Implications For Smoking Cessation Research Articles

From Smoking to Vaping: The Motivation for E-Cigarette Use at the Neurobiological Level - An fMRI Study.

Electronic cigarettes (e-cigarettes) are considered a potential aid for smoking cessation. This study investigates the neurobiological mechanisms underlying the motivational properties of e-cigarettes compared to tobacco cigarettes and provides insights into their addictive potential and implications for smoking cessation. The study included 47 daily e-cigarette users, the majority of whom were former smokers (n=43), and 28 nicotine-naïve participants as controls. Among the e-cigarette users, 32 individuals currently used e-cigarettes exclusively, while 15 also used tobacco cigarettes (dual users). Functional magnetic resonance imaging was used to examine anticipatory brain activation to reward-predictive stimuli for money, e-liquid, or tobacco cigarettes, as well as the instrumental response to obtain each reward. Exclusive e-cigarette users demonstrated increased activation in limbic regions, e.g., the nucleus accumbens, during the anticipation of e-liquid and money over tobacco cigarettes. Prefrontal regions showed greater activation during the anticipation of money compared to e-liquid or tobacco cigarettes. Dual users showed greater activation for money compared to tobacco cigarettes in the hippocampal limbic system. No significant differences were observed in the anticipation of e-liquid and tobacco cigarettes among dual users. E-cigarettes are perceived as equally rewarding as money, highlighting their addictive potential. Among exclusive e-cigarette users, money and e-liquid have stronger motivational properties than tobacco cigarettes (even among former smokers), suggesting that e-cigarettes may be an effective tool for tobacco cessation. The comparable appeal of e-liquid and tobacco cigarettes among dual users may suggest that a complete switch to e-cigarettes may be more effective for smoking cessation. It is important to understand the motivational properties of e-cigarettes, particularly compared to traditional tobacco products. E-cigarettes with little or no addictive potential might not be effective as a substitute for tobacco cigarettes; however, a high addictive potential would, conversely, pose a risk to non-smokers. Our data suggest that e-cigarettes have a sufficiently high addictive potential to make them an attractive alternative for smokers, especially if they switch completely from tobacco to e-cigarettes.

The Relationship Between Cigarette Dependence and Cessation Methods: Implications for Smoking Cessation Among People With HIV.

These analyses investigate how dependence may be related to cessation method choice and how this relationship may vary by subpopulation among people with HIV (PWH) who smoke cigarettes. PWH who smoke (N = 71) were recruited from clinics in Boston, MA. The Fagerström Test for Nicotine Dependence (FTND) and Smoking History Questionnaire (SHQ) were completed to assess for cigarette dependence, past-week cigarettes per day (CPD), and past cessation method use. Logistic regression examined the association between dependence and previous cessation methods for the whole sample, and moderation analyses assessed this relationship by age and race. Higher FTND was associated with less use of behavioral modification methods (odds ratio [OR] = 0.658, 95% CI [0.435, 0.994], p = .047). Higher past-week CPD was associated with use of the American Cancer Society/American Lung Association (ACS/ALA) programs (OR = 1.159, 95% CI [1.011, 1.328], p = .035) and telephone counselling (OR = 1.142, 95% CI [1.006, 1.295], p = .040]). Older participants with more past-week CPD were more likely to have used the ACS/ALA programs (B = 0.0169, 95% CI [0.0008, 0.0331], p = .0401), and White participants with more past-week CPD were less likely to have tried to quit "cold turkey" (B = 0.1676, 95% CI [0.0027, 0.3326], p = .0464). These preliminary results suggest that there is likely not a "one-size-fits-all" approach to cessation for PWH who smoke, especially within subpopulations (i.e., age and race). Implications include ensuring access to multiple cessation methods, identifying methods that could be culturally appropriate outside of the clinical intervention setting, and providing education and support on cessation methods offered.

34 Normative beliefs about tobacco products differ by age: Implications for smoking cessation and harm reduction

OBJECTIVES/GOALS: The prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with zero declines attributable to e-cigarette (EC) use. Normative beliefs predict quitting and switching to ECs (a behavior likely to yield health benefits for those unable to quit), so this study seeks to characterize the role of age in norms about CC and EC use. METHODS/STUDY POPULATION: Data come from Wave 5 (2018-2019) of the adult Population Assessment of Tobacco Use and Health (PATH) study, a nationally-representative, U.S. longitudinal cohort. Analyses were restricted to people with established CC use (smoked CCs in the past year, currently smoke regularly, and smoked ≥100 lifetime CCs; n=8,590). Cross-sectional weighted estimates of the prevalence of normative beliefs about CCs and ECs were calculated by age using the Balanced Repeated Replication (BRR) method with Fay=0.3. We used chi-square tests to examine the association of age group (18-24, 25-34, 35-44, 45-54, 55-64, or ≥65) with the prevalence of 2 descriptive and 4 personal social norms. RESULTS/ANTICIPATED RESULTS: The prevalence of the normative belief that most people disapprove of CCs (p DISCUSSION/SIGNIFICANCE: Older adults are more likely than younger adults to endorse anti-tobacco norms, which prior work shows is associated with quitting smoking. These beliefs could be leveraged to create targeted communications towards older adults encouraging smoking cessation. More research is needed to assess age-related tobacco beliefs and switching from CC to EC.

