Hypothalamic-pituitary-adrenal and sympathetic nervous system responses to social evaluative stress in chronic cannabis users and non-users.

BACKGROUND: To advance our understanding of the health-related consequences of chronic cannabis use, this study examined hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) reactivity and regulation in response to a well-characterized, acute, social evaluative stress task among cannabis users and non-users. We also explored differences in HPA-SNS coordination across the stress task in cannabis users and non-users. METHOD: Participants were 75 adults (53% female) who reported no use of tobacco/nicotine products. Cannabis use was measured using self-report and salivary/urinary THC levels. Participants were classified as cannabis users (n = 33) if they reported using cannabis at least twice per week in the prior year and had a positive salivary/urinary THC test or as non-users (n = 42) if they reported no use in the prior year and had a negative THC test. During a laboratory visit, participants completed the standard Trier Social Stress Test (TSST) and provided saliva samples before, and 5, 20, and 40 min after the task. Samples were assayed for salivary cortisol and alpha-amylase (sAA) as indices of HPA axis and SNS activity, respectively. RESULTS: Multilevel piecewise growth models revealed that, relative to non-users, cannabis users showed (a) blunted cortisol reactivity and recovery to the TSST, and (b) greater reductions in sAA concentrations following the TSST. Chronic cannabis users may exhibit blunted HPA axis responses and greater SNS recovery to acute psychosocial stress. Implications of individual differences in stress reactivity and regulation for the biobehavioral health of chronic cannabis users are discussed.

Taking context to heart: Momentary emotions, menstrual cycle phase, and cardiac autonomic regulation.

Emotions have long been discussed in conjunction with the autonomic nervous system. Most research on emotion-autonomic linkages does not consider sex differences or an evident underlying mechanism for sex differences: menstrual cycle phase. Further, most research is limited to cross-sectional and laboratory studies. The degree to which emotion-autonomic associations manifest in everyday life may be different and may vary by sex and, for women, by menstrual cycle phase. This study employs the ambulatory monitoring of cardiovascular measures (e.g., heart rate and heart rate variability; HRV) and concurrent emotional states (e.g., sadness, stress, anxiety, anger, and happiness) in everyday life to better characterize emotion-autonomic associations as a function of sex and menstrual cycle phase. Participants (N = 174; 87 female) ages 18 to 46 (31.23 ± 6.49) were monitored over a 5-day observation period (one 2- and one 3-day session), using an ambulatory 24-hour electrocardiogram to monitor heart rate and ecological momentary assessment to record emotions every ~30 min. Women were monitored in both the early to mid-follicular and -luteal phases and men in two comparably distanced sessions. Multilevel models indicated that across sex, negative emotions and happiness were associated with elevated heart rate. Relative to men, women exhibited an elevated heart rate and reduced HRV during reports of anger. For women, during the luteal phase, but not follicular phase, momentary sadness, stress, and anxiety predicted increased heart rate and reduced HRV. These findings demonstrate the importance of considering sex and menstrual cycle phase in research investigating emotion-autonomic linkages.

Effect of ß-blockers on triggering of symptomatic atrial fibrillation by anger or stress.

BACKGROUND: Anger and stress can trigger episodes of atrial fibrillation (AF) in patients with a history of AF. OBJECTIVE: The purpose of this study was to determine whether ß-blockers can protect against emotionally triggered AF. METHODS: In this prospective, controlled, electronic diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF (N = 91) recorded their rhythm on event monitors at the time of AF symptoms and completed a diary entry querying mood states (eg, anger and stress) for the preceding 30 minutes (pre-AF "case period") for 1 year. Also, patients underwent monthly 24-hour Holter monitoring during which they were prompted to complete a diary entry twice per hour. Diaries recorded during sinus rhythm comprise controls. Patients' exposure to each emotion was compared between the pre-AF case period and control periods by using generalized estimating equation modeling, as well as interactions between ß-blocker use and emotion tested. RESULTS: Sixty percent were prescribed ß-blockers. A total of 163 symptomatic AF episodes (in 34 patients) and 11,563 Holter-confirmed sinus rhythm control periods had associated diary data. Overall, the likelihood of an AF episode was significantly higher during anger or stress. This effect, however, was significantly attenuated in patients on ß-blockers (odds ratio 22.5; 95% confidence interval 6.7-75.4, P < .0001 for patients not prescribed ß-blockers vs odds ratio 4.0, 95% confidence interval 1.7-9.5, P = .002 for those prescribed ß-blockers; P = .02 for the interaction). Exclusion of patients on sotalol did not affect findings. CONCLUSION: Anger or stress can trigger AF, but use of ß-blockers greatly attenuates this deleterious physiological response.

