Smoking history, and not depression, is related to deficits in detection of happy and sad faces.

INTRODUCTION: Previous research has demonstrated that chronic cigarette smoking and major depressive disorder (MDD) are each associated with cognitive decrements. Further, these conditions co-occur commonly, though mechanisms in the comorbid condition are poorly understood. There may be distinct, additive, or overlapping factors underlying comorbid cigarette smoking and MDD. The present study investigated the impact of smoking and MDD on executive function and emotion processing. METHODS: Participants (N=198) were grouped by diagnostic category (MDD and healthy controls, HC) and smoking status (ever-smokers, ES and never-smokers, NS). Participants completed the Facial Emotion Perception Test (FEPT), a measure of emotional processing, and the parametric Go/No-go task (PGNG), a measure of executive function. RESULTS: FEPT performance was analyzed using ANCOVA with accuracy and reaction time as separate dependent variables. Repeated measures MANCOVA was conducted for PGNG with performance measure and task level as dependent variables. Analyses for each task included diagnostic and smoking group as independent variables, and gender was controlled for. Results for FEPT reveal that lower overall accuracy was found for ES relative to NS, though MDD did not differ from HC. Post-hoc analyses revealed that ES were poorer at identifying happy and sad, but not fearful or angry, faces. For PGNG, poorer performance was observed in MDD relative to HC in response time to Go targets, but there were no differences for ES and NS. Interaction of diagnosis and smoking group was not observed for performance on either task. CONCLUSIONS: The results of this study provide preliminary evidence for distinctive cognitive decrements in smokers and individuals with depression.

Race differences in weight concerns among women smokers: results from two independent samples.

To investigate attitudes about weight as they interact with smoking in African American women, we analyzed data from two independent samples of white and African American women smokers--one assembled via a national random-digit-dialing survey, the other consisting of candidates for enrollment in local studies. Findings for the two samples were remarkably consistent. African American women were significantly heavier and significantly more likely to have a self-reported BMI > or = 27. Although the preferred weight for African American women was significantly higher than for white women, the percentage by which they exceeded their preferred body weight did not differ significantly between groups, and the difference between actual and preferred weights was actually greater for African American women. African American women were more likely to be satisfied with their body shape and were significantly less likely to exercise to control weight. They did not differ significantly on binge-eating or dieting. African American women were more likely than white women to be unwilling to gain any weight upon quitting smoking but did not differ significantly on any other smoking-related weight concerns. Our results suggest that weight concerns, though differently conceptualized, may motivate African American women as powerfully as white women. They strongly suggest that race differences need to be considered in designing optimal smoking cessation interventions for weight-concerned women smokers. To accomplish this goal, efforts to identify a vocabulary for the expression of weight concerns in African American women will be needed, as will attention to ways to avoid exacerbating obesity and to encourage exercise.

Emergence of depression during early abstinence in depressed and non-depressed women smokers.

The emergence of depression early in a quit attempt and its relationship to ability to maintain abstinence were studied in 99 depressed and non-depressed women smokers. Participants rated withdrawal symptomatology during a baseline week and the first two weeks of a quit attempt, during which they used a 21-mg nicotine patch and received behavioral counseling. Depressed women experienced greater difficulty maintaining early abstinence than non-depressed women. They were significantly more likely to smoke on the first day of abstinence and smoked marginally more days during the first week. Among participants who relapsed during the first two weeks, latency to relapse was significantly shorter for depressed women. Although craving and all withdrawal symptoms except insomnia showed significant increases over baseline, only depression showed significant group differences, with trend analyses suggesting that depression asymptotes in non-depressed women after the first week but continues increasing in depressed women. Larger increases in depression on the first day of abstinence were associated with earlier lapse. Because depression is relatively infrequent as a withdrawal symptom, it may not be a "true" withdrawal symptom except in depressed people. Identification of depressed smokers and anticipation of their increased need for support during this period may help to counteract the "first-day effect" and difficulties during early abstinence.

Characterizing concerns about post-cessation weight gain: results from a national survey of women smokers.

