Society for Research on Nicotine and Tobacco as an Outgrowth of the 1988 Surgeon General's Report on Nicotine Addiction: Reflections of the Early Presidents

INTRODUCTION

The Society for Research on Nicotine and Tobacco began in the United States as a scientific organization "to stimulate the generation and dissemination of new knowledge concerning nicotine and tobacco in all its manifestations." Now in its 30th year, the Society is taking on new challenges in tobacco control, nicotine vaping, product regulation, and public policy.

AIMS AND METHODS

This Review describes the formative years of the Society from the perspective of researchers who were in leadership positions during that time, documenting how biobehavioral and clinical research in the first 10 years was a continuation of the scientific mission of the 1988 United States Surgeon General's Report on Nicotine Addiction and summarizing organizational innovations during each president's term of office.

CONCLUSIONS

The Society's promotion of scientific research served as a catalyst for funding, policy, and regulation, setting the stage for its influence and credibility.

IMPLICATIONS

This Commentary provides context and an overview of the scientific research and the organizational innovations that occurred during the early years of the Society for Research on Nicotine and Tobacco using publications and available documentation. The Society was able to thrive because biobehavioral research on nicotine addiction provided the scientific underpinnings for the tobacco control enterprise as a whole. The objective of this Commentary is to describe formative events in the Society's history based on the accomplishments of its early leaders.

Balancing Consideration of the Risks and Benefits of E-Cigarettes

The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes' risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public-including most smokers-now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers' use of e-cigarettes in quit attempts. Because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay's authors, encourage the health community, media, and policymakers to more carefully weigh vaping's potential to reduce adult smoking-attributable mortality. We review the health risks of e-cigarette use, the likelihood that vaping increases smoking cessation, concerns about youth vaping, and the need to balance valid concerns about risks to youths with the potential benefits of increasing adult smoking cessation.

Rewarding psychiatric aides for the behavioral improvement of assigned patients

Different ways of modifying the aide-patient relationship to promote improvement in psychiatric patients were investigated. Psychiatric aides were given information about the behavior of assigned patients, cash awards based on the improvement of assigned patients, and different kinds of supervision by the psychology staff; the effects of these variables on a large number of psychiatrically relevant behaviors were measured. Appropriate behavior of patients increased when the aides were given quantitative information about the improvement of assigned patients. Cash awards for aides, which were not contingent on the behavior of patients had little effect, while cash awards contingent on the behavior of assigned patients were associated with more appropriate behavior. Direct supervision of aide-patient interactions was associated with an increase in appropriate behavior, while required consultation for the aides about assigned patients was not. Behavior of patients deteriorated when the program was terminated.

Race differences in factors relating to smoking initiation

To investigate race differences in retrospectively-reported early smoking experiences, we studied African-American (n=48) and Caucasian (n=155) current smokers who participated in a study designed to identify phenotypic and genotypic factors associated with smoking. Compared with Caucasian smokers, African-American smokers were less educated (mean+/-s.e.m.: 13.3+/-0.25 vs. 14.3 +/- 0.16; p<.01), had higher BMI (28.9+/-1.06 vs. 26.7+/-0.52; p<.05), and smoked significantly fewer cigarettes/day (14.1+/-1.00 vs. 18.4+/-0.74; p<.01). Ninety percent of African-American smokers consumed menthol cigarettes, as opposed to 25% of Caucasian smokers. African-American smokers were significantly older than Caucasian smokers upon initial smoking experimentation (17.4+/-1.1 vs. 14.7+/-0.3; p<.05) and onset of regular smoking (19.7+/-0.9 vs. 17.4+/-0.4; p<.05). African-American smokers were significantly more likely than Caucasian smokers to endorse global pleasurable sensations (48% vs. 30%; p<.05), "pleasurable rush or buzz" (62% vs. 43%; p<.05), and "relaxing" (45% vs. 27%; p<.05) as early experiences with smoking, whereas Caucasian smokers were marginally more likely to report dizziness and difficulty inhaling (61% vs. 45%; p<.10 and 48% vs. 31%; p<.10, respectively). Caucasian smokers were significantly more likely to endorse friends (6.9+/-0.2 vs. 4.8+/-0.4; p<.0001) and "perk me up" (4.2+/-0.3 vs. 3.1+/-0.4; p<.05) and marginally more likely to endorse buzz (4.2+/-0.2 vs. 3.4+/-0.5; p<.10) as reasons for starting to smoke. Further research is needed to determine the relative contributions of genetic, developmental, and socio-cultural factors to these findings.

Substance use, trait measures, and subjective response to nicotine in never-smokers stratified on parental smoking history and sex

INTRODUCTION

Male and female never-smokers stratified on parental history of smoking were tested for possible differences in susceptibility to the hedonic effects of nicotine.

METHODS

We recruited nicotine-exposed never-smokers with two never-smoking biological parents (PH-) or two ever-smoking biological parents (PH+). After completing a baseline assessment battery focusing on conditions or behaviors associated with smoking, participants were tested for subjective and hedonic effects in response to administration of three different nicotine doses (0.0, 0.5, and 1.0 mg) via nasal spray. Physiological and biochemical reactivity also was monitored.

RESULTS

PH+ were significantly more likely to report having experienced a "buzz" upon early smoking experimentation and to have histories of alcohol abuse and alcoholism; they also scored higher on disordered eating. In response to nicotine dosing, PH+ reported an increase in depressed mood, compared with a minimal response in PH-, in keeping with our expectation that nicotine would have more pronounced effects in PH+. Regardless of parental history, women reported experiencing greater anxiety in response to the highest nicotine dose, compared with men.

DISCUSSION

Further exploration in larger samples, using more stringent selection criteria, a wider range of measures, and a less aversive dosing method, may provide a full test of the possible utility of the parental history model for illuminating biobehavioral mechanisms underlying response to nicotine. Also important would be broadening the scope of inquiry to include comparisons with ever-smokers to determine what protected PH+ from becoming smokers, despite the presence of factors that might be expected to decrease resilience and increase susceptibility.

Using MIMIC models to examine the relationship between current smoking and early smoking experiences

INTRODUCTION

The present study expands previous research on early experiences with tobacco by using a Multiple Indicator Multiple Causes (MIMIC) model, which permits combining indicators tapping into pleasant experiences into one latent construct and those indicators of unpleasant experiences into another latent construct.

