Anxiogenic and stress-inducing effects of peripherally administered acetaldehyde in mice: similarities with the disulfiram-ethanol reaction

Peripheral accumulation of acetaldehyde, the first metabolite of ethanol, produces autonomic responses in humans called “flushing”. The aversive characteristics of flushing observed in some populations with an isoform of aldehyde dehydrogenase (ALDH2) less active, are the basis for treating alcoholics with disulfiram, an ALDH inhibitor. Although ethanol and centrally formed acetaldehyde have anxiolytic effects, peripheral accumulation of acetaldehyde may be aversive in part because it is anxiogenic.

Objectives

We investigated the effect of direct administration of acetaldehyde on behavioral measures of anxiety and on hormonal markers of stress in mice. The impact of disulfiram on the anxiolytic actions of ethanol was evaluated. Acetate (a metabolite of acetaldehyde) was also studied.

Methods

CD1 male mice received acetaldehyde (0, 25, 50, 75 or 100 mg/kg) at different time intervals and were assessed in the elevated plus maze and in the dark-light box. Corticosterone release after acetaldehyde administration was also assessed. Additional experiments evaluated the impact of disulfiram on the anxiolytic effect of ethanol (0 or 1 mg/kg), and the effect of acetate on the plus maze.

Results

Direct administration of acetaldehyde (100 mg/kg) had an anxiogenic effect at 1, 11 or 26 min after IP administration. Acetaldehyde was ten times more potent than ethanol at inducing corticosterone release. Disulfiram did not affect behavior on its own, but blocked the anxiolytic effect of ethanol at doses of 30 and 60 mg/kg, and had an anxiogenic effect at the highest dose (90 mg/kg) when co-administered with ethanol. Acetate did not affect any of the anxiety parameters.

Conclusions

Peripheral administration or accumulation of acetaldehyde produces anxiogenic effects and induces endocrine stress responses. This effect is not mediated by its metabolite acetate.     

Using expired air carbon monoxide to determine smoking status during pregnancy: Preliminary identification of an appropriately sensitive and specific cut-point

Background

Measurement of carbon monoxide in expired air samples (ECO) is a non-invasive, cost-effective biochemical marker for smoking. Cut points of 6 ppm–10 ppm have been established, though appropriate cut-points for pregnant woman have been debated due to metabolic changes. This study assessed whether an ECO cut-point identifying at least 90% of pregnant smokers, and misidentifying fewer than 10% of non-smokers, could be established.

Methods

Pregnant women (N = 167) completed a validated self-report smoking assessment, a urine drug screen for cotinine (UDS), and provided an expired air sample twice during pregnancy.

Results

Half of women reported non-smoking status early (51%) and late (53%) in pregnancy, confirmed by UDS. Using a traditional 8 ppm + cut-point for the early pregnancy reading, only 1% of non-smokers were incorrectly identified as smokers, but only 56% of all smokers, and 67% who smoked 5 + cigarettes in the previous 24 h, were identified. However, at 4 ppm +, only 8% of non-smokers were misclassified as smokers, and 90% of all smokers and 96% who smoked 5 + cigarettes in the previous 24 h were identified. False positives were explained by heavy second hand smoke exposure and marijuana use. Results were similar for late pregnancy ECO, with ROC analysis revealing an area under the curve of .95 for early pregnancy, and .94 for late pregnancy readings.

Conclusions

A lower 4 ppm ECO cut-point may be necessary to identify pregnant smokers using expired air samples, and this cut-point appears valid throughout pregnancy. Work is ongoing to validate findings in larger samples, but it appears if an appropriate cut-point is used, ECO is a valid method for determining smoking status in pregnancy.     

The dynamic role of parental influences in preventing adolescent smoking initiation

Background

As adolescents grow, protective parental influences become less important and peer influences take precedence in adolescent's initiation of smoking. It is unknown how and when this occurs. We sought to: prospectively estimate incidence rates of smoking initiation from late childhood through mid-adolescence, identify important risk and protective parental influences on smoking initiation, and examine their dynamic nature in order to identify key ages.

Methods

Longitudinal data from the National Survey of Parents and Youth of 8 nationally representative age cohorts (9–16 years) of never smokers in the U.S. were used (N = 5705 dyads at baseline). Analysis involved a series of lagged logistic regression models using a cohort-sequential design.

