effects in African American Smokers

Introduction

African American (AA) smokers are at disproportionate risk of tobacco dependence, utilizing smoking to regulate stress, and poor cessation outcomes. Positive emotional traits may function as coping factors that buffer the extent to which dependence increases vulnerability to adverse responses to acute tobacco abstinence (ie, tobacco withdrawal). This laboratory study examined subjective happiness (SH; dispositional orientation towards frequent and intense positive affect [PA] and life satisfaction) as a moderator of the relation between tobacco dependence and subjective and behavioral abstinence effects among AA smokers.

Methods

AA smokers (N = 420, 39.0% female) completed self-report measures of tobacco dependence and SH followed by two counterbalanced experimental sessions (nonabstinent vs. 16-hour abstinent) involving self-report measures of composite withdrawal, urge to smoke, and mood, and a behavioral smoking task in which participants could: (1) earn money to delay smoking reinstatement, and (2) subsequently purchase cigarettes to smoke.

Results

Tobacco dependence was positively associated with increased abstinence effects in composite withdrawal, urge to smoke, PA, and latency to smoking reinstatement (ps < .04). SH significantly moderated the relation between dependence and abstinence-induced increases in composite withdrawal (β = -.17, p < .001), such that the predictive power of dependence on withdrawal severity grew proportionately weaker as levels of SH increased.

Conclusions

SH may insulate against adverse effects of dependence on withdrawal during acute smoking abstinence, particularly withdrawal symptom clusters that are craving- and mood-based. Consideration of positive emotional traits as stress-coping factors in the dependence-withdrawal link may be warranted in research and practice with AA smokers.

Implications

The current study contributes to a growing body of literature examining the potentially advantageous role of positive emotional traits to smokers. We do so by identifying a relatively understudied psychological construct within tobacco research-subjective happiness-that may suppress the extent to which more severe tobacco dependence increases risk for subjective withdrawal-related distress during acute smoking abstinence in AA smokers. In doing so, the study provides a primer for future targeting of subjective happiness and other positive emotional traits as means to understand and treat acute tobacco abstinence effects among dependent AA smokers.

Is in utero exposure to maternal socioeconomic disadvantage related to offspring ovarian reserve in adulthood?

BACKGROUND

Because the ovarian follicle pool is established in utero, adverse exposures during this period may be especially impactful on the size and health of the initial follicle endowment, potentially shaping trajectories of ovarian follicle loss and the eventual onset of menopause. Building on a robust literature linking socioeconomic status (SES) and menopausal timing, the current study examined adverse prenatal exposures related to maternal SES, hypothesizing that greater maternal socioeconomic disadvantage would be associated with lower ovarian reserve in the adult offspring.

METHODS

In a healthy, community-based sub-sample (n = 350) of reproductive age participants in the OVA Study (2006-2011), prenatal maternal SES was examined in relation to two biomarkers of ovarian reserve, antimullerian hormone (AMH) and antral follicle count (AFC). Prenatal maternal SES was assessed indirectly using maternal addresses abstracted from participant birth certificates, geocoded, and linked to US Census-derived variables, including neighborhood-level characteristics: education (% of individuals with a HS diploma); poverty (% of families below the poverty line); unemployment (% of individuals > 16 years who are unemployed); and income (median family income).

RESULTS

In separate covariate-adjusted linear regression models (following the backward elimination of main effects with P > .10), greater maternal neighborhood education was related to higher ovarian reserve as marked by higher levels of offspring AMH (beta = .142, P < .001) and AFC (beta = .092, P < .10) with models accounting for 19.6% and 21.5% of the variance in AMH and AFC, respectively. In addition, greater maternal neighborhood poverty was related to lower ovarian reserve as marked by lower offspring AMH (beta = -.144, P < .01), with the model accounting for 19.5% of the variance in AMH.

CONCLUSIONS

Maternal socioeconomic disadvantage measured indirectly at the neighborhood level was associated with lower ovarian reserve among the adult offspring, independently of offspring SES and other potential confounding factors. This suggests SES-related adversity exposures may have a detrimental impact on the size or health of the initial follicle endowment, leading to accelerated follicle loss over time.

