Daniel S. McGrath

The comorbidity of tobacco smoking and gambling: A review of the literature

ISSUES Evidence suggests that tobacco smoking and gambling frequently co-occur. Although high rates of comorbid smoking and gambling have been documented in studies with clinical populations of pathological gamblers in treatment, in studies using samples drawn from the community, and in large-epidemiological surveys, little empirical attention has been directed towards investigating the exact nature of this relationship. APPROACH In this review, we stress the literature that has examined the epidemiology, aetiology and environmental factors implicated in comorbid smoking and gambling. Publications included in the review were identified through PsycInfo, PubMed and Medline searches. KEY FINDINGS Although conclusive evidence is lacking, a growing body of literature suggests that smoking and gambling might share similar neurobiological, genetic and/or common environmental influences. IMPLICATIONS Comorbid tobacco smoking and gambling are highly prevalent at the event and syndrome levels. However, research investigating how smoking might affect gambling or vice versa is currently lacking. CONCLUSION More studies that examine the impact of this comorbidity on rates of tobacco dependence and problem gambling, as well as implications for treatment outcomes, are needed.

Reformulating and testing the perfectionism model of binge eating among undergraduate women: a short-term, three-wave longitudinal study.

The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating.

Self-generated motives for gambling in two population-based samples of gamblers

In the present study, self-generated responses to a question regarding reasons for gambling from two epidemiological surveys were combined and placed into another earlier motivational model for alcohol use, adapted for gambling. Of the 3601 reasons, 954 could be categorised into the models categories: (a) coping motives (internal, negative reinforcement); (b) enhancement motives (internal, positive reinforcement); and (c) social motives (external, positive reinforcement). Results indicate that coping gamblers experienced greater gambling severity and psychopathology, enhancement gamblers were most likely to gamble while intoxicated and social gamblers were more likely to choose socially-related gambling. An examination of remaining motives suggests additional categories may be warranted – specifically financial and charitable reasons. These findings offer some support for the model; however, it may need to be expanded to account for other motives. The study highlights the advantages and limitations of using self-generated reasons to study gambling motivation.

Alcohol and tobacco co-use in nondaily smokers: An inevitable phenomenon?

INTRODUCTION AND AIMS Alcohol use has consistently been associated with smoking among nondaily smokers. However, this may not be an inevitable relationship that extends across all drinking sessions and/or all nondaily smokers. Recently, distinct subgroups of nondaily smokers have been identified, with one subgroup maintaining a stable pattern of nondaily smoking (long-term occasional smokers; LOS), and others transitioning to nondaily smoking either from a non-smoking status (early occasional smokers; EOS) or from a daily smoking status (former daily smokers; FDS). However, little is known about the extent to which these subgroups differ in their alcohol-tobacco co-administration patterns. DESIGN AND METHODS 183 nondaily smokers (74 LOS; 55 EOS; 54 FDS) completed face-to-face interviews during which they provided details about their lifetime and past-week tobacco and alcohol administration patterns. RESULTS EOS were more likely to report having used alcohol at the time of their first-ever cigarette relative to the other subgroups (P ≤ 0.001), but there were no differences in past-week co-administration patterns between the subgroups. Overall, less than one-third of all smoking sessions occurred when drinking, but these accounted for more than half of all cigarettes consumed during the previous week. Moreover, while only 42% of drinking sessions involved tobacco co-administration, when drinking and smoking did co-occur, significantly greater amounts of alcohol were consumed relative to drinking sessions where no tobacco was used (P < 0.01). DISCUSSION AND CONCLUSIONS Findings suggest that alcohol use is not invariably related to smoking in EOS, FDS or LOS, but when it is, across all subgroups co-administration is associated with mutual dose escalation.

