Adolescent's respiratory sinus arrhythmia is associated with smoking rate five years later.

INTRODUCTION: Vulnerability factors like respiratory sinus arrhythmia (RSA) may help identify adolescents at risk for nicotine dependence. We examined if resting RSA and the acute effects of smoking on RSA was associated with cigarette smoking five years later among adolescents at high risk for smoking escalation and nicotine dependence. METHODS: Sixty-nine adolescents participated in a baseline laboratory session- RSA was collected before and after smoking a single cigarette ad libitum. Participants were then followed for five years. RESULTS: Lower pre-smoke resting RSA was related to higher past month smoking rate five years later, even after controlling for baseline smoking rate and other relevant covariates including gender, race/ethnicity, age of initiated use, and frequency of exercise at baseline (p=0.018). Exploratory analyses suggested resting RSA is an independent predictor of increased cigarette rate beyond other baseline predictors. CONCLUSIONS: Low resting RSA may be a vulnerability factor, helping to identify adolescents at risk for cigarette escalation.

A comprehensive examination of hookah smoking in college students: use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use.

The practice of waterpipe smoking (hookah) has rapidly increased in popularity among young adults yet burgeoning research suggests that its use is associated with nicotine dependence and other negative smoking-related health consequences. Moreover, descriptive studies indicate that consumers may hold the belief that hookah smoking is safer than smoking cigarettes. The current study extended previous work by conducting a comprehensive assessment of patterns and contexts of hookah use, psychological correlates of use, co-occurring substance use as well as social norms and health perceptions surrounding the practice. Participants were 143 ethnically diverse undergraduate students at a large urban US university. Approximately half of the sample (48%) reported life-time use of hookah and 22% reported use within the past 30days. Relative to cigarette smoking, hookah smoking was associated with less perceived harm and addiction potential and higher social approval. Participants who reported life-time hookah use, as compared to those who did not, perceived less associated harm, had a greater number of friends who had tried and approved of hookah, were more likely to use cigarettes, marijuana, and alcohol and in higher frequencies and quantities and were at higher risk for problem tobacco and alcohol use. Among participants who were not current smokers, those with hookah experience were more likely to endorse intent to try a cigarette soon. Hookah users did not differ from non-users on measures of trait anxiety, depression and impulsivity though they were more likely to drink alcohol for coping, social and enhancement purposes than non-users. Implications are discussed for public health initiatives to educate young adults about the potential consequences of hookah smoking.

The combined effects of alcohol, caffeine, and expectancies on subjective experience, impulsivity, and risk-taking.

Caffeinated alcoholic beverage (CAB) consumption is a rapidly growing phenomenon among young adults and is associated with a variety of health-risk behaviors. The current study examined whether either caffeinated alcohol or the expectation of receiving caffeinated alcohol altered affective, cognitive, and behavioral outcomes hypothesized to contribute to risk behavior. Young adult social drinkers (N = 146) participated in a single session where they received alcohol (peak Breath Alcohol Content = .088 g/dL, SD = .019; equivalent to about four standard drinks) and were randomly assigned to one of four further conditions: 1) no caffeine, no caffeine expectancy, 2) caffeine and caffeine expectancy, 3) no caffeine but caffeine expectancy, 4) caffeine but no caffeine expectancy. Participants' habitual CAB consumption was positively correlated with measures of impulsivity and risky behavior, independently of study drugs. Administration of caffeine (mean dose = 220 mg, SD = 38; equivalent to about 2.75 Red Bulls) in the study reduced subjective ratings of intoxication and reversed the decrease in desire to continue drinking, regardless of expectancy. Caffeine also reduced the effect of alcohol on inhibitory reaction time (RT) (faster incorrect responses). Participants not expecting caffeine were less attentive after alcohol, whereas participants expecting caffeine were not, regardless of caffeine administration. Alcohol decreased response accuracy in all participants except those who both expected and received caffeine. Findings suggest that CABs may elevate risk for continued drinking by reducing perceived intoxication, and by maintaining the desire to continue drinking. Simply expecting to consume caffeine may reduce the effects of alcohol on inattention, and either expecting or consuming caffeine may protect against other alcohol-related performance decrements. Caffeine, when combined with alcohol, has both beneficial and detrimental effects on mechanisms known to contribute to risky behavior.