Results

The mean sample cumulative incidence rates of tobacco use increased from 1.8% to 22.5% between the 9 and 16 years old age cohorts. Among risk factors, peer smoking was the most important across all ages; 11–15 year-olds who spent time with peers who smoked had 2 to 6.5 times higher odds of initiating smoking. Parent–youth connectedness significantly decreased the odds of smoking initiation by 14–37% in 11–14 year-olds; parental monitoring and punishment for smoking decreased the odds of smoking initiation risk by 36–59% in 10–15 year-olds, and by 15–28% in 12–14 year-olds, respectively.

Conclusions

Parental influences are important in protecting against smoking initiation across adolescence. At the same time, association with peers who smoke is a very strong risk factor. Our findings provide empirical evidence to suggest that in order to prevent youth from initiating smoking, parents should be actively involved in their adolescents' lives and guard them against association with peers who smoke.     

Binge drinking and marijuana use among menthol and non-menthol adolescent smokers: Findings from the Youth Smoking Survey

Introduction

Research has shown that smoking menthol cigarettes induces smoking initiation and hinders cessation efforts especially among youth. The objective of this paper is to examine the association between menthol cigarette smoking and substance use among adolescent students in Canada.

Methods

A nationally representative cross-sectional sample of 4466 Canadian students in grades 7 to 12 from the 2010–2011 Youth Smoking Survey is analyzed. A bivariate probit model is used jointly to examine the association of menthol smoking status with binge drinking and marijuana use.

Results

32% of the current smokers in grades 7 to 12 smoke mentholated cigarettes, 73% are binge drinkers and 79% use marijuana. Results of the bivariate probit regression analysis, controlling for other covariates, show statistically significant differences in the likelihood of binge drinking and marijuana use between menthol and non-menthol smokers. Menthol cigarette smokers are 6% (ME = 0.06, 95% CI = 0.03–0.09) more likely to binge drink and 7% (ME = 0.07, 95% CI = 0.05–0.10) more likely to use marijuana.

Conclusion

Smoking menthol cigarettes is associated with a higher likelihood of binge drinking and marijuana use among Canadian adolescents. Banning menthol in cigarettes may be beneficial to public health.     

Secondhand smoke avoidance by preteens living with smokers: To leave or stay?

Introduction

Secondhand smoke (SHS) is hazardous to children's health. Designing interventions to reduce exposure requires understanding children's behavior in the presence of smokers, yet little is known about this behavior.

Purpose

To determine whether children's avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model.

Method

Preteens aged 8–13 (N = 358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person's smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multiple Logistic Regression was used to determine predictors of SHS avoidance.

Results

Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking.

Discussion

Most SHS exposure reduction interventions have targeted changes in smokers' behavior. Reductions can also be achieved by changing exposed nonsmokers' behavior, such as avoiding the exposure. Future studies should measure young people's SHS avoidance and test interventions to increase their avoidance practices.     

Combined exposure to nicotine and ethanol in adolescent mice differentially affects anxiety levels during exposure, short-term, and long-term withdrawal.

Smoking and consumption of alcoholic beverages are frequently associated during adolescence. This association could be explained by the cumulative behavioral effects of nicotine and ethanol, particularly those related to anxiety levels. However, despite epidemiological findings, there have been few animal studies of the basic neurobiology of the combined exposure in the adolescent brain. In the present work we assessed, through the use of the elevated plus maze, the short- and long-term anxiety effects of nicotine (NIC) and/or ethanol (ETOH) exposure during adolescence (from the 30th to the 45th postnatal day) in four groups of male and female C57BL/6 mice: (1) Concomitant NIC (nicotine free-base solution (50 microg/ml) in 2% saccharin to drink) and ETOH (ethanol solution (25%, 2 g/kg) i.p. injected every other day) exposure; (2) NIC exposure; (3) ETOH exposure; (4) Vehicle. C57BL/6 mice were selected, in spite of the fact that they present slower ethanol metabolism, because they readily consume nicotine in the concentration used in the present study. During exposure (45th postnatal day: PN45), our results indicated that ethanol was anxiolytic in adolescent mice and that nicotine reverted this effect. Short-term drug withdrawal (PN50) elicited sex-dependent effects: exposure to nicotine and/or ethanol was anxiogenic only for females. Although neither nicotine nor ethanol effects persisted up to 1 month postexposure (PN75), the coadministration elicited an anxiogenic response. In spite of the fact that generalizations based on the results from a single strain of mice are prone to shortcomings, our results suggest that the deficient response to the anxiolytic effects of ethanol in adolescents co-exposed to nicotine may drive higher ethanol consumption. Additionally, increased anxiety during long-term smoking and drinking withdrawal may facilitate relapse to drug use.     

