Smoking, Lung Cancer Stage, and Prognostic Factors-Findings from the National Lung Screening Trial.

BACKGROUND: Low-dose computed tomography (LDCT) increases the early detection of lung cancer. Identifying modifiable behaviors that may affect tumor progression in LDCT-detected patients increases the likelihood of long-term survival and a good quality of life. METHODS: We examined cigarette smoking behaviors on lung cancer stage, progression, and survival in 299 ever-smoking patients with low-dose CT-detected tumors from the National Lung Screening Trial. Univariate and multivariate Cox models were used to estimate the hazard ratio (HR) for smoking variables on survival time. RESULTS: Current vs. former smokers and early morning smokers (≤5 min after waking, i.e., time to first cigarette (TTFC) ≤ 5 min) had more advanced-stage lung cancer. The adjusted HR for current vs. former smokers was 1.3 (95% confidence interval [CI] 0.911-1.98, p = 0.136) for overall survival (OS) and 1.3 (0.893-1.87, p = 0.1736) for progression-free survival (PFS). The univariate hazard ratios for TTFC ≤ 5 min vs. >5 min were 1.56 (1.1-2.2, p = 0.013) for OS and 1.53 (1.1-2.12, p = 0.01) for PFS. Among current smokers, the corresponding HRs for early TTFC were 1.78 (1.16-2.74, p = 0.0088) and 1.95 (1.29-2.95, p = 0.0016) for OS and PFS, respectively. In causal mediation analysis, the TTFC effect on survival time was mediated entirely through lung cancer stage. CONCLUSION: The current findings indicate smoking behaviors at diagnosis may affect lung cancer stage and prognosis.

Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients.

Continued smoking after a cancer diagnosis is causally associated with increased risks of all-cause and cancer-specific mortality, and of smoking-related second primary cancers. Patient navigation provides individualized assistance to address barriers to smoking cessation treatment and represents a promising bridge to smoking cessation in persons with cancer who smoke cigarettes. We conducted a single-arm interventional cohort study of current smokers identified through prospective health record screening and recruited from Penn State Cancer Institute outpatient clinics. Consented participants received two telephone intervention sessions and gain-framed messaging-based smoking cessation educational materials designed for persons with cancer. The primary study outcome was the feasibility of the patient navigation-based intervention; the secondary outcome was the engagement in smoking cessation treatment at the two-month follow-up. Of 1168 unique screened Cancer Institute patients, 134 (11.5%) were identified as current cigarette smokers. Among 67 patients approached at outpatient clinics, 24 (35.8%) were interested in participating, 12 (17.9%) were enrolled, eight (11.9%) completed the intervention sessions and study assessments, and six engaged in smoking cessation treatment. The participants expressed satisfaction with the intervention sessions (median = 8.5, scale 0-10). The low recruitment rates preclude patient navigation as a feasible method for connecting cancer patients to smoking cessation treatment resources.

Nighttime Waking to Smoke, Stress, and Nicotine Addiction.

INTRODUCTION: Up to one-half of cigarette smokers may wake up during the night and smoke. This behavior may result in greater likelihood of cessation failure, clinically relevant sleep difficulties, and a range of health issues. Whereas the scientific literature has often attributed this behavior to nicotine dependence, up to 85% of smokers who wake at night and smoke attribute this behavior to factors other than nicotine. This study examines the relations between nicotine dependence, psychological distress, perceived stress, and waking at night to smoke. METHODS: A total of 351 adult smokers from the Pennsylvania Adult Smoking Study (PASS) completed self-report surveys and provided saliva for the evaluation of cotinine values. Survey instruments included measures of nicotine addiction, perceived stress, a broad measure of global psychological distress, and a range of demographic factors. RESULTS: Logistic regression demonstrated that nicotine addiction, psychological distress, and perceived stress were all related to waking at night to smoke, but cotinine levels were not. Mediation models found that psychological distress had a direct relation to waking at night to smoke, even when considering nicotine addiction and other causes of sleep disturbances (e.g., apnea and chronic physical pain). Alternative moderation and mediation models were conducted but did not support other plausible associations between variables. CONCLUSIONS: Waking at night to smoke is likely the result of both nicotine dependence and psychological distress. Given that cotinine levels were not associated with waking at night, the mechanisms of how nicotine dependence may affect waking at night need further investigation.

