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.     

Smoking clinic failures and recent life stress

To test the assumption that people with greater current life stress would more likely fail at quitting smoking in stop smoking clinics, 231 smokers who attended at least one session of an ongoing series of clinics were given a “Life Change Inventory” and had their smoking status assessed at the clinic's end. A high life stress score was a strong predictor for men (n = 88) of continuing smoking and dropping out of the clinics, but not for the women (n = 143). No difference in the numbers of life change items was reported between the sexes. Younger, lighter-smoking women did significantly better at stopping than older, heavier-smoking females, a relationship not found in the males. For this sample's males, life stress appears to be an important factor reducing motivation when undertaking changing another habit. It seems reasonable to counsel males under high life stress about their low chances of stopping smoking before subjecting themselves to a failure experience in a clinic.     

Effects of stopping smoking for 48 hours on oxygen availability from the blood: a study on pregnant women.

The effects of stopping smoking for 48 hours on factors governing the availability of oxygen from the blood--that is, carboxyhaemoglobin (COHb), haemoglobin-oxygen (HbO2) affinity, and haemoglobin concentration--were measured in women in the last trimester of pregnancy. Three groups were studied: smokers, smokers who stopped smoking for 48 hours, and non-smokers. The 22 smokers had higher initial COHb values and greater HbO2 affinity than the 10 non-smokers, but their total haemoglobin concentrations were also higher, so that their oxygen availability was not significantly reduced. In the 11 smokers who stopped the reduction in COHb and decrease in HbO2 affinity led to a significant increase of 8% in "available oxygen" in 48 hours. Since even small improvements in oxygen delivery to the tissues may confer critical benefit to the fetus, particularly during labour or when exposed to general anaesthesia, smoking should be discouraged for 48 hours before elective deliveries. The same consideration might reasonably be applied to patients undergoing general anaesthesia for all elective operations.     

Does living with smokers make quitting cigarettes more difficult?

To test the assumptions that living with smokers and having housemates with low interest in one's stopping smoking would make quitting cigarettes difficult, successful stoppers were compared with non-stoppers for housemates ' smoking and attitudes. Subjects were 147 people who attended several American Cancer Society Stop Smoking Clinics. Chances of stopping smoking were not enhanced by living either with non-smokers or with people believed to have high interest in one's stopping regardless of how close their relationship was. Giving up a smoking addiction seems to require inner motivation from the smoker, with external cues for smoking and support having minimal influence in a clinic stopping process.     

Who quits smoking in a behavioral treatment program?

Data from a smoking cessation program were analyzed to identify the variables that best predicted posttreatment abstinence. Nonsmoking immediately following treatment was predicted by lower daily pretreatment intake of nicotine and total particulate matter (TPM), as well as higher score on the "handling" scale of the "Why Do You Smoke" scale. Abstinence at any time in the 6 months following treatment was also predicted by lower pretreatment nicotine and TPM intake; other predictors were lower scores on the "craving" scale, greater number of weeks spent participating in the program, citing reasons for wanting to quit smoking other than to overcome an addiction, and lower self-rated craving for cigarettes. Abstinence was not predicted by subjects' adherence to the treatment rules calling for changing the times, occasions and feelings that are associated with the heaviest smoking. Daily cigarette consumption dropped during treatment at similar rates for the smokers who would eventually be abstinent and those who would not. These results replicate the finding that a behavioral self-control program can bring about a reduction in smoking in many smokers, though relatively few actually quit smoking. Also, smokers who find the manipulations involved in smoking to be rewarding are more likely to be abstinent, at least temporarily, following a behaviorally oriented program than are smokers who are most rewarded by the self-administration of nicotine. Smoking cessation programs might benefit by tailoring treatment to such pretreatment subject characteristics.     

Smokers' self-categorization and the reduction of cognitive dissonance

Sixty per cent of a sample of smokers who smoked between one and two packages of cigarettes per day considered themselves “moderate” smokers, while the remaining 40% considered themselves “heavy” smokers. This study compares the answers of these two groups of smokers to questions concerning the health risk of smoking. The results suggest that those respondents who assigned themselves to the lower-risk category, i.e., the “moderate”, were more aware of the pathological, long-term effects of smoking than the smokers who classified themselves as “heavy” smokers. The smokers' tendency to minimize the extent of their smoking, as well as the avoidance of words which have threatening association for the smoker were interpreted as a means for reducing cognitive dissonance.     

