Subsequent Smoking Behavior Research Articles

Learning & motivational talk in smoking cessation interventions: An examination of session language in two randomized trials

ObjectivesMotivational Interviewing (MI), a client-centered approach that seeks to evoke and resolve ambivalence, and health education (HE), which provides health information and advice, may both provide some benefit to unmotivated smokers. In HE, it is possible that client language reflective of new learning, or “learning talk” (LT), and rejection of health advice, or “rejection talk,” (RT), may uniquely reflect intent of subsequent behavior change. MethodsThis project utilized MI and HE sessions from two randomized clinical trials (RCTs), one in a low-income, diverse community civilian sample of 255 unmotivated smokers, and the other in a sample of Veterans with mental illness who were unmotivated smokers (n = 55).Mixed methods approaches were utilized to reliably code sessions using the Motivational Interviewing Skill Code 2.5 (MISC 2.5)1 and a refined Learning Talk coding system2. ResultsReliability of LT and RT codes ranged from fair to excellent (ICCs from 0.43–0.93). ConclusionLT appears to be a unique construct and its impact on post-session changes in smoking is warranted. Practice implicationsThis system can be used in a study to code existing interventions for smokers using both MI and HE techniques and relate in-session client LT to subsequent smoking behaviors.

Brief training in regulation of craving reduces cigarette smoking

IntroductionCraving is an important contributing factor in cigarette smoking and has been added as a diagnostic criterion for addiction in the DSM-5. Cognitive-behavioral therapy and other treatments that incorporate craving regulation strategies reduce smoking and the likelihood of relapse. Although this finding suggests that the regulation of craving is an important mechanism underlying smoking cessation, whether targeted interventions that train smokers to regulate craving can directly impact real-world smoking behaviors is unclear. MethodAcross two pilot studies (N = 33; N = 60), we tested whether a brief, computer-delivered training session in the cognitive regulation of craving altered subsequent smoking behaviors in daily life. The study first randomly assigned participants to either a no training (control) group, or one of two Regulation of Craving Training (ROC-T) conditions. Next, all participants came into the lab and those assigned to ROC-T conditions were trained to implement a cognitive strategy to regulate their craving, by either focusing on the negative consequences of smoking, or by distracting themselves. Then, these participants underwent ROC-T during which they practiced using the strategy to regulate their craving during cue exposure. The study subsequently assessed participants' smoking via daily diaries for 3–6 days, and via self-report up to 1-month follow-up. ResultsAcross both studies, ROC-T conditions were associated with significant reductions in average cigarettes smoked per day, with effects persisting through follow-up. ConclusionThese results confirm that the regulation of craving is an important mechanism of smoking cessation, and can be targeted via easily administered training procedures, such as ROC-T.

Chromosome aberrations among atomic-bomb survivors exposed in utero: updated analysis accounting for revised radiation doses and smoking

A previous study of peripheral blood lymphocyte translocations around age 40 among atomic-bomb survivors exposed in utero revealed no overall association with radiation dose—despite a clear association between translocations and dose among their mothers—but the data suggested an increase at doses below 100 mGy with a definite peak. That analysis of the in utero-exposed survivors did not adjust for their subsequent smoking behavior, an established cause of chromosomal aberrations, or their subsequent exposures to medical irradiation, a potential mediator. In addition, atomic-bomb survivor radiation dose estimates have subsequently been updated and refined. We therefore re-estimated the dose response using the latest DS02R1 dose estimates and adjusting for smoking as well as for city and proximal–distal location at the time of exposure to the atomic bomb. Sex of the survivor, mother’s age around the time of conception, and approximate trimester of gestation at the time of exposure were also considered as explanatory variables and modifiers. Precision of the estimated dose response was slightly lower due to greater variability near zero in the updated dose estimates, but there was little change in evidence of a low-dose increase and still no suggestion of an overall increase across the entire dose range. Adjustment for smoking behavior led to a decline in background number of translocations (the dose–response intercept), but smoking did not interact with dose overall (across the entire dose range). Adjustment for medical irradiation did not alter the association between dose and translocation frequency. Sex, mother’s age, and trimester were not associated with number of translocations, nor did they interact with dose overall. Interactions with dose in the low-dose range could not be evaluated because of numerical instability.

