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1.
Cancer Causes Control ; 32(4): 391-399, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33559769

RESUMO

INTRODUCTION: In Vietnam, 60% of men living with HIV smoke tobacco, and 92% of HIV-infected people who inject drugs (PWID) smoke tobacco. Tobacco use increases mortality through increased health risks including tuberculosis and malignancy in HIV-infected smokers. However, tobacco use treatment is not widely available in Vietnam. The objective was to examine current barriers and facilitators of smoking cessation and tobacco use treatment for HIV-infected PWID in Hanoi, Vietnam. METHODS: Native speaking ethnographers conducted semi-structured qualitative interviews about tobacco use and tobacco use treatment with sixteen HIV-infected PWID and eight healthcare providers, recruited from four HIV-Methadone Maintenance Treatment (MMT) clinics in Hanoi, Vietnam. Interviews were recorded, transcribed, and translated for thematic analysis in Dedoose. RESULTS: Clients and providers had learned the general health risks of smoking from public awareness campaigns. Half had tried to quit previously, often motivated by advice from family members but not by HIV providers' advice. Almost all clients did not want to quit, citing the low price of tobacco, prevalence of smoking in Vietnam, and physical cravings. HIV provider's counseling was brief, inconsistent, and limited by low provider knowledge and competing burdens of HIV and injection drug use. Providers recently trained by NGO-led seminars on tobacco prioritized tobacco use treatment. CONCLUSIONS: Smoking cessation efforts for people living with HIV/AIDS (PLHA) and PWID smokers in Hanoi, Vietnam could benefit from further community public awareness campaigns, and exploring increased tobacco taxation. Tobacco use treatment at HIV clinics could benefit from involving family and friends in cessation, and training providers in treatment methods.


Assuntos
Infecções por HIV/psicologia , Abandono do Hábito de Fumar/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Tabagismo/psicologia , Adulto , Família , Pessoal de Saúde , Promoção da Saúde , Humanos , Masculino , Motivação , Vietnã
2.
Psychopharmacology (Berl) ; 238(3): 845-855, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33410984

RESUMO

RATIONALE: Systemic administration of the tobacco smoke constituent nicotine stimulates brain reward function in rats. However, it is unknown if the inhalation of tobacco smoke affects brain reward function. OBJECTIVES: These experiments investigated if exposure to smoke from high-nicotine SPECTRUM research cigarettes increases reward function and affects the rewarding effects of nicotine in adult male and female Wistar rats. METHODS: Reward function after smoke or nicotine exposure was investigated using the intracranial self-stimulation (ICSS) procedure. A decrease in reward thresholds reflects an increase in reward function. In the first experiment, the rats were exposed to tobacco smoke for 40 min/day for 9 days, and the rewarding effects of nicotine (0.03-0.6 mg/kg) were investigated 3 weeks later. In the second experiment, the dose effects of tobacco smoke exposure (40-min sessions, 1-4 cigarettes burnt simultaneously) on reward function were investigated. RESULTS: Tobacco smoke exposure did not affect the nicotine-induced decrease in reward thresholds or response latencies in male and female rats. Smoke exposure lowered the brain reward thresholds to a similar degree in males and females and caused a greater decrease in latencies in females. There was a positive relationship between plasma nicotine and cotinine levels and the nicotine content of the SPECTRUM research cigarettes. Similar smoke exposure conditions led to higher plasma nicotine and cotinine levels in female than male rats. CONCLUSION: These findings indicate that tobacco smoke exposure enhances brain reward function but does not potentiate the rewarding effects of nicotine in male and female rats.


