Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure.

Smoking rates are elevated among individuals with attention-deficit/hyperactivity disorder (ADHD). The association of ADHD diagnosis and smoking treatment outcome has not been examined. The present study examined abstinence rates among 428 adult smokers participating in two randomized controlled trials. Treatments included nicotine replacement, antidepressants, and psychological interventions. Childhood ADHD was assessed retrospectively by diagnostic interview. In a survival analysis, ADHD status predicted time to relapse after controlling for gender, history of depression, and baseline smoking variables. Only 1 of 47 participants with a history of childhood ADHD remained abstinent by week 52, compared with 18% of those who had no history of childhood ADHD (adjusted OR=0.36, 95% CI=0.28-0.45). The current findings provide preliminary evidence for an association between childhood ADHD and smoking cessation treatment failure. Further investigation is warranted.     

Smoking and education: Do psychosocial variables explain the relationship between education and smoking behavior?

The effect of education, depressive symptoms, trait anxiety, and coping traits (approach-belief, monitoring-creating-executing, and self-regulating) were tested on smoking behavior among 574 young adult males. We hypothesized that depression, anxiety, and coping traits were mediators in the relationship between education and smoking. Univariate analyses showed a significant association between smoking behavior and depressive symptoms, higher trait anxiety score, and lower scores on approach-belief and self-regulating traits. Education was significantly associated with depressive symptoms and coping traits. Although we found significant associations between smoking and education, smoking and depression, and education and depression, the hypothesis was not supported. A similar pattern was found in the case of coping traits. A multivariate logistic regression showed that low education (OR = 4.29), severe depression (OR = 1.84), and low self-regulating coping traits (OR = 2.19) were independent risk factors for smoking. The relationship between education and smoking cannot be explained by these individual variables.     

Interactions between genotype and retrospective ADHD symptoms predict lifetime smoking risk in a sample of young adults.

Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with an increased risk of smoking, and genetic studies have identified similar candidate genes associated with both ADHD and smoking phenotypes. This paper addresses the question of whether ADHD symptoms interact with candidate gene variation to predict smoking risk. Participants were a subsample of individuals from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of adolescents followed from 1995 to 2002. The sample analyzed included a subset from Add Health of 1,900 unrelated individuals with genotype data. Multiple logistic regression was used to examine relationships between self-reported ADHD symptoms, genotype, and lifetime history of regular smoking. Polymorphisms in the DRD2 gene and, among females, the MAOA gene interacted with retrospective reports of ADHD symptoms in contributing to risk for smoking. Trends were observed for interactions between the DRD4 gene and, among males, the MAOA gene and ADHD symptoms to predict smoking risk. No main effect for any of these polymorphisms was observed. We observed neither main effects nor interactions with CYP2A6, DAT, and SLC6A4 genes. These findings suggest that genotypes associated with catecholamine neurotransmission interact with ADHD symptoms to contribute to smoking risk.     

Ad lib smoking in post-traumatic stress disorder: an electronic diary study

Using ambulatory methods for 1 week of monitoring, this study investigated the association between smoking and situational cues in 22 smokers with post-traumatic stress disorder (PTSD) and 23 smokers without PTSD. Generalized estimating equations contrasted 1,759 smoking and 1,088 nonsmoking situations by group status controlling for multiple covariates. PTSD smokers reported higher stress and PTSD symptoms across daily activities. For all smokers, higher nicotine dependence, craving, food and caffeine consumption, and being outside were related to smoking. PTSD smokers were more likely to smoke when experiencing PTSD symptoms, anxiety, and stress. Following smoking, smokers with PTSD reported a significant reduction in negative affect. These results are consistent with previous ambulatory findings regarding mood in smokers, and underscore that in smokers with PTSD, PTSD symptom variables as well as stress and anxiety are significantly associated with ad lib smoking.     

The reinforcing effects of nicotine and stimulant medication in the everyday lives of adult smokers with ADHD: A preliminary examination.

