Cessation Failure Research Articles

Differential prevalence of established risk factors for poor cessation outcomes among smokers by level of social anxiety.

Despite clear associations between social anxiety (SA), high prevalence of smoking, and cessation failure, little is known about factors contributing to these relationships. Moreover, the extent to which smokers with moderate SA represent an at-risk group of smokers is also unknown. This study examined the extent to which established risk factors for poor cessation (eg, sociodemographic, smoking history, mental health comorbidity) are prevalent among smokers with low, moderate, and high levels of SA. Participants (N = 2,637) were adult smokers from a web-based smoking cessation trial. Nineteen characteristics considered risk factors for poor cessation outcomes were assessed at baseline. Those associated with social anxiety were subsequently compared by SA level. Regression models indicated that 10/19 risk factors were associated with SA. Compared to smokers with low SA, those with moderate and high SA endorsed 4/10 and 10/10 risk factors as more prevalent or severe, respectively. Compared to smokers with low SA, High SA was associated with greater sociodemographic risk factors, while both moderate and high SA was associated with more severe mental health symptoms. Smokers with moderate and high levels of SA endorse more risk factors for poor cessation outcomes than those with low levels of SA, particularly mental health symptoms. These factors may help explain the differential smoking outcomes of socially anxious smokers. Results suggest that smokers with both moderate and high levels of SA would likely benefit from cessation interventions that address and consider these risk factors. (Am J Addict 2017;26:176-182).

Determinants of Nicotine Dependence in Chronic Obstructive Pulmonary Disease.

BackgroundSmoking cessation is the most powerful intervention to modify progress of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. We evaluated nicotine dependence status and investigated factors associated with moderate to high nicotine dependence in patients with COPD.MethodsWe included 53 current smokers with COPD in the Korean Obstructive Lung Disease II cohort enrolled between January 2014 and March 2016. Nicotine dependence was measured by using Fagerstrom test for nicotine dependence (FTND). Cognitive function was assessed by Korean version of Montreal Cognitive Assessment.ResultsThe median FTND score was 3, and 32 patients (60%) had moderate to high nicotine dependence. The median smoking amount was 44 pack-years, which was not related to nicotine dependence. Multiple logistic regression analysis revealed that high education status (odds ratio, 1.286; 95% confidence interval, 1.036–1.596; p=0.023), age <70 (odds ratio, 6.407; 95% confidence interval, 1.376–29.830; p=0.018), and mild to moderate airflow obstruction (odds ratio, 6.969; 95% confidence interval, 1.388–34.998; p=0.018) were related to moderate to high nicotine dependence.ConclusionNicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.

Racial/Ethnic Differences in Self-reported Withdrawal Symptoms and Quitting Smoking Three Years Later: A Prospective, Longitudinal Examination of US Adults.

Racial/ethnic groups appear to differ on quit success and withdrawal is a key factor in cessation failure, yet little is known about racial/ethnic differences in withdrawal symptoms. This study of US adults examined racial/ethnic differences in current smokers' report of withdrawal symptoms and the relationship between withdrawal symptoms and quitting smoking 3 years later. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2001; Wave 2, 2004-2005), analyses were conducted on participants who identified as non-Hispanic White, non-Hispanic Black, or Hispanic; reported current cigarette smoking at Wave 1; and provided smoking status information at Wave 2 (n = 7981). Withdrawal symptoms during past quit attempts were assessed at Wave 1. Among Wave 1 current smoking adults, non-Hispanic White respondents were more likely than non-Hispanic Black and Hispanic respondents to report experiencing at least one withdrawal symptom, seven out of eight withdrawal symptoms, withdrawal-related discomfort, and withdrawal-related distress (ps < .0001). While withdrawal symptoms were associated with a lower odds of quitting smoking for all groups, a stronger relationship between number of symptoms and lower odds of quitting was evident among non-Hispanic White compared to non-Hispanic Black respondents (interaction β = 0.065, p = .0001). For non-Hispanic White participants, each additional withdrawal symptom was associated with a 6% decrease in the odds of quitting. Withdrawal symptoms were more commonly reported by non-Hispanic White adults than non-Hispanic Black and Hispanic adults and appeared to have a greater impact on failure to quit smoking for non-Hispanic White compared to non-Hispanic Black adults. To our knowledge, this is the first study to use prospective, longitudinal data to examine the relationship between race and withdrawal symptoms and the impact of withdrawal symptoms on quitting smoking among adults in the United States. Non-Hispanic White adults were more likely to report withdrawal symptoms and there was a stronger relationship between greater number of withdrawal symptoms and lower odds of quitting for non-Hispanic White adults compared to non-Hispanic Black adults. Developing a better understanding of racial/ethnic differences in withdrawal and cessation can help to tailor efforts to improve outcomes for smokers in various racial/ethnic groups.