Effects of resistance exercise on the HPA axis response to psychological stress during short-term smoking abstinence in men

Purpose

The purpose of this study was to examine the effects of resistance exercise on the hypothalamic–pituitary–adrenal axis (HPA) response to mental challenge, withdrawal symptoms, urge to smoke, and cognitive stress during 24-hour smoking abstinence.

Methods

8 sedentary smokers (mean ± SD age: 20.1 ± 1.7 y; height: 171.6 ± 10.8 cm; body mass: 70.4 ± 12.0 kg; smoking history: 2.9 ± 0.8 y) completed a 24-hour ad libitum smoking trial (SMO) followed by two 24-hour smoking abstinence trials. During abstinence trials, participants performed six whole body resistance exercises (EX) or a control condition (CON) in the morning, followed by mental challenge tasks in the afternoon. Plasma adrenocorticotropin hormone (ACTH), and salivary and serum cortisol were measured during each visit at rest (REST), and then before (PRE-EX), immediately after (IP-EX), and 30 min after exercise (30-EX); and before (PRE-MC), immediately after (IP-MC), and 30 min after mental challenge (30-MC).

Results

Resistance exercise significantly (p ≤ 0.05) elevated plasma ACTH and serum cortisol at IP-EX during EX compared with SMO and CON trials. Resting ACTH, salivary and serum cortisol concentrations at Pre-MC did not differ between EX and CON trials. The HPA axis response to mental challenge was similar after EX and CON trials. Finally, resistance exercise did not reduce withdrawal symptoms, urge to smoke, or stress.

Conclusion

Resistance exercise did not substantially alter resting HPA hormones or the HPA response to mental challenge tasks during 24 h of smoking abstinence.     

Alcohol intake and its correlates in a transitional predominantly Muslim population in southeastern Europe

Objective

Our aim was to assess alcohol consumption and its correlates in Albania, a predominantly Muslim though largely secular Southeast European republic in transition from rigidly structured socialism to a market-oriented system.

Methods

A population-based sample of Tirana residents aged 35–74 years was interviewed and examined in 2003–2006 (450 men and 235 women with data on alcohol intake, 65.5% response). Multivariable-adjusted logistic regression was used to assess the association of drinking frequency, quantity and type of drink with socioeconomic, psychosocial and coronary risk characteristics.

Results

30.6% (95%CI = 26.3%–34.9%) of men, age-standardized to the 2005 census, and 5.6% (95%CI = 2.6%–8.6%) of women reported almost daily intake of alcohol, whereas 17.0% (95%CI = 13.4%–20.5%) of men and 46.6% (95%CI = 40.2%–53.1%) of women abstained. In men, frequent drinking was positively associated with age and not receiving financial support from close family emigrants, and was strongly inversely related to religious observance in both Muslims and Christians. In women it was associated with smoking and upward social mobility. Alcohol intake was not associated with religious affiliation in either sex. In men, intake of spirits (predominantly raki) and beer were associated with lower socioeconomic indices, smoking and obesity (beer only), whereas wine intake was associated with financial security, being secular, and not smoking. Among men, 11.3% (95%CI = 8.3%–14.3%) reported high intakes (≥ 210 g of pure alcohol/week) and 6.0% (95%CI = 3.8%–8.3%) very high intakes (≥ 420 g/week). High intakes were associated with frequent, rather than episodic, drinking.

Conclusions

Our study may be the first to provide information on alcohol intake and its characteristics in an Albanian population sample, one of the few predominantly Muslim countries in Europe. Alcohol consumption in women was extremely low. However, consistent very heavy intake of alcohol appears to be more frequent among Albanian men than in many former communist countries in Europe, and is cause for concern.     

Influence of reinforcer magnitude and nicotine amount on smoking's acute reinforcement enhancing effects

Background

Nicotine's acute effects on enhancing reinforcement from sensory rewards, shown in animal models, appear to occur with smoking in humans. These effects may vary due to reinforcer magnitude and amount of acute smoke intake (dose).

