Passive smoking among adolescents in Estonia.

1. The objective of this study was to assess prevalence and patterns of passive smoking in Estonia and to describe how environmental tobacco smoke is likely to initiate the desire in adolescents to start active smoking. 2. A population sample of 2170 students within the age groups of 13-14, 15-16 and 17-18 of school grades 8, 10 and 12, respectively, at Tallinn High Schools participated in this study. The data were collected using questionnaires which mainly consisted of structured multiple-choice and a few open questions. 3. Every fourth adolescent in Tallinn was either an occasional or a habitual smoker. 4. Nearly half (48%) of the respondents had no daily exposure to cigarette smoke. Almost one third (31%) was exposed daily for less than 1 h, 15% for 1-5 h and 6% for over 5 h a day. 5. The number of adolescent smokers was higher than non-smokers among those daily inhaling tobacco sidestream smoke. 6. In conclusion, environment gives considerable impact to the development of smoking habits among adolescents. Passive smoking as an inducing factor is associated with higher prevalence of smoking among the adolescents studied.     

Effect of cigarettes on memory search and subjective ratings

The effects of smoking a nicotine versus a nonnicotine cigarette on performance on Sternberg's memory search task and subjective ratings were examined. Testing sessions were undertaken both before and after a period of 24 hours' abstinence in occasional and regular smokers. Memory search rate was significantly faster after the nicotine cigarette than the nonnicotine cigarette. No significant difference in search rate was found between the results from occasional and regular smokers, and between the effect of a cigarette before and after the period of abstinence. The regular smokers inhaled more smoke from the nicotine and nonnicotine cigarettes than did the occasional smokers, but the amount of smoke inhaled from the test cigarettes did not change significantly from pre- to postabstinence. The nicotine cigarette produced stronger dizziness, tremor and palpitations than the nonnicotine cigarette, the more so after abstinence than before in the regular smokers. The results indicate that smoking a cigarette can produce subjective effects and performance improvements in regular and occasional smokers during the course of normal smoking, and that some subjective effects can be greater after abstinence.     

The role of social networks and media receptivity in predicting age of smoking initiation: a proportional hazards model of risk and protective factors.

The increasing prevalence of adolescent smoking demonstrates the need to identify factors associated with early smoking initiation. Previous studies have shown that smoking by social network members and receptivity to pro-tobacco marketing are associated with smoking among adolescents. It is not clear, however, whether these variables also are associated with the age of smoking initiation. Using data from 10,030 California adolescents, this study identified significant correlates of age of smoking initiation using bivariate methods and a multivariate proportional hazards model. Age of smoking initiation was earlier among those adolescents whose friends, siblings, or parents were smokers, and among those adolescents who had a favorite tobacco advertisement, had received tobacco promotional items, or would be willing to use tobacco promotional items. Results suggest that the smoking behavior of social network members and pro-tobacco media influences are important determinants of age of smoking initiation. Because early smoking initiation is associated with higher levels of addiction in adulthood, tobacco control programs should attempt to counter these influences.     

The role of curiosity in smoking initiation

CONTEXT: Although advertising theories have long viewed curiosity as an intermediate goal to encouraging consumption of a product among previous nonusers, this variable is rarely discussed in psychological theories and its role in smoking uptake has not been addressed adequately. DESIGN AND SETTING: Using a longitudinal design, in 1999, we reinterviewed 12- to 15-year-old adolescent never smokers (N=2119; 970 committed never smokers, 1199 susceptible never smokers) 3 years after they responded to a population survey on tobacco use in California. RESULTS: Logistic regression showed curiosity and susceptibility to smoke were independently associated with increased future smoking in all never smokers. Committed never smokers reporting curiosity were more likely to become susceptible by follow-up than those not curious. A multivariate analysis of committed never smokers from the cross-sectional survey identified best friends who smoke and receptivity to tobacco advertising and promotions as associated with curiosity. CONCLUSIONS: Curiosity may be a critical precursor to smoking. Future research on smoking initiation should examine curiosity and investigate factors influencing it.     

Developmental trajectories of cigarette use from early adolescence into young adulthood.