METHODS

A sample of 458 participants was recruited via newspaper advertisements. Response to early experimentation with cigarettes was assessed using the Early Smoking Experiences questionnaire, in which participants were asked the following question: "The first time you tried cigarettes, did you experience any of the following? (pleasurable and displeasurable sensations [overall], pleasurable rush or buzz, dizziness, relaxation, nausea, cough, difficulty inhaling)." These experiences were rated on a scale ranging from 1 = none to 4 = intense.

RESULTS

The MIMIC model revealed that current smoking status and age of initial experimentation with cigarettes were significantly associated with both early pleasant and unpleasant experiences (p < .05). African Americans were less likely than Whites to have early unpleasant experiences (p < .05). No association was found between race and early pleasant experiences.

DISCUSSION

Our findings are consistent with the inferences that pleasant experiences in response to early experimentation with smoking lead to regular smoking and that positive experiences play a stronger role than negative experiences in the transition to regular smoking. Our study also demonstrates that the MIMIC model is pertinent and practicable in nicotine and smoking research. We recommend it as a useful tool for identifying endophenotypes related to nicotine dependence and tobacco use latent constructs.

Never-smokers with a positive family smoking history are more likely to be overweight or obese than never-smokers with a negative family smoking history

To shed light on the complex relationship between smoking and body weight, we used never-smokers stratified on family smoking history to model the effects of a diathesis for smoking on body weight without the potential confound of metabolic changes or decreased physical activity caused by chronic tobacco smoke exposure. Participants were 100 family history negative never-smokers (FH-; 2 never-smoking parents) and 71 family history positive never-smokers (FH+; 2 ever-smoking parents). Controlling for significant group differences in race and age, BMI was significantly higher in FH+ (26.7+/-.6) than in FH- (24.5+/-.4; F=10.351 p<.01). Further analysis using logistic regression showed that FH+ were 2.7 times as likely to be overweight/obese (BMI > or = 25; 95% C.I. 1.398-5.351; p<.01). FH+ scored significantly higher on the Dieting and Bingeing Severity Scale than FH- and were significantly more likely to score in the severe or at-risk range. FH+ drank significantly more alcohol than FH-; they scored significantly higher on the CAGE and on the Michigan Alcohol Screening Test. Our analyses provide support for the role of inherited and/or environmentally-driven tendencies towards disinhibited eating and/or risky behaviors in general in the observed differences in BMI. No group differences in BMI or likelihood of being overweight/obese emerged based on prenatal exposure to nicotine in FH+ smokers, although our sample was too small to rule out an association. Further research in larger samples, using more complex statistical models, will be needed to disentangle these issues and identify causal pathways.

Association of a single nucleotide polymorphism in neuronal acetylcholine receptor subunit alpha 5 (CHRNA5) with smoking status and with 'pleasurable buzz' during early experimentation with smoking

AIMS

To extend the previously identified association between a single nucleotide polymorphism (SNP) in neuronal acetylcholine receptor subunit alpha-5 (CHRNA5) and nicotine dependence to current smoking and initial smoking-experience phenotypes.

DESIGN, SETTING, PARTICIPANTS

Case-control association study with a community-based sample, comprising 363 Caucasians and 72 African Americans (203 cases, 232 controls).

MEASUREMENTS

Cases had smoked > or = five cigarettes/day for > or = 5 years and had smoked at their current rate for the past 6 months. Controls had smoked between one and 100 cigarettes in their life-time, but never regularly. Participants also rated, retrospectively, pleasurable and displeasurable sensations experienced when they first smoked. We tested for associations between smoking phenotypes and the top 25 SNPs tested for association with nicotine dependence in a previous study.

FINDINGS

A non-synonymous coding SNP in CHRNA5, rs16969968, was associated with case status [odds ratio (OR) = 1.5, P = 0.01] and, in Caucasians, with experiencing a pleasurable rush or buzz during the first cigarette (OR = 1.6, P = 0.01); these sensations were associated highly with current smoking (OR = 8.2, P = 0.0001).

CONCLUSIONS

We replicated the observation that the minor allele of rs16969968 affects smoking behavior, and extended these findings to sensitivity to smoking effects upon experimentation. While the ability to test genetic associations was limited by sample size, the polymorphism in the CHRNA5 subunit was shown to be associated significantly with enhanced pleasurable responses to initial cigarettes in regular smokers in an a priori test. The findings suggest that phenotypes related to subjective experiences upon smoking experimentation may mediate the development of nicotine dependence.

Association of withdrawal features with nicotine dependence as measured by the Fagerström Test for Nicotine Dependence (FTND)

The aim of this study was to advance our understanding of how nicotine dependence level, defined by the Fagerström Test of Nicotine Dependence (FTND), relates to nicotine withdrawal features. We classified nicotine dependence in two categories, 1) low dependence (LD; FTND<4) and 2) high dependence (HD; FTND> or =4). A sample of 241 smokers was recruited via newspaper ads and public notices. Using a multivariate response model with adjustments for age, sex, age at first cigarette, race, and current or lifetime depression, we observed a small to modest statistically robust association between nicotine dependence level and withdrawal features such as, irritation/anger (adjusted relative risk, aRR=1.2; 95% CI 1.0, 1.3); nervousness (aRR=1.3; 95% CI 1.1, 1.6); restlessness (aRR=1.2; 95% CI 1.1, 1.4); difficulty concentrating (aRR=1.3; 95% CI 1.1, 1.7); and trouble sleeping (aRR=1.8; 95% CI 1.2, 2.6). Our findings are consistent with the inference that the FTND measures "physiological dependence" and that multidimensional approaches are needed to capture the full range of smoking phenotypology.

Web-based smoking-cessation programs: results of a randomized trial

BACKGROUND

Initial trials of web-based smoking-cessation programs have generally been promising. The active components of these programs, however, are not well understood. This study aimed to (1) identify active psychosocial and communication components of a web-based smoking-cessation intervention and (2) examine the impact of increasing the tailoring depth on smoking cessation.

DESIGN

Randomized fractional factorial design.

SETTING

Two HMOs: Group Health in Washington State and Henry Ford Health System in Michigan.

PARTICIPANTS

1866 smokers.

INTERVENTION

A web-based smoking-cessation program plus nicotine patch. Five components of the intervention were randomized using a fractional factorial design: high- versus low-depth tailored success story, outcome expectation, and efficacy expectation messages; high- versus low-personalized source; and multiple versus single exposure to the intervention components.

