Maintenance Of Smoking Behavior Research Articles

Associations Between the Wisconsin Inventory of Smoking Dependence Motives and Regional Brain Volumes in Adult Smokers.

The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) is a 68-item questionnaire to assess nicotine dependence as a multifactorial construct based on 13 theoretically derived smoking motives. Chronic smoking is associated with structural changes in brain regions implicated in the maintenance of smoking behavior; however, associations between brain morphometry and the various reinforcing components of smoking behavior remain unexamined. The present study investigated the potential association between smoking dependence motives and regional brain volumes in a cohort of 254 adult smokers. The WISDM-68 was administered to participants at the baseline session. Structural magnetic resonance brain imaging (MRI) data from 254 adult smokers (Mage = 42.7 ± 11.4) with moderate to severe nicotine dependence (MFTND = 5.4 ± 2.0) smoking for at least 2 years (Myears = 24.3 ± 11.8) were collected and analyzed with Freesurfer. Vertex-wise cluster analysis revealed that high scores on the WISDM-68 composite, secondary dependence motives (SDM) composite, and multiple SDM subscales were associated with lower cortical volume in the right lateral prefrontal cortex (cluster-wise p's < .035). Analysis of subcortical volumes (ie, nucleus accumbens, amygdala, caudate, and pallidum) revealed several significant associations with WISDM-68 subscales, dependence severity (Fagerström Test for Nicotine Dependence), and overall exposure (pack-years). No significant associations between cortical volume and other nicotine dependence measures or pack-years were observed. Results suggest that smoking motives may play a larger role in cortical abnormalities than addiction severity and smoking exposure per se, whereas subcortical volumes are associated with smoking motives, addiction severity, and smoking exposure. The present study reports novel associations between the various reinforcing components of smoking behavior assessed by the WISDM-68 and regional brain volumes. Results suggest that the underlying emotional, cognitive, and sensory processes that drive non-compulsive smoking behaviors may play a larger role in gray matter abnormalities of smokers than smoking exposure or addiction severity.

Pain Severity and Smoking Abstinence Expectancies among Latinx Individuals Who Smoke Cigarettes: The Moderating Role of Perceived Discrimination.

Latinx individuals experience significant health disparities related to smoking cessation in the United States (US). Although past works have consistently implicated pain in the maintenance of smoking behavior, limited research has examined the role of social determinants (e.g., perceived discrimination) in pain-smoking relations. The current study sought to examine the moderating role of perceived discrimination in the relation between pain severity and smoking abstinence expectancies (i.e., a cognitive factor related to poor smoking outcomes) among 226 Latinx individuals who currently smoke cigarettes (Mage = 34.95 years; SD = 8.62; 38.5% female). The results indicated a statistically significant interaction between pain severity and perceived discrimination with regard to smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences). Post-hoc analyses revealed the association of pain severity and negative mood, harmful consequences, and positive consequences smoking abstinence expectancies evident for individuals with higher perceived discrimination. Moreover, the association between pain severity and somatic symptoms smoking abstinence expectancies was stronger for individuals with higher perceived discrimination. Overall, these results suggest that clinical and community-based public health strategies may benefit from addressing the role of perceived discrimination among Latinx individuals who smoke cigarettes in the context of pain.

Emotion Regulation Difficulties in Relation to Anxiety, Depression, and Functional Impairment Among Treatment-Seeking Smokers.

Psychological distress is elevated among smokers and plays a key role in the maintenance of smoking behavior. Although research has implicated emotion regulation (ER) difficulties as a transdiagnostic construct for psychological distress, empirical work has not yet investigated ER difficulties among treatment-seeking smokers. The purpose of the current study was to increase understanding of ER difficulties in relation to depression, anxious arousal, and functional impairment among treatment-seeking smokers. Participants included adult daily treatment-seeking smokers (N = 568; Mage = 37, SD = 13.46; 51.9% male). Results indicated that global ER difficulties were significantly related to depression, anxious arousal, and functional impairment. Analyses focused on the lower-order facets of ER and indicated that limited access to ER strategies, difficulty engaging in goal-directed behavior, and lack of emotional clarity were significantly related to depression; limited access to ER strategies, nonacceptance of emotions, and impulsivity were significantly associated with anxious arousal; and limited access to ER strategies and difficulty engaging in goal-directed behavior were significantly related to functional impairment. The significant ER effects were evident above and beyond the variance accounted for by neuroticism and tobacco dependence. These findings highlight the importance of considering ER difficulties to better understand psychological distress among smokers.