The effect of the interdialytic interval on cognitive function in patients on haemodialysis.

BACKGROUND: Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction may shift over the course of the interdialytic interval. OBJECTIVES: To use ecological momentary assessment (EMA) to examine the relationship between the length of the interdialytic interval and reports of cognitive dysfunction. DESIGN: A quantitative study whereby each patient's cognitive functioning was measured during both short and long interdialytic intervals. PARTICIPANTS: Adults maintained on HD (Female n = 15, Male n = 11; MAge = 42.7 ± 15.8 years) were drawn from a standalone HD unit within a large university medical centre. MEASUREMENTS: Tests of baseline neurocognitive functioning were undertaken (Mini-Mental Status Examination, Digit Span, California Verbal Learning Test, Benton Visual Retention Test, Trail-Making Test) and smartphone-based electronic diary reports of cognitive impairment were made around six times each day for one week. RESULTS: Cognitive function and aptitude in this sample, although low, did not reflect clinically-significant impairment, with a mean Mini-Mental Status Exam score of 25.7 ± 3.0. Diary reports of cognitive impairment were also minimal, with an overall mean rating of .22 out of 5. Contrary to expectations, cognitive impairment was significantly greater on the one-day interdialytic days than on Day 2 of the two-day interdialytic interval (ß = .094, p = .017). CONCLUSIONS: Although cognitive impairment appears to be mild in stable, young patients with end stage renal disease, volumetric disruptions caused by HD may exacerbate such dysfunction.

I (should) need a cigarette: adolescent social anxiety and cigarette smoking.

BACKGROUND: Approximately half of high school students in the USA have used tobacco. Social anxiety can put adolescents at increased risk for smoking. PURPOSE: This study aims to determine whether adolescents high in trait social anxiety report more cigarette use and greater urge to smoke before, during, and after friend interactions than do teens low in trait social anxiety. METHODS: Four hundred two students who reported smoking more than once during high school were assessed approximately every 30 min during up to 84-day monitoring sessions. RESULTS: Controlling for momentary anxiety, high socially anxious teens were equally or less likely to smoke, but more likely to report urge to smoke, surrounding friend interactions than low socially anxious teens. CONCLUSIONS: Although high socially anxious adolescents do not smoke more than low socially anxious peers, they may believe that they should need a cigarette in anxiety-provoking situations. Such urges may later develop into smoking behaviors.

Bummed out now, feeling sick later: weekday versus weekend negative affect and physical symptom reports in high school freshmen.

PURPOSE: This study examined adolescent negative affect (NA) in daily life on school days and weekend days during the spring and associations with physical symptoms during the following summer. METHODS: Using experience sampling methodology (ESM), participants provided electronic diary (eDiary) reports of NA on weekdays (Thursday and Friday) and weekend days during their 9th grade year. In telephone interviews during the winter and summer months they reported physical symptoms. Multiple regression analyses were conducted to examine associations between weekday NA, weekend NA, and their interaction and four constellations of physical symptoms reported in summer (pain, respiratory, gastrointestinal, and immune symptoms). RESULTS: Findings indicated that weekend NA was associated with later reports of pain, respiratory, and immune symptoms. For gastrointestinal symptoms only adolescents who reported low NA on both weekend and school days reported fewer gastric symptoms than other adolescents. CONCLUSIONS: Mapping the predictors and correlates of weekend NA may be important not only for understanding teenage mood patterns but also for enhancing the interpretation of physical symptom reporting by adolescents.

The impact of menstrual cycle phase on cardiac autonomic regulation.

This study investigated menstrual cycle phase differences in heart rate (HR) and RR interval variability (RRV) in 49 healthy, premenopausal, eumenorrheic women (age 30.2+/-6.2 years). HR and RRV were computed from ambulatory 24-h electrocardiogram, collected for up to 6 days, with at least 1 day each during early to midfollicular and midluteal menstrual phases. Phase effects on HR and RRV were assessed using linear mixed effects models with a random intercept to account for the correlation of observations within each subject as well as intrasubject variation. During follicular phase monitoring, women had significantly lower average HR (-2.33 bpm), and higher standard deviation, the root mean squared successive difference, and high frequency (0.04-0.15 Hz) and low frequency (0.15-0.40 Hz) RRV than during the luteal phase. These results provide strong support for the influence of menstrual phase on cardiac autonomic regulation in premenopausal women.

