Non-dependent Smokers Research Articles

The relative impact of acute nicotine and tobacco administration on craving, withdrawal, and cigarette self-administration in dependent and nondependent smokers.

Negative reinforcement mechanisms, wherein individuals smoke at regular intervals to ameliorate craving and withdrawal, are integral to persistent smoking. This is consistent with the behavior of dependent smokers but does not fully account for the behavior of intermittent smokers, who do not smoke enough to maintain steady nicotine levels. This study examined the independent and combined impacts of nicotine and tobacco consumption on cigarette craving, withdrawal, and subsequent smoking behavior in 18 nondependent light and intermittent smokers (LITS) and 23 daily, dependent smokers (DDS). Participants administered conventional nicotine-containing cigarettes (NC; 18.9 mg nicotine; 1.41 mg deliverable), reduced nicotine content cigarettes (RNC; 0.4 mg nicotine, 0.05 mg deliverable), nicotine inhalers (NI; 10 mg nicotine, 4 mg deliverable), or nicotine-free inhalers (NFI) across 4 sessions following overnight abstinence. Participants rated craving and withdrawal before and after product administration, then completed a cigarette self-administration task. For cigarette self-administration, neither smoking status nor product affected latency to initiate smoking; however, LITS were more likely to abstain from smoking and administered fewer puffs than DDS. Across participants, pharmacologically active products (NC, RNC, NI) were associated with fewer cigarette puffs than the NFI. For subjective measures, only cigarettes (NC, RNC) reduced craving in both LITS and DDS. NC, RNC, and NI reduced withdrawal in DDS, while withdrawal remained at floor levels across time points among LITS. While subjective ratings and smoking behavior were largely comparable across LITS and DDS, differing patterns of withdrawal symptoms suggest that dependent smoking is motivated by negative reinforcement while nondependent smoking is not. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Threshold dose for intravenous nicotine self-administration in young adult non-dependent smokers.

Reducing nicotine content of inhaled tobacco products may prevent nicotine addiction, but the threshold for nicotine reinforcement has not been systematically evaluated in controlled human laboratory studies. The current study uses a novel double-blind placebo-controlled intravenous (IV) nicotine self-administration (NSA) model to determine threshold for subjective effects of nicotine and nicotine reinforcement using a forced choice self-administration procedure. Young adults (n = 34) had 5 laboratory sessions after overnight nicotine abstinence. In each session, participants sampled and rated the subjective effects of an IV dose of nicotine (0.0125, 0.025, 0.05, 0.1, or 0.2 mg nicotine/70 kg bodyweight) versus saline (placebo), then were given a total of 10 opportunities to self-administer either the IV dose of nicotine or placebo. Mixed effect models revealed a significant effect of nicotine dose for positive (i.e., "stimulatory" and "pleasurable"; p < .0001) effects, but not "aversive" effects during sampling period. Post hoc comparisons showed that higher doses (i.e., 0.1 and 0.2 mg) were associated with greater stimulatory, pleasurable, and physiological effects than placebo and lower doses. Mixed effect models revealed that only the highest dose (i.e., 0.2 mg) was consistently preferred over placebo. Sex differences were generally weak (p = .03-.05). Using our IV nicotine NSA model, the threshold for detecting positive effects of nicotine in young adult smokers is about 0.1 mg, but a higher dose of nicotine, 0.2 mg, is required to produce a consistent nicotine reinforcement. Regarding the regulatory impact, our findings further support the value of nicotine reinforcement threshold as a tobacco regulatory target.