Preventing tobacco in vocational high schools: study protocol for a randomized controlled trial of P2P, a peer to peer and theory planned behavior-based program

BackgroundIn France, the issue of youth smoking remains a major challenge for public health. School failure, socio-economic and socio-cultural backgrounds influence the initiation and maintenance of smoking behavior in adolescents. Vocational students are at particularly high risk of using psychoactive substances, including tobacco. One of the most important factors is the environment, whether family, friends or peers. Therefore, peer education has a positive potential to change smoking behavior of adolescents. It has also been demonstrated that the Theory of Planned Behavior (TPB) has yielded the best prediction of intentions and behavior, in several health domains, including on tobacco. However, it is usually confined to the measurement of processes by which interventions change behavior, rather than to the development of these interventions. The objective of this paper is to describe the protocol for a randomized controlled trial of a peer intervention based on the TPB on a highly exposed young population.Methods/designsThis is a cluster randomized controlled trial comparing an intervention group to a control group, randomized into clusters (professional schools and classes) and stratified in three departments (Hérault, Aude and Gard) in the Languedoc-Roussillon region. The primary issue is the prevalence of daily smoking at 24 months, defined by a daily tobacco use of at least 1 cigarette, validated by CO levels in exhaled air. The primary hypothesis is that intervention will lead to decrease the daily smoking prevalence of 10% between the intervention group and the control group during a 2-year follow-up.DiscussionThe results from this trial will provide evidence on the effectiveness of an innovative peer-to-peer intervention based on the TPB.Trial registrationISRCTN: 37336035, Retrospectively registered 11/12/2015.

The prospective relationship between distress tolerance and cigarette smoking expectancies in adolescence.

The current study examined the prospective relationship between distress tolerance (DT) and positive and negative cigarette smoking outcome expectancies, which are reliable predictors of the onset and maintenance of smoking behaviors. Data from a longitudinal study (N = 204) examining risk behaviors in adolescence were used to assess whether DT predicts individual differences in rate of change in smoking outcome expectancies over 4 annual assessment waves through adolescence. Adolescents (mean age at first wave: 13.03 years; SD = 0.88 years) completed a behavioral task assessing DT at baseline and a self-report measure of adolescent smoking expectancies annually across 4 years. Latent growth curve models were estimated to test our hypotheses. Results showed that DT at baseline did not significantly predict initial levels of negative affect reduction (NAR) expectancies, but NAR expectancies increased more quickly over time for adolescents with lower DT. Moreover, as hypothesized, DT did not prospectively predict significant changes in smoking expectancies outside of the domain of NAR, including negative physical feelings, negative social impression, and boredom reduction expectancies. These findings suggest that DT is a useful indicator of adolescent expectancies about the consequences of cigarette smoking, particularly those focused on reducing negative affect. Thus, DT may be an important target for preventing smoking initiation among adolescents via this putative mechanism. Theoretical and clinical implications are discussed within the context of observed effect sizes. (PsycINFO Database Record

Assessment of pain in adolescents: Influence of gender, smoking status and tobacco abstinence