Efficacy of smoking cessation therapy alone or integrated with prolonged exposure therapy for smokers with PTSD: Study protocol for a randomized controlled trial

Posttraumatic stress disorder (PTSD) is related to an increased risk of smoking cessation failure. In fact, the quit rate in smokers with PTSD (23.2%) is one of the lowest of all mental disorders. Features of PTSD that contribute to smokers' progression to nicotine dependence and cessation relapse include negative affect, fear, increased arousal, irritability, anger, distress intolerance, and anxiety sensitivity. Anxiety sensitivity is higher in people with PTSD than in any other anxiety disorder except for panic disorder. High anxiety sensitivity is uniquely associated with greater odds of lapse and relapse during quit attempts. Distress intolerance, a perceived or behavioral tendency to not tolerate distress, is related to both the maintenance of PTSD and problems in quitting smoking. Prolonged exposure (PE) and interoceptive exposure (IE) reduce PTSD symptoms, distress intolerance, and anxiety sensitivity. Thus, they emerge as promising candidates to augment standard smoking cessation interventions for individuals with PTSD. The present study tests a 12-session specialized treatment for smokers with PTSD. This Integrated PTSD and Smoking Treatment (IPST) combines cognitive-behavioral therapy and nicotine replacement treatment for smoking cessation (standard care; SC) with PE to target PTSD symptoms and IE to reduce anxiety sensitivity and distress intolerance. Adult smokers (N=80) with PTSD will be randomly assigned to either: (1) IPST or (2) SC. Primary outcomes are assessed at weeks 0, 6, 8, 10, 14, 16, 22, and 30.

Smoking Cessation and Relapse among Smoking Cessation Scholarship Beneficiaries

Background/Objectives: In this study, a survey was conducted to examine the factors associated with success and failure in smoking cessation among smoking cessation scholarship beneficiaries at N university. Methods/Statistical Analysis: The data were collected via structural questionnaires completed by 139 university students located in Cheonan who agreed to participate in this study from September to December 2015 and was analyzed using the SPSS 18.0 program. Findings: There were statistically significant differences among the scholarship beneficiaries who succeeded in quitting smoking in following areas: CO2 ppm, cigarettes smoked during the period, nicotine dependency, participation in regular smoking cessation education (including attendance at smoking cessation clinics and recognition of the need for followup programs), motivation, factors which allowed one to remain a non-smoker, symptoms, stress, and amount of regular exercise. Logistic regression analysis related to general characteristics shows that CO2 ppm (p<.001), participation in regular smoking cessation education (p = .002), attendance at smoking cessation clinics (p = .021), were shown to exert a significant influenced smoking cessation success. Logistic regression analysis related to smoking factors shows that need a follow up program (p = .035), direct health benefits (p = .034, weight gain (p<.001), improve self-confidence (p = .001), willpower (p<.001) and in-house smoking (p<.001) exert a significant influenced smoking cessation. Additional factors related to health such as alcohol consumption (p = .002), stress-relieving exercise (p = .028), and health screening check (p = .040) exert a significant influenced smoking cessation. Applicants/Improvement: The present findings suggest that conducting enhanced smoking cessation education programs is a good way to guide more students to smoking cessation success in the future.