Adherence to low-calorie and low-sugar diets is uniquely associated with distinct facets of appearance/weight-related smoking motivations.

Smokers report weight and appetite control as motivators to smoking continuance. These concerns are particularly salient for smokers who use cigarettes to suppress appetite and manage weight. Dieting may influence weight, shape, and appetite-related smoking motivation; however, this has not yet been examined. This study tested associations between five diet types and smoking motivation to control weight, shape, and appetite among adult daily cigarette smokers (N = 550). A multivariate analysis was used to test the incremental association between diet types and Smoking-Related Weight and Eating Episodes Test (SWEET) subscales, adjusting for age, body mass index, sex, and cigarette dependence. Smokers who diet (n = 83, 15.1%) reported higher scores on all SWEET subscales compared to smokers not on a diet. Low-calorie dieting was associated with greater smoking motivation to cope with body dissatisfaction, and low-sugar dieting was associated with greater motivation for smoking to prevent withdrawal-related appetite increases. Treatment implications for smoking cessation are discussed.

Opioid Use and Rate of Nicotine Metabolism Among Pregnant Smokers.

Smokers who use opioids smoke more cigarettes per day (CPD) than non-opioid users, which could be due to the effects of opioids on nicotine metabolism. Moreover, nicotine metabolism increases during pregnancy, potentially making quitting more difficult for pregnant smokers. We examined nicotine metabolism and its association with opioid use (OU) and CPD in pregnant smokers. We recruited pregnant women who smoked at least 5 CPD for a clinical trial of smoking cessation. Plasma nicotine metabolite ratio (NMR; trans-3'-hydroxycotinine (3HC)/cotinine)-a biomarker of nicotine metabolism-OU (involving methadone, buprenorphine, fentanyl, oxycodone, or tramadol), and CPD were assessed at baseline. We used linear regression to examine the associations between log-transformed NMR, OU, and CPD, adjusting for race/ethnicity and menthol smoking. Among 129 pregnant smokers, 25 (19%) were opioid users; most were maintained on methadone (n = 14). Compared to non-OU smokers, OU smokers had higher median CPD (10.0 vs. 7.0, p = .0007), serum 3HC (81.0 vs. 42.0 ng/mL, p = .0001), and NMR (0.63 vs. 0.43, p < .0001). In addition, methadone-maintained smokers had a higher median NMR than non-OU smokers (0.66 vs. 0.43, p = .0004). Adjusting for covariates, log-transformed NMR was greater in OU smokers (p = .012), specifically methadone-maintained smokers (p = .024), than non-OU smokers. Our preliminary results show that OU is associated with a higher NMR in pregnant smokers. A larger study sample is needed to replicate this finding, examine potential mechanisms, and determine its clinical significance. Among pregnant smokers, we observed that nicotine metabolism was significantly faster among opioid users-the majority of whom were on methadone maintenance-compared to nonusers, which could have implications for smoking cessation. Further studies are needed to replicate this finding, evaluate potential mechanisms, and determine its clinical significance.

The emigration of adult children and smoking behaviors of parents

PurposeThe purpose of this paper is to examine the impact of adult children’s migration on the smoking behavior of rural parents who are left behind and raise the concern that the rural residents’ increasing tendency to migrate to urban areas in China nowadays could encourage such a behavior.Design/methodology/approachUsing data from the China Health and Nutrition Survey and applying propensity score matching method and individual-level fixed effects model, this paper addresses the potential endogeneity issues that may arise between the children’s migration decisions and parental smoking behavior.FindingsThis study’s results indicate that rural parents left behind by their emigrant children indeed are more likely to sustain their smoking habit. The validated smoking effect of emigration calls for effective government programs that entail intervention to curb such potentially aggravating health risk, especially among middle-aged and older fathers.Originality/valueThis paper is the first to examine the impact of children’s migration on the smoking behavior of left-behind parents in rural households in China. Our findings call for immediate attention to the smoking behavior of older age cohort in China as the scale of rural−urban migration trend is expected to increase. Moreover, given that many countries in Asia, such as India, Vietnam and Indonesia, are confronting similar issues, our findings could provide useful implications for smoking cessation and control policies in those countries.