PurposeWe examined sex differences between smokers and nonsmokers in pain threshold, tolerance, and intensity and the effect of pain on cardiovascular measures, withdrawal, and craving during acute smoking abstinence. MethodsNinety-six (53 smokers, 43 nonsmokers) adolescents completed the Cold Pressor Task (CPT) to assess pain responses after minimal (1h) and 42-hour smoking deprivation. Vital signs and craving were assessed before and after CPT completion. ResultsSmokers, compared to nonsmokers, had significantly lower pain tolerance (p<0.01) and pain threshold (p<0.001). Female smokers had significantly lower pain tolerance prior to, and following, 42-hour deprivation compared to male smokers (p's<0.01), male nonsmokers (p's<0.01), and female nonsmokers (p's<0.001), while male smokers demonstrated significantly decreased pain tolerance following 42-hour deprivation (p<0.05). Additionally, during minimal deprivation, at time of hand removal, female smokers had higher pain intensity compared to female nonsmokers (p<0.05) and male smokers (p<0.01). Withdrawal was not significantly correlated with any CPT measures or subjective pain during or following minimal deprivation or acute abstinence. Craving was associated with pain 15s after hand submersion (p=0.007) at 42-hour deprivation. ConclusionsSmokers had a lower pain threshold than non-smokers, with female smokers demonstrating lower pain tolerance during minimal deprivation than all comparison groups, and, continuing to have diminished pain tolerance compared to female nonsmokers following 42h of abstinence. Male smokers demonstrated tobacco-deprivation-induced reductions in pain tolerance. Further study of pain-related factors that may contribute to relapse and maintenance of smoking behaviors, and mechanisms of these relationships among adolescent smokers is warranted.

An Analysis of Electronic Cigarette and Cigarette Advertising in US Women's Magazines.

Background:Traditional cigarette advertising has existed in the US for over 200 years. Studies suggest that advertising has an impact on the initiation and maintenance of smoking behaviors. In recent years, electronic cigarettes (e-cigarettes) emerged on the market as an alternative to the traditional tobacco cigarette. The purpose of this study was to describe advertisements in popular US magazines marketed to women for cigarettes and e-cigarettes.Methods:This study involved analyzing 99 issues of 14 popular US magazines marketed to women.Results:Compared to advertisements for traditional cigarettes, advertisements for e-cigarettes were more often found in magazines geared toward the 31–40-year-old audience (76.5% vs. 53.1%, P = 0.011) whereas traditional cigarette advertisements were nearly equally distributed among women 31–40 and ≥40 years. More than three-quarters of the e-cigarette advertisements presented in magazines aimed at the higher median income households compared to a balanced distribution by income for traditional cigarettes (P = 0.033).Conclusions:Future studies should focus on specific marketing tactics used to promote e-cigarette use as this product increases in popularity, especially among young women smokers.

FKBP5 variation is associated with the acute and chronic effects of nicotine.

Stress and hormones released in response to stress influence the effects of nicotine and the severity of nicotine withdrawal. Here, we systematically examine the contribution of a stress response gene, FKBP5, to the acute and chronic behavioral effects of nicotine in smokers. Subjects were European- and African-American (EA and AA) heavy smokers who participated in an intravenous (IV) nicotine administration study (total n=169). FKBP5 rs3800373 genotype was analyzed for association to several outcomes, including nicotine withdrawal and the acute subjective, heart rate (HR), blood pressure and plasma cortisol responses to IV nicotine. Nicotine withdrawal was also examined in relation to rs3800373 allele frequencies in an independent cohort of EA and AA current smokers (n=3821). For a subset of laboratory subjects FKBP5 mRNA (n=48) expression was explored for an association to the same outcomes. The rs3800373 minor allele was associated with less severe nicotine withdrawal in laboratory subjects and the independent cohort of smokers. The rs3800373 minor allele was also associated with lower subjective ratings of negative drug effects in response to IV nicotine. Low FKBP5 mRNA expression was associated lower cortisol levels, lower subjective ratings of negative drug effects and a blunted HR response to nicotine. Stress hormone regulation via FKBP5 warrants further investigation as a potential contributor to the effects of nicotine withdrawal, which occurs commonly, and has an important role in the maintenance of smoking behavior and relapse following a quit attempt.

