Nicotine-related interpretation biases in cigarette smoking individuals.

Addictive behaviors are characterized by information processing biases, including substance-related interpretation biases. In the field of cigarette smoking, such biases have not been investigated yet. The present study thus adopted an open-ended scenario approach to measure smoking-related interpretation biases. Individuals who smoke, those who ceased smoking, and those without a smoking history (total sample N = 177) were instructed to generate spontaneous continuations for ambiguous, open-ended scenarios that described either a smoking-related or neutral context. Overall, people who smoke generated more smoking-related continuations in response to smoking-relevant situations than non-smoking individuals or people who had stopped smoking, providing evidence for a smoking-related interpretation bias. When differentiating for situation type within smoking-relevant scenarios, smoking individuals produced more smoking-related continuations for positive/social and habit/addictive situations compared to negative/affective ones. Additionally, the tendency to interpret habit/addictive situations in a smoking-related manner was positively associated with cigarette consumption and levels of nicotine dependence. Exploratory analyses indicated that other substance-related continuations were correlated with their respective behavioral counterparts (e.g., the level of self-reported alcohol or caffeine consumption). The present study is the first to demonstrate smoking-related interpretation biases in relation to current cigarette smoking. Future studies should investigate the causal role of such biases in the initiation and/or maintainance of nicotine addiction and the merit of Interpretation-Bias-Modification training to support smoking cessation.

First Used Nicotine/Cannabis Product and Associated Outcomes in Late Adolescents.

BACKGROUND: Nicotine and tobacco product (NTP) and cannabis use are common in adolescence/young adulthood and increase risk for negative psychosocial outcomes. This study investigated associations among adolescent/young adults' initial experiences with NTPs, lifetime frequency of substance use, substance-related problems, and mental health symptoms. METHOD: Adolescents and young adults enrolled in a study on NTP and cannabis use were asked at what age they initiated the use of NTPs and were assigned to groups based on which product or substance(s) they reported using at the earliest age. Participants who reported use of NTPs (in isolation, without cannabis) first (N = 78, "NTP-only"), simultaneous use of NTPs and cannabis first (e.g., blunt or bowl; N = 25, "Simult-only"), use of both NTPs in isolation and simultaneous use at the same age (N = 48, "NTP + Simult"), and no NTP use (N = 53, "NTP-naïve") were compared on substance use, substance-related problems, and mental health symptoms. RESULTS: Groups differed on lifetime frequency of NTP, simultaneous, and cannabis use, with NTP users reporting more substance use episodes and substance-related problems than the NTP-naïve group. The lifetime frequency of cannabis use did not differ across NTP use groups. NTP use was associated with increased anxiety and depression, with no significant differences between groups. CONCLUSIONS: Adolescents and young adults who use nicotine may be at increased risk for greater nicotine use and mental health consequences, but initiating NTP use simultaneously with cannabis may not increase the risk of negative outcomes above and beyond nicotine initiation. Prospective longitudinal research is needed to establish temporal associations between first-used NTP/cannabis products and relevant outcomes.

Dying to Quit: Understanding the Burden of Tobacco in Psychiatric Patients-A Clinical Review.

Smoking is the leading cause of preventable death worldwide and remains a critical public health challenge. The burden of disease caused by smoking is disproportionately borne by persons living with mental illness. Public health efforts to address smoking have not historically translated to a significant reduction in smoking prevalence among patients with mental illness. Smoking is a substantial cause of morbidity and mortality among psychiatric patients who smoke at 1.7 to 3.3 times the rate of the general population. Among those with serious mental illness, tobacco-related illness accounts for half of all deaths. Nicotine dependence also interferes with treatment and worsens many psychiatric symptoms. Interventions are underutilized due to persistent misunderstandings regarding tobacco cessation for patients who are mentally ill. Addressing these misunderstandings is crucial in targeting the disparate rates of smoking in this population. Therefore, it is incumbent on psychiatrists to address the outsized effect that smoking has on patients with mental illness.