Household Smoking Restrictions, Time to First Cigarette and Tobacco Dependence.

OBJECTIVE: Environmental factors, such as household smoking restrictions (HSR), may impact a range of smoking-related outcomes. The current study examined the effects of various levels of HSR on smoking behaviors, including the number of cigarettes smoked per day and levels of nicotine dependence in a population of adult smokers. (1) Having specific HSR reduces the urges to smoke (path A); (2) having specific HSR reduces CPD (path B); (3) having specific HSR results in lower overall nicotine addiction (path C), and later, TTFC will be associated with (4) lower urges to smoke in the morning (path A'), (5) fewer CPD (path B'), and (6) lower levels of nicotine addiction (path C'). METHOD: Regression models using self-reported data from the Pennsylvania Adult Smoking Study (N = 353) were used. TTFC was measured minutes between waking and the first cigarette of the day. Household smoking restrictions were measured as follows: (1) full ban on smoking in the home, (2) partial ban, or (3) no ban. RESULTS: Subjects with no household smoking restrictions had lower incomes and education than those with at least some household smoking restrictions; those with full bans smoked less and had an earlier TTFC than those with at least some household smoking restrictions. Smokers with a full ban had a later TTFC, mediated by fewer cigarettes per day and lower cravings. Among those with partial bans, there is no reduction in cigarettes per day and an increase in urges to smoke. CONCLUSIONS: Partial household smoking restrictions are no better than no household smoking restrictions with regard to cigarettes per day and TTFC, and may cause an increase in urges to smoke in the morning.

Harsh and Sweet Sensations Predict Acute Liking of Electronic Cigarettes, but Flavor Does Not Affect Acute Nicotine Intake: A Pilot Laboratory Study in Men.

INTRODUCTION: Electronic cigarette use is increasing in popularity, and thousands of flavors are available. Adolescent vaping rates in the United States have nearly doubled in the past year. Unlike combustible tobacco, added flavors are not currently regulated for some types of electronic cigarette products. Here, we investigated the role of flavor in electronic cigarette liking and acute intake. METHODS: Men (n = 39) aged 18-45 vaped in a controlled laboratory setting after being randomized to one of four e-liquids: 6 mg nicotine/mL cherry, 18 mg/mL cherry, 6 mg/mL chocolate, or 18 mg/mL chocolate. They completed several questionnaires, and vaped ad libitum for 10 minutes. After the first puff, participants rated sensations (sweetness, bitterness, coolness, harshness/irritation) on general labeled magnitude scales (gLMS) and rated overall liking on a generalized hedonic scale. Once the 10-minute session ended, participants made another set of ratings. RESULTS: Liking was generally stable across the vaping session and liking varied substantially across the four conditions. Across all conditions, sensory ratings predicted liking: harshness/irritation was negatively associated with first puff liking, whereas perceived sweetness was positively associated with first puff liking. First puff liking associated with increased amount of e-liquid vaped, but not total nicotine intake. Participants appeared to titrate their nicotine intake regardless of assigned condition. CONCLUSION: Flavored e-liquids affect acute liking ratings, but not acute nicotine intake. IMPLICATIONS: These data suggest individuals who regularly vape may titrate their nicotine intake, regardless of flavor, and contrary to expectations, acute liking did not predict total nicotine intake. However, more-liked flavors may potentially make higher nicotine levels more tolerable by adding pleasant sensations directly, rather than by perceptual masking that reduces aversive sensations.

Time to First Cigarette: A Potential Clinical Screening Tool for Nicotine Dependence.