Single dose propranolol does not affect physiologic or emotional reactivity to smoking cues.

Smoking cue exposure reactivates salient smoking-related memories, triggering craving to smoke, a phenomenon associated with maintenance of smoking behavior and relapse after periods of abstinence. Acute β-adrenergic blockade with propranolol reduces physiologic reactivity during subsequent recollection of traumatic events by inhibiting reconsolidation of reactivated memories in a process called memory reconsolidation blockade. The objective of this study is to determine whether a single dose of propranolol prior to retrieval of smoking-related memories reduces subsequent physiologic reactivity to personally salient smoking imagery scripts in current smokers. Fifty-four overnight-abstinent, adult smokers received a single-dose propranolol or placebo prior to reactivation of smoking-related memories in a randomized, double-blind, placebo-controlled trial and resumed smoking afterward. One week later, skin conductance (SC), heart rate (HR), left corrugator electromyogram (EMG), self-reported emotional state, and craving were assessed following script-driven imagery with neutral and personalized smoking-related scripts. Smoking scripts were associated with increased physiologic activation (SC, HR, EMG), craving, and negative emotional state compared with neutral scripts. Propranolol did not moderate the effect of script type on any outcome. Personalized smoking script-driven imagery robustly increased physiologic activation, negative emotional state, and craving, and a single dose of propranolol prior to memory reactivation did not moderate this effect.

Gene × smoking interactions on human brain gene expression: finding common mechanisms in adolescents and adults

Numerous studies have examined gene × environment interactions (G × E) in cognitive and behavioral domains. However, these studies have been limited in that they have not been able to directly assess differential patterns of gene expression in the human brain. Here, we assessed G × E interactions using two publically available datasets to assess if DNA variation is associated with post-mortem brain gene expression changes based on smoking behavior, a biobehavioral construct that is part of a complex system of genetic and environmental influences. We conducted an expression quantitative trait locus (eQTL) study on two independent human brain gene expression datasets assessing G × E for selected psychiatric genes and smoking status. We employed linear regression to model the significance of the Gene × Smoking interaction term, followed by meta-analysis across datasets. Overall, we observed that the effect of DNA variation on gene expression is moderated by smoking status. Expression of 16 genes was significantly associated with single nucleotide polymorphisms that demonstrated G × E effects. The strongest finding (p = 1.9 × 10⁻¹¹) was neurexin 3-alpha (NRXN3), a synaptic cell-cell adhesion molecule involved in maintenance of neural connections (such as the maintenance of smoking behavior). Other significant G × E associations include four glutamate genes. This is one of the first studies to demonstrate G × E effects within the human brain. In particular, this study implicated NRXN3 in the maintenance of smoking. The effect of smoking on NRXN3 expression and downstream behavior is different based upon SNP genotype, indicating that DNA profiles based on SNPs could be useful in understanding the effects of smoking behaviors. These results suggest that better measurement of psychiatric conditions, and the environment in post-mortem brain studies may yield an important avenue for understanding the biological mechanisms of G × E interactions in psychiatry.

Examining the interrelationships between social anxiety, smoking to cope, and cigarette craving

Smokers with symptoms of social anxiety often report smoking as a way to cope with negative affect. These individuals have lower success rates when attempting cessation compared with the general population. However, there is a paucity of research examining the role of social anxiety in nicotine dependence. The present study explored the relationships between symptoms of social anxiety, smoking to cope with these symptoms during social situations (STC), and cigarette craving. Thirty-eight participants completed measures of social anxiety and STC at baseline. Cigarette craving was subsequently assessed pre and post exposure to smoking-related images during periods of nicotine satiation and deprivation. Regression analyses revealed that greater symptoms of social anxiety predicted the frequency of STC behaviors and the number of cigarettes participants thought they would need in order to feel more comfortable in social situations. Symptoms of social anxiety and several behaviors associated with STC (e.g., avoiding social situations in which smoking is not permitted) predicted increases in craving during nicotine deprivation, but not satiation. These findings suggest that symptoms of social anxiety and STC behaviors may play a role in the maintenance of smoking behaviors. Further, targeting symptoms of social anxiety within the context of smoking cessation treatment may be particularly helpful and may improve the rates of smoking cessation among individuals with symptoms of social anxiety.

