Persistence Of Cigarette Smoking Research Articles

Cannabis Use and the Onset of Cigarette and E-cigarette Use: A Prospective, Longitudinal Study Among Youth in the United States.

Cigarette use is declining among youth in the United States, whereas cannabis use and e-cigarette use are increasing. Cannabis use has been linked with increased uptake and persistence of cigarette smoking among adults. The goal of this study was to examine whether cannabis use is associated with the prevalence and incidence of cigarette, e-cigarette, and dual product use among U.S. youth. Data included U.S. youth ages 12-17 from two waves of the Population Assessment of Tobacco and Health (PATH) Study (Wave 1 youth, n = 13 651; Wave 1 tobacco-naive youth, n = 10 081). Weighted logistic regression models were used to examine the association between Wave 1 cannabis use and (1) Wave 1 prevalence of cigarette/e-cigarette use among Wave 1 youth and (2) Wave 2 incidence of cigarette/e-cigarette use among Wave 1 tobacco-naive youth. Analyses were run unadjusted and adjusted for demographics and internalizing/externalizing problem symptoms. Wave 1 cigarette and e-cigarette use were significantly more common among youth who used versus did not use cannabis. Among Wave 1 tobacco-naive youth, Wave 1 cannabis use was associated with significantly increased incidence of cigarette and e-cigarette use by Wave 2. Youth who use cannabis are more likely to report cigarette and e-cigarette use, and cannabis use is associated with increased risk of initiation of cigarette and e-cigarette use over 1 year. Continued success in tobacco control-specifically toward reducing smoking among adolescents-may require focusing on cannabis, e-cigarette, and cigarette use in public health education, outreach, and intervention efforts. These data extend our knowledge of cigarette and e-cigarette use among youth by showing that cannabis use is associated with increased prevalence and incidence of cigarette and e-cigarette use among youth, relative to youth who do not use cannabis. The increasing popularity of cannabis use among youth and diminished perceptions of risk, coupled with the strong link between cannabis use and tobacco use, may have unintended consequences for cigarette control efforts among youth.

CHRNA5/A3/B4 Variant rs3743078 and Nicotine-Related Phenotypes: Indirect Effects Through Nicotine Craving.

Nicotine craving is considered an important element in the persistence of cigarette smoking, but little is known about the role of craving in the widely recognized association between variants mapped to the neuronal nicotinic acetylcholine receptor (CHRN) genes on chromosome 15 and nicotine phenotypes. The associations between CHRNA5-CHRNA3-CHRNB4 variants and cigarettes per day (CPD), the Fagerström Test for Nicotine Dependence (FTND), and craving were analyzed in data from 662 lifetime smokers from an Israeli adult Jewish household sample. Indirect effects of genotype on nicotine phenotypes through craving were formally tested using regression and bootstrapping procedures. At CHRNA3, allele G of rs3743078 was associated with increased craving, CPD, and FTND scores: Participants with one or two copies of the G allele had, on average, higher scores on the craving scale (p = .0025), more cigarettes smoked (p = .0057), and higher scores on the FTND (p =.0024). With craving in the model, variant rs3743078 showed a significant indirect effect through craving on CPD (p = .0026) and on FTND score (p = .0024). A sizeable proportion of the total rs3743078 effect on CPD (56.4%) and FTND (65.2%) was indirect through craving. These results suggest that nicotine craving may play a central role in nicotine use disorders and may have utility as a therapeutic target.

Symptoms of alcohol dependence and smoking initiation and persistence: A longitudinal study among US adults

BackgroundA large number of adults report symptoms of, but do not meet diagnostic criteria for, an alcohol use disorder. Yet, little is known about the relationship between symptoms of alcohol use disorders and the initiation and persistence of smoking. This study prospectively examines the relationship between having 1–2 symptoms of alcohol dependence (without abuse) and smoking initiation and persistence as well as nicotine dependence over a 3-year period among adults in the United States. MethodsData were drawn from Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Relationships between Wave 1 symptoms of alcohol dependence, alcohol abuse, and alcohol dependence and initiation and persistence of cigarette smoking and nicotine dependence at Wave 2 were examined using logistic regression analyses. Analyses were adjusted for demographics, mood and anxiety disorders. ResultsSymptoms of alcohol dependence were associated with smoking initiation at Wave 2. There was no association between symptoms of alcohol dependence and smoking persistence. Symptoms of alcohol dependence predicted incident and persistent nicotine dependence. Findings persisted after adjusting for demographic characteristics and mood/anxiety disorders. ConclusionsEven 1–2 symptoms of alcohol dependence are associated with increased vulnerability to smoking initiation and onset and persistence of nicotine dependence at a similar strength as alcohol use disorders. Efforts at smoking cessation must address problematic alcohol use, even at the subclinical level, in order to improve efficacy.

Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States

Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9-10 years among adults in the United States (n = 4,938, ages 25-74). Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work-family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up. High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit. Interventions to address psychosocial stress may be important components within smoking cessation efforts.

Association Between COMT, PTSD, and Increased Smoking Following Hurricane Exposure in an Epidemiologic Sample

Tobacco smoking has been found to increase after the experience of a traumatic event and has been associated with posttraumatic stress disorder (PTSD). Initiation and persistence of cigarette smoking is moderately heritable; two recent investigations have implicated the COMT Val158Met (also known as rs4680) polymorphism in smoking age of initiation, dependence, as well as in quantity and frequency of smoking.To examine a possible association of COMT Val158Met and posttrauma increases in cigarette smoking, we studied 614 adults from the 2004 Florida Hurricane Study who returned saliva DNA samples via mail.PTSD was strongly associated with increased smoking. Moreover, each COMT Val158Met ‘Met’ allele predicted a 2.10-fold risk of smoking post-hurricane, independent of PTSD; follow-up analyses revealed that this finding was primarily driven by European-American males.This study represents the first genetic association study (to our knowledge) of smoking behavior following an acute stressor.

Cigarette smoking and the lifetime alcohol involvement continuum

Greater understanding of how alcohol use relates to the initiation, progression, and persistence of cigarette smoking is of great significance for efforts to prevent and treat smoking and excessive drinking and their substantial combined iatrogenic effects on health. Studies investigating the relationship between levels of alcohol involvement and smoking have typically been limited by analytic approaches that treat drinking behavior and alcohol use disorder diagnoses as separate phenomena rather than as indicators of a single latent alcohol involvement dimension. The purposes of the present study were (a) to create a lifetime index of alcohol involvement that integrates information about alcohol consumption and alcohol problems into a single measure and (b) to relate this index to initiation of smoking, progression from initiation to daily smoking, progression from initiation to dependence, and persistence of smoking. Rasch model analyses of data from 1508 middle-aged (34–44 years) adults showed that creating an additive index of lifetime alcohol involvement was psychometrically supported. Significant quadratic effects of alcohol involvement on initiation, progression, and persistence of smoking demonstrated that there were specific regions of the alcohol involvement continuum that were particularly strongly related to increased smoking. These results provide the most comprehensive depiction to date of the nature of the relationship between lifetime alcohol involvement and lifetime cigarette smoking and suggest potential avenues for research on the etiology and maintenance of smoking and tobacco dependence.