Developmental Pathways from Parental Socioeconomic Status to Adolescent Substance Use: Alternative and Complementary Reinforcement

Although lower socioeconomic status has been linked to increased youth substance use, much less research has determined potential mechanisms explaining the association. The current longitudinal study tested whether alternative (i.e., pleasure gained from activities without any concurrent use of substances) and complementary (i.e., pleasure gained from activities in tandem with substance use) reinforcement mediate the link between lower socioeconomic status and youth substance use. Further, we tested whether alternative and complementary reinforcement and youth substance use gradually unfold over time and then intersect with one another in a cascading manner. Potential sex differences are also examined. Data were drawn from a longitudinal survey of substance use and mental health among high school students in Los Angeles. Data collection involved four semiannual assessment waves beginning in fall 2013 (N = 3395; M baseline age = 14.1; 47% Hispanic, 16.2% Asian, 16.1% multiethnic, 15.7% White, and 5% Black; 53.4% female). The results from a negative binomial path model suggested that lower parental socioeconomic status (i.e., lower parental education) was significantly related to an increased number of substances used by youth. The final path model revealed that the inverse association was statistically mediated by adolescents' diminished engagement in pleasurable substance-free activities (i.e., alternative reinforcers) and elevated engagement in pleasurable activities paired with substance use (i.e., complementary reinforcers). The direct effect of lower parental education on adolescent substance use was not statistically significant after accounting for the hypothesized mediating mechanisms. No sex differences were detected. Increasing access to and engagement in pleasant activities of high quality that do not need a reinforcement enhancer, such as substances, may be useful in interrupting the link between lower parental socioeconomic status and youth substance use.

A growing geographic disparity: Rural and urban cigarette smoking trends in the United States

Rural areas of the United States have a higher smoking prevalence than urban areas. However, no recent studies have rigorously examined potential changes in this disparity over time or whether the disparity can be explained by demographic or psychosocial characteristics associated with smoking. The present study used yearly cross sectional data from the National Survey on Drug Use and Health from 2007 through 2014 to examine cigarette smoking trends in rural versus urban areas of the United States. The analytic sample included 303,311 respondents. Two regression models were built to examine (a) unadjusted rural and urban trends in prevalence of current smoking and (b) whether differences remained after adjusting for demographic and psychosocial characteristics. Results of the unadjusted model showed disparate and diverging cigarette use trends during the 8-year time period. The adjusted model also showed diverging trends, initially with no or small differences that became more pronounced across the 8-year period. We conclude that differences reported in earlier studies may be explained by differences in rural versus urban demographic and psychosocial risk factors, while more recent and growing disparities appear to be related to other factors. These emergent differences may be attributable to policy-level tobacco control and regulatory factors that disproportionately benefit urban areas such as enforcement of regulations around the sale and marketing of tobacco products and treatment availability. Strong federal policies and targeted or tailored interventions may be important to expanding tobacco control and regulatory benefits to vulnerable populations including rural Americans.

Gender and Menthol Cigarette Use in the United States: A Systematic Review of the Recent Literature (2011 - May 2017)

Purpose of review

To summarize current research on gender differences in mentholated cigarette use and related outcomes. Secondarily, to summarize literature on gender differences in mentholated cigarette use and related outcomes among Black smokers.

Recent findings

Women smokers are more likely to use menthol cigarettes than men. Other than prevalence, there is a paucity of research on gender differences in menthol related outcomes (e.g., cessation, disease). Among both women and men, menthol preference is stable during adolescence and young adulthood. A substantial portion of both women and men who smoke menthol report an expectation of quitting should menthol be banned. We did not identify any studies of gender differences in mentholated cigarette use among Black smokers.

Summary

Despite public health relevance, there is little current research on gender differences in mentholated cigarette use, other than studies of prevalence, and very little research on gender differences among Black smokers, including prevalence.

Gender differences in the real-world effectiveness of smoking cessation medications: Findings from the 2010-2011 Tobacco Use Supplement to the Current Population Survey

BACKGROUND

Meta-analyses of clinical trial data have identified clinically relevant gender differences in the efficacy of smoking cessation pharmacotherapy. It is unclear whether these findings are generalizable to smokers quitting in real-world contexts.

METHODS

Using Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2010-2011 cross-sectional data, we generated propensity score matched samples of smokers who quit either unassisted by medication, using only varenicline, or using only transdermal nicotine patch (TNP). We used generalized estimating equations to estimate gender differences in the comparative effectiveness of these cessation options for achieving 30-days of abstinence, adjusting for potential confounders.