Associations Between Childhood Trauma and Tobacco Use Outcomes in Adults after Overnight Abstinence.

INTRODUCTION: Childhood trauma is known to be associated with nicotine dependence, yet limited smoking outcomes have been examined and few studies have assessed associations between specific trauma subscales and smoking. Additionally, sex differences in trauma-smoking relations are understudied. This study examined associations between childhood trauma and several smoking-related outcomes in adults who smoke after overnight abstinence. AIMS AND METHODS: People who smoke (N = 205) completed self-report and biochemical assessments evaluating childhood trauma, affect, nicotine dependence, smoking urges, withdrawal, and plasma cortisol and cotinine levels. Smoking outcomes were compared between those with and without a history of moderate to severe childhood trauma among the total sample and by sex. RESULTS: Relative to those with no to minimal abuse, those with moderate to severe abuse had higher negative affect, withdrawal severity, and plasma cotinine levels. Exploratory analyses revealed that women were more likely than men to have urges to smoke for negative reinforcement and have higher withdrawal severity, but no interactions between abuse group and sex were observed. Examining specific trauma subscales, the moderate to severe emotional abuse group had more severe nicotine dependence, negative affect, and withdrawal compared to the no to minimal group. The moderate to severe sexual abuse group had more severe nicotine dependence and withdrawal compared to the no to minimal group. CONCLUSIONS: Exposure to childhood trauma is associated with more severe nicotine dependence, negative affect, withdrawal, and higher plasma cotinine levels. Findings also indicate that different types of trauma may differentially affect smoking behaviors. IMPLICATIONS: This study of adults who smoke finds that childhood trauma history may be a marker for smoking susceptibility and suggests that individuals with experiences of emotional and sexual abuse may require targeted forms of smoking cessation interventions. Moreover, findings suggest that smoking risks may differ for men and women. Findings inform public health interventions intended to reduce cigarette use in individuals with exposure to childhood trauma.

Tobacco withdrawal-induced changes in sensorimotor filtering as a predictor of smoking lapse in trauma-exposed individuals.

Prepulse inhibition (PPI) is a measure of sensorimotor filtering thought to shield the processing of initial weaker auditory stimuli from interruption by a later startle response. Previous studies have shown smoking withdrawal to have a negative impact on sensorimotor filtering, particularly in individuals with psychopathology. Because tobacco use may alleviate sensory and sensorimotor filtering deficits, we examined whether smoking withdrawal-induced changes in PPI were associated with maintenance of smoking abstinence in trauma-exposed individuals with and without PTSD who were attempting to quit smoking. Thirty-eight individuals (n = 24 with current or past PTSD; 14 trauma-exposed healthy controls) made an acute biochemically-verified smoking cessation attempt supported by 8 days of contingency management (CM) and cognitive behavioral therapy (CBT) for smoking. Participants completed a PPI task at the pre-quit baseline, 2 days post-quit, and 5 days post-quit. Post-quit changes in PPI were compared between those who remained abstinent for the first 8-days of the quit attempt and those who lapsed back to smoking. PPI changes induced by biochemically-verified smoking abstinence were associated with maintenance of abstinence across the 8-day CM/CBT-supported quit attempt. As compared to those who maintained tobacco abstinence, participants who lapsed to smoking had significantly lower PPI at 2 and 5 days post-quit relative to baseline. Thus, among trauma-exposed individuals, decreases in PPI during acute smoking cessation supported by CM/CBT are associated with lapse back to smoking. Interventions that improve PPI during early smoking abstinence may facilitate smoking cessation among such individuals who are at high risk for chronic, refractory tobacco use.

