Individual Smoking Behavior Research Articles

Abstract B85: WINCART Center: Technology and tobacco use assessment for young adult Pacific Islanders

Abstract Introduction: This research study (WINCART – Weaving an Islander Network for Cancer Awareness, Research and Training) focuses on the development of a smoking cessation intervention for late adolescent and young adult PIs in Southern California. Methods: The comprehensive tobacco use and quitting assessment is geared towards young adult Pacific Islanders between 18 and 29 years old. The assessment is comprised of four parts: 1) smoking history semistructured interview or “talk story” session with current and former tobacco users to understand the individual's tobacco use history; 2) Computerassisted Iowa Gambling Test (IGT), a neurocognitive decision-making test in the form of a card game, to assess affective decision making that may make an individual more susceptible to tobacco use, 3) Ecological momentary assessment (EMA) which will be used to track in real time, an individual's smoking behaviors and cues that are in response to stressors, moods, and other environmental influences, using an iPhone, and 4) online survey tool to collect relevant demographic information. Results: Results of the assessment will be used to inform the development of an evidence-based online tobacco cessation program geared towards young adult Pacific Islanders. This study has been recently awarded and a work in progress. The WINCART community and academic research team have established a governance structure, developed measures, and is building the technological infrastructure. Conclusion: When compared with all other major racial/ethnic groups in the U.S., young adult Pacific Islanders have a high prevalence rate of tobacco use. Evidence-based smoking cessation programs tailored to the culture and lifestyle of PIs in the U.S. do not exist. Findings from our assessment will fill many knowledge gaps and will lead in the development of a novel multicomponent cessation intervention for late adolescent and young adult PIs consisting of interactive technological components. The intervention will be highly engaging, interactive, and age- and culturally appropriate. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B85.

Influence of measurement setting and home smoking policy on smoking topography

While cigarette puffing style, measured by smoking topography, is highly variable between individuals, smoking behavior or style tends to vary relatively little within individuals. Recent research has demonstrated that certain situational factors may produce variation in smoking topography, including location of smoking. Smoking topography directly observed by researchers in a laboratory may differ from that indirectly observed via portable measurement devices at participants' homes. The introduction of clean indoor air laws may also influence smokers' puffing styles, as smokers modify their smoking topography to ensure a quicker, more efficient smoking style. The goal of this analysis was to examine whether directly observed laboratory measures are representative of indirectly observed smoking behavior and to examine the influence of smokers' preference for indoor or outdoor home smoking on puffing style. Overall, participants smoked more intensively in the directly observed setting than when in the indirectly observed setting in terms of total volume intake, inter-puff interval, and total time spent smoking. This difference was most pronounced among individuals who reported smoking indoors when at home. The data suggest that adherence to an indoor home smoking policy may further influence an individual's smoking behavior.

Association between the STin2 VNTR polymorphism and smoking behavior in oral cancer patients and healthy individuals

The serotonergic system may be involved in smoking behavior since the intake of nicotine increases serotonin secretion in the CNS. Moreover, evidence supporting the beneficial effect of selective serotonin reuptake for quitting smoking suggesting that the serotonin transporter (5-HTT) is a plausible target for the understanding and elucidation of smoking behavior. The transcriptional activity of its human gene (SLC6A4) is modulated by a polymorphism described in the second intron, the STin2 VNTR, which thus may interfere with 5-HTT synthesis. In this study was analyzed the polymorphism STin2 VNTR of 60 smokers male patients diagnosed for oral carcinoma, 61 male smokers without cancer and 65 non-smoker healthy blood donors. The STin2. 9 allele carriers were more present in smoker groups (with cancer and without cancer, respectively) than in the non-smoker (OR=7.11, 95% CI=0.83-60.91 and OR=24.73; IC 95%=3.17-192.66). Conversely, individuals carrying allele 10 were more prevalent in non-smokers compared with smokers (oral cancer patients and individuals without cancer, respectively), showing a protective factor of this allele (OR=0.56; 95% CI=0.24-1.33 and OR=0.46; 95% CI=0.20-1.07). This is the first report of a study assessing the importance of STin2 VNTR smoking behavior in Brazilian individuals and the association of STin2. 9 allele carriers in nicotine dependence. It is suggested that individuals with low serotonin concentration in the central nervous system, probably due to the presence of the allele for high expression of 5-HTT,especially STin2. 9, were more susceptible to nicotine dependence. Moreover, individuals with the 10 allele might have less risk for nicotine dependence.

