Immediate antecedents of cigarette smoking in smokers with and without posttraumatic stress disorder: a preliminary study

Using ambulatory methods for 1 day of monitoring, the authors of this study investigated the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. Smoking was strongly related to craving, positive and negative affect, PTSD symptoms, restlessness, and several situational variables among PTSD smokers. For non-PTSD smokers, the only significant antecedent variables for smoking were craving, drinking coffee, being alone, not being with family, not working, and being around others who were smoking. These results are consistent with previous ambulatory findings regarding mood in smokers but also underscore that, in certain populations, mood and symptom variables may be significantly associated with ad lib smoking.     

Examining the relationships between posttraumatic stress disorder symptoms,positive smoking outcome expectancies,and cigarette smoking in people with substance use disorders: A multiple mediator model

Cigarette smoking is highly prevalent in people with substance use disorders (SUDs) and is associated with significant physical health problems. Posttraumatic stress disorder (PTSD) is also highly associated with both SUDs and cigarette smoking and may serve as a barrier to smoking cessation efforts. In addition, people with PTSD are more likely to hold positive smoking outcome expectancies (i.e., beliefs that smoking cigarettes results in positive outcomes); these beliefs may contribute to cigarette smoking in people with SUDs experiencing PTSD symptoms. The present study examined the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of 227 trauma-exposed current smokers with SUDs (59.9% male, 89.4% Caucasian) seeking detoxification treatment services. Additionally, the indirect effects of multiple types of positive smoking outcome expectancies on these relationships were examined. Participants completed questionnaires assessing PTSD symptoms, positive smoking outcome expectancies, cigarette consumption, and cigarette dependence symptoms. Results indicated that PTSD symptoms were not directly related to cigarette consumption or cigarette dependence symptoms. However, negative affect reduction outcome expectancies were shown to have a significant indirect effect between PTSD symptoms and cigarette consumption, while negative affect reduction, boredom reduction, and taste-sensorimotor manipulation outcome expectancies were all found to have significant indirect effects between PTSD symptoms and cigarette dependence symptoms. The indirect effect involving negative affect reduction outcome expectancies was statistically larger than that of taste sensorimotor manipulation outcome expectancies, while negative affect reduction and boredom reduction outcome expectancies were comparable in magnitude. These results suggest that expectancies that smoking can manage negative affective experiences are related to cigarette smoking in people with SUDs experiencing PTSD symptoms and suggest that effective smoking cessation treatments should take into account these expectancies.     

Gender differences in immediate antecedents of ad lib cigarette smoking in smokers with and without posttraumatic stress disorder: a preliminary report

Using ambulatory methods for monitoring, this study investigated gender differences regarding the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Smokers were instructed to complete a diary entry each time an ambulatory blood pressure monitor took a reading and each time they prepared to smoke. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. For all smokers, ad lib smoking was strongly related to craving. For women with PTSD, ad lib smoking was strongly related to total PTSD symptoms, PTSD reexperiencing symptoms, and PTSD hyperarousal symptoms. For men with PTSD, ad lib smoking was significantly related to negative affect, PTSD reexperiencing symptoms, restlessness, and worry. No other mood antecedents were significant for women or men smokers without PTSD. These results are consistent with previous studies documenting gender differences in smoking behavior, and underscore the importance of examining gender differences in psychiatric samples.     

An examination of differences in variables maintaining smoking behavior in adult smokers with and without attention-deficit/hyperactivity disorder

Individuals with attention-deficit/hyperactivity disorder (ADHD) smoke cigarettes at higher rates and have greater difficulty quitting than their non-diagnosed peers. This study examined differences between smokers with and without ADHD on a range of smoking-related variables. Twenty-two subjects with ADHD and 22 controls completed self-report measures of withdrawal symptoms, smoking motivation, sensory experience of smoking, and positive and negative affect. Compared to control smokers, smokers with ADHD reported greater craving and negative affect; perceived smoking as providing greater enhancement of concentration and alertness, as more calming, and as providing a greater decrease in irritability; found cigarette puffs to be more enjoyable and satisfying; and rated smoking as providing greater positive and negative reinforcement and greater cognitive enhancement. Women with ADHD reported the greatest effects of smoking on improving concentration and reducing irritability. Findings support the hypothesis that smokers with ADHD may experience smoking differently than smokers without the disorder, and that they may identify different motivations for smoking.     