RESULTS

When stratified by gender, TNP was significantly more effective than unassisted quit attempts for men (OR=1.37; 95%CI=1.02,1.83; p=0.03), but not for women (OR=0.96; 95%CI=0.71,1.31; p=0.82). Varenicline was significantly more effective than unassisted quit attempts for women (OR=1.63; 95%CI=1.16, 2.31; p=0.005), but not men (OR=1.35; 95%CI=0.94,1.96; p=0.11). Varenicline was also more effective than TNP for women (OR=1.51; 95%CI=0.12,2.05; p=0.007) but not men (OR=0.92; 95%CI=0.65,1.31; p=0.64). A significant gender by medication interaction was found only for the comparison of varenicline to TNP (OR=1.64; 95%CI=1.04,2.61; p=0.04).

CONCLUSIONS

Findings for varenicline vs. TNP were consistent with clinical trial data, showing greater differences in effectiveness for women compared to men. Results lend support to the generalizability of clinical trial findings, highlighting the importance of considering gender when offering treatment for smoking cessation.

Neighborhood, Family, and Peer Factors Associated with Early Adolescent Smoking and Alcohol Use

There is broad agreement that neighborhood contexts are important for adolescent development, but there is less consensus about their association with adolescent smoking and alcohol use. Few studies have examined associations between neighborhood socioeconomic contexts and smoking and alcohol use while also accounting for differences in family and peer risk factors for substance use. Data drawn from the Seattle Social Development Project (N = 808), a gender-balanced (female = 49%), multiethnic, theory-driven longitudinal study originating in Seattle, WA, were used to estimate trajectories of smoking and alcohol use from 5th to 9th grade. Time-varying measures of neighborhood socioeconomic, family, and peer factors were associated with smoking and alcohol use at each wave after accounting for average growth in smoking and alcohol use over time and demographic differences. Results indicated that living in more socioeconomically disadvantaged neighborhoods, lower family income, lower family general functioning, more permissive family smoking environments, and affiliation with deviant peers were independently associated with increased smoking. Lower family functioning, more permissive family alcohol use environments, and deviant peers were independently associated with increased alcohol use. The effect of neighborhood disadvantage on smoking was mediated by family income and deviant peers while the effect of neighborhood disadvantage on alcohol use was mediated by deviant peers alone. Family functioning and family substance use did not mediate associations between neighborhood disadvantage and smoking or alcohol use. The results highlight the importance of neighborhood, family, and peer factors in early adolescent smoking and alcohol use. Future studies should examine the unique association of neighborhood disadvantage with adolescent smoking net of family socioeconomics, functioning, and substance use, as well as peer affiliations. Better understanding of the role of contextual factors in early adolescent smoking and alcohol use can help bolster efforts to prevent both short and long harms from substance use.

Disparities in Anxiety and its Disorders

Much of the scientific work addressing the enigmas of anxiety and its disorders has been conducted among European Americans. This work has led to great progress into the nature of anxiety psychopathology, including etiologic, maintenance, and relapse processes. Moreover, evidenced-based treatments for anxiety and its disorders have arguably been among the best in the field of psychopathology for well over two decades. Yet, the progress thus far attained on the nature and treatment of anxiety disorders has not benefited all members of society equally. In fact, there are striking gaps of inequalities in anxiety disorder research and practice. The population in the United States (U.S.) and many parts of the industrialized world is rapidly changing in terms of diversity, and gaps between segments of society are growing in many instances (e.g., financial inequity). Health disparities in anxiety disorders are not a generic issue, but rather, reflect a systematic difference disproportionately affecting groups often not afforded a high social status ranking. We developed this Special Issue in the Journal of Anxiety Disorders to call attention to matters of inequality in anxiety disorders. The present special issue is designed to contextualize contemporary health disparity work on anxiety and its disorders. The special issue highlights three domains of study that are starting to guide research and practice in this arena, including sociocultural and contextual influences on anxiety and its disorders; intra-individual transdiagnostic mechanisms underpinning the expression and etiology/maintenance of anxiety psychopathology; and the close interconnection between anxiety processes and health status and health compromising behaviors. By covering a range of issues interconnected by their focus on understanding health disparity issues, it is hoped that this issue will: alert readers to the significance of this work at different levels of analysis; illustrate the many domains currently being explored via innovative approaches; and identify fecund areas for future systematic study.

