Do cognitive attributions for smoking predict subsequent smoking development?

To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals' cognitive attributions for smoking were associated with subsequent smoking development and through which pathways.Middle and high school students in seven large cities in China (N = 12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008).Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (β = 0.11, p < 0.001) and autonomy (β = 0.08, p = 0.019) were associated with smoking initiation among baseline non-smokers. Coping (β = 0.07, p < 0.001) and social image (β = 0.10, p = <.0001) were associated with smoking progression among baseline lifetime smokers. Social image (β = 0.05, p = 0.043), engagement (β = 0.07, p = 0.003), and mental enhancement (β = 0.15, p < 0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%.This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.     

Does mother's smoking influence girls' smoking more than boys' smoking? A 20-year review of the literature using a sex- and gender-based analysis

A systematic literature review was conducted to examine whether mother's smoking influences girls' smoking more than boys' smoking. Fifty-seven studies, published between 1989 and 2009, were analyzed using a sex and gender lens. Results indicate that mother's prenatal and postnatal smoking influences girls' smoking more than boys' smoking. Despite evidence that sex and gender are important determinants of smoking among adolescents when examined in relation to mother's smoking, the theoretical understanding of why girls are more likely to smoke if prenatally and postnatally exposed to mother's smoking remains unclear. Implications for future research are discussed.     

Can home smoking restrictions influence adolescents' smoking behaviors if their parents and friends smoke?

Research suggests that the presence of a total ban on smoking in the home is associated with a reduced likelihood of tobacco experimentation among adolescents. While the influence of parental smoking on this association is examined in this work, no study has examined the influence of friends' smoking behavior. In this study, we use data from a statewide survey of students (n=4125) from the Australian State of Victoria to examine the association between home smoking bans and stage of smoking uptake after controlling for parental smoking and smoking among friends. Logistic regression revealed that students residing in homes with a total ban on smoking were least likely to be susceptible to smoking or to have experimented with smoking. While there was an interaction between parental smoking status and home bans on smoking uptake stage, indicating that the effect of home bans was strongest when neither parent smoked, there was no interaction between home bans and friends' smoking. The results suggest that home smoking bans reduce the likelihood of an adolescent trying tobacco regardless of their friends' smoking behavior. By adopting strong home smoking bans, parents can reduce some of the influence friends' smoking can have on the smoking behavior of their adolescent.     

Toward a more systematic assessment of smoking: development of a smoking module for PROMIS®

Introduction

The aim of the PROMIS® Smoking Initiative is to develop, evaluate, and standardize item banks to assess cigarette smoking behavior and biopsychosocial constructs associated with smoking for both daily and non-daily smokers.

Methods

We used qualitative methods to develop the item pool (following the PROMIS® approach: e.g., literature search, “binning and winnowing” of items, and focus groups and cognitive interviews to finalize wording and format), and quantitative methods (e.g., factor analysis) to develop the item banks.

Results

We considered a total of 1622 extant items, and 44 new items for inclusion in the smoking item banks. A final set of 277 items representing 11 conceptual domains was selected for field testing in a national sample of smokers. Using data from 3021 daily smokers in the field test, an iterative series of exploratory factor analyses and project team discussions resulted in six item banks: Positive Consequences of Smoking (40 items), Smoking Dependence/Craving (55 items), Health Consequences of Smoking (26 items), Psychosocial Consequences of Smoking (37 items), Coping Aspects of Smoking (30 items), and Social Factors of Smoking (23 items).

Conclusions

Inclusion of a smoking domain in the PROMIS® framework will standardize measurement of key smoking constructs using state-of-the-art psychometric methods, and make them widely accessible to health care providers, smoking researchers and the large community of researchers using PROMIS® who might not otherwise include an assessment of smoking in their design. Next steps include reducing the number of items in each domain, conducting confirmatory analyses, and duplicating the process for non-daily smokers.     

Young adult smoking: What factors differentiate ex-smokers,smoking cessation treatment seekers and nontreatment seekers?

The present study investigated demographic and psychosocial correlates of smoking status and predictors of smoking cessation among young adults, ages 18–30 years old. Young adults (n = 294) completed a self-report survey regarding their health habits and smokers were offered the opportunity to enroll in a smoking cessation program. Substitute reinforcers were greater among ex-smokers compared to nontreatment-seeking smokers, treatment-seeking smokers who did participate in a smoking cessation program and treatment-seeking smokers who did not subsequently participate in a smoking cessation program. Greater complementary reinforcers and delay discounting rates differentiated nontreatment-seeking smokers from ex-smokers and treatment-seeking smokers who subsequently attended a smoking cessation program. Nontreatment seekers were less likely to have higher depression symptoms than ex-smokers. Treatment seekers who did not attend a smoking cessation program tended to live in a household with another smoker, to not be college educated, and to be non-white. Young adult smokers who increased their substitute reinforcers across treatment were almost two times more likely to be quit at treatment end. These results highlight variables that may be important to consider in recruitment strategies and treatment components for smoking cessation interventions for young adult smokers.     