Top-down and bottom-up attentional biases for smoking-related stimuli: Comparing dependent and non-dependent smokers

IntroductionSubstance use causes attentional biases for substance-related stimuli. Both bottom-up (preferential processing) and top-down (inhibitory control) processes are involved in attentional biases. We explored these aspects of attentional bias by using dependent and non-dependent cigarette smokers in order to see whether these two groups would differ in terms of general inhibitory control, bottom-up attentional bias, and top-down attentional biases. This enables us to see whether consumption behaviour would affect these cognitive responses to smoking-related stimuli. MethodsSmokers were categorised as either dependent (N = 26) or non-dependent (N = 34) smokers. A further group of non-smokers (N = 32) were recruited to act as controls. Participants then completed a behavioural inhibition task with general stimuli, a smoking-related eye tracking version of the dot-probe task, and an eye-tracking inhibition task with smoking-related stimuli. ResultsResults indicated that dependent smokers had decreased inhibition and increased attentional bias for smoking-related stimuli (and not control stimuli). By contrast, a decreased inhibition for smoking-related stimuli (in comparison to control stimuli) was not observed for non-dependent smokers. ConclusionsPreferential processing of substance-related stimuli may indicate usage of a substance, whereas poor inhibitory control for substance-related stimuli may only emerge if dependence develops. The results suggest that how people engage with substance abuse is important for top-down attentional biases.

Supplemental Material for The Relative Impact of Acute Nicotine and Tobacco Administration on Craving, Withdrawal, and Cigarette Self-Administration in Dependent and Nondependent Smokers

Supplemental Material for The Relative Impact of Acute Nicotine and Tobacco Administration on Craving, Withdrawal, and Cigarette Self-Administration in Dependent and Nondependent Smokers

Accounting for the Consequences of Tobacco Dependence on Cravings, Self-efficacy, and Motivation to Quit: Consideration of Identity Concerns.

Tobacco dependence has been found to increase smoking cravings, and reduce both self-efficacy and motivation to quit. The present research proposes to test the hypothesis that such negative consequences are related to identity concerns and should thus appear more strongly in dependent smokers with a high (vs. low) smoker identity. In two correlational studies, daily smokers (Study 1: N = 237; Study 2: N = 154) were assessed for tobacco dependence, smoker identity, self-efficacy, craving to smoke (Study 1), and motivation to quit (Study 2). Among smokers who declared to be strongly dependent, those scoring high in smoker identity reported more smoking cravings (β = .28, p = .008, 95% CI [0.084, 0.563], $ {\upeta}_p^{{}^2} $ = .03) and less motivation to quit than those scoring low (β = -.58, p = .003, 95% CI [-1.379, -0.282], $ {\upeta}_p^{{}^2} $ = .06). Smoker identity was unrelated to these variables among non-dependent smokers (ps > .40). The relationship between tobacco dependence and self-efficacy was not affected by smoker identity (ps > .45). Through these studies, we provided evidence that the implications of tobacco dependence on smoking maintenance and difficulties in quitting may be, in part, explained by identity mechanisms.

Individual and combined effects of cannabis and tobacco on drug reward processing in non-dependent users

RationaleCannabis and tobacco are often smoked simultaneously in joints, and this practice may increase the risks of developing tobacco and/or cannabis use disorders. Currently, there is no human experimental research on how these drugs interact on addiction-related measures.ObjectivesThis study aimed to investigate how cannabis and tobacco, each alone and combined together in joints, affected individuals’ demand for cannabis puffs and cigarettes, explicit liking of drug and non-drug-related stimuli and craving.MethodA double-blind, 2 (active cannabis, placebo cannabis) × 2 (active tobacco, placebo tobacco) crossover design was used with 24 non-dependent cannabis and tobacco smokers. They completed a pleasantness rating task (PRT), a marijuana purchase task (MPT) and a cigarette purchase task (CPT) alongside measures of craving pre- and post-drug administration.ResultsRelative to placebo cannabis, active cannabis reduced liking of cannabis-associated stimuli and increased response time to all stimuli except cigarette-related stimuli. Relative to placebo cannabis, active cannabis decreased demand for cannabis puffs (trends for breakpoint and elasticity) and cigarettes (breakpoint, Pmax, Omax) on several characteristics of the purchase tasks. We found no evidence that active tobacco, both alone or combined with cannabis, had an effect on liking, demand or craving.ConclusionsAcutely, cannabis reduced liking of cannabis-related stimuli and demand for cannabis itself. Acute cannabis also reduced demand for cigarettes on the CPT. Acute tobacco administration did not affect demand or pleasantness ratings for cigarettes themselves or cannabis. In non-dependent cannabis and tobacco co-users, tobacco did not influence the rewarding effects of cannabis.