Methods

In a fully within-subjects design, dependent smokers (n = 23) participated in 3 sessions. Each session followed overnight abstinence and involved 4 trials to assess responding via progressive ratio (PR 50%) for sensory reinforcement from high, moderate, or low preference music, or no reward (counter-balanced, 30-s/reinforcer). Sessions differed in smoking prior to each trial: 8 puffs on arrival and 2 puffs/trial (“8 + 2″), 2 puffs/trial only (“0 + 2″), or no smoking. Puffs were consumed via CReSS (Clinical Research Support System) to control topography, and smoking involved own brand to ensure palatability and increase generalizability of results.

Results

Reinforced responding was influenced by main effects of smoking condition (p < .05) and music reward type (p < .001). Compared to no smoking, responding for music was increased after smoking 8 + 2/trial puffs (p < .005), but not after 0 + 2/trial puffs. Smoking condition significantly increased reinforced responding only for the high preference music (p = .01), and not for moderate or low preference music, or for no reward. Withdrawal did not differ between the two smoking sessions, ruling out withdrawal relief as an explanation for differential reinforcement enhancement.

Conclusions

Our findings confirm that just one cigarette after abstinence is sufficient for reinforcement enhancing effects and suggest that such enhancement is greater as magnitude of a reward's reinforcing efficacy increases.     

The association between smoking bans and nicotine dependence: A longitudinal analysis of current smokers in Canada

Background

While a substantial body of research has examined the effects of smoking bans on smoking behavior, little is known about the relationship between smoking bans and nicotine dependence. The objective of this study was to examine whether home and workplace smoking bans are associated with reduced nicotine dependence among continuing smokers.

Methods

We used longitudinal data of 1073 adult daily smokers from the Canadian National Population Health Survey (2004–2010). Generalized estimating equations were used to examine the association between smoking bans and nicotine dependence.

Results

Smokers living in homes where smoking is restricted were less likely to be nicotine dependent (OR = 0.40, 95% CI = 0.32–0.50) than smokers living in homes with no such smoking restriction. Workplace smoking policies had no significant association with nicotine dependence (complete ban: OR = 0.79, 95% CI = 0.56–1.11; partial ban: OR = 0.82, 95% CI = 0.57–1.16). There was some evidence that workplace smoking bans were significantly associated with nicotine dependence when single items of the Fagerstrom test were considered.

Conclusions

This paper demonstrates that the presence of a home smoking ban was associated with lower nicotine dependence among continuing smokers. The relationship of workplace bans with nicotine dependence was less clear and was contingent on the measure of nicotine dependence employed. These findings further confirm the importance of bans on smoking in the home, workplace, and other public places on reducing tobacco-related harms.     

Effectiveness of school-based smoking intervention in middle school students of Linzhi Tibetan and Guangzhou Han ethnicity in China

Purpose

The purpose of this paper is to assess the effectiveness of school-based intervention aimed to increase knowledge, to change attitudes and to reduce smoking-related behavior in both Linzhi Tibetan and Guangzhou Han middle school students in China.

Design

A concurrent intervention study was conducted in both Linzhi and Guangzhou. Two schools were randomly chosen and one was randomly assigned to the intervention group and the other to the control group in both settings.

Setting/participants

Participants were grade one and grade two middle school students drawn from two schools in Linzhi, Tibet Autonomous Region (southwest China) and two schools in Guangzhou, Guangdong Province (south China).

Intervention

The intervention program lasted for one year and covered three aspects: health policies in school, health environment in school and personal health skills.

Main outcome measures

Primary outcomes were smoking-related knowledge, attitudes and behavior (including ever smoking, daily smoking, weekly smoking and current smoking) and were measured by a self-administered questionnaire before and after the intervention.

Results

This intervention increased smoking-related knowledge in both Tibetan (β = 1.32, 95% CI (0.87–1.77)) and Han ethnic groups (β = 0.47, 95% CI (0.11–0.83)). It changed attitudes toward smoking in Tibetan (β = 1.47, 95% CI (0.06–2.87)) but not so in Han (β = − 0.33, 95% CI (− 1.68–1.01)). The intervention changed the prevalence of smoking in neither ethnic groups (P > 0.05).

Conclusions

The impact of school-based smoking intervention is different among Tibetan and Han students. This intervention was more effective for Tibetans when compared with the Han ethnic group. More research is needed on how intervention can be adapted to address ethnic and cultural differences.     

First cigarette on waking and time of day as predictors of puffing behaviour in UK adult smokers

Background

There is known inter- and intra-individual variation in how cigarettes are smoked. The aim of this study was to explore the influence of diurnal factors, particularly the first cigarette of the day, on puffing behaviour in a sample of adult smokers.