One last puff? Public smoking bans and smoking behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's federal states. We exploit this variation to identify the effect that smoke-free policies had on individuals’ smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates point to important heterogeneous effects. Individuals who go out more often to bars and restaurants did adjust their smoking behavior. Following the ban, they became less likely to smoke and also smoked less.

Prediction of Individual Long-term Outcomes in Smoking Cessation Trials Using Frailty Models

In smoking cessation clinical trials, subjects commonly receive treatment and report daily cigarette consumption over a period of several weeks. Although the outcome at the end of this period is an important indicator of treatment success, substantial uncertainty remains on how an individual's smoking behavior will evolve over time. Therefore it is of interest to predict long-term smoking cessation success based on short-term clinical observations. We develop a Bayesian method for prediction, based on a cure-mixture frailty model we proposed earlier, that describes the process of transition between abstinence and smoking. Specifically we propose a two-stage prediction algorithm that first uses importance sampling to generate subject-specific frailties from their posterior distributions conditional on the observed data, then samples predicted future smoking behavior trajectories from the estimated model parameters and sampled frailties. We apply the method to data from two randomized smoking cessation trials comparing bupropion to placebo. Comparisons of actual smoking status at one year with predictions from our model and from a variety of empirical methods suggest that our method gives excellent predictions.

Smoking Behavior and Alcohol Consumption in Individuals With Panic Attacks.

Individuals with anxiety often report greater smoking and drinking behaviors relative to those without a history of anxiety. In particular, smoking and alcohol use have been directly implicated among individuals experiencing panic attacks, diagnosed with panic disorder, or high on panic-relevant risk factors such as anxiety sensitivity. Less is known, however, about specific features of panic that may differentiate among those who do or do not use cigarettes or alcohol. The purpose of the current study was to replicate previous research findings of an association between panic symptomatology, cigarette smoking, and alcohol consumption, as well as extend findings by examining whether specific symptoms of panic attacks differentiated among those who do or do not use cigarettes or alcohol. Participants (n = 489) completed the Panic Attack Questionnaire-IV, a highly detailed assessment of panic attacks and symptoms, as well as self-report measures of smoking history and alcohol use. Consistent with previous research, participants who reported a history of panic attacks (n = 107) were significantly more likely to report current daily or lifetime daily cigarette smoking, and significantly greater hazardous or harmful alcohol use than participants with no panic history (n = 382). Although smoking and hazardous alcohol use were highly associated regardless of panic status, participants with panic attacks showed elevated hazardous alcohol use after controlling for daily or lifetime smoking. Surprisingly, although participants who reported having had at least one panic attack were more likely to smoke, panic attack symptoms, intensity, or frequency did not differentiate panickers who did or did not smoke. Furthermore, panic-related variables were not shown to differentially relate to problematic drinking among panickers. Implications for understanding the complex relationship between panic attacks and smoking and drinking behaviors are discussed.