The Role of Nicotine Dependence in E-Cigarettes' Potential for Smoking Reduction.

E-cigarettes (Electronic Nicotine Delivery Systems, or ENDS) are an increasingly popular tobacco product among youth. Some evidence suggests that e-cigarettes may be effective for harm reduction and smoking cessation, although these claims remain controversial. Little is known about how nicotine dependence may contribute to e-cigarettes' effectiveness in reducing or quitting conventional smoking. A cohort of young adults were surveyed over 4 years (approximately ages 19-23). Varying-coefficient models (VCMs) were used to examine the relationship between e-cigarette use and conventional smoking frequency, and how this relationship varies across users with different nicotine dependence levels. Lifetime, but not recent, e-cigarette use was associated with less frequent concurrent smoking of conventional cigarettes among those with high levels of nicotine dependence. However, nondependent e-cigarette users smoked conventional cigarettes slightly more frequently than those who had never used e-cigarettes. Nearly half of ever e-cigarette users reported using them to quit smoking at the last measurement wave. For those who used e-cigarettes in a cessation attempt, the frequency of e-cigarette use was not associated with reductions in future conventional smoking frequency. These findings offer possible support that e-cigarettes may act as a smoking reduction method among highly nicotine-dependent young adult cigarette smokers. However, the opposite was found in non-dependent smokers, suggesting that e-cigarette use should be discouraged among novice tobacco users. Additionally, although a substantial proportion of young adults used e-cigarettes to help them quit smoking, these self-initiated quit attempts with e-cigarettes were not associated with future smoking reduction or cessation. This study offers potential support for e-cigarettes as a smoking reduction tool among highly nicotine-dependent young adult conventional smokers, although the extent and nature of this remains unclear. The use of e-cigarettes as a quit aid was not associated with reductions in conventional smoking, consistent with most other quit aids in this sample except for nicotine replacement therapy, which was only effective for the most dependent smokers. Notably, these findings highlight the necessity of accounting for smokers' nicotine dependence levels when examining tobacco use patterns.

Preliminary test of cigarette nicotine discrimination threshold in non-dependent versus dependent smokers

BackgroundDespite its potential for understanding tobacco dependence, behavioral discrimination of nicotine via smoking has not been formally examined as a function of nicotine dependence level. MethodsSpectrum research cigarettes were used to compare non-dependent with dependent smokers on the lowest content of nicotine they could discriminate (i.e., “threshold”). Dependent (n=21; 16M, 5F) or non-dependent (n=7; 4M, 3F) smokers were tested on ability to discriminate between cigarettes with nicotine contents of 17, 11, 5, 2, and 1mg/g, one per session, from an “ultra-low” cigarette with 0.4mg/g (all had 9–10mg “tar”). All abstained from smoking overnight prior to sessions, and number of sessions was determined by the lowest nicotine content they could reliably discriminate from the ultra-low on >80% of trials (i.e., ≥5 of 6). Subjective perceptions and cigarette choice behavior were also assessed and related to discrimination behavior. ResultsDiscrimination thresholds (and most perceptions) did not differ between dependent and non-dependent smokers, with median thresholds of 11mg/g for both subgroups. Yet, “liking” and puff choice for threshold cigarettes were greater in dependent but not non-dependent smokers, while cigarettes with nicotine contents below threshold did not support “liking” or choice in both groups. ConclusionsIn sum, this preliminary study suggests threshold for discriminating nicotine via smoking may not vary by dependence level, and further study is needed to confirm that cigarettes unable to be discriminated are also not reinforcing.

The impact of social context on cigarette self-administration in nondependent smokers.