Severity of Nicotine Addiction and Disruptions in Sleep Mediated by Early Awakenings.

Sleep disruption is common among smokers, however, extant studies primarily explore differences between smokers and nonsmokers. The time to smokers' first cigarette of the day (TTFC) after waking, a strong indicator of addiction severity, is inversely associated with numerous health outcomes. The present study tests the hypotheses that, in a representative sample of daily smokers, the severity of nicotine addiction is associated with shorter habitual sleep duration and excessive daytime sleepiness. We examined the associations between TTFC and sleep outcomes (sleep duration and daytime excessive sleepiness) and the mediating effects of specific sleep disruption pathways (delayed sleep onset, awakenings at night, and early awakening) using structural equation modeling. Analyses included cross-sectional data from 2015 current daily smokers aged 16-85 years who participated in the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey. Among daily smokers, earlier TTFC was associated with both shorter sleep duration and excessive daytime sleepiness (p values < .001, R 2 values = .15 and .29, respectively). Of sleep disruption pathways, only early awakening mediated the associations of TTFC with both outcomes (sleep duration: b = .02, 95% confidence interval [CI]: 0.006 to 0.042; daytime sleepiness: b = -.01, 95% CI: -0.03 to -0.004), even after controlling for variables confounded with smoking status and sleep outcomes. Findings suggest that early awakening may be the mechanism responsible for the association between nicotine addiction severity and poor sleep outcomes of shorter sleep duration and excessive daytime sleepiness. These data may inform cessation strategies, risk assessment, and future longitudinal studies on the relations between sleep and nicotine addiction. Smokers have impaired sleep quality and quantity as compared to nonsmokers; however, that severity of nicotine addiction is an important factor in sleep quality, not just smoking status. Higher levels of addiction lead to less sleep and more daytime sleepiness. The relation between addiction severity and sleep is mediated by waking too early in the morning, and not by difficulty falling asleep or waking during the night. These findings could play an important role in supplementing cessation efforts; sleep disruption may interact with other negative physiological and emotional symptoms related to nicotine withdrawal and could result in more cessation failure.

Insomnia symptoms as a risk factor for cessation failure following smoking cessation treatment

Insomnia symptoms are associated with smoking and may interfere with smoking cessation. Specifically, studies have shown that smoking-related sleep problems are associated with long-term smoking relapse, and longer sleep duration is associated with successful smoking cessation. However, it is currently unclear whether pre- or post-quit insomnia symptoms are associated with smoking cessation outcomes. As such, the current study aimed to extend previous findings by using a measure of insomnia symptoms as a predictor of smoking cessation failure by Month 3 following smoking cessation treatment. Additionally, we examined whether post-quit insomnia symptoms predicted cessation outcomes. Results indicated that pre-, but not post-quit insomnia, predicted smoking cessation failure by 3-month post-cessation, after covarying for depressive symptoms, anxiety sensitivity, alcohol use disorder severity, treatment condition, and number of cigarettes per day. These findings add to the literature on insomnia symptoms as a risk factor for difficulties with smoking cessation, and suggest it may be a worthy clinical target for smoking populations who are interested in quitting smoking.

Repeated measures latent class analysis of daily smoking in three smoking cessation studies

