Depressive symptoms affect changes in nicotine withdrawal and smoking urges throughout smoking cessation treatment: Preliminary results

Background: Individuals who report more depressive symptoms consistently demonstrate higher rates of nicotine dependence and less successful smoking cessation than do individuals who report fewer depressive symptoms. Nicotine withdrawal and smoking urges are two potential factors that may account for the differences observed between these two groups. This study assessed whether elevated depression symptoms among nicotine-dependent smokers are associated with changes in withdrawal and urges to smoke when undergoing smoking cessation treatment. Method: Data on 81 nicotine-dependent smokers were collected as part of a smoking cessation randomized trial that compared standard and contingency management (CM) treatment across one baseline week and four treatment weeks. Linear mixed model analyses were conducted with high and low depression scores predicting changes in withdrawal and urge ratings from a baseline week and four treatment weeks. Results: Participants with elevated depression symptoms reported more intense nicotine withdrawal and smoking urges throughout treatment. Further, participants with greater depressive symptoms exhibited an increase in smoking urges at the start of treatment, compared with a gradual decline in urges among participants with fewer depressive symptoms. Conclusions: Smokers with elevated depressive symptoms experience significantly elevated discomfort during smoking cessation efforts in the form of increased withdrawal and craving. This discomfort has the potential to make quitting smoking more difficult.     

High-dose transdermal nicotine and naltrexone: effects on nicotine withdrawal, urges, smoking, and effects of smoking

Although treatment with transdermal nicotine replacement (TNR) has improved smoking abstinence rates, higher doses of TNR could improve effects on urge to smoke, nicotine withdrawal, and reinforcement from smoking, and naltrexone might further reduce reinforcement and urges. A laboratory investigation with 134 smokers using a 3 x 2 parallel-group design evaluated the effects of TNR (42-mg, 21-mg, or 0-mg patch) as crossed with a single dose of naltrexone (50 mg) versus placebo on urge to smoke, withdrawal, and responses to an opportunity to smoke (intake, subjective effects) after 10 hr of deprivation. Urge and withdrawal were assessed both prior to and after cigarette cue exposure. Only 42 mg TNR, not 21 mg, prevented urge to smoke, heart rate change, and cue-elicited increase in withdrawal. Both 21 and 42 mg TNR blocked cue-elicited drop in heart rate and arterial pressure. Naltrexone reduced cue-elicited withdrawal symptoms but not urges to smoke or deprivation-induced withdrawal prior to cue exposure. Neither medication significantly affected carbon monoxide intake or subjective effects of smoking except that 42 mg TNR resulted in lower subjective physiological activation. No interaction effects were found, and no results differed by gender. Results suggest that starting smokers with 42 mg TNR may increase comfort during initial abstinence, but limited support is seen for naltrexone during smoking abstinence.     

Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT

IntroductionIn the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics.MethodsHomeless smokers (n = 430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group.ResultsAmong the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites.ConclusionsWhite participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.     

Assessment of smoking urge and its concomitants under an environmental smoking cue manipulation

The construct validity of smoking urge was examined through investigation of the effects of an environmental smoking cue manipulation on subjective smoking urge ratings and on the physiological, behavioral and cognitive responses hypothesized to relate to smoking urges. Forty-eight moderate cigarette smokers served as participants. All participants underwent an exposure to smoking cues condition and a nonexposure condition. Order of conditions was counterbalanced across participants. Results indicated that measures of physiological response, cognitions, and behavior vary with urge to smoke. Higher physiological indices and closer association between specific cognitive measures and smoking urges occurred under the cue exposure manipulation. Results were interpreted as preliminary data supporting the construct validity of smoking urge.     

Acute effects of self-paced walking on urges to smoke during temporary smoking abstinence

Rationale Recent research highlights the need to extend our understanding of how exercise may aid smoking cessation, through exploration of different modes, intensity and duration of exercise. Objectives The purpose of the study was to examine the effects of a 1-mile self-paced walk on different measures of urges to smoke following temporary smoking abstinence. Methods In a within-subject counterbalanced design, following 15 h of smoking abstinence, participants (N=15) exercised or sat passively on separate days. A single-item measure of strength of desire to smoke (West and Russell in Psychopharmacology 87:407–415, 1985) was administered during, immediately post, and at 10 and 20 min post-treatment. The two-factor Questionnaire for Smoking Urges (QSU; Tiffany and Drobes in Br J Addict 86:467–1476, 1991), involving intention and desire to engage in smoking behaviour which is anticipated as pleasant, enjoyable and satisfying (desire–behave), and anticipation of relief from negative affect through smoking (desire–affect relief), was administered before and 20 min post-treatment. Results A two-way repeated-measures MANOVA revealed a significant overall interaction effect for time by condition for strength of desire to smoke, and the two QSU scales. Two-way repeated-measures univariate ANOVAs revealed significant interaction effects for time by condition for each of the three urges to smoke measures. Planned contrasts revealed that exercise reduced cigarette cravings for up to 20 min after exercise, in comparison with the control condition. ANCOVAs revealed mixed support for independent effects of exercise on all measures of urges to smoke. Conclusion A self-paced walk, at a low intensity, lasting 15–20 min can have a rapid and measurable positive effect on both single and multi-item measures of urges to smoke, lasting at least 20 min, during temporary smoking abstinence.     