Differences among adult women smokers with differing levels of concern about post-cessation weight gain were investigated in a national random-digit-dialing survey. To avoid defining weight concerns in terms of possible etiologies or contributory factors, respondents were stratified using a single item querying concern about post-cessation weight gain; 39% described themselves as very concerned (VC), 28% as somewhat concerned (SC), and 33% as not concerned (NC). Significant between-groups differences were detected for measures of weight and body image, eating patterns and weight control practices, and nicotine dependence, but not for depression. Differences, primarily between VC and NC, were also detected for several weight-related smoking variables, including importance of weight as a factor in initiation, smoking as a weight control strategy, increased appetite and weight gain as withdrawal symptoms, willingness to gain weight upon quitting, self-efficacy about relapse in the face of weight gain, and readiness to quit smoking. Most differences persisted even after adjusting for body mass index and nicotine dependence. Although the importance of thinness was rated higher by weight-concerned women, the difference did not reach significance. Rather, what differentiated groups was the importance of overall body image, suggesting a larger pattern of preoccupation with body image that may not be captured by queries about weight concerns alone. We conclude that weight-concerned women smokers will be especially unlikely to seek treatment or attempt self-quitting; and that redirecting attention to other aspects of body image is likely to be more helpful than attempting to divert attention away from body image.

Abstinence effects and reactivity to nicotine during 11 days of smoking deprivation.

The purpose of the present study was to investigate smoking abstinence effects and the dissipation of tolerance (reactivity to nicotine) under controlled laboratory conditions. Seventeen male and female regular smokers were tested first in a session following ad libitum smoking and then in an additional five sessions over the course of 11 days during which they abstained from smoking. A metered dose of nicotine was administered via intranasal spray to ensure standard exposure, and pre- and post-dosing measures of heart rate, blood pressure, cortisol, galvanic skin response (GSR), craving, and several DSM-IV withdrawal symptoms (anxiety, irritability, restlessness, difficulty concentrating, and appetite) were collected. Prior to the nicotine test dose during deprivation sessions, heart rate and systolic blood pressure evinced elements of both an 'offset abstinence pattern' (deflection in a direction opposite to that produced by smoking) and a 'transient abstinence pattern' (deflection followed by a subsequent return); for cortisol, an offset pattern was observed, whereas for GSR and craving, a transient pattern was found. With respect to loss of tolerance, heart rate reactivity was found to increase significantly after 2 days' abstinence from nicotine, and the increase was sustained in subsequent sessions. Cortisol reactivity revealed more gradual dissipation, with significant differences evident only after 9 days of abstinence. These findings extend research on nicotine abstinence effects and on the dissipation of tolerance to nicotine deprivation intervals of nearly 2 weeks and confirm prior observations of variability across different response systems.

Who gets what symptom? Effects of psychiatric cofactors and nicotine dependence on patterns of smoking withdrawal symptomatology.

The present study used logistic regression techniques to examine the extent to which depression, anxiety, disordered eating, and nicotine dependence increased risk of experiencing craving and the eight DSM-IV withdrawal symptoms (depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite) during smoking abstinence, assessed retrospectively. Data were provided by a racially diverse sample of 365 male and female smokers recruited to participate in laboratory studies. Results indicate that variables known to be associated with smoking are risk factors for distinct and only somewhat overlapping patterns of symptomatology. Smokers scoring high on measures of anxiety, depression, or disordered eating were at increased risk primarily of experiencing withdrawal symptomatology pathognomonic to their particular disorder, whereas smokers scoring high on nicotine dependence appeared to be at increased risk of experiencing a syndromal pattern of withdrawal, encompassing craving and insomnia as well as cognitive/affective symptoms. Our results support the possibility that some individuals use smoking as a form of self-medication and suggest that elucidation of patterns of withdrawal symptomatology may contribute to improved specification of smoking phenotypes as well as facilitate treatment-matching.

Weight concerns in women smokers during pregnancy and postpartum.

When women smokers become pregnant, they are asked to control weight gain and at the same time to relinquish an addictive drug with weight suppressing effects. For women with serious body image concerns or a history of unhealthful eating patterns, smoking cessation may be particularly problematic. To investigate the relationship of weight concerns with smoking and weight gain during pregnancy and postpartum weight loss strategies, we conducted a retrospective study of women who had given birth to their first child within the past 10 years and were smokers when they became pregnant. We observed that women smokers with high weight and body image concerns (HC) gained significantly more weight during pregnancy-in amounts that far exceeded maximum recommended weight gain-than did women with low concerns (LC). HC were more likely to adopt smoking as a weight-control strategy and to be receptive to multiple weight-control strategies. Although they lost significantly more weight in the first month postpartum than did LC, they had also gained significantly more during pregnancy; the net result was that weight loss as a percentage of weight gained did not differ significantly between groups. HC were significantly less likely to experience food cravings in the first trimester and marginally less likely to vomit than LC. We conclude that early identification of high-risk women, coordination of prenatal care with smoking cessation counseling, and development of effective relapse prevention strategies that specifically address weight issues both during and after pregnancy will be needed if efforts to reduce smoking during pregnancy and postpartum are to be optimized.