Smoking Is So Ew!: College Smokers’ Reactions to Health- Versus Social-Focused Antismoking Threat Messages

ABSTRACTThis study utilizes Terror Management Theory (TMT) to examine differences between eliciting social death and physical death anxiety related to smoking, smoking attitudes, and quitting intent among college students. Moreover, an important TMT variable—self-esteem—was used as a moderator. A 2 × 3 between-subjects factorial design crossed smoking-based self-esteem (low, high) with mortality salience manipulation (health-focused, social-focused, control). Results suggest while both making health-focused salient and making social-focused mortality salient were effective at getting smokers to quit, there was less effect for health-focused mortality salience on those whose self-esteem is strongly tied to smoking. Effect of social-focused mortality salience was more pronounced among participants who highly linked self-esteem with smoking. For smokers with low smoking-based self-esteem, both health-focused and social-focused mortality salience were effective at motivating attitude change toward smoking and quitting intentions. Implications for smoking cessation ad design and TMT are discussed.

Suffering in Silence: Impact of Tobacco Use on Communication Dynamics Within Vietnamese and Chinese Immigrant Families.

The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker-family member pairs of Vietnamese ( n = 9 dyads, 18 individuals) and Chinese ( n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members "suffering in silence" and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions.

Black Cigarette Smokers Report More Attention to Smoking Cues Than White Smokers: Implications for Smoking Cessation.

Black cigarette smokers have lower rates of smoking cessation compared with Whites. However, the mechanisms underlying these differences are not clear. Many Blacks live in communities saturated by tobacco advertisements. These cue-rich environments may undermine cessation attempts by provoking smoking. Moreover, attentional bias to smoking cues (attention capture by smoking cues) has been linked to lower cessation outcomes. Cessation attempts among Blacks may be compromised by attentional bias to smoking cues and a cue-rich environment. Attention to smoking cues in Black and White smokers was examined in 2 studies. In both studies, assessments were completed during 2 laboratory visits: a nonabstinent session and an abstinent session. In study 1, nontreatment-seeking smokers (99 Whites, 104 Blacks) completed the Subjective Attentional Bias Questionnaire (SABQ; a self-report measure of attention to cues) and the Smoking Stroop task (a reaction time measure of attentional bias to smoking cues). In study 2, 110 White and 74 Black treatment-seeking smokers completed these assessments and attempted to quit. In study 1, Blacks reported higher ratings than Whites on the SABQ (p = .005). In study 2, Blacks also reported higher ratings than Whites on the SABQ (p = .003). In study 2, Blacks had lower biochemical-verified point prevalence abstinence than Whites, and the between-race difference in outcome was partially mediated by SABQ ratings. Blacks reported greater attention to smoking cues than Whites, possibly due to between-race differences in environments. Greater attention to smoking cues may undermine cessation attempts.

Increasing availability and consumption of single cigarettes: trends and implications for smoking cessation from the ITC Mexico Survey

Increasing availability and consumption of single cigarettes: trends and implications for smoking cessation from the ITC Mexico Survey

Increasing availability and consumption of single cigarettes: trends and implications for smoking cessation from the ITC Mexico Survey

ObjectiveDetermine (1) trends in single cigarette availability and purchasing in Mexico and (2) the association between neighbourhood access to singles and cessation behaviour among adult Mexican smokers.MethodsWe analysed data from...

Computed Axial Tomography Scans, Calories, and Computers

Low-dose computed tomography (LDCT) has shown promise in the early detection of lung cancer in prior observational studies. The National Lung Screening Trial (NLST) is the largest multicenter, randomized, controlled trial comparing LDCT with chest radiography with an intention-to-screen analysis (1). High-risk (.30 pack-years) active or ex-smokers between 55 and 74 years of age (n 1⁄4 53,454) were screened three times at 1-year intervals and followed for a median of 6.5 years. Lesions suspicious for cancer (noncalcified nodules . 4 mm) were found in 39.1% of individuals with LDCT and 16.0% with radiography during the trial. A total of 96.4% of these lesions in the LDCT group and 94.5% in the radiography group were false-positive results. The LDCT group had 247 deaths from lung cancer per 100,000 person-years and the radiography group had 309 deaths per 100,000 person-years. This meant a 20% (95% CI, 6.8–26.7; P 1⁄4 0.004) relative reduction in mortality from lung cancer, and a 6.7% (95% CI, 1.2–13.6; P 1⁄4 0.02) reduction in all-cause mortality with LDCT screening. Of the 17,053 LDCT lesions suspicious for cancer in which cancer was not confirmed, 457 (2.7%) resulted in an invasive procedure, with 11 (0.06%) major complications. Multiple unanswered questions regarding lung cancer screening remain. First, this study was done at large centers of excellence, with potentially different results at smaller hospitals. Second, 1,060 individuals in the LDCT and 941 in the radiography group were found to have lung cancer, suggesting the possibility of overdiagnosis with LDCT (2). Are there individuals who die with, rather than from, lung cancer (3)? Third, the implications for smoking cessation are unclear. Smokers might use screening as a tool to continue smoking. Alternatively, a positive screening test might also induce smokers to quit. Last, there are unanswered questions about the optimal demographic group to screen (age, sex, and smoking history), frequency and duration of screening, risks of increasing radiation exposure, risks of false-positive tests, and cost. The number of LDCT screening tests needed to prevent one lung cancer death was 320. I believe this study should not inform health policy decision making until these questions are better answered.