MEASUREMENTS

Primary outcome was 7 day point-prevalence abstinence at the 6-month follow-up.

FINDINGS

Abstinence was most influenced by high-depth tailored success stories and a high-personalized message source. The cumulative assignment of the three tailoring depth factors also resulted in increasing the rates of 6-month cessation, demonstrating an effect of tailoring depth.

CONCLUSIONS

The study identified relevant components of smoking-cessation interventions that should be generalizable to other cessation interventions. The study also demonstrated the importance of higher-depth tailoring in smoking-cessation programs. Finally, the use of a novel fractional factorial design allowed efficient examination of the study aims. The rapidly changing interfaces, software, and capabilities of eHealth are likely to require such dynamic experimental approaches to intervention discovery.

Genetic research on complex behaviors: an examination of attempts to identify genes for smoking

A conference on the conduct of genomic research on complex behaviors was convened at the University of Michigan to demystify genetic research by describing the tools and methodologies for identifying genes and to assess the feasibility of conducting genomic research on smoking, a complex behavior with major public health import. These proceedings are excerpts based on the presentations at the conference.

Behavioural studies in humans: anxiety, stress and smoking

Numerous observers have reported that smokers smoke more under stressful conditions. The most frequent explanation is that nicotine reduces anxiety, an intervening variable identified as a negative reinforcer for smoking behaviour. The conditions under which anxiety reduction occurs in response to smoking, however, have not been well defined, nor are underlying mechanisms well understood. There are several possible explanations, including Schachter's theory based on stress-induced changes in urinary pH and the hypothesis of endogenous opioid involvement. The work of Collins and his associates in animals has shown that genetic variations in corticosteroid responsiveness to nicotine are associated with differences in sensitivity to nicotine. Research in our laboratory has extended to humans Collins' findings that sensitivity to nicotine is inversely related to corticosteroid activity. We also found that the combination of a psychological stressor and smoking produced additive effects on cortisol release in humans. These findings suggest a novel way of explaining the interaction between smoking and stress, in that increased nicotine intake in the context of stress may in part reflect behavioural compensation for diminished sensitivity to nicotine when corticosteroid activity is enhanced by the stressor.

Genome-wide linkage analysis for smoking-related regions, with replication in two ethnically diverse populations

As part of the Genetic Epidemiology Network of Arteriopathy, hypertensive sibships were collected and smoking behavior recorded. Using an affected sibpair design and genome-wide microsatellite data markers ( approximately 10 cM coverage), we identified 214 non-Hispanic White sibships (502 sibpairs) from Rochester, Minnesota (M (age) [SD] = 55.68 years [10.56]) and 206 Black sibships (376 sibpairs) from Jackson, Mississippi (M (age) = 57.97 [8.94]), who had smoked for at least 3 years, and performed nonparametric linkage analysis using GENEHUNTER. We found evidence of linkage on chromosome 3 in both Whites (LOD = 1.76@109 cM) and Blacks (LOD = 2.03@122 cM). Each of these peaks had a secondary smaller peak at 140-147 cM that was statistically suggestive only in the Black sample (LOD = 1.4). The peak for the combined samples was suggestive of strong linkage (LOD = 3.24@124 cM). Additional suggestive peaks (LOD>1.3) were found in the White (chromosomes 8 [26 cM] and 19 [36 cM]) and Black sibships (chromosome 10 [153 cM]) but did not overlap with corresponding regions in the other ethnic group. This is the first study to identify a chromosomal region that has replicate evidence of linkage to smoking in two independent samples of similar size differing both geographically and ethnically. The gene for serotonin receptor 1F (HTR1F) is located in the region of the chromosome 3 linkage signal, representing at least one potential candidate gene. Fine mapping may well provide useful new information about genetic factors underlying nicotine dependence.

Novel genes identified in a high-density genome wide association study for nicotine dependence

Tobacco use is a leading contributor to disability and death worldwide, and genetic factors contribute in part to the development of nicotine dependence. To identify novel genes for which natural variation contributes to the development of nicotine dependence, we performed a comprehensive genome wide association study using nicotine dependent smokers as cases and non-dependent smokers as controls. To allow the efficient, rapid, and cost effective screen of the genome, the study was carried out using a two-stage design. In the first stage, genotyping of over 2.4 million single nucleotide polymorphisms (SNPs) was completed in case and control pools. In the second stage, we selected SNPs for individual genotyping based on the most significant allele frequency differences between cases and controls from the pooled results. Individual genotyping was performed in 1050 cases and 879 controls using 31 960 selected SNPs. The primary analysis, a logistic regression model with covariates of age, gender, genotype and gender by genotype interaction, identified 35 SNPs with P-values less than 10(-4) (minimum P-value 1.53 x 10(-6)). Although none of the individual findings is statistically significant after correcting for multiple tests, additional statistical analyses support the existence of true findings in this group. Our study nominates several novel genes, such as Neurexin 1 (NRXN1), in the development of nicotine dependence while also identifying a known candidate gene, the beta3 nicotinic cholinergic receptor. This work anticipates the future directions of large-scale genome wide association studies with state-of-the-art methodological approaches and sharing of data with the scientific community.

Differences in smoking-related variables based on phenylthiocarbamide "taster" status

Test strips impregnated with phenylthiocarbamide (PTC) have been used to identify genetic differences based on whether a bitter taste is perceived. To determine whether smokers who perceive PTC as bitter tasting ("tasters") would differ from those who describe it as tasteless ("non-tasters") on smoking-related variables, we studied 464 current smokers (70% female, 79% White; mean age 30.5+/-9 years) recruited to participate in laboratory experiments and clinical trials. Of these, 217 (47%) reported the PTC strips as tasteless and 154 (33%) as tasting bitter. The remaining 93 (20%) described the taste as salty, sweet, or other and were excluded from further analyses. Comparing tasters with non-tasters, we found significant differences in mean (S.D.) total years smoked (14.5 [9.2] for non-tasters, vs. 12.6 [8.4] for tasters, p<.05), Fagerstrom Tolerance Questionnaire scores (6.4 [2.1] vs. 5.8 [2.1], p<.01), and scores on the Positive Reinforcement scale of the Michigan-Nicotine Reinforcement Questionnaire (8.1 [2.9] vs. 6.8 [3.1], p<.05). Results suggest that among smokers, ability to taste PTC may confer some protection from development of nicotine dependence and positive reinforcement from smoking.