Cutting Down One Puff at a Time: The Acute Effects of Exercise on Smoking Behaviour

AbstractResearch consistently demonstrates that a bout of moderate exercise alleviates cravings to smoke among abstaining smokers. This pilot study examined the effects of an acute bout of brisk walking on cigarette cravings and smoking topography. Using a within-subject, crossover design, two 10-minute treatment sessions were conducted on separate days by 19 participants(Mage = 24.6 years): passive (i.e., sitting) and brisk walking conditions. Participants rated cravings at baseline, midcondition, and at 0-, 10-, and 20-minutes postcondition and objective measures of smoking topography (puff count, puff duration, puff volume, interpuff interval [IPI], time to first puff [TTFP]) were obtained with the first cigarette smoked postcondition. A 2 (condition) × 4 (time) ANCOVA indicated lower desire to smoke (p< .05) during the walking condition than the passive condition. After the brisk walking condition, a series of ANOVAs demonstrated a significantly increased delay to first puff in comparison to the passive condition. Posthoc analyses (controlling for abstinence period) indicated significant lower puff volume and a trend for shorter puff duration following brisk walking in comparison to the passive sitting condition. A greater reduction in cravings was associated with a longer delay to first puff. In addition to reducing cravings, these results suggest that a bout of brisk walking may also change an individual's smoking behaviour.

Adolescent Smoking: Effect of School and Community Characteristics

A substantial challenge in addressing adolescent tobacco use is that smoking behaviors occur in complex environments that involve the school setting and larger community context. This study provides an integrated description of factors from the school and community environment that affect youth smoking and explains variation in individual smoking behaviors both within and across schools/communities. Data were collected from 82 randomly sampled secondary schools in five Canadian provinces (British Columbia, Manitoba, Ontario, Quebec, Newfoundland, and Labrador) during the 2003-2004 school year. Cross-sectional data were obtained from students; school administrators (school-based tobacco control policies and programs); and from observations in the community. In 2009, hierarchic logistic regression was used to model the role of individual, school, and community variables in predicting student smoking outcomes. Students who attended a school with a focus on tobacco prevention (OR=0.87, 95% CI=0.81, 0.94) and stronger policies prohibiting tobacco use (OR=0.92, 95% CI=0.88, 0.97) were less likely to smoke than students who attended a school without these characteristics. A student was more likely to smoke if a greater number of students smoked on the school periphery (OR=1.25, 95% CI=1.07, 1.47). Within the community, price per cigarette (OR=0.91, 95% CI=0.84, 0.99) and immigrants (OR=0.99, 95% CI=0.98, 0.99) were inversely related to students' smoking status. The results suggest that school and community characteristics account for variation in smoking levels across schools. Based on the current findings, the ideal school setting that supports low student smoking levels is located in a neighborhood where the cost of cigarettes is high, provides tobacco prevention education, and has a policy prohibiting smoking.

Estimating the Determinants of Smoking Behavior in Taiwan

This paper investigates the determinants of the smoking behavior of people in Taiwan based on data obtained from the 2004 Taiwan Panel Study of Family Dynamics. The sample size consists of 3,015 individuals whose ages range from 33 to 75. Probit models are estimated separately for the smoking behavior equations. The results indicate that gender, marital status, age, health, employment, and the presence of young children have a relatively important impact on an individual's smoking behavior. In addition, the results of the estimated predictors, such as having higher educational attainment, having smoking family members and smoking peers, and being aware of the harmful effects of smoking, also bring to light crucial policy implications. Study limitations are noted.

One Last Puff? Public Smoking Bans and Smoking Behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's sixteen federal states. We exploit this variation in the timing of state bans to identify the effect that smoke-free policies had on individuals' smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates also point to important heterogeneous effects. Groups that go out more often, and hence are more exposed to the constraints of public smoking bans in everyday life, did adjust their smoking behavior. Specifically, we find that young, unmarried individuals, men, and those living in urban areas are groups that are both less likely to smoke and smoke less intensively following the introduction of public smoking bans. Furthermore, effects on individual smoking habits proved stronger in states that had more strict smoking bans. Public smoking bans, therefore, have important health benefits over and above the reduction in exposure of non-smokers to second-hand smoke that is their immediate and prime objective.

One Last Puff? - Public Smoking Bans and Smoking Behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's federal states. We exploit this variation to identify the effect that smoke-free policies had on individuals’ smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates point to important heterogeneous effects. Individuals who go out more often to bars and restaurants did adjust their smoking behavior. Following the ban, they became less likely to smoke and also smoked less.