Assuntos
Encéfalo/efeitos dos fármacos , Nicotina/administração & dosagem , Tempo de Reação/efeitos dos fármacos , Recompensa , Poluição por Fumaça de Tabaco/efeitos adversos , Tabagismo/psicologia , Animais , Cotinina/sangue , Feminino , Masculino , Nicotina/sangue , Nicotina/farmacologia , Ratos , Ratos Wistar , Autoestimulação/efeitos dos fármacos , Tabaco , Tabagismo/sangue
4.
Nutrients ; 12(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33334010

RESUMO

As food addiction is being more commonly recognized within the scientific community, parallels can be drawn between it and other addictive substance use disorders, including tobacco use disorder. Given that both unhealthy diets and smoking are leading risk factors for disability and death, a greater understanding of how food addiction and tobacco use disorder overlap with one another is necessary. This narrative review aimed to highlight literature that investigated prevalence, biology, psychology, and treatment options of food addiction and tobacco use disorder. Published studies up to August 2020 and written in English were included. Using a biopsychosocial lens, each disorder was assessed together and separately, as there is emerging evidence that the two disorders can develop concurrently or sequentially within individuals. Commonalities include but are not limited to the dopaminergic neurocircuitry, gut microbiota, childhood adversity, and attachment insecurity. In addition, the authors conducted a feasibility study with the purpose of examining the association between food addiction symptoms and tobacco use disorder among individuals seeking tobacco use disorder treatment. To inform future treatment approaches, more research is necessary to identify and understand the overlap between the two disorders.


Assuntos
Dependência de Alimentos/epidemiologia , Dependência de Alimentos/psicologia , Tabagismo/epidemiologia , Tabagismo/psicologia , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Terapia Comportamental , Encéfalo/fisiopatologia , Comorbidade , Terapia por Estimulação Elétrica , Feminino , Dependência de Alimentos/terapia , Microbioma Gastrointestinal/fisiologia , Humanos , Masculino , Apego ao Objeto , Prevalência , Fatores de Risco , Abandono do Uso de Tabaco , Tabagismo/terapia
5.
Lancet Glob Health ; 8(11): e1408-e1417, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33069301

RESUMO

BACKGROUND: Smoking cessation is important in patients with tuberculosis because it can reduce the high rates of treatment failure and mortality. We aimed to assess the effectiveness and safety of cystine as a smoking cessation aid in patients with tuberculosis in Bangladesh and Pakistan. METHODS: We did a randomised, double-blind, placebo-controlled, trial at 32 health centres in Bangladesh and Pakistan. Eligible patients were adults (aged >18 years in Bangladesh; aged >15 years in Pakistan) with pulmonary tuberculosis diagnosed in the previous 4 weeks, who smoked tobacco on a daily basis and were willing to stop smoking. Patients were randomly assigned (1:1) to receive behavioural support plus either oral cytisine (9 mg on day 0, which was gradually reduced to 1·5 mg by day 25) or placebo for 25 days. Randomisation was done using pregenerated block randomisation lists, stratified by trial sites. Investigators, clinicians, and patients were masked to treatment allocation. The primary outcome was continuous abstinence at 6 months, defined as self-report (of not having used more than five cigarettes, bidis, a water pipe, or smokeless tobacco products since the quit date), confirmed biochemically by a breath carbon monoxide reading of less than 10 parts per million. Primary and safety analysis were done in the intention-to-treat population. This trial is registered with the International Standard Randomised Clinical Trial Registry, ISRCTN43811467, and enrolment is complete. FINDINGS: Between June 6, 2017, and April 30, 2018, 2472 patients (1527 patients from Bangladesh; 945 patients from Pakistan) were enrolled and randomly assigned to receive cytisine (n=1239) or placebo (n=1233). At 6 months, 401 (32·4%) participants in the cytisine group and 366 (29·7%) participants in the placebo group had achieved continuous abstinence (risk difference 2·68%, 95% CI -0·96 to 6·33; relative risk 1·09, 95% CI 0·97 to 1·23, p=0·114). 53 (4·3%) of 1239 participants in the cytisine group and 46 (3·7%) of 1233 participants in the placebo group reported serious adverse events (94 events in the cytisine group and 90 events in the placebo group), which included 91 deaths (49 in the cytisine group and 42 in the placebo group). None of the adverse events were attributed to the study medication. INTERPRETATION: Our findings do not support the addition of cytisine to brief behavioural support for the treatment of tobacco dependence in patients with tuberculosis. FUNDING: European Union Horizon 2020 and Health Data Research UK. TRANSLATIONS: For the Bengali and Urdu translations of the abstract see Supplementary Materials section.