The absence of association between anorexia nervosa and smoking: converging evidence across two studies

Previous studies have found increased smoking prevalence amongst adults with anorexia nervosa (AN) compared to the general population. The current investigation explored bidirectional associations between AN and smoking behaviour (initiation and heaviness), to address questions surrounding causation. In Study One, logistic regression models with variance robust standard errors assessed longitudinal associations between AN and smoking, using data from adolescent participants of the Avon Longitudinal Study of Parents and Children (N = 5100). In Study Two, two-sample Mendelian randomisation (MR) tested possible causal effects using summary statistics from publicly available genome-wide association studies (GWAS). Study One provided no clear evidence for a predictive effect of AN on subsequent smoking behaviour, or for smoking heaviness/initiation predicting later AN. MR findings did not support causal effects between AN and smoking behaviour, in either direction. Findings do not support predictive or causal effects between AN and smoking behaviour. Previously reported associations may have been vulnerable to confounding, highlighting the possibility of smoking and AN sharing causal risk factors.

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).

A Qualitative Study of the Impact of COVID-19 on Smoking Behavior for Participants in a Post-Hospitalization Smoking Cessation Trial.

(1) Background: COVID-19 has substantially altered individual environments and behaviors. We aim to explore the impact of COVID-19 on the smoking behavior of individuals trying to quit tobacco. (2) Methods: This study presents a qualitative analysis of individual interviews focused on perceived impacts of the COVID-19 pandemic on tobacco use among 39 participants in the Helping HAND 4 (HH4) post-hospitalization smoking cessation trial (NCT03603496). (3) Results: Emergent impacts of COVID-19 included change in routine, isolation, employment changes, and financial challenges; these in turn were associated with boredom, altered cravings and triggers, and increased stress. The availability of effective coping mechanisms instead of smoking to deal with stress heavily influenced subsequent smoking behavior. These results were triangulated with the Transactional Model of Stress, providing a framework to elucidate connections between factors such as perceived control, self-efficacy, and dispositional coping style, and highlighting potential areas for intervention. (4) Conclusions: Results suggest that stress during the COVID-19 pandemic may undermine effective coping skills among individuals enrolled in a post-hospitalization smoking cessation trial. Strengthening effective coping skills (e.g., minimizing the use of tobacco as a default stress response) and increasing perceived control and self-efficacy are promising intervention targets.

Tobacco Imagery in the 20 Best-Selling Video Games of 2018.

Video games are played by the majority of American adolescents. A small body of research has shown that video games expose users to tobacco imagery, potentially influencing subsequent smoking behavior. We examine the presence, type, and quantity of tobacco imagery in recent popular video games. After identifying 20 best-selling US video games of 2018 and selecting each YouTube video of all cut scenes and bridging game play, we coded each video for the presence of five types of tobacco imagery. We also recorded the length of time tobacco content was visible during the video. Seven of the top 20 video games contained tobacco imagery, which comprised between 7 seconds and 38 minutes of game play. All five types of tobacco imagery were accounted for: visible tobacco paraphernalia, tobacco products used to further game play, background characters using tobacco products, and main characters (playable and nonplayble) using tobacco products. Visible tobacco paraphernalia was the most common type of tobacco imagery and included both real and fictionalized tobacco brands that sometimes drew on real cigarette brand imagery. Three games allowed players to control tobacco-using characters. Popular video games continue to expose players to tobacco imagery. Because video games are played repeatedly, the potential exists for adolescents to experience even more tobacco imagery than the baseline exposure established here, further increasing the potential for harm. Existing voluntary and regulatory approaches to policing tobacco content are inadequate; thus, policymakers should consider further interventions to minimize tobacco content in video games. Video games, popular among youth and young adults, are known to contain tobacco imagery. Less is known about the quantity and type of this imagery among recent popular games. We found that 7 of the 20 best-selling video games of 2018 in the United States contained a variety of tobacco imagery and exposed players to as much as 38 minutes of tobacco content. Given the established link between exposure to tobacco marketing in media such as films and subsequent smoking behavior, policies to minimize tobacco imagery in video games that exceed the scant protections offered by the Master Settlement Agreement could help reduce smoking prevalence among youth.