Asociación bidireccional entre uso de tabaco y riesgo de depresión en el estudio de cohorte SUN / Bidirectional association between tobacco use and depression risk in the SUN cohort study

Evaluamos la asociación del consumo de tabaco o su abandono con el riesgo de depresión y determinamos si presentar depresión se asoció al inicio de fumar. Diseño: estudio de cohortes prospectivo de 16.519 graduados universitarios españoles sin depresión al inicio del estudio. El consumo de tabaco se determinó al inicio y tras cuatro años de seguimiento. Los casos incidentes de depresión fueron autoinformados en los cuestionarios de seguimiento. Usamos modelos de regresión de Cox para estimar los Hazard Ratios (HR) de depresión según el nivel de tabaquismo inicial y sus cambios. Se estimaron los Odds Ratios (OR) para la asociación entre prevalencia de tabaquismo a lo largo de la vida y comienzo del hábito con modelos de regresión logística. Se observó un HR (IC 95%) para fumadores de 1,24 (1,05-1,46) en comparación con los que nunca habían fumado. Los participantes con la exposición más alta al tabaco (≥ 20 paquetes-año) tuvieron un incremento relativo del riesgo de depresión de 38%. Dejar de fumar durante los primeros cuatro años de seguimiento se asoció inversamente con la depresión (HR = 0,63; IC 95% = 0,40-0,99). Observamos un incremento significativo del riesgo de aparición de tabaquismo en los participantes con prevalencia de depresión a lo largo de la vida (OR multivariable = 1,44; IC 95% = 1,13-1,83). Encontramos una asociación bidireccional entre el consumo de tabaco y la depresión en la cohorte SUN. El control del tabaco y las campañas sanitarias de abstinencia deberían considerarse estrategias efectivas de salud pública para prevenir y manejar los trastornos depresivos. (AU)

We assessed the association of tobacco use or smoking cessation with depression risk and determined if the presence of a depressive disorder was associated with smoking onset. We conducted a prospective cohort study (SUN Project) based on 16,519 Spanish university graduates without depression at baseline. Tobacco use was determined at baseline and after four years of follow-up. Incident cases of depression were ascertained according to a previously validated report of a clinical diagnosis of depression during follow-up. Multivariable Cox regression models were used to estimate hazard ratios (HR) of depression according to previous smoking status. We used logistic regression models as a secondary analysis to estimate Odds Ratios (OR) of smoking onset during the first four years of follow-up according to lifetime depression prevalence at baseline. The multivariable HR (95% CI) for current smokers was 1.24 (1.05-1.46) as compared to participants who had never smoked. Participants with the highest exposure to tobacco (≥ 20 packsyears) had a significant 38% relative increment in depression risk. Smoking cessation during the first four years of follow-up was inversely associated with depression (HR = 0.63; 95% CI = 0.40-0.99). Finally, a significant increment in the risk of smoking onset for participants with lifetime depression prevalence was observed (multivariable OR = 1.44; 95% CI = 1.13-1.83). A bidirectional association between tobacco use and depression in the SUN cohort was found. Therefore, tobacco control and health promotion campaigns for smoking cessation could be considered as effective strategies of public health for the prevention and management of depressive disorders. (AU)

Transcranial Direct Current Stimulation in Nicotine Use: Nursing Implications for Patient Outcomes.

ABSTRACT: Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.

Modeling Idiographic Longitudinal Relationships between Affect and Cigarette Use: An Ecological Momentary Assessment Study.

Background: Despite public knowledge of the adverse health effects of tobacco use, cigarettes remain widely used due to the addictive nature of nicotine. Physiologic adaptation to the presence of nicotine over time leads to unpleasant effects during withdrawal periods. Alongside these physiological effects, tobacco users often report changes in their consumption of tobacco in response to their emotional state. Objectives: We hypothesized that idiographic, or person-specific level, increases in participants' negative affect (NA) and positive affect (PA) ratings at a given time point would be associated with higher and lower craving and smoking over the following several hours, respectively. Fifty-two participants completed block randomized ecological momentary assessment surveys on their smartphones 4 times per day for 30 days, reporting from 0-100 their level of seven discrete emotions, stress, current craving, and smoking behavior. We analyzed the relationships between affect and smoking and craving using idiographic generalized linear models. Results: While some participants exhibited the hypothesized relationships, each participant varied in the strength and direction of the relationships between affect and craving/smoking. These outcomes were partially moderated at the group level by anxiety/depression at baseline, but not by level of nicotine dependence or sex. Conclusions: This suggests that the factors driving cigarette use vary significantly between individuals.