One Last Puff? Public Smoking Bans and Smoking Behavior

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's sixteen federal states. We exploit this variation in the timing of state bans to identify the effect that smoke-free policies had on individuals' smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates also point to important heterogeneous effects. Groups that go out more often, and hence are more exposed to the constraints of public smoking bans in everyday life, did adjust their smoking behavior. Specifically, we find that young, unmarried individuals, men, and those living in urban areas are groups that are both less likely to smoke and smoke less intensively following the introduction of public smoking bans. Furthermore, effects on individual smoking habits proved stronger in states that had more strict smoking bans. Public smoking bans, therefore, have important health benefits over and above the reduction in exposure of non-smokers to second-hand smoke that is their immediate and prime objective.

Estimating the effects of potential public health interventions on population disease burden: a step-by-step illustration of causal inference methods.

Causal inference methods allow estimation of the effects of potential public health interventions on the population burden of disease. Motivated by calls for epidemiologic research to be presented in ways that are more informative for intervention, the authors present a didactic discussion of the steps required to estimate the population effect of a potential intervention using an imputation-based causal inference method and discuss the assumptions of and limitations to its use. An analysis of neighborhood smoking norms and individual smoking behavior is used as an illustration. The implementation steps include the following: 1) modeling the adjusted exposure and outcome association, 2) imputing the outcome probability for each individual while manipulating the exposure by "setting" it to different values, 3) averaging these probabilities across the population, and 4) bootstrapping confidence intervals. Imputed probabilities represent counterfactual estimates of the population smoking prevalence if neighborhood smoking norms could be manipulated through intervention. The degree to which temporal ordering, randomization, stability, and experimental treatment assignment assumptions are met in the illustrative example is discussed, along with ways that future studies could be designed to better meet the assumptions. With this approach, the potential effects of an intervention targeting neighborhoods, individuals, or other units can be estimated.

A Study of Smoking Disparity and Factors Associated With Children Smoking Behavior in the Mountain and City Schools in Taiwan

While higher smoking prevalences have been better described for adults and adolescents in the mountainous areas than in the plain area in Taiwan, no studies have previously examined whether this disparity begins with children in elementary schools. The purpose of this study was thus designed to explore clustering in smoking behavior among elementary school children attending mountain schools compared to those attending city schools. This study analyzed data obtained by a survey on smoking behavior collected during the School Smoking Survey Project performed in 13 elementary schools of Taoyuan County, Taiwan. Overall, 1585 third and fourth graders (mean age 8.9 years) participated in the study. A multilevel logistic regression analysis was performed to explore the effects of school location on individual smoking behavior among elementary school children while controlling for individual-level characteristics. Overall, 34.9% of the elementary school students in the mountain schools reported having tried cigarette smoking compared to only 9.6% of students from city schools. Students attending mountain schools had a greater likelihood of reporting smoking than students attending city schools after controlling for individual-level characteristics (OR = 2.57, 95% CI = 1.10-5.99). A significant individual clustering in smoking behavior was found among third- and fourth-grade children attending mountain schools. The new findings suggest that the adult geographic smoking disparity begins in elementary school. Interventions aimed at reducing smoking disparity in adults need to target elementary schools in high-risk locations.

The Effects of Public Place Smoking Restrictions on Individual Smoking Behaviour in Australia

While smoking remains the leading preventable cause of death in Australia, existing policy options, except for bans on smoking at public places, seem to have limited scope for expansion. Eight new smoking bans, introduced in six different Australian jurisdictions over 2003 and 2005, provide a basis for evaluation. The analysis extends a popular two-part model of smoking behaviour by GLM and correlated random effect models. Difference-in-differences estimation using 4 waves of the Household, Income, Labour Dynamics Australia Survey indicates that neither the probability nor the intensity of smoking was affected. The results are robust to alternative specifications and estimation methods.