Nicotine dependence, depression, and gender: characterizing phenotypes based on withdrawal discomfort, response to smoking, and ability to abstain

Smoking is often viewed as a comprehensive phenotype rather than a complex set of traits involving intermediate phenotypes. To explore this issue in a laboratory setting, we tested 69 smokers stratified on depression, nicotine dependence, and gender. On the third day of an initial withdrawal period, we tested for differences among participants in uncued and cued craving and withdrawal; on the fourth day, we exposed them to a controlled dose of smoke and assessed them for physiological and hedonic effects and reduction of craving and withdrawal. Following resumption of smoking for at least a week, we then tested participants on their ability to abstain for an 11-day interval. During the withdrawal test, high-depressed smokers and men exhibited elevated craving and withdrawal scores overall, whereas no differences emerged for dependence. Cue exposure produced significant increases in craving but not withdrawal. During the smoke-exposure test, men were significantly more likely than women, and high-depressed smokers more likely than low-depressed smokers, to show evidence of experiencing pleasurable "buzzes." High-dependent smokers showed significant increases in diastolic blood pressure, possibly suggestive of greater sensitivity to nicotine. During the quit test, high-dependent smokers had more difficulty abstaining than low-dependent smokers, and women more than men; no differences emerged based on depression. Independently of group membership, inability to abstain was predicted by increased anxiety, depression, and difficulty concentrating in response to cue exposure. These findings provide support for the existence of phenotypes that can be distinguished by withdrawal symptomatology (primarily driven by depression) and ability to remain abstinent (primarily driven by dependence).

Unaided smoking cessation among smokers in treatment for alcohol dependence

To investigate the possible impact of treatment of alcohol dependence on smoking, we studied 144 smokers in an alcohol treatment center for whom 6-month data were available. Of those, 18 reported not smoking at 6 months. No significant differences in age, gender, or race were observed between quitters and continuing smokers. Quitters at 6 months were significantly more likely to be low dependent smokers than were continuing smokers and were significantly more likely to report no drinking during the past 28 days at the end of 1 month's treatment (93%) than continuing smokers (62%). These findings suggest that quitting smoking may be associated with low levels of nicotine dependence and favorable alcohol treatment response in alcoholic smokers.

Differences in accuracy of offspring assessment based on parental smoking status

To investigate the accuracy of offspring assessments of parental smoking status, we studied 116 parents and 151 adult children (276 parent-child dyads) who provided data on both their own and their parents' smoking status. All currently smoking and all ex-smoking parents were correctly classified as ever-smokers by their offspring (n = 79 and 100, respectively). Of the 97 offspring who reported on never-smoking parents, 88 correctly classified their parents as never-smokers. Thus, sensitivity for detecting ever-smoking in parents was 100%, and specificity, 91%. Because all incorrect classifications involved never-smoking parents, further analyses focused on this group. Too few parents were misclassified to permit testing of parental characteristics. Offspring who misclassified their parents were significantly older than those who did not; neither sex nor smoking status of the offspring was associated with the increased likelihood of misclassification. No significant differences were discovered for dyadic factors (concordance/discordance for sex; parent-offspring age difference). Overall, these results support the utility of proxy reports of parental smoking phenotype by adult informants when self-report is unavailable.

Validation of retrospective reports of early experiences with smoking

Initial sensitivity to the pharmacological effects of a drug may affect patterns of future use and dependence for a wide variety of drugs. Retrospective reports of sensations experienced upon early experimentation, however, may be limited by recall bias based on time elapsed and subsequent experiences. To validate reports of early experiences with nicotine, we studied 34 smokers who had contributed retrospective data on early experiences with smoking. Half had reported experiencing a buzz from smoking their first cigarette (the "yes" group), the other half had not (the "no" group). To simulate initial sensitivity to nicotine, we asked participants to remain abstinent from smoking for 5 days to allow for the dissipation of tolerance. They then participated in a laboratory session in which they were reexposed to nicotine in an unfamiliar form (nicotine nasal spray) and asked to indicate pleasurable responses by depressing a foot pedal if and when they experienced a "pleasurable buzz." Smokers in the "yes" group were marginally more likely to be male. The two groups did not differ significantly on age or race. The "yes" group smoked significantly more cigarettes/day than the "no" group. When the two groups were compared for response to nasal spray following 5 days' abstinence, smokers in the "yes" group were marginally more likely to have signaled experiencing at least one pleasurable buzz and rated "pleasurable sensation from spray" on a 100-mm visual analogue scale administered 10 min after nicotine dosing significantly higher than were those in the "no" group. To the extent that several days' abstinence can serve as a model for initial sensitivity to nicotine, our findings validate retrospective reports of pleasurable sensations upon early smoking experimentation.

Heterogeneity in phenotypes based on smoking status in the Great Lakes Smoker Sibling Registry

We investigated whether 52 same-sex sibling pairs discordant for ever-smoking differed on psychiatric cofactors, alcohol and caffeine use, and responses to initial exposure to smoking. Ever-smokers scored significantly higher on measures of novelty seeking, depression, and childhood ADHD, and on alcohol dependence, alcohol intake, and caffeine intake. They reported significantly more pleasurable experiences, dizziness, "buzz," and relaxation upon initial exposure to smoking and significantly fewer displeasurable sensations, nausea, and cough than did nicotine-exposed, never-smoking siblings. Ever-smokers had significantly fewer years of education than their never-smoking siblings, suggesting that the concentration of smokers in lower socioeconomic strata may be partly due to downward mobility among smokers, possibly because of the observed elevation in psychiatric cofactors, which may interfere with academic performance. These findings are consistent with differences previously identified in unrelated ever- and never-smokers. Because same-sex siblings typically share a large set of common environments during childhood, our findings could be due either to genetic differences among siblings and/or (excepting educational level and responses to early exposure) to differences in adult environments.

