Modeling mood variation associated with smoking: an application of a heterogeneous mixed-effects model for analysis of ecological momentary assessment (EMA) data

Aims   Mixed models are used increasingly for analysis of ecological momentary assessment (EMA) data. The variance parameters of the random effects, which indicate the degree of heterogeneity in the population of subjects, are considered usually to be homogeneous across subjects. Modeling these variances can shed light on interesting hypotheses in substance abuse research.
Design   We describe how these variances can be modeled in terms of covariates to examine the covariate effects on between-subjects variation, focusing on positive and negative mood and the degree to which these moods change as a function of smoking.
Setting   The data are drawn from an EMA study of adolescent smoking.
Participants   Participants were 234 adolescents, either in 9th or 10th grades, who provided EMA mood reports from both random prompts and following smoking events.
Measurements   We focused on two mood outcomes: measures of the subject's negative and positive affect and several covariates: gender, grade, negative mood regulation and smoking level.
Findings and conclusions   Following smoking, adolescents experienced higher positive affect and lower negative affect than they did at random, non-smoking times. Our analyses also indicated an increased consistency of subjective mood responses as smoking experience increased and a diminishing of mood change.     

How confident should we be that smoking cessation treatments work?

Aim   To determine (i) the concordance among recent meta-analyses about which treatments for smoking cessation are efficacious; (ii) the similarity of odds ratios (ORs) across meta-analyses; and (iii) among the validated treatments, the proportion of studies that found higher quit rates.
Methods   Computerized literature search for meta-analyses during the last 5 years in PubMed and PsychInfo. Data were extracted from summary tables of overall effect of validated treatments.
Results   Fourteen meta-analyses agreed 100% on the presence/absence of efficacy of 17 proven treatments. The ORs differed by <0.5 in 72/76 of the comparisons of meta-analyses. Among 37 comparisons in 33 comparisons, >85% of the studies reported numerical superiority for the active treatment.
Conclusions   The efficacy of treatments for smoking cessation are extremely reliable. This argues for inclusion of treatment as an essential feature of tobacco control and clinical practice and argues for reimbursement of smoking cessation treatments on a par with other medical and behavioral disorders.     

A randomized trial of short psychotherapy versus sustained‐release bupropion for smoking cessation

Aims To compare the efficacy and safety of a novel psychological intervention for smoking cessation called psychodynamic model (PDM) training to an active control condition of sustained‐release bupropion. Design Randomized controlled clinical trial with allocation concealment. Setting Private psychiatric practice. Participants Seven hundred and seventy‐nine adult smokers recruited by advertising. Interventions PDM training (n = 366 participants) consisted of a very brief (1.5 days) psychoeducation and a supervised training in autosuggestion techniques (guided imageries) aimed at enhancing self‐management, decidedness, assertiveness, security and competence in relationships, natural functions of organs and awareness of bodily functions. Bupropion SR (n = 413) was increased to 150 mg twice daily over 1 week and given over a 8‐week period. Measurements Twelve‐month continuous abstinence confirmed by exhaled carbon monoxide (CO) of 9 parts per million (p.p.m.) or less at all interviews conducted at 3, 6 and 12 months. Findings Intention‐to‐treat analysis revealed Russell standard 12‐month continuous abstinence rates of 39.1% in the psychotherapy group versus 12.3% in the bupropion SR group (P < 0.001) with a relative benefit (RB) of 3.16 (2.38–4.26). Completer analysis revealed 12‐month continuous abstinence rates of 39.9% in the psychotherapy group versus 22.5% in the bupropion group [P < 0.001; RB 1.78 (1.35–2.34)]. Of note, bupropion abstinence rates were comparable to previous medications/placebo‐only comparisons in geographically different samples. Conclusions The 1.5‐day psychotherapy exceeded bupropion's efficacy, presenting an alternative to pharmacological smoking cessation aids, especially for smokers who reject drugs to treat their substance dependence, at a similar cost (€350) as the bupropion treatment (€355).     