The neighbourhood effects of geographical access to tobacco retailers on individual smoking behaviour

To investigate whether neighbourhood measures of geographical accessibility to outlets selling tobacco (supermarkets, convenience stores and petrol stations) are associated with individual smoking behaviour in New Zealand. Using geographical information systems, travel times from the population-weighted centroid of each neighbourhood to the closest outlet selling tobacco were calculated for all 38,350 neighbourhoods across New Zealand. These measures were appended to the 2002/03 New Zealand Health Survey, a national survey of 12, 529 adults. Two-level logistic regression models were fitted to examine the effects of neighbourhood locational access upon individual smoking behaviour after controlling for potential individual- and neighbourhood-level confounding factors, including deprivation and urban/rural status. After controlling for individual-level demographic and socioeconomic variables, individuals living in the quartiles of neighbourhoods with the best access to supermarkets (OR 1.23, 95% CI 1.06 to 1.42) and convenience stores (OR 1.19, 95% CI 1.03 to 1.38) had a higher odds of smoking compared with individuals in the worst access quartiles. However, the association between neighbourhood accessibility to supermarkets and convenience stores was not apparent once other neighbourhood-level variables (deprivation and rurality) were included. At the national level, there is little evidence to suggest that, after adjustment for neighbourhood deprivation, better locational access to tobacco retail provision in New Zealand is associated with individual-level smoking behaviour.

Association study of monoamine oxidase and catechol-O-methyltransferase genes with smoking behavior

The genes of catalytic enzymes of dopamine, including monoamine oxidase (MAOA and MAOB) and catechol-O-methyltransferase (COMT), have been major candidates for genes that affect smoking behavior. In this study, we investigated the relationship between smoking behavior and four polymorphisms of these genes, the MAOA variable number tandem repeat polymorphism, the MAOA 1460 T/C polymorphism, the MAOB intron 13 G/A polymorphism, and the COMT Val158Met polymorphism. The association between the MAOB polymorphism and personality traits was also explored. The polymorphisms were genotyped in 451 healthy Japanese volunteers. Data on smoking habits were obtained from structured interviews. In addition to testing the association between each polymorphism and smoking status, epistatic and additive effects between two polymorphisms were also investigated. A significant association was observed between the COMT Val158Met polymorphism and smoking status. Male participants with the Val/Val genotype had a significantly higher risk of heavy smoking compared with those with other genotypes, although no significant association was observed in female participants. No evidence was obtained for an association between the MAO genes and smoking behavior, including epistatic or additive effects. No significant association was observed between the MAOB polymorphism and personality traits. This study may suggest a role of the COMT Val158Met polymorphism in smoking behavior in Japanese individuals.

Effect of Delivered Dosage of Cigarette Smoke Toxins on the Levels of Urinary Biomarkers of Exposure