Depression, smoking abstinence and HPA function in women smokers

To determine whether smokers with a history of depression are differentially susceptible to smoking withdrawal, depressed mood induction and/or hypothalamic-pituitary-adrenal (HPA) axis dysregulation during smoking abstinence, 24 women smokers with and without such a history were studied. During one 5-day interval, participants smoked ad libitum; during a second they abstained. On day 4, the participants were exposed to the Velten mood induction procedure (VMIP). Participants were then instructed to take 1 mg dexamethasone at 11 pm. At 4 pm on day 5, blood samples were withdrawn to determine the cortisol and ACTH response. Despite lower baseline cotinine levels, history-positive participants displayed more pronounced overall withdrawal distress than did history-negative participants, regardless of condition. The VMIP increased depression as well as negative responses on other profile of mood states subscales. Despite many overall group differences, no significant main effects for smoking condition nor interaction effects emerged. All participants evinced cortisol suppression in response to dexamethasone during both conditions, but the degree of suppression did not differ as a function of either abstinence or depression history. In history-positive smokers, however, ACTH levels trended toward overall elevation and showed almost no suppression during abstinence; thus exacerbation of HPA dysregulation in history-positive smokers during smoking abstinence cannot be ruled out.

Defining a never-smoker: results from the nonsmokers survey

The U.S. Centers for Disease Control defines a never-smoker as someone who has smoked < 100 cigarettes per lifetime. In an attempt to explore differences among nonsmokers and to validate this cutpoint, we surveyed 69 nonsmokers who had smoked between 1 and 200 cigarettes in their lifetime on their experiences during the time they smoked. Of the 7 who classified themselves as ex-smokers, 2 met DSM-IV criteria for nicotine dependence, compared with none who classified themselves as never-smokers. No respondents provided data permitting the computation of a Fagerstrom Test for Nicotine Dependence (FTND) score. Withdrawal effects were minimal, but craving, tolerance, and subjective effects showed a pattern of significant differences that were most prominent between those who smoked only 1 cigarette and those who smoked at least a pack. Our data indicate a graded effect but also suggest that 19 cigarettes per lifetime is a more conservative cutpoint than 99 for defining the never-smoker phenotype. Further investigation of the smoking trajectory and characteristics associated with development of signs of dependence in never- vs. ever-smokers may help refine this cutpoint and shed light on what protects some people who experiment with smoking from becoming chronic users.

Relationship between early experiences with tobacco and early experiences with alcohol

Initial sensitivity to substances may affect patterns of future use and dependence. Because smoking and alcohol use are strongly linked, because animal studies indicate cross-sensitivity, and because genetic determinants of nicotine and alcohol dependence overlap, we studied the relationships between retrospectively reported responses to both substances in current smokers (n = 111) and never-smokers (n = 86). Early smoking experiences were correlated with comparable responses to alcohol in smokers, and to a lesser extent, in never-smokers. Both pleasurable early experiences with nicotine and pleasurable experiences with alcohol predicted current alcohol intake; pleasurable early experiences with alcohol also predicted alcohol dependence. Neither pleasurable nor displeasurable experiences with either substance predicted current amount smoked or degree of nicotine dependence. These preliminary findings may have implications for understanding the mechanisms underlying the smoking-alcohol link.

Nicotine metabolite ratio as a predictor of cigarette consumption

The rate of nicotine metabolism is hypothesized to be a determinant of how much a person smokes. That is, rapid metabolizers would be expected to need more nicotine and, therefore, smoke more than slow metabolizers. Nicotine is metabolized extensively by the liver enzyme CYP2A6, primarily to cotinine. Cotinine is itself metabolized by CYP2A6 to 3'-hydroxycotinine (3-HC). The ratio of metabolite to parent (i.e., 3-HC:cotinine) would be expected to reflect CYP2A6 activity. We measured the ratio of 3-HC:cotinine in the urine of 72 smokers. This ratio was significantly correlated with the number of cigarettes smoked per day (r=.33, p=.005), though not with the Fagerström Test for Nicotine Dependence. This finding supports the hypothesis that the rate of nicotine metabolism is a determinant of the level of cigarette consumption and supports the use of the 3-HC:cotinine ratio as a noninvasive marker of nicotine metabolism.

Development and validation of a self-rating scale for positive- and negative-reinforcement smoking: The Michigan Nicotine Reinforcement Questionnaire

Positive- and negative-reinforcement consequences of smoking were assessed using a self-report inventory. Data from 429 current smokers (348 women, 81 men) were subjected to an exploratory factor analysis, with concurrent validation of resulting scales in 288 current smokers (235 women, 53 men), controlling for sex and age. The solution with three factors--positive reinforcement, negative reinforcement, and smoking patterns--provided the clearest and most interpretable factor solution. The Michigan Nicotine Reinforcement Questionnaire (M-NRQ), which yields positive- and negative-reinforcement scales, was developed based on these results. Positive-reinforcement smoking was associated with higher scores on novelty seeking, reward dependence, alcohol dependence, and pleasurable sensations upon early smoking experimentation, and with lower scores on displeasurable sensations and nausea upon early smoking experimentation. Negative-reinforcement smoking was associated with higher scores for nicotine dependence, depression, anxiety, and harm avoidance. The M-NRQ has potential as a diagnostic tool for individualizing behavioral intervention and pharmacotherapy and also may be useful in identifying new phenotypes for genetic research on smoking.

Agreement between proband and parental self-report of smoking behavior and nicotine dependence

Although investigators have used family history methods to investigate familial clustering of disorders such as depressive disorder, alcoholism, coronary heart disease, and cancer, research of this type is relatively new to the field of smoking. We examined agreement between proband report of parental smoking behavior and parent's self-reported smoking behavior in 126 proband-parent pairs. Probands were either never, current, or exsmokers; parents were either current or exsmokers. Agreement between proband and parent was better for smoking behaviors when the parent was a current smoker. We found good proband-parent agreement for some smoking behaviors when the parent was a current smoker (e.g., age started smoking [mean (SD) difference between proband and parental report, 1.36 years (9.07 years)], and cigarettes per day and brand smoked [kappa=.49 and.56, respectively]) but poor agreement for items that may represent more complex or less observable indicators of nicotine dependence, regardless of parental smoking status. Reliability was excellent for probands of either current- or exsmoker parents for smoking status (kappa=.92). As a result of probands' difficulty in reliably answering several items that comprise the Fagerström Tolerance Questionnaire (FTQ) (e.g., number of minutes to parent's first cigarette of the day, whether parent smoked more in the morning than during the rest of the day) and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis (e.g., sleep difficulties and difficulty concentrating during nicotine withdrawal), reliability for an FTQ score >/=7 (kappa=.067) and the DSM-IV nicotine dependence diagnosis (kappa=.28) was poor. Our findings should aid investigators in defining the limits of proband reports of parental smoking behavior and identify opportunities for the development of better approaches for the assessment of familial nicotine dependence.