Cue-induced cigarette craving and mixed emotions: a role for positive affect in the craving process.

Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.

Quantifying reinforcement value and demand for psychoactive substances in humans.

Behavioral economics is an emerging cross-disciplinary field that is providing an exciting new contextual framework for researchers to study addictive processes. New initiatives to study addiction under a behavioral economic rubric have yielded variable terminology and differing methods and theoretical approaches that are consistent with the multidimensional nature of addiction. The present article is intended to provide an integrative overview of the behavioral economic nomenclature and to describe relevant theoretical models, principles and concepts. Additionally, we present measures derived from behavioral economic theories that quantify demand for substances and assess decision making processes surrounding substance use. The sensitivity of these measures to different contextual elements (e.g., drug use status, acute drug effects, deprivation) is also addressed. The review concludes with discussion of the validity of these approaches and their potential for clinical application and highlights areas that warrant further research. Overall, behavioral economics offers a compelling framework to help explicate complex addictive processes and it is likely to provide a translational platform for clinical intervention.

The separate and combined effects of alcohol and nicotine on anticipatory anxiety: a multidimensional analysis.

Individuals who smoke cigarettes are significantly more likely to smoke more when they drink alcohol. Indeed, smoking and drinking appear strongly linked, at both between- and within-person levels of analyses. Anecdotal evidence further suggests that alcohol consumption in combination with smoking cigarettes reduces anxiety, yet the mechanisms by which this may occur are not well understood. The current study assessed the separate and combined effects of alcohol and nicotine on self-reported and psychophysiological (startle eyeblink magnitude) indices of anxiety. Results indicated that alcohol provided anxiolytic benefits alone and in combination with nicotine, as evidenced by significant reductions in startle eyeblink magnitude. According to self-reported anxiety, alcohol and nicotine exerted a conjoint effect on diminishing increases in anxiety subsequent to a speech stressor. These data highlight the importance of studying both the separate and combined effects of these two widely used substances, as well as the advantages of employing a multimodal assessment of emotional response.

Predictors and sequelae of smoking topography over the course of a single cigarette in adolescent light smokers.

PURPOSE: The objective of this study was to determine whether adolescent smokers, who varied in their smoking histories and symptoms of nicotine dependence, exhibit any decrease in puff volume and duration similar to that typically seen in dependent adolescent and adult smokers. Moreover, we examined whether puffing trajectories were moderated by individual difference factors, as well as whether puffing topography over the course of smoking a single cigarette was predictive of an escalation in dependence symptoms. METHODS: We assessed smoking topography (puff number, duration, volume, maximum flow rate [velocity], and inter-puff interval) over the course of smoking a single cigarette in a sample of 78 adolescent light smokers, using hierarchical linear modeling. We examined moderators (anxiety, depression, nicotine dependence) of the topographic trajectories, as well as whether smoking topography predicted any change in dependence over a 2-year period. RESULTS: Puff volume and puff duration decreased over the course of smoking the cigarette, whereas puff velocity and inter-puff interval increased. Slopes for puff volume and duration were moderated by anxiety and depressive symptoms. Moreover, individuals with a less "typical" topography pattern (exhibited stable or increasing volume and duration over the course of smoking the cigarette) demonstrated a heightened dependence escalation in the subsequent 2 years. CONCLUSION: Our findings suggest that adolescent light smokers self-regulate nicotine during the course of smoking a single cigarette, similar to that reported in dependent adolescent and adult smokers. However, single cigarette self-regulation was influenced by certain affective factors. Implications of these findings and future directions for adolescent smoking research are discussed.

Adolescents' expectancies for smoking to regulate affect predict smoking behavior and nicotine dependence over time.