Associations between affect, craving, and smoking in Korean smokers: An ecological momentary assessment study

Cigarette smoking remains the largest cause of preventable death in the United States and worldwide. In South Korea and other Asian countries, a large proportion of males smoke, increasing the need to examine cigarette smoking in these populations. Research suggests that the association between positive affect and negative affect, and between affect and craving, may differ across cultures, and that it is useful to examine these associations using Ecological Momentary Assessment (EMA). South Korean smokers (N = 20, Mean Age = 21.15, 25% female) completed baseline questionnaires and downloaded an EMA app which prompted 4 random assessments (RAs) each day for 1-week. At each assessment, participants responded to items assessing momentary negative affect (NA) and positive affect (PA), craving, and number of cigarettes smoked since the previous EMA assessment. Linear mixed models (LMMs) were used to analyze EMA data (544 assessments), separating out between- and within- subject associations. There was a significant positive association between positive affect and negative affect at the between-subjects level. Both positive affect and negative affect were significantly positively associated with craving at between-subjects and within-subject levels. Craving was associated with subsequent smoking behavior at the within-subjects level. Overall, results suggest that associations between positive affect and negative affect may be different in South Korean smokers than in Western smokers, and that there are robust associations between both negative and positive affect and craving.

Cue salience of the use of an electronic nicotine delivery system (ENDS) device marketed to women

IntroductionPassive exposure to the use of electronic nicotine delivery systems (ENDS or e-cigarettes) has been shown to generalize as a smoking cue. As young adult women in particular are increasingly targeted by ENDS distributors, the present study examined whether passive exposure to the use of a female-marketed ENDS product selectively enhanced smoking urge, cigarette and e-cigarette desire, and smoking behavior among women (vs men) smokers. MethodsUsing a mixed design, young adult smokers (n = 64; mean age 28.2 yrs.; ≥5 cigarettes/day) observed a study confederate drink bottled water (control cue) and then vape a female-marketed tank-based ENDS (active cue). Main measures were the Brief Questionnaire of Smoking Urges (BQSU) and visual analog scales (VAS) for cigarette and e-cigarette desire pre- and post-cue exposure, followed by a smoking latency task. ResultsCompared to the control cue, the female-marketed ENDS cue increased smoking urge and desire for cigarettes and e-cigarettes to a similar extent in women and men. It also affected subsequent smoking behavior similarly between the sexes, with 68% of men and 58% of women opting to smoke (vs. obtaining monetary reinforcers). ConclusionsBoth women and men were sensitive to the use of the female-marketed ENDS as a smoking cue. Consistent with prior work by our group, findings demonstrate the cue salience of ENDS, which may be attributable to the aspects of vaping that resemble traditional smoking (e.g. hand-to-mouth and inhalation and exhalation behaviors).

E-cigarette Use and Cigarette Smoking Cessation among Texas College Students.

We examined the relationships between e-cigarette use and subsequent cigarette smoking behaviors at 6- and 12-month follow-ups among young adults. Participants were 18-29 year-old current and former cigarette smokers (N = 627) at 24 Texas colleges, participating in a 3-wave study. Multi-level, multivariable logistic regression models, accounting for school clustering, examined the impact of self-reported use of e-cigarettes on cigarette smoking status at 6- and 12-month follow-ups. Two mutually-exclusive groups of e-cigarette users were examined: those that used for cigarette smoking cessation and those that used for reasons other than cessation. Baseline covariates included socio-demographics, past quit attempts, nicotine dependence, cigarettes per day, and other tobacco use. Use of e-cigarettes for cigarette smoking cessation was associated with increased odds of cigarette smoking cessation at 6- and 12-month follow-ups, while using e-cigarettes for other reasons was not, when adjusting for covariates. Use of e-cigarettes for cigarette smoking cessation may reduce cigarette smoking rates in young adult college students. Additional research is needed examining e-cigarettes as a complement to evidence-based cessation resources that are associated with cigarette smoking cessation among young adults.

Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior

IntroductionTobacco advertising can create false beliefs about health harms that are reinforced by product design features. Reduced nicotine content (RNC) cigarettes may reduce harm, but research has not addressed advertising influences. This study examined RNC cigarette advertising effects on false harm beliefs, and how these beliefs – along with initial subjective ratings of RNC cigarettes – affect subsequent smoking behaviors. We further explored whether subjective ratings moderate associations between false beliefs and behavior. MethodsSeventy-seven daily, non-treatment-seeking smokers (66.2% male) participated in the first 15days of a randomized, controlled, open-label RNC cigarette trial. Participants viewed an RNC cigarette advertisement at baseline before completing a 5-day period of preferred brand cigarette use, followed by a 10-day period of RNC cigarette use (0.6mg nicotine yield). Participants provided pre- and post-advertisement beliefs, and subjective ratings and smoking behaviors for cigarettes smoked during laboratory visits. ResultsViewing the advertisement increased beliefs that RNC cigarettes contain less nicotine and are healthier than regular cigarettes (p’s<0.001 and 0.011), and decreased the belief that they are less likely to cause cancer (p=0.046). Neither false beliefs nor subjective ratings directly affected smoking behaviors. Significant interactions of strength and taste ratings with beliefs (p’s<0.001), however, indicated that among smokers with less negative initial subjective ratings, greater false beliefs were associated with greater RNC cigarette consumption. ConclusionsSmokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.

Change in Neighborhood Disadvantage and Change in Smoking Behaviors in Adults: A Longitudinal, Within-individual Study.

Evidence for an association between neighborhood disadvantage and smoking is mixed and mainly based on cross-sectional studies. To shed light on the causality of this association, we examined whether change in neighborhood socioeconomic disadvantage is associated with within-individual change in smoking behaviors. The study population comprised participants of the Finnish Public Sector study who reported a change in their smoking behavior between surveys in 2008/2009 and 2012/2013. We linked participants' residential addresses to a total population database on neighborhood disadvantage with 250 × 250-m resolution. The outcome variables were changes in smoking status (being a smoker vs. not) as well as the intensity (heavy/moderate vs. light smoker). We used longitudinal case-crossover design, a method that accounts for time-invariant confounders by design. We adjusted models for time-varying covariates. Of the 3,443 participants, 1,714 quit, while 967 began to smoke between surveys. Smoking intensity increased among 398 and decreased among 364 participants. The level of neighborhood disadvantage changed for 1,078 participants because they moved residence. Increased disadvantage was associated with increased odds of being a smoker (odds ratio of taking up smoking 1.23 [95% confidence interval: 1.2, 1.5] per 1 SD increase in standardized national disadvantage score). Odds ratio for being a heavy/moderate (vs. light) smoker was 1.14 (95% confidence interval: 0.85, 1.52) when disadvantage increased by 1 SD. These within-individual results link an increase in neighborhood socioeconomic disadvantage, due to move in residence, with subsequent smoking behaviors.

A population study of first and subsequent pregnancy smoking behaviors in Ohio.

The objective of this study is to identify maternal characteristics associated with non-smoking during a subsequent pregnancy after first pregnancy smoking. We conducted a retrospective population-based analysis of Ohio vital birth records from 2007 to 2013. We used logistic regression to calculate adjusted odds ratios with 95% confidence intervals for detection of characteristics associated with non-smoking during a subsequent pregnancy after first pregnancy smoking. Among 75 190 mothers, 75.6% were non-smokers and 13.7% were smokers during both pregnancies. During their first pregnancy, 49.7% of 15 075 smokers quit. Of them, 50.1% remained non-smokers during their subsequent pregnancy. Women who reduced, but continued smoking during their first pregnancy, were more than five times as likely to smoke during their subsequent pregnancy than women who quit (odds ratio (95% confidence interval): 2.85 (2.43 to 3.35) vs 0.55 (0.45 to 0.67)). Interventions targeting complete cessation, rather than reduction in smoking among first-time mothers, may be the most effective at optimizing long-term health benefits.

Examining the relationship between cue-induced craving and actual smoking.

Smoking cue-reactivity studies have consistently demonstrated heightened self-report craving, as well as moderate autonomic reactivity, among smokers exposed to salient drug-related cues. However, significantly fewer studies have examined whether exposure to smoking cues affects smokers' actual smoking, or examined the predictive relationship between cue-induced craving and smoking behavior. Using our well-tested pictorial cues in a cue-reactivity paradigm, we investigated the impact of smoking-related cues relative to neutral cues on subjective craving and smoking behavior (assessed via CReSS; Plowshare Technologies, Baltimore, MD) measures of latency to smoke, puff volume, and number of puffs). Further, we examined the predictive value of cue-induced craving on subsequent smoking behavior. Sixty nondeprived daily smokers completed 2 experimental sessions involving exposure to either smoking-related or neutral pictorial cues. Following initial exposure to cues, smokers rated their craving and were then allowed to smoke freely if they chose to during a subsequent 6-min cue exposure period. Result showed that exposure to smoking cues relative to neutral predicted significantly greater craving and increases in smoking behavior. Likewise, the magnitude of the difference in cue-induced craving when exposed to smoking cues relative to neutral cues (i.e., the cue-reactivity effect) was highly predictive of shorter latency to smoke, as well as increased number of puffs and puff volume.