Tobacco use in nondependent smokers (i.e. chippers) is believed to be largely determined by situational factors including social context. However, little empirical research has examined how different social contexts impact chippers' smoking behaviour. Twenty-eight (16 men) chippers completed two laboratory sessions where they were offered an opportunity to self-administer puffs of their preferred tobacco brand using a progressive ratio task. During an individual session, participants self-administered cigarettes alone and during a paired session, they self-administered cigarettes with a coparticipant who was also smoking. The strongest predictors for number of self-administered puffs and breakpoint during the paired session were coparticipants' number of puffs and breakpoint, respectively (P<0.001), followed by puffs taken and breakpoint during the individual session (P<0.01). Current smoking frequency (cigarettes/week) did not significantly predict puffs taken or breakpoint during the paired session. Latency to cigarette self-administration during the paired session was correlated positively with coparticipants' latency (P<0.05), but not with latency during the individual session or cigarettes per week. The findings suggest that the presence of another smoker exerts an important influence on the quantity of chippers' smoking behaviour, such that chippers match their smoking behaviour to that of other smokers in their proximate environment.

Impulsivity and Stress Response in Nondependent Smokers (Tobacco Chippers) in Comparison to Heavy Smokers and Nonsmokers.

Tobacco chippers are light smokers with stable patterns of smoking that exhibit lower nicotine dependence severity than heavy smokers. Chippers may provide valuable information about the factors influencing drug dependence. Impulsivity and stress are two factors known to influence smoking. By comparing nondependent smokers (tobacco chippers, n = 25) to dependent smokers (heavy smokers, n = 23) and nonsmokers (n = 25), this study examines the relationship between nicotine dependence, impulsivity, chronic stress, and stress reactivity. A total of 73 adult participants completed a study visit that included questionnaires to measure nicotine dependence, chronic stress, personality, affect, withdrawal, and craving. Impulsivity was measured with the delay discounting task and the flanker task. Stress reactivity was assessed by monitoring respiration, heart rate, and salivary cortisol during performance of a titrated Stroop task. Effects of acute stress on affect and craving were examined. Tobacco chippers were as impulsive as heavy smokers on the delay discounting task but no different from nonsmokers on the flanker task. Heavy smokers reported higher perceived stress than chippers and nonsmokers. Perceived stress was a significant predictor of discounting only in heavy smokers. Acute stress induced changes in respiration, heart rate, and heart rate variability. Craving and negative affect increased after stress in both smoking groups, but craving was associated with affect only in chippers. Tobacco chippers do not differ from heavy smokers in impulsivity, but do differ in perceived stress. One's perception and experience of stress might be associated to nicotine dependence resistance and could inform smoking cessation treatments. By examining impulsivity, chronic stress, and stress reactivity in nondependent smokers (tobacco chippers) compared to dependent smokers and nonsmokers, this study contributes to the understanding of nicotine addiction and informs smoking cessation programs.

Nicotine Dependence in Adolescence and Physical Health Symptoms in Early Adulthood.

To examine the prospective associations of Diagnostic and Statistical Manual of Mental Disorders nicotine dependence (ND) and other individual and parental factors in adolescence on self-reported health symptoms in early adulthood. Multiethnic prospective longitudinal cohort of adolescents from grades 6-10 and a parent (N = 908) from the Chicago Public Schools. Adolescents were interviewed five times at 6-month intervals (Waves 1-5) and once 4.5 years later (Wave 6). Parents were interviewed annually three times (W1, W3, W5). Multivariate regressions estimated prospective associations of Diagnostic and Statistical Manual of Mental Disorders ND, other individual and familial risk factors in adolescence (mean age 16.6) on physical health symptoms in early adulthood (mean age 21.3), controlling for health symptoms in adolescence. Levels of health symptoms declined from adolescence to early adulthood, except among dependent smokers. Nicotine dependent adolescents reported more health symptoms as young adults than nonsmokers and nondependent smokers, especially if depressed. ND and health symptoms in adolescence were the strongest predictors of health in early adulthood. These two adolescent factors, depression, and the familial factors of parental ND, depression and health conditions, each independently predicted health symptoms in young adulthood. Females reported more symptoms than males. There is continuity of health status over time. ND, depression, and parental factors in adolescence contribute to poor health in early adulthood. The findings highlight not only the role of adolescent behavior, but the importance of the family in the development of young adult health. Reducing smoking, particularly ND, and depression among adolescents and parents will decrease physical health burden.

