Modeling the effects of combined behavioral and pharmacological treatment on cigarette smoking: behavioral-economic analyses

Effects of different response requirements, response-independent cigarette puffs, and an alternative nondrug reinforcer on cigarette smoking were assessed in 2 experiments. The response requirement to obtain 2 puffs on a cigarette was manipulated while various numbers of response-independent puffs were provided (0, 6, or 12 in Experiment 1; 0 or 12 in Experiment 2). In Experiment 2, effects of response-dependent money ($0.25) on smoking were assessed within subjects. Response-dependent puff consumption decreased as price increased and as the number of response-independent puffs increased. Concurrently available money also decreased response-dependent smoking. The largest decrease in smoking occurred when puffs were at the highest price and when response-independent puffs and response-dependent money were both concurrently available. Findings suggest that combined pharmacological and behavioral interventions produce the greatest reductions in smoking.     

Olanzapine reduces urge to smoke and nicotine withdrawal symptoms in community smokers.

Olanzapine (OLAN), an atypical antipsychotic medication with mixed 5-HT2/DA antagonist properties, was predicted to dose-dependently decrease urge to smoke, withdrawal, and cigarette reinforcement in smokers without psychosis. A double-blind placebo-controlled within-subjects cross-over trial investigated the acute effects of OLAN (0, 2.5, and 5.0 mg; counterbalanced order) in 24 community smokers who underwent 10-hr smoking deprivation. Urge to smoke, tobacco withdrawal, and cigarette reinforcement were assessed with cue reactivity and behavioral choice procedures. OLAN (2.5 mg) reduced withdrawal symptoms before and during cue exposure and decreased urge associated with anticipated positive affect from smoking before and during cue exposure; 5.0 mg OLAN decreased withdrawal only when cues were included. OLAN did not affect preference for cigarette puffs versus money, smoke intake, or urge to smoke associated with negative affect relief. The results indicate a potentially beneficial effect of 2.5 mg OLAN on tobacco withdrawal and urge to smoke. Combined 5HT/DA antagonists should be considered for future development of pharmacotherapies for smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Possible amotivational effects following marijuana smoking under laboratory conditions.

Human participants earned money by responding on a progressive-ratio (PR) schedule (initial value $50) or received money without responding on a fixed-time (FT) schedule. During the session, participants could terminate the PR schedule and initiate an FT 200-s schedule. In Experiment 1, increases in monetary value produced increased number of responses, time spent, and money earned in the PR component. In Experiment 2, marijuana smoking produced potency-related reductions in the number of responses, time spent, and money earned in the PR component, effects that can be interpreted as amotivational. Increasing the monetary value of the reinforcer diminished the acute marijuana effects on PR responding, suggesting that marijuana exerted an effect primarily on reinforcers of a smaller magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-dose transdermal nicotine and naltrexone: Effects on nicotine withdrawal, urges, smoking, and effects of smoking.

Although treatment with transdermal nicotine replacement (TNR) has improved smoking abstinence rates, higher doses of TNR could improve effects on urge to smoke, nicotine withdrawal, and reinforcement from smoking, and naltrexone might further reduce reinforcement and urges. A laboratory investigation with 134 smokers using a 3 × 2 parallel-group design evaluated the effects of TNR (42-mg, 21-mg, or 0-mg patch) as crossed with a single dose of naltrexone (50 mg) versus placebo on urge to smoke, withdrawal, and responses to an opportunity to smoke (intake, subjective effects) after 10 hr of deprivation. Urge and withdrawal were assessed both prior to and after cigarette cue exposure. Only 42 mg TNR, not 21 mg, prevented urge to smoke, heart rate change, and cue-elicited increase in withdrawal. Both 21 and 42 mg TNR blocked cue-elicited drop in heart rate and arterial pressure. Naltrexone reduced cue-elicited withdrawal symptoms but not urges to smoke or deprivation-induced withdrawal prior to cue exposure. Neither medication significantly affected carbon monoxide intake or subjective effects of smoking except that 42 mg TNR resulted in lower subjective physiological activation. No interaction effects were found, and no results differed by gender. Results suggest that starting smokers with 42 mg TNR may increase comfort during initial abstinence, but limited support is seen for naltrexone during smoking abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similarity in cigarette smoking attracts: A prospective study of romantic partner selection by own smoking and smoker prototypes.