OBJECTIVES: The time to first cigarette (TTFC) of the day has been identified as the best single-item indicator of nicotine dependence. However, TTFC has not been extensively used in clinical settings and is not a criterion for tobacco use disorder, perhaps due to a lack of information about TTFC's predictive value. This review provides a synthesis of the accumulating literature on TTFC's relationships with nicotine dependence, identify gaps, and inform future clinical and epidemiologic research of potential uses of TTFC. METHODS: A systematic review of the literature was conducted using PubMed, Google Scholar, and Web of Science ISI databases. We identified 16 articles examining the relation between TTFC and negative outcomes associated with high levels of nicotine addiction and Tobacco Use Disorders (eg, high levels of nicotine and toxicant exposure, progressive use over time, failed cessation, head-and-neck cancers). RESULTS: Earlier TTFC was consistently associated with greater likelihood of cessation failure and relapse, and higher levels of biomarkers of tobacco exposure. Several of these associations were found among both adult and adolescent smokers, and remained even after accounting for smoking behaviors (eg, cigarettes/day). CONCLUSIONS: Earlier TTFC is a key indicator of greater nicotine dependence. Knowledge of a smoker's TTFC may allow clinicians to accurately inform smokers of health risks and assign greater resources during cessation attempts. Smokers may be able to use TTFC to self-select cessation aids and accurately assess their unique smoking-related health risks. TTFC may be a better item than cigarettes/day for accurately quantifying dependence and risk in epidemiologic studies.

Pharmacokinetic Profile of Spectrum Reduced Nicotine Cigarettes.

INTRODUCTION: Spectrum research cigarettes have been developed with varying nicotine content for use in studies evaluating the effects of a regulatory policy reducing the permissible nicotine content in cigarettes. This study aimed to characterize the nicotine pharmacokinetic profile of Spectrum cigarettes. METHODS: Twelve daily smokers attended four sessions and had blood nicotine, exhaled carbon monoxide, and subjective effects measured before and after smoking either a single cigarette of their preferred brand or high (10.9 mg/cigarette), medium (3.2 mg/cigarette), or low (0.2 mg/cigarette) nicotine content Spectrum research cigarettes, in a double-blind design with order counterbalanced. RESULTS: The boost in blood nicotine concentration was dose-dependent, with a boost of 0.3, 3.9, and 17.3 ng/mL for low-, medium-, and high-nicotine content Spectrum cigarettes. The high dose Spectrum had a similar nicotine boost to the "preferred brand" cigarettes (19 ng/mL). Subjects took longer puffs on the low nicotine cigarettes, but smoked these cigarettes faster than other cigarette types. High nicotine Spectrum cigarettes reduced the urge to smoke more than other cigarette types. CONCLUSIONS: This study shows that Spectrum research cigarettes produce blood nicotine absorption in a dose-dependent manner, and therefore, are appropriate for use in studies of nicotine reduction in cigarettes. IMPLICATIONS: This is the first study to determine the pharmacokinetic profile of Spectrum reduced nicotine content research cigarettes following an overnight abstinence. These data could provide evidence to regulatory agencies about the effects of reduced nicotine cigarettes when considering regulations on tobacco reduction.

Time to first cigarette of the day and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in adult regular and non-daily smokers: (NHANES) 2007-10.

As the number of regular smokers has decreased over the last decade, the prevalence of light (<10 cigarettes per day) and non-daily smokers has increased. As the FDA continues to develop regulations for tobacco products, understanding factors related to toxin exposure in all smokers is essential. The present study evaluated the relation between the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), as measured by its metabolite, and patterns of heavy smoking (>10 cigarettes per day), light smoking and non-daily smoking and the time to the first cigarette of the day (TTFC), a robust predictor of nicotine addiction, cessation failure, sleep disruption and other health indicators. Findings from a sample of 352 smokers suggest that among intermittent, non-daily and light daily smokers, TTFC of the day was associated with higher levels of NNK metabolite, an effect which was mediated by urinary cotinine levels, but not by the number of cigarettes smoked per day. This suggests these groups of smokers may be puffing each cigarette more intensely, thus increasing nicotine and toxin exposure, despite fewer overall cigarettes. These findings provide further information regarding toxicant exposure associated with lower-frequency smoking and has implications for future regulatory research approaches with lowered nicotine cigarettes and other tobacco products.

An introduction to the electronic waterpipe.

Despite the associated negative health outcomes, waterpipe smoking remains a popular method of tobacco consumption, specifically in young adults. While there have been expanding efforts to decrease waterpipe use, there is a new, non-combustible waterpipe device on the market, the electronic waterpipe (e-waterpipe), that could serve as an alternative to traditional, combustible waterpipe smoking. There is currently no known literature evaluating the e-waterpipe including prevalence of use or its health risks. This mini review defines the e-waterpipe, explains how an e-head is used to construct an e-waterpipe, and describes the various e-head models available for use. The review also discusses implications of e-head use and provides recommendations for future research and regulation.