Poor inhibitory control predicts sex-specific vulnerability to nicotine rewarding properties in mice.

RATIONALE: The risk of becoming addicted to tobacco varies greatly from individual to individual, raising the possibility of behavioural biomarkers capable of predicting sensitivity to nicotine reward, a crucial step in the development of nicotine addiction. Amongst all of nicotine's pharmacological properties, one of central importance is the enhancement of cognitive performances, which depend on the balance between attentional processes and inhibitory control. However, whether the cognitive enhancement effects of nicotine are predictive of sensitivity to its rewarding properties is still unknown. OBJECTIVE: Using male and female mice, we investigated whether the effects of nicotine on cognitive performances are predictive of sensitivity to the rewarding properties of nicotine and, if so, whether this relationship is sex dependent. METHODS: Naïve male and female mice were first assessed for their performances in both baseline conditions and following nicotine injection (0.15 and 0.30 mg/kg) in a cued-Fixed Consecutive Number task (FCNcue) measuring both optimal (attention) and premature (inhibitory control) responding. Next, all mice underwent nicotine-induced conditioned place preference (CPP) in order to evaluate inter-individual differences in response to nicotine reward (0.30 mg/kg). RESULTS: Results showed that males and females benefited from the effect of nicotine as a cognitive enhancer in the FCNcue task. However, only those males displaying poor inhibitory control, namely high-impulsive animals, subsequently displayed sensitivity to nicotine reward. In females, sensitivity to nicotine reward was independent of FCNcue performances, in both basal and nicotine conditions. CONCLUSION: Thus, our study suggests that poor inhibitory control and its modulation by nicotine may be a behavioural biomarker for sensitivity to nicotine reward and consequent vulnerability to nicotine addiction in males but not females.

Tobacco/nicotine dependence as a risk factor for substance use disorders and related mental health conditions among cancer patients.

BACKGROUND: Cancer patients often face multiple comorbidities and are at risk for various mental health conditions and substance use disorders. Tobacco/nicotine dependence (TND) is a known risk factor for poor health outcomes and has been associated with psychiatric disorders including substance use disorder. However, the specific relationship between TND and the risk of substance use disorder and mental health conditions among cancer patients remains underexplored. This study aimed to assess the association between TND and the risk of comorbid conditions among cancer patients. METHODS: Data were obtained from a database of electronic health records for patients from the University of California health system. The odds for every condition among cancer patients with TND were calculated and compared with those for cancer patients without TND. ORs were adjusted for gender, ethnicity, and race. RESULTS: Three thousand seven hundred and ninety-one cancer patients with TND had 252,619 total conditions, and 51,711 cancer patients without TND had 2,310,880 conditions. After adjusting for confounders, the condition for which TND most exacerbated risk was psychoactive substance-induced organic anxiety disorder (OR = 16.3, p < 0.001). This appeared consistent with the second, third, and fifth most-exacerbated conditions: stimulant use disorder (OR = 12.8, p < 0.001), cocaine induced mental disorder (OR = 11.0, p < 0.001), and cocaine use disorder (OR = 11.0, p < 0.001). Different conditions exacerbated by TND include acute alcoholic intoxication (OR = 11.4, p < 0.001), opioid use disorder (OR = 7.6, p < 0.001), schizoaffective disorder (OR = 7.4, p < 0.001), and cannabis use disorder (OR = 6.3, p < 0.001). CONCLUSIONS: Our findings reveal a strong association between TND and an increased risk of substance use disorder and mental health conditions among cancer patients. Specifically, cancer patients with TND were at an elevated risk for psychoactive substance-induced organic anxiety disorder, stimulant use disorder, and cocaine-related disorders. Additionally, TND was associated with an increased risk of acute alcoholic intoxication, opioid use disorder, schizoaffective disorder, and cannabis use disorder. These findings underscore the need for comprehensive screening and interventions to address TND and comorbid conditions among cancer patients.