This study identified developmental trajectories of cigarette smoking from early adolescence into young adulthood, and delineated whether risk factors derived from a social learning-problem behavior framework could differentiate among trajectories. Participants (N=374) were interviewed five times from age 12 until age 30/31. Using growth mixture modeling, three trajectory groups were identified--heavy/regular, occasional/maturing out, and non/experimental smokers. Being a female, having higher disinhibition, receiving lower grades, and more frequent use of alcohol or drugs significantly increased the probability of belonging to a smoking trajectory group compared with being a nonsmoker. Higher disinhibition and receiving lower grades also differentiated regular smokers from the rest of the sample. None of the risk factors distinguished occasional from regular smokers. When models were tested separately by sex, disinhibition, other drug use, and school grades were associated with smoking for both sexes. On the other hand, environmental factors, including socioeconomic status, parent smoking and friend smoking, were related to smoking for females but not for males. Sex differences in developmental trajectories and in smoking behavior among regular smokers were notable. Future research should examine transitions and turning points from adolescence to adulthood that may affect cessation and escalation differently for males and females.     

Gender-specific effects of prenatal and adolescent exposure to tobacco smoke on auditory and visual attention.

Prenatal exposure to active maternal tobacco smoking elevates risk of cognitive and auditory processing deficits, and of smoking in offspring. Recent preclinical work has demonstrated a sex-specific pattern of reduction in cortical cholinergic markers following prenatal, adolescent, or combined prenatal and adolescent exposure to nicotine, the primary psychoactive component of tobacco smoke. Given the importance of cortical cholinergic neurotransmission to attentional function, we examined auditory and visual selective and divided attention in 181 male and female adolescent smokers and nonsmokers with and without prenatal exposure to maternal smoking. Groups did not differ in age, educational attainment, symptoms of inattention, or years of parent education. A subset of 63 subjects also underwent functional magnetic resonance imaging while performing an auditory and visual selective and divided attention task. Among females, exposure to tobacco smoke during prenatal or adolescent development was associated with reductions in auditory and visual attention performance accuracy that were greatest in female smokers with prenatal exposure (combined exposure). Among males, combined exposure was associated with marked deficits in auditory attention, suggesting greater vulnerability of neurocircuitry supporting auditory attention to insult stemming from developmental exposure to tobacco smoke in males. Activation of brain regions that support auditory attention was greater in adolescents with prenatal or adolescent exposure to tobacco smoke relative to adolescents with neither prenatal nor adolescent exposure to tobacco smoke. These findings extend earlier preclinical work and suggest that, in humans, prenatal and adolescent exposure to nicotine exerts gender-specific deleterious effects on auditory and visual attention, with concomitant alterations in the efficiency of neurocircuitry supporting auditory attention.     

Olanzapine reduces urge to smoke and nicotine withdrawal symptoms in community smokers

Olanzapine (OLAN), an atypical antipsychotic medication with mixed 5-HT2/DA antagonist properties, was predicted to dose-dependently decrease urge to smoke, withdrawal, and cigarette reinforcement in smokers without psychosis. A double-blind placebo-controlled within-subjects cross-over trial investigated the acute effects of OLAN (0, 2.5, and 5.0 mg; counterbalanced order) in 24 community smokers who underwent 10-hr smoking deprivation. Urge to smoke, tobacco withdrawal, and cigarette reinforcement were assessed with cue reactivity and behavioral choice procedures. OLAN (2.5 mg) reduced withdrawal symptoms before and during cue exposure and decreased urge associated with anticipated positive affect from smoking before and during cue exposure; 5.0 mg OLAN decreased withdrawal only when cues were included. OLAN did not affect preference for cigarette puffs versus money, smoke intake, or urge to smoke associated with negative affect relief. The results indicate a potentially beneficial effect of 2.5 mg OLAN on tobacco withdrawal and urge to smoke. Combined 5HT/DA antagonists should be considered for future development of pharmacotherapies for smoking cessation.     

Tobacco outlet density and attitudes towards smoking among urban adolescent smokers

ABSTRACT

Background: This study investigates whether residential exposure to tobacco outlets (i.e., convenience stores and other stores selling tobacco) is associated with attitudes towards smoking among a sample of urban, primarily African American, adolescent smokers. Methods: Cross-sectional survey data for 197 adolescents were integrated with spatial data on tobacco outlets via subject home addresses. Ordinal regression was employed to test hypotheses that closer proximity to, and higher concentrations of, tobacco outlets are associated with higher measures of intention to continue to smoke in the future, weaker self-efficacy related to stopping smoking, and more accepting social norms related to smoking, while controlling for characteristics of age, gender, family and peer smoking contexts, and level of nicotine dependence. Moderation by age and gender was also investigated. Results: Higher residential tobacco outlet density is significantly associated with a greater intention to smoke in the next 3 months, a lower readiness to stop smoking, and a greater likelihood of accepting a cigarette from a friend. Residential proximity to a tobacco outlet is significantly associated with a greater intention to smoke 5 years on. Evidence of a relationship between exposure to tobacco outlets and social norms related to smoking was not found, nor was there evidence for moderation of these relationships by age or gender. Conclusions: These results suggest that among urban adolescents who currently smoke, higher residential exposure to tobacco outlets is associated with greater predisposition towards future smoking and lower self-evaluation of the ability to stop smoking.     