The Effect of Price on the Consumption of Reduced Nicotine Cigarettes.

BACKGROUND: Price affects the demand for cigarettes, indicating that smokers, perhaps especially lower income smokers, may choose low nicotine cigarettes (LNC) if they were commercially available and cost less than fully nicotinized conventional cigarettes. The present study tests the hypothesis that smokers will prefer purchasing LNCs at a lower price point than conventional cigarettes given a fixed budget. METHOD: A laboratory-based, within-subject, 3 (nicotine level) × 3 (price) factorial design provided smokers opportunities to purchase standard (0.7 per mg tobacco), moderately reduced (0.3 mg), and very low-nicotine (0.03 mg). Spectrum research cigarettes according to an escalating price structure (low-nicotine costing the least, high-nicotine costing the most) given a fixed, laboratory-provided "income." Participants were 20 overnight-abstinent smokers who previously smoked and rated each of the three cigarettes. RESULTS: Overall, smokers rated LNCs as less satisfying compared with standard nicotine cigarettes (SNC), t(18) = -5.40, p < .001. In the free-choice session, subjects were more likely to choose LNC that cost less compared with SNC that cost more, even after an 8-hour abstinence period, F(2, 19) = 4.32, p = .03. Those selecting LNC or moderate nicotine cigarettes after abstinence smoked more cigarettes per day, t(17) = 2.40, p = .03 and had higher dependence scores on the HONC, t(18) = 2.21, p = .04 that those selecting SNC. CONCLUSION: The results indicate that smokers' response to price points when purchasing cigarettes may extend to LNC if these were commercially available. Differential cigarette prices based on nicotine content may result in voluntary selection of less addicting products. IMPLICATIONS: The Food and Drug Administration has proposed a rule that would reduce nicotine content in commercially available cigarettes. However, it is not known how smokers may respond in an environment where products of differing nicotine content and of differing prices are available. This study demonstrates that price may be an important factor that could lead smokers to select reduced nicotine products voluntarily, even if those products are rated as inferior or less satisfying.

Effect of e-cigarette advertisement exposure on intention to use e-cigarettes in adolescents.

INTRODUCTION: With the growth of electronic cigarettes use, curiosity about and experimentation with these products has increased among adolescents. The purpose of the present study was to evaluate the moderating effect of e-cigarette advertisement (ad) exposure on the relation between perceptions of use and intentions to use in youth. METHODS: Multiple regression analyses utilizing data from the 2014 National Youth Tobacco Survey (N = 17,286) were used to evaluate the effect of ad exposure, perceived harmfulness, barriers, and benefits of e-cigarette use on intentions to use among youth who had never used e-cigarettes. RESULTS: Models for non-smokers accounted for 15.5% of the variance in intention to use (R2 = 0.155, F (15) = 187.0, p < 0.001). Results demonstrate that an increase in the number of exposures to e-cigarette ads was associated with an increase in intent to use (b = 0.039, t = 7.4, p < 0.001). Models also demonstrated significant interactions between ad exposure and perceptions of use on future intention to use. For smokers, models explained 11.1% of the variance in intention to use (R2 = 0.111, F (15) = 3.1, p < 0.001). Ad exposure had a non-significant effect on intention to use e-cigarettes (b = -0.010, t = -0.2, p = 0.859). In smokers, ad exposure did not significantly affect the association between perceptions of use and intention to use. CONCLUSIONS: Ads are most effective at attracting non-smoking youth as new users rather than promoting product switching in young cigarette smokers.

Time to First Cigarette, Physical Activity, and Pulmonary Function in Middle-aged to Older Adult Smokers.