Effects of menstrual phase and smoking abstinence in smokers with and without a history of major depressive disorder.

Although considerable progress has been made towards understanding the role of menstrual cycle phase in smoking, little is known about the possible effects of menstrual phase upon nicotine intake, withdrawal symptomatology, and craving in women with psychiatric cofactors. Fourteen women with and without a history of Major Depressive Disorder (MDD) were studied during five biologically-confirmed phases over the course of one menstrual cycle: smoking logs, salivary cotinine, and ratings of craving and withdrawal were collected daily. During a second cycle, subjects remained abstinent for 3 consecutive days during the postmenses and premenstrual phases. Although a significant omnibus F-test emerged for cigarettes per day across phases during ad libitum smoking, only trends were observed post hoc and supported midcycle rather than premenstrual elevations. There were no significant phase differences for cotinine. Withdrawal symptomatology was markedly elevated during smoking abstinence and in women with a history of depression. but showed no evidence of phase effects. Thus, the hypothesis that depressed individuals would be differentially affected by phase and abstinence was not strongly supported by our results, though overall elevations emphasize the need for special attention to withdrawal severity in this population. Craving was significantly elevated during smoking abstinence and was significantly higher during postmenses, consistent with the midcycle elevation in smoking rate, but showed no group differences. Our findings overall lend little support for the need to control for menstrual phase under conditions of ad libitum smoking. The strong association of self-reported menstrually related dysphoria during abstinence with both craving and withdrawal symptoms, however, is consistent with an exacerbation of smoking abstinence effects in women with severe menstrual symptomatology.

Short-term weight gain in abstaining women smokers.

Although most studies of weight gain following smoking cessation assess long-term change, weight gain during the critical period immediately following cessation may be more salient to the smoker for whom fear of weight gain constitutes a serious barrier to cessation. The current study examined weight change in 20 highly dependent women smokers provided with monetary incentives to abstain for 1 week, along with concomitant changes in cotinine. Abstaining smokers (n = 7) gained 3.1 pounds, compared with 0.3 pounds in women who continued to smoke (n = 13). Across all subjects, change was significantly negatively correlated with final plasma cotinine concentration and marginally negatively correlated with percent cotinine reduction. Weight gain in women abstainers in the luteal phase of the menstrual cycle exceeded that in women abstainers in the follicular phase; a significant interaction such that continuing smokers showed no phase-related differences in weight suggests that the effect was not an artifact of perimenstrual increases in eating or fluid retention. Although long-term weight gain has been shown to be positively associated with success in quitting, little is known about the effects of short-term weight gain. Since many weight-concerned individuals either do not attempt to quit or terminate their quit attempts very early, it may be that if weight gain can be postponed beyond the first few fragile days of cessation, women with strong weight concerns may actually be good candidates for success.

"Prequit attrition" among weight-concerned women smokers.

The impact of concerns about postcessation weight gain is sometimes minimized based on the finding of many (though not all) studies of an association between actual weight gain and successful quitting. A possible explanation is that many weight-concerned individuals either never attempt cessation or terminate their attempts very early, without seeking treatment. To investigate further, we compared attrition after screening and acceptance but prior to the first treatment session of women in two cessation trials, one targeting women with high dieting severity and concerns about body shape, the other not. The trials were similar in length and intensity. As expected, dieting severity scores for the groups were significantly higher for participants in the weight-concerns trial (WCT) than in the trial that did not involve weight concerns (NWCT). Race distribution and Body Mass Index (BMI) did not differ significantly between trials. Compared with the WCT, women accepted into the NWCT were significantly older, significantly more nicotine dependent, smoked significantly more cigarettes per day, and were significantly more depressed. Yet, despite a profile predictive of poorer outcome, "prequit attrition" was significantly lower for NWCT than for WCT (3% vs. 16%). Among WCT participants, those who dropped out scored significantly higher on dieting severity than those reporting for treatment, even after covarying for degree of dependence. To the extent that "prequit attrition" represents a proxy for unwillingness to enter treatment, our findings support the hypothesis that weight concerns constitute a more serious barrier to quitting than is evident simply from looking at treatment outcomes, since these individuals may never make it into the trial samples.

Initial exposure to nicotine in college-age women smokers and never-smokers: a replication and extension.

Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine upon initial exposure than those who do not take up smoking. The present study was designed to extend these findings to a sample of college-age women never-smokers and light smokers. Subjects were asked to rate pleasurable and displeasurable sensations upon first smoking and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea, and cough. Pleasurable sensations were marginally greater in smokers; pleasurable rush or buzz and dizziness were significantly more likely to be reported by smokers. Relaxation, displeasurable sensations, nausea, and cough did not differ significantly between groups. Fagerstrom Test for Nicotine Dependence scores significantly predicted pleasurable but not displeasurable sensations; Center for Epidemiological Studies-Depression scores predicted neither. These findings lend further support to the following conclusions: (1) people who become cigarette smokers experience more pleasurable sensations upon initial exposure to tobacco than their never-smoking counterparts; and (2) unpleasant reactions to the first cigarette do not protect against subsequent smoking.

Effects of menstrual phase on reactivity to nicotine.

The possible impact of menstrual phase upon reactivity to nicotine was investigated in 12 healthy women smokers. Controlled doses of nicotine were administered via an intranasal aerosol delivery device to overnight-deprived women smokers in four hormonally verified menstrual phases. Physiological, biochemical, and subjective measures were collected. Cycle-related symptomatology differed significantly across phase, with lowest values during the mid-follicular phase. No significant differences were found for baseline variables, including withdrawal measures. Nicotine increment was stable across phase, confirming reliability of the dosing method. No significant menstrual phase differences were found for physiological, subjective, or biochemical responses to nicotine. Pending investigations conducted over longer intervals, in a wider variety of subjects; findings suggest that for this type of study, complex strategies to control for menstrual-cycle phase effects may be unnecessary.

Differential prevalence of cigarette smoking in patients with schizophrenic vs mood disorders.

Rates of substance-use disorders among psychiatric patients are consistently higher than in the general population, yet there is no clear specificity to the relationship between types of substance use and psychiatric diagnoses. Cigarette smoking may represent a substance-use behavior which has greater specificity for major psychiatric diagnoses. We examined the self-reported history of cigarette smoking vs marijuana, alcohol and cocaine use among 83 male veteran psychiatric patients with primary mood (major depression or bipolar disorder; n = 20) or schizophrenic (schizophrenia or schizoaffective; n = 63) disorders. Those in the SCZ group compared to those in the AFF group were more likely to be ever-smokers (OR 8.5, 95% CI [2.2, 32.3]), and current smokers (OR 12.0%, 95% CI [3.6, 40]), independent of age differences between the groups. There were no significant differences in marijuana, alcohol or cocaine use between the two groups when age differences were controlled. Generalizability of the findings is limited by small number of subjects, male gender and veteran status; however, the significantly higher prevalence of smoking among individuals with schizophrenic disorders may support the growing evidence of linkages between the effects of nicotine and the neurobiology of schizophrenia.

Early experiences with tobacco among women smokers, ex-smokers, and never-smokers.

AIMS: Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine than those who do not take up smoking. DESIGN AND SETTING: The present study was designed to investigate this hypothesis by querying initial experiences with cigarette smoking in smokers, ex-smokers and never-smokers recruited from the local community. PARTICIPANTS: Subjects were 80 women (23 highly-dependent smokers (Fagerstrom Tolerance Questionnaire score > or = 7), 30 less-dependent smokers (FTQ < or = 6), 12 ex-smokers and 15 never-smokers). MEASUREMENTS: Subjects were asked to rate pleasurable sensations and displeasurable sensations on a scale of 1 = none to 4 = intense, and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea and cough; social context was also queried. Pleasurable rush or buzz, relaxation, dizziness, nausea and cough were related to ratings of pleasurable and unpleasant sensations to establish their affective valence. FINDINGS: Pleasurable sensations, pleasurable rush or buzz and relaxation (pleasant effects) were significantly more likely to occur in the smoker categories than in never-smokers. The ratio of pleasurable to unpleasant sensations, computed as an index of overall hedonic impact of initial exposure, also significantly favored the smoker categories. By contrast, unpleasant sensations, nausea and cough (unpleasant effects) did not differ significantly among groups. Dizziness, which did not definitely emerge as either pleasurable or unpleasant, was significantly more likely to be reported among the smoker groups than among never-smokers. CONCLUSIONS: People who become highly dependent cigarette smokers appear to have more pleasurable sensations at their initial exposure to tobacco; unpleasant reactions to the first cigarette do not seem to protect against subsequent smoking.

The effect of a restricted smoking policy on motivation to quit smoking in psychiatric patients.