Analogue assessment, affective arousal, and the smoking taste test.

The relation between conditions of affective arousal and smoking was evaluated by the utilization of the taste test as the dependent measure for smoking behavior. Experimentally manipulated levels of arousal did not significantly influence smoking intensity or topography; however, the results are qualified by data which casts doubt on the validity of the taste test. There were no significant correlations between performance on the taste test and smoking in the natural environment. The implications regarding the validity of assessment analogue procedures are presented.     

Effects of cigarette nicotine content and smoking pace on subsequent craving and smoking

Abstract Rationale. The relative contribution of sensory and pharmacological variables in regulating craving and smoking remains unclear. Rapid smoking procedures and denicotinized cigarettes can be used to further disentangle these factors, and to explore the relationship between craving and smoking. Objective. The present study examined the role of nicotine and sensory cues in mediating craving and smoking, and the relationship between craving and smoking. Methods. Participants (n=15) engaged in one session each of rapid smoking (up to nine cigarettes with puffs taken every 6 s) and normal paced smoking with nicotinized and denicotinized cigarettes (total of four sessions). During the next 3 h, craving and withdrawal assessments and smoking opportunities were scheduled every 15 min. Plasma nicotine levels were measured at baseline, immediately and 15 min after the smoking interventions, and subsequently at the time when the participant first chose to smoke. Results. Craving ratings were equally suppressed immediately after all conditions. After self-paced conditions, both types of cigarettes produced equivalent effects on latency to smoke. Latency to smoke was significantly longer after rapid smoking of nicotinized cigarettes compared to all other conditions. Finally, changes in craving were associated with choices to smoke. Conclusions. The sensory cues associated with smoking suppressed craving ratings regardless of the smoking pace or nicotine content. Only at high doses did nicotine levels play an additional role in acutely suppressing smoking behavior. Small elevations in craving ratings were associated with choices to smoke. Electronic Publication     

Effects of 21 days of varenicline versus placebo on smoking behaviors and urges among non-treatment seeking smokers

Varenicline promotes smoking cessation and reduces urges to smoke. However, the mechanisms associated with these effects and their time course are not well characterized. One mechanism may be extinction, but the duration of the current dosing protocol may not be sufficient. We examined the effect of extended pre-treatment with varenicline on smoking behavior among 17 non-treatment seeking adult smokers. Using a within-subjects, double-blind, placebo-controlled crossover design, participants received standard dosing of varenicline for 21 days, followed by a 14-day washout period and 21 days of placebo; order counterbalanced. Cigarettes per day (CPD), smoking topography, smoking urges (QSU), and side effects were assessed every three days. Biomarkers (e.g. nicotine metabolites) were collected on days 1, 7, and 21. There was a significant drug by time interaction indicating a reduction in CPD during varenicline phase (between days 10-21), but no reduction during placebo. Varenicline also led to reductions in nicotine metabolites and urges to smoke. Among this sample of non-treatment seeking smokers, varenicline significantly reduced smoking behavior. Results have important treatment implications because changes in CPD and craving did not occur until after the typical one-week run-up period. This suggests that a longer duration of pre-treatment may be beneficial for some smokers.     

A comparison of daily and occasional smokers' implicit affective responses to smoking cues

Previous research has not compared implicit affective responses to smoking-related stimuli in occasional (i.e., those who smoke less than one cigarette per day) and daily smokers (i.e., those who smoke at least once per day). In addition to assessing their motivations for smoking, implicit affective responses were measured using the Affect Misattribution Procedure (AMP) in occasional (n = 19) and daily smokers (n = 34) to smoking-related and neutral cues. Half of the cues depicted a human interacting with an object (i.e., active), whereas the remaining cues depicted objects alone (i.e., inactive). Results indicated that for the active cues, daily smokers responded more positively to smoking-related than to neutral cues, whereas occasional smokers showed no difference in their implicit responses. In addition to smoking frequency, relative differences in implicit responses to active cues were related to cognitive enhancement motivation. For inactive cues, implicit responses were related to cognitive enhancement as well as reinforcement. Because daily smokers have more positive implicit responses to active smoking-related cues than occasional smokers, these cues may play an important role in maintaining smoking behavior in daily smokers.     