Obsessive-compulsive symptoms and negative affect during tobacco withdrawal in a non-clinical sample of African American smokers

The association between obsessive-compulsive (OC) symptomatology and smoking is poorly understood, particularly in African Americans-a group subject to smoking- and OC-related health disparities. In a non-clinical sample of 253 African American smokers, we tested the negative reinforcement model of OC-smoking comorbidity, purporting that smokers with higher OC symptoms experience greater negative affect (NA) and urge to smoke for NA suppression upon acute tobacco abstinence. Following a baseline visit involving OC assessment, participants completed two counterbalanced experimental visits (non-abstinent vs. 16-h tobacco abstinence) involving affect, smoking urge, and nicotine withdrawal assessment. OC symptom severity predicted larger abstinence-provoked increases in overall NA, anger, anxiety, depression, fatigue, urge to smoke to suppress NA, and composite nicotine withdrawal symptom index. African American smokers with elevated OC symptoms appear to be vulnerable to negative reinforcement-mediated smoking motivation and may benefit from cessation treatments that diminish NA or the urge to quell NA via smoking.

The case for investigating social context in laboratory studies of smoking

BACKGROUND

With increasing frequency, addiction is conceived of as a brain disease, and such accounts seem especially pertinent with regard to the rapid delivery of nicotine to the brain via cigarette smoke. Moreover, drug administration trials (cigarette puffs) suggest that the behavior of smoking becomes automatized, with individuals developing prototypical approaches to smoking a cigarette. Compared with presumably more social activities, such as drinking alcohol, there may be little opportunity for social processes to influence smoking behavior. However, survey research examining smoking motivation often reveals a broadly defined 'social' factor and field research suggests that social context does influence smoking.

ARGUMENT

We posit that laboratory smoking research has largely ignored social contextual factors that may help to understand better the precise mechanisms underlying smoking behavior and smoking motivation.

METHOD

We reviewed laboratory studies examining the effect of social context (operationalized as modeling) on smoking behavior. Studies were identified by searching PsychInfo and Medline using the following keywords: smoking, nicotine, tobacco, cigarette, consumption, topography, puff, smoking behavior, cigarettes smoked, modeling, imitation, social context, social influence and peer pressure. The reference and citation lists of these studies were then searched to identify additional studies.

CONCLUSIONS

Few laboratory smoking studies target social context. Those few studies indicate that smoking behavior can be influenced by the presence of others. There is also some evidence that social context influences the effects of smoking as well as processes related to self-perception and self-regulation that reinforce smoking and hamper smoking cessation efforts.

Sex/gender differences in smoking cessation: A review

Data from treatment studies tends to show women are less likely to quit smoking than men, but these findings have been disputed, typically based on contradictory evidence from epidemiological investigations. The purpose of this review was to shed light on this conflict. We conducted a qualitative review in January 2016 to examine sources of variation in sex/gender differences for smoking cessation. We identified 214 sex/gender difference tests from 190 studies through Medline and studies were categorized into efficacy trials (k=37), effectiveness trials (k=77), prospective observational studies of cessation (k=40; current smokers transitioning to former smokers), prospective observational studies of relapse (k=6; former smokers transitioning to current smokers), cross-sectional investigations of former smoker prevalence (k=32), and community-based interventions (k=4). We also summarized evidence across time periods, countries, outcome assessments, study sample, and treatment. Evidence from efficacy and effectiveness trials, as well as prospective observational studies of relapse, demonstrated that women have more difficulty maintaining long-term abstinence than men. Findings from prospective observational studies and cross-sectional investigations were mixed and demonstrated that bio-psycho-social variation in samples across place and time may determine whether or not women or men are less likely to quit smoking. Based on these findings, we consider whether sex/gender differences in quitting meet criteria for a disparity and outline directions for further research.

Risk Factors for Smoking in Rural Women: The Role of Gender-Based Sexual and Intimate Partner Violence

BACKGROUND

Women living in Ohio Appalachia experience cervical cancer at disproportionately high rates. Intimate partner and sexual gender-based violence (GBV) and smoking are independent risk factors for cervical cancer and interact to heighten risk. Appalachian women smoke at higher rates than other Ohio women, but little is known about GBV exposure in the region. The purpose of this study was to establish prevalence of women's exposure to GBV in Ohio Appalachia and examine the association between GBV and smoking among women in the region.