Nicotine and Non-Nicotine Smoking Factors Differentially Modulate Craving,Withdrawal and Cerebral Blood Flow as Measured with Arterial Spin Labeling

Smoking cessation results in withdrawal symptoms such as craving and negative mood that may contribute to lapse and relapse. Little is known regarding whether these symptoms are associated with the nicotine or non-nicotine components of cigarette smoke. Using arterial spin labeling, we measured resting-state cerebral blood flow (CBF) in 29 adult smokers across four conditions: (1) nicotine patch+denicotinized cigarette smoking, (2) nicotine patch+abstinence from smoking, (3) placebo patch+denicotinized cigarette smoking, and (4) placebo patch+abstinence from smoking. We found that changes in self-reported craving positively correlated with changes in CBF from the denicotinized cigarette smoking conditions to the abstinent conditions. These correlations were found in several regions throughout the brain. Self-reported craving also increased from the nicotine to the placebo conditions, but had a minimal relationship with changes in CBF. The results of this study suggest that the non-nicotine components of cigarette smoke significantly impact withdrawal symptoms and associated brain areas, independently of the effects of nicotine. As such, the effects of non-nicotine factors are important to consider in the design and development of smoking cessation interventions and tobacco regulation.     

Exercise effects on withdrawal and mood among women attempting smoking cessation.

This study investigated both acute and longer term ("chronic") effects of vigorous exercise training on affect, nicotine withdrawal, and cigarette craving among women enrolled in a smoking cessation research study. All subjects participated in a 12-week cognitive behavioral smoking cessation program and were randomly assigned to attend three sessions per week of either a vigorous exercise program or contact control. Measures of positive and negative affect, cigarette craving, and nicotine withdrawal were administered immediately before, and again immediately after the final exercise or contact session each week of the program. Study I enrolled 24 women who had been assigned to the exercise condition. Significant reductions in negative affect, nicotine withdrawal and cigarette craving were observed following exercise most weeks of the program. No significant changes in positive affect were observed. In Study II this protocol was repeated among 62 women (44 exercise, 18 contact control) in two consecutive cohorts of the larger study. Significant reduction were observed in negative affect, nicotine withdrawal and cigarette craving during most weeks of the program among exercise subjects but not contact condition subjects. No chronic (baseline to posttreatment) changes in positive or negative affect, cigarette craving or withdrawal symptoms were observed in either study. Vigorous exercise appears to produce acute improvements in withdrawal symptoms, cigarette craving, and negative affect among sedentary women attempting to quit smoking.     

Effects of d-amphetamine and smoking abstinence on cue-induced cigarette craving

In this study, the authors investigated the effects of the indirect dopamine agonist d-amphetamine (AMPH) on cue-induced cigarette craving in smokers. Abstinent or nonabstinent cigarette smokers (N=21) rated their cravings for cigarettes and for food (control) after pretreatment with AMPH (15 mg) or placebo and before and after viewing blocks of smoking-related, food-related, and neutral pictures. Before the cues were presented, AMPH increased cigarette craving and decreased food craving. Smoking and food cues increased craving for cigarettes and for food, respectively. AMPH also further increased cigarette craving (and decreased food craving) after cue presentation, but it did so regardless of cue type (food or smoking). Smoking abstinence markedly increased craving regardless of cue presentation or drug condition. These results suggest that both AMPH and smoking abstinence can increase cigarette craving, but they do not appear to specifically affect responses to conditioned smoking-related cues.     

Smoking history, nicotine dependence, and changes in craving and mood during short-term smoking abstinence in alcohol dependent vs. control smokers

Objective

The goal of this study was to compare lifetime cigarette smoking, severity of nicotine dependence, and subjective effects of short-term tobacco abstinence in abstinent alcohol dependent (AD) and control smokers.

Method

AD (n = 119) and control (n = 55) ever-smokers were compared on tobacco use history and nicotine dependence. Negative affect and craving to smoke were examined in a subsample of currently smoking AD (N = 34) and control (N = 19) participants during a 6-h period of tobacco abstinence using the Profile of Mood States (POMS) and the Questionnaire on Smoking Urges-Brief (QSU-B).