Is self-efficacy for smoking abstinence a cause of, or a reflection on, smoking behavior change?

Social learning theory considers self-efficacy as a causal factor in behavior change. However, in line with behavioral theory, recent clinical research suggests self-efficacy ratings may reflect, rather than cause, behavior change. To test these two disparate views, self-efficacy was related to actual smoking abstinence on the next day (i.e., self-efficacy causes change), and abstinence status over 1 day was tested as a predictor of rated self-efficacy for quitting the next day (i.e., reflects change). All data were from two similar crossover studies evaluating the short-term effects of both placebo versus medication, nicotine patch (n = 209) or varenicline (n = 123), on smoking abstinence during week-long practice quit attempts. Placebo and active medication periods were separated by an ad lib smoking washout, and analyses were controlled for prior-day's abstinence or self-efficacy values. Results were very consistent between studies in showing essentially bidirectional associations: daily self-efficacy predicted next-day's abstinence, and current-day's abstinence status predicted self-efficacy for abstinence the next day. However, secondary factors differentially predicted abstinence and, to a lesser extent, self-efficacy, between these two medication studies. These data provide some support for both social learning and behavioral theories of smoking behavior change, although self-efficacy may only briefly predict subsequent short periods of abstinence as assessed in these studies. Nonetheless, because self-efficacy has long been assumed to cause behavior change, including smoking cessation, the notion of self-efficacy as a reflection of recent smoking behavior change in these studies warrants greater attention in clinical research on smoking cessation treatment.     

Does cigarette smoking increase plasma urotensin II concentrations?

Objective Human urotensin II (UII) acts on the urotensin (UT) receptor and is the most potent mammalian vasoconstrictor identified to date. The role of UII in human cardiovascular regulation remains unclear, and the results of plasma measurements have been conflicting, perhaps because different measurement techniques have been used. The effects of cigarette smoking on plasma UII concentrations are unknown. The primary aim of our study was to demonstrate whether cigarette smoking had any effect on plasma UII concentrations in otherwise healthy volunteers. Our secondary aim was to compare the results obtained from assaying simultaneously using both radioimmunoassay (RIA) and immunoluminometric assay (ILMA). Methods Blood was taken from 20 healthy male non-smokers and 20 healthy male cigarette smokers. Plasma was separated and stored at −70°C. Samples were batch analysed simultaneously for UII using RIA and ILMA. Results Median (range) plasma UII concentrations were lower in non-smokers [1.67 (1.0–2.27) pg ml⁻¹] compared to smokers [2.62 (1.87–3.46) pg ml⁻¹] (P = 0.03) measured using RIA. Those who had smoked a cigarette in the 10 min before sampling had greater concentrations of UII [3.10 (1.87–4.60) pg ml⁻¹] compared to controls (P = 0.01). Plasma UII concentrations determined by ILMA were consistently low with no differences between groups. Conclusion The data obtained by RIA show that smoking may increase plasma concentrations of UII with a more pronounced increase when a cigarette has been smoked recently. There was a complete lack of correlation between RIA and ILMA for the whole data set, which suggests that some of the variability in plasma UII reported in the literature may result from differences between assays. Presented in part at the Anaesthetic Research Society meeting, Leicester, UK, 24 November 2005.     

Could vaping help lower smoking rates in Australia?

In this brief article, we review the evidence on whether easier access to vaping could help lower smoking rates in Australia. To make a convincing case for vaping the following conditions need to be met: that vaping assists in smoking cessation; that the prevalence of vaping is high enough to produce measurable effects at a population level; and that the decline in smoking prevalence is slower in countries where vaping is less common. The evidence suggests that these criteria are satisfied.     

Adolescent smoking and depression: Which comes first?

Despite the well-known health risks of smoking, adolescents continue to smoke at alarming rates. Smoking is also known to be associated with depression, but the direction of this relation is unclear. This study used data from the National Longitudinal Study of Adolescent Health (Add Health) to evaluate the direction of the relation between cigarette smoking and depression among adolescents. A total of 14,634 adolescents (7132 males and 7502 females) completed in-home surveys in 1995 and 1996 and were split into four smoking status groups. Adolescents who were Starters, Quitters, and Maintainers were found to be 1.5, 1.4, and 2.0 times more likely, respectively, than Nevers to be depressed at Time 2. In addition, females showed a striking pattern of increases in depression around the onset of smoking and decreases around the time of quitting. While these findings do not prove that smoking leads to depression, they are consistent with such a prediction.     