Methods

We recruited 130 adults aged 18–60 years who were smoking one of seven cigarette brands popular in the UK. Puffing behaviour was measured using a portable smoking device (CReSSmicro) through which participants smoked their cigarettes over a 24 h study period. The primary outcome was total smoke volume per cigarette (obtained by summing the puff volumes for each cigarette). Secondary outcome measures were puffing frequency, average puff volume, average puff flow, average puff duration and inter-puff interval.

Results

Total smoke volume was found to be significantly associated with the time the cigarette was smoked (P < 0.001), with cigarettes smoked between 2 and 10 a.m. being smoked less intensively than other cigarettes. After adjusting for time of cigarette, the first cigarette on waking was smoked slightly less intensively than other cigarettes and significantly so if smoked within 5 min of waking (P = 0.004).

Conclusions

This study suggests that cigarettes smoked during the night and early morning, including the first cigarette of the day, are puffed less intensively. This is a potentially important finding that merits more research given the importance of the first cigarette of the day and diurnal smoking patterns for determining dependence, cessation and relapse.     

Socialization to binge drinking: A population-based,longitudinal study with emphasis on parental influences

Background

Binge drinking is associated with considerable harm. However, too little is known about socialization to this pattern of alcohol consumption.

Aim

To identify longitudinal predictors of young adult binge drinking, with an emphasis on possible parental influences.

Methods

A population-based prospective study, in which respondents (N = 2558) were surveyed from mid-adolescence until their late 20 s. The data set was linked to national registers. Data were collected on parental alcohol consumption, parental binge drinking and parental alcohol problems, as well as on other aspects of the family milieu. The respondents’ frequency of alcohol consumption was assessed, as well as a number of binge drinking measures: (i) frequency of intoxication episodes, (ii) frequency of consuming 5+ units, and (iii) “usual” consumption patterns of 5–6+ units, 7–9+ units, and 10+ units.

Results

A surprisingly high proportion of the sample met the criteria for binge drinking. After control for parental, peer and individual characteristics, parental binge drinking predicted respondents’ binge drinking, using all definitions, at age 28 years (p < .001). Parental frequency of alcohol consumption predicted frequency of alcohol consumption in their offspring at age 28 (p < .001).

Conclusion

The findings suggest a socialization pattern of alcohol role modeling from parents to offspring. The findings are also consistent with genetic research showing alcohol use to have moderate heritability. We may witness new binge drinking cultures in Norway, but binge drinking patterns also seem to echo parental influences.     

Level of cigarette consumption and quit behavior in a population of low-intensity smokers—Longitudinal results from the International Tobacco Control (ITC) survey in Mexico

Background

Mexican smokers are more likely to be non-daily smokers and to consume fewer cigarettes per day than smokers in other countries. Little is known about their quit behaviors.

Aim

The aim of this study is to determine factors associated with having made a quit attempt and being successfully quit at 14-month follow-up in a population-based cohort of adult Mexicans who smoke at different levels of intensity.

Design

A longitudinal analysis of wave-III and wave-IV (2010) Mexican administration of International Tobacco Control Policy Evaluation Project was conducted.

Setting

This study was conducted in six large urban centers in Mexico

Participants

The participants of this study comprised 1206 adults who were current smokers at wave-III and who were followed to wave-IV.

Measurements

We compared three groups of smokers: non-daily smokers—who did not smoke every day in the past 30 days (n = 398), daily light smokers who smoked every day at a rate of ≤ 5 cigarettes per day (n = 368) and daily heavy smokers who smoked every day at a rate of > 5 cigarettes per day (n = 434). Data on smoking behavior, psychosocial characteristics and socio-demographics were collected at baseline and after 14 months.

Findings

In multivariate logistic regression predicting having made a quit attempt at follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj = 1.83, 95% CI: 1.19–2.83), less perceived addiction (ORadj = 1.86, 95% CI: 1.20–2.87), greater worry that cigarettes will damage health (ORadj = 2.04, 95% CI: 1.16–3.61) and having made a quit attempt in the past year at baseline (ORadj = 1.70, 95% CI: 1.23–2.36). In multivariate logistic regression predicting being successfully quit at one-year follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj = 2.54, 95% CI: 1.37–4.70) and less perceived addiction (not addicted: ORadj = 3.26, 95% CI: 1.73–6.14; not much: ORadj = 1.95, 95% CI: 1.05–3.62 versus very much).

