Michelle A. Rait

Smoking-Related Cue-Induced Brain Activation in Adolescent Light Smokers

PURPOSE To examine using functional magnetic resonance imaging whether adolescents with low levels of nicotine exposure (light smokers) display neural activation in areas shown to be involved with addiction in response to smoking-related stimuli. DESIGN/SETTING/PARTICIPANTS A total of 12 adolescent light smokers (aged 13-17, who smoked 1-5 cigarettes per day) and 12 nonsmokers (ages 13-17, never smoked a cigarette) from the San Francisco Bay Area underwent functional magnetic resonance imaging scanning. During scanning, the adolescents were shown photographic blocks of smoking and control cues. Smoking cues comprised pictures of individuals smoking cigarettes and smoking-related objects such as lighters and ashtrays. Neutral cues comprised images of everyday objects and individuals engaged in daily activities. FINDINGS For smokers, smoking cues elicited greater activation than neutral cues in the mesolimbic reward circuit (left anterior cingulate: t = 7.04, p < .001; right hippocampus: t = 6.37, p < .001). We found activation from smoking cues versus neutral cues within both the left and right frontal medial orbital regions (t = 5.09, p < .001 and t = 3.94, p = .001, respectively). Nonsmokers showed no significant difference in activation between smoking-related cues and neutral cues. CONCLUSION Our finding that smoking cues produced activation in adolescent light smokers in brain regions, similar to that seen in adult and teenage heavy smokers, suggests that adolescents exhibit heightened reactivity to smoking cues even at low levels of smoking. This article adds to the existing published data by suggesting that nicotine dependence may begin with exposure to low levels of nicotine, thus underscoring the need for early intervention among adolescent smokers.

Parents' Specific Concerns about Daily Asthma Medications for Children

Specific concerns from 706 parents regarding their childrens (M age = 8.0, SD = 3.9) use of daily asthma medications were systematically identified and organized. 270 (38.2%) of 706 parents expressed a total of 470 concerns (M = 1.74, SD = 0.93; Range 1–5), including concerns about side effects (48.9%; e.g., growth retardation); aspects of the regimen (29.3%; e.g., medication amount); and “steroid” use (10.4%). Independent predictors of parental concern included use of inhaled corticosteroids (OR = 1.60, 95% CI 1.07–2.40), nasal corticosteroids (OR = 1.70, 95% CI 1.21–2.38), and alternative therapies (OR = 1.84, 95% CI 1.32–2.56). Providers should be prepared to address a wide range of medication concerns, especially those related to side effects.

Characteristics of Adolescent Intermittent and Daily Smokers

INTRODUCTION Intermittent smoking is common among adolescent smokers, but little is known about adolescent intermittent smokers (ITS). This study describes a cohort of adolescent ITS and compares them to adolescent daily smokers (DS) for the purpose of providing a more detailed characterization of adolescent ITS, specifically patterns of smoking, level of self-reported addiction, and experience with cessation METHODS Participants were 124 ITS and 55 DS. ITS were defined as smoking at least monthly but <30 days per month; and DS as smoking daily. Participants completed demographic, smoking and addiction surveys including the HONC and mFTQ. RESULTS ITS started smoking at an older age, smoked fewer cigarettes per day and scored significantly lower on addiction scales, but had similar difficulty to DS in quitting smoking with similar numbers of reported quit attempts. These differences remained after adjusting for years of smoking. ITS were more likely to smoke in social situations, while DS were more likely to smoke when angry. Both groups were equally likely to report smoking when drinking alcohol. CONCLUSIONS We documented significant differences in smoking related behaviors between adolescent ITS and DS. Importantly, we also found that, despite low level infrequent smoking, ITS reported difficulty in quitting smoking. Given the risks from light and intermittent smoking, it is essential that we develop a greater understanding of adolescent ITS, including their difficulty in quitting and the contextual factors influencing their smoking, so that we may develop new targeted interventions.

Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers.

BACKGROUND Marijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use. METHODS Participants were 165 adolescents (13-17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS). RESULTS The adolescent sample (mean age=16.1 years, SD=0.95) averaged 3.0 CPD (SD=3.0) for 1.98 years (SD=1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25-44% of the variance for all four measures of adolescent nicotine dependence. CONCLUSIONS Marijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.

A Randomized Controlled Trial to Evaluate the Effectiveness of a Distance Asthma Learning Program for Pediatricians

Objectives. To assess provider acceptability of a distance learning program for pediatric asthma and pilot test its effects on physician knowledge, attitudes and treatment practices. Design. Randomized controlled trial. Setting. Louisville and the surrounding central Kentucky region. Participants. Twenty-four pediatricians in clinical practice. Interventions. A distance learning program for pediatric asthma consisting of Web- or CD-ROM–based multimedia learning modules and two teleconference calls. Outcome Measures. Learner satisfaction and change in physician asthma knowledge, attitudes, and treatment behavior at 1 to 4 months (short term) and 6 to 8 months (long term). Results. Pediatricians had graduated from medical school a mean of 11.6 years before baseline (SD ±8.9); 56% were female. On all learner satisfaction items, the average score was a 4.0 or greater on a 5-point scale, indicating a favorable response from the participants. Participants in the education group reported increased familiarity with asthma guideline for prescribing daily-inhaled corticosteroids compared to control physicians (p = .03) at short-term follow-up. Participants also expressed increased confidence in selecting a medicine for patients requiring a low-dose inhaled steroid (p = .03). However, these differences were not seen at long-term follow-up. Compared to the control group, there was no significant increase in the proportion of patients receiving inhaled steroids for persistent asthma at short- or long-term follow-up. Conclusions. Pediatricians utilizing an asthma distance learning program expressed a high degree of learner satisfaction. The program was associated with a temporary increase in familiarity and confidence in implementing components of the asthma guidelines.