Assuntos
Alcaloides/uso terapêutico , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Tuberculose/epidemiologia , Adulto , Azocinas/uso terapêutico , Bangladesh/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Psicoterapia Breve , Quinolizinas/uso terapêutico , Tabagismo/psicologia , Resultado do Tratamento
6.
Ann Epidemiol ; 49: 61-67, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32951805

RESUMO

PURPOSE: Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers. METHODS: The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design. RESULTS: After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs.

Assuntos
Hispano-Americanos/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/etnologia , Tabagismo/psicologia , Aculturação , Adolescente , Adulto , Distribuição por Idade , Idoso , Ansiedade , Depressão , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fumantes/psicologia , Fumar Tabaco/psicologia , Tabagismo/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-32630743

RESUMO

Up to 95% of women who use other substances also smoke tobacco during pregnancy. Challenging psychosocial circumstances and other barriers that contribute to high levels of tobacco dependence result in few quitting successfully. This case report describes the treatment of a highly tobacco dependent 34-year-old pregnant woman with a history of recent substance use, mental illness and trauma, enrolled in the Incentives to Quit Tobacco in Pregnancy program. Heavy smoking, both during the day and overnight, was reported. An extensive history of quit attempts, as well as a strong desire to cease tobacco use during pregnancy, was also noted. Treatment utilising extensive behavioural supports, including financial incentives for carbon monoxide verified abstinence and telephone-based counselling, in combination with nicotine replacement therapy (NRT), was offered to assist cessation. Excellent uptake and adherence to all aspects of treatment saw tobacco cessation achieved and maintained for 24 weeks while on the program. NRT used at doses well above those recommended for pregnancy was required to alleviate strong withdrawal symptoms and maintain abstinence. Daily monitoring of carbon monoxide, financial incentives for continued abstinence and regular phone support were critical to maintaining motivation and preventing relapse to smoking. Post-program relapse to smoking did occur, as is common, and highlights the need for longer-term intensive support for pregnant women with complex behavioural and social problems. Given the prevalence of tobacco smoking in such populations, long-term harm reduction treatment models using extensive behavioural support in combination with NRT should be considered for inclusion in current smoking cessation guidelines.


Assuntos
Abandono do Hábito de Fumar , Tabagismo/terapia , Adulto , Feminino , Humanos , Gravidez , Dispositivos para o Abandono do Uso de Tabaco , Tabagismo/tratamento farmacológico , Tabagismo/psicologia
8.
High Blood Press Cardiovasc Prev ; 27(5): 349-362, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32578165

RESUMO

Tobacco use is one of the major public health concerns and it is the most preventable cause of morbidity and mortality worldwide. Smoking cessation reduces subsequent cardiovascular events and mortality. Smoking is a real chronic disorder characterized by the development of an addiction status mainly due to nicotine. This condition makes the smokers generally unable to quit smoking without help. Different strategies are available to treat smoking dependence that include both non-pharmacological (behavioral counselling) and pharmacological therapies. Currently, it is well accepted that smoking cessation drugs are effective and safe in real-world settings. Nicotine replacement therapy (NRT), varenicline, bupropion and cytisine are the main pharmacological strategies available for smoking cessation. Their efficacy and safety have been proved even in patients with chronic cardiovascular disease. Each of these drugs has peculiar characteristics and the clinician should customize the smoking cessation strategy based on currently available scientific evidence and patient's preference, paying particular attention to those patients having specific cardiovascular and psychiatric comorbidities. The present document aims to summarize the current viable pharmacological strategies for smoking cessation, also discussing the controversial issue regarding the use of alternative tobacco products, in order to provide useful practical indications to all physicians, mainly to those involved in cardiovascular prevention.