Smoking patterns and abstinence effects in smokers with no ADHD, childhood ADHD, and adult ADHD symptomatology

Cigarette smokers are known to be overrepresented among adults with Attention Deficit Hyperactivity Disorder (ADHD). To date, however, no attempt has been made to determine the extent to which a lifetime diagnosis of ADHD may be associated with smoking even in the absence of current symptomatology. We hypothesized that nicotine dependence and abstinence effects-especially effects relevant to ADHD symptomatology-would be more pronounced in adult ADHD smokers in comparison with those who reported childhood ADHD symptoms only. Results indicated that, in contrast to controls without ADHD symptomatology, both adult and childhood ADHD groups were significantly more likely to experience a number of nicotine withdrawal symptoms, including irritability and difficulty concentrating; in no instance did the ADHD groups differ from one another in this regard. Thus, studying people with childhood symptoms of ADHD, even in the absence of an adult diagnosis, may shed light on the known association between smoking and ADHD.

Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood

To test the efficacy of sustained nicotine patch use among at-risk smokers, 55 smokers with a history of abstinence-induced depressed mood were randomly assigned to either Nicotine Maintenance or Standard Treatment following preliminary high-dose patch treatment. The Nicotine Maintenance group received 21 mg transdermal nicotine for 8 additional weeks; the Standard Treatment group followed a tapered dosing regimen. Significant differences favoring the Nicotine Maintenance group were found in self-reported craving but not withdrawal. No difference was observed in continuous abstinence or in relapse rates. When dropouts who did not relapse during patch use were classified as successful, however, the Nicotine Maintenance group had significantly lower relapse rates. Rate of lapse in the Nicotine Maintenance group during post-trial tapering did not differ significantly from that in the Standard Treatment group during tapering in the trial, suggesting that the benefits of sustained dosing may persist only as long as dosing continues.

Race differences in weight concerns among women smokers: results from two independent samples

To investigate attitudes about weight as they interact with smoking in African American women, we analyzed data from two independent samples of white and African American women smokers--one assembled via a national random-digit-dialing survey, the other consisting of candidates for enrollment in local studies. Findings for the two samples were remarkably consistent. African American women were significantly heavier and significantly more likely to have a self-reported BMI > or = 27. Although the preferred weight for African American women was significantly higher than for white women, the percentage by which they exceeded their preferred body weight did not differ significantly between groups, and the difference between actual and preferred weights was actually greater for African American women. African American women were more likely to be satisfied with their body shape and were significantly less likely to exercise to control weight. They did not differ significantly on binge-eating or dieting. African American women were more likely than white women to be unwilling to gain any weight upon quitting smoking but did not differ significantly on any other smoking-related weight concerns. Our results suggest that weight concerns, though differently conceptualized, may motivate African American women as powerfully as white women. They strongly suggest that race differences need to be considered in designing optimal smoking cessation interventions for weight-concerned women smokers. To accomplish this goal, efforts to identify a vocabulary for the expression of weight concerns in African American women will be needed, as will attention to ways to avoid exacerbating obesity and to encourage exercise.

Emergence of depression during early abstinence in depressed and non-depressed women smokers

The emergence of depression early in a quit attempt and its relationship to ability to maintain abstinence were studied in 99 depressed and non-depressed women smokers. Participants rated withdrawal symptomatology during a baseline week and the first two weeks of a quit attempt, during which they used a 21-mg nicotine patch and received behavioral counseling. Depressed women experienced greater difficulty maintaining early abstinence than non-depressed women. They were significantly more likely to smoke on the first day of abstinence and smoked marginally more days during the first week. Among participants who relapsed during the first two weeks, latency to relapse was significantly shorter for depressed women. Although craving and all withdrawal symptoms except insomnia showed significant increases over baseline, only depression showed significant group differences, with trend analyses suggesting that depression asymptotes in non-depressed women after the first week but continues increasing in depressed women. Larger increases in depression on the first day of abstinence were associated with earlier lapse. Because depression is relatively infrequent as a withdrawal symptom, it may not be a "true" withdrawal symptom except in depressed people. Identification of depressed smokers and anticipation of their increased need for support during this period may help to counteract the "first-day effect" and difficulties during early abstinence.

Who gets what symptom? Effects of psychiatric cofactors and nicotine dependence on patterns of smoking withdrawal symptomatology

The present study used logistic regression techniques to examine the extent to which depression, anxiety, disordered eating, and nicotine dependence increased risk of experiencing craving and the eight DSM-IV withdrawal symptoms (depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite) during smoking abstinence, assessed retrospectively. Data were provided by a racially diverse sample of 365 male and female smokers recruited to participate in laboratory studies. Results indicate that variables known to be associated with smoking are risk factors for distinct and only somewhat overlapping patterns of symptomatology. Smokers scoring high on measures of anxiety, depression, or disordered eating were at increased risk primarily of experiencing withdrawal symptomatology pathognomonic to their particular disorder, whereas smokers scoring high on nicotine dependence appeared to be at increased risk of experiencing a syndromal pattern of withdrawal, encompassing craving and insomnia as well as cognitive/affective symptoms. Our results support the possibility that some individuals use smoking as a form of self-medication and suggest that elucidation of patterns of withdrawal symptomatology may contribute to improved specification of smoking phenotypes as well as facilitate treatment-matching.

Effects of menstrual phase and smoking abstinence in smokers with and without a history of major depressive disorder

Although considerable progress has been made towards understanding the role of menstrual cycle phase in smoking, little is known about the possible effects of menstrual phase upon nicotine intake, withdrawal symptomatology, and craving in women with psychiatric cofactors. Fourteen women with and without a history of Major Depressive Disorder (MDD) were studied during five biologically-confirmed phases over the course of one menstrual cycle: smoking logs, salivary cotinine, and ratings of craving and withdrawal were collected daily. During a second cycle, subjects remained abstinent for 3 consecutive days during the postmenses and premenstrual phases. Although a significant omnibus F-test emerged for cigarettes per day across phases during ad libitum smoking, only trends were observed post hoc and supported midcycle rather than premenstrual elevations. There were no significant phase differences for cotinine. Withdrawal symptomatology was markedly elevated during smoking abstinence and in women with a history of depression. but showed no evidence of phase effects. Thus, the hypothesis that depressed individuals would be differentially affected by phase and abstinence was not strongly supported by our results, though overall elevations emphasize the need for special attention to withdrawal severity in this population. Craving was significantly elevated during smoking abstinence and was significantly higher during postmenses, consistent with the midcycle elevation in smoking rate, but showed no group differences. Our findings overall lend little support for the need to control for menstrual phase under conditions of ad libitum smoking. The strong association of self-reported menstrually related dysphoria during abstinence with both craving and withdrawal symptoms, however, is consistent with an exacerbation of smoking abstinence effects in women with severe menstrual symptomatology.