Differences in biobehavioral measures of cigarette smoking by depression symptomology.

INTRODUCTION: Research that explores the clinical relevance of subclinical depressive symptoms and smoking is primarily focused on smoking cessation. We examine whether depression symptoms vary across an array of biological (carbon monoxide boost), behavioral (FagerströmTest of Nicotine Dependence, cigarettes per day, smoking topography), and psychological smoking-related outcomes (Questionnaire on Smoking Urges, Withdrawal Symptoms Checklist) in non-treatment-seeking smokers. METHODS: Baseline data were pooled from three research trials with identical procedures designed to assess individual smoking behavior using smokers preferred cigarette brands. Depression symptom level (asymptomatic, subsyndromal, syndromal) was defined using established Center for Epidemiological Depression Scale (CES-D) cutpoint criteria. Smokers were instructed to smoke as usual for one-week. At the beginning and end of the baseline period, nicotine dependence, smoking topography, CO boost, desire to smoke, anticipation of positive reinforcement, negative affect, and withdrawal were measured. RESULTS: Ordinary least squares linear regression models were used to test the association between depression symptom level and outcome measures adjusting for sex and education (N = 355). The results revealed no differences in topography measures, cigarettes per day and FTND. Smoking withdrawal and smoking urges were higher among both individuals with subsyndromal symptoms and syndromal depression symptoms compared to those who were asymptomatic. Individuals with subsyndromal depressive symptoms experienced higher smoke exposure and higher relief from negative affect. CONCLUSION: Increased smoke exposure, greater withdrawal symptoms and urges to smoke, and anticipation of negative affect relief among smokers with subsyndromal depression symptoms suggest that depression symptoms need not reach syndromal levels to alter smoking-related outcomes.

Patterns and Characteristics of Nicotine Dependence Among Adults With Cigarette Use in the US, 2006-2019.

Importance: Nicotine dependence increases the risk of persistent smoking, which is the leading preventable cause of morbidity and death. However, evidence regarding the associations of nicotine dependence with age, psychiatric conditions, and sociodemographic characteristics is limited. Objective: To assess whether and how nicotine dependence among US adults with cigarette use varies by year, age, psychiatric comorbidities, and sociodemographic characteristics. Design, Setting, and Participants: This exploratory serial cross-sectional study used data from 152 354 US community-dwelling individuals 18 years or older who participated in the 2006-2019 National Surveys on Drug Use and Health. Data analyses were conducted from January 15 to February 15, 2023. Exposure: Past-month cigarette use. Past-year major depressive episode (MDE) and/or substance use disorder (SUD) based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), Text Revision. Main Outcomes and Measures: Past-month nicotine dependence based on criteria from the Nicotine Dependence Syndrome Scale or the Fagerström Test of Nicotine Dependence. Results: Among 152 354 adults with past-month cigarette use (54.1% male; 40.2% aged 18-34 years; 29.0% aged 35-49 years; 69.8% non-Hispanic White), the adjusted prevalence of nicotine dependence decreased from 59.52% (95% CI, 57.93%-61.10%) in 2006 to 56.00% (95% CI, 54.38%-57.60%) in 2019 (average annual percentage change [AAPC], -0.4%; 95% CI, -0.5% to -0.4%; P < .001) and among each examined age group, except for stability among those aged 18 to 25 years (AAPC, -0.5%; 95% CI, -1.4% to 0.4%; P = .27). Compared with those 50 years and older with past-month cigarette smoking, the adjusted prevalence of nicotine dependence among those aged 18 to 49 years was 32% lower for those aged 18 to 25 years (adjusted risk ratio [ARR], 0.68; 95% CI, 0.66-0.70), 18% lower for those aged 26 to 34 years (ARR, 0.82; 95% CI, 0.80-0.84), and 6% lower for those aged 35 to 49 years (ARR, 0.94; 95% CI, 0.92-0.96). The adjusted prevalence of nicotine dependence varied by age, MDE and/or SUD status, and sociodemographic characteristics. For example, by 2019, prevalence was 41.27% (95% CI, 39.21%-43.37%) among those aged 18 to 25 years and 64.43% (95% CI, 60.98%-67.74%) among those 50 years and older. Differences in nicotine dependence prevalence between those with co-occurring MDE and SUD and those without both conditions were more than 2 times larger for those 50 years and older vs those aged 18 to 49 years (eg, ages ≥50 years vs 18-25 years: 18.69 percentage point difference [83.32% vs 64.63%] vs 7.67 percentage point difference [48.88% vs 41.21%]; P < .001). Conclusions and Relevance: In this cross-sectional study, there were significant reductions in nicotine dependence prevalence from 2006 to 2019 among US adults with cigarette use and all examined subgroups 26 years and older. Adults 50 years and older (especially those with MDE and/or SUD) had the highest nicotine dependence prevalence compared with other age groups, highlighting the importance of assisting with smoking cessation efforts and addressing nicotine dependence for this older population. Evidence-based tobacco cessation strategies tailored to age and comorbidities are needed.