Smoking behavior and interest in quitting among homeless smokers

OBJECTIVES: To examine smoking behavior in homeless persons, including the impact of self-reported tobacco-related health problems and drug and alcohol abuse on readiness to quit and interest in smoking cessation counseling. METHODS: Cross-sectional survey of outpatients and inpatients on the homeless service at Massachusetts General Hospital. RESULTS: Among 98 homeless smokers with a mean age of 44 years, tobacco-related medical diagnoses and symptoms and psychiatric illnesses were common, as were drug and alcohol abuse. One third of the smokers in this sample intended to quit smoking within the next 6 months, including 19% who planned to quit in the next 1 month. Forty-four percent of the participants were somewhat or very interested in smoking cessation counseling. In multivariate analyses, significant (P < .05) predictors of readiness to quit smoking were greater confidence in one's ability to quit (self-efficacy) and more social support for quitting. Multivariate predictors of interest in smoking cessation counseling were smoking-related symptoms and higher self-efficacy for quitting. CONCLUSIONS: Homeless smokers recruited from the inpatient and outpatient services of a large, urban teaching hospital reported interest in both stopping tobacco use and receiving assistance to quit smoking. Having an illness that a smoker believes is tobacco-related, having greater confidence in the ability to quit, and having more social support for quitting were associated with greater readiness to quit and more interest in smoking cessation counseling. Alcohol and drug abuse were not associated with reduced interest in quitting smoking. These findings suggest that homeless smokers may benefit from smoking cessation programs that are colocated in medical or drug treatment settings.     

A method for studying controlled substance use: a preliminary investigation

This study examined relapse following treatment in a smoking reduction program. Twenty-two smokers with an average daily smoking rate of 25.7 cigarettes were provided a reduction-oriented smoking self-management program. Subjects were then classified on the basis of their reduction at posttreatment. A 50% or greater reduction from pretreatment qualified subjects as successful reducers. To provide further understanding of controlled smoking, subjects who successfully maintained at least a 50% reduction (at three month follow-up) were compared to those subjects who were unable to maintain that level of reduced smoking. A set of cognitive, smoking history, and reduction motivation variables were used to compare the two groups in a stepwise discriminant function analysis. Two variables, internal locus of control and self-label as a nonsmoker, produced an overall correct classification rate of 88.9%. Multiple regression analyses further demonstrated the importance of these two cognitive variables; self-label and internal locus of control accounted for 50.4% of the variance in smoking at three months follow-up. The implications of these findings for future study of controlled smoking are discussed.     

Nicotine dependence as a moderator of a quitline-based message framing intervention

High nicotine dependence is a reliable predictor of difficulty quitting smoking and remaining smoke-free. Evidence also suggests that the effectiveness of various smoking cessation treatments may vary by nicotine dependence level. Nicotine dependence, as assessed by Heaviness of Smoking Index baseline total scores, was evaluated as a potential moderator of a message-framing intervention provided through the New York State Smokers' Quitline (free telephone based service). Smokers were exposed to either gain-framed (n=810) or standard-care (n=1222) counseling and printed materials. Those smoking 10 or more cigarettes per day and medically eligible were also offered a free 2-week supply of nicotine patches, gum, or lozenge. Smokers were contacted for follow-up interviews at 3 months by an independent survey group. There was no interaction of nicotine dependence scores and message condition on the likelihood of achieving 7-day point prevalence smoking abstinence at the 3-month follow-up contact. Among continuing smokers at the 3-month follow-up, smokers who reported higher nicotine dependence scores were more likely to report smoking more cigarettes per day and this effect was greater in response to standard-care messages than gain-framed messages. Smokers with higher dependence scores who received standard-care messages also were less likely to report use of nicotine medications compared with less dependent smokers, while there was no difference in those who received gain-framed messages. These findings lend support to prior research demonstrating nicotine dependence heterogeneity in response to message framing interventions and suggest that gain-framed messages may result in less variable smoking outcomes than standard-care messages.     