BACKGROUND: How addiction severity relates to physical activity (PA), and if PA moderates the relation between PA and lung function among smokers, is unknown. This study explored the independent and interactive associations of nicotine addiction severity and PA with lung function. METHODS: The study used cross-sectional data from 343 adult smokers aged 40 to 79 participating in the 2009-10 and 2011-12 National Health and Nutrition Examination Survey. Assessed were the independent relations of nicotine addiction severity, as measured by the time to first cigarette (TTFC), and average daily minutes of moderate and vigorous PA with lung function ratio (FEV1/FVC). Additional analysis examined whether PA moderated the relationship between addiction severity and lung function. RESULTS: Greater lung function was independently associated with moderate PA and later TTFC, but not vigorous PA, when controlling for cigarettes per day (CPD), past month smoking, ethnicity, years smoked, and gender (P-values < .05). PA did not moderate the association between addiction severity (TTFC) and lung function (P = .441). CONCLUSION: Among middle-aged to older smokers, increased PA and lower addiction severity were associated with greater lung function, independent of CPD. This may inform research into the protective role of PA and identification of risk factors for interventions.

Reduced Nicotine Content Expectancies Affect Initial Responses to Smoking.

OBJECTIVES: We sought to determine if negative responses to reduced nicotine content (RNC) cigarettes during open-label trials result from smokers' (negative) expectancies. We examined the effects of nicotine content description - independent of actual nicotine content - on subjective responses (craving reduction, withdrawal suppression, mood changes, and sensory ratings) and smoking behaviors (topography measures and carbon monoxide [CO] boost). METHODS: Thirty-six 12-hour-abstinent daily smokers completed a 3-session crossover trial. During each session, participants smoked their preferred brand cigarette - blinded and described as containing "usual," "low," and "very low" nicotine content - through a topography device and completed CO and subjective response assessments. RESULTS: Although nicotine content was identical, compared to the "usual" content cigarette, participants experienced less craving reduction after smoking the "very low" nicotine cigarette, and rated its smoke as weaker (p < .05). Participants took shallower puffs of the "low" nicotine cigarette (p < .05), and rated the "low" and "very low" nicotine cigarettes as weaker and too mild (p < .01). CONCLUSIONS: Negative responses to RNC cigarettes may be due, in part, to negative expectancies about using cigarettes containing less nicotine. In this context, RNC cigarette marketing and labeling are likely important considerations if a federal nicotine reduction policy is initiated.

Severity of Nicotine Addiction and Disruptions in Sleep Mediated by Early Awakenings.

INTRODUCTION: Sleep disruption is common among smokers, however, extant studies primarily explore differences between smokers and nonsmokers. The time to smokers' first cigarette of the day (TTFC) after waking, a strong indicator of addiction severity, is inversely associated with numerous health outcomes. The present study tests the hypotheses that, in a representative sample of daily smokers, the severity of nicotine addiction is associated with shorter habitual sleep duration and excessive daytime sleepiness. METHODS: We examined the associations between TTFC and sleep outcomes (sleep duration and daytime excessive sleepiness) and the mediating effects of specific sleep disruption pathways (delayed sleep onset, awakenings at night, and early awakening) using structural equation modeling. Analyses included cross-sectional data from 2015 current daily smokers aged 16-85 years who participated in the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey. RESULTS: Among daily smokers, earlier TTFC was associated with both shorter sleep duration and excessive daytime sleepiness (p values < .001, R 2 values = .15 and .29, respectively). Of sleep disruption pathways, only early awakening mediated the associations of TTFC with both outcomes (sleep duration: b = .02, 95% confidence interval [CI]: 0.006 to 0.042; daytime sleepiness: b = -.01, 95% CI: -0.03 to -0.004), even after controlling for variables confounded with smoking status and sleep outcomes. CONCLUSIONS: Findings suggest that early awakening may be the mechanism responsible for the association between nicotine addiction severity and poor sleep outcomes of shorter sleep duration and excessive daytime sleepiness. These data may inform cessation strategies, risk assessment, and future longitudinal studies on the relations between sleep and nicotine addiction. IMPLICATIONS: Smokers have impaired sleep quality and quantity as compared to nonsmokers; however, that severity of nicotine addiction is an important factor in sleep quality, not just smoking status. Higher levels of addiction lead to less sleep and more daytime sleepiness. The relation between addiction severity and sleep is mediated by waking too early in the morning, and not by difficulty falling asleep or waking during the night. These findings could play an important role in supplementing cessation efforts; sleep disruption may interact with other negative physiological and emotional symptoms related to nicotine withdrawal and could result in more cessation failure.