In the current research, we used a multiwave longitudinal design to examine how young adults’ own smoking and smoker prototypes are associated with selection of romantic partners over time. Results indicate that participants who smoke, versus participants who do not smoke, and participants who have a more positive prototype of the typical smoker are more likely to initiate a romantic relationship with someone who smokes and who has greater perceived approval for smoking. Among participants who smoke, higher levels of smoking are associated with initiating a relationship with a romantic partner who smokes more and approves of smoking more. The findings suggest some important aspects of romantic partner selection effects in terms of what is selected for, partner smoking and approval, and key young adult variables that contribute to selection, such as participant’s own smoking and smoker prototype. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivating Latino caregivers of children with asthma to quit smoking: A randomized trial.

Objective: Secondhand smoke exposure is associated with asthma onset and exacerbation. Latino children have higher rates of asthma morbidity than other groups. The current study compared the effectiveness of a newly developed smoking cessation treatment with existing clinical guidelines for smoking cessation. Method: Latino caregivers who smoked (N = 133; 72.9% female; mean age = 36.8 years) and had a child with asthma were randomly assigned to receive 1 of 2 smoking cessation counseling interventions during a home-based asthma program: (a) behavioral action model (BAM; modeled on clinical guidelines for smoking cessation) or (b) precaution adoption model (PAM; feedback on the caregiver’s carbon monoxide level and child’s secondhand smoke exposure using Motivational Interviewing). Counseling was delivered by a bilingual Latina health educator, and the content was tailored to Latino values and culture. It was not necessary for smokers to want to quit smoking to participate. Smoking cessation was biochemically verified and secondhand smoke exposure was objectively measured through passive nicotine monitors. Results: Intent-to-treat analyses showed that 20.5% of participants in the PAM condition and 9.1% of those in the BAM condition were continuously abstinent at 2 months posttreatment (OR = 2.54; 95% CI = 0.91–7.10), whereas 19.1% of participants in the PAM condition and 12.3% of those in BAM condition were continuously abstinent at 3 months posttreatment (OR = 1.68; 95% CI = 0.64–4.37). Secondhand smoke exposure decreased only in the BAM condition (p p     

Testing the influence of external and internal cues on smoking motivation using a community sample.

Exposing smokers to either external cues (e.g., pictures of cigarettes) or internal cues (e.g., negative affect induction) can induce urge to smoke and other behavioral and physiological responses. However, little is known about whether the two types of cues interact when presented in close proximity, as is likely the case in the real word. Additionally, potential moderators of cue reactivity have rarely been examined. Finally, few cue-reactivity studies have used representative samples of smokers. In a randomized 2 × 2 crossed factorial between-subjects design, the current study tested the effects of a negative affect cue intended to produce anxiety (speech preparation task) and an external smoking cue on urge and behavioral reactivity in a community sample of adult smokers (N = 175), and whether trait impulsivity moderated the effects. Both types of cues produced main effects on urges to smoke, despite the speech task failing to increase anxiety significantly. The speech task increased smoking urge related to anticipation of negative affect relief, whereas the external smoking cues increased urges related to anticipation of pleasure; however, the cues did not interact. Impulsivity measures predicted urge and other smoking-related variables, but did not moderate cue-reactivity. Results suggest independent rather than synergistic effects of these contributors to smoking motivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chewing gum affects smoking topography.