The Gambling Motives Questionnaire financial: factor structure, measurement invariance, and relationships with gambling behaviour

Abstract Items assessing financial motives were recently integrated with the Gambling Motives Questionnaire (GMQ), resulting in a revised measure that assesses coping, enhancement, social and financial motives for gambling (GMQ-F). The aim of this research was to test the proposed four-factor structure of the GMQ-F, determine if GMQ-F responses were invariant across sex, and test a structural model that specifies links between motives, gambling frequency and problem gambling severity. Telephone surveys were conducted with 932 adult gamblers from across Manitoba, Canada, who responded to items from the GMQ-F and reported their frequency of gambling and levels of problem gambling severity. Confirmatory factor analysis yielded strong support for the four-factor structure of GMQ-F scores, and invariance testing provided evidence of measurement invariance across sex. Finally, support was found for the hypothesized structural model in which each gambling motive predicted gambling frequency, which in turn predicted problem gambling severity. Coping motives also directly predicted problem gambling severity. These results provide strong evidence in support of the validity of GMQ-F responses, offer further support for the integration of financial motives with the GMQ, and delineate relationships between gambling motives, gambling frequency and gambling-related harm.

Polytobacco use in non-daily smokers: An issue requiring greater attention

Cigarette smoking is the most common route of tobacco administration and has been the primary focus for the majority of tobaccorelated research initiatives and tobacco control programs. Cigarettes, however, are only oneof several tobaccoproducts that are commercially available to consumers; other forms of tobacco can include: cigarillos, cigars, smokeless tobacco, shisha (i.e. water pipes), and traditional pipes. Although the use of alternative tobacco products has traditionally been examined on a product-by-product basis (e.g., Wetter et al., 2002; Henley et al., 2004; Knishkowy and Amitai, 2005; Timberlake and Huh, 2009) recent attention has been directed toward examining the use of multiple tobacco products, or polytobacco use (PTU) (e.g., Bombard et al., 2007; Backinger et al., 2008; Bombard et al., 2008) and this phenomena is becoming an increasing clinical concern. Epidemiological reports suggest that current PTU is very common among daily smokers with prevalence rates as high as 8.5% (Rigotti et al., 2000) in adult populations. A recent report suggests that lifetime PTU rates among young adults are in the area of 26% (Bombard et al., 2009). To date, themajority of research on PTUhas focused exclusively on regular daily smokers. In one exception, Backinger et al. (2008) reported rates of concurrent PTU among non-daily smokers ranging from 5.9% to 10.0%; similar to that of daily smokers. However, little is currently known about PTU initiation or patterns of use among nondaily tobacco users. As many alternative tobacco products are sold in single-use formats, non-daily smokers may be particularly prone to PTU. In the present letter we report on the characteristics of PTU in a sample comprised entirely of non-daily smokers. As part of a larger study (see Campbell et al., 2011), 255 non-daily tobacco users (49%male) ranging in age from16 to 55 (mean=22.9± 5.7) were recruited from the Halifax Regional Municipality between November 2007 and April 2009. Participants completed a semistructured interview in which they provided details about their lifetime and past 30 day use of six specific forms of tobacco administration: cigarettes, cigarillos, cigars, shisha (water pipe), smokeless tobacco, and traditional pipes. The results suggest that lifetime PTU was very common with only 3% (n=7) of the sample having restricted their total tobacco use to one form of administration. On average, participants reported using 3.6 (±1.1) different forms of tobacco with the prevalence rates for different forms of use being: cigarette 99% (n=253), cigarillo 84% (n=214), cigar 79% (n=202), shisha 56% (n=142), smokeless tobacco 27% (n=69), and pipe 18% (n=46). Current PTU was also common with 44% of the sample

A Comparison of Gambling Behavior, Problem Gambling Indices, and Reasons for Gambling Among Smokers and Nonsmokers Who Gamble: Evidence from a Provincial Gambling Prevalence Study