The effects of nicotine dependence and acute abstinence on the processing of drug and non-drug rewards.

Drug addiction may be characterised by a hypersensitivity to drug rewards and a hyposensitivity to non-drug rewards. This imbalance may become further polarised during acute abstinence. (i) Examine the differences between dependent and occasional smokers in choices for, motivation for and self-reported wanting and liking of cigarette and non-drug rewards. (ii) Examine the effects of 12-h nicotine abstinence on these metrics. Dependent (n = 20) and occasional, non-dependent smokers (n = 20) were tested after ad libitum smoking and ≥12-h of nicotine abstinence. A novel task was developed (Drug, Reward and Motivation-Choice (DReaM-Choice)) in which different rewards (cigarettes, music and chocolate) could be won. In each trial, participants chose between two rewards and then could earn the chosen reward via repeated button-pressing. Participants subsequently 'consumed' and rated subjective liking of the rewards they had won. Compared with occasional smokers, dependent smokers made more choices for (p < 0.001), pressed more for (p = 0.046) and reported more wanting (p = 0.007) and liking (p < 0.001) of cigarettes, and also made fewer choices for chocolate (p = 0.005). There were no differences between the groups on button-pressing for chocolate or music. However, the balance between drug and non-drug reward processing was different between the groups across all metrics. Twelve-hour nicotine abstinence led to more cigarette choices (p < 0.001) and fewer music choices (p = 0.042) in both groups. Nicotine dependence was associated with a hypersensitivity to cigarette rewards, but we found little evidence indicating a hyposensitivity to non-drug rewards. Our findings question the moderating influence of dependence on how acute nicotine abstinence affects reward processing.

Acute effects of nicotine on alcohol cue-reactivity in nondependent and dependent smokers.

Evidence from alcohol self-administration studies suggests that nicotine replacement therapy may influence subjective and behavioral responses to alcohol. However, its effect on alcohol cue-reactivity is unknown. The present study examined the impact of acutely administered nicotine on subjective responses to alcohol-focused pictorial stimuli. In a mixed within/between-subjects design, nondependent smokers (n = 51) and dependent smokers (n = 45) who socially drink were assigned to either a nicotine (4 mg) or placebo lozenge condition following overnight tobacco abstinence. Following lozenge absorption, participants viewed neutral images followed by alcohol-focused pictures. Craving measures for alcohol and tobacco were completed at baseline, following lozenge absorption, following neutral cues, and following alcohol cues. The presentation of alcohol cues increased alcohol-related craving relative to neutral cues, especially among men, but the administration of nicotine did not influence the magnitude of these effects. Nicotine lozenges were found to decrease intentions to smoke and withdrawal-related craving in dependent but not in nondependent smokers. Finally, the presentation of alcohol cues was found to increase intentions to smoke relative to neutral cues across participants regardless of lozenge condition. Findings suggest that although the presentation of alcohol cues can increase alcohol- and tobacco-related cravings in smokers, such effects do not appear to be affected by acute nicotine administration.

An examination of reactivity to craving assessment: Craving to smoke does not change over the course of a multi-item craving questionnaire

IntroductionSelf-report measures are typically used to assess drug craving, but researchers have questioned whether completing these assessments can elicit or enhance craving. Previous studies have examined cigarette craving reactivity and found null craving reactivity effects. Several methodological limitations of those studies, however, preclude definitive conclusions. The current study addresses limitations of previous studies and extends this area of research by using a large sample size to examine: (1) item-by-item changes in craving level during questionnaire completion, (2) craving reactivity as a function of craving intensity reflected in item content, (3) craving reactivity differences between nicotine dependent and nondependent smokers, and (4) potential reactivity across multiple sessions. This study also used a more comprehensive craving assessment (the 32-item Questionnaire on Smoking Urges; QSU) than employed in previous studies. MethodsNicotine dependent and nondependent smokers (n=270; nicotine dependence determined by the Nicotine Addiction Taxon Scale) completed the QSU on six separate occasions across 12weeks. Craving level was observed at the item level and across various subsets of items. ResultsAnalyses indicated that there was no significant effect of item/subset position on craving ratings, nor were there any significant interactions between item/subset position and session or level of nicotine dependence. ConclusionsThese findings indicate that, even with relatively sensitive procedures for detecting potential reactivity, there was no evidence that completing a craving questionnaire induces craving.