Exploring the Severity of Dependence Scale (SDS) as a possible measure of nicotine dependence.

BACKGROUND: The time to first cigarette (TTFC) of the day is an emerging single-item indicator of nicotine dependence due to its robust associations with indices of physical dependence. However, it is unclear if this measure adequately captures other dimensions of dependence. The Severity of Dependence Scale (SDS) is a brief questionnaire used to assess psychological aspects of dependence that has not yet been extensively applied to smoking research. METHODS: We examined associations between the SDS and TTFC among 255 smokers during the baseline session of a cessation trial. We also examined associations of the SDS and TTFC with biobehavioral dependence indices, quitting behaviors, and cognitive-affective variables and compared the relative contributions of both measures in predicting these variables. RESULTS: TTFC was unrelated to SDS total score, but was related to individual SDS items. TTFC, but not SDS, was correlated with indices of physical dependence (e.g., cigarettes per day [CPD], carbon monoxide [CO]). Both TTFC and SDS were associated with quitting behaviors, with opposite directionality of associations. TTFC and SDS were both associated with cognitive-affective variables, but SDS outperformed TTFC in strength and number of these relationships. Including both the SDS and TTFC as regression model predictors often increased the amount of variance explained. CONCLUSIONS: Findings suggest that SDS and TTFC assess different constructs of nicotine dependence; among smokers, the SDS appears to tap into nonphysical components of dependence (e.g., loss of control) that relate to quitting motivation and affect. Assessing nicotine dependence using only the SDS may fail to capture physical dependence and, further, may not reflect the same domains of addiction the SDS assesses in other drugs of abuse. Nonetheless, using 3 SDS items in addition to TTFC may offer utility over using TTFC alone.

Knowledge and perceptions of tobacco-related media in rural Appalachia.

INTRODUCTION: A critical component of the US Food and Drug Administration's new authority to regulate tobacco products is understanding communications and marketing of tobacco products and their perceived risks in different geographic, age, race, ethnic and socioeconomic groups. Such information might be particularly useful in subgroups of the population or geographic areas that experience high tobacco use and suffer a disproportionate burden from tobacco-related diseases. For certain populations, there may be additional cultural factors unique to the geographical region which may promote smoking behavior. The purpose of the present study was to examine the perceptions of tobacco-related media messages among a sample of rural Appalachian natives, a population with smoking rates higher than the national average and who are disproportionately affected by tobacco-related and other cancers. METHODS: A series of four focus group sessions were conducted in a north-central area of Pennsylvania, in one of 52 counties in Pennsylvania designated as within the Appalachian region. Participants were recruited via direct mail letters, advertisements in a local newspaper, and recruiting flyers posted at the local library. The focus groups were moderated by trained professional staff from The Pennsylvania State University's Center for Survey Research (CSR). Focus group sessions sought to examine perceptions of tobacco-related media in an Appalachian region of Pennsylvania. The sessions were audiotaped and transcribed, and the data was analyzed using qualitative approaches. RESULTS: Participants reported that pro-tobacco ads and favorable messages were received through the internet, direct mail, convenience stores, billboards, movies, and other sources. Anti-tobacco messages were identified primarily from television and magazines. In general, participants concluded that quitting was a matter of choice and was not influenced by pro- or anti-tobacco media. CONCLUSIONS: These results indicate that both pro- and anti-tobacco messages from a variety of sources are highly recognized and remembered in detail in Appalachia, but the effectiveness of anti-tobacco messages is questionable within this group. It was found that, without exception, group members reported that no media messages - either pro- or anti-tobacco - had any meaningful impact on their current behavior. Group members did, however, recognize that media messages influenced their behavior at the time they were first starting to smoke. The failure of these messages to connect with this population may reflect the lack of specific tailoring of messages to fit the distinct culture and values of this Appalachian population.

Predictors of the Nicotine Dependence Behavior Time to the First Cigarette in a Multiracial Cohort.