Encoded Exposure to Tobacco Use in Social Media Predicts Subsequent Smoking Behavior

Assessing the potential link between smoking behavior and exposure to mass media depictions of smoking on social networking Web sites. A representative longitudinal panel of 200 young adults in Connecticut. Telephone surveys were conducted by using computer assisted telephone interviewing technology and electronic dialing for random digit dialing and listed samples. Connecticut residents aged 18 to 24 years. To measure encoded exposure, respondents were asked whether or not they had smoked a cigarette in the past 30 days and about how often they had seen tobacco use on television, in movies, and in social media content. Respondents were also asked about cigarette use in the past 30 days, and a series of additional questions that have been shown to be predictive of tobacco use. Logistic regression was used to test for our main prediction that reported exposure to social media tobacco depictions at time 1 would influence time 2 smoking behavior. Encoded exposure to social media tobacco depictions (B = .47, p < .05) was a significant predictor of time 2 smoking, even after controlling for all the aforementioned predictors. Our results suggest that social media depictions of tobacco use predict future smoking tendency, over and above the influence of TV and movie depictions of smoking. This is the first known study to specifically assess the role of social media in informing tobacco behavior.

Abstract 2157: Causal effects of delaying smoking initiation on subsequent lung cancer risk

Abstract Background: Methods that report relative risks when describing the association between age at smoking initiation and lung cancer adjust for variables unknown or unpredictable at the time of initiation (smoking duration, pack-years etc.). Such methods do not provide valid estimates of the causal effect of smoking initiation. Also, relative risks are not informative for assessing the effects of youth smoking prevention programs or describing the impact of individuals' decisions to start smoking. Applying a causal modelling framework, we estimate absolute lung cancer risk - a metric more relevant to public health than relative risk - given variables fixed at the age of smoking initiation and averaging over subsequent smoking behaviors. Methods: We used the Environment And Genetics in Lung cancer Etiology (EAGLE) study (1942 lung cancer cases, 2116 controls), a population-based case-control study in Lombardy, Italy. We classified risk factors as fixed at smoking initiation (gender, childhood exposure to tobacco smoke [CETS], lung cancer family history [FH], birth cohort) and as causally related to the initiation age (pack-years, cigarettes per day, quitting, nicotine dependency). Using the sampling fractions for controls selection, we reconstructed the original study cohort and estimated absolute lung cancer risks overall and conditionally on fixed factors. We predicted lung cancer rates for different ages at smoking initiation as number of cases per 100,000 person-years (PY) using a binomial linear model and estimated corresponding risk differences (RD) and 95% confidence intervals (CI). Instead of adjusting for the effects of smoking behaviors that happen after initiation, we averaged over them. We show how assumptions about factors unknown at smoking initiation affect the estimates. Results: Delaying smoking initiation from age 16 to age 20 reduces estimated lung cancer rate in men from 149 to 78 cases per 100,000 PY with a RD=71 (95% CI 25 to 120), but there is apparently no corresponding effect in women (RD= -1 [95% CI -50 to 48] from 26 to 27 cases per 100,000 PY). The effect of delaying initiation is larger for those without CETS (RD=113 [95% CI 52 to 174] cases per 100,000 PY from 156 to 43) than those with CETS (RD=45 [95% CI -2 to 92] cases per 100,000 PY from 92 to 47). For those with FH RD was 214 (95% CI -106 to 534) cases per 100,000 PY from 282 to 68, and for those without FH it was 44 (95% CI 3 to 85) cases per 100,000 PY from 85 to 41). RDs were greater for early birth cohorts. There was heterogeneity among individuals with same initiation age but different subsequent smoking behaviors. Conclusion: We estimated absolute lung cancer risk from a case-control study using information fixed at the initiation age and averaging over subsequent smoking behaviors. Our estimates show substantial impact of delaying initiation in men, even if the person eventually smokes. Extrapolation to current youths and young adults requires integration of data on contemporary smoking patterns. Citation Format: Orestis A. Panagiotou, Fangyi Gu, Carolyn Reyes-Guzman, Maria-Teresa Landi, Michele Bloch, Neil E. Caporaso, Sholom Wacholder. Causal effects of delaying smoking initiation on subsequent lung cancer risk. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2157. doi:10.1158/1538-7445.AM2014-2157

Frequency and characteristics associated with exposure to tobacco direct mail marketing and its prospective effect on smoking behaviors among young adults from the US Midwest.