In a previous study, Wrigley's chewing gum was shown to reduce cravings to smoke and nicotine withdrawal when smokers were not allowed access to cigarettes. The present study expanded these findings by examining smoking behavior of 20 dependent cigarette smokers who were allowed free access to cigarettes throughout the study session but were encouraged and rewarded not to smoke. Each experimental session consisted of the participant watching a movie, then waiting an additional 30 min. Half of the participants were assigned to a gum condition in which they were asked to chew at least one piece of gum and had free access to chewing gum throughout the experimental session; half were assigned to a no-gum control. Results from this study indicate that when gum was present, participants took significantly fewer puffs and abstained for a longer period of time until their first cigarette. These results suggest that chewing gum may facilitate quit attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of smoking opportunity on attentional bias in smokers.

The emotional Stroop task was used to examine the influence of opportunity to smoke on attentionall bias to smoking-related stimuli. At the outset of the study, 92 nicotine-deprived smokers were told that they (a) would, (b) would not, or (c) might be able to smoke during the experiment. Next, participants completed an emotional Stroop task, in which they were presented with smoking-related or -unrelated words in an unblocked format. Smokers demonstrated interference to the smoking words, relative to matched neutral words, F(1, 87)?=?18.0, p?F(2, 87)?=?4.35, p?     

Hostility, cigarette smoking, and responses to a lab-based social stressor.

High-trait hostility is associated with persistent cigarette smoking. To better understand mechanisms that may account for this association, we examined the effects of acute smoking abstinence and delayed versus immediate smoking reinstatement on responses to a social stressor among 48 low hostile (LH) and 48 high hostile (HH) smokers. Participants completed two laboratory sessions, one before which they had smoked ad lib and one before which they had abstained for the prior 12 hr. During each session, participants completed a stressful speaking task and then smoked immediately after the stressor or after a 15-min delay. The effect of immediate versus delayed smoking reinstatement on recovery in negative mood was significantly moderated by hostility. When reinstatement was delayed, HH participants showed significant increases in negative mood over time, whereas LH participants showed little change. When reinstatement was immediate, HH and LH smokers showed similar significant decreases in negative mood. Smoking abstinence did not moderate hostility effects. Cigarette smoking may prevent continuing increases in negative mood after social stress in HH smokers, which may partially explain their low rates of quitting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Movie exposure to smoking cues and adolescent smoking onset: A test for mediation through peer affiliations.

Objective: To determine whether the effect of movie exposure to smoking on adolescent smoking onset is mediated through increased affiliation with peers who smoke. Design: A longitudinal study was conducted with a sample of 5th- 8th graders; persons who were nonsmokers at the baseline assessment (N = 2,614) were followed up 18 months later. Movie exposure to smoking cues was assessed at baseline with a rigorous coding procedure. Main Outcome Measure: A school-based survey and follow-up telephone interview determined whether the participant smoked cigarettes. Results: Longitudinal structural modeling analysis indicated movie-smoking exposure was related to smoking onset both through an indirect effect involving increased affiliation with peer smokers and through a direct effect. The analysis controlled for demographics, parenting style, rebelliousness and sensation seeking, school performance, parental smoking, and sibling smoking; several of these variables also had mediated or direct effects to smoking onset. Conclusion: The effect of movie exposure on adolescent smoking onset is attributable in part to a social mechanism. Implications of media effects for prevention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smoking and chewing gum: Response to a laboratory-induced stressor.

The current study examined the anxiolytic effects of cigarette smoking and chewing gum on urge to smoke, withdrawal, and anxiety in response to a public speaking task in 45 undergraduate smokers. Participants were asked to smoke, chew gum, or do nothing in response to the stressor. Participants completed measures of anxiety, withdrawal symptoms, and urge to smoke pre- and poststressor. The smoke group reported fewer urges to smoke pre- and poststressor than the other groups. The smoke and gum groups reported fewer withdrawal symptoms than did the control group poststressor. Chewing gum was helpful in managing levels of withdrawal symptoms compared with the control group. Groups did not differ on measures of anxiety. Results suggest that smoking in response to a stressor may not reduce levels of affective stress. Furthermore, chewing gum may be helpful in managing withdrawal symptoms in response to a stressor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of abstinence on cigarette smoking among outpatients with schizophrenia.