Tobacco: The Effects Of Nicotine And Non-Nicotine Tobacco Constituents On Cigarette Craving, Withdrawal And Self-Administration In Male And Female Smokers: Implications For Smoking Cessation

Tobacco: The Effects Of Nicotine And Non-Nicotine Tobacco Constituents On Cigarette Craving, Withdrawal And Self-Administration In Male And Female Smokers: Implications For Smoking Cessation

Stimulus and Response Expectancies Influence the Cognitive Effects of Cigarettes.

The pharmacological, stimulus expectancy, and response expectancy effects of light cigarettes (0.60 mg yield of nicotine) compared with virtually nicotine-free cigarettes (less than 0.05 mg yield of nicotine) were examined using a between-subjects design. A total of 103 college-student smokers completed tests of cognition before and after smoking one type of cigarette, which was evaluated on a number of dimensions. Cigarettes with nicotine were preferred on most dimensions, and stimulus expectancy partially mediated the relationship between nicotine and subjective effects of the cigarettes. Stimulus expectancy also mediated the effect of nicotine on tension reduction immediately after smoking, but not near the end of the experiment. Response expectancy effects of nicotine were related to predicted and actual recall performance, such that participants who performed well tended to attribute the effect to the cigarette they smoked. Implications for smoking cessation and research studies using non-nicotine cigarettes are discussed.

Modeling the effect of alcohol on smoking lapse behavior

The primary aim of this project was to examine the role of alcohol use in smoking lapse behavior, as alcohol consumption is a known risk factor for poor smoking cessation outcomes. We have developed a novel human laboratory model to examine two primary aspects of alcohol-mediated tobacco relapse: (1) Does alcohol facilitate the initiation of the first cigarette? (2) Once the first cigarette is initiated, does alcohol facilitate subsequent smoking? Using a within-subject design, 16 daily smokers who were also heavy social drinkers received a priming drink (0.03 g/dl or taste-masked placebo) and then had the option of initiating a tobacco self-administration session or delaying initiation by 5-min increments for up to 50 min in exchange for monetary reinforcement. Subsequently, the tobacco self-administration session consisted of a 1-h period in which subjects could choose to smoke their preferred brand of cigarettes using a smoking topography system or receive monetary reinforcement for cigarettes not smoked. Alcohol craving, tobacco craving, subjective reactivity to alcohol, and nicotine withdrawal were assessed as secondary outcomes. Results demonstrated that after consuming the alcohol beverage, subjects were less able to resist the first cigarette and initiated their smoking sessions sooner, and smoked more cigarettes compared to the placebo beverage. These findings have implications for smoking cessation in alcohol drinkers and model development to assess smoking lapse behavior.

Self‐Control of Smoking: When Does Narrowed Attention Help?1

Two studies examined the capacity of cognitive load to enhance or disrupt the self‐control of smoking in the presence of situational pressures that either promote or discourage the behavior. In Study 1, participants who were exposed to cues encouraging smoking smoked more under high cognitive load than under low cognitive load. In Study 2, participants who were exposed to cues discouraging smoking smoked less under high load than under low load. Cognitive load appears to narrow attention, resulting in a state of attentional myopia, which leads to disinhibited smoking behavior when pressures to smoke are disproportionately salient and enhanced control of smoking when pressures not to smoke are disproportionately salient. Implications for smoking cessation are discussed.

Rationality and self-control: the implications for smoking cessation

This paper clarifies a popular misunderstanding that self-control theory competes with rational addiction to explain a smoker's quitting behavior [Keeler, T.E., Marciniak, M., Hu, T., 1999. Rational addiction and smoking cessation: an empirical study. Journal of Socio-Economics 28 (5), 633–643]. While a smoker's rationality plays a critical role in his decision to quit, whether the quitting will be successful or not is affected by his self-control and other socioeconomic characteristics. The empirical evidence from the CPS Tobacco Use Supplements, a nationally representative sample, are consistent with hypotheses derived from both theories.