AIMS: Mounting evidence suggests that individuals smoke, in part, to regulate affective experience (e.g., tension reduction, mood enhancement). Implicit in such motives is the expectancy or belief that smoking will decrease negative affect and increase positive affect. The contribution of cognitively-driven expectancies to the initiation and continuation of smoking during adolescence remains largely uninvestigated. The current study examined the influence of negative affect relief expectancies (NAREs) for smoking on smoking behavior and nicotine dependence using longitudinal data from a study on the emotional and social contexts of youth smoking. METHODS: Participants were 568 adolescents with smoking experience (mean age 15.67, 56.7% female). Three separate mixed regression models were estimated to determine the relative contribution of NAREs to smoking behavior and nicotine dependence measured at 4 time points over 2 years. RESULTS: NAREs for smoking influenced all smoking outcomes at baseline and predicted increases in smoking behavior and nicotine dependence over time, even after controlling for anxious and depressive symptoms and baseline nicotine dependence. CONCLUSIONS: Outcome expectancies for affect management emerged as an important risk factor for smoking escalation and the development of nicotine dependence during adolescence. The present findings highlight the potential importance of cognitively-driven expectancies as a risk factor for smoking escalation during this critical developmental period.

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.

The effects of smoking on selective attention as measured by startle reflex, skin conductance, and heart rate responses to auditory startle stimuli.

The present study examined the effects of cigarette smoking on attentional processing by measuring nondeprived smokers' (n=39), minimally deprived smokers' (n=36), and nonsmokers' (n=34) startle eyeblink reflex, heart rate, and skin conductance responses (SCR) to acoustic startle stimuli (105 dB) during directed attention tasks. Whereas smokers demonstrated smaller startle responses than nonsmokers during a directed attention visual task, no difference in startle response magnitude emerged between the two smoking groups, nor did we observe an effect of smoking on SCR or heart rate response to the startle stimuli. Our findings suggest that smokers differ from nonsmokers in their selective attention abilities and that smoking does not enhance minimally deprived smokers' selective attention.

Smoking, arousal, and affect: the role of anxiety sensitivity.

PURPOSE: Despite evidence that smoking elevates peripheral autonomic nervous system activity, cigarette smokers commonly report smoking to reduce negative affect, or "calm down." Studies suggest that anxiety sensitivity is positively associated with the use of anxiolytic substances, but anxiety sensitivity is also characterized by aversive responding to elevations in physiological arousal. As such, anxiety sensitivity may be an important factor in the study of smoking, affect, and arousal. METHOD: Smokers smoked cigarettes in two experimental sessions: a Stressful Speech Condition and a No Stress Condition. Psychophysiological and self-report served as within-subjects, repeated measures. RESULTS: Findings revealed that smoking reduced anxiety in high anxiety sensitive smokers who smoked during a stressful situation, but not a no stress situation. Low anxiety sensitive smokers endorsed anxiolysis in both conditions. CONCLUSIONS: Results suggest that high anxiety sensitive smokers may be sensitive to the physiologically arousing effects of smoking in low stress, low arousal, situations.

Caffeine expectancy: instrument development in the Rasch measurement framework.

Although caffeine is the most widely consumed psychoactive drug in the world, the mechanisms associated with consumption are not well understood. Nonetheless, outcome expectancies for caffeine use are thought to underlie caffeine's reinforcing properties. To date, however, there is no available, sufficient measure by which to assess caffeine expectancy. Therefore, the current study sought to develop such a measure employing Rasch measurement models. Unlike traditional measurement development techniques, Rasch analyses afford dynamic and interactive control of the analysis process and generate helpful information to guide instrument construction. A 5-stage developmental process is described, ultimately yielding a 37-item Caffeine Expectancy Questionnaire (CEQ) comprised of 4 factors representing "withdrawal symptoms," "positive effects," "acute negative effects," and "mood effects." Initial evaluation of the CEQ yielded sufficient evidence for various aspects of validity. Although additional research with more heterogeneous samples is required to further assess the measure's reliability and validity, the CEQ demonstrates potential with regard to its utility in experimental laboratory research and clinical application.

Adolescent smoking and depression: evidence for self-medication and peer smoking mediation.