BackgroundPerson-centered approaches to the study of behavior change, such as repeated measures latent class analysis (RMLCA), can be used to identify patterns of change and link these to later behavior change outcomes. MethodsDaily smoking status data from three smoking cessation studies (N=287, N=334, and N=403) were submitted to RMLCA to identify latent classes of smokers based on patterns of abstinence across the first 27days of a quit attempt. Three-month biochemically verified abstinence rates were compared among latent classes with particular patterns of smoking across days. Pharmacotherapy variables and baseline individual differences were added as covariates of latent class membership. ResultsResults of separate and pooled analyses supported a five-class solution that replicated across studies. Latent classes included a large class that achieved immediate stable abstinence, a smaller class of cessation failures, and three classes with partial abstinence that increased, decreased, or remained stable over time. Three-month point-prevalence abstinence rates varied among the latent classes, with 38–55% abstinent among early quitters, 3–20% abstinent among those who smoked intermittently throughout the first 27days, and fewer than 5% abstinent in the classes marked by little or delayed change in smoking. High-dose nicotine patch and bupropion promoted membership in abstinent classes. Demographics, nicotine dependence, and craving were related to latent class in multiple studies and pooled analyses. ConclusionsWe identified five patterns of smoking behavior in the first weeks of a smoking cessation attempt. These patterns are robust across multiple studies and are related to later point-prevalence abstinence rates.

Effects of cognitive load on neural and behavioral responses to smoking-cue distractors.

Smoking cessation failures are frequently thought to reflect poor top-down regulatory control over behavior. Previous studies have suggested that smoking cues occupy limited working memory resources, an effect that may contribute to difficulty achieving abstinence. Few studies have evaluated the effects of cognitive load on the ability to actively maintain information in the face of distracting smoking cues. For the present study, we adapted an fMRI probedrecall task under low and high cognitive load with three distractor conditions: control, neutral images, or smoking-related images. Consistent with a limited-resource model of cue reactivity, we predicted that the performance of daily smokers (n = 17) would be most impaired when high load was paired with smoking distractors. The results demonstrated a main effect of load, with decreased accuracy under high, as compared to low, cognitive load. Surprisingly, an interaction revealed that the effect of load was weakest in the smokingcue distractor condition. Along with this behavioral effect, we observed significantly greater activation of the right inferior frontal gyrus (rIFG) in the low-load condition than in the high-load condition for trials containing smokingcue distractors. Furthermore, load-related changes in rIFG activation partially mediated the effects of load on task accuracy in the smoking-cue distractor condition. These findings are discussed in the context of prevailing cognitive and cue reactivity theories. These results suggest that high cognitive load does not necessarily make smokers more susceptible to interference from smoking-related stimuli, and that elevated load may even have a buffering effect in the presence of smoking cues under certain conditions.

Does Depression Affect Smoking Cessation and Relapse

Depression is positively associated with smoking, but whether depression is linked to failure in smoking cessation is uncertain. Investigators used

Study of pharmacotherapy role in smoking cessation giving an insight into the frequency of smoking among Zagazig University Hospitals’ staff in 2013

Background“Smoking is the main avoidable cause of death around the world”. It’s prevalence is about one billion smokers in the global adult population. “The most cost effective and well-documented methods for smoking cessation are professional advice combined with the nicotine replacement therapy”. So the main aim of hospital staff must be to give advices about smoking cessation and the ways to it. The aim of this work was to study the pharmacotherapy role in smoking cessation giving an insight into the frequency of smoking among Zagazig University Hospitals’ staff in 2013. Subjects and methodsThis epidemiological, observational and prospective study was carried out at Zagazig University Hospitals from the period January 2013 to December 2013. Subjects150 of those current smokers agreed to answer the study questionnaire and share in this study. The included subjects were 144 males and 6 females with a mean age of 39.48±11.95years. MethodsThe studied subjects were subjected to the following: (1) personal history including: smoking history and family history, (2) routine investigations and (3) plain X-ray. The studied subjects (150) were divided into 2 groups according to their agreement for taking pharmacotherapy: group I: included 111 subjects treated by behavioral therapy alone for 3months. Group II: included 39 subjects treated by behavioral therapy plus pharmacotherapy (Bupropion SR tablet) for 3months. ResultsA statistically highly significant percentage of subjects who did previous trial of quitting was found in group II than that in group I. Also, there was a statistically highly significant percentage of subjects who are less nicotine dependent in group II than that in group I, but the reverse was present in highly nicotine dependent subjects according to Fagerstrom score. The final outcome of quitting trial with a successful cessation rate was 48%, while the failed cessation rate was 52% and there was a statistically significant higher successful rate in group II (69.3%) than that in group I (40.5%). As regards occupation, the physicians had statistically highly significant higher levels of successful rate than para-medicals who had high levels of failed cessation rate. A statistically highly significant increase in the percentage of other smoker family member was found in failed cessation group than that in successful cessation one. Regarding Fagerstrom score, there were statistically significant increases in percentage of subjects who were less nicotine dependent in successful cessation group than that in failed cessation one and also in percentage of subjects who were highly nicotine dependent in failed cessation group than that in successful one. Conclusion(1) Programs promoting smoking cessation including behavioral therapy in addition to the complementary role of pharmacotherapy (Bubropion SR) enhanced the chance of success in smoking cessation. (2) This pilot study (regarding the number of the studied individuals) pointed to the smoking dilemma in a locality where smoking behavior should be brought to a minimum especially among physicians.