Conclusions

Mexican adult smokers who are non-daily smokers were more likely than daily heavy smokers to have attempted to quit during follow-up and to succeed in their quit attempt. Future research should determine whether tobacco control policies and programs potentiate this tendency and which interventions are needed to help heavier smokers to quit.     

Risky drinking in the older population: A comparison of Florida to the rest of the US

Introduction

While alcohol use has traditionally been thought to decrease with age, several recent studies have shown an increase in heavy drinking among retirees. Florida's unique population distribution that includes a higher proportion of elderly residents warrants an in-depth look at the drinking patterns in the elderly and how they may differ from those in other areas of the country. However, state-level comparisons of excessive alcohol consumption are limited.

Methods

We compared risky drinking (defined as ten or more drinks/week in men and seven or more drinks/week in women; or five or more drinks at one sitting, one or more times/year for both men and women) in Florida to the rest of the US. We used pooled data from the 1997–2010 National Health Interview Survey (NHIS).

Results

The prevalence of risky drinking for those aged ≥ 65 in Florida and the rest of the US was 24.1%, and 21.8%, respectively, compared to 31.9% and 37.4% for all ages in Florida and the rest of the US, respectively. In multivariable analyses of those aged ≥ 65 years, risky drinking was significantly associated with male gender, younger age, non-Hispanic White race/ethnicity, more than a high school education, unemployment (including retirement), lower BMI, and current or former smoking. Floridians aged ≥ 65 were significantly more likely to report risky drinking than their counterparts in the rest of the US (Odds ratio = 1.13; 95% CI: 1.04–1.21), in contrast to analyses of all ages where Floridians were less likely to report risky drinking compared to the rest of the US (0.77; 0.67–0.86).

Discussion

Excessive alcohol consumption is an important modifiable risk factor for cancer, cardiovascular disease, and liver disease; a reduction among the elderly has great potential to reduce disease burden. Although Floridians overall were less likely to be risky drinkers than the rest of the US, almost a third of the Florida population reported this behavior. It is, therefore, an important public health concern, particularly in Florida's older population who are more likely to engage in this behavior than their counterparts in the rest of the US.     

Implicit alcohol cognitions in risky drinking nicotine users with and without co-morbid major depressive disorder

Objective

Alcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n = 83) and non-users (n = 63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD.

Method

Participants were assessed on lifetime MDD (n = 84) or no MDD (n = 62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and “approach” words.

Results

Regression analyses showed that implicit alcohol–approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol–approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD.

Conclusions

Implicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.     

Anxiety and depressive symptoms and affective patterns of tobacco withdrawal

Background

The complex concordance and discordance across and within anxiety and depressive symptoms complicates understanding of the relation between emotional symptoms and manifestations of tobacco withdrawal. The goal of this study was to parse the broad variation in anxiety and depressive symptoms into conceptually discrete components and explore their relative predictive influence on affective patterns of acute tobacco withdrawal.

Methods

We employed a within-participant experimentally manipulated tobacco abstinence design involving: (i) a baseline visit at which past-week depression and anxiety symptoms were assessed and (ii) two counterbalanced experimental visits—one after ad lib smoking and one after 16-h of tobacco abstinence—at which state affect was assessed. Participants were community-dwelling adults (N = 187) smoking 10+ cig/day for at least two years without an active mood disorder.

Results

Anxiety-related general distress symptoms (e.g., tension, nervousness) predicted greater abstinence-induced increases in various negative affective states but not changes in positive affect (βs .17–.33). Depression-related general distress symptoms (e.g., sadness, worthlessness) predicted greater abstinence-induced increases in acute depressed affect only (βs .24–.25). Anhedonic symptoms (e.g., diminished interest, lack of pleasure) predicted larger abstinence-induced decreases in acute positive affect only (βs .17–.20). Anxious Arousal symptoms (e.g., shakiness, heart racing) predicted larger abstinence-induced increases in fatigue and depressive affect (βs .15–.24).

Conclusion

Different components of anxiety and depressive symptoms are associated with unique affective patterns of acute tobacco withdrawal. These results provide insight into the affective mechanisms underlying tobacco dependence and could inform smoking cessation treatment approaches tailored to individuals with emotional distress.     