AIMS: The nature of the relationship between adolescent smoking and depression is unclear and the mechanisms that account for the comorbidity have received little investigation. The present study sought to clarify the temporal precedence for smoking and depression and to determine whether these variables are linked indirectly through peer smoking. PARTICIPANTS: The sample was composed of 1093 adolescents participating in a longitudinal study of the behavioral predictors of smoking adoption. DESIGN AND MEASUREMENTS: In this prospective cohort study, smoking, depression, peer smoking and other covariates were measured annually from mid-adolescence (9th grade; age 14) to late adolescence (12th grade, age 18). FINDINGS: Parallel processes latent growth curve models supported a bidirectional relationship between adolescent smoking and depression, where higher depression symptoms in mid-adolescence (age 14) predicted adolescent smoking progression from mid- to late adolescence (ages 14-18). A significant indirect effect indicated that higher depression symptoms across time predicted an increase in the number of smoking peers, which in turn predicted smoking progression from mid-adolescence to late adolescence. In addition, smoking progression predicted a deceleration of depression symptoms from mid- to late adolescence. A significant indirect effect indicated that greater smoking at baseline predicted a deceleration in the number of smoking peers across time, which predicted a deceleration in depression symptoms from mid-adolescence to late adolescence. CONCLUSIONS: The current study provides the first evidence of bidirectional self-medication processes in the relationship between adolescent smoking and depression and highlights peer smoking as one explanation for the comorbidity.

The effects of smoking and smoking abstinence on verbal and visuospatial working memory capacity.

Several studies have examined the effects of smoking and abstaining from smoking on working memory (WM) but have yielded inconclusive findings. Thus, the authors used a repeated measures design to assess the effects of smoking and abstaining from smoking on both visuospatial and verbal WM capacity (WMC) using highly reliable, well-validated, and theoretically driven WM span tasks. Verbal n-back was also administered to examine its relationship to these complex WM span tasks and to compare this study's results with previous findings. Smokers (n=23) and nonsmokers (n=21) participated in 2 sessions separated by 1 week. During 1 session, smokers completed the WM tasks after abstaining from smoking for at least 12 hr, whereas in the other session smokers did not abstain from smoking and were tested immediately after smoking (all WM tasks were completed 45 min or less since last cigarette). Results indicated that smokers' verbal WM span was lower than nonsmokers' and was lower during the nonabstinent session compared with the abstinent session. Smokers' verbal n-back performance was also lower than nonsmokers', although there was no difference in verbal n-back performance between the smoking sessions. In contrast, there was no difference in visuospatial WM span between the smoking sessions or between smokers and nonsmokers. Taken together, these findings demonstrate that (a) smokers' verbal WM is lower than nonsmokers, (b) smokers' verbal WMC is lower during nonabstinence compared with abstinence, and (c) smoking exhibits differential effects on the different WM domains.

The role of cognitive structure in college student problem drinking.

Although motivational models of alcohol use often invoke constructs relevant to affective distress (e.g., depressive symptoms), to date, no study has assessed the potential role of cognitive structures (enduring cognitive belief systems) in promoting problematic drinking behavior. Thus, the current study evaluated the relationship between cognitive structure, specifically dysfunctional attitudes and automatic negative thoughts, and problem-related drinking, while controlling for the influence of alcohol consumption, drinking motives related to affect management, demographic variables, and depressive symptoms. Participants were 182 male and female (80%) college undergraduates, who completed a battery of self-report questionnaires on two occasions, separated by 8 weeks. Initial correlational analyses indicated strong (positive) associations among the cognitive structure variables, depressive symptoms, and problem drinking behavior. Findings from set-wise hierarchical regression analyses demonstrated that dysfunctional attitudes measured at Time 1 (T1) predicted problem drinking eight weeks later at Time 2 (T2) even after controlling for age and sex, alcohol consumption (T2), depressive symptoms (T2), and drinking motives linked to affect regulation (T1). These findings highlight the potential importance of cognitive structure as a risk factor for problem drinking, above and beyond the risk posed by more traditionally studied variables.

What underlies appraisals? Experimentally testing a Knowledge-and-Appraisal Model of Personality Architecture among smokers contemplating high-risk situations.

We tested a theoretical model of personality structures underlying patterns of intra-individual variability in contextualized appraisals. The KAPA (Knowledge-and-Appraisal Personality Architecture) model was tested experimentally among smokers appraising their efficacy to resist the urge to smoke in high-risk situations. In a novel design, we assessed self-knowledge and situational beliefs idiographically and employed cognitive priming to manipulate the accessibility of self-knowledge experimentally. The results confirmed the unique KAPA-model prediction that priming would affect appraisals in a contextualized manner. Priming positively valenced self-knowledge enhanced self-efficacy appraisals specifically within that subset of situations that were relevant to the primed knowledge. The results were consistent with the hypothesis that systems of self- and situational knowledge underlie consistency and variability in appraisals.