Associations Between the Wisconsin Inventory of Smoking Dependence Motives and Regional Brain Volumes in Adult Smokers.

INTRODUCTION: The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) is a 68-item questionnaire to assess nicotine dependence as a multifactorial construct based on 13 theoretically derived smoking motives. Chronic smoking is associated with structural changes in brain regions implicated in the maintenance of smoking behavior; however, associations between brain morphometry and the various reinforcing components of smoking behavior remain unexamined. The present study investigated the potential association between smoking dependence motives and regional brain volumes in a cohort of 254 adult smokers. AIMS AND METHODS: The WISDM-68 was administered to participants at the baseline session. Structural magnetic resonance brain imaging (MRI) data from 254 adult smokers (Mage = 42.7 ± 11.4) with moderate to severe nicotine dependence (MFTND = 5.4 ± 2.0) smoking for at least 2 years (Myears = 24.3 ± 11.8) were collected and analyzed with Freesurfer. RESULTS: Vertex-wise cluster analysis revealed that high scores on the WISDM-68 composite, secondary dependence motives (SDM) composite, and multiple SDM subscales were associated with lower cortical volume in the right lateral prefrontal cortex (cluster-wise p's < .035). Analysis of subcortical volumes (ie, nucleus accumbens, amygdala, caudate, and pallidum) revealed several significant associations with WISDM-68 subscales, dependence severity (Fagerström Test for Nicotine Dependence), and overall exposure (pack-years). No significant associations between cortical volume and other nicotine dependence measures or pack-years were observed. CONCLUSIONS: Results suggest that smoking motives may play a larger role in cortical abnormalities than addiction severity and smoking exposure per se, whereas subcortical volumes are associated with smoking motives, addiction severity, and smoking exposure. IMPLICATIONS: The present study reports novel associations between the various reinforcing components of smoking behavior assessed by the WISDM-68 and regional brain volumes. Results suggest that the underlying emotional, cognitive, and sensory processes that drive non-compulsive smoking behaviors may play a larger role in gray matter abnormalities of smokers than smoking exposure or addiction severity.

A methodological framework allows the identification of personomic markers to consider when designing personalized interventions.

OBJECTIVES: To develop a methodological framework to identify and prioritize personomic markers (e.g., psychosocial situation, beliefs…) to consider for personalizing interventions and to test in smoking cessation interventions. STUDY DESIGN AND SETTING: (1) We identified potential personomic markers considered in protocols of personalized interventions, in reviews of predictors of smoking cessation, and in interviews with general practitioners. (2) Physicians, and patient smokers or former smokers selected the markers they considered most relevant during online paired comparison experiments. Data were analyzed with Bradley Terry Luce models. RESULTS: Thirty-six personomic markers were identified from research evidence. They were evaluated by 795 physicians (median age: 34, IQR [30-38]; 95% general practitioners) and 793 patients (median age: 54, IQR [42-64], 71.4% former smokers) during 11,963 paired comparisons. Physicians identified patients' motivation for quitting (e.g., Prochaska stages), patients' preferences, and patients' fears and beliefs (e.g., concerns about weight gain) as the most relevant elements to personalize smoking cessation. Patients considered their motivation for quitting, smoking behavior (e.g., smoking at home/at work), and tobacco dependence (e.g., Fagerström Test) as the most relevant elements to consider. CONCLUSION: We provide a methodological framework to prioritize which personomic markers should be considered when developing smoking cessation interventions.