Short-term weight gain in abstaining women smokers

Although most studies of weight gain following smoking cessation assess long-term change, weight gain during the critical period immediately following cessation may be more salient to the smoker for whom fear of weight gain constitutes a serious barrier to cessation. The current study examined weight change in 20 highly dependent women smokers provided with monetary incentives to abstain for 1 week, along with concomitant changes in cotinine. Abstaining smokers (n = 7) gained 3.1 pounds, compared with 0.3 pounds in women who continued to smoke (n = 13). Across all subjects, change was significantly negatively correlated with final plasma cotinine concentration and marginally negatively correlated with percent cotinine reduction. Weight gain in women abstainers in the luteal phase of the menstrual cycle exceeded that in women abstainers in the follicular phase; a significant interaction such that continuing smokers showed no phase-related differences in weight suggests that the effect was not an artifact of perimenstrual increases in eating or fluid retention. Although long-term weight gain has been shown to be positively associated with success in quitting, little is known about the effects of short-term weight gain. Since many weight-concerned individuals either do not attempt to quit or terminate their quit attempts very early, it may be that if weight gain can be postponed beyond the first few fragile days of cessation, women with strong weight concerns may actually be good candidates for success.

Abstinence effects and reactivity to nicotine during 11 days of smoking deprivation

The purpose of the present study was to investigate smoking abstinence effects and the dissipation of tolerance (reactivity to nicotine) under controlled laboratory conditions. Seventeen male and female regular smokers were tested first in a session following ad libitum smoking and then in an additional five sessions over the course of 11 days during which they abstained from smoking. A metered dose of nicotine was administered via intranasal spray to ensure standard exposure, and pre- and post-dosing measures of heart rate, blood pressure, cortisol, galvanic skin response (GSR), craving, and several DSM-IV withdrawal symptoms (anxiety, irritability, restlessness, difficulty concentrating, and appetite) were collected. Prior to the nicotine test dose during deprivation sessions, heart rate and systolic blood pressure evinced elements of both an 'offset abstinence pattern' (deflection in a direction opposite to that produced by smoking) and a 'transient abstinence pattern' (deflection followed by a subsequent return); for cortisol, an offset pattern was observed, whereas for GSR and craving, a transient pattern was found. With respect to loss of tolerance, heart rate reactivity was found to increase significantly after 2 days' abstinence from nicotine, and the increase was sustained in subsequent sessions. Cortisol reactivity revealed more gradual dissipation, with significant differences evident only after 9 days of abstinence. These findings extend research on nicotine abstinence effects and on the dissipation of tolerance to nicotine deprivation intervals of nearly 2 weeks and confirm prior observations of variability across different response systems.

Initial exposure to nicotine in college-age women smokers and never-smokers: a replication and extension

Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine upon initial exposure than those who do not take up smoking. The present study was designed to extend these findings to a sample of college-age women never-smokers and light smokers. Subjects were asked to rate pleasurable and displeasurable sensations upon first smoking and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea, and cough. Pleasurable sensations were marginally greater in smokers; pleasurable rush or buzz and dizziness were significantly more likely to be reported by smokers. Relaxation, displeasurable sensations, nausea, and cough did not differ significantly between groups. Fagerstrom Test for Nicotine Dependence scores significantly predicted pleasurable but not displeasurable sensations; Center for Epidemiological Studies-Depression scores predicted neither. These findings lend further support to the following conclusions: (1) people who become cigarette smokers experience more pleasurable sensations upon initial exposure to tobacco than their never-smoking counterparts; and (2) unpleasant reactions to the first cigarette do not protect against subsequent smoking.

Nicotine withdrawal and psychiatric symptoms in cigarette smokers with schizophrenia

The prevalence of smoking is markedly elevated in schizophrenia. Low smoking cessation rates and reports that some smokers with schizophrenia experience an acute increase in symptoms during attempts to quit smoking, suggest a self-medication model. Alternatively, smoking may modulate medication side effects. The effects of treated and untreated smoking abstinence on psychotic symptoms and medication side effects were examined in this study. Nineteen outpatients with schizophrenia or schizoaffective disorder participated in a randomized, double-blind, balanced crossover study: 1 day of ad libitum smoking followed by 3 days of acute smoking abstinence while wearing 22 mg/day active or placebo transdermal nicotine patches, with a return to 3 days of smoking between patch conditions. Daily symptom and side-effect ratings, nicotine and cotinine blood levels were collected. Twelve subjects completed the study. Neither positive symptoms nor mood symptoms changed. An increase in negative symptoms during the first abstinent day occurred in both placebo and active patch conditions, but was not sustained over subsequent abstinent days. Despite physiological signs of withdrawal, completers did not endorse increased nicotine withdrawal symptoms. Dropouts reported higher withdrawal symptoms, but also had no increase in psychiatric symptoms in either phase of the study. Of note, dyskinesias decreased during abstinence and placebo patch treatment, but increased during abstinence and the active patch conditions. Acute exacerbation of psychiatric symptoms is an unlikely explanation for any difficulty smokers with schizophrenia have in early abstinence.

Effects of menstrual phase on reactivity to nicotine

The possible impact of menstrual phase upon reactivity to nicotine was investigated in 12 healthy women smokers. Controlled doses of nicotine were administered via an intranasal aerosol delivery device to overnight-deprived women smokers in four hormonally verified menstrual phases. Physiological, biochemical, and subjective measures were collected. Cycle-related symptomatology differed significantly across phase, with lowest values during the mid-follicular phase. No significant differences were found for baseline variables, including withdrawal measures. Nicotine increment was stable across phase, confirming reliability of the dosing method. No significant menstrual phase differences were found for physiological, subjective, or biochemical responses to nicotine. Pending investigations conducted over longer intervals, in a wider variety of subjects; findings suggest that for this type of study, complex strategies to control for menstrual-cycle phase effects may be unnecessary.

Early experiences with tobacco among women smokers, ex-smokers, and never-smokers

AIMS

Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine than those who do not take up smoking.