Is Smoking-related Attentional Bias a Useful Marker for Treatment Effects?

Theoretical models of nicotine abuse suggest that preferential attention allocation towards smoking-related stimuli plays an important role in the development and maintenance of smoking behavior. However, little is known about the impact of standard treatment programs for nicotine cessation on this effect. In the current study, we investigated smoking-related attentional bias using a visual dot probe task and an emotional Stroop task before and after a standard behavioral group therapy. Smokers (n = 39) who received treatment, a smoker control group without treatment (n = 20) and a non-smoker control group (n = 20) were investigated. Although we found a reduction in attentional bias scores after successful treatment, this effect failed to reach statistical significance. Of note, we observed a low test–retest reliability in low-dependence smokers in both tasks which is a substantial limitation for using these paradigms in longitudinal studies. Additionally, there was no significant correlation between the attentional bias scores from both tasks.

Brain fMRI reactivity to smoking-related images before and during extended smoking abstinence.

Reactivity to smoking-related cues may play a role in the maintenance of smoking behavior and may change depending on smoking status. Whether smoking cue-related functional MRI (fMRI) reactivity differs between active smoking and extended smoking abstinence states currently is unknown. We used fMRI to measure brain reactivity in response to smoking-related versus neutral images in 13 tobacco-dependent subjects before a smoking cessation attempt and again during extended smoking abstinence (52 +/- 11 days) aided by nicotine replacement therapy. Prequit smoking cue induced fMRI activity patterns paralleled those reported in prior smoking cue reactivity fMRI studies. Greater fMRI activity was detected during extended smoking abstinence than during the pre-quit [corrected] assessment subcortically in the caudate nucleus and cortically in prefrontal (BA 6, 8, 9, 10, 44, 46), [corrected] primary somatosensory (BA 1, 2, 3), temporal (BA 22), [corrected] parietal (BA 5, 7, 40), occipital (BA 17, 18), [corrected] and posterior cingulate (BA 31) cortex. These data suggest that during extended smoking abstinence, fMRI reactivity to smoking versus neutral stimuli persists in brain areas involved in attention, somatosensory processing, motor planning, and conditioned cue responding. In some brain regions, fMRI smoking cue reactivity is increased during extended smoking abstinence in comparison to the prequit state, which may contribute to persisting relapse vulnerability.

Nicotine-induced conditioned place preference in rats: Sex differences and the role of mGluR5 receptors

To elucidate sex differences in nicotine addiction and the underlying mechanisms of the conditioning aspects of nicotine, nicotine-induced conditioned place preference (CPP) was evaluated in male and female Sprague Dawley rats using a three-chambered CPP apparatus and a biased design. In a series of experiments, the dose-response curve was obtained, pairings between the drug and initially non-preferred versus preferred compartments were compared, and the involvement of mGluR5 receptors in nicotine-induced CPP was evaluated. Modulation of nicotine-induced CPP with mGluR5 inhibition was obtained by MPEP (2-methyl-6-(phenylethynyl)-pyridine hydrochloride). Our results show that nicotine induces CPP dose-dependently in male rats but not in female rats. The comparison of the biased protocol, pairing nicotine with the initially preferred and non-preferred chambers, indicated that nicotine-induced CPP in male rats under both conditions, but the effect was stronger when nicotine was paired with the initially non-preferred side. The selective mGluR5 antagonist MPEP inhibited nicotine-induced CPP in male rats. In conclusion, the results of the current study in rats demonstrate that the conditioning effect of nicotine is more important in males than in females. Furthermore, in line with reported findings, our results suggest that mGluR5 antagonism may be therapeutically useful in smoking cessation during the maintenance of smoking behavior when conditioning plays an important role, notwithstanding the fact that this effect is observed only in male rats, not in females.

