Alcohol use as a signal for sensitivity to nicotine dependence among recent onset smokers

Objective

This study evaluated the association between alcohol use, abuse and dependence and cigarette smoking to determine whether alcohol may signal greater sensitivity to nicotine dependence at very low levels of smoking.

Method

Data were drawn from five annual National Surveys on Drug Use and Health and included individuals age 12 to 21 who reported first exposure to smoking within the past two years and smoking at least once in the past month.

Results

Both alcohol abuse and alcohol dependence were associated with increased likelihood of symptoms that seem to tap tolerance for nicotine. These included items such as “the amount you smoke has increased”; “needing to smoke a lot more now in order to be satisfied”; and “smoking much more before starting to feel anything”. Alcohol dependence, but not abuse was associated with the remaining symptoms, “after not smoking for a while, needing to smoke to feel less restless and irritable”; “craving cigarettes after not smoking for a while”; and “worrying about running out of cigarettes”. All associations were not better accounted for by either alcohol use or amount smoked.

Conclusion

If causally associated, treatment of alcohol-use disorders may prevent or reduce the early emergence of nicotine dependence symptoms among new smokers, very early in the smoking uptake process. If instead alcohol disorders are a signal of sensitivity for nicotine dependence best accounted for by a third variable, then adolescents with alcohol dependence and/or abuse during early exposures to smoking represents an important subgroup that may benefit from interventions directly targeting this association.     

The relationship between impulsivity,risk-taking propensity and nicotine dependence among older adolescent smokers

Impulsivity and risk-taking propensity are neurobehavioral traits that reliably distinguish between smoking and non-smoking adults. However, how these traits relate to smoking quantity and nicotine dependence among older adolescent smokers is unclear. The current study examined impulsivity and risk-taking propensity in relation to smoking behavior and nicotine dependence among current older adolescent smokers (age 16–20 years; N = 107). Participants completed the Barratt Impulsiveness Scale‐11 (BIS-11), the Balloon Analogue Risk Task (BART), and self-report measures of smoking behavior and nicotine dependence. Results indicated a significant positive relationship between nicotine dependence and the Attention subscale (β = .20, t = 2.07, p < .05) and the Non-planning subscale (β = .19, t = 1.92, p < .06) of the BIS-11. Contrary to expectation, the results also indicated a significant negative relationship between performance on the BART and nicotine dependence (β = − .19, t = − 2.18, p < .05), such that greater risk-taking propensity was associated with less dependence. These data suggest that impulsivity and risk-taking propensity are related to older adolescent smoking but are separable traits with distinguishable associations with nicotine dependence among adolescents. These findings support the notion that impulsivity is related to heightened nicotine dependence, but suggest that the relationship between risk-taking propensity and nicotine dependence is more ambiguous and warrants further investigation.     

Time-varying effects of smoking quantity and nicotine dependence on adolescent smoking regularity

Background

Little is known about time-varying effects of smoking quantity and nicotine dependence on the regularity of adolescent smoking behavior.

Methods

The sample was drawn from the Social and Emotional Contexts of Adolescent Smoking Patterns Study which followed adolescent smokers over 5 assessment waves spanning 48 months. Participants included former experimenters (smoked <100 cigarettes/lifetime but did not smoke in past 90 days), recent experimenters (smoked <100 cigarettes/lifetime and smoked in past 90 days), and current smokers (smoked >100 cigarettes/lifetime and smoked in past 30 days). Mixed-effects regression models were run to examine the time-varying effects of smoking quantity and nicotine dependence on regularity of smoking behavior, as measured by number of days smoked.

Results

Smoking quantity and nicotine dependence were each found to be significantly associated with regularity of adolescent smoking and the size of each effect exhibited significant variation over time. The effect of smoking quantity decreased across time for each smoking group, while the effect of nicotine dependence increased across time for former and recent experimenters. By the 48-month follow-up, the effects of smoking quantity and nicotine dependence had each stabilized across groups.

Conclusions

This study reveals that smoking quantity and nicotine dependence are not static risk factors for the development of more regular smoking patterns. At low levels of smoking when nicotine dependence symptoms are less common, smoking quantity is a stronger predictor of increased regularity of smoking, while for more experienced smokers, nicotine dependence predicts further increases in regularity.     

Smoking family, secondhand smoke exposure at home, and nicotine addiction among adolescent smokers

Introduction

Smoking family predicts adolescent smoking, but whether the level of nicotine addiction is affected by exposure to secondhand smoke (SHS) is unclear. We investigated the associations of smoking family and SHS exposure at home with morning smoking and heavier smoking among Chinese adolescent smokers.