DESIGN AND SETTING

The present study was designed to investigate this hypothesis by querying initial experiences with cigarette smoking in smokers, ex-smokers and never-smokers recruited from the local community.

PARTICIPANTS

Subjects were 80 women (23 highly-dependent smokers (Fagerstrom Tolerance Questionnaire score > or = 7), 30 less-dependent smokers (FTQ < or = 6), 12 ex-smokers and 15 never-smokers).

MEASUREMENTS

Subjects were asked to rate pleasurable sensations and displeasurable sensations on a scale of 1 = none to 4 = intense, and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea and cough; social context was also queried. Pleasurable rush or buzz, relaxation, dizziness, nausea and cough were related to ratings of pleasurable and unpleasant sensations to establish their affective valence.

FINDINGS

Pleasurable sensations, pleasurable rush or buzz and relaxation (pleasant effects) were significantly more likely to occur in the smoker categories than in never-smokers. The ratio of pleasurable to unpleasant sensations, computed as an index of overall hedonic impact of initial exposure, also significantly favored the smoker categories. By contrast, unpleasant sensations, nausea and cough (unpleasant effects) did not differ significantly among groups. Dizziness, which did not definitely emerge as either pleasurable or unpleasant, was significantly more likely to be reported among the smoker groups than among never-smokers.

CONCLUSIONS

People who become highly dependent cigarette smokers appear to have more pleasurable sensations at their initial exposure to tobacco; unpleasant reactions to the first cigarette do not seem to protect against subsequent smoking.

Endogenous opioids and smoking: a review of progress and problems

The present report examines efforts to elucidate the role of opioid mechanisms in the reinforcement of smoking. A number of approaches have been used to evaluate nicotine-opioid interactions. Opiate agonists such as heroin or methadone have been found to increase cigarette smoking reliably in humans, and morphine has been shown to increase the potency and efficacy of nicotine in rats. There is also an extensive literature documenting the nicotine-stimulated release of endogenous opioids in various brain regions involved in the mediation of opiate reinforcement. Blockade studies using opioid antagonists have not been as conclusive. Although animal models have demonstrated commonalities between nicotine withdrawal and the opiate abstinence syndrome, including reversibility by morphine, and although the impact of nicotine on certain response systems such as respiratory reflexes has clearly been shown to involve opioid mediation, attempts to demonstrate opioid modulation for the key indicators of smoking reinforcement--cigarette consumption and nicotine self-administration--have been fraught with difficulty. Resolution of the apparent contradictions will require taking into account: (a) the biphasic properties of nicotine-opioid effects at higher doses and anti-opioid effects at lower doses; (b) the contributions of the opioid receptor populations--mu, kappa, sigma--stimulated at various dose levels; (c) the possibility that endogenous-opioid activity is entrained primarily during the acquisition or re-acquisition of nicotine self-administration; (d) the possibility that the endogenous opioid response does contribute to nicotine reinforcement but only as a delimited component of the neuroregulatory cascade of nicotine; and (e) the possibility that opioids contribute primarily to nicotine reinforcement under special conditions such as stress. Taking these considerations into account should allow studies on endogenous opioid effects to begin to do justice to the complexity of both smoking behavior and the actions of nicotine.

Self-reported alcohol use patterns in a sample of male and female heavy smokers

In an attempt to characterize differences among male and female smokers based on past and current alcohol use, we studied patterns of drinking, smoking, caffeine intake, and depression as a function of lifetime history of alcohol dependence and current drinking status in a community sample of current smokers. Subjects were 65 male and 152 female moderate-to-heavy smokers. The CAGE was used to screen for lifetime history of alcohol dependence; current drinking status was classified using self-reported number of alcoholic drinks/week. No significant differences were detected for smoking rate, scores on the Fagerstrom Test for Nicotine Dependence, or either coffee or total caffeine intake. Drinkers with a history of alcohol dependence drank significantly more per week than drinkers with no history, with significant gender differences and interaction effects emerging as well; the phenomenon was particularly pronounced in men. Drinkers of both genders with a history of alcohol dependence scored significantly higher on the Center for Epidemiological Studies-Depression scale, with means exceeding the cutoff of 16 associated with clinical depression. Since comorbidity of depression and alcohol dependence is known to exert a detrimental effect on ability to stop smoking, the number of individuals at risk for smoking cessation treatment failure may be much larger than might be inferred from data based on psychiatric assessments or collected in inpatient settings. Routine screening for depressive symptomatology combined with heavy alcohol use in primary care settings may therefore be helpful in identifying smokers in need of more intensive stop-smoking interventions.

Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population

Compared to attention deficit hyperactivity disorder (ADHD) in children, relatively little is known about the clinical characteristics of adults with persistent ADHD. We elected to use established tests with age-corrected norms to compare the battery of psychological and neuropsychological tests conducted on outpatients admitted to our Adult ADHD clinic. ADHD patients scored significantly higher than norms on the TPQ novelty seeking and harm avoidance scales and MMPI-2 scales F, 2, 4, 7, and 8. Further, these patients were impaired on the California verbal learning test, the attentional capacity test, and the omissions and variability subtests of the test of variables of attention. Adult ADHD had high comorbidity with current depressive disorder, antisocial personality disorder, and alcohol and drug abuse/dependence. High correlations were found between patients' and independent observers' reports of ADHD symptom severity. Implications for further research are discussed.

Personality differences related to smoking and adult attention deficit hyperactivity disorder

Tridimensional Personality Questionnaire (TPQ) scores are compared for three groups of adults: (a) current smokers with Attention Deficit Hyperactivity Disorder (ADHDSmk, n = 14); (b) current smokers without ADHD (NonADHDSmk, n = 21); and (c) ADHD never smokers (ADHDNevSmk, n = 17). The ADHASmk participants started smoking at a significantly younger age than NonADHDSmk participants. On the TPQ Novelty Seeking (NS) scale, all groups scored more than a standard deviation above the norm, and ADHDSmk participants scored significantly higher than NonADHDSmk participants. The earlier onset of smoking in ADHD adults suggests that smoking prevention efforts may be particularly important for ADHD children. Previous studies have reported that both smokers and ADHD patients have elevated NS scores; this study suggests an additive effect for smokers with ADHD. This exaggerated tendency towards thrill seeking in ADHDSmk participants may complicate smoking-cessation treatment in this population, because the health consequences of smoking may be of less concern to ADHD smokers.