Nicotine-induced brain metabolism associated with anger provocation.

Cortico-limbic brain activity associated with anger may be susceptible to nicotine and, thus, may contribute to smoking initiation and nicotine addiction. The purpose of the study was to identify the brain regions that are most reactive to nicotine and show the greatest association with anger task performance. Twenty adult nonsmokers (9 women, 11 men) participated in two laboratory sessions to assess brain metabolism with fluoro deoxy-glucose Positron Emission Topography (FDG-PET) in response to nicotine and placebo patches during an anger provocation task. Outcome variables for the anger provocation task were reaction time, intensity and length of retaliation. Reaction time was associated with nicotine-induced changes in the left thalamus. Length of retaliation was associated with a functionally linked set of cortical and subcortical structures such as right frontal lobe, right anterior cingulate (BA 24), right uncus, left parietal lobe, left BA 11, left cingulate, left BA 25, left amygdala, left BA 30, left BA 38 and BA 9. These findings reveal the underlying brain circuitry targeted by nicotine during anger provocation.

Mapping the social and physical contexts of physical activity across adolescence using ecological momentary assessment.

BACKGROUND: Research has sought to understand how environmental factors influence adolescent physical activity, yet little is known about where and with whom adolescents are physically active. PURPOSE: This study used electronic ecological momentary assessment (e.EMA) to map the social and physical contexts of exercise and walking across adolescence. Differences in physical activity contexts by gender, grade in school, day of the week, and season were examined. METHODS: Twice a year between 9th and 12th grade, 502 adolescents (51% female) of mixed ethnicity (55% White) participated in 4-day e.EMA intervals (Thursday-Sunday) where their primary activity (e.g., exercise, TV, homework), social company (e.g., friends, family, class), and physical location (e.g., home, school, outdoors) were assessed every 30 (+/-10) min during waking hours. RESULTS: Overall, greater proportions of exercise and walking were reported with friends, outdoors, and at school. However, boys were more likely to report exercising and walking in outdoor locations than girls. Exercising with classmates, family, and at school decreased across high school. Walking with family, friends, and outdoors also decreased. On weekdays compared to weekends, students reported a greater proportion of their exercise and walking at school. Students were more likely to report exercising and walking outdoors in the fall and the spring than in the winter. CONCLUSION: e.EMA showed that the social and physical contexts of adolescent exercise and walking vary as a function of gender, grade in school, day of the week, and season. Understanding the contexts of physical activity during the high school years can be helpful in designing interventions during adolescence.

Smoking to self-medicate attentional and emotional dysfunctions.

Individuals with attentional and emotional dysfunctions are most at risk for smoking initiation and subsequent nicotine addiction. This article presents converging findings from human behavioral research, brain imaging, and basic neuroscience on smoking as self-medication for attentional and emotional dysfunctions. Nicotine and other tobacco constituents have significant effects on neural circuitry underlying the regulation of attention and affect. Age, sex, early environment, and exposure to other drugs have been identified as important factors that moderate both the effects of nicotine on brain circuitry and behavior and the risk for smoking initiation. Findings also suggest that the effects of smoking differ depending on whether smoking is used to regulate attention or affect. Individual differences in the reinforcement processes underlying tobacco use have implications for the development of tailored smoking cessation programs and prevention strategies that include early treatment of attentional and emotional dysfunctions.

Paradoxical effects of social support on blood pressure reactivity among defensive individuals.

BACKGROUND: Social support can reduce cardiovascular responses to an acute stressor. However, prior clinical research suggests that defensive individuals may react negatively to social support. PURPOSE: This experiment examined whether emotional support provided during a speech stressor would escalate rather than decrease blood pressure (BP) reactivity among defensive individuals. METHODS: After completing personality measures, 176 female undergraduates were randomly assigned to give a speech in 1 of 3 social conditions: alone, or with a neutral or supportive confederate present. Mean arterial BP was assessed at baseline, immediately before, and during and after the stressor. RESULTS: In the supportive condition, defensiveness predicted higher BP reactivity during anticipation (beta = .35, p = .04) and delivery of the speech (beta = .32, p = .03), and longer recovery to baseline BP levels (beta = .35, p = .01). In the absence of support (i.e., alone and neutral conditions), defensiveness was not associated with BP reactivity. Defensiveness also predicted greater dissociation between subjective stress and BP responses (beta = .35, p = .05), but only in the supportive condition. CONCLUSIONS: According to results, the provision of social support during stressors does not benefit defensive individuals' BP reactivity but has the opposite effect.