BACKGROUND: The time to first cigarette of the day (TTFC) is a strong indicator of nicotine dependence behaviors such as nicotine uptake and quit success in young and older smokers. There are substantial differences in levels of nicotine dependence by race and ethnic group. METHODS: Data from Wave III of the multiracial National Longitudinal Study of Adolescent Health were analyzed for young smokers between the ages of 21 and 28 (N = 1,425). Time to first cigarette data was compared between Hispanic, White, Black, Native American, and Asian smokers. RESULTS: Black smokers were significantly more likely to smoke within 5min of waking than White, Hispanic, and Asian smokers. Lower personal income predicted smoking within 5min of waking for both White and Black smokers. For White smokers, increased number of cigarettes per day and increased years of smoking also predicted smoking within 5min of waking. The number of days smoked or number of cigarettes per day did not predict smoking within 5min of waking among smokers. CONCLUSIONS: The higher prevalence of early TTFC among Blacks indicates increased nicotine and carcinogen exposure, and may help explain the increased lung cancer rates and failed cessation attempts among Black smokers. TTFC may be an important screening item, independent of cigarettes per day, for clinicians and interventions to identify those at highest risk for cessation failure and disease risk.

Development and validation of a smoking expectancies measure for adolescents seeking to quit smoking.

BACKGROUND: A more comprehensive understanding of factors that affect smoking cessation outcomes among adolescents may help enhance treatment interventions. One promising but underexplored factor that may influence cessation success is teens' specific expectancies or beliefs about smoking outcomes. The present study evaluated the validity and reliability of a new measure of expectancies and its association with cessation outcomes among 762 adolescent smokers participating in studies of the American Lung Association's Not On Tobacco cessation program. METHODS: Self-report questionnaires were collected prior to and following participation in a smoking cessation program. Self-reported cigarette use was verified with expired-air carbon monoxide. A multistep exploratory and confirmatory factor analysis and reliability and validity analyses were performed. RESULTS: Four theoretically related yet empirically independent factors were identified by the Smoking Expectancies Questionnaire (SEQ): (1) Positive Reinforcement, (2) Negative Reinforcement-Emotional Regulation, (3) Negative Reinforcement-Addiction and Withdrawal, and (4) Negative Outcomes/Risk. These factors could be subsumed by a single SEQ factor that reflected an overall concept of smoking expectancies relevant for adolescent smoking cessation. An overall SEQ Function score reflecting the balance between positive and negative expectancies predicted both preintervention cigarettes per day and cessation outcomes. CONCLUSIONS: A single, overall SEQ Function score may prove useful for understanding the associations among individual, social, and contextual factors in predicting treatment outcomes. Additionally, study findings may assist with modifying smoking expectancies among cessation program participants, thereby enhancing treatment outcomes with diverse youth smoking populations.

Time to first cigarette predicts 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in adolescent regular and intermittent smokers, National Health and Nutrition and Examination Survey (NHANES) 2007-10.

BACKGROUND AND AIMS: The time to first cigarette (TTFC) of the day is an indicator of nicotine intake in adults and adolescents. However, the relation between TTFC and biological markers of nicotine addiction and health risk in youths has not been well described. The current study examined whether an earlier TTFC predicts higher levels of a tobacco-specific carcinogen, 4-(methylnitrosamino)-1-(3-pyridal)-1 (NNAL), in regular and intermittent adolescent smokers and if this relation is mediated by nicotine intake (measured by cotinine) or cigarettes per day (CPD). DESIGN: A cross-sectional analysis of a nationally representative subsample of adolescents. SETTING: A general community sample from the 2007-08 and 2009-10 National Health and Nutrition and Examination Survey. PARTICIPANTS: A total of 215 adolescents in the United States between the ages of 12 and 19 years who reported smoking at least once in the 5 days prior to data collection. MEASUREMENTS: The primary outcome measure was urinary levels of NNAL. FINDINGS: In both regular and intermittent smokers, earlier TTFC was associated dose-dependently with higher levels of NNAL (P < 0.03 in both cases). TTFC had an indirect effect on NNAL, mediated by nicotine intake (cotinine) in both regular [ß = -0.08, standard error (SE) = 0.03, 95% confidence interval (CI) = -0.15, -0.03] and intermittent (ß = -0.02, SE = 0.01, 95% CI = -0.05, -0.002) smokers. CPD was not found to be an important mediator of the relation between TTFC and NNAL. CONCLUSIONS: Time between waking and the first cigarette of the day is correlated in daily and non-daily adolescent smokers with overall nicotine and therefore carcinogen intake.