Non-abstinent Smokers Research Articles

Efficacy of personalised text message intervention in reducing smoking frequency and amount for non-abstinent smokers: A double-blind, randomised controlled trial.

Emerging evidence supports the efficacy of mobile phone interventions for smoking cessation. However, behaviour changes of smokers who fail to reach abstinence and the related psychological mechanism are still understudied. We aimed to evaluate the efficacy of a behaviour change theory-based smoking cessation intervention delivered through personalised text messages from the perspective of smokers who fail to reach abstinence. We conducted a two-arm, double-blind, randomised controlled trial, with the intervention group receiving personalised text messages developed specifically for this study, and the control group receiving non-personalised ones related to smoking cessation. These messages were sent over a period of three months. We looked at three outcomes: changes in smoking frequency, in smoking amount, and in protection motivation theory (PMT) construct scores. We obtained smoking cessation results for 722 participants who went through the randomisation process (intervention: 360, control: 362; block randomisation design). Overall, 32.3% of baseline daily smokers in the intervention group and 20.0% in the control group changed to weekly smokers during the follow-up period (P < 0.001), while 43.4% of consistent daily smokers in the intervention group and 32.8% in the control group continuously reduced their smoking amount (P < 0.001). We observed associations between the intrinsic rewards of smoking and changes from daily to weekly smoking, the perceived severity of smoking and reductions in smoking amount, as well as the self-efficacy of quitting and changes from daily to weekly smoking/reductions in smoking amount. We found that a personalised text message-based intervention was more likely to decrease the frequency and amount of smoking in smokers who failed to reach abstinence compared to a non-personalised one. We also explored the possible psychological mechanism of such positive effects. Here we provide evidence for countries to consider the promotion of smoking cessations using behaviour theory-driven personalised text messages, which may be more cost-effective than traditional approaches. Peking University: ChiCTR2100041942.

Differences in Cognitive Task Performance, Reinforcement Enhancement, and Nicotine Dependence Between Menthol and Nonmenthol Cigarette Smokers.

Menthol has been shown to target similar brain regions and neural receptors as nicotine, yet the association between menthol cigarette use and cognitive performance remains unknown. This study examined differences in cognitive task performance between menthol (MS) and nonmenthol (NMS) cigarette smokers after acute cigarette consumption. Sixty white and black and/or African American, nonabstinent, MS (n = 30) and NMS (n = 30) were assessed presmoking and postsmoking their preferred cigarette on four computerized tasks: Continuous Performance Task (CPT; alerting attention), N-Back Task (working memory), Finger Tapping Task (motor control), and Apple Picker Task (reinforcement enhancement). Self-reported nicotine dependence and objective smoking topography measures were also compared between groups. Initial unadjusted analyses showed a significant effect of cigarette type × time on CPT speed (p = .042), where MS improved while NMS group worsened in CPT speed after smoking. After controlling for baseline cigarette craving and cigarette nicotine levels, the effect of cigarette type × time for all cognitive outcomes was statistically nonsignificant (ps > .05). However, there remained a significant effect of cigarette type, where MS versus NMS had poorer CPT (p = .046) and N-Back Task accuracy (p = .006) but faster N-Back speed (p = .039). There were no statistically significant differences between groups on reinforcement enhancement, nicotine dependence, or smoking behavior outcomes (ps > .05). Contrary to our hypotheses, results did not find a significant effect of cigarette type on the change in cognitive performance after acute smoking in nonabstinent smokers. Further studies are needed to clarify the specific pharmacological effects of nicotine and menthol on cognitive functioning. The current study is the first to compare the potential enhancement of cognitive task performance after acute cigarette smoking between satiated menthol and nonmenthol cigarette smokers. Study results suggest that acute menthol cigarette use may not enhance cognitive function above and beyond nonmenthol cigarettes to increase dependence among menthol smokers. However, the contribution of other psychological factors (eg, craving, mood) and cigarette characteristics (eg, nicotine content) may be involved in cognitive function enhancement to perpetuate dependence and smoking persistence for menthol smokers.