“Shotgunning” as an illicit drug smoking practice

There has been a rise in illicit drug smoking in the United States. “Shotgunning” drugs (or “doing a shotgun”) refers to the practice of inhaling smoke and then exhaling it into another individual's mouth, a practice with the potential for the efficient transmission of respiratory pathogens. Three hundred fifty-four drug users (239 from a syringe exchange and 115 from a drug detoxification program) were interviewed about shotgunning and screened for tuberculosis (TB). Fifty-nine (17%; 95% CI l2.9%–20.9%) reported shotgunning while smoking crack cocaine (68%), marijuana (41%), or heroin (2%). In multivariate analysis, age ≤35 years (OR 2.0, 95% CI 1.05-3.9), white race (OR 1.2, 95% CI 1.2–4.8), drinking alcohol to intoxication (OR 2.2, 95% CI 1.1–4.3), having engaged in high-risk sex (OR 2.6, 95% CI 1.04–6.7), and crack use (OR 6.0, 95% CI 3.0–12) were independently associated with shotgunning. Shotgunning is a frequent drug smoking practice with the potential to transmit respiratory pathogens, underscoring the need for education of drug users about the risks of specific drug use practices, and the ongoing need for TB control among active drug users.     

What smoking cessation approaches will young smokers use?

The purpose of this study was to examine the attitudes of youth smokers toward nine common smoking cessation approaches. Attitudes were examined among 3660 youth smokers who intended to quit smoking. The majority of youth smokers report that they would never use the smoking cessation approaches that are commonly recommended for youth populations. The approaches that were appealing to youth are quitting on their own and using the advice of friends. Future initiatives need to more effectively communicate to youth the benefits of existing cessation approaches, make existing interventions more appealing, or develop new approaches that address youth needs.     

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.     

Nicotine or tar titration in cigarette smoking behavior?

A significant problem in assessing the relative relevance of nicotine and tar yield for compensatory smoking after switching from high to low yield cigarettes is that nicotine and tar yield are highly intercorrelated across conventional cigarettes and that the tar/nicotine ratios vary only within a modest range. A better differentiation between the impacts of nicotine and tar yield was expected by comparing in a laboratory experiment a new low nicotine/medium tar cigarette (Next) with conventional low nicotine/low tar (ultra-light) cigarettes and with medium nicotine/medium tar cigarettes with respect to nicotine absorption and physiological effects. Twelve females, habitually smoking medium type cigarettes (0.7 mg nicotine) participated in the study. Neither the number of cigarettes smoked under field conditions nor the puffing behavior during the laboratory experiment differed between the three types of cigarettes. In the laboratory, Next produced only very small increases in plasma nicotine and changes in cardiovascular or EEG measures, whereas the effects of the medium cigarettes were in the expected range and those of the ultra-light cigarettes about halfway in between. The nicotine absorption/nicotine yield and the CO absorption/CO yield ratios were similar for Next and the habitual cigarettes, but about twofold higher for the ultra-light cigarettes. This suggests that gustatory and olfactory sensations, which are supposed to be more dependent on tar than on nicotine yield, may play a greater role for the regulation of smoking behavior than hitherto believed.     

Do tobacco countermarketing campaigns increase adolescent under-reporting of smoking?

This study assesses whether a national anti-tobacco campaign for youth could create a social context that would elevate social desirability response bias on surveys, as measured by an increase in under-reporting of smoking. This could give rise to data that falsely suggest a campaign-induced decline in youth smoking, or it could exaggerate campaign effects. Data were obtained from a national sample of 5511 students from 48 high schools that were matched to schools sampled for the 2002 National Youth Tobacco Survey (NYTS). Self-reported smoking was compared with biochemical indicators of smoking, measured using saliva cotinine. The rate of under-reporting detected was 1.3%. Level of truth exposure was not related to under-reporting. This study suggests that for high school students, anti-tobacco campaigns are not an important cause of social desirability responses on surveys, and that in general under-reporting smoking is not a major source of error in school-based surveys.     

Do indigenous helpers foster smoking cessation in adult smokers?

An intervention based on the Transtheoretical Model of behavior change (TTM) used an indigenous helper (a helping relationship) to promote smoking cessation. The research examined whether there was a difference in post-intervention smoking behavior between smokers who had an indigenous helper compared with those who did not among adult FreshStart participants. Smoking behavior was measured in two ways: forward movement along the TTM stages of change, and point prevalence. A two-group, two-time, five-week multi-site experimental design was used. Participants (N=111) completed instruments at baseline and four weeks. The findings did not support use of the TTM construct helping relationships for smoking cessation. The use of a helping relationship did not predict smoking cessation. Nicotine replacement therapy and/or bupropion predicted smoking behavior in all analyses.