Reflexive reaction to feelings predicts failed smoking cessation better than does lack of general self-control.

Many treatment-seeking smokers have difficulty quitting and maintaining abstinence. Trait impulsivity versus self-control is relevant to this problem. However, impulsivity is a multifaceted construct, and different measures emphasize different parts of it. This study compared 2 self-report measures of self-control versus impulsiveness as predictors of smoking cessation. One measure taps a very specific tendency to respond impulsively when experiencing emotions. The other taps overall self-control without reference to emotional states. Adult smokers (N = 116) recruited from the community participated in a group-based smoking cessation intervention. The sample was racially/ethnically diverse, mostly male, middle aged, single, low income, and moderately nicotine dependent. Self-reports on scales titled Reflexive reaction to feelings and Self-control were completed at entry. Seven-day point prevalence abstinence (ppa) was assessed at end-of-therapy (EOT) and at 3- and 6-month follow-ups. A generalized estimating equation (GEE) tested overall relationships of the self-report scales with 7-day ppa across the assessments. Bivariate analyses revealed inverse associations between Reflexive reaction to feelings and 7-day ppa; a positive association emerged between Self-control and 7-day ppa only at EOT. A GEE found that elevated scores on Reflexive reaction to feelings predicted failure in smoking cessation across the study period (adjusted odds ratio [AOR] = 0.69 [0.49-0.96], p = .03) and that Self-control scores did not do so significantly (AOR = 1.26 [0.80-1.99], p = .32). Results add to a literature suggesting the importance of emotion-related impulsivity to behavioral problems by showing its relevance to smoking cessation in treatment-seekers. (PsycINFO Database Record

Effects of readiness to change, quit history, and health perceptions on depressive symptoms among young adult smokers.

The current study sought to evaluate the main and interactive effect of health perceptions, smoking quit attempt history, and readiness to change with respect to depressive symptoms among college student smokers. The present data came from baseline data from a randomized trial and included 495 undergraduate students (Mage = 23.84, SD = 4.92, 47.47% female) who reported smoking at least 1 cigarette per day. A three-way interaction emerged between smoking quit attempt history, health perceptions, and readiness to change with respect to depressive symptoms. Quit attempt history was positively associated with depressive symptoms, particularly among individuals high in readiness to change if they perceived their health as poorer relative to peers; however, quit attempt history was negatively associated with depressive symptoms, particularly among individuals high in readiness to change if they perceived their health as comparable or better than that of their peers. These findings support the assertion that readiness to change, quit history and perceived health interact in a dynamic way to confer greater risk for poor outcomes including smoking- (e.g., cessation failure) and psychological-related outcomes (e.g., increased depressive symptoms). As such, development of informed interventions and programs targeting readiness to change to improve quit history and perceptions of health may provide unique benefit.

