Neal Doran

Randomized Controlled Trial for Behavioral Smoking and Weight Control Treatment: Effect of Concurrent Versus Sequential Intervention.

The authors compared simultaneous versus sequential approaches to multiple health behavior change in diet, exercise, and cigarette smoking. Female regular smokers (N = 315) randomized to 3 conditions received 16 weeks of behavioral smoking treatment, quit smoking at Week 5, and were followed for 9 months after quit date. Weight management was omitted for control and was added to the 1st 8 weeks for early diet (ED) and the final 8 weeks for late diet (LD). ED lacked lasting effect on weight gain, whereas LD initially lacked but gradually acquired a weight-suppression effect that stabilized (p = .004). Behavioral weight control did not undermine smoking cessation and, when initiated after the smoking quit date, slowed the rate of weight gain, supporting a sequential approach.

Effect of impulsivity on craving and behavioral reactivity to smoking cues

IntroductionNearly 25% of American adults remain regular smokers. Current smokers may be especially likely to possess characteristics that impair their ability to quit, such as impulsivity. Impulsive individuals may be overly prone to smoke because they are particularly drawn to rewarding stimuli and related cues. The aim of this study was to test the hypothesis that more impulsive smokers are more responsive to cigarette cues than other smokers.Materials and methodsIn a repeated measures design, 60 euthymic, adult smokers (50% female) were exposed to a smoking cue and a neutral cue in two experimental sessions. Cue reactivity was operationalized as changes in cigarette craving and preference for immediate vs delayed smoking after cue exposure.ResultsImpulsivity predicted a heightened craving response to both cues but particularly the smoking cue (t [161] = 3.21, p = 0.002). Smokers with high levels of impulsivity exhibited a greater preference for immediate rewards over larger, delayed rewards in terms of both hypothetical (t [58] = 5.99, p = 0.001) and actual (z = 3.02, p = 0.003) rewards.ConclusionThese data suggest that increased reactivity to environmental smoking cues contributes to the link between impulsivity and smoking.

Impulsivity and cigarette craving: differences across subtypes

RationaleCigarette smoking has been linked to a number of personality characteristics, including impulsivity. Smokers tend to endorse high levels of impulsivity, and more impulsive smokers have greater difficulty quitting, but little is known about potential explanatory mechanisms. Although indirect evidence suggests craving as a candidate mechanism, direct evidence has been mixed.Materials and methodsThis study assessed whether specific aspects of impulsivity (sensation seeking, lack of premeditation, lack of perseverance, and urgency) were associated with cue-induced craving. Regular smokers (n = 60; 50% female) were exposed to a smoking cue and a neutral cue in a repeated measure counter-balanced design.ResultsMixed effects regression models indicated that smokers who were high in sensation seeking reported greater increases in appetitive craving after smoking cue exposure, whereas, smokers who were high in urgency and lack of perseverance reported greater increases in negative affect craving.ConclusionsFindings suggest a complex relationship between impulsivity and cue-induced craving that may be masked by single construct conceptualizations of impulsivity.

Effects of anhedonia on days to relapse among smokers with a history of depression: A brief report

INTRODUCTION Despite the strong co-occurrence between lifetime prevalence of depression and smoking, a history of major depressive disorder (MDD history) does not reliably predict smoking cessation outcomes. However, depression is a heterogeneous syndrome comprising several dimensions (e.g., anhedonia, vegetative symptoms, negative affect), and each symptom expression may differentially influence cessation failure. Measuring proximal depressive dimensions may provide a more reliable way of identifying MDD history smokers most at risk for smoking relapse. Anhedonia, in particular, is a core feature of depression that may increase risk for smoking relapse among MDD history smokers. The primary goal of the present study was to investigate the relation between anhedonia and relapse latency among MDD history smokers following a brief smoking cessation workshop. METHODS Participants (N = 45, 48.9% female), who were euthymic regular smokers with a history of MDD, were randomized to 1 of 3 treatment groups that all involved participation in a daylong group workshop. Workshops were followed by 48 hr of bioverified abstinence and weekly follow-up visits for 1 month. RESULTS Cox proportional hazard modeling was used to evaluate the effect of anhedonia on relapse latency 30 days following quitting smoking. Results showed that higher levels of anhedonia predicted reduced relapse latencies, both with and without prequit depressive symptom severity included in the model. DISCUSSION Results suggest that anhedonia may constitute a proximal risk factor identifying depressive history smokers more likely to relapse to smoking.

A prospective study of the Acquired Preparedness Model: the effects of impulsivity and expectancies on smoking initiation in college students.

This study reports on a prospective test of the Acquired Preparedness Model, which posits that impulsivity influences cigarette smoking through the formation of more positive and fewer negative expectancies about smoking effects. College freshman never-smokers (n = 400; 45% male) completed a baseline interview and quarterly online follow-up assessments for 15 months after baseline. Structural equation modeling indicated that the effects of the impulsivity components of sensation seeking and negative urgency on risk of smoking initiation were mediated by expectancies for positive and negative reinforcement from smoking, respectively. Expectancies about negative consequences from smoking predicted initiation but did not mediate the effects of sensation seeking or negative urgency. Findings are consistent with the Acquired Preparedness Model and suggest that heightened impulsivity is associated with heightened expectancies for reinforcement from smoking, and thus with greater risk for smoking initiation.