Short-term clinical exposure evaluation of a second-generation electrically heated cigarette smoking system

This randomized, controlled, forced-switching, open-label, parallel-group study in 100 adult male and female smokers of conventional cigarettes evaluated 8 biomarkers of tobacco smoke exposure. After baseline exposure determinations, adult smokers were switched to a second-generation electrically heated cigarette smoking system (EHCSS) for 8 days in a clinical setting. After 8 days of smoking the EHCSS biomarkers of exposure decreased by 43% to 85% compared to baseline. After correction for residual effects (carryover effects due to long elimination half-life and non-tobacco-confounding sources of exposure), reductions in exposure ranged from 59% to 97%. Results from this short-term clinical exposure study indicate that switching from a conventional cigarette to a second-generation electrically heated cigarette smoking system substantially reduced the exposure to several measured potentially harmful constituents of tobacco smoke.     

Short-term exposure evaluation of adult smokers switching from conventional to first-generation electrically heated cigarettes during controlled smoking

This randomized, controlled study in 110 male and female adult smokers evaluated biomarkers of tobacco smoke exposure (carbon monoxide [CO], carboxyhemoglobin [CO-Hb], nicotine, urine mutagenicity) under controlled smoking conditions when adult smokers of 1 conventional cigarette brand (CC1) were switched to an electrically heated cigarette smoking system (EHCSS) or a low-tar conventional cigarette (CC2). Baseline exposure was determined while all subjects smoked CC1. Subjects then were stratified for gender and cigarette consumption and randomized to 1 of 5 groups-EHCSS1, EHCSS2, CC1, CC2, or no smoking-and monitored for 8 days. Compared to baseline, biomarkers of exposure on day 8 decreased 53% to 93% (P < .0001) for EHCSS groups and 18% to 39% (P < .02) for CC2. Environmental tobacco smoke arising from the smoking activities of the different study groups was measured in the air of a separate smoking room over 1-hour periods. Concentrations of respirable suspended particulates in both EHCSS groups were about 90% lower than in the CC1 and CC2 groups, similar to the 95% reduction in the no-smoking group. CO was undetectable in the EHCSS and no-smoking groups. Results from this short-term clinical study indicate that switching from a conventional cigarette to a first-generation EHCSS reduces the generation of environmental tobacco smoke and can reduce the exposure to the measured, potentially harmful constituents in tobacco smoke if smokers do not compensate by numbers of cigarettes. The study design was found to be suitable for the evaluation of the exposure of adult smokers to the measured smoke constituents and to allow the differentiation of different cigarette designs.     

Progression of college-age cigarette samplers: what influences outcome

Experimental and occasional cigarette use among college students is widespread. Little is known about what differentiates the occasional college smoker who becomes a regular smoker from the one who does not. Possible risk factors include peer smoking, lifestyle factors, such as lack of exercise, and health/addiction concerns. The current study investigated the progression of smoking in a cohort of 321 low-level/occasional smokers. Over the course of 4 years, 45% of low-level/occasional users had become nonsmokers, 35% became occasional smokers, and 20% became daily smokers. Baseline exercise patterns, addiction beliefs, and smoking pervasiveness were modestly related to distal smoking outcome. The level of baseline smoking was strongly related to smoking outcome. These results support the wisdom of limiting access and exposure to cigarettes among the college population.     

Visuospatial memory deficits emerging during nicotine withdrawal in adolescents with prenatal exposure to active maternal smoking.

Active maternal smoking during pregnancy elevates the risk of cognitive deficits and tobacco smoking among offspring. Preclinical work has shown that combined prenatal and adolescent exposure to nicotine produces more pronounced hippocampal changes and greater deficits in cholinergic activity upon nicotine withdrawal than does prenatal or adolescent exposure to nicotine alone. Few prior studies have examined the potential modifying effects of gestational exposure to active maternal smoking on cognitive or brain functional response to tobacco smoking or nicotine withdrawal in adolescents. We examined visuospatial and verbal memory in 35 adolescent tobacco smokers with prenatal exposure to active maternal smoking and 26 adolescent tobacco smokers with no prenatal exposure to maternal smoking who were similar in age, educational attainment, general intelligence, and baseline plasma cotinine. Subjects were studied during ad libitum smoking and after 24 h of abstinence from smoking. A subset of subjects from each group also underwent functional magnetic resonance imaging while performing a visuospatial encoding and recognition task. Adolescent tobacco smokers with prenatal exposure experienced greater nicotine withdrawal-related deficits in immediate and delayed visuospatial memory relative to adolescent smokers with no prenatal exposure. Among adolescent smokers with prenatal exposure, nicotine withdrawal was associated with increased activation of left parahippocampal gyrus during early recognition testing of visuospatial stimuli and increased activation of bilateral hippocampus during delayed recognition testing of visuospatial stimuli. These findings extend prior preclinical work and suggest that, in human adolescent tobacco smokers, prenatal exposure to active maternal smoking is associated with alterations in medial temporal lobe function and concomitant deficits in visuospatial memory.     