METHODS

A two-phase address-based random sampling approach was used in three purposefully selected Ohio Appalachian counties to identify women to complete an interviewer administered cross-sectional survey (n = 398). The primary exposure variable was GBV Index Score, a 4 level indices representing increasing exposure to eight abuse types. Correlation analysis and logistic regression were used to examine smoking correlations and risk.

RESULTS

Almost 57% of women in the three selected Ohio Appalachian counties experienced GBV, with rate increasing to 77.5% among current smokers. The distribution of the GBV Exposure Index Score was significantly different across smoking status (p < = 0.0001), with exposure of GBV increasing when moving from never, to former, to current smokers. When controlling for depression, age, and adult socioeconomic position, GBV Exposure Index was significantly associated with current smoking behavior (OR:1.62, 95% CI [1.21-2.17]).

DISCUSSION

Professionals working to reduce disparate disease burden among women in Ohio Appalachia should consider the role GBV plays in health behavior and behavioral change interventions, including smoking and smoking cessation.

Asians compared to Whites show increased response to d-amphetamine on select subjective and cardiovascular measures

OBJECTIVE

Identifying factors that moderate subjective response to stimulants is important for understanding individuals at risk for abusing these drugs. Some research suggests that Asians may respond differently to stimulants than other races, but controlled human laboratory research of stimulant administration effects in Asians is scant.

METHODS

In this double-blind counterbalanced within-subject study, healthy stimulant-naïve participants (N = 65; 55% Asian; 63% female; age 18-35) received a single dose of 20-mg oral d-amphetamine or placebo on separate days. At each testing day, subjective measures of abuse liability and cardiovascular assessments were administered at repeated intervals before and after drug administration over a 4-hour period.

RESULTS

Asians (vs. Whites) demonstrated greater d-amphetamine-induced increases in diastolic blood pressure and ratings of 'Feel High' and 'Like Drug'.

CONCLUSIONS

Asian and White healthy young adults may differ in certain subjective and cardiovascular responses to acute doses of d-amphetamine. Such individual differences could help explain between-person differences in abuse potential of d-amphetamine and other stimulants.

Tobacco Withdrawal Amongst African American, Hispanic, and White Smokers

INTRODUCTION

Persistent tobacco use among racial and ethnic minority populations in the United States is a critical public health concern. Yet, potential sources of racial/ethnic disparities in tobacco use remain unclear. The present study examined racial/ethnic differences in tobacco withdrawal-a clinically-relevant underpinning of tobacco use that has received sparse attention in the disparities literature-utilizing a controlled laboratory design.

METHODS

Daily smokers (non-Hispanic African American [n = 178], non-Hispanic white [n = 118], and Hispanic [n = 28]) attended two counterbalanced sessions (non-abstinent vs. 16-hour abstinent). At both sessions, self-report measures of urge, nicotine withdrawal, and affect were administered and performance on an objective behavioral task that assessed motivation to reinstate smoking was recorded. Abstinence-induced changes (abstinent scores vs. non-abstinent scores) were analyzed as a function of race/ethnicity.

RESULTS

Non-Hispanic African American smokers reported greater abstinence-induced declines in several positive affect states in comparison to other racial/ethnic groups. Relative to Hispanic smokers, non-Hispanic African American and non-Hispanic white smokers displayed larger abstinence-provoked increases in urges to smoke. No racial/ethnic differences were detected for a composite measure of nicotine withdrawal symptomatology, negative affect states, and motivation to reinstate smoking behavior.

CONCLUSIONS

These results suggest qualitative differences in the expression of some components of tobacco withdrawal across three racial/ethnic groups. This research helps shed light on bio-behavioral sources of tobacco-related health disparities, informs the application of smoking cessation interventions across racial/ethnic groups, and may ultimately aid the overall effort towards reducing the public health burden of tobacco addiction in minority populations.

IMPLICATIONS

The current study provides some initial evidence that there may be qualitative differences in the types of tobacco withdrawal symptoms experienced among non-Hispanic African American, Hispanic, and non-Hispanic white smokers. Extending this line of inquiry may elucidate mechanisms involved in tobacco-related health disparities and ultimately aid in reducing the public health burden of smoking in racial/ethnic minority populations.