The reinforcing effects of nicotine and stimulant medication in the everyday lives of adult smokers with ADHD: A preliminary examination.

Whereas the smoking prevalence rates in the general population are declining, rates among people diagnosed with attention-deficit/hyperactivity disorder (ADHD) continue to be elevated. Previous research has shown that nicotine may improve attention and mood, suggesting that nicotine may help ameliorate the attentional and emotional problems associated with ADHD. The present study examined the effects of nicotine with and without stimulant medication on ADHD symptoms, moods, and arousal in the everyday lives of smokers with ADHD. A total of 10 smokers with ADHD who were being treated with stimulant medication were asked to abstain from smoking while participating in the study. Participants underwent four conditions in randomized order: (a) Nicotine patch+stimulant medication, (b) nicotine patch only, (c) placebo patch+stimulant medication, and (d) placebo patch only. Each condition continued for 2 days, during which self-reports of ADHD symptoms and moods were obtained using electronic diaries. Lightweight ambulatory monitors recorded cardiovascular activity at each diary entry. Smoking abstinence was verified by expired carbon monoxide and salivary cotinine analysis. Results showed that nicotine patches and stimulant medication alone and in combination reduced difficulty concentrating and core ADHD symptoms compared with placebo patch only. Borderline improvement in impatience and self-control was seen with nicotine patch administration primarily on day 1. Nicotine patches also tended to elevate systolic and diastolic blood pressure compared with placebo patch during day 2. The findings suggest that smokers with ADHD experience nicotine-related reductions in ADHD symptoms during their everyday lives.

Toward mapping daily challenges of living with ADHD: maternal and child perspectives using electronic diaries.

Attention-deficit/hyperactivity disorder (ADHD) has an impact on the family as well as the affected child. This study developed and tested an electronic diary for mapping the challenges of everyday family life in a sample of children with ADHD being treated with pharmacotherapy. Across 7 days, mothers and children (27 ADHD; 25 non-ADHD) independently reported their moods, behaviors, and social contexts every 30 min during nonschool hours. Symptomatic behaviors and negative moods were elevated in the ADHD group, combined with maternal perceptions of lower parenting effectiveness and quality of life. Differences in the contexts of maternal anger were salient, with mothers in the ADHD group more often angry when with their children and comparison mothers more often angry when not. Although mothers' diaries were more informative, children's diaries also distinguished the two groups, especially during mornings and weekends. The need for family-wide interventions, the utility of child self-reports, and the promise of electronic diaries are discussed.

An electronic diary study of contextual triggers and ADHD: get ready, get set, get mad.

OBJECTIVE: This study was designed to examine context effects or provocation ecologies in the daily lives of children with ADHD. METHOD: Across 7 days, mothers and children (27 children with attention-deficit/hyperactivity disorder [ADHD] taking stimulant medication; 25 children without ADHD; ages 7-12 years) provided electronic diary reports every 30 +/- 5 minutes during non-school hours. Child and maternal perceptions of behaviors, moods, and interaction quality during preparatory and transitional ("getting ready") activities were compared with those during other activities. RESULTS: Maternal reports revealed that child symptomatic behaviors and negative moods, maternal negative moods, and parent-child disagreement were elevated in the ADHD but not in the comparison group while getting ready versus other activities. Children's self-ratings also revealed situational effects, indicating that school-age children with ADHD can give meaningful self-reports using carefully structured electronic diaries. CONCLUSIONS: Even when children with ADHD are receiving stimulant pharmacotherapy, the preparatory tasks of daily living are especially challenging and linked disproportionately to child behavior problems, parent negative affect, and contentious interactions. Treatment targeted on these transitional hurdles may improve child behavior patterns and enhance parent-child relationships and family harmony.

Using ecologic momentary assessment to measure physical activity during adolescence.