Étude PRETAGREF : prévalence et facteurs associés au tabagisme chez les patients transplantés rénaux

IntroductionTobacco use increases the risk of mortality, cancers and cardiovascular diseases in transplanted patients. Transplanted patients are encouraged to quit tobacco use before and after renal transplantation. This study was carried out to evaluate the prevalence of tobacco consumption in transplanted patients in one French region. This survey was also conducted to identify factors associated with failure in smoking cessation. Materials and methodA questionnaire was sent by mail to transplanted patients followed in our center between the 1/01/95 and the 31/12/10. A second mail was sent to increase the response rate. ResultsDuring the study period, 544 questionnaires were sent to kidney transplant recipients. Among these 544 patients, there were 362 responders. Of these 362 patients, 121 patients (33.4%) were past smokers, and 21 (5.8%) were active smokers. Among the smokers, 20% were exposed to second-hand smoke, 48% had criteria for tobacco moderate to high dependency, and 13.4% were addicted to alcohol. In the multivariate analysis, exposure to second-hand smoke and living alone at home were associated with failure in smoking cessation. ConclusionThis study shows that the prevalence of tobacco use is not high in transplanted patients. Only 6% of our patients report tobacco use at the study time. Environmental factors are associated with failure in tobacco cessation. Living alone and exposure to second-hand smoke are associated with smoking. Therefore, in transplantation centers, programs devoted to tobacco cessation should be implemented and should take care of patients’ lifestyle.

Smoking Cessation Failure Among Korean Adolescents.

The aim of this study was to identify smoking cessation failure subgroups among Korean adolescents. Participants were 379 smoking adolescents who joined a smoking cessation program. A questionnaire and a cotinine urine test were administered before the program began. Three months after the program ended, the cotinine urine test was repeated. A decision-tree model identified seven subgroups with low or high smoking cessation rates. The predictors of smoking cessation were intention to stop smoking, initiation of smoking, amount of cigarette use, self-efficacy, and paternal smoking status. The subgroup with the lowest smoking cessation rate included adolescents who did not have any intention to stop smoking and who had started smoking after eighth grade, and none of the participants in this group stopped smoking. The results of this study provide crucial information for tailored smoking cessation programs.

The DRD2/ANKK1 Taq1A polymorphism is associated with smoking cessation failure in patients with coronary heart disease.

We speculated whether DRD2 or CHRN subunit polymorphisms might be associated with the risk of smoking cessation failure in subjects after coronary heart disease (CHD) manifestation. A total of 964 patients with CHD, mean age 64.3 years (standard deviation [SD] 9.0), examined in the EUROASPIRE III and IV surveys were genotyped for rs1800497 (DRD2/ANKK1 Taq1A), rs578776 (CHRNA5-A3-B4), rs16969968 (CHRNA5) and rs1051730 (CHRNA3) SNPs. The presence of DRD2/ANKK1 Taq1A minor T allele was independently associated with increased relative risk of smoking persistence (odds ratio: 1.79; 95% CI: 1.13-4.35). We observed no association between CHRN SNPs and smoking habit. DRD2/ANKK1 Taq1A polymorphism is associated with a decreased likelihood of smoking cessation in patients after CHD manifestation.

Qualitative research on the smoking cessation failure among patients after percutaneous coronary intervention

Objective To explore the results of smoking cessation failures in cardiovascular patients after percutaneous coronary intervention. Methods The qualitative phenomenological research method was adopted in this study. Self-structured in-depth interviews were conducted with 15 cardiovascular patients after percutaneous coronary intervention. Data were analyzed by content analysis. Results Four themes were extracted including mental slack, self comfort, external obstacle, the failure of external force. Conclusions The course of smoking abstinence in cardiovascular patients after percutaneous coronary intervention was long and hard. Nurses should pay attention to those people and provide comprehensive and multilevel measures. Key words: Qualitative research; Smoking cessation; Percutaneous coronary intervention

Using ecological measures of smoking trigger exposure to predict smoking cessation milestones.