Rimonabant: Unique and Promising

The global pandemic of overweight has evoked increasing alarm as a risk factor for multiple adverse health outcomes. Prominent among these are obesity, metabolic syndrome, and diabetes, all of which promote the development of cardiovascular disease. The magnitude of the problem is reflected by estimates that on a worldwide scale, overweight (body mass index >25 kg/m2) and frank obesity (body mass index >30 kg/m2) affect 1 billion and 300,000 persons, respectively,1 and in this country 97 million people are categorized as overweight or obese.2 This situation prompted The Surgeon Generals' Call to Action to Prevent and Decrease Overweight and Obesity.3 It is well known that overnutrition and underactivity play important roles in the development of obesity. Together with the persistence of cigarette smoking, these unfavorable lifestyles are prime examples of the extent to which adverse health outcomes are a result of self-imposed practices. Although it has been established that favorable lifestyle modifications exert beneficial effects on obesity and its clinical aftermaths, alteration of personal habits has proved a daunting challenge to individuals, health care providers, and society. In such circumstances, the search for pharmacologic alleviation has been our practice, often with gratifying results, as exemplified by the statin class of drugs.4 Enter rimonabant—a unique drug with therapeutic potential in obesity, smoking, and the metabolic syndrome. Rimonabant is the first of a new class of drugs that acts as a selective inhibitor of cannabinoid-1 receptors in the endocannabinoid system. Stimulation of these receptors, which are densest in the brain, appears to influence 1) lipid and glucose metabolism in adipose tissue; and 2) regulation of appetite, energy balance, and nicotine dependence.5 Through these mechanisms, the endocannabinoid system appears to be involved in weight gain and the urge to smoke. Rimonabant has a high affinity for central cannabinoid receptors, blocks the actions of cannabinoid receptor agonists, and has induced weight loss in animal investigations. Evidence that the drug can induce decreased appetite and weight loss has been extended to humans in phase 1 and 2 trials, which have led to the current phase 3 prospective, randomized, placebo-controlled trials on obesity and smoking cessation. The phase 3 trials on obesity (Rimonabant in Obesity) include RIO-Lipids, RIO-Diabetes, RIO-Europe, and RIO-America. Preliminary results have shown favorable effects of rimonabant compared with placebo on weight loss, multiple factors of the metabolic syndrome, and incidence of the metabolic syndrome.6 The effect of the drug is dose-related, and approximately 60% of study patients have lost 5%-10% of body weight. The results in the metabolic syndrome are unique in that there is currently no single drug aimed at the cluster of factors comprising this condition. RIO-Europe was recently published and confirmed the preliminary findings.7 The effects of rimonabant on smoking cessation are currently being investigated in the three STRATUS trials (Studies with Rimonabant and Tobacco Use). Initial findings suggest a significantly higher quit rate compared with placebo. Adverse effects of rimonabant have been dose-related and generally mild, including gastrointestinal disturbances, nausea, dizziness, and upper respiratory tract infections.7 These promising results suggest that rimonabant may afford a unique approach to combating two of the major health hazards of our society: obesity and smoking. Multiple, long-term studies are in progress to determine whether the early promise will translate into enduring fulfillment.

Persistence of cigarette smoking: familial liability and the role of nicotine dependence.

It has been suggested that high genetic vulnerability may explain why smoking persists in spite of general acceptance of the health risks of cigarette smoking. Indeed, heritability estimates for smoking persistence range from 27% to 70%. It has also been suggested that genetic influences on smoking persistence may operate through nicotine dependence, which epidemiological studies have found to be an important risk factor for smoking persistence. We examined alternative ways that familial liability to persistence, nicotine dependence and smoking persistence may be related. Cohort study. South-east Michigan, United States. A subset of 389 daily smokers informative for familial smoking characteristics from an epidemiological sample of young adults 26-35 years old (n = 979). Nicotine dependence criteria were assessed using the NIMH-DIS revised interview and diagnosed according to the DSM-III-R. Familial smoking characteristics were assessed by subject report. Absent nicotine dependence, daily smokers with medium and high familial density of persistence were at increased risk of smoking persistence (OR = 4.2 and 7.0, respectively). However, familial density of persistence was not associated with smoking persistence among nicotine dependent daily smokers. Level of education also appeared to limit the influence of familial liability, although nicotine dependence also modified this effect. Nicotine dependence does not appear to be in the causal pathway from familial liability to smoking persistence, but rather modifies the association between them.

Cigarette Smoking Four Years Following Treatment for Adolescent Substance Abuse

ABSTRACT The present study was undertaken to provide information relevant to intervening with cigarette smoking by substance abusing adolescents. The persistence of cigarette smoking and predictors of smoking 4 years following treatment were examined for 125 adolescent substance abusers. Eighty percent of participants were still smoking 4 years following treatment. Analyses found that age of initial cigarette use and extent of smoking at the time of treatment significantly predicted late adolescent/early adult smoking for male but not female participants. Those no longer smoking at the 4-year time-point reported less alcohol and drug involvement than those whose smoking persisted. The substantial persistence of cigarette smoking into early adulthood reinforces the need for smoking intervention with adolescent substance abusers.

Nicotine addiction and treatment.