Reactivity to in vivo smoking cues in older adolescent cigarette smokers

Most smokers initiate smoking in adolescence, and craving for cigarettes may play an important role in maintenance of smoking behavior and relapse to smoking during a quit attempt. Although a significant body of literature explores cue-reactivity in adult smokers, little has been published on cue-reactivity among adolescent smokers. In a previously published work, we found that videotaped smoking cues may not be robust in eliciting craving among adolescent smokers. Hence, in this preliminary study, we examined reactivity to in vivo smoking cues among adolescent smokers (N = 11, average age = 18.1 years, range = 15-19 years, predominantly female). Participants were presented with in vivo smoking and neutral cues (counterbalanced). We recorded subjective craving and real-time heart rate in response to each type of cue. Adolescent smokers had a significantly greater "desire" to smoke (p < .05) in response to smoking cues vs. both baseline and neutral cues. Participants had faster heart rates after the smoking cues during the epochs of 21-30 s and 31-40 s (p values<.05) as compared with baseline, and mean heart rate was higher during the smoking cues relative to neutral cues among participants who received the smoking cues first (p < .05). Results of this preliminary study further demonstrate the feasibility of conducting cue-reactivity studies with adolescent cigarette smokers. Findings from this study suggest that adolescent smokers may show patterns of responding to smoking cues similar to those of adult smokers. Implications for future laboratory studies with adolescent smokers are discussed.

Development and validation of an adolescent smoking consequences questionnaire

Several researchers have investigated the role of outcome expectancies in the initiation and maintenance of smoking behavior. Empirical studies with adults, using a validated self-report instrument, have shown that smokers identify higher levels of positive smoking expectancies and lower levels of negative smoking expectancies compared with nonsmokers and ex-smokers. Studies examining smoking outcome expectancies among adolescents have yielded similar findings, but many of these studies did not use a self-report expectancy measure validated with teens. Therefore, the present study sought to modify a well-known adult smoking expectancy instrument, the Smoking Consequences Questionnaire (SCQ), and to validate its factor structure with a community sample of adolescent nonsmokers and current smokers (aged 11-19 years). Results of a confirmatory factor analysis provided support for a seven-latent-factor structure modeled after the SCQ-Adult. As expected, smoking behavior and the intent to smoke in the future were associated with the endorsement of positive and negative smoking outcome expectancies. The psychometric data provide early support for the validity and reliability of this modified SCQ, renamed the Adolescent Smoking Consequences Questionnaire, for the assessment of smoking expectancies among smoking inexperienced and experienced teens.

Nicotine metabolism variability and nicotine addiction

Individual variation in nicotine metabolism may play a role in a person's level of smoking, as well as in the transition from initiation to maintenance of a smoking behavior pattern. Since there is a paucity of research on nicotine metabolism in youth that smoke, a brief review of salient aspects of nicotine metabolism in adults provides a basis from which to extrapolate. We do know that factors influencing the rate of nicotine metabolism include differences in nicotine intake and absorption, inhalation patterns, genetic polymorphisms of pertinent enzymes, as well as daily activities such as meal consumption. Variability is illustrated with differences in cotinine levels identified in African-American and Caucasian women and in menthol and nonmenthol smokers. There are a number of areas where more information to improve understanding the initiation and maintenance of smoking behavior is needed. Characterization of nicotine metabolism and smoking topography in youth from multiple ethnic groups who are engaged in smoking initiation is currently lacking. Important measures of smoke constituent exposure such as carbon monoxide, nicotine and cotinine, as well as puff volume and duration and respiratory movements should be addressed. While there are numerous factors that impact initiation and maintenance of smoking behavior, nicotine metabolism may represent one important aspect.

Cigarette promotional items in public schools.