Methods

In a school-based anonymous survey, 2182 adolescent smokers reported their smoking behaviors, smoking status of family members and peers, and SHS exposure at home and outside home in the past 7 days. Families with one or more smoking members (excluding the subject) were classified as smoking families and otherwise as non-smoking families. Smoking or wanting to smoke first thing in the morning (morning smoking), and consuming more cigarettes (heavier smoking) denoted higher levels of nicotine addiction. Regression analysis yielded adjusted odds ratios (AORs) for morning smoking and β-coefficients for heavier smoking adjusting for potential confounders.

Results

Living with siblings and other co-residing family members who smoked was significantly associated with morning smoking and heavier smoking. Compared with non-smoking families without SHS exposure at home, the AORs (95% CI) for morning smoking were 0.99 (0.76 to 1.29) for 0 day/week, 1.19 (0.95 to 1.50) for 1–3 days/week, 1.76 (1.41 to 2.21) for 4–7 days/week (p for trend < 0.001) and 1.50 (1.23 to 1.83) for any days/week of SHS exposure at home in smoking families. Similarly, 4–6 days/week of SHS exposure at home significantly predicted heavier smoking.

Conclusion

Living with smoking family members and SHS exposure at home are associated with nicotine addiction in Chinese adolescent smokers.     

Assessment of nicotine dependence among adolescent and young adult smokers: A comparison of measures

Introduction

Tobacco use often starts in adolescence, yet assessment of dependence among adolescent smokers remains a challenge, particularly given the potential discord between self-reports of smoking behavior and actual use. We could find no prior study, among adolescents, that directly compares the association between objective biomarkers of tobacco exposure (e.g., cotinine) and multiple measures of dependence. This study examined the concurrent validity of two common dependence measures: the Fagerström Test for Nicotine Dependence (FTND) and the Hooked on Nicotine Checklist (HONC). We further examined the FTND by removing the one item on cigarettes smoked per day.

Methods

Based within a parent clinical trial for adolescent smoking cessation, eligible participants were 12–21 years old, smoking ≥ 5 cigarettes per day on average, and with urine cotinine > 100 ng/ml at baseline. Results are based on participants who completed each measure and who provided a urine cotinine sample at baseline (N = 73).

Results

Results showed that the FTND was associated with cotinine (p < 0.001; R² = 0.25), and that this relationship held true for the revised FTND as well (p < 0.001; R² = 0.18). However, the HONC was only marginally associated with cotinine (p = 0.06; R² = 0.09).

Discussion

Our results suggest that the FTND may be better associated with actual smoking behavior in adolescents as compared to the HONC. Pending replication, our data provide caution with regard to assessment of nicotine dependence at least among established adolescent smokers who have more entrenched smoking behavior.     

Risk factors for adolescent smoking: parental smoking and the mediating role of nicotine dependence

Background

Parental smoking and early-emerging nicotine dependence symptoms are well-documented risk factors for adolescent smoking. However, very little is known about the mediating pathways through which these risk factors may act, or whether parental smoking may cause or signal early-emerging nicotine dependence symptoms.

Methods

Data were drawn from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study. Adolescents who had smoked under 100 cigarettes in their lifetime (n = 594; low-exposure group) and adolescents who had smoked over 100 cigarettes, but fewer than 5 cigarettes per day (n = 152) were included in the analyses. Path analysis was performed on longitudinal data to investigate the association between parental smoking and smoking frequency at the 48 months follow-up, both directly and through mediating variables of smoking frequency, smoking quantity, and nicotine dependence.

Results

Father's smoking was associated with higher adolescent nicotine dependence scores at the baseline assessment wave. Structural equation modeling revealed that mother's smoking at baseline was associated with adolescent's smoking frequency at the 48-month follow-up, and its effect was partially mediated by both smoking frequency and nicotine dependence among low-exposure adolescent smokers.

Conclusions

Parental smoking is a risk factor for future smoking in low-exposure adolescent smokers, above and beyond the risks posed by smoking behavior and nicotine dependence. Moreover, parental smoking is associated with early-onset nicotine dependence in low-exposure adolescent smokers. As an easily measureable risk factor, parent smoking status can be used to identify and intervene with novice adolescent smokers who are at high risk for chronic smoking behavior.     