The persistence of cigarette smoking despite widespread awareness of adverse health effects results from an underlying addiction to nicotine. Unaided attempts to quit smoking are generally unsuccessful. This article discusses nicotine addition and therapeutic techniques that have been or are being developed to relieve smoking withdrawal symptoms and promote abstinence from smoking. These techniques include nicotine chewing gum, skin patches, nasal sprays, and inhalers, as well as pharmacotherapies such as mecamylamine and clonidine, serotonergic treatments such as buspirone, and antidepressants such as buproprion. A nondrug approach using cigarette substitutes that mimic the airway sensations produced by cigarette smoke is also discussed.

Smoking and Health in Substance-Abusing Adolescents: A Two-Year Follow-up

To examine the prevalence and persistence of cigarette smoking along with health outcomes in a clinical sample of substance-abusing adolescents. This is a 2-year prospective case series study. Subjects were recruited from two private, hospital-based inpatient adolescent substance abuse treatment facilities. A consecutive sample of 166 adolescents, ages 12 to 18, meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for substance abuse participated in the present investigation. Of the original sample, 154 and 144 were interviewed 12 and 24 months after discharge, respectively. Information regarding cigarette smoking, drug and alcohol use, and respiratory problems was based on self-report by the adolescents and was corroborated by parent interview. The prevalence of smoking in this sample of teens immediately before treatment was 85%. Sixty-one percent of the sample smoked 1/2 pack or more/day and 75% were daily smokers. Although prevalence (74 and 77%) and average daily cigarette consumption (11.1 and 10.7 cigarettes daily) decreased at 12 and 24 months after treatment, rates remained very high. Teens reporting posttreatment respiratory problems smoked more, and heavier smokers at the time of treatment were more likely to report respiratory problems at follow-up than lighter smokers. Substance-abusing teens smoke at rates far and above those of the general adolescent population. Further, these teens appear at increased risk for negative health consequences regardless of posttreatment drug and alcohol use. These findings highlight the importance of preventing adolescent cigarette smoking by substance abuse treatment programs.

Prognostic indexes for patients with ischemic heart disease enrolled in an exercise-centered rehabilitation program

Indexes of prognosis were calculated for 610 postinfarction patients who participated in a vigorous exercise-centered rehabilitation program for an average of 36.5 ± 6.5 months (mean ± standard deviation), commencing 8.2 ± 11.7 months after infarction. Over this period, 23 (group F) had a fatal and 21 (group R) a nonfatal recurrence of infarction; the remaining 566 patients (group C [“control” group]) had no recurrence, although 12 of these patients died of unrelated causes. Recurrences in group R occurred 22.8 ± 17.6 months, and deaths in group F 19.6 ± 17.8 months after the patients had joined the exercise program. The most significant individual index of prognosis was noncompliance with the exercise program, observed in 47.8 percent of those with a fatal (F) recurrence, 57.1 percent of those with a nonfatal (R) recurrence and 0.7 percent of those in the control group; the risk ratio for the combined group F plus R was 22.6. Risk ratios were at the expected level for certain other traditional indicators of prognosis (persistent angina 2.01; aneurysm 2.05; enlarged heart 2.34; and polyfocal exercise-induced ventricular premature complexes 1.52). For three factors (S-T segment depression on exercise 0.2 mv or greater, serum cholesterol 270 mg/100 ml [7 mmol/liter] or greater and persistence of cigarette smoking), risk ratios (3.20,1.98, and 1.93, respectively) were somewhat higher than usually reported for postinfarction patients who do not exercise. However, because of the overall low fatality rate among patients (1.2 percent/year, with 0.7 percent/year in those free of S-T depression on exercise), the prognosis for patients with such risk factors remained at least as good as in comparable patients not receiving exercise rehabilitation. Age, hypertension ( 150 100 mm Hg or greater, 20.0 13.3 kPa ), persistence of resting electrocardiographic abnormalities and the results of physiologic tests had little influence on the prognosis of patients who exercise. However, a combination of S-T segment depression during exercise and a high serum cholesterol level yielded a risk ratio of 4.26. The apparent absence of risk from resting hypertension and from a high systolic blood pressure on exercise probably reflects the inability of patients with myocardial impairment to sustain a high systemic pressure.