The authors of this study examined the effects of brief smoking abstinence on smoking among 6 individuals with schizophrenia or schizoaffective disorder. Before 6 of 12 experimental sessions, participants were required to provide breath carbon monoxide (CO) samples indicative of smoking abstinence; before the remaining sessions, participants provided CO samples indicating no abstinence. During sessions, participants obtained smoking opportunities (2 puffs/opportunity) under either fixed ratio-1 or progressive ratio (PR) schedules of reinforcement. Abstinence increased smoking under both schedules and increased breakpoint for smoking under the PR schedule. These data offer further evidence that smoking by individuals with schizophrenia is orderly, operant behavior that is modulated, at least in part, by variables that also affect smoking in people without major mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary investigation of rapid smoking as a lapse-responsive treatment for tobacco dependence.

Lapses within the first 2 weeks of a smoking cessation attempt are strongly associated with a return to regular smoking (S. L. Kenford et al., 1994). Unfortunately, little is known about how to prevent an initial lapse from progressing to a full relapse, and presently there are no validated lapse-responsive therapeutic interventions. The present study tested the efficacy and feasibility of rapid smoking plus counseling as a novel lapse-responsive intervention. Sixty-seven participants enrolled in a smoking treatment program involving brief counseling and a 9-week course of bupropion. Beginning on the quit day, participants' smoking behavior was tracked daily for 14 days. Once an early smoking lapse was identified, participants were randomly assigned to receive either 3 sessions of rapid smoking plus counseling or no intervention (usual care). Consistent with previous research, participants who smoked during the first 2 weeks of the quit attempt had significantly poorer 6-month outcomes (3% abstinent) than did those who did not smoke (64% abstinent). Compared with early abstainers, early lapsers were more nicotine dependent and reported greater cravings and lower confidence in their ability to abstain from smoking during the first 48 hours of abstinence. As expected, rapid smoking produced a variety of aversive effects, including increased nausea, dizziness, and vomiting as well as sharply decreased cravings to smoke. However, rapid smoking did not improve abstinence outcomes relative to usual care. Although rapid smoking has been shown to be an effective treatment for initial smoking cessation, in this preliminary study the authors failed to demonstrate its effectiveness as a lapse-responsive treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Influence of Instructions and Nicotine Dose on the Subjective and Reinforcing Effects of Smoking.

Subjective and reinforcing effects of smoking a cigarette were examined within a 2 x 2 modified balanced-placebo design, which manipulated instructions about nicotine content (i.e., told regular nicotine vs. told low nicotine) and actual nicotine dose (given a regular nicotine brand vs. a denicotinized brand). Most ratings of the nicotine content and reward value of cigarettes were higher for those told regular nicotine versus told low nicotine, and for those given regular nicotine versus given low nicotine. Nicotine and instructions did not affect craving, withdrawal, or smoke-reinforced responding, but instructions affected the number of puffs earned for those given low nicotine (i.e., placebo effect). Thus, verbal information (instructions) can influence some responses to smoking consistent with the presence of placebo and antiplacebo effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-affirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels.

Objective: Little is known about how smokers respond to graphic images depicting the health consequences of smoking. The authors tested whether smokers respond defensively to such images and whether allowing them to self-affirm reduces their defensiveness. Design: Young smokers (N = 87) were randomly allocated to self-affirm or perform a control task prior to viewing 4 images intended for future use on cigarette packs in the European Union. Measures were taken immediately postexposure and after 1 week. Main Outcome Measures: Participants rated each image for threat and personal relevance. Once all 4 images had been viewed, they completed measures of intentions, self-efficacy, and perceived behavioral control for reducing cigarette consumption, negative thoughts and feelings about smoking, personal vulnerability to 6 smoking-related diseases, desire to quit, and plans to quit. At the 1-week follow-up, measures of self-reported smoking and desire to reduce consumption were taken. Results: Relative to controls, self-affirmed participants rated the images as more threatening and personally relevant, and they reported more negative thoughts and feelings and higher levels of control, self-efficacy, and intentions. Risk level moderated the effect of self-affirmation on relevance and intentions: Self-affirmation increased ratings on both measures among those who smoked more. In addition, self-affirmation moderated the threat-intention relationship, which was weaker in the self-affirmed group. At follow-up, motivation to reduce consumption remained higher in self-affirmed participants, but there were no differences in reported consumption. Conclusion: Self-affirmation can promote less defensive responding even to visual material about well-established health risks such as smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of contingency management to reduce cigarette smoking among college students.