Affective style among smokers: Understanding anxiety sensitivity, emotional reactivity, and distress tolerance using biological challenge

The present investigation evaluated affective style in terms of anxiety sensitivity, emotional reactivity, and distress tolerance in heavy smokers. Specifically, heavy smokers (> or = 20 cigarettes per day) were partitioned into those who were able to quit for at least 7 days (n = 10) and those who were able to quit for less than 7 days (n = 12). All participants completed measures of anxiety sensitivity and maximum breath-holding duration and then were exposed to a 20% carbon dioxide-enriched air challenge. Results indicated that heavy smokers who had not been able to remain abstinent from smoking for at least 1 week during a quit attempt demonstrated significantly greater cognitive-affective reactivity to the challenge relative to their counterparts but did not differ at a physiological level of analysis. Contrary to our hypotheses, neither anxiety sensitivity scores nor maximum breath-holding duration significantly differed between the groups. These findings are discussed in relation to better understanding affective style among heavy smokers.     

Individual differences in preferences for and responses to four nicotine replacement products

RATIONALE: With several different forms of nicotine replacement therapy available for smokers, it is useful to know about factors that may influence choice of form. OBJECTIVE: To examine factors associated with preference for different nicotine replacement products and effectiveness of these products. The simple comparison of success rates between the products has been reported previously. METHODS: Five hundred and four smokers were invited to rank order four products (gum, patch, nasal spray and inhaler) in terms of preference and were then randomly allocated to receive one of the products for a smoking cessation attempt. They were followed up 1 week, 4 weeks, 12 weeks and 15 weeks later. Ratings of the products were repeated 1 week after the quit date. Mood and physical symptoms were assessed at baseline and at each follow-up visit. Urges to smoke were assessed at all post-quit date sessions. Abstinence was assessed by self-report with expired air carbon monoxide verification. RESULTS: The patch was the most popular product initially, followed by the spray and inhaler and then the gum. The difference was greater for women than men. However, all smokers quickly came to like whichever product they had been allocated. Smokers who initially preferred the spray or inhaler were heavier smokers than those who preferred the gum or patch. Prior experience of the gum was associated with lower initial preference for it, but did not affect outcome. Prior experience with the patch had no effect on preference or outcome. Being allocated to the preferred product did not increase success at stopping smoking. Women were more successful at stopping smoking on the inhaler than the gum. Among highly dependent smokers, those on the inhaler had a lower relapse rate than those on the other products. CONCLUSIONS: Regardless of initial preferences, whether patients obtain their preferred form of NRT or one selected for them did not seem to affect outcome. This may be because smokers came to like particular products as they got used to them. Other things being equal, women may be better advised to use inhaler rather than gum and men vice versa.     

The Heaviness of Smoking Index as a predictor of smoking cessation in Canada

Nicotine addiction is believed to be a major impediment for many people in quitting smoking, but measures of nicotine dependence such as the Heaviness of Smoking Index (HSI) have had mixed success in predicting cessation. Using the National Population Health Survey, the relationship between HSI at baseline in cycle 2 (1996-1997) and successful smoking cessation at cycle 3 (1998-1999) and cycle 4 (2000-2001) was examined in 2938 Canadian adult smokers. A logistic regression model was developed for HSI as a predictor of smoking cessation, and then tested for interaction and confounding. The odds ratio of not smoking in cycle 3 was 2.08 (95% CI: 1.51, 2.86; p<0.001) for low HSI (<2) compared to medium HSI. When the period of follow-up was extended, individuals with both high (>4) HSI scores (OR 2.16; 95% CI: 1.11, 4.21; p=0.02) and low scores (OR 2.22; 95% CI: 1.41, 3.49) had higher odds of not smoking at both cycle 3 and cycle 4 than those with medium HSI scores. The likelihood of reporting cessation was higher than expected in the Canadian population among highly dependent smokers, particularly among older smokers, those with middle or greater income adequacy, and those with no intention to quit smoking. There were no substantial changes to the results when those lost-to-follow-up were treated as continuing smokers. These findings indicate that nicotine dependence is only one factor in succeeding at a quit attempt. Individual and population strategies for smoking cessation may need to consider other influences such as cognitive, affective and environmental factors.     