OBJECTIVE: Examine the validity of using high-density electronic ecologic momentary assessment (EMA) to assess physical activity. EMA was further used to explore within- and between-subject variability in adolescent physical activity (PA) patterns. METHODS: Adolescents (n=526, 51% male) participated in EMA waves occurring approximately every 6 months between the 9th and 12th grade. Each wave extended over 4 consecutive days (Thursday to Sunday). Using a Palm III handheld computer, each participant reported his or her primary activity (e.g., exercise, walking, homework) every 30 (+/-10) minutes during waking hours. Heart rate (via Polar heart rate monitor) and activity counts (via wrist accelerometer) were simultaneously assessed during the EMA intervals. RESULTS: Overall, heart rates and accelerometer counts were greater for diary-reported exercise and walking than for nonphysical activities (p's<0.001). EMA revealed that the typical duration of exercise sessions was longer than walking sessions (p<0.05). Rates of walking and exercise were more consistent between waves (i.e., across high school) than within waves (i.e., across the 4 days of monitoring), most likely due to the significantly higher rates of walking and exercise occurring on weekdays as compared to weekend days (p's<0.001). Average rates of walking were greater for girls than boys, and the reverse was true for exercise. Rates of both walking and exercise declined steadily between 9th and 12th grade (p's<0.001). CONCLUSIONS: Physical activity reported via EMA corresponded to objective activity indicators. EMA yielded information about within-person variability in PA that cannot be obtained readily from traditional self-report instruments. Given its potential for simultaneously assessing important physiologic, psychological, and contextual factors, EMA presents a promising approach to studying adolescent physical activity.

Adolescents react to the events of September 11, 2001: focused versus ambient impact.

This study examined the perceived impact of the events of September 11, 2001, on adolescents distant from the disaster sites and compared these perceptions with changes in everyday moods. A survey of reactions to September 11 was completed 2-5 months after the events by 171 adolescents participating in a longitudinal study of stress and health. Electronic diary ratings of contemporaneous moods before and after the attacks were also compared. Many adolescents distant from the disaster sites reported changes in everyday activities and signs of distress along with some positive outcomes. Elevated levels of negative affect emerged when adolescents were asked directly about the event (focused impact), but no changes were detected in their ongoing, momentary mood reports before and after September 11 (ambient impact). Trait and electronic diary measures of anxiety independently predicted posttraumatic distress. Refined assessments are needed to evaluate the degree to which self-reported traumatic symptoms reflect significant clinical distress versus an attentional focus generated by the question-asking process.

Is there a link between adolescent cigarette smoking and pharmacotherapy for ADHD?

There is continuing concern that pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) may raise the risk of smoking (the gateway hypothesis). Alternatively, unmedicated people with ADHD may use nicotine to improve attentional and self-regulatory competence (the self-medication hypothesis). From a community sample of 511 adolescents participating in a longitudinal health study, 27 were identified as having ADHD, and 11 of these were receiving pharmacotherapy. Self-report surveys, electronic diaries, and salivary cotinine all indicated that adolescents treated with pharmacotherapy for ADHD smoked less than their untreated counterparts over 2 years of high school. These convergent findings from 3 disparate indicators lend support to the self-medication hypothesis over the gateway hypothesis, although alternative explanations need further study. The findings also suggest that early treatment of psychological and behavioral problems may prevent or delay smoking initiation.

Tobacco use across the formative years: a road map to developmental vulnerabilities.

Different vulnerabilities are launched or play a more active role at different developmental stages and different ages. Furthermore, the interplay between developmental and biological, psychosocial, and environmental vulnerabilities is expected to differ across stages of smoking. This article focuses on the intersection of vulnerability associated with adolescence with tobacco-use vulnerability resulting from biological, psychological, and environmental characteristics of an adolescent. Recommendations include the following: (a) Effectively treat childhood and adolescent behavioral and emotional disorders that place adolescents at risk; (b) target programs toward specific high-risk subgroups; (c) incorporate training in self-control, affect regulation, and healthy coping strategies into educational programs and extracurricular activities; (d) encourage youth to develop healthy sources of success and satisfaction; (e) encourage communities and states to launch environmental, policy, and regulatory initiatives to protect youth from tobacco; (f) consider bold initiatives that will require fundamental changes in public attitudes, including monetary rewards for nonsmoking, heightened penalties for facilitating and engaging in underage smoking, and government subsidies for substitute pharmacological agents.

Situations and moods associated with smoking in everyday life.

On 4 days, in everyday situations, 21 female and 26 male smokers used an electronic diary to record situations and moods at times of smoking and at control nonsmoking occasions. Self-reports of particular locations, activities, posture, consumption, social context, moods, and internal states were specifically associated with smoking. Real-time assessments in everyday situations provide useful information about the interplay of environmental factors and internal states in smoking. The findings suggest that conditioning and learning processes play a role in smoking and should be considered in smoking cessation programs.