Assuntos
Alcaloides/uso terapêutico , Bupropiona/uso terapêutico , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Tabagismo/tratamento farmacológico , Vareniclina/uso terapêutico , Alcaloides/efeitos adversos , Azocinas/efeitos adversos , Azocinas/uso terapêutico , Bupropiona/efeitos adversos , Tomada de Decisão Clínica , Sistemas Eletrônicos de Liberação de Nicotina , Humanos , Quinolizinas/efeitos adversos , Quinolizinas/uso terapêutico , Recidiva , Fatores de Risco , Agentes de Cessação do Hábito de Fumar/efeitos adversos , Dispositivos para o Abandono do Uso de Tabaco , Tabagismo/diagnóstico , Tabagismo/fisiopatologia , Tabagismo/psicologia , Resultado do Tratamento , Vareniclina/efeitos adversos
9.
Psicothema (Oviedo) ; 32(2): 176-181, mayo 2020. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-197255

RESUMO

BACKGROUND: The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence. METHOD: The sample included 275 adult treatment-seeking daily smokers (Mage = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted. RESULTS: A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms. CONCLUSIONS: Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions


ANTECEDENTES: el presente estudio tiene como objetivo examinar la relación entre la conducta de evitación, el reforzamiento ambiental percibido, la sintomatología depresiva y la dependencia del tabaco. MÉTODO: la muestra estaba formada por 275 fumadores que demandan tratamiento para dejar de fumar (Medad = 45,36, DT = 10,96; 61,5% mujeres). Para examinar la relación entre las variables de estudio se realizaron análisis de correlación y de mediación serial. RESULTADOS: se encontró una correlación positiva significativa entre la dependencia del tabaco, la evitación y la sintomatología depresiva, y una correlación negativa significativa con el reforzamiento ambiental percibido. El análisis de mediación serial reveló una vía indirecta significativa entre la evitación y la dependencia del tabaco a través de la sintomatología depresiva; así como entre la evitación y la dependencia del tabaco a través del reforzamiento ambiental percibido y la sintomatología depresiva. CONCLUSIONES: los resultados de este estudio contribuyen a la comprensión de factores conductuales y psicológicos implicados en la dependencia del tabaco, la cual es considerada una barrera para lograr la abstinencia. Por lo tanto, la evaluación y abordaje de estas variables podría considerarse un aspecto relevante en el contexto de las intervenciones para dejar de fumar


Assuntos
Humanos , Masculino , Feminino , Adulto , Depressão/psicologia , Recompensa , Tabagismo/psicologia , Abandono do Hábito de Fumar , Fumar/psicologia , Aprendizagem da Esquiva , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Produtos do Tabaco
10.
Compr Psychiatry ; 100: 152175, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32345436

RESUMO

BACKGROUND: Multiple developmental risk factors for Substance Use Disorders (SUDs) during young adulthood have been identified. In this investigation, we examined the impact of homelessness, foster care, and adverse childhood experiences (ACEs) prior to 12th grade on the development of three common SUDs during young adulthood-Alcohol Use Disorder (AUD), Tobacco Use Disorder (TUD) and Cannabis Use Disorder (CUD). Our hypothesis was that while both homelessness and ACEs are significant risk factors for young adult SUDs, foster care involvement might convey protection. METHODS: Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health, measures of ACEs were derived from the CDC-Kaiser ACE study, and DSM-V SUD diagnoses were derived from items originally based on DSM-IV. SUD diagnoses were binned into "mild", "moderate", and "severe" groupings. Survey-based logistic models were used to estimate risks of SUDs while controlling for demographics. RESULTS: The results suggest that the experience of homelessness prior to 12th grade in addition to ACEs were significantly associated with the development in young adulthood of the most severe forms of AUD and TUD and all severity levels of CUD. Foster care was not associated with either risk or protection from SUDs. CONCLUSIONS: The experience of homelessness during development may be viewed as another detrimental ACE that is a risk factor for the most common SUDs in young adulthood. Given the magnitude of the current epidemic of homelessness in the U.S., these results should raise substantial concern.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Alcoolismo/epidemiologia , Criança Acolhida , Pessoas em Situação de Rua/estatística & dados numéricos , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tabagismo/epidemiologia , Adolescente , Adulto , Alcoolismo/psicologia , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Estudos Longitudinais , Masculino , Abuso de Maconha/psicologia , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Tabagismo/psicologia , Adulto Jovem
11.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32253889

RESUMO

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.