Results

Although AD smokers did not differ from controls on heaviness of smoking, they were more likely to meet lifetime criteria for nicotine dependence. AD smokers also reported more withdrawal symptoms and were more likely to endorse withdrawal-related depressed mood during past smoking reduction or abstinence periods. During short-term abstinence, AD smokers were more likely to report high craving to smoke for negative affect relief within the first 150 min of tobacco abstinence, but did not differ from controls on overall craving to smoke or withdrawal-related negative affect on the POMS.

Conclusions

Results support previous findings that AD smokers have a greater prevalence of nicotine dependence and more severe nicotine withdrawal, with a greater propensity toward withdrawal-related depressed mood. These results, along with our novel finding that greater craving to smoke in abstaining smokers with AD is specific to negative affect-related craving, suggest that negative reinforcement may be a particularly salient factor in the maintenance of tobacco use among individuals with AD.     

Smoking a virtual cigarette increases craving among smokers

Previous studies have shown the efficacy of virtual reality (VR) environments that reproduce smoking-related stimuli for increasing self-reported craving and psychophysiological reactivity in smokers. However, no study to date has attempted to simulate smoking behavior itself by means of VR technology. The aim of this study was to assess the effect of smoking a virtual cigarette on self-reported craving levels and heart rate (HR) in a sample of smokers. Participants were 45 smokers randomly assigned to three VR conditions built into a virtual pub: smoking a virtual cigarette, throwing virtual darts at a virtual dartboard or just being in the virtual pub. Results showed that smoking a virtual cigarette significantly increased self-reported craving and HR when compared to the other two conditions. These results reveal that simulation of smoking behavior in a VR environment functions as an efficacious proximal cue that can be used for triggering craving under the cue-exposure paradigm.     

Cue-induced cigarette craving and mixed emotions: A role for positive affect in the craving process

Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.     

The effect of nicotine and trauma context on acoustic startle in smokers with and without posttraumatic stress disorder

Rationale  

Exaggerated startle response is a prominent feature of posttraumatic stress disorder (PTSD) although results examining differences in the acoustic startle response (ASR) between those with and without PTSD are mixed. One variable that may affect ASR among persons with PTSD is smoking. Individuals with PTSD are more likely to smoke and have greater difficulty quitting smoking. While smokers with PTSD report that smoking provides significant relief of negative affect and PTSD symptoms, the effects of smoking or nicotine deprivation on startle reactivity among smokers with PTSD are unknown.     

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

IntroductionKorean American emerging adult (KAEA) smokers represent a culturally and developmentally unique population constituted of primarily light, intermittent smokers. Sociocultural contexts might play an important role in contributing to instances of acute cigarette craving and motivation to smoke in this population; yet, research testing such hypotheses is scant. The current study tests whether and how social contexts are associated with the craving among KAEA smokers.MethodsSeventy-eight daily KAEA smokers, who smoke 4 + cigs/day, participated in a 7-day ecological momentary assessment (EMA), in which participants responded to both signal-contingent (random) and event-contingent (smoking) prompts to answer surveys on their mobile phones (prompt-level n = 1377; 603 random + 774 smoking prompts). Nicotine dependence was measured at baseline; cigarette craving, negative affect, presence of others smoking, social contexts were measured with EMA.ResultsModeling of within-participant variation and covariation showed that being with Korean friends (vs. alone) was associated with increased levels of momentary craving. This association between Korean friends and craving disappeared when adjusted for presence of others smoking, which was a strong predictor of momentary craving. The positive association between Korean friends and craving was amplified immediately prior to smoking (vs. non-smoking random) instances.ConclusionsBeing with Korean friends might serve as a culturally-specific salient smoking cue, which might have been learned throughout their smoking history. Our data also showed that increased craving associated with Korean friends may represent social settings that primarily involve cigarette smoking. Given our findings on cigarette use among KAEA's social network, addressing cigarette use as a group behavior might be a fruitful intervention strategy.     