Level of abstinence mediates heart-rate response to cue-elicited craving in smokers

&#x0D; &#x0D; &#x0D; &#x0D; The subjective and autonomic components of nicotine craving were examined in abstinent and non-abstinent smokers using a cue reactivity paradigm. A cigarette abstinent condition was used to examine how smoking deprivation mediates the activity of positive and negative reinforcement mechanisms. Levels of craving and physiologic responses were monitored during the presentation of videotaped neutral and smoking stimuli. Relative to the neutral material, smoking stimuli increased several indices of subjective craving in both abstinent and non-abstinent smokers. Autonomic responses to the smoking stimuli however, appeared to be mediated by the level of abstinence. Non-deprived smokers showed an increase in heart rate during the first minute of the smoking stimuli presentation relative to the first minute of the control video, while abstinent smokers showed no change. The autonomic responses of cigarette craving may be dependent on the perceived reinforcing value of cigarettes, which can be modulated by cigarette abstinence. These findings are consistent with the hypothesis that increased heart rate may be a marker for incentive motivation, but also strongly support a multi-dimensional model of nicotine craving. Furthermore, they stress the importance of recognising the condition of the smoker as a critical determinant in craving responses.&#x0D; &#x0D; &#x0D; &#x0D;

Momentary changes in craving predict smoking lapse behavior: a laboratory study.

Current research on factors that predict smoking lapse behavior is limited in its ability to fully characterize the critical moments leading up to decisions to smoke. We used a validated and widely used experimental analogue for smoking lapse to assess how moment-to-moment dynamics of craving relate to decisions to smoke. Heavy smokers (N = 128, M age = 35.9) participated in a 50-min laboratory delay to smoking task on 2 consecutive days, earning money for each 5min they remained abstinent or ending the task by choosing to smoke. Participants rated craving and negative affect levels immediately prior to each choice. Participants were randomized to smoking as usual (n = 50) or overnight abstinence (n = 50 successfully abstained, n = 22 failed abstaining) prior to session 2. Discrete-time hazard models were used to examine craving and negative affect as time-varying predictors of smoking. Higher craving levels prior to smoking opportunities predicted increased risk of smoking. When controlling for craving levels, incremental increases in craving predicted increased smoking risk. Increases in negative affect incrementally predicted increased smoking risk at session 2 only. Smokers who failed to abstain were at a higher risk of smoking than those who successfully abstained, whereas abstinent and non-abstinent smokers did not differ in smoking risk. Findings demonstrate an extension of the smoking lapse paradigm that can be utilized to capture momentary changes in craving that predict smoking behavior. Evaluations of nuanced craving experiences may inform clinical and pharmacological research on preventing smoking lapse and relapse.

Nicotine delivery and pharmacologic response from Verve, an oral nicotine delivery product

Verve, an oral nicotine delivery product (ONDP), was introduced by Nu Mark (Altria Client Group, Richmond VA) for smokers to use in places where smoking is prohibited. This study assessed the effect of this ONDP on plasma nicotine levels, heart rate, product satisfaction, and ability to suppress smoking urge and cigarette cravings. Thirteen daily cigarette smokers [8 men and 5 women; average age 33.4years] attended two laboratory sessions, one occurred after overnight tobacco abstinence. Plasma samples were collected before and after ONDP use and measured for nicotine. In non-abstinent smokers, mean plasma nicotine levels increased from 18.3 to 21.0ng/mL. In abstinent smokers, average nicotine levels increased from 3.1 to 4.5ng/mL. After overnight tobacco abstinence, ONDP use significantly (p<0.01) increased heart rate from 69beats per minute (bpm) to 75bpm; while urge to smoke decreased significantly (p<0.01) from a score of 8.6 to 4.9. Participants indicated moderate product satisfaction that was not changed by tobacco abstinence. Analysis of unused ONDP revealed total nicotine levels of 1.68±0.09mg/disc. Spent ONDP discs were also analyzed to determine % nicotine liberated during chewing; results were 80% in the non-abstinent and 82% in the abstinent conditions (ns). Our study results indicate that ONDP use can increase plasma nicotine levels and heart rate and reduce cigarette cravings in abstinent smokers.

Effects of 7.5% carbon dioxide inhalation on anxiety and mood in cigarette smokers.

Cigarette smoking is associated with elevated risk of anxiety and mood disorder. Using the 7.5% carbon dioxide (CO2) inhalation model of anxiety induction, we examined the effects of smoking status and abstinence from smoking on anxiety responses. Physiological and subjective responses to CO2 and medical air were compared in smokers and non-smokers (Experiment One) and in overnight abstinent and non-abstinent smokers (Experiment Two). CO2 induced greater increases in blood pressure in non-smokers compared with smokers (ps < 0.043), and greater increases in anxiety (p = 0.005) and negative affect (p = 0.054) in non-abstinent compared with abstinent smokers. CO2 increased physiological and subjective indices of anxiety. There were differences across smoking groups indicating that the CO2 inhalation model is a useful tool for examining the relationship between smoking and anxiety. The findings suggested that both acute smoking and acute abstinence may protect against anxious responding. Further investigation is needed in long-term heavy smokers.