Alcohol problems as a signal for sensitivity to nicotine dependence and future smoking

Background

Alcohol use is a well-documented risk factor for the emergence of chronic smoking behavior. Very little is known, however, about the mediating pathways through which alcohol and/or alcohol-related problems influence future smoking.

Methods

Data were drawn from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study (SECASPS). Adolescents who had smoked under 100 cigarettes in their lifetime (n = 898; experimenters) and adolescents who had smoked over 100 cigarettes, but fewer than 5 cigarettes per day (n = 152: current smokers) were examined separately (grouping variable). Path analysis was performed to investigate the association between alcohol related problems at baseline (primary predictor) and smoking regularity at the 48 month follow-up (primary outcome), both directly and through mediating variables of smoking quantity and frequency, and nicotine dependence (averaged across these measures at 6-, 15-, and 24-month assessment waves).

Results

Among experimenters, after controlling for smoking and alcohol use, the association between alcohol-related problems at baseline and smoking frequency 48 months later was fully mediated by nicotine dependence symptoms. Among current smokers, only past smoking behavior was associated with 48-month smoking frequency.

Conclusions

Alcohol-related problems are a risk factor for future smoking among novice adolescent smokers above and beyond drinking or smoking per se. By signaling sensitivity to nicotine dependence symptoms, alcohol related problems represent an easily measureable risk factor that can be used to identify and intervene with adolescents before more chronic smoking behaviors emerge.     

Adolescents' rationalizations to continue smoking: The role of disengagement beliefs and nicotine dependence in smoking cessation

Adult smokers were found to reduce cognitive dissonance regarding their smoking behaviour by adhering to rationalizations or justifications to continue smoking, also known as disengagement beliefs. These beliefs were found to be an important barrier with regard to smoking cessation practices. Neither the occurrence of disengagement beliefs, nor its effect on motivation to quit and actual smoking cessation have been studied among adolescent smokers. Therefore, this prospective study among a sample of 363 adolescents examined the extent to which adolescents adhere to disengagement beliefs, and the relations between disengagement beliefs and adolescents' motivation to quit smoking, motivation change and smoking cessation. The association and interplay between disengagement beliefs and level of nicotine dependence was also assessed. Results showed that the degree to which adolescent smokers adhere to disengagement beliefs was similar to that of adults, if not stronger. Higher levels of dependence coincided with stronger adherence to disengagement beliefs. Further, when controlling for nicotine dependence, disengagement beliefs were strongly negatively associated with motivation to quit, but only marginally inversely associated with smoking cessation one year later. Nicotine dependence was the strongest barrier for smoking cessation at follow-up.     

Refining the depression-nicotine dependence link: Patterns of depressive symptoms in psychiatric outpatients with current,past, and no history of nicotine dependence

The aim of this study was to elucidate the depression-nicotine dependence link by evaluating which specific depressive symptoms are uniquely associated with nicotine dependence in psychiatric outpatients. Participants were assessed using structured clinical interviews which yielded psychiatric diagnoses and clinical ratings on a wide variety of depressive symptoms. Depressive symptoms were compared across three groups: (1) patients with no history of nicotine dependence (NND; n = 1015); (2) patients with past nicotine dependence in full remission for at least 2 months (PND; n = 211); and (3) patients with current nicotine dependence (CND; n = 342). Participants with CND evidenced elevations on certain typical-vegetative, melancholic, and dysphoric depressive symptoms as compared to patients with NND and (to a lesser extent) patients with PND. Group differences were most consistent for depressed mood, anhedonia, appetite/weight loss, psychomotor disturbance, fatigue, and insomnia. Differences were least apparent for atypical symptoms. The symptomatic profiles of PND and NND patients were virtually indistinguishable. Certain vegetative, melancholic and dysphoric depressive symptoms are closely associated with nicotine dependence and could play an important etiological role in depression-nicotine dependence comorbidity.     

The influence of message framing, intention to quit smoking, and nicotine dependence on the persuasiveness of smoking cessation messages

This study explores the combined effect of message framing, intention to quit smoking, and nicotine dependence on the persuasiveness of smoking cessation messages. Pre- and post-message measures of quit intention, attitude toward smoking cessation, and perceived behavioral control were taken in two separate waves from current cigarette smokers with varying levels of nicotine dependence (N=151). In the second wave, participants were randomly assigned to one of two groups. In the first group, participants read a smoking cessation message which emphasized the benefits of quitting (positive frame). In the second group participants read a message which emphasized the costs of not quitting (negative frame). Results show that smokers' intentions to quit smoking and their level of nicotine dependence jointly influence the persuasiveness of positive and negative message frames. When nicotine dependence and quitting intention are both high, a negative frame works best. Conversely, a positive frame is preferable when nicotine dependence or quitting intention is low. Smokers' level of processing is proposed as the underlying mechanism explaining the different effects of message frames.     