Baseline reaction time predicts 12-month smoking cessation outcome in formerly depressed smokers.

Burgeoning evidence points to a positive association between cigarette smoking and depression. Moreover, depressive symptomatology, whether historical, current, or subsyndromal, appears to negatively influence smoking cessation efforts. Whereas depression is typically assessed via clinical interview or self-report, rarely are the known neurocognitive deficits linked to depression (e.g., global slowing) assessed in the context of smoking cessation research. Hence, this study examined whether simple reaction time -- color naming of affectively neutral words -- is predictive of 12-month smoking cessation outcome among a sample of formerly depressed smokers (N = 28). Results revealed a significant, positive correlation between reaction time and depressive symptoms such that those who exhibited slower reaction times were at heightened risk to relapse. Baseline depressive symptoms, as assessed via self-report, neither correlated with nor predicted smoking cessation outcome. Results from logistic regression analyses further showed that reaction time added incremental variance to the prediction of smoking cessation outcome. Therefore, simple reaction time may capture aspects of depression not typically assessed in self-report questionnaires. These results are discussed in terms of their theoretical and clinical implications for smoking cessation research.

The acute effects of nicotine on positive and negative affect in adolescent smokers.

Although adolescent cigarette smoking remains a critical public health concern, little is known about the reinforcing mechanisms governing smoking in this vulnerable population. To assess predictions derived from both positive and negative reinforcement models of drug use, the authors measured the acute effects of nicotine, as administered via tobacco cigarettes, on both positive and negative affect in a group of 15- to 18-year-old smokers. A matched group of nonsmokers served as a comparison group. Findings revealed that whereas adolescents who smoked a cigarette experienced reductions in both positive and negative affect, the observed reductions in negative affect were moderated by nicotine content of the cigarette (high yield vs. denicotinized), level of nicotine dependence, level of baseline craving, and smoking expectancies pertinent to negative affect regulation. Nonsmokers experienced no change in affect over the 10-min assessment period, and no interaction effects were observed for positive affect. Overall, the findings conform to a negative reinforcement model of nicotine effects and strongly suggest that, even among young light smokers, nicotine dependence and resultant withdrawal symptomatology may serve as motivating factors governing smoking behavior.

Prediction of lapse from associations between smoking and situational antecedents assessed by ecological momentary assessment.

Smoking is associated with particular moods and activities, but it is not known whether there are individual differences in these associations and whether these differences are associated with success in smoking cessation. We assessed such associations using ecological momentary assessment: real-world, real-time data, collected by palm-top computer. Two hundred and fourteen smokers participating in a smoking cessation study provided data during ad lib smoking at baseline. Participants recorded moods and activities each time they smoked and, for comparison, at randomly selected non-smoking occasions. Situational associations with smoking were captured by examining the associations between smoking and antecedents considered relevant to lapse risk: negative affect (NA), arousal, socializing with others, the presence of others smoking, and consumption of coffee and alcohol. The associations varied across participants, confirming individual differences in situational smoking associations. Survival analyses revealed that only the NA pattern predicted first lapse. The effect was only seen in EMA assessments of NA smoking, and was not captured by questionnaire measures of negative affect smoking, which did not predict lapse risk. Moreover, the effect was not mediated by nicotine dependence.

Using a knowledge-and-appraisal model of personality architecture to understand consistency and variability in smokers' self-efficacy appraisals in high-risk situations.

The present research used idiographic methods for identifying intraindividual, cross-contextual patterns of consistency and variability in self-efficacy appraisal among smokers. Building on a knowledge-andappraisal model of personality architecture, the authors assessed (a) schematic self-knowledge, (b) beliefs about the relevance of high-risk smoking-related situations to those schematic attributes, and (c) appraisals of self-efficacy for smoking avoidance in specific contexts. The idiographic assessments of situational and self-knowledge robustly predicted patterns of intraindividual consistency and variability in self-efficacy appraisal. A response-time measure revealed that speed in making positive self-appraisals varied systematically across schema-relevant contexts. Results speak to the field's need for assessment strategies to detect, and theoretical models to explain, within-person, across-context variations in self-efficacy for avoiding addictive behaviors.