To assess the prevalence of ownership of cigarette promotional items (CPIs) by rural northern New England students and to examine the association between CPI ownership and smoking behavior. Voluntary, self-administered survey of 1265 sixth- through 12th-grade students representing 79% to 95% of all students attending 5 rural New Hampshire and Vermont public schools in October 1996. We examined the association between ownership of a CPI and smoking behavior through regression models and conducted a sensitivity analysis on the findings. Adjusted odds of being a smoker (lifetime use of > or = 100 cigarettes) and, among never smokers and experimental smokers, adjusted cumulative odds of having higher levels of smoking uptake given CPI ownership. One third of students owned a CPI. Prevalence of ownership did not vary by grade or sex, but was higher among poor-to-average school performers (45.0% vs 21.0% for excellent school performers, P < .001) and children whose friends and family members smoked (43.4% vs 13.8% for students with no family members or friends smoking, P < .001). Cigarette promotional items included articles of clothing (T-shirts, hats, backpacks, and jackets), smoking paraphernalia (lighters and ashtrays), camping gear, and electronics. More than half of CPIs (58.2%) bore the Marlboro logo, and almost one third (31.7%) bore the Camel logo. These items were obtained directly from catalogs or vendors 22.4% of the time. Whereas only 4.5% of students reported bringing a CPI to school with them the day of the survey, 44.5% reported seeing such an item at school the day of the survey. After controlling for confounding factors, such as having friends who smoke, students who owned CPIs were 4.1 times more likely to be smokers than those who did not own CPIs (95% confidence interval [CI], 3.1-5.5). Never and experimental smokers (n = 1008) who owned CPIs were more likely to be in a higher category on the smoking uptake index in grades 6 (cumulative odds ratio [OR = 5.7, 95% CI, 1.9-16.8), 7 (OR = 1.8, 95% CI, 0.9-3.7), 8 (OR = 2.3, 95% CI, 1.1-4.8), and 9 (OR = 2.1, 95% CI, 1.1-3.9), periods when children are most vulnerable to initiating cigarette use. A sensitivity analysis indicated that an unmeasured confounder of CPI ownership and smoking was unlikely to alter our conclusions. Cigarette promotional items are owned by one third of students in these rural northern New England schools. These items are highly visible in the public school setting, and their ownership is strongly associated with initiation and maintenance of smoking behavior. These data lend support to a ban on CPIs to be included in US Food and Drug Administration regulations to prevent tobacco use among US youth.

Does nicotine withdrawal affect smoking cessation? Clinical and theoretical issues

Pharmacological theories of smoking relapse emphasize the role of nicotine withdrawal in the maintenance of smoking behavior and general failure of treatment interventions. In this article, prospective studies are reviewed which examine the relationship of nicotine withdrawal to unsuccessful smoking cessation and relapse. The relative effectiveness of smoking treatments that directly address nicotine withdrawal is also discussed. It is concluded that the research to date does not appear to strongly implicate nicotine withdrawal in adversely affecting smoking cessation or maintenance of abstinence. Some major obstacles to our understanding of the predictive validity of nicotine withdrawal are addressed including: (a) measurement problems, (b) exclusion bias, and (c) insufficient research on nicotine withdrawal in certain subgroups of highly nicotine-dependent smokers. Other factors which may account for smoking relapse, including behavioral and psychosocial variables, as well as their possible interaction with nicotine withdrawal, are also considered. Recommendations for further research are offered.

Exposure to smoking-relevant cues: Effects on desire to smoke and topographical components of smoking behavior

The effects of exposure to two classes of smoking-relevant cues (environmental; negative affect) on desire to smoke and smoking topography were evaluated. Sixty chronic smokers were randomly assigned to one of six groups in a two-way ANOVA design in which the salience of environmental cues and presence of negative affective cues were manipulated. This was followed by a 20-minute interval during which ad libitum smoking was videotaped in an unobtrusive manner. Results indicated that the experimental manipulations differentially influenced ratings of desire and topographical components of smoking behavior. Implications are raised regarding the role of cue reactivity in the maintenance of smoking behavior.