Effects of a brief pain and smoking cessation intervention in adults with chronic pain: A randomized controlled trial

Tobacco cigarette smokers with comorbid chronic pain experience greater difficulty quitting smoking relative to those without chronic pain. A brief smoking cessation intervention was developed to address smoking in the context of chronic pain to increase the intention to engage in smoking cessation treatment. The primary aim of this randomized controlled trial was to investigate the effects of a brief pain and smoking (BPS) cessation intervention on the willingness to consider quitting smoking in adults with chronic pain seeking treatment in a pain specialty outpatient clinic. Subjects randomized to the BPS intervention were 7.5 times more likely to endorse willingness to consider quitting smoking. Subjects who received the BPS intervention were also greater than 2.5 times more likely to report an interest in learning about cessation programs, and nearly 5 times more likely to endorse willingness to consider participating in an intensive smoking cessation program. Moreover, subjects who received the BPS intervention evinced a trend-level reduction in perceived difficulty of quitting smoking. These results contribute to a growing multidisciplinary literature examining pain-smoking interrelations and suggest that smokers with chronic pain may become more willing to consider engaging a cessation attempt as awareness increases about how continued smoking may interfere with the clinical outcomes of pain treatment. These results are also consistent with clinical practice guidelines for promoting intention to quit among smokers currently unwilling to engage a quit attempt by incorporating strategies aimed at identifying ambivalence about the continued use of tobacco.     

Alcohol abusers who want to quit smoking: implications for clinical treatment.

Although most alcohol abusers are dependent on nicotine, studies of such individuals have been scarce. Consequently, little information is available for advising clients who wish to consider resolving both problems. Clients entering an outpatient alcohol treatment program who were also current smokers were asked about their temporal preferences for changing their alcohol and cigarette use. Over three-quarters of alcohol abusers who were also smokers when asked said they would be willing to consider stopping smoking during or after treatment for an alcohol problem. Individuals who were interested in quitting smoking cigarettes while in treatment for an alcohol problem were different from those who did not want to stop smoking, and such differences may influence their ability to successfully address both problems together. Compared to those who preferred to change their drinking first then address their smoking, those who said they would be willing to address both problems (i.e. smoking and drinking) together in treatment were not only considerably more likely to think that quitting smoking would affect quitting drinking, but also more likely to be planning to quit smoking in the next six months. These results suggest that some individuals whose alcohol problems are not severe and who also smoke cigarettes will be more receptive to a dual recovery approach than others. In the absence of research findings, health care practitioners who encounter individuals who drink heavily and smoke cigarettes should at a minimum explore the option of dual cessation with their clients. The clinical and research implications of the present results are discussed.     

Urging the alcoholic client to quit smoking cigarettes

Cigarette smoking is highly correlated with alcohol abuse. Yet information regarding smoking cessation for alcoholics is largely absent. To begin addressing this gap, 311 alcohol treatment professionals staffing 23 inpatient facilities in Washington state reviewed a list of 8 different time points, including "never," at which an alcohol-involved adult could be urged to quit smoking cigarettes. Respondents first selected those time points at which they favored and then those at which they personally encouraged smoking cessation. One year after the onset of sobriety emerged as the preferred time point. Responses were analyzed according to the treatment staff's self-reported alcohol and smoking status. Staff who described themselves as alcoholics and smokers were significantly less likely than nonalcoholic-nonsmokers to urge smoking cessation efforts.     