Tetrahydrocannabinol content and differences in marijuana smoking behavior

Changes in smoking behavior in response to a change in marijuana potency were measured in marijuana users. A marijuana cigarette containing 1.2% or 3.9% tetrahydrocannabinol (THC) was smoked on separate days by ten experienced users. Puff volume, duration and number, interpuff interval, inhalation volume and duration were averaged for each cigarette. The high potency cigarettes were smoked with more puffs and longer interpuff intervals, but also with greater inhaled volumes of air, thereby diluting the marijuana smoke.     

Higher smoking prevalence among United States adults with co-occurring affective and drug use diagnoses

IntroductionIndividuals with drug use disorders or affective disorders have higher cigarette smoking prevalence and smoking intensity and are less likely to quit than the general population. We sought to estimate the prevalence of cigarette smoking by drug use and psychiatric diagnoses and to explore to what extent a co-occurring diagnosis was associated with current smoking.MethodsData were derived from the most recent National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012–2013; n = 36,309). Cigarette smoking status was examined among those with any past-year or lifetime drug use disorders (i.e., alcohol, cannabis, opioid, cocaine) or affective disorders (i.e., mood, anxiety). Diagnoses were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-5).ResultsAdjusting for sociodemographic characteristics, those with drug use disorders (past-year AOR = 3.3, 95% CI: 3.0, 3.6; lifetime AOR = 3.2, 95% CI: 3.0, 3.5) and those with affective disorders (past-year AOR = 1.7; 95%CI: 1.5, 1.8, lifetime AOR = 1.3, 95% CI: 1.2; 1.4), had higher odds of current cigarette smoking compared to individuals with no diagnosis. The odds of current cigarette smoking was significantly higher in individuals with both drug use disorders and affective disorders compared to those with either a drug use or affective disorder or no disorder (past-year AOR = 5.1; 95% CI: 4.3, 5.9, lifetime AOR = 4.3; 95% CI: 3.8, 4.7).ConclusionsApproximately 30% of the population had a past-year drug use or affective disorder, 17% of whom report both. The combination of both diagnoses produced a 1.5 to 3-fold higher correlation with smoking than either alone.     

An investigation of smoking cessation video content on YouTube

This study examines smoking cessation content posted on youtube.com. The search terms "quit smoking" and "stop smoking" yielded 2,250 videos in October 2007. We examined the top 100 as well as 20 randomly selected videos. Of these, 82 were directly relevant to smoking cessation. Fifty-one were commercial productions that included antismoking messages and advertisements for hypnosis and NicoBloc fluid. Thirty-one were personally produced videos that described personal experiences with quitting, negative health effects, and advice on how to quit. Although smoking cessation content is being shared on YouTube, very little is based on strategies that have been shown to be effective.     

Nicotine content of cigarettes and the smoking habit: Their relevance to subjective ratings of preferences in smokers

One lettuce-leaf and three tobacco cigarettes with different nicotine content were smoked by 24 habitual smokers in the course of 4 successive sessions. Their previous smoking habits were found to be significantly related to their preferences for the various cigarettes. Whilst the heavy smokers (>10 cigarettes per day) preferred only the tobacco cigarettes and strongly disliked the lettuce-leaf, light smokers disliked mostly the highest nicotine cigarette. These ratings were also related to differences in the nicotine intake. It is suggested that these findings support the importance of nicotine in the smoking habit, although other factors may be related to the likableness of tobacco smoking. The relevance of this type of study is discussed.This work was supported by the Tobacco Research Council.     

Effects of cigarette nicotine content on smoking behavior of baboons

Human cigarette smokers modify the way in which they smoke cigarettes of differing nicotine content, apparently to maintain nicotine exposure at a preferred level. The effects of changing from moderate to high or low nicotine content cigarettes were examined in 11 baboons (superspecies Papio cynocephalus) trained to smoke cigarettes for water rewards. Relative to the moderate nicotine content cigarette, the animals took significantly (p < .05) more puffs on the high nicotine content cigarette, and the puffs on the high nicotine cigarette were significantly larger in volume. The animals made the same number of puffs, relative to the moderate nicotine content cigarette, on the low nicotine content cigarette, but the volume of the puffs was significantly smaller. The cotinine output in urine varied significantly and was directly related to cigarette nicotine content; cotinine is the primary metabolite of nicotine. Baboons, like people, prefer high nicotine content cigarettes. Nonhuman primates also regulate nicotine exposure by modification of their puffing behavior. These results indicate that the nonhuman primate also can be used as a model for the investigation of the behavioral aspects of cigarette smoking.