Whereas the smoking prevalence rates in the general population are declining, rates among people diagnosed with attention-deficit/hyperactivity disorder (ADHD) continue to be elevated. Previous research has shown that nicotine may improve attention and mood, suggesting that nicotine may help ameliorate the attentional and emotional problems associated with ADHD. The present study examined the effects of nicotine with and without stimulant medication on ADHD symptoms, moods, and arousal in the everyday lives of smokers with ADHD. A total of 10 smokers with ADHD who were being treated with stimulant medication were asked to abstain from smoking while participating in the study. Participants underwent four conditions in randomized order: (a) Nicotine patch+stimulant medication, (b) nicotine patch only, (c) placebo patch+stimulant medication, and (d) placebo patch only. Each condition continued for 2 days, during which self-reports of ADHD symptoms and moods were obtained using electronic diaries. Lightweight ambulatory monitors recorded cardiovascular activity at each diary entry. Smoking abstinence was verified by expired carbon monoxide and salivary cotinine analysis. Results showed that nicotine patches and stimulant medication alone and in combination reduced difficulty concentrating and core ADHD symptoms compared with placebo patch only. Borderline improvement in impatience and self-control was seen with nicotine patch administration primarily on day 1. Nicotine patches also tended to elevate systolic and diastolic blood pressure compared with placebo patch during day 2. The findings suggest that smokers with ADHD experience nicotine-related reductions in ADHD symptoms during their everyday lives.     

Smokeless Tobacco Use and Its Relation to Panic Disorder, Major Depression, and Posttraumatic Stress Disorder in American Indians

INTRODUCTION: Rates of nicotine use are high in American Indians. Anxiety and depression tend to be associated with cigarette use, but the association of anxiety and depression with smokeless tobacco (ST) is less clear. We asked if panic disorder, major depression, and posttraumatic stress disorder (PTSD) are related to lifetime ST use in 2 American Indian tribes. METHODS: Logistic regression analyses examined the association between lifetime panic disorder, major depression, and PTSD and the odds of lifetime ST use status after controlling for sociodemographic characteristics, smoking status, and alcohol use disorders in 1,506 Northern Plains and 1,268 Southwest tribal members. RESULTS: Odds of lifetime ST use was 1.6 times higher in Northern Plains tribal members with a lifetime history of PTSD after controlling for sociodemographic variables and smoking (95% CI: 1.1, 2.3; p = .01). This association remained significant after further adjustment for panic disorder and major depression (odds ratio [OR] = 1.5; 95% CI: 1.0, 2.2; p = .04) but was diminished after accounting for alcohol use (OR = 1.3; 95% CI: 0.9, 1.9; p = .23). In the Southwest, lifetime psychiatric disorders were not associated with lifetime ST use status. Increasing psychiatric comorbidity was significantly linked to increased odds of ST use in both tribes. Conclusions: This study is the first to examine psychiatric conditions and lifetime ST use in a large, geographically diverse American Indian community sample. Although approximately 30% of tribal members were lifetime users of ST, the association with lifetime psychiatric disorders was not as strong as those observed with cigarette smoking. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation.     

Long-term changes in sleep and depressive symptoms of smokers in abstinence.

Few studies have evaluated the impact of smoking cessation on objective measures of sleep. The present study assessed the long-term effects of tobacco smoking abstinence on sleep and depression. A total of 15 chronic smokers with Hamilton Rating Scale for Depression (HAM-D) scores of less than 9 were evaluated. Subjects were screened for baseline data when they were smoking chronically. They underwent a 5-week psychological treatment for tobacco smoking, after which their depressive symptoms and sleep architecture were evaluated at 1, 2, 4, 6, 9, and 12 months of abstinence. We report the results of the seven patients who completed 1 year of evaluations and of those patients who achieved only partial abstinence. Polysomnographic recordings were taken, level of depression was measured with the HAM-D, and urinary cotinine levels also were evaluated. HAM-D scores were analyzed with and without sleep items. Nicotine abstinence reduced latency to rapid eye movement (REM) sleep and increased HAM-D scores, suggesting that chronic smokers have depressive symptoms that may be controlled by nicotine administration.     

湖北烤烟感官质量状况及与其它质量的关系分析

对湖北烟区烤烟感官质量状况进行了综合评价,并分析了感官质量与外观质量、物理特性和化学成分的关系。结果表明,湖北烟区烤烟感官质量较好,评吸总分以中部叶>上部叶>下部叶;感官质量指数与评吸总分表现一致,中部叶最高(0.90),上部叶次之(0.88),下部叶较低(0.86);感官质量得分最高的一类烤烟外观质量亦最好,在一定范围内,糖、总氮和烟碱含量相对较高;烤烟的厚度和拉力在第3类中最小,叶面密度居中,含梗率和单叶重最高。     

Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature

Recent studies suggest a possible comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and obesity. To gain insight into this potential association, we performed a systematic review of the literature excluding case reports, non-empirical studies, and studies not using ADHD diagnostic criteria. Empirically based evidence suggests that obese patients referred to obesity clinics may present with higher than expected prevalence of ADHD. Moreover, all reviewed studies indicate that subjects with ADHD are heavier than expected. However, data on the prevalence of obesity in subjects with ADHD are still limited. As for the mechanisms underlying the potential association between ADHD and obesity, ADHD might lead to obesity via abnormal eating behaviors, impulsivity associated with binge eating might contribute to ADHD in obese patients, or, alternatively, both obesity and ADHD might be the expression of common underlying neurobiological dysfunctions, at least in a subset of subjects. In patients with obesity and ADHD, both conditions might benefit from common therapeutic strategies. Further empirically based studies are needed to understand the potential comorbidity between obesity and ADHD, as well as the possible mechanisms underlying this association. This might allow a more appropriate clinical management and, ultimately, a better quality of life for patients with both obesity and ADHD.     

Anxiety sensitivity and perceived control over anxiety-related events: associations with smoking outcome expectancies and perceived cessation barriers among daily smokers.

The present investigation examined the extent to which the cognitive factors of anxiety sensitivity (AS) and perceived control over anxiety-related events are independently related to smoking outcome expectancies and perceived barriers to quitting. Participants were 125 community-recruited adult, daily smokers. Consistent with hypotheses, AS and perceived control over anxiety-related events independently and significantly predicted smokers' expectancies for negative affect reduction from smoking, whereas only AS predicted expectancies for negative personal consequences from smoking. Also as hypothesized, AS and perceived control over anxiety-related events each independently and significantly predicted level of general perceived barriers to quitting smoking. All of the observed significant effects were evident above and beyond the variance accounted for by gender, alcohol consumption, number of cigarettes smoked per day, and negative affectivity. Together, these findings further the literature on the relation between anxiety-relevant cognitive factors and psychological smoking processes.     

Effect of nicotine on 35% CO2-induced anxiety: A study in healthy volunteers.

Panic disorder and cigarette smoking co-occur at a rate that exceeds what would be expected by chance. Theoretically, cigarette smoking may (a) attenuate panicky symptoms via cognitive factors or pharmacological action, (b) contribute to the development of panic disorder, or (c) share an etiological vulnerability with panic. The present study was aimed at testing whether nicotine has a direct influence on laboratory-elicited panic. In a placebo-controlled, double-blind, randomized, cross-over study, 33 healthy nonsmokers underwent a 35% CO2 challenge after transdermal administration of a nicotine patch on one test day and a placebo patch on another test day. Physiological measures (blood pressure, heart rate) and rating scale scores (Panic Symptom List [PSL], Visual Analog Scale of Anxiety, State-Trait Anxiety Inventory) were assessed. Compared with the placebo condition, nicotine increased diastolic blood pressure (p < .1), heart rate (p < .001), and PSL scores (p < .005) prior to the CO2 challenge but did not affect responding to the CO2 challenge itself. Results are consistent with the notion that nicotine promotes autonomic activation. However, the present study did not provide direct evidence that nicotine elicits panic in healthy volunteers. Replication in a clinical sample is warranted.     

Impact of Posttraumatic Stress Disorder on early smoking lapse and relapse during a self-guided quit attempt among community-recruited daily smokers

The present investigation examined whether daily smokers with posttraumatic stress disorder (PTSD), as compared to daily smokers with either anxiety psychopathology or no current Axis I psychopathology, have decreased success in the early phases of a self-guided smoking quit attempt. Participants were 140 daily smokers (81 women; M (age) = 29.5; SD = 11.9; range = 18-65 years); approximately one-third of the sample met criteria for current PTSD (n = 47), one-third met criteria for other current anxiety disorders (without PTSD; n = 33), and one-third did not meet criteria for any current Axis I disorder (n = 60). Consistent with prediction, membership in the PTSD group, compared to membership in the other anxiety disorders group and the group with no current Axis I psychopathology, was associated with increased risk of lapse during the first week following quit day. Additionally, daily smokers with PTSD and other anxiety disorders were at significantly increased risk of relapse during the first week post-cessation compared to persons without Axis I psychopathology. However, the PTSD group and the other anxiety disorders group did not differ from one another in terms of relapse. Results suggest that PTSD is associated with increased risk of smoking lapse and relapse compared to smokers with no current Axis I psychiatric problems, and increased risk of early smoking lapse but not relapse, as compared to those with other anxiety disorders. Findings provide novel evidence that PTSD, and perhaps anxiety disorders more generally, may be important factors in reducing the odds of successful unaided quit attempts in the early phases of cessation.     

