Megan Conrad

A comprehensive examination of hookah smoking in college students: Use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use

The practice of waterpipe smoking (hookah) has rapidly increased in popularity among young adults yet burgeoning research suggests that its use is associated with nicotine dependence and other negative smoking-related health consequences. Moreover, descriptive studies indicate that consumers may hold the belief that hookah smoking is safer than smoking cigarettes. The current study extended previous work by conducting a comprehensive assessment of patterns and contexts of hookah use, psychological correlates of use, co-occurring substance use as well as social norms and health perceptions surrounding the practice. Participants were 143 ethnically diverse undergraduate students at a large urban US university. Approximately half of the sample (48%) reported life-time use of hookah and 22% reported use within the past 30days. Relative to cigarette smoking, hookah smoking was associated with less perceived harm and addiction potential and higher social approval. Participants who reported life-time hookah use, as compared to those who did not, perceived less associated harm, had a greater number of friends who had tried and approved of hookah, were more likely to use cigarettes, marijuana, and alcohol and in higher frequencies and quantities and were at higher risk for problem tobacco and alcohol use. Among participants who were not current smokers, those with hookah experience were more likely to endorse intent to try a cigarette soon. Hookah users did not differ from non-users on measures of trait anxiety, depression and impulsivity though they were more likely to drink alcohol for coping, social and enhancement purposes than non-users. Implications are discussed for public health initiatives to educate young adults about the potential consequences of hookah smoking.

Project exhale: Preliminary evaluation of a tailored smoking cessation treatment for HIV-positive African American smokers

This study examined the feasibility, acceptability, and outcomes of a culturally tailored smoking cessation intervention for HIV-positive African American male smokers. Eligible smokers were enrolled in a seven-session group-based treatment combined with nicotine patch. The mean age of participants was M=46 years. The majority were daily smokers (71%), smoked a mentholated brand (80%), and averaged 8.6 (standard deviation [SD]=8.1) cigarettes per day. Baseline nicotine dependency scores (M=5.8) indicated a moderate to high degree of physical dependence. Of the 31 participants enrolled, the majority completed treatment (≥3 sessions; 68%), 1-month follow-up (74%), and 3-month follow-up (87%) interviews. Program acceptability scores were strong. However, adherence to the patch was low, with 39% reporting daily patch use. The majority of participants (80%, n=24) made a quit attempt. Furthermore, over the course of the intervention, smoking urge, cigarettes smoked, nicotine dependence, withdrawal symptoms, and depression scores all significantly decreased. Follow-up quit rates at 1 and 3 months ranged from 6% to 24%, with treatment completers having better outcomes. This first of its kind intervention for HIV-positive African American male smokers was feasible, acceptable, and showed benefit for reducing smoking behaviors and depression scores. Smoking cessation outcomes were on par with other similar programs. A larger trial is needed to address limitations and to confirm benefits.

Stress-induced changes in mood and cortisol release predict mood effects of amphetamine

BACKGROUND Stress is thought to contribute to both initiation and relapse to drug abuse. However, the mechanisms by which stress influences drug use are unclear. Interestingly, responses to acute administration of stimulant drugs resemble certain neuronal and hormonal responses to acute stress, and there is accumulating evidence that individual variation in the positive reinforcing or euphorigenic effects of a drug is related to individual differences in responsivity to acute stress. METHODS In this study we evaluated relationships between physiological and subjective responses to a stressful task and to an oral dose of d-amphetamine in healthy adult volunteers (N=34). Individuals participated in four experimental sessions; two behavioral sessions involving a stressful task (i.e., public speech) or a non-stressful control task, and two drug sessions involving oral administration of d-amphetamine (20mg) or a placebo. The dependent measures included salivary cortisol, heart rate, mean arterial pressure, and subjective ratings of mood. RESULTS As expected, both stress and d-amphetamine increased cortisol, heart rate and blood pressure. Stress increased negative mood, whereas d-amphetamine induced prototypic stimulant effects and increased ratings of drug liking. Analyses revealed that increased negative mood states after stress were correlated with positive mood after amphetamine. In addition, increased cortisol after stress was correlated with positive mood responses to amphetamine. Finally, there were modest positive correlations between cortisol and heart rate increases after stress and mean arterial pressure after amphetamine. CONCLUSIONS These results support and extend previous observations that responses to acute stress are correlated with certain subjective, hormonal and cardiovascular effects of a stimulant drug.

Sex Differences in the Relationship Between Alcohol- Associated Smoking Urge and Behavior: A Pilot Study

This study examined sex differences in alcohol-associated smoking urge and smoking patterns to elucidate factors contributing to the co-use of alcohol and cigarettes. Participants were 39 (22M, 17F) binge-drinking tobacco chippers. Although men and women showed similar alcohol-smoking patterns and similar alcohol-induced smoking urges, a positive association between these factors was observed only in men. The lack of relationship in women suggests that co-use of these substances may be due to exteroceptive factors beyond the pharmacological effects of alcohol potentiating smoking urge.