We examined the exposure to tobacco direct mail marketing and its effect on subsequent smoking behaviors in a US Midwest regional cohort of young adults. Data were collected from 2622 young adults (mean age = 24 years) in 2010 to 2011 (baseline) and 2011 to 2012 (follow-up). We collected information on demographics, tobacco use, and exposure to tobacco direct mail materials in the previous 6 months at baseline. Smoking behaviors were reassessed at follow-up. We investigated the characteristics associated with receiving these materials at baseline, and the associations between receiving cigarette coupons in the mail at baseline and smoking behaviors at follow-up. Thirteen percent of participants reported receiving tobacco direct mail materials in the previous 6 months. Receipt of these materials was associated with age, education, and tobacco use (P < .05). Among those who received these materials, 77% and 56% reported receiving coupons for cigarettes and other tobacco products, respectively. Among baseline nonsmokers and ex-smokers, receiving coupons was associated with becoming current smokers at follow-up (P < .05). Among baseline current smokers, receiving coupons was associated with lower likelihood of smoking cessation at follow-up (P < .05). Tobacco direct mail marketing promoted and sustained smoking behaviors among US Midwest young adults. Regulating this marketing strategy might reduce the prevalence of smoking in this population.

Cognitive and affective predictors of smoking after a sentinel health event

Objective: This study examined how smoking-related causal attributions, perceived illness severity, and event-related emotions relate to both intentions to quit and subsequent smoking behavior after an acute medical problem (sentinel event). Methods: Three hundred and seventy-five patients were enrolled from 10 emergency departments (EDs) across the USA and followed for six months. Two saturated, manifest structural equation models were performed: one predicting quit attempts and the other predicting seven-day point prevalence abstinence at 14 days, three months, and six months after the index ED visit. Stage of change was regressed onto each of the other predictor variables (causal attribution, perceived illness severity, event-related emotions) and covariates, and tobacco cessation outcomes were regressed on all of the predictor variables and covariates. Results: Non-White race, baseline stage of change, and an interaction between causal attribution and event-related fear were the strongest predictors of quit attempt. In contrast, abstinence at six months was most strongly predicted by baseline stage of change and nicotine dependence. Conclusion: Predictors of smoking behavior after an acute medical illness are complex and dynamic. The relations vary depending on the outcome examined (quit attempts vs. abstinence), differ based on the time that has progressed since the event, and include significant interactions.

School Connectedness and Susceptibility to Smoking Among Adolescents in Canada

Smoking susceptibility in early adolescence is strongly predictive of subsequent smoking behavior in youth. As such, smoking susceptibility represents a key modifiable factor in reducing the onset of smoking in young people. A growing literature has documented a number of factors that influence susceptibility to smoking; however, there is limited amount of research examining associations of susceptibility to smoking and school connectedness. The current study examines whether school connectedness has an independent protective effect on smoking susceptibility among younger adolescents. A nationally representative sample of 12,894 Canadian students in grades 6-8 (11-14 years old), surveyed as part of the 2010-2011 Youth Smoking Survey, was analyzed. Multilevel logistic regression models examined unadjusted and adjusted associations between school connectedness and smoking susceptibility. The impacts of other covariates on smoking susceptibility were also explored. Approximately 29% of never-smokers students in grades 6-8 in Canada were susceptible to future smoking. Logistic regression analysis, controlling for standard covariates, found that school connectedness had strong protective effects on smoking susceptibility (odds ratio [OR] 0.91, 95% CI 0.89-0.94). The finding that school connectedness is protective of smoking susceptibility, together with previous research, provides further evidence that improving school conditions that promote school connectedness could reduce risky behavior in adolescents. While prevention efforts should be directed at youth of all ages, particular attention must be paid to younger adolescents in the formative period of 11-14 years of age.

The role of cognitive attributions for smoking in subsequent smoking progression and regression among adolescents in China

Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents' future smoking behaviors, especially transitions to more advanced stages of smoking.Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders.Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression.This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.