Hostility in smokers with past major depressive disorder: relation to smoking patterns, reasons for quitting, and cessation outcomes.

We examined trait hostility in 85 participants in a clinical trial of cessation treatment for smokers with a history of major depressive disorder. Consistent with hypotheses, trait hostility, as indexed by the Cook-Medley Hostility Scale, was associated with greater smoking in social situations, greater expectations of being evaluated negatively by others because of smoking, and stronger extrinsic social reasons for quitting. Greater hostility was associated with significantly lower odds of smoking abstinence after treatment. Hostility was not associated significantly with smoking to manage negative affect, nor did it predict change in negative mood during treatment. Results suggest hostility may play an important role in smoking motivation and cessation outcomes among smokers with past major depression.     

Mutual interaction effects between discomfort and cognitive task performance in clothing systems

The focus of this study was to establish a relationship between physical discomfort and performance. Eleven healthy male subjects participated in this pilot study. The subjects performed a 2-h protocol without and with significant thermal and mechanical discomfort. Various cognitive tasks were executed repeatedly during the protocol to evaluate cognitive performance on memory, tracking, and vigilance tasks. Prior and after each task, subjective comfort scores were asked and objective task performance was measured. Mechanical and/or thermal discomfort only minimally influenced the overall scores for comfort. The only significant change in objective performance was a 2% increase in percentage missed stimuli during thermal discomfort. The type of task did influence the change in comfort scores, increasing the scores during the attention and memory task and decreasing during the vigilance and tracking task and fine motor tasks. Surprisingly, not discomfort, but the type of task mainly influenced the changes in comfort, discomfort became worse (increased) during easy, less challenging tasks.     

Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th-grade Chinese adolescent smokers

This study addressed the question of whether poor decision making would be associated with adolescent past 7-day smoking. We conducted a cross-sectional study of 208 10th-grade adolescents in Chengdu City, China. We used the Iowa Gambling Task (IGT) to assess decision-making, and the Self-ordered Pointing Task (SOPT) to assess working memory capacity. Paper and pencil questionnaires assessed the school academic performance (SAP) and smoking variables. The results showed that a significantly higher proportion of past 7-day smokers (91.7%) were susceptible to future smoking and cigarette offers from best friends compared to other levels of smokers (never, ever and past 30-day smokers). Consistent with these behavioral data, the neuropsychological assessments revealed that relative to never smokers, past 7-day adolescent smokers (but not ever smokers or past 30-day smokers) demonstrated significantly lower scores on the IGT. Moreover, a higher proportion of past 7-day smokers (91.7%) performed poorly (no more than an overall net score of 10) on the IGT than nonsmokers and irregular (ever or past 30-day) smokers (about 65.3%). There were no differences on working memory performance for smokers (at any level) compared to never smokers after adjusting for school-type. In addition, logistic regression showed that the IGT significantly predicted past 7-day smoking after controlling for the working memory, school academic performance and demographic variables. These results suggest that poor affective decision making might predispose some adolescents to smoking in the future or in the social situations where their peers are smoking. Intervention targeting affective decision making might hold promise for reducing adolescents' risks for substance use.     

膳食干预改善轻度认知障碍患者认知能力的疗效观察

目的:研究膳食干预对轻度认知障碍患者认知能力的影响。方法:90例高胆固醇血症合并轻度认知功能障碍患者按照血胆固醇水平随机分为研究组和对照组,每组45例。研究组患者每日给予膳食干预并口服鱼油补充剂胶囊1000mg进行营养强化,对照组只给予膳食干预,试验周期为12w。两组分别于干预前和干预后测定两组患者的认知能力(用MoCA得分评定)和总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平。结果:两组受试者经膳食干预后血清TC、TG、LDL-C数值均下降,血清HDL-C水平升高,差异有统计学意义(P0.01),研究组受试者胆固醇数值低于对照组受试者胆固醇数值,差异有统计学意义(P0.01);对照组受试者MoCA得分降低,与之前得分相比差异无统计学意义,但在注意(P0.05)及延迟回忆(P0.01)方面得分降低,与之前得分相比差异有统计学意义;研究组受试者MoCA得分增加,与之前得分相比差异有统计学意义(P0.01),主要表现在抽象及延迟回忆方面得分增加,与之前得分相比差异有统计学意义(P0.01)。结论:个体化膳食干预可以降低轻度认知障碍患者的血胆固醇水平,进一步进行营养强化可以在降低血胆固醇的同时改善患者的认知水平。     

Carry-over effects of smoking cue exposure on working memory performance.