This study used ecological momentary assessment data from adult daily smokers attempting to quit smoking to assess relations between exposure to contextual risk factors and cessation failure, latency to a first smoking lapse, or progression from lapse to relapse (smoking 7 days in a row). Participants were adult, daily smokers enrolled in a randomized controlled clinical trial of bupropion SR and individual counseling who were followed to 1 year postquit. Participants reported exposure to high-risk contexts and behaviors, including being where cigarettes were available or smoking was permitted, being around others smoking in prospective, real-time assessment for 2 weeks pre- and 4 weeks postquit. Results showed that greater exposure to contextual risk factors during the prequit did not predict cessation failure. However, Cox regression survival analyses revealed that spending a greater proportion of time where cigarettes were easily available following at least 1 day of abstinence predicted shorter latency to a first lapse, even after controlling for baseline risk factors such as gender, nicotine dependence, depressive symptoms, and living with a smoker. Greater cigarette availability following a lapse was not associated with progression from lapse to relapse with or without baseline risk factors in the model. This suggests that postquit environmental risk factors, such as cigarette availability, increase lapse risk, and stable risk factors, such as living with smokers and higher baseline carbon monoxide level or depressive symptoms, remain potent predictors of progression to relapse. Real-time contextual risk assessments postquit predict lapse above and beyond stable, baseline risk factors. (PsycINFO Database Record

Predictors of the Nicotine Dependence Behavior Time to the First Cigarette in a Multiracial Cohort.

The time to first cigarette of the day (TTFC) is a strong indicator of nicotine dependence behaviors such as nicotine uptake and quit success in young and older smokers. There are substantial differences in levels of nicotine dependence by race and ethnic group. Data from Wave III of the multiracial National Longitudinal Study of Adolescent Health were analyzed for young smokers between the ages of 21 and 28 (N = 1,425). Time to first cigarette data was compared between Hispanic, White, Black, Native American, and Asian smokers. Black smokers were significantly more likely to smoke within 5min of waking than White, Hispanic, and Asian smokers. Lower personal income predicted smoking within 5min of waking for both White and Black smokers. For White smokers, increased number of cigarettes per day and increased years of smoking also predicted smoking within 5min of waking. The number of days smoked or number of cigarettes per day did not predict smoking within 5min of waking among smokers. The higher prevalence of early TTFC among Blacks indicates increased nicotine and carcinogen exposure, and may help explain the increased lung cancer rates and failed cessation attempts among Black smokers. TTFC may be an important screening item, independent of cigarettes per day, for clinicians and interventions to identify those at highest risk for cessation failure and disease risk.

Reward dependence moderates smoking-cue- and stress-induced cigarette cravings

BackgroundCigarette cravings following exposure to smoking cues in a smoker's environment are thought to play an important role in cessation failure. The possibility that dispositional factors may impact cue-induced cravings, though intriguing, has received little attention. According to Cloninger's Tridimensional Personality Theory, factors such as reward dependence (RD), harm avoidance (HA), and novelty seeking (NS) may figure prominently in risk for addiction, as well as relapse, in individuals attempting to abstain from drug and alcohol use. Particularly interesting in this regard is the possibility that smokers with higher levels of RD, who are especially sensitive to reward signals, will have heightened craving reactions to smoking cues. MethodsTo that end, non-treatment-seeking nicotine dependent smokers (n=96, mean age=41.1, 47% African American, 17% Caucasian, 22% Hispanic, 19.3cigs/day, FTND=7.5) underwent a classic experimental cue-induction, during which they were exposed to imagery of: (1) smoking, (2) neutral, and (3) stress cues, and reported their cigarette cravings (0–100) before and after each exposure. Participants also completed the Tridimensional Personality Questionnaire. ResultsNot surprisingly, smoking and stress cues (but not neutral cues) elicited significant elevations in craving (p's<0.0001). Consistent with study hypothesis, smokers who scored higher on RD had stronger craving reactions to both smoking cues (p<.02) and stress cues (p<.03). ConclusionsFindings raise the possibility that dispositional characteristics, in particular, reward dependence, influence smoking by potentiating reactions to environmental smoking cues. Furthermore, the similar effects of RD on stress-induced craving suggest that both cue-and stress-induced cravings may be influenced by a common underlying disposition.