Assuntos
Terapia Comportamental/métodos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Fumar/terapia , Tabagismo/terapia , Adolescente , Adulto , Idoso , Aconselhamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Estudos Prospectivos , Fumar/efeitos adversos , Fumar/psicologia , Inquéritos e Questionários , Tabagismo/complicações , Tabagismo/diagnóstico , Tabagismo/psicologia , Adulto Jovem
12.
BMJ Case Rep ; 13(3)2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32139447

RESUMO

There are many tobacco users who wish to quit. In some cases, ostracism related to religious proscriptions serves as a barrier and prevents them from revealing their addiction status. Religion as an institution has an immense influence on human behaviour. It contributes to the cultural identity of individuals, moderating uniformity in their behaviour and social life. We describe a case from a province in Punjab in North India, where tobacco use is a 'taboo' due to the widely practised faith of Sikhism. The case illustrates how a doctoral thesis student, along with the healthcare providers at a non-communicable disease clinic, overcame the concealment of tobacco use of a patient with hypertension due to fear of social exclusion. The student assisted him in quitting tobacco use through a culturally specific, patient-centric, individualised, behavioural intervention using religion as a backdrop. This case study highlights the importance of recognising and appreciating the dynamics of sociocultural factors to develop a suitable and successful deaddiction strategy. This case elaborates how a simple 'nudge' of religious tenets-based counselling helps the tobacco addict transgress or tide over such barriers.


Assuntos
Aconselhamento , Religião , Abandono do Hábito de Fumar , Normas Sociais , Valores Sociais , Tabagismo/psicologia , Decepção , Humanos , Índia , Masculino , Tabagismo/prevenção & controle
13.
Dtsch Arztebl Int ; 117(1-2): 7-13, 2020 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-32008606

RESUMO

BACKGROUND: Clinical guidelines on smoking cessation contain recommendations for various evidence-based methods. The goal of this study was to provide a represen- tative analysis for Germany of the percentage of smokers who try to quit smoking at least once per year, the use of evidence-based methods and other methods of smoking cessation, and potential associations of the use of such methods with the degree of tobacco dependence and with socioeconomic features. METHODS: Data from 19 waves of the German Smoking Behavior Questionnaire (Deutsche Befragung zum Rauchverhalten, DEBRA), from the time period June/July 2016 to June/July 2019, were analyzed. Current smokers and recent ex-smokers (<12 months without smoking) were asked about their smoking cessation attempts in the past year and the methods they used during the last attempt (naming more than one method was permitted). The degree of tobacco dependence in current smokers was assessed with the Heaviness of Smoking Index. RESULTS: Out of 11 109 current smokers and 407 recent ex-smokers, 19.9% (95% confidence interval: [19.1; 20.6]) had tried to quit smoking at least once in the preceding year. 13.0% of them [11.6; 14.5] had used at least one evidence-based method during their last attempt. The stronger the tobacco dependence, the more likely the use of an evidence-based method (odds ratio [OR] = 1.27 [1.16; 1.40]). Pharmacotherapy (nicotine replacement therapy, medication) was used more com- monly by persons with higher incomes (OR = 1.44 per 1000 euro/month [1.28; 1.62]). Electronic cigarettes were the most commonly used single type of smoking cessation support (10.2 % [9.0; 11.6]). CONCLUSION: In Germany, only one in five smokers tries to quit smoking at least once per year. Such attempts are only rarely supported by evidence-based methods and are thus likely to fail. The high cost of treatment must be borne by the individual and thus fall disproportionately on poorer smokers. It follows that there is an urgent need for vered by health insurance pro- viders, in order to give all smokers fair and equal access to the medical care they need.