P50 amplitude reduction: a nicotinic receptor-mediated deficit in first-degree relatives of schizophrenia patients

Impaired P50 gating is a putative index of genetically mediated nicotinic dysfunction in schizophrenia. However, assessment is confounded, in patients, by differential effects of smoking, symptoms, and treatment. This double-blind placebo-controlled study was designed to tease apart the relationships among P50, acute and chronic nicotine exposure, and familial risk. Experiment 1: To assess the putative effects of genetic vulnerability without other confounds, 14 unaffected relatives of schizophrenia patients and 15 controls, all nonsmokers, were tested with/without 7 mg transdermal nicotine. Family members had reduced P50 amplitude to an initial auditory stimulus, but normal P50 gating. Nicotine decreased P50 amplitude in controls; family members had a mixed response: eight decreased and six increased P50 amplitude with nicotine. Experiment 2: To assess chronic nicotine use and short-term withdrawal as a model of nicotinic dysfunction, 26 healthy smokers (14 abstinent for >12 h) received 21 mg transdermal nicotine. Chronic nicotine use, alone, did not alter P50 amplitude or gating. Short-term withdrawal resulted in decreased P50 amplitude, with no effect on P50 gating. Nicotine increased P50 amplitude in abstinent smokers and decreased it in nonabstinent smokers. Familial vulnerability to schizophrenia reduces P50 amplitude. Nicotinic modulation of this deficit mirrors the effect of nicotine during smoking abstinence and suggests an "inverted-U" relationship between P50 amplitude and endogenous nicotinic activity. P50 amplitude may, therefore, be a sensitive marker of nicotinic dysfunction in individuals with familial risk for schizophrenia, which is mediated through mechanisms (e.g., α₄β₂ receptors) that are distinct from those (e.g., α₇ receptors) that mediate P50 gating.

Effects of smoking abstinence on impulsive behavior among smokers high and low in ADHD-like symptoms

Impulsivity, a multifaceted construct that includes inhibitory control and heightened preference for immediate reward, is central to models of drug use and abuse. Within a self-medication framework, abstinence from smoking may lead to an increase in impulsive behavior and the likelihood of relapse, particularly among persons with disorders (e.g., attention-deficit/hyperactivity disorder, ADHD) and personality traits (e.g., impulsivity) linked to impulsive behavior. This study aimed to examine the effects of smoking abstinence on multiple measures of impulsivity among a non-clinical sample of adult smokers selected for high and low levels of ADHD symptoms. In a within-subjects design, participants selected for high or low levels of self-reported ADHD symptoms (N = 56) completed sessions following overnight abstinence and when smoking as usual (order counterbalanced). Measures of impulsive behavior included response inhibition (i.e., stop signal task), interference control (i.e., attentional modification of prepulse inhibition (PPI) of startle), and impulsive choice (i.e., hypothetical delay discounting). As hypothesized, abstinence decreased response inhibition and PPI. Although ADHD symptoms moderated abstinence effects on impulsive choice and response inhibition, the pattern was opposite to our predictions: the low-ADHD group responded more impulsively when abstinent, whereas the high-ADHD group was relatively unaffected by abstinence. These findings highlight the importance of utilizing multiple laboratory measures to examine a multifactorial construct such as impulsive behavior and raise questions about how best to assess symptoms of ADHD and impulsivity among non-abstinent smokers.

The separate and combined effects of nicotine and alcohol on working memory capacity in nonabstinent smokers.

Research indicates that nicotine and alcohol are often used on the same occasion. However, the reasons for their concurrent use are not well understood. We hypothesized that one reason smokers use tobacco when they drink alcohol is to compensate for alcohol's negative effects on processing capacity with nicotine's enhancement of processing capacity. As such, the present study tested this theory by using an independent groups design to examine the separate and combined acute effects of alcohol and nicotine on working memory (WM) capacity. Nonabstinent daily smokers (n = 127) performed the counting span task (CSPAN) after consuming either an alcohol (men: 0.8 g/kg; women: 0.7 g/kg) or placebo beverage and smoking either nicotinized (1.14 mg nicotine, 15.9 mg tar) or denicotinized (.06 mg nicotine, 17.9 mg tar) cigarettes. Analyses revealed that smokers who smoked the nicotinized cigarettes performed significantly worse on the CSPAN task than smokers who smoked the denicotinized cigarettes. Although there was no main effect of alcohol on WM performance, women exhibited better WM performance than men after consuming alcohol whereas men performed better than women on the WM task after consuming the placebo beverage. Findings also revealed no interaction between the two substances on WM performance. Taken together, results suggest that nicotine impairs nonabstinent smokers' verbal WM capacity and that gender moderates the effects of alcohol on WM. Furthermore, the present findings failed to support the notion that nicotine compensates for alcohol-related decrements in working memory capacity.