Tobacco use and nicotine dependence among HIV-infected and uninfected injection drug users

IntroductionUrban U.S. populations are burdened by intersecting epidemics of HIV infection, injection drug use, and cigarette smoking. Given the substantial morbidity attributable to tobacco in these populations, we characterized smoking behaviors, nicotine addiction, and tobacco exposure among HIV-infected and HIV-uninfected injection drug users (IDUs) in Baltimore, Maryland.MethodsSmoking behaviors among participants in the ALIVE Study were assessed using interviewer-administered questionnaires. Smoking history and nicotine dependence (Fagerstrom Index scores) were compared by HIV and drug injecting status. Serum cotinine (a nicotine metabolite) was measured for a sample of participants by enzyme immunoassay.ResultsAmong 1052 participants (29.7% HIV-infected, 39.8% active injectors), 85.2% were current smokers and 9.3% were former smokers. Smoking prevalence, age at smoking initiation, and cumulative tobacco exposure were similar by HIV status. Median Fagerstrom scores of 4 for HIV-infected and HIV-uninfected smokers indicated moderate nicotine dependence. Daily cigarette consumption was identical by HIV status (median 10 cigarettes), although HIV-infected participants were less likely to smoke 1+ pack daily compared to HIV-uninfected participants (18.0% vs. 26.9%, p = 0.001). Compared to former injectors, active injectors had higher smoking prevalence (90.5% vs. 81.7%, p = 0.0001), greater daily cigarette consumption (30.7% vs. 19.6% smoked 1+ pack daily, p = 0.0001), and slightly higher Fagerstrom scores (median 5 vs. 4). Cotinine levels paralleled self-reported cigarette consumption.DiscussionTobacco use is extremely common among inner-city IDUs. Smoking behavior and nicotine dependence did not materially differ by HIV status but were associated with active drug injection. Cessation efforts should target the dual dependence of cigarettes and drugs experienced among this population.     

Characteristics of cigarette smokers seeking treatment for cessation versus reduction

Comparisons were made between cigarette smokers seeking treatment to quit smoking and cigarette smokers seeking treatment to reduce the number of cigarettes they smoke. Potential subjects were recruited from the local metropolitan area by advertisement in the local media. A total of 665 cigarette smokers telephoned our clinic to seek treatment for smoking cessation and 565 cigarette smokers telephoned to seek treatment to gradually reduce the number of cigarettes they smoke but not quit smoking. Potential subjects were instructed to call the clinic to find out additional information about the studies, and while on the telephone they were asked questions pertaining to tobacco use and health status. The results show that the two populations are similar in many respects with the following exceptions: smokers seeking treatment to reduce cigarette use tend to smoke more cigarettes per day, are less motivated to quit, make fewer quit attempts, drink more alcoholic beverages per day, and have more health problems (Ps<.05). These results indicate that cigarette smokers seeking treatment for smoking reduction but not cessation may be more dependent smokers who experience more medical disorders.     

Correlates of Blunt Smoking Among African American,Hispanic/Latino,and White Adults: Results From the 2014 National Survey on Drug Use and Health

Background: Blunt use is highly prevalent in the United States and has been associated with several negative health consequences, such as an increased risk for cardiovascular and pulmonary diseases. Although recent studies have identified characteristics (e.g., gender) that are associated with blunt use, it is unclear if these factors correlate with blunt use equally across racial/ethnic groups. Methods: Using cross-sectional data from the 2014 National Survey on Drug Use and Health, this study aimed to determine if demographic, health and substance use correlates of current (i.e., past 30-day) and lifetime blunt use were similar across 37,628 non-Hispanic African American, Hispanic/Latino and non-Hispanic White adults. Results: Findings revealed 8.3% of African American, 3.3% of Hispanic/Latino and 2.5% of White adults reported current blunt smoking. Across all racial/ethnic groups, age and current and lifetime cigarette and illicit drug use were associated with current and lifetime blunt use. However, gender, educational level, income, current alcohol use and self-reported health status were differentially associated with current and lifetime blunt use across racial/ethnic groups. Employment status and lifetime depression were not associated with blunt use behaviors among any of the racial/ethnic groups. Conclusions: The relationship between gender, socioeconomic status, alcohol use and self-reported health status and blunt use differs among African American, Hispanic/Latino and White adults. Researchers and providers should consider the heterogeneity in factors that are associated with blunt use when designing prevention and treatment interventions for African American, Hispanic/Latino and White adult blunt smokers.     