Assuntos
Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Alemanha , Humanos , Fumantes/estatística & dados numéricos , Fatores Socioeconômicos , Tabagismo/psicologia
14.
Psychopharmacology (Berl) ; 237(4): 1081-1090, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31900525

RESUMO

RATIONALE: A reduced willingness to perform effort based on the magnitude and probability of potential rewards has been associated with diminished dopamine function and may be relevant to chronic drug use. OBJECTIVES: Here, we investigated the influence of smoking status on effort-based decisions. We hypothesized that smokers would make fewer high-effort selections than ex-smokers and never-smokers. METHODS: Current smokers (n = 25), ex-smokers (≥ 1 year quit, n = 23), and never-smokers (n = 19) completed the Effort Expenditure for Rewards Task in which participants select between low-effort and high-effort options to receive monetary rewards at varying levels of reward magnitude, probability and expected value. RESULTS: Overall, participants selected more high-effort options as potential reward magnitude and expected value increased. Smokers did not make fewer high-effort selections overall, but smokers were less sensitive to the changes in magnitude, probability, and expected value compared to never-smokers. Smokers were also less sensitive to the changes in probability and expected value, but not magnitude, compared to ex-smokers. Among smokers and ex-smokers, less nicotine dependence was associated with an increased likelihood of high-effort selections. CONCLUSIONS: These results demonstrate the relevance of smoking status to effort-based decisions and suggest that smokers have diminished sensitivity to nondrug reward value. Among ex-smokers, greater pre-existing sensitivity to reward value may have been conducive to smoking cessation, or sensitivity was improved by smoking cessation. Future prospective studies can investigate whether effort-related decision making is predictive of smoking initiation or cessation success. IMPLICATIONS: Willingness to perform effort to achieve a goal and sensitivity to changes in reward value are important aspects of motivation. These results showed that smokers have decreased sensitivity to changes in effort-related reward probability and expected value compared to ex-smokers and never-smokers. Potentially, improved sensitivity to rewards among ex-smokers may be a cause or consequence of smoking cessation. These findings may help explain why some smokers are able to achieve long-term abstinence.


Assuntos
Fumar Cigarros/psicologia , Tomada de Decisões/fisiologia , Desempenho Psicomotor/fisiologia , Recompensa , Tabagismo/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Estudos Prospectivos , Tabagismo/diagnóstico , Adulto Jovem
15.
Nicotine Tob Res ; 22(8): 1419-1423, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31725872

RESUMO

INTRODUCTION: The rate of nicotine metabolism, estimated by the nicotine metabolite ratio (NMR), is an important determinant of tobacco dependence. This study investigated the effect of NMR on smoking behavior due to nicotine reinforcement during ad libitum smoking. AIMS AND METHODS: As part of a larger study, participants were stratified based on saliva NMR as fast and slow metabolizers. After smoking a cigarette and measuring nicotine blood concentrations, participants smoked as desired over a 90-minute period. Analysis included time to first cigarette, total number of cigarettes, total number of puffs, and weight of tobacco consumed. RESULTS: Sixty-one (48%) participants were fast metabolizers and 66 (52%) slow metabolizers by NMR. No significant differences were found regarding the smoking topography variables by NMR. Normal metabolizers by genotype (n = 79) had a shorter time to first cigarette than reduced metabolizers (n = 39; p = .032). Blacks smoked fewer cigarettes (p = .008) and took fewer total puffs (p = .002) compared with Whites. Among Whites, fast metabolizers by NMR had a shorter time to first cigarette compared with slow metabolizers (p = .014). Among fast metabolizers, Whites had, compared with Blacks, shorter latency to first cigarette (p = .003) and higher number of total puffs (p = .014) and cigarettes smoked (p = .014). Baseline cigarettes per day and nicotine elimination half-life significantly predicted topography outcomes. CONCLUSIONS: Saliva NMR did not predict cigarette reinforcement during a relatively brief period of ad libitum smoking. Differences were seen by race, with White fast metabolizers by NMR having shorter time to first cigarettes compared with slow metabolizers. IMPLICATIONS: After a 90-minute period of nicotine abstinence, NMR was not significantly associated with smoking reinforcement. Slow and fast metabolizers had similar time to first cigarette, number of cigarettes smoked, total number of puffs, and tobacco consumed; however, within-race differences show that within Whites, fast metabolizers had a faster time to first cigarette than slow metabolizers.