Effect of variation in BDNF Val66Met polymorphism, smoking, and nicotine dependence on symptom severity of depressive and anxiety disorders

BackgroundSmoking, especially nicotine dependence is associated with more severe symptoms of depression and anxiety disorders. However, the mechanisms underlying this association are unclear. We investigated the effect of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on the severity of depressive and anxiety symptoms in never-smokers, former smokers, non-dependent, and nicotine-dependent smokers with a current diagnosis of depression and/or anxiety. MethodsPatients with depressive or anxiety disorders and with available BDNF Val66Met polymorphism data (N=1271) were selected from Netherlands Study of Depression and Anxiety (NESDA). Dependent variables were severity of symptoms. Independent variables were smoking status and BDNF genotype. Age, sex, education, recent negative life events, alcohol use, body mass index, and physical activity were treated as covariates. ResultsAfter controlling for covariates, nicotine-dependent smokers had more severe depressive symptoms than non-dependent smokers, former and never-smokers. The latter three groups did not differ in severity of depression. In Val66Val carriers, nicotine-dependent smokers had more severe symptoms of depression and anxiety than the other three groups, which were comparable in symptom severity. In Met66 carriers, there were no group differences on severity of depression and anxiety. Nicotine dependence was the strongest predictor of severity of symptoms only in Val66Val carriers. ConclusionsIn patients with a current diagnosis of depression or anxiety, the relationship between nicotine dependence and symptom severity may be moderated by BDNF Val66Met. These results suggest that inherent genetic differences may be crucial for the worse behavioral outcome of nicotine, and that Val66Val carriers may benefit most in mental health from smoking cessation.

Response Time to Craving-Item Ratings as an Implicit Measure of Craving-Related Processes.

Drug craving is typically measured through explicit ratings of craving levels. We examined response time to craving ratings as an implicit measure of craving processes in cigarette smokers. Response time and inter-item variability were investigated as potential indices of certainty in craving ratings. Cigarette smokers, categorized as tobacco dependent or nondependent, completed multiple cue-reactivity sessions with smoking and neutral cues. After each cue, craving level and response time was assessed. Significant inverted-U relationships emerged between craving level and both response time and inter-item variability across conditions, sessions, and groups. Faster response times and less inter-item variability emerged after neutral relative to smoking cues for nondependent smokers and after smoking relative to neutral cues for dependent smokers. Response time provided incremental validity beyond craving level in predicting dependence. Results support use of response time as an implicit measure of craving processes and further distinguish craving experiences between dependent and nondependent smokers.

Neural correlates of performance monitoring in daily and intermittent smokers

ObjectivesDespite efforts that have increased smoking regulation, cigarette taxation, and social stigma, cigarette smoking remains the leading cause of preventable death worldwide, and a significant personal and public economic burden. In the U.S., intermittent smokers comprise approximately 22% of all smokers and represent a stable, non-dependent group that may possess protective factors that prevent the transition to dependence. One possibility is that intermittent smokers have intact CNS frontal regulatory and control mechanisms that enable resistance to nicotine-induced changes. MethodsThe present study measured inhibitory control using a flanker task and a go–nogo continuous performance tasks in daily dependent smokers, intermittent non-dependent smokers, and nonsmokers. Event-related potential (ERP) measures of were concurrently recorded to measure performance monitoring via Event-Related Negativity (ERN) and error positivity (Pe) components during error trials for each task. ResultsIn both tasks, behavioral and ERN measures did not differ between groups; however, amplitude of the Pe component was largest among intermittent smokers. ConclusionsThus, intermittent smokers differed from both daily smokers and nonsmokers on error processing, potentially revealing neuroprotective cognitive processes in nicotine dependence. SignificanceA better understanding of factors that mediate behavioral regulation may provide novel treatment approaches that help individuals achieve controlled smoking or cessation.