Relationship between cigarette smoking and other coronary risk factors in atherosclerosis: risk of cardiovascular disease and preventive measures

Among the major Coronary Risk Factors (CRF) cigarette smoking has shown undoubtedly harmful effects on the heart and blood vessels either as active smoking (smoking a cigarette) or passive smoking (exposure to environmental tobacco smoke -ETS). The strong relationship between cigarette smoking and cardiovascular disease has been seen independent of the other CRF in a number of well-designated epidemiologic studies. However, a strong increase in the excess of cardiovascular risk has been defined along with the interaction of cigarette smoking and other major CRF. Thousands of pharmacologically active substances are present in tobacco smoke, and a large number of direct and indirect effects have been demonstrated. Different responses are also related to these types of exposure: active exposure or passive exposure. The cardiovascular risk increases with increasing levels of blood pressure and/or serum cholesterol and diabetes mellitus, and at each level of these three risk factors, distributed with different rates according to age and gender in individuals, the risk in active smokers or passive smokers is greater than the risk in nonsmokers. Further analytical and methodological observations are needed for better understanding of the chemical and biological synergism. Nevertheless, evidence is clear that cigarette smoking greatly increases the risk of cardiovascular diseases in individuals already at increased risk because of other CRF. Preventive measures must be absolutely conducted to prevent the CRF interaction. These are the changes in lifestyle (i.e. to give up smoking and make physical activity), drug administration, diet supplementation especially by those substances with antioxidant effects.     

Cigarette Exposure,Dependence, and Craving Are Related to Insula Thickness in Young Adult Smokers

The age period spanning late adolescence to emergent adulthood is associated with the highest prevalence of cigarette smoking in the United States, and is also a time of continued brain development. Nonetheless, although prior research has shown group differences in brain structure associated with smoking status in adults, few studies have examined how smoking and associated behavioral states relate to brain structure in this age group. Neuroimaging and lesion studies have suggested that the insula, a cortical region that integrates heterogeneous signals about internal states and contributes to executive functions, plays an important role in cigarette smoking behavior. Using high-resolution structural magnetic resonance imaging, we therefore measured cortical thickness of the insula in 18 smokers and 24 nonsmokers between the ages of 16 and 21 years. There were no group differences in insula thickness, but cigarette exposure (pack-years) was negatively associated with thickness in right insula. Cigarette dependence and the urge to smoke were negatively related to cortical thickness in the right ventral anterior insula. Although the results do not demonstrate causation, they do suggest that there are effects of cigarette exposure on brain structure in young smokers, with a relatively short smoking history. It is possible that changes in the brain due to prolonged exposure or to the progression of dependence lead to more extensive structural changes, manifested in the reported group differences between adult smokers and nonsmokers. Structural integrity of the insula may have implications for predicting long-term cigarette smoking and problems with other substance abuse in this population.     

Menthol cigarettes and indicators of tobacco dependence among adolescents

OBJECTIVES: This study examines measures of nicotine dependence among adolescent menthol and non-menthol cigarette smokers in a nationally representative sample. METHODS: We examined rates of menthol smoking and measures of nicotine dependence among 1345 current established smokers in grades 9-12 who participated in the 2004 National Youth Tobacco Survey. Logistic regression was used to generate an adjusted odds ratio (OR) for menthol smoking for four measures of nicotine dependence, controlling for demographic characteristics and smoking patterns. RESULTS: Approximately 46% of all current established cigarette smokers were menthol smokers. Menthol smokers had 2.6 and 1.6 greater odds than non-menthol smokers for reporting that they could go for less than 1 h before feeling like they need a cigarette and that they experience cravings after not smoking for a while, respectively. CONCLUSIONS: Menthol cigarette smoking was associated with two dependence measures and may be more addictive than regular cigarettes in young smokers. Future research should continue to explore relationships between dependency and menthol use as well as the high prevalence of menthol use among adolescents.