Posttraumatic stress disorder,smoking, and cortisol in a community sample of pregnant women

Background

The prevalence of posttraumatic stress disorder (PTSD) in the United States is higher among pregnant women than women generally. PTSD is related to adverse birth outcomes via physiological and behavioral alterations, such as smoking.

Methods

We utilize salivary cortisol measures to examine how traumatic stress, smoking and the hypothalamic–pituitary–adrenal axis interact. Pregnant women (n = 395) gave cortisol specimens as part of a cohort study of PTSD and pregnancy at three health systems in the Midwestern United States. Women were divided into three groups: nonsmokers, quitters (who stopped smoking during pregnancy), and pregnancy smokers. Mean cortisol values at three points, sociodemographics, trauma history, and PTSD were compared across groups. We assessed the association of smoking group and PTSD with late afternoon cortisol levels.

Results

Smokers, quitters, and nonsmokers differed on demographic risk factors and PTSD symptom load. Late afternoon and bedtime cortisol measures were significantly positively correlated with smoking in pregnancy, with smokers with PTSD presenting the highest cortisol levels. Regression analysis showed that smoking in pregnancy was associated with higher late afternoon cortisol in an additive manner with PTSD symptoms.

Conclusions

Smoking appears to have a different relationship with cortisol level for those with and without PTSD. This is the first study to show additive effects of smoking and PTSD on cortisol levels in pregnant women. Since high cortisol, smoking, and PTSD have been shown to adversely affect perinatal outcomes, and since those continuing to smoke in pregnancy had the highest PTSD symptom load, PTSD-specific smoking cessation programs in maternity settings are warranted.     

Self-perceived problem with alcohol use among opioid substitution treatment clients

Background and aim

Excessive alcohol use increases mortality and morbidity among opioid substitution therapy (OST) clients. Regular attendance for OST dosing presents key opportunities for screening and treatment. However, individuals' perception of their alcohol consumption as problematic or otherwise may impact their willingness to change. This study examines patterns of alcohol consumption among OST clients, perceptions of their own use and correlates of excess consumption.

Methods

Confidential, structured interviews were conducted with 264 clients of two Sydney OST clinics. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT); and illicit drug dependence with the Severity of Dependence Scale.

Results

Forty-one percent of the participants scored ≥ 8 on the AUDIT (‘AUDIT-positive’), indicating excessive alcohol use. The higher a participant's AUDIT score, the more likely they were to demonstrate insight into the potential problems associated with their drinking (linear trend, p < 0.01). However, only half of AUDIT-positive participants believed they drank too much and/or had a problem with alcohol. One-third had discussed their drinking with OST staff, and a similar proportion reported a history of alcohol treatment. AUDIT-positive participants were more likely than others to be classified as dependent on an illicit drug in the last six months (AOR = 1.76, 95% CI:1.00–3.09), report a history of alcohol treatment (AOR = 5.70, 95% CI:2.83–11.48) and believe it is safe to drink 4 + standard drinks in one session (AOR = 5.30, 95% CI:2.79–10.06).

Conclusions

OST clients with AUDIT scores ≥ 8 appear to underestimate the risks associated with their alcohol consumption. Regular assessments of alcohol use and targeted brief alcohol interventions may improve health outcomes among OST clients.     

Results from a pilot clinical trial of varenicline for the treatment of alcohol dependence

Background

Alcohol use, abuse and dependence remain a pressing public health problem. Based on its mechanism of action, varenicline seemed to be a likely candidate for treating alcohol dependence.

Methods

Alcohol dependent subjects (n = 40) were enrolled in a 13-week double-blind placebo controlled clinical trial. Subject visits were once per week. At each visit, subjects were tested for breath alcohol levels, provided self-report data on alcohol and nicotine use, and on mood and craving. In addition, subjects received once a week medical management (MM).

Results

There was no difference between varenicline and placebo treated groups on any of the drinking outcomes. Compared to placebo-treated subjects, varenicline treated subjects had decreased rates of alcohol craving and cigarette smoking, as well as greater mood improvements during the later part of the study (weeks 6–13). In addition, among subjects who were cigarette smokers, those treated with varenicline were significantly less likely to report heavy drinking during the trial.

Conclusions

Although varenicline was not significantly more effective than placebo at reducing drinking during the trial, its effects on alcohol craving and mood suggest that future investigation of the mechanism of action of varenicline, as well as additional clinical studies may be warranted. In particular, the findings regarding the influence of smoking status on heavy drinking among varenicline-treated subjects should be investigated in future studies.