Effects of acute abstinence and nicotine administration on taste perception in cigarette smokers

We investigated the effects of short-term abstinence from smoking and acute nicotine administration on taste perception in smokers. We assessed sensitivity for salt and sucrose solutions and the self-reported intensity and pleasantness of these tastes, using a previously validated model of taste perception. This was in order to investigate mechanisms by which cigarette smoking and smoking cessation may modulate dietary behaviour. Male and female daily smokers attended a single testing session. Participants were randomised to either abstain for smoking for 12 h or smoke as usual on the morning of testing. At the testing session, participants completed subjective ratings of mood and ratings of intensity and pleasantness of salt and sucrose solutions, followed by measurement of the threshold at which these solutions could be detected on the tongue. Participants were then randomised to smoking either a nicotine-containing or denicotinised cigarette, after which they completed the same measures as previously. Our data suggest that following cigarette smoking, lower taste thresholds are obtained after smoking a denicotinised cigarette compared with a nicotinised cigarette, but among females only. This effect was not observed among males and did not differ as a function of abstinence condition. In addition, among non-abstinent smokers, females demonstrated higher taste thresholds (i.e. reduced sensitivity) for salt than males, but this sex difference was not observed among abstinent smokers.

Research Highlights

Research Highlights

Fear-Potentiated Startle to Threat, and Prepulse Inhibition Among Young Adult Nonsmokers, Abstinent Smokers, and Nonabstinent Smokers

Evidence suggests that the transition from experimental to regular smoking is facilitated by the influence of tobacco on affective and attentional mechanisms. The objective of this study was to examine affective and attentional responses in young adult smokers using fear-potentiated startle and prepulse inhibition. Participants were 56 college nonsmokers, nonabstinent smokers, and overnight-abstinent smokers. The fear-potentiated startle test examined phasic responses to imminent threat cues and more sustained responses to unpredictable aversive events. Prepulse inhibition investigated responses to attended and ignored prepulse stimuli. Abstinent and nonabstinent smokers showed increased sustained potentiation of startle to contextual cues, compared to controls. Abstinent smokers showed increased fear-potentiated startle to threat cues, compared to nonsmokers. PPI did not discriminate between abstinent or nonabstinent smokers and controls. These findings suggest that negative affectivity or anxiety is associated with smoking, particularly during short withdrawal. Potentiated startle may provide a valuable tool in understanding the biologic mechanisms underlying nicotine withdrawal and inform cessation and prevention efforts.

Comparing attentional bias to smoking cues in current smokers, former smokers, and non-smokers using a dot-probe task

Much evidence documents that individuals with emotional and drug-use disorders demonstrate biased attention toward stimuli associated with their disorder. This bias appears to diminish following successful treatment. Two studies examined whether current cigarette smokers show biased attention toward smoking-related images compared with non-smokers (Studies 1 and 2) and whether this bias is less pronounced in former smokers (Study 2). Attentional bias toward cigarette-related photographs was examined using the dot-probe task. Pairs of images (one smoking-related) appeared side by side for 500 ms on a computer screen prior to the presentation of a probe (an asterisk) replacing one of the photographs. Subjects struck a key as quickly as possible to indicate the probe location. Attentional bias was defined as faster reaction times when the probe replaced the smoking-related image. In both studies, current smokers displayed significantly greater attentional bias toward cigarette stimuli than did non-smokers. Former smokers in Study 2 displayed an intermediate level of bias, but did not differ significantly in bias score from either of the other groups. These results support further use of the dot-probe task as a measure of attentional bias in non-abstinent smokers and in individuals undergoing smoking cessation treatment.

The effects of cigarette consumption on the Sternberg visual memory search paradigm.

To examine the performance of non-smokers (n = 24), light smokers (n = 22, mean 6.5 cigarettes per day) and heavy smokers (n = 19, mean 23 cigarettes per day) on the Sternberg memory search task. A repeated-measures, counterbalanced design was used with one between-subject factor, status (heavy, light or non-smoker) and two within-subject factors, condition (12 hours abstinence or ad libitum smoking) x time (pre- or post-cigarette). Heavy smokers in the pre-cigarette abstinent session had significantly slower reaction times, movement times and higher intercepts (a measure of factors contributing to performance other than rate of memory scan) than non-smokers. After smoking these differences were removed. This suggests that rather than improving performance smoking ameliorates a deficit in certain measures of the Sternberg task produced by abstinence. Under ad libitum conditions improvements in performance were attributed to practice. Across all within-subject conditions, there were no significant main effects of smoking status, and this result was consistent with the lack of relationship between measures of saliva continine and expired air carbon monoxide and performance. These data do not support the view that non-abstinent smokers differ from non-smokers in the performance of the Sternberg memory search procedure.