Assuntos
Nicotina/metabolismo , Reforço Psicológico , Produtos do Tabaco/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Tabagismo/epidemiologia , Adulto , Feminino , Humanos , Masculino , Nicotina/análise , Fumar Tabaco/metabolismo , Fumar Tabaco/psicologia , Tabagismo/metabolismo , Tabagismo/psicologia , Estados Unidos/epidemiologia
16.
Drug Alcohol Depend ; 207: 107796, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31864163

RESUMO

BACKGROUND: Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined. METHODS: Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n  = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit. RESULTS: Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence. CONCLUSIONS: Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.


Assuntos
Transtornos Mentais/epidemiologia , Tabagismo/epidemiologia , Adulto , Comorbidade , Fissura , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Recidiva , Fatores de Risco , Abandono do Hábito de Fumar/psicologia , Síndrome de Abstinência a Substâncias , Fatores de Tempo , Tabagismo/psicologia , Cooperação e Adesão ao Tratamento
17.
Drug Alcohol Depend ; 206: 107715, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31760252

RESUMO

BACKGROUND: Menthol cigarettes appeal to adolescents because they mask the harsh taste and sensation of tobacco smoke thereby making it easier to inhale the smoke. As a result, menthol cigarette users expose themselves to higher levels of nicotine relative to non-menthol cigarettes and increase their risk for developing nicotine dependence. We examined whether adolescent menthol smokers (vs. non-menthol smokers) reported higher nicotine dependence. METHODS: Data were from adolescent past 30-day cigarette smokers participating in Wave 2 of the Population Assessment of Tobacco and Health survey (n = 434). Nicotine dependence was assessed using eight items from the Wisconsin Inventory of Smoking Dependence Motives corresponding to individual subscale constructs. Linear regression models evaluated the association of past 30-day menthol (vs. non-menthol) cigarette use with each dependence outcome in separate models, adjusting for age, gender, race, and other tobacco product use. RESULTS: 49.5% of past 30-day youth cigarette smokers reported smoking menthol cigarettes. In adjusted models, menthol smokers (vs. non-menthol smokers) reported significantly higher nicotine dependence for three constructs: craving (p = 0.005), affiliative attachment (p = 0.005), and tolerance (p = 0.003). No differences for menthol vs. non-menthol smokers were observed for loss of control, negative reinforcement, cognitive enhancement, automaticity, or social environment after correction for multiple comparisons. CONCLUSIONS: Findings suggest that menthol cigarette smokers are not just more physically dependent on nicotine but also experience increased emotional attachments to cigarettes compared to their non-menthol smoking peers. Because adolescents are vulnerable to developing nicotine dependence, tobacco control policies that restrict youth access to menthol cigarettes are urgently needed.


Assuntos
Fumar Cigarros/psicologia , Mentol/análise , Fumantes/psicologia , Produtos do Tabaco/análise , Tabagismo/epidemiologia , Adolescente , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Tabagismo/psicologia , Estados Unidos/epidemiologia
18.
Nicotine Tob Res ; 22(3): 408-414, 2020 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-30452739