INTRODUCTION Numerous epidemiological and clinical studies have found that tobacco use and gambling frequently cooccur. Despite high rates of smoking among regular gamblers, the extent to which tobacco potentially influences gambling behavior and vice versa is poorly understood. The current study aimed to provide more insight into this relationship by directly comparing nonsmoking and smoking gamblers on gambling behavior, problem gambling indices, and reasons for gambling. METHODS The data for this study came from the 2005 Newfoundland and Labrador Gambling Prevalence Study. Gamblers identified as nonsmokers (N = 997) were compared with gamblers who smoke (N = 622) on numerous gambling-related variables. Chi-square analyses were used to compare groups on demographic variables. Associations between smoking status and gambling criteria were assessed with a series of binary logistic regressions. RESULTS The regression analyses revealed several significant associations between smoking status and past 12-month gambling. Higher problem gambling severity scores, use of alcohol/drugs while gambling, amount of money spent gambling, use of video lottery terminals, and reasons for gambling which focused on positive reinforcement/reward and negative reinforcement/relief were all associated with smoking. CONCLUSIONS The findings suggest an association between smoking and potentially problematic gambling in a population-based sample. More research focused on the potential reinforcing properties of tobacco on the development and treatment of problematic gambling is needed.

The influence of intrinsic and extrinsic job values on turnover intention among continuing care assistants in Nova Scotia.

This article examines the influence that intrinsic and extrinsic job values have on the turnover intention of continuing care assistants (CCAs) who work either in home care or facility-based care in Nova Scotia (n = 188). Factor analysis of job values identified three latent job values structures: “compensation and commitment,” “flexibility and opportunity,” and “positive work relationships.” Using binary logistic regression, we examined the predictive utility of these factors on two indices of turnover intention. Regression results indicate that, in general, job values constructs did not significantly predict turnover intention when controlling for demographics and job characteristics. However, a trend was found for the “positive work relationships” factor in predicting consideration of changing employers. In addition, CCAs who work in facility-based care were significantly more likely to have considered leaving their current employer. With projected increases in the demand for these workers in both home and continuing care, more attention is needed to identify and address factors to reduce turnover intention.

Disordered gambling and psychosis: Prevalence and clinical correlates

A paucity of research has examined the relationship between psychosis and disordered gambling. Individuals with both psychosis and disordered gambling may represent a uniquely vulnerable clinical population given important commonalities in underlying brain pathology and clinical symptomatology that occur across both disorders (e.g., Potenza and Chambers, 2001), which may manifest in increased risk of poly-comorbidity and symptom severity among this dual disorder population. To our knowledge, only one study has examined rates of psychosis among disordered gamblers, which were found to be 3.5 times higher than non-gamblers (Cunningham-Williams et al., 1998), and no studies have examined the demographic and clinical correlates in a sample of disordered gamblers with and without psychosis. We addressed this empirical gap by examining the co-occurrence of psychosis and disordered gambling in a sample of treatment-seeking disordered gamblers to identify the rates and demographic and clinical correlates. We hypothesized that rates of psychosis would be higher in the population of disordered gamblers compared to the general population and that the dual diagnosis would be associated with greater severity of gambling-related problems and elevated rates of other psychiatric comorbidities.

The influence of acutely administered nicotine on cue-induced craving for gambling in at-risk video lottery terminal gamblers who smoke.

Evidence indicates that tobacco use and gambling often co-occur. Despite this association, little is known about how tobacco use affects the propensity to gamble. Nicotine, the putative addictive component of tobacco, has been reported to potentiate the hedonic value of other nonsmoking stimuli. Environmental cues have been identified as an important contributor to relapse in addictive behavior; however, the extent to which nicotine can affect the strength of gambling cues remains unknown. This study examined whether nicotine influences subjective ratings for gambling following gambling cues. In a mixed within/between-subjects design, 30 (20 men) video lottery terminal (VLT) gamblers (‘moderate-risk’ or ‘problem’ gamblers) who smoke daily were assigned to nicotine (4 mg deliverable) or placebo lozenge conditions. Subjective and behavioral responses were assessed at baseline, following lozenge, following neutral cues, and following presentation of gambling cues. Nicotine lozenge was found to significantly reduce tobacco-related cravings (P<0.05) but did not affect gambling-related cravings, the choice to play a VLT, or other subjective responses. These results suggest that a low dose of acutely administered nicotine does not increase cue-induced craving for gambling in at-risk VLT gamblers who smoke.