Study of the relationship between anxiety sensitivity,smoking abstinence expectancies,nicotine withdrawal,and cigarette dependence among daily smokers

Introduction: Anxiety sensitivity (AS) is the fear of anxiety symptoms related to physical, cognitive, and social concerns. AS has been implicated in amplifying negative emotional states and maintaining smoking behavior. Aims: The current cross-sectional study evaluated the lower-order facets of AS (Physical, Cognitive, Social concerns) in relation to current nicotine withdrawal symptoms, short-term consequences of abstaining from smoking, and cigarette dependence. Methods: 331 adult Italian smokers were recruited from the general population and asked to fill in scales assessing AS, nicotine withdrawal symptoms, and cigarette dependence. Results: All ASI-3 subscales were associated with psychological symptoms of nicotine abstinence (β?=?0.30–0.10; p?≥?0.001), whereas ASI-3 physical concerns (β?=?0.62; p?≥?0.001) and ASI-3 cognitive concerns (β?=?0.25; p?≥?0.001) were associated with physical symptoms of nicotine abstinence. No ASI-3 subscales were associated with short-term smoking abstinence expectancies. ASI-3 physical concerns (β?=?0.72; p?≥?0.001) and ASI-3 cognitive concerns (β?=?0.25; p?≥?0.001) were associated with cigarette dependence. Discussion: ASI-3 physical concerns and ASI-3 cognitive concerns could amplify withdrawal-related factors, thereby increasing the negative reinforcement processes which might motivate smoking.     

The High-Ethanol Preferring rat as a model to study the shift between alcohol abuse and dependence

The High-Ethanol Preferring line of rats (HEP), recently selected by R.D. Myers, is characterised by a high voluntary consumption of alcohol (3-4 g/kg/day for males and 6-8 g/kg/day for females, when a 10% ethanol solution is available as a choice vs. water) and a high sensitivity to taste reinforcement (saccharin, quinine). Our previous data obtained with HEP rats showed no evidence of development of dependence after long-term sustained alcohol intake. In this study, we subjected these rats to several long-term administration protocols suggested to favour the development of alcohol dependence, including multiple alcohol concentrations or sweetened alcohol solutions (ethanol 10% or 20%+saccharin), and deprivation periods. The results showed no increase in alcohol consumption, no shift of preference for alcohol solutions when offered as a free choice vs. a preferred saccharin solution, and a very limited alcohol-deprivation effect when alcohol is made available after a period of deprivation, the three criteria used to demonstrate the development of dependence. Regardless of the method used, HEP rats failed to show dependence after long-term, heavy ethanol consumption. Resistance to ethanol dependence may in fact be genetically influenced and the HEP rat appears as a valuable model to search for factors involved in the transition from alcohol abuse to dependence.     

Should harm minimization as an approach to adolescent substance use be embraced by junior and senior high schools?: Empirical evidence from An integrated school- and community-based demonstration intervention addressing drug use among adolescents

The objective of this demonstration project was to determine if school-based harm minimization drug education was potentially acceptable and effective for junior and senior high school students in Nova Scotia. We conducted a four-year quasi-experimental intervention using mixed quantitative and qualitative methodologies. The intervention was a co-operative participatory research project with various activities determined by the participants. The project involved a partnership of four schools, two school boards, two regional addiction services, the provincial department of health, and a university. The outcomes evaluation was based on a sample of 1117 and 849 students in the intervention schools, compared with 3755 and 4247 students in the rest of the province, in 1998 and 2002, respectively. The evaluation of acceptability was based on an analysis of 491 documents generated from 1998 to 2002. The outcomes of effectiveness were specific risks and harmful consequences associated with substance use. We found that harm minimization was an acceptable approach to drug education targeting the senior high school population, and there was also some evidence of effectiveness in that age group in that the prevalence of several risks and negative consequences of substance use decreased significantly in the intervention schools relative to the rest of the province. In junior high school, harm minimization was found to not be an acceptable approach to drug education. This demonstration project provides evidence that school-based harm minimization may be acceptable and effective in senior high schools but may not be acceptable in junior high schools.