Quitting cigarette smoking produces minimal loss of chronic tolerance to nicotine

RATIONALE: Long-term exposure to nicotine is associated with chronic tolerance to its acute effects, adaptation that may lead to tobacco dependence. The time course for loss of this tolerance after cessation of exposure is not known in humans but could relate to risk of smoking relapse. OBJECTIVES: We examined changes in responses to nicotine as a function of days, weeks, or years of smoking cessation in formerly dependent smokers to determine at what point sensitivity to nicotine is reinstated (i.e., loss of tolerance). METHODS: Acute subjective, cardiovascular, performance, and reinforcing (self-administration) effects of nicotine nasal spray (0-20 microg/kg) were assessed prospectively in men and women smokers before and then day-by-day (study 1) or 3 weeks (study 2) after stopping smoking. A smoking resumption period (study 1) and a group of non-quitting smokers (study 2) were included to control for the passage of time. These effects were also compared cross-sectionally between those who had quit for 1-4 years and those who had for 6-19 years in a separate sample of long-time ex-smokers to determine whether lengthier abstinence causes greater loss of tolerance (study 3). RESULTS: No clear loss of tolerance was observed on any measure in studies 1 or 2, suggesting that chronic tolerance is fully maintained for at least weeks after quitting smoking. Sensitivity to nicotine's effects was also not different as a function of years quit in study 3. CONCLUSIONS: Chronic tolerance to nicotine is not lost within several weeks of quitting smoking and may not change even after years of abstinence from tobacco use.     

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.     

Impulsivity in smoking, nonsmoking, and ex-smoking alcoholics

The impulsivity levels were evaluated and compared in smoking, nonsmoking, and ex-smoking abstinent alcoholics (N=400) in a French alcohol detoxification center. Impulsivity was measured using the Barratt Impulsiveness Scale, French version (BIS 10). The BIS scores correlated inversely with age. Gender had no effect on impulsivity scores, while impulsivity was associated with smoking. Adding age as a covariate, however, eliminated or moderated the association, with three exceptions: (1) among males, heavy smokers were more impulsive than nonsmokers and medium smokers; (2) on the nonplanning subscale, heavy smokers were more impulsive than all other groups, and (3) current smokers were more impulsive than ex-smokers. Elevated impulsivity levels appear to be an obstacle to smoking cessation. In addition, stopping smoking may diminish impulsivity levels in alcoholics. Routine testing of impulsivity in current alcoholic smokers might predict who might successfully become an ex-smoker.     

Weight change following smoking cessation: The role of food intake and exercise

While much of the interest in the relationship between weight change and smoking cessation has focused on weight gain, several studies have also reported weight loss or no change. To assess determinants of the direction of weight change, this study followed middle aged smokers from before to after their participation in various local smoking cessation programs. Measures included caloric consumption, available macro- and micronutrients in the diet, taste sensitivity and hedonics, smoking behavior, mood and exercise patterns. Smoking status was confirmed by determination of salivary cotinine levels. Subjects who successfully stopped smoking could be divided in those who gained weight and those who showed no change or lost. These subjects were compared to those who continued smoking and could be divided into the same weight categories. Subjects who gained weight after cessation did not consume more calories but ate somewhat less protein and significantly more carbohydrate than quitters whose weights did not change. Percentage of calories as sugar, in particular, was increased. Regardless of weight change, subjects who stopped smoking showed increased preference for sweet taste. Subjects who gained weight engaged in significantly less aerobic activity than those who did not.     

Psychosocial mediators of abstinence, relapse, and continued smoking: a one-year follow-up of a minimal intervention

This study investigates the relationship of health locus of control, health beliefs, social support, use of nonsmoking areas, and objecting to another person's smoking to long-term abstinence and relapse following a minimal intervention for smoking cessation. Subjects participated in a single session group hypnosis treatment for smoking cessation. Questionnaires were completed by participants pretreatment and at a 1-year follow-up. Ex-smoker, recidivist, and continuing smoker groups were defined using follow-up data from 219 participants (70 males and 149 females). The data were analyzed using univariate and multiple discriminant analysis techniques. The results show that the three smoking status groups could be discriminated. Ex-smokers actively coped with smokers in their environment, avoided other smokers in public places, and received considerable support from spouses and friends. In contrast, recidivists prior to treatment had been unable to quit smoking for extended periods of time and placed greater responsibility on powerful others for their health. Following treatment, recidivists did not actively cope with smokers, were more likely to participate in additional hypnosis, and placed less responsibility on either powerful others or themselves for their own health. It was concluded that posttreatment factors appear to be more important for long-term maintenance of nonsmoking than entry characteristics of participants. Recommendations include incorporation of coping skills training into cessation programs and restrictions on smoking in the ex-smokers' environments to prevent relapse.