Urinary metabolites of tobacco smoke toxins are often used as biomarkers for the evaluation of active and passive exposure to cigarette smoke toxins. In a study of healthy smokers, we investigated concentrations of urinary biomarkers in relation to concentrations of selected toxins in mainstream cigarette smoke as determined by machine smoking of cigarettes in a manner that mimics an individual's smoking behavior (topography). Concentrations of nicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, and benzo(a)pyrene, in mainstream smoke determined under human smoking conditions, and their urinary metabolites cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and 1-hydroxypyrene were established for 257 individuals who smoked low-yield (0.1-0.8 mg Federal Trade Commission nicotine/cigarette; mean, 0.66; n = 87), medium-yield (0.9-1.2 mg nicotine/cigarette; mean, 1.1; n = 109), and high-yield cigarettes (nicotine, >1.3 mg nicotine/cigarette; mean, 1.41; n = 61). Levels of urinary metabolites expressed per unit of delivered parent compounds decreased with increased smoke emissions. In smokers of low-, medium-, and high-yield cigarettes, the respective cotinine (ng/mg creatinine)-to-nicotine (mg/d) ratios were 89.4, 77.8, and 57.1 (low versus high; P = 0.06); the 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (pmol/mg creatinine)-to-4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (ng/d) ratios were 0.81, 0.55, and 0.57 (low versus high; P = 0.05); and the 1-hydroxypyrene (pg/mg creatinine)-to-benzo(a)pyrene (ng/d) ratios were 1.55, 1.13, and 0.97 (low versus high; P = 0.008). Similarly, means of cotinine per unit of delivered nicotine in smokers who consumed <20 cigarettes per day was 3.5-fold higher than in those who smoked >20 cigarettes per day. Likewise, a negative correlation was observed between cotinine-to-nicotine ratios and delivered doses of nicotine in subgroups of smokers who used the identical brand of cigarette, namely a filter tip-vented Marlboro (r = -0.59), which is a popular brand among Euro-Americans, and Newport (r = -0.37), a menthol-flavored cigarette without filter tip vents that is preferred by African-Americans. Thus, the intensity of the exposures significantly affects the levels of urinary biomarkers of exposure and should be taken into account in the evaluation of human exposure to cigarette smoke toxins.

Biomarkers Derived from Nicotine and its Metabolites: A Review

Abstract Nicotine is the major alkaloid present in tobacco and the most frequently determined compound as a biomarker of tobacco exposure in both smokers and non-smokers exposed to environmental tobacco smoke. Current knowledge on the human metabolism and disposition kinetics of nicotine is reviewed, together with methods for the determination of nicotine and various metabolites in different human biological fluids and matrices. Only short-term biomarkers of nicotine exposure exist and long-term biomarkers of exposure such as the incorporation of nicotine and cotinine into human hair, toenails and deciduous teeth require further investigation. Determination of ‘nicotine boost’, the difference in blood nicotine concentrations that occur after smoking a single cigarette, provides an experimental indication of individual smoking behaviour, but is unsuitable for population studies. The determination of nicotine plus multiple phase I and phase II metabolites in 24-hour urine, often expressed as ‘nicotine equivalents’, provides the most accurate way to determine exposure to nicotine in smokers; however, few laboratories are equipped to perform the complex analysis required for this purpose. Nicotine equivalents can be used to estimate the uptake of nicotine from a cigarette in both individuals and in population studies. Despite recent advancements in analytical methodology and the possibility of determining multiple nicotine metabolites in various biological fluids, determination of cotinine, the major metabolite of nicotine, is likely to remain the most commonly used approach to assess exposure to tobacco smoke in both smokers and non-smokers. Representative data for cotinine in blood, saliva and urine of smokers and non-smokers are presented.

The application of household expenditure data in the development of anti‐smoking campaigns

PurposeDespite widespread anti‐smoking campaigns, prevalence and the consequent damage to the community remains high and are therefore of concern to health educators. Several studies have identified a clear socio‐economic status gradient in smoking prevalence. One purpose of this paper is to re‐examine this gradient to assist in the more accurate targeting of anti‐smoking campaigns. Another purpose of this paper is to examine the financial cost of smoking from a household perspective and also to compare survey data with data compiled by other means to test whether smokers are accurately reporting their smoking behaviour. This can assist in the refining of anti‐smoking message strategies.Design/methodology/approachData from a large‐scale survey of Australian households – the Household Expenditure Survey – was analysed and compared with data from other sources to examine demographic correlates and self‐reported estimates of smoking behaviour.FindingsApproximately one third of households reported expenditure on tobacco. Expenditure is more prevalent among households with a female head and among lower status occupations. Young people are continuing to take up smoking. Smoking households appear to underestimate their expenditure on tobacco by more than 40 percent.Research limitations/implicationsData are drawn from households, not individuals; therefore exact estimations of smoking prevalence and individual smoking behaviour are not possible.Originality/valueThe findings provide important guidance for health educators developing anti‐smoking campaigns. The findings provide assistance in the development of targeting and message strategy guidelines.