The magnitude and reliability of cue-specific craving in nondependent smokers

BackgroundCue-reactivity is a robust phenomenon in regular cigarette smokers (Carter and Tiffany, 1999), but it has not been widely investigated in nondependent smokers. Further, most research on cue-specific craving assesses response to cues in a single experimental session. As such, investigations of cue-specific craving have primarily measured state-like but not trait-like responses to smoking stimuli. MethodsThis study measured general and cue-specific craving in nondependent smokers and assessed the within-session and cross-session reliability of these two facets of craving. Participants (n=154) attended five laboratory sessions over the course of three months and completed multiple cue-reactivity trials (using smoking and neutral in vivo and photographic stimuli) during each study visit. ResultsResults indicated that smoking cues elicited significantly stronger craving than neutral cues across study sessions, and that craving ratings following smoking cues decreased across subsequent sessions. Within-session and cross-session reliability was extremely high. ConclusionsOverall, findings indicate that nondependent smokers experience reactivity to smoking cues, and that this response is quite reliable within and across sessions. Further, the magnitude of cue-specific craving was comparable to what has been observed in heavy, dependent smokers.

Are waterpipe users tobacco-dependent?

Jawad and colleagues (1) argue that waterpipe tobacco smoking has the potential to become the next public health priority, as the global prevalence of waterpipe smoking is increasing, especially among younger users. They note that, across a number of geographical regions, users typically lack knowledge about the health risks of waterpipe tobacco smoking. A number of misbeliefs appear to be common, such as that the water in the waterpipe bowl acts as a filter for harmful chemicals, that waterpipe tobacco has fewer toxic chemicals than cigarettes, and that the aromatic flavour and smell of waterpipe tobacco (something that is regulated for cigarettes in many countries) implies safety. Although these misbeliefs are worrying, there is also a lack of reliable evidence on the health effects of waterpipe tobacco smoking. There have been relatively few studies investigating the effect of waterpipe tobacco smoking on health, and those that have been conducted are typically of limited quality. Similarly, research on the relative level of toxicant exposure resulting from waterpipe tobacco smoking (compared with cigarette smoking) is misleading, due to the differing patterns of use between the two. In many groups, particularly those where it is a recent phenomenon, waterpipe is often infrequent and more social in nature. It may therefore not be associated with the same pattern of dependence seen in regular, habitual cigarette smokers.

The effect of snus on alcohol-related cigarette administration in dependent and non-dependent smokers

IntroductionAlcohol has been found to increase tobacco smoking in both dependent daily smokers (DDS) and nondependent nondaily smokers (NNS), yet little attention has been directed toward examining how different treatments/products modify drinking-related smoking behavior. MethodsThis study examined the acute effects of snus (4mg of nicotine) on alcohol-related smoking responses in 18 DDS and 17 NNS. During each double-blind session, participants were randomly assigned to receive one of the following combinations: alcohol and snus, alcohol and placebo snus, placebo alcohol and snus, or placebo alcohol and placebo snus. Participants consumed their assigned beverage before absorbing their session's product, and after 30min participants could self-administer puffs of their preferred brand of cigarette over a 60-minute period using a progressive ratio task. ResultsAlcohol significantly increased tobacco craving (p<.001) and tended to decrease latency to start smoking (p=.021) but only among NNS. In contrast, snus tended to decrease the number of puffs earned and how hard DDS worked for puffs in both beverage conditions (ps≤.019) but it did not alter the smoking behavior of NNS. Craving was not significantly impacted by snus in either type of smoker. DiscussionThese findings raise the possibility that different processes mediate alcohol and cigarette co-use in NNS and DDS and suggest that snus may be effective in reducing alcohol-related cigarette use in DDS specifically.