Cue-induced cigarette craving and mixed emotions: a role for positive affect in the craving process.

Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.

The influence of acculturation on substance use behaviors among Latina sexual minority women: the mediating role of discrimination.

Background: A large body of work has demonstrated that sexual minority women have elevated rates of substance use morbidity, as compared with heterosexual women, and that this might be especially true for women of color. Objectives: This study examines the influence of acculturation and discrimination on substance use among Latina sexual minority women. Methods: Data were collected from 2007 to 2008 as part of a larger community-based survey in the greater Chicago area. Scales measured discrimination, acculturation, and substance use. Structural equation modeling validated scales and examined their relationships, which were further described via mediation analysis. Results: Increased acculturation leads to substance use and this relationship is partially mediated by discrimination (Sobel test = 2.10; p < .05). Conclusions/Importance: Implications of these findings and directions for future research are discussed. Funding was provided by several womens and public health organizations.

The separate and combined effects of alcohol and nicotine on anticipatory anxiety: a multidimensional analysis.

Individuals who smoke cigarettes are significantly more likely to smoke more when they drink alcohol. Indeed, smoking and drinking appear strongly linked, at both between- and within-person levels of analyses. Anecdotal evidence further suggests that alcohol consumption in combination with smoking cigarettes reduces anxiety, yet the mechanisms by which this may occur are not well understood. The current study assessed the separate and combined effects of alcohol and nicotine on self-reported and psychophysiological (startle eyeblink magnitude) indices of anxiety. Results indicated that alcohol provided anxiolytic benefits alone and in combination with nicotine, as evidenced by significant reductions in startle eyeblink magnitude. According to self-reported anxiety, alcohol and nicotine exerted a conjoint effect on diminishing increases in anxiety subsequent to a speech stressor. These data highlight the importance of studying both the separate and combined effects of these two widely used substances, as well as the advantages of employing a multimodal assessment of emotional response.

Relationship of self-reported and acute stress to smoking in emerging adult smokers

OBJECTIVE In the current study, we examined subjective and objective measures of stress and their relationship to baseline and future cigarette smoking behaviors over a 1-year follow-up in young adult experimental smokers. METHOD Participants (N = 56) completed two laboratory sessions to determine subjective and objective responses to a controlled laboratory stressor versus a control task. Baseline measures included drug use and smoking histories and a self-report measure of habitual stress (i.e., daily hassles). They were re-contacted 1 year after the laboratory sessions to determine smoking status. RESULTS There was wide variability in smoking trajectories, with 34% of participants increasing their smoking over the course of the year. Contrary to predictions, neither daily hassles nor stress reactivity was related to smoking at baseline or change over the year. CONCLUSIONS These preliminary findings suggest that daily stress or responses to acute social stress are not strong predictors of progression in emerging adult smokers.

Smoking's effects on respiratory sinus arrhythmia in adolescent smokers.

Respiratory sinus arrhythmia (RSA) has emerged as an indicator of how well the body maintains homeostasis and flexibly responds to environmental demands. Previous research has shown that smoking has both acute and chronic effects on RSA in adults. More recent work has focused on adolescent smokers because the natural decrease in RSA over the lifespan might be hastened by smoking at an early age. The goal of the current study, then, was to examine the acute effects of smoking on RSA and mean heart rate (HR) in a group of adolescent smokers. Participants completed two experimental sessions separated by 6-10 weeks, during which resting electrocardiogram (EKG) data were collected before and after smoking or not smoking a single cigarette ad libitum. Results indicate that smoking significantly decreased resting RSA and increased mean HR. In addition, those who smoked their first cigarette earlier in life (i.e., before age 8 or 10) evidenced a greater decrease in RSA during their smoking session relative to those who tried smoking after age 10. Importantly, these findings are largely consistent with the adult literature and suggest that smoking has acute effects on both RSA and HR in adolescence.

Adolescent's respiratory sinus arrhythmia is associated with smoking rate five years later.

INTRODUCTION Vulnerability factors like respiratory sinus arrhythmia (RSA) may help identify adolescents at risk for nicotine dependence. We examined if resting RSA and the acute effects of smoking on RSA was associated with cigarette smoking five years later among adolescents at high risk for smoking escalation and nicotine dependence. METHODS Sixty-nine adolescents participated in a baseline laboratory session- RSA was collected before and after smoking a single cigarette ad libitum. Participants were then followed for five years. RESULTS Lower pre-smoke resting RSA was related to higher past month smoking rate five years later, even after controlling for baseline smoking rate and other relevant covariates including gender, race/ethnicity, age of initiated use, and frequency of exercise at baseline (p=0.018). Exploratory analyses suggested resting RSA is an independent predictor of increased cigarette rate beyond other baseline predictors. CONCLUSIONS Low resting RSA may be a vulnerability factor, helping to identify adolescents at risk for cigarette escalation.