UNLABELLED: As dissatisfaction with unrestricted smoking in institutional settings has grown, a number of psychiatric facilities have banned smoking. A compromise, restricted smoking, was recently introduced on an inpatient psychiatric unit at a University of Michigan Hospital. The subsequent rescission of the restricted smoking policy enabled us to compare the effects of restricted smoking vs. ad lib smoking on motivation to quit smoking. METHOD: Current smokers admitted to an inpatient psychiatry unit were asked to participate in this study. As soon as possible after intake, the patient completed a smoking history questionnaire, depression and anxiety scales, and a stage of change measure. The stage of change measure was readministered upon discharge from the unit. RESULTS: Repeated measures ANOVA revealed an interaction for Condition (Restricted vs. Ad Lib) by Time (Admission vs. Discharge) for the Action scale, which assesses current level of activity in smoking cessation efforts. Restricted smokers decreased while ad lib smokers increased in motivation over time. CONCLUSIONS: Results suggest that the restricted smoking policy does not have beneficial motivational effects. Alternative strategies for controlling smoking on an inpatient psychiatric unit are suggested.

Co-factors for smoking and evolutionary psychobiology.

Smoking is becoming increasingly concentrated in people with co-factors such as depression, attention deficit-hyperactivity disorder, anxiety disorders, and bulimia/bingeing. These behavioral or cognitive patterns may be adaptive or neutral in the conditions under which we evolved but maladaptive in environments requiring alertness for extended periods, where a fully mobilized fight-or-flight response is inappropriate, and where food availability makes lack of an "appestat" a liability. Such conditions are amenable to management by nicotine because of its ability to produce small but reliable adjustments in relevant cognitive and behavioral functions. Moreover, symptomatology may be unmasked or exacerbated by nicotine abstinence, persisting beyond the usual time-course for nicotine withdrawal, which may explain the particular attraction of smoking and the difficulty these individuals experience in quitting without necessarily requiring that they be more nicotine-dependent. The implications are: (1) a better understanding of the evolutionary psychobiology of smoking may promote development of tailored interventions for smokers with co-factors; (2) nicotine may have therapeutic applications for non-smokers with co-factors; (3) because smoking has a fairly high heritability index, and because of evidence of assortative mating, special prevention efforts targeting children of smokers with co-factors, as well as early identification of the co-factor itself, may be needed.

Self-reported alcohol use patterns in a sample of male and female heavy smokers.

In an attempt to characterize differences among male and female smokers based on past and current alcohol use, we studied patterns of drinking, smoking, caffeine intake, and depression as a function of lifetime history of alcohol dependence and current drinking status in a community sample of current smokers. Subjects were 65 male and 152 female moderate-to-heavy smokers. The CAGE was used to screen for lifetime history of alcohol dependence; current drinking status was classified using self-reported number of alcoholic drinks/week. No significant differences were detected for smoking rate, scores on the Fagerstrom Test for Nicotine Dependence, or either coffee or total caffeine intake. Drinkers with a history of alcohol dependence drank significantly more per week than drinkers with no history, with significant gender differences and interaction effects emerging as well; the phenomenon was particularly pronounced in men. Drinkers of both genders with a history of alcohol dependence scored significantly higher on the Center for Epidemiological Studies-Depression scale, with means exceeding the cutoff of 16 associated with clinical depression. Since comorbidity of depression and alcohol dependence is known to exert a detrimental effect on ability to stop smoking, the number of individuals at risk for smoking cessation treatment failure may be much larger than might be inferred from data based on psychiatric assessments or collected in inpatient settings. Routine screening for depressive symptomatology combined with heavy alcohol use in primary care settings may therefore be helpful in identifying smokers in need of more intensive stop-smoking interventions.

Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers.

We compared nicotine dependence and withdrawal in male alcoholic and control ever-smokers, controlling for relevant demographic and clinical variables. Alcoholics were more likely to meet criteria for moderate or severe nicotine dependence and endorse more nicotine dependence symptoms. Symptoms reported more frequently by alcoholics included: (a) using nicotine in larger amounts or over a longer time than intended; (b) continued use despite problems caused or exacerbated by nicotine; (c) marked tolerance; and (d) experiencing characteristic nicotine withdrawal symptoms. Alcoholics also smoked more heavily. Other than "headaches," and "decreased heart rate," alcoholics consistently endorsed nicotine withdrawal symptoms at a higher rate. After controlling for demographic and clinical variables and level of nicotine dependence, only "feel depressed" differed significantly between groups. Our research supports previous findings suggesting that nicotine dependence is more severe in those with a history of alcohol dependence. As a result, alcoholics may experience greater discomfort from nicotine withdrawal upon smoking cessation.