A prospective study of cigarette smoking initiation during college: Chinese and Korean American students.

OBJECTIVE The present study was a prospective investigation of baseline influences on initial smoking and transition to established smoking among college students who had not smoked prior to college. DESIGN Included were 267 participants in a longitudinal study of tobacco use. Students of Chinese (52%) or Korean (48%) descent were enrolled during their freshman year in college. Data for the present study were collected during four annual in-person interviews. MAIN OUTCOME MEASURES (1) Initial use of a cigarette reflected having first smoked a cigarette (more than a puff) during college. (2) Established smoking was defined as having smoked at least 100 cigarettes. RESULTS Over the course of the study, 25% of baseline never-smokers tried their first cigarette, and 9% became established smokers. Overall, men were significantly more likely to experiment and progress to established smoking. Baseline alcohol and drug use, behavioral undercontrol, and parental smoking predicted smoking experimentation but not established smoking. Students of Korean ethnicity were more likely to become established smokers. However, acculturation was not a significant predictor of experimentation or established smoking after accounting for the effects of other predictors. CONCLUSION These findings suggest a need for efforts to prevent smoking uptake among Asian American college students.

Effect of nicotine on negative affect among more impulsive smokers.

In the present study, the authors tested the hypothesis that nicotine would provide greater relief from negative affect for more impulsive smokers than for less impulsive smokers. Euthymic adult smokers (N=70) participated in 2 laboratory sessions, during which they underwent a negative mood induction (music + autobiographical memory), then smoked either a nicotinized or de-nicotinized cigarette. Mixed-effects regression yielded a significant Impulsivity x Condition (nicotinized vs. de-nicotinized) x Time interaction. Simple effects analyses showed that heightened impulsivity predicted greater negative affect relief after smoking a nicotinized cigarette but not after smoking a de-nicotinized cigarette. These data suggest that nicotine may be a disproportionately powerful negative reinforcer for highly impulsive smokers, promoting higher levels of nicotine dependence and inhibiting smoking cessation.

Fluoxetine, Smoking, and History of Major Depression: A Randomized Controlled Trial

The study was a randomized placebo-controlled trial testing whether fluoxetine selectively enhances cessation for smokers with a history of depression. Euthymic smokers with (H+, n = 109) or without (H-, n = 138) a history of major depression received 60 mg fluoxetine or placebo plus group behavioral quit-smoking treatment for 12 weeks. Fluoxetine initially enhanced cessation for H+ smokers (p = .02) but subsequently impaired cessation regardless of depressive history. Six months after quit date, fluoxetine-treated participants were 3.3 times more likely to be smoking (p = .02). Further research is warranted to determine why high-dose fluoxetine produces continuing effects that oppose tobacco abstinence.

Mediating Influences of Negative Affect and Risk Perception on the Relationship Between Sensation Seeking and Adolescent Cigarette Smoking

INTRODUCTION A substantial number of adolescents are current and regular cigarette smokers, and there is a need to better understand factors that contribute to smoking behavior during these years. Sensation seeking (SS) is one factor that has consistently been associated with smoking, but less is known about mechanisms that may explain this relationship. METHODS The present study tested the hypothesis that high school students high in SS would report heavier cigarette smoking and that this relationship would be mediated by negative affect and by perceptions about the risks of smoking. Students (n = 1,688) participated in an annual survey of substance use and related attitudes and characteristics. RESULTS As expected, higher SS was associated with greater levels of past 30-day (odds ratio [OR] = 1.46, p = .004) and lifetime (OR = 1.37, p = .004) smoking, particularly for males. Multiple mediation models indicated that effect of SS on both 30-day (combined indirect effect z = 5.38, p < .001) and lifetime (z = 6.14, p < .001) smoking was mediated by both negative affect and risk perception. CONCLUSIONS These findings suggest a need for increasing the sensation value of anti-tobacco messages to increase their efficacy for high SS youth. High SS youth may also benefit from prevention efforts designed to teach healthy ways of coping with negative affect.

Sex differences in smoking cue reactivity: craving, negative affect, and preference for immediate smoking.

BACKGROUND AND OBJECTIVES Female smokers have greater difficulty quitting, possibly due to increased reactivity to smoking-related cues. This study assessed sex differences in craving, affect, and preference for immediate smoking after cue exposure. METHODS Regular smokers (n = 60; 50% female) were exposed to smoking and neutral cues in separate, counterbalanced sessions. Outcomes included changes in craving and affect and preference for immediate smoking following cue exposure. RESULTS Findings indicated that women exhibited greater preference for immediate smoking (p = .004), and reported greater cue-induced increases in cigarette craving (p = .046) and negative affect (p = .025). DISCUSSION AND CONCLUSIONS These data suggest that women may have greater difficulty inhibiting smoking after cue exposure, possibly as a consequence of greater increases in craving and negative affect. SCIENTIFIC SIGNIFICANCE AND FUTURE DIRECTIONS Findings suggest a mechanism that may contribute to greater cessation failure among female smokers.