被动吸烟对大鼠后代学习记忆功能及海马内生长抑素含量的影响

目的：探讨被动吸烟对大鼠后代学习记忆功能的影响及其机制。方法：采用反映学习记忆功能的水迷宫法测试大鼠神经行为的发迹，ＲＩＡ法测定大鼠海马内生长抑素的含量变化。结果：胚胎期被动吸烟使大鼠学习记忆能力下降，海马内生长抑素含量明显降低。结论：胚胎期被动吸烟降低大鼠学习记忆功能与海马内源性生长抑素代谢的调节有关。     

Intention to Quit Tobacco Use among Clients in Substance Use Disorder Treatment Settings

The purpose of this study was to investigate the influence of age, gender, tobacco-related knowledge, treatment modality, and changes in smoking patterns on intention to quit tobacco use among individuals participating in substance use disorder (SUD) treatment in Ohio. Of the 791 SUD program attendees, 91.7% currently used tobacco, with cigarette smoking being the most prevalent form of use. Among tobacco users, 67% reported intention to quit tobacco use. Four of the five hypothesized predictor variables had a significant relationship with intention to quit tobacco: gender, age, treatment modality, and smoking pattern, with age and gender demonstrating the strongest relationships to intention to quit smoking.     

Peripheral blood dendritic cell subtypes are significantly elevated in subjects with asthma

Background Dendritic cells (DCs) are crucial for the processing of antigens, T lymphocyte priming and the development of asthma and allergy. Smokers with asthma display altered therapeutic behaviour and a reduction in endobronchial DC CD83 expression compared with non‐smokers with asthma. No information is available on the impact of smoking on peripheral blood DC profiles. Objective Determine peripheral blood DC profiles in subjects with and without asthma with differing smoking histories. Methods Forty‐three asthmatics (17 smokers, nine ex‐smokers and 17 never–smokers) and 16 healthy volunteers (nine smokers and seven never–smokers) were recruited. Spirometry, exhaled nitric oxide and venesection was performed. DC elution was by flow cytometry via the expression of DC surface markers [plasmacytoid (pDC) (BDCA‐2, CD303), type 1 conventional (cDC) (BDCA‐1, CD1c), and type 2 cDC (BDCA‐3, CD141)]. Results Subjects with asthma displayed increases in all DC subtypes compared with normal never‐smokers: [type 1 cDCs – asthma [median% (IQR)]: 0.59% (0.41, 0.74), normal never‐smokers: 0.35% (0.26, 0.43), P=0.013]; type 2 cDCs – asthma: 0.04% (0.02, 0.06), normal never‐smokers: 0.02% (0.01, 0.03), P=0.008 and pDCs – asthma: 0.32% (0.27, 0.46), normal never‐smokers: 0.22% (0.17, 0.31), P=0.043, and increased pDC and type 1 cDCs compared with normal smokers. Smoking did not affect DC proportions in asthma. Cigarette smoking reduced pDC proportions in normal subjects [normal never–smokers: 0.22% (0.17, 0.31); normal smokers: 0.09% (0.08, 0.15), P=0.003]. Conclusions and Clinical Relevance This study shows for the first time that subjects with asthma display a large increase in peripheral blood DC proportions. Cigarette smoking in asthma did not affect the peripheral blood DC profile but did suppress pDC proportions in non‐asthmatic subjects. Asthma is associated with a significant increase in circulating DCs, reflecting increased endobronchial levels and the importance of DCs to the development and maintenance of asthma. (Clinical trials.gov identifier: NCT00411320) Cite this as: M. Spears, C. McSharry, I. Donnelly, L. Jolly, M. Brannigan, J. Thomson, J. Lafferty, R. Chaudhuri, M. Shepherd, E. Cameron and N. C. Thomson, Clinical & Experimental Allergy, 2011 (41) 665–672.     