The Questionnaire of Smoking Urges is sensitive to abstinence and exposure to smoking-related cues

The Questionnaire of Smoking Urges (QSU) was designed to measure cravings elicited by abstinence from cigarette smoking. In the present study, the sensitivity of the QSU both to brief periods of abstinence and to exposure to smoking-related cues was investigated. A progressive ratio (PR) operant procedure was also employed, in which behaviour was maintained either by primary reinforcement (puffs on a cigarette) or by secondary reinforcement (tokens exchanged later for puffs on a cigarette) in separate experiments. Dependent smokers, who were not abstinent or who were abstinent for either 2 or 4 h, were tested in both a cue-rich and a no-cue environment. The results indicated that the QSU was sensitive both to brief periods of abstinence and to exposure to smoking-related cues, but the effect of smoking-related cues on QSU scores was maximal in non-abstinent smokers. In contrast, neither abstinence nor exposure to smoking-related cues significantly influenced the number of reinforcers earned, or the number of responses made, in either PR task. However, there was a significant interaction between gender and degree of abstinence on PR performance under primary reinforcement, and correlations between PR and QSU measures that were dependent on a complex interaction between the presence/absence of smoking-related cues and the type of reinforcer used. These results suggest that the QSU is sensitive to subtle influences on subjective urges to smoke in dependent smokers and, although PR measures are relatively insensitive to these influences, there is some evidence that PR performance is related to subjective measures of the urge to smoke.

Comparative mood states and cognitive skills of cigarette smokers, deprived smokers and nonsmokers

Regular cigarette smokers (na 15), overnight deprived smokers (na 15) and nonsmokers (na 20), were assessed on a battery of mood questionnaires and cognitive performance tasks, before and after a cigarette/rest period. At the initial session, deprived smokers reported significantly greater feelings of stress, irritability, depression, poor concentration and low pleasure, than both nondeprived smokers and nonsmokers (all comparisons, p50.01). After the rest/cigarette break, the mood states of all three groups became generally similar, although the previously deprived smokers still reported elevated depression. These findings suggest that mood gains after smoking reflect the simple reversal of abstinence eAects. On the cognitive tasks, there were no significant diAerences in letter cancellation performance between subgroups, either before or after smoking. With mental arithmetic, abstinent and nonabstinent smokers attempted more problems than nonsmokers, both before and after the rest/cigarette break. This is suggestive of faster cognitive processing in smokers, irrespective of their nicotine status. However, the cognitive performance data were untypical in various ways and need replication. #1998 John Wiley & Sons, Ltd.

Memory for cigarette advertisements enhanced by smoking abstinence.

Abstinent and nonabstinent smokers were exposed to a series of cigarette and automobileadvertisements. After a distractor event, a subsequent task tested recognition. Nonabstinentsmokers showed no differences in recognition for the 2 types of stimuli. Abstinent smokers, on theother hand, recognized more cigarette advertisements than automobile advertisements (p < .001).These results, coupled with previous research, indicate that although withdrawal induces generalcognitive deficits, abstinent smokers selectively attend to, and remember, smoking stimuli. Such abias may have ramifications for cessation efforts.

Abstinence from smoking decreases habituation to food cues

Smokers typically gain weight after cessation due, in part, to increased caloric intake. This increase may be due to enhanced responding to sensory characteristics of foods resulting from a failure to habituate to food cues. To test this possibility, salivation to eight presentations of strawberry yogurt was assessed in male smokers and nonsmokers in two sessions. To test stimulus specificity, on the ninth trial, subjects were presented either more strawberry yogurt or lemon yogurt. Smokers were studied under nonabstinent or abstinent conditions. Salivation for nonabstinent smokers and nonsmokers decreased over presentations, while abstinent smokers showed little change. Nonabstinent smokers and nonsmokers recovered salivation when the new flavor yogurt was presented, and showed greater consumption on the final trial for the different versus same flavor yogurt. Nonabstinent smokers participated in additional within-session smoking sessions to control for withdrawal. Nonabstinent subjects were not different across smoking or not smoking sessions, suggesting the effects are not due to the acute effects of withdrawal.