RESUMO

INTRODUCTION: Network theories of psychopathology highlight that, rather than being indicators of a latent disorder, symptoms of disorders can causally interact with one another in a network. This study examined tobacco withdrawal from a network perspective. METHODS: Participants (n = 525, 50.67% female) completed the Minnesota Tobacco Withdrawal Scale four times (2 weeks prior to a target quit day, on the target quit day, and 4 and 8 weeks after the target quit day) over the course of 8 weeks of treatment with nicotine patch and behavioral counseling within a randomized clinical trial testing long-term nicotine patch therapy in treatment-seeking smokers. The conditional dependence among seven withdrawal symptoms was estimated at each of the four measurement occasions. Influential symptoms of withdrawal were identified using centrality indices. Changes in network structure were examined using the Network Comparison Test. RESULTS: Findings indicated many associations among the individual symptoms of withdrawal. The strongest associations that emerged were between sleep problems and restlessness, and associations among affective symptoms. Restlessness and affective symptoms emerged as the most central symptoms in the withdrawal networks. Minimal differences in the structure of the withdrawal networks emerged across time. CONCLUSIONS: The cooccurrence of withdrawal symptoms may result from interactions among symptoms of withdrawal rather than simply reflecting passive indicators of a latent disorder. Findings encourage greater consideration of individual withdrawal symptoms and their potential interactions and may be used to generate hypotheses that may be tested in future intensive longitudinal studies. IMPLICATIONS: This study provides a novel, network perspective on tobacco withdrawal. Drawing on network theories of psychopathology, we suggest that the cooccurrence of withdrawal symptoms may result from interactions among symptoms of withdrawal over time, rather than simply reflecting passive indicators of a latent disorder. Results indicating many associations among individual symptoms of withdrawal are consistent with a network perspective. Other results of interest include minimal changes in the network structure of withdrawal across four measurement occasions prior to and during treatment with nicotine patch and behavioral counseling.


Assuntos
Terapia Comportamental/métodos , Nicotina/administração & dosagem , Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Rede Social , Síndrome de Abstinência a Substâncias/prevenção & controle , Dispositivos para o Abandono do Uso de Tabaco , Adolescente , Adulto , Terapia Combinada , Redes Comunitárias , Aconselhamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Síndrome de Abstinência a Substâncias/psicologia , Tabagismo/psicologia , Adulto Jovem
19.
Nicotine Tob Res ; 22(4): 492-497, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-30624745

RESUMO

INTRODUCTION: Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants. METHODS: Adolescent daily smokers (n = 166; ages 14-18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6). RESULTS: Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states-regardless of valence-were associated with 12%-13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen's mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences. CONCLUSIONS: This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group. IMPLICATIONS: This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens' daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.


Assuntos
Comportamento do Adolescente/psicologia , Comportamento Aditivo/psicologia , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Tabagismo/psicologia , Adolescente , Fissura/efeitos dos fármacos , Fissura/fisiologia , Feminino , Humanos , Masculino , Abandono do Hábito de Fumar/métodos
20.
Psychol Addict Behav ; 34(1): 156-163, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31380658

RESUMO

The recognition of the interplay between cigarette demand and impulsivity as a proxy of reinforcer pathology (RP) has prompted studies that assess these 2 constructs. Scarce research has examined their interrelation within clinical contexts. This secondary analysis sought to identify different types of treatment-seeking smokers based on cigarette demand and delay discounting and examine their differential response to contingency management (CM). The dataset included 305 participants (68% female) receiving either a cognitive-behavioral treatment (CBT) or CBT + CM. A cluster analysis based on the bifactorial structure of a cigarette purchase task (i.e., psychological inertia and persistence) and delay discounting (base-10 logarithmic transformation of the area under the curve) was conducted. Clusters were compared in abstinence rates at posttreatment and 6-month follow-up. Two RP subgroups emerged, Cluster 1 (n = 128) and Cluster 2 (n = 177), which were interpreted as "individuals with excessive tobacco valuation" and "steep discounters," respectively. At 8 weeks, the percentage of abstinent individuals was higher in those in Cluster 2 compared to those in Cluster 1 (76.3% vs. 61%; χ2 = 8.291, p = .004, ϕ = .16). The nonsignificant effect of treatment condition on cessation outcomes indicated that both clusters equally benefited from CBT or CBT + CM. Support was reached for the generalizability of CBT and CM irrespective of patients' RP subtype. The fact that CM did not enhance abstinence outcomes beyond those obtained with CBT alone, underscores the need to evaluate the effect of innovative treatment procedures tailored to these RP phenotypes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Comportamental/métodos , Fumar Cigarros/terapia , Desvalorização pelo Atraso , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Adulto , Fumar Cigarros/psicologia , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Comportamento Impulsivo , Masculino , Pessoa de Meia-Idade , Prognóstico , Fumantes , Abandono do Hábito de Fumar/psicologia , Tabaco , Tabagismo/psicologia , Resultado do Tratamento
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