Allergen inhalation challenge in smoking compared with non‐smoking asthmatic subjects

Background Smoking asthmatics experience more severe symptoms, require more rescue medication and have more asthma‐related hospitalizations than non‐smoking asthmatics. However, studies in mice suggest that mainstream cigarette smoke may reduce airway inflammation and may attenuate airway hyperresponsiveness. A comparison of allergen‐induced airway inflammatory responses of smoking and non‐smoking atopic asthmatics has not been examined previously. Objectives To determine whether allergen‐induced airway responses and inflammatory profiles are attenuated in smoking when compared with non‐smoking mild allergic asthmatic subjects. Methods Allergen inhalation challenges were performed in 13 smoking and 19 non‐smoking mild allergic asthmatic subjects. The forced expired volume in 1 s (FEV₁) was measured up to 7 h after allergen inhalation. Methacholine airway responsiveness was measured before and at 24 h after allergen and sputum was induced before and at 7 and 24 h after allergen. Results Both the smoking and non‐smoking groups developed similar allergen‐induced falls in FEV₁ during the early and late asthmatic responses and similar increases in allergen‐induced airway eosinophils. The mean maximum fall in FEV₁ during the late response was 16.3±4.3% in non‐smokers and 12.9±7.2% in smokers. The smoking asthmatics, however, did not develop allergen‐induced methacholine airway hyperresponsiveness, whereas the non‐smoking controls developed a 1.18 doubling dose shift in methacholine PC₂₀ (P<0.05). Conclusions and Clinical Relevance Mild allergic asthmatic subjects, who were current smokers with a mean 6‐year pack history, develop allergen‐induced eosinophilic airway inflammation and late responses, similar in magnitude to non‐smoking asthmatics, but do not develop methacholine airway hyperresponsiveness associated with the allergen‐induced airway eosinophilia. Cite this as: Z. Meghji, B. Dua, R. M. Watson, G. M. Gauvreau and P. M. O'Byrne, Clinical & Experimental Allergy, 2011 (41) 1084–1090.     

Effects of individual characteristics and school environment on cigarette smoking among students ages 13–15: A multilevel analysis of the 2007 Global Youth Tobacco Survey (GYTS) data from Vietnam

Abstract

This paper aims to estimate the prevalence of cigarette smoking among students in Vietnam ages 13–15 and examines its relationship with compositional and contextual factors. The data used in this paper were obtained from the 2007 Global Youth Tobacco Survey conducted in nine provinces in Vietnam. A multilevel logistic regression model was applied to analyse the association between the current incidence of cigarette smoking and factors on both the individual and school level. The prevalence of cigarette smoking among students was 3.3% overall. The prevalence of smoking among male students (5.9%) was higher than that among females (1.2%). Parental smoking was a significant risk factor for smoking among the students. Having a friend who smoked was the strongest predictor of smoking status among the study subjects. We have demonstrated that school-level factors appeared to impact the prevalence of cigarette smoking among students ages 13–15. This paper highlights the importance of utilising an extensive range of actions to prevent students from using tobacco in Vietnam. These actions should include providing specific curricula for students that address both individual characteristics and the school environment. Further, prevention programmes should also target both parental- and peer-smoking issues.     

Smoking Cessation Programs for Seniors:A Group Model That Works

We describe an intensive group program for older adults, facilitated by a tobacco cessation specialist and a geriatric social worker, designed to focus on factors that maintain smoking behavior. Integral components dealt with issues specific to the older adult such as social isolation or economic need. Pharmacological therapy was provided. Participants with a mean age of 67 years who smoked an average of 19 cigarettes per day completed the program. Sixty-six percent of participants had been treated or were in treatment for depression and/or anxiety. Follow-up was completed at 1, 3, 6, and 12 months. The cessation rate across follow-up points was 68%. This program shows that older adults can maintain smoking cessation when provided with programs designed to address their issues.