The current study tested the feasibility of using contingency management to reduce cigarette smoking among college students. Eighty-eight undergraduate smokers were enrolled in a 3-week ABA study. During the baseline weeks, participants earned noncontingent monetary payments for attending data collection sessions. During the intervention week, participants earned monetary payments contingent on demonstrating recent abstinence. Participants were randomly assigned to either a low- or a high-reinforcer magnitude condition that controlled the amount of money that could be earned during the intervention week. Cigarette smoking was significantly reduced during the intervention week relative to the baseline weeks, and greater reductions were achieved under the high-reinforcer magnitude condition. These results suggest that cigarette smoking among college students is responsive to contingency management procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distribution of major and minor alkaloids in tobacco, mainstream and sidestream smoke of popular Indian smoking products

Various Indian smoking products--cigarette, bidi, chutta and a brand of US cigarette--were analysed by gas chromatography-flame ionization detection (GC-FID) for the levels of nicotine and minor tobacco alkaloids in tobacco, mainstream smoke (MS) and sidestream smoke (SS) employing modified smoking standards, namely two puffs/min. The analysis clearly demonstrated relatively higher levels of nicotine and minor tobacco alkaloids in tobacco from bidi (37.7 mg/g) and chutta (34.5 mg/g) when compared with Indian and US cigarettes (14-16 mg/g) studied. Relatively lower levels (SS/MS) of nicotine in SS from bidi and chutta compared with Indian/US cigarettes, suggest that the contribution of nicotine in SS from a single bidi/chutta to environmental tobacco smoke (ETS) is very much less than that of a single Indian/US cigarette. Reduced levels of nicotine in SS of bidi/chutta result in relatively higher deliveries of nicotine in MS as reflected by higher MS/SS values. The observed differences are likely to be due to difference in tobacco processing, burning rate/temperature and design of the smoking product.     

Preference for alcohol consumption as a function of amount and delay of alternative reward.

Sixty male normal drinkers were placed in a choice situation with two behavioral alternatives; one produced access to alcohol consumption, and one produced access to opportunities to win money on a probabilistic dice throw task. Any alcohol chosen was available during the session, and constraints on access to it were held constant. Two independent variables involving constraints on access to money were manipulated in a 2?×?3 factorial design: (a) amount of money available, which was determined by the probability of a "win" on the dice throw task (either .17 or .83), and (b) delay in receipt of any money won (either no delay, a 2-week delay, or an 8-week delay). The main dependent measures were the proportion of responses allocated to gain access to alcohol, response-outcome expectancies, and mood state. Subjects' preferences for alcohol varied positively with delay but were not significantly influenced by the money-amount manipulation. Subjects' choice behavior was not related to mood states or expectations. The results partially replicate those of an earlier experiment and lend credence to a formulation of the determinants of drinking behavior based on behavioral theories of choice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of a worksite smoking cessation program in the military. Program evaluation

1. A program evaluation was conducted to evaluate the effectiveness of the smoking cessation program. Substantiating data enhances the value of health promotion programs as key components of the health care delivery system. 2. Persons enrolled in the 8 week smoking cessation program and members of a comparison group were administered an evaluation tool prior to participating in the program, with a second evaluation tool upon completion of the program. Afterward, the smoking status of the members of both groups was evaluated at 3 month intervals for a period of 1 year. 3. Of the participants, 26.7% were not smoking 12 months after the program, compared to 6.9% of the comparison group. Of those participants who resumed smoking, 64% smoked less than half the amount they smoked before taking the class.