Reducing tobacco-associated lung cancer risk: a study protocol for a randomized clinical trial of AB-free kava.

BACKGROUND: Tobacco use is the leading cause of many preventable diseases, resulting in premature death or disease. Given that the majority of adult who smoke want to stop, this health burden could be significantly reduced if the success rate of tobacco cessation can be improved. In addition, most adults planning to quit were interested in trying complementary approaches to facilitating tobacco cessation, which is currently lacking. Therefore, there is an unmet and urgent need for novel interventions to improve the success of tobacco cessation. If such an intervention can reduce tobacco-associated lung carcinogenesis, that will be more desirable. The goal of this project is to develop a safe and effective kava-based intervention to enable tobacco cessation and reduce lung cancer risk, which will improve the health of smokers. METHODS: A randomized controlled trial will enroll 80 adults who currently smoke at least 10 cigarettes daily and randomize 1:1 into the placebo and AB-free kava arms, being exposed for 4 weeks, with a total of six visits (weeks 0, 1, 2, 4, 8, and 12) to evaluate the compliance and potential issues of AB-free kava use among the participants, explore the potential effect of the AB-free kava intervention on tobacco dependence, tobacco use, and lung carcinogenesis biomarkers. Participants will be enrolled during their primary care clinic visit. DISCUSSION: Primary care settings play a critical role in tobacco-related disease screening, counseling, and early intervention, as the majority of adults who smoke visit their physicians annually. Building upon our promising pilot human trial results in conjunction with ample compelling lab animal results, and consistent with evidence of kava's benefits from epidemiological data, this trial will evaluate the compliance of AB-free kava among adults who currently smoke with no intention to quit. The other exploratory aims include (1) whether AB-free kava intervention can reduce tobacco use and tobacco dependence; (2) whether AB-free kava use suppresses tobacco-induced carcinogenesis; and (3) the potential of the mechanism-based noninvasive biomarkers in precision AB-free kava intervention. The positive results from this study are expected to provide a great opportunity to effectively reduce smoking rates and tobacco-related diseases. TRIAL REGISTRATION: ClinicalTrials.gov with the identifier: NCT05081882. Registered on October 18, 2021.

Perceived Stress and Smoking Cessation: The Role of Smoking Urges.

Despite the fact that perceived stress is related to abstinence smoking outcomes, no studies have investigated the mediational effect of specific tobacco-related variables on this relationship. This study aimed to explore the indirect effect of perceived stress on abstinence at the end of treatment through smoking urges. The sample comprised 260 treatment-seeking smokers (58.5% female; Mage = 46.00; SD = 11.1) who underwent psychological smoking cessation treatment. The brief version of the Questionnaire of Smoking Urges (QSU) and the Perceived Stress Scale (PSS14) were used. Mediation analyses were conducted in which smoking urges and their dimensions were potential mediators in the relationship between perceived stress and abstinence at the end of treatment. The results showed a non-significant direct effect of perceived stress on abstinence. However, a significant indirect effect was found through smoking urges (QSU-total) and, specifically, through smoking urges associated with the expectation of negative affect relief (QSU-Factor 2). A non-significant indirect effect through smoking urges related to the expectation of tobacco use as a pleasurable experience (QSU-Factor 1) was also found. Analyzing possible mediator variables could contribute to understanding previous conflicting data. These findings point to potential interest in including treatment components targeting perceived stress and smoking urges to improve the effectiveness of smoking cessation treatments.