The present study investigated the effects of drug cue exposure on working memory performance in cigarette smokers. Adult smokers (N = 23) deprived for 12 hr performed a working memory task during which they were exposed to three types of task-irrelevant stimuli: Pictures containing smoking related-content, pictures devoid of smoking content, and a fixation cross. Consistent with prior research, we found that drug cue exposure affected the processing of subsequent items (i.e., carry-over effects). Specifically, we found that working memory performance was worse on trials containing neutral pictures preceded by trials containing smoking cues compared with performance on trials containing neutral pictures preceded by trials not containing smoking-related stimuli. Previously observed effects of smoking cue exposure on cognitive processing were replicated but only after removing trials subject to carry-over effects. These results replicate and extend previous research demonstrating similar effects and highlight the significant methodological and conceptual implications of carry-over effects.     

Association of post-treatment smoking change with future smoking and cessation efforts among adolescents with psychiatric comorbidity.

Little is known about how initial change following a smoking intervention relates to longer-term smoking outcomes among adolescent smokers with psychiatric comorbidity. The present study investigated this relationship among psychiatrically hospitalized adolescents (N = 183) who participated in a controlled trial comparing motivational interviewing to brief advice. Quit attempters (n = 37), reducers (n = 45), and maintainers (n = 101) were assembled based on, respectively, having made a quit attempt, having reduced smoking by at least 50%, and having reduced smoking by less than 50% in the first week after hospital discharge. Hierarchical linear models and generalized estimating equations were conducted to test group differences in average number of cigarettes per smoking day and odds of making a quit attempt during subsequent weeks of a 12-month continuous follow-up, and in cotinine-verified abstinence rates at 1, 6, and 12 months posthospitalization. Baseline smoking levels and presence of a substance use disorder or anxiety disorder were predictive of outcomes. After controlling for covariates, we found that quit attempters smoked less during follow-up than did the other change groups and that reducers smoked less than maintainers. Quit attempters evidenced a higher percentage of quit attempts during follow-up than did the other change groups. Reducers had a greater average percentage of quit attempts during follow-up than did maintainers. However, groups did not differ on cotinine-verified abstinence rates across the follow-up period. Findings have implications for initial post-treatment change as it relates to subsequent smoking and cessation outcomes among adolescent smokers at especially high risk for smoking persistence.     

Food intake and academic performance among adolescents

Purpose: Prince Edward Island adolescents' food use was examined, as were possible associations between food use and grade, sex, and academic performance. Methods: Participants (n=325) were purposively selected from four junior high schools. Dietary data were collected using an adaptation of the 2003 Youth Risk Behavior Survey. Demographic information and self-reported academic performance were also assessed. Vegetable and fruit (VF) and milk scores were created, and multivariate analysis was performed to identify which combination of grade, sex, VF score, and milk score predicted academic performance best. Results: Mean daily intakes of VF (4.3 +/- 2.9 servings) and milk (1.7 +/- 1.4 servings) were below recommended levels. Students with higher academic performance (average grades above 90%) were more likely to consume milk, vegetables, and fruit daily than were those who reported lower grades. There was no significant difference in the proportion of adequate milk intakes between students reporting higher and lower academic performance. Conclusions: The association between VF intake and academic performance supports the need for further research with a larger, more representative sample.     

Severity of nicotine dependence moderates performance on perceptual-motor tests of attention.

Acute abstinence from cigarette smoking by nicotine-dependent smokers has been linked with cognitive deficits, but the role of nicotine dependence per se in these effects is not known. We therefore tested the relationships of nicotine dependence and smoking history with performance in perceptual-motor, timed tests of attention. Nicotine-dependent smokers (n = 37) and nonsmokers (n = 48), 18-55 years old, took both the d2 Test of Attention and the Digit Symbol Test on each of 2 test days. For smokers, testing on one day began after ad libitum smoking (<45 min since last cigarette); and on the other day, it began after overnight abstinence (>13 hr since last cigarette). On each test day, there were two test blocks with an intervening break, when only the smokers each smoked one cigarette. There were no significant effects of abstinence or of smoking one cigarette on the performance of smokers; however, across conditions, the smokers' performance on both tests correlated negatively with severity of nicotine dependence but not lifetime cigarette consumption or cigarette craving. Smokers with high nicotine dependence performed more slowly on both tests than less dependent smokers or nonsmokers. The findings suggest that severity of nicotine dependence and slowness in perceptual-motor tasks of attention share an underlying basis.