Within-day temporal patterns of smoking, withdrawal symptoms, and craving

We examined the temporal relationships between smoking frequency and craving and withdrawal. 351 heavy smokers (≥15 cigarettes per day) used ecological momentary assessment and electronic diaries to track smoking, craving, negative affect, arousal, restlessness, and attention disturbance in real time over 16 days. The waking day was divided into 8 2-h "bins" during which cigarette counts and mean levels of craving and withdrawal were computed. Cross-sectional analyses showed no association between restlessness and smoking, and arousal and smoking, but craving (b=0.65, p<0.01) was positively associated, and negative affect (b=-0.20, p<0.01), and attention disturbance (b=-0.24, p<0.01) were inversely associated with smoking. In prospective lagged analyses, higher craving predicted more subsequent smoking and higher smoking predicted lower craving (p's<0.01). Higher restlessness also predicted more subsequent smoking and higher smoking predicted lower restlessness (p's<0.01). Higher negative affect did not predict later smoking, but more smoking preceded lower negative affect (p<0.01). Neither attention disturbance nor arousal predicted, or were predicted by variations in smoking. In short, smoking exhibits time-lagged, reciprocal relationships with craving and restlessness, and a one-way predictive relationship with negative affect. Temporal patterns of craving and restlessness may aid in the design of smoking cessation interventions.     

Cigarette smoking, ambulatory cardiovascular monitoring, and mood in Vietnam veterans with and without chronic posttraumatic stress disorder

This study investigated the association among cigarette smoking, posttraumatic stress disorder (PTSD), and ambulatory cardiovascular and mood monitoring in 117 male Vietnam combat veterans (61 with PTSD and 56 without PTSD). Positive smoking status was associated with higher systolic blood pressure (SBP) and heart rate (HR), as well as greater diastolic blood pressure (DBP) variability. Compared to individuals without PTSD, PTSD patients had higher HR, anger/hostility ratings, and depression/anxiety ratings. Significant diagnosis by smoking status interactions were found indicating that compared to nonsmokers with PTSD, smokers with PTSD had higher DBP, mean arterial pressure (MAP), and positive affect. Ad lib cigarette smoking during the previous 30 min did not have a significant effect on mood or cardiovascular parameters, except in non-PTSD smokers who reported lower depression/anxiety ratings after smoking. Findings suggest that the effect of smoking on cardiovascular parameters may be amplified in smokers in PTSD. Findings suggest that the interrelationships among cardiovascular parameters, cigarette smoking, and PTSD deserve more research attention.     

Smoking environment cues reduce ability to resist smoking as measured by a delay to smoking task

Introduction: Environments associated with smoking may promote lapse and relapse in smokers attempting to quit. Here we examined the effects of exposure to visual smoking environment cues on smoking urge and the ability to resist smoking, as measured with a delay-to-smoking task in which monetary contingencies are provided for resisting smoking. Methods: Adult daily smokers (n = 22) completed two experimental sessions, each following 6 h smoking abstinence. Sessions differed only in the type of cue participants were exposed to (smoking environments vs. nonsmoking environments). Participants completed subjective ratings of smoking urge, withdrawal and other reactions (i.e. craving, affect). Behavioral outcomes on the delay-to-smoking task included latency to first cigarette, number of cigarettes smoked and average number of puffs per cigarette. Results: Across cue exposure sessions, 64% of participants initiated smoking (no effect of condition was observed). However, exposure to smoking environments as compared to the nonsmoking environments resulted in greater craving, faster initiation of smoking, and more smoked cigarettes. Greater craving was associated with a shorter time to initiate smoking, but this effect did not differ across sessions. In contrast, withdrawal was more strongly associated with number of cigarettes smoked during smoking environment sessions. Conclusion: Together, these results suggest smoking environments increase smoking urge and promote smoking behavior. Further research is necessary to examine the specific and interactive effects of smoking-related environments on real-world smoking lapse and relapse.     

Comparative analysis of waterpipe and cigarette suppression of abstinence and craving symptoms

This study's objective is to examine the relative effectiveness of cigarettes and waterpipe (WP) in reducing tobacco abstinence symptoms in dual cigarette/WP smokers. Sixty-one dual cigarette/WP smokers participated (mean age±SD 22.0±2.6 year; mean cigarettes/day 22.4±10.1; mean WPs/week 5.2±5.6). After 12-hour abstinence participants completed two smoking sessions (WP or cigarette), while they responded to subjective measures of withdrawal, craving, and nicotine effects administered before smoking and 5, 15, 30 and 45 min thereafter. For both tobacco use methods, scores on measures of withdrawal and craving were high at the beginning of session (i.e., before smoking) and were reduced significantly and comparably during smoking. Analysis of smoking and recovery (post-smoking) phases showed similarity in the way both tobacco use methods suppressed withdrawal and craving, but the recovery of some of these symptoms can be faster with cigarette use. This study is the first to show the ability of WP to suppress abstinence effects comparably to cigarettes, and its potential to thwart cigarette cessation.