Validation of the Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ) to Evaluate Nicotine Dependence in Spanish Clinical Settings.

An assessment of the different aspects of tobacco addiction is central to adapting interventions to the profiles and needs of smokers. The Glover−Nilsson Smoking Behavioral Questionnaire (GN-SBQ) is one of the few and most used scales to evaluate the behavioral aspects of tobacco addiction. However, few studies involve the validation of the GN-SBQ in clinical settings. Thus, this study aimed to analyze the psychometric properties of the GN-SBQ in a sample of Spanish smokers. A total of 341 smokers attending clinical services in Spain participated in this cross-sectional study. Measures included the psychological factors related to tobacco addiction, assessed with the GN-SBQ, the physical factors of nicotine addiction, withdrawal symptoms, smoking-related variables, and alcohol use. Data analysis included descriptive statistics, internal consistency coefficients, confirmatory factor analyses, Spearman correlations, and the Kruskal−Wallis test. The GN-SBQ showed adequate reliability (α = 0.76 and ω = 0.76) and a unidimensional structure. GN-SBQ scores also provided evidence of convergent and concurrent validity. GN-SBQ scores significantly correlated with the physical symptoms of addiction, age, number of cigarettes, and withdrawal symptoms. The results of discriminant validity were also adequate, as no correlation was observed between GN-SBQ scores and CO levels or alcohol use. Significant differences were found between all levels of psychological addiction based on the GN-SBQ scores regarding physical nicotine addiction, withdrawal symptoms, and age. Thus, this questionnaire is a reliable and valid instrument to assess the psychological aspects of tobacco addiction in smokers in clinical settings. The short length of the GN-SBQ proves advantageous for its use in time-limited assessments, which are common in public health services.

Impact of neuropsychological disorders on clinical aspects of smoking. / Impacto de las alteraciones neuropsicológicas sobre aspectos clínicos en tabaquismo.

Studies examining associations between cognitive measures and clinical aspects of smoking are scarce and generally limited to predicting risk profiles or relapses. However, it is essential to understand the influence of several measures of executive function in nicotine addiction in order to investigate factors associated with smoking maintenance. This study examined the ability of working memory and delay discount to predict years of smoking. The sample consisted of 180 smokers who were assessed at baseline with measures of cognitive impulsivity (Delay Discounting Task) and working memory [Visual Search and Attention Test (VSAT) and Letter-Number Sequencing (WAIS III)] while the outcome measure was years of smoking. Consistent with predictions, working memory evaluated with Visual Search and Attention Test was a statistically significant factor in predicting years of nicotine addiction. These findings suggest that working memory is clinically relevant in nicotine dependence and proposes a pattern of executive functioning associated with smoking.

Los estudios que examinan las asociaciones entre las medidas cognitivas y los aspectos clínicos del tabaquismo son limitados y, en general, se limitan a predecir perfiles de riesgo o recaídas. Sin embargo, es esencial comprender la influencia de varias medidas de la función ejecutiva en la adicción a la nicotina a fin indagar factores asociados al mantenimiento del tabaquismo. En el presente estudio se examinó la capacidad de la memoria de trabajo y el descuento por retraso para predecir los años de tabaquismo. La muestra consistió en 180 fumadores que fueron evaluados en la línea de base con medidas de impulsividad cognitiva (Tarea de Descuento de Retraso) y memoria de trabajo [Prueba de Búsqueda y Atención Visual (VSAT) y Secuenciación de Números de Letras (WAIS III)] mientras que la medida de resultado fue los años de adicción. De acuerdo con las predicciones, la memoria de trabajo evaluada con la Prueba de Búsqueda y Atención Visual fue un factor estadísticamente significativo para predecir los años de adicción a la nicotina. Estos hallazgos sugieren que la memoria de trabajo es clínicamente relevante en la dependencia de la nicotina y plantea un patrón de funcionamiento ejecutivo asociado al tabaquismo.