Race differences in nicotine dependence in the Collaborative Genetic study of Nicotine Dependence (COGEND)

In a general population sample from the Detroit site of the Collaborative Genetic Study of Nicotine Dependence (COGEND), we tested Black-White differences in nicotine dependence, measured by "how soon after wake-up the smokers smoked their first cigarette (time to first cigarette TTFC)", and its relationship with number of cigarettes per day (CPD). Analysis was conducted on respondents who have smoked > or =100 cigarettes in lifetime and were current smokers (n = 1,442; 1,087 Whites and 355 Blacks). In univariate analysis, we found no significant race differences on time to first cigarette (chi2 = 2.9, p value = 0.41), but significant race differences on CPD (chi2 = 154.3, p<.01), both categorized by the Fagerstr?m Test of Nicotine Dependence (FTND) cutoffs. We estimated the probability of TTFC < or =30 min given CPD using probit models. The interactions between race and CPD indicated significant differences in dependence at various levels of CPD. The same probability of nicotine dependence was associated with smaller increments in CPD for Blacks than for Whites. The data support the hypothesis that the relationship between CPD and nicotine dependence as reflected in relapse varies by race, and that Black smokers are dependent at lower levels of CPD than Whites.     

Ethnic differences among adolescents seeking smoking cessation treatment: a structural analysis of responses on the Fagerstr?m Test for Nicotine Dependence.

Features of tobacco dependence vary by ethnicity, which could be partially due to measurement bias inherent in instruments that assess nicotine dependence. This study compared responses on the Fagerstr?m Test for Nicotine Dependence (FTND) by African American adolescents (n = 478) with those of White adolescents (n = 661) seeking smoking cessation treatment. We conducted item-by-item comparisons by ethnicity for the six questions composing the FTND and confirmatory factor analyses and multiple indicators-multiple causes (MIMIC) modeling to test the hypothesis of measurement invariance of the FTND by ethnicity. Study participants (N = 1,139) were daily smokers of average age 15.4 years (SD = 1.3); 42.0% were African American and 61.5% female. White adolescents' pattern of responses to the FTND indicated a greater degree of dependence; these differences were statistically significant for five of the six items. The FTND exhibited a unidimensional structure with similar factor loadings in both White and African American adolescents. However, MIMIC modeling indicated differential reporting for three out of six items, suggesting that the FTND may not measure nicotine dependence equivalently for White and African American youth.     

A comparison of the Hooked on Nicotine Checklist and the Fagerstr?m Test for Nicotine Dependence in adult smokers.

Diminished autonomy is a core feature common to all forms of dependence involving drugs or behaviors. The Hooked on Nicotine Checklist (HONC) is a reliable and valid measure of diminished autonomy over tobacco. It has not previously been compared with the Fagerstr?m Test for Nicotine Dependence (FTND) in adult smokers. In the present study, 1,130 smokers (M age = 41; M cigs/day = 18.5) completed both measures. Factor analysis yielded one factor for both the HONC and the FTND. Mean HONC score was 7.0, and mean FTND score was 4.6; the measures correlated at r = .44. The HONC had higher internal consistency (alpha = .82) than the FTND (alpha = .61; z(1127) = 7.1, p < .001). The measures correlated similarly with age at smoking onset and days smoked per month, but the FTND correlated higher with cigarette consumption. Subjects who used nicotine replacement therapy or bupropion during an abstinence attempt scored higher on both measures, whereas those who maintained abstinence for at least 3 days scored lower. The HONC has several advantages: (a) It measures a clearly defined construct, and each item has face validity; and it has (b) better psychometric properties, (c) a logical cutpoint (zero symptoms), (d) greater sensitivity to the onset and low levels of dependence, and (e) easily interpretable scores. The HONC is uniquely suited for use with smokers whose cigarette consumption is low.     

Cotinine levels in relation to smoking behavior and addiction in young adolescent smokers.

The goal of this study was to identify associations among self-reported nicotine exposure, nicotine addiction, and actual nicotine intake as measured by salivary cotinine levels in adolescent smokers. A total of 170 adolescent smokers with a mean age of 15 years were recruited from seven northern Californian public high schools. Data were collected on smoking behaviors, addiction, craving, and withdrawal. Nicotine dependence was assessed using a modified teen Fagerstr?m Tolerance Questionnaire (mtFTQ), a modified Nicotine Dependence Syndrome Scale (mNDSS), and a simple self-rating. Withdrawal was assessed using the Minnesota Withdrawal Questionnaire, and craving was assessed using a survey created by the authors. Salivary cotinine levels were collected from and analysed in participants who self-identified as smokers; data from the 54 participants who smoked in the past 4 days and whose salivary cotinine levels were greater than 0.1 ng/ml were used in the analysis. Among this group of adolescent smokers, the mean number of cigarettes smoked per day was 3.51 (SD = 3.44) and the mean level of salivary cotinine was 44.1 ng/ml (Mdn = 24.2). Even at this low level of nicotine exposure, cotinine was highly correlated with measures of nicotine dependence such as the mtFTQ (r = 0.497, p = .001), NDSS (r = 0.439, p = .002), timing of craving in the morning (r = -0.601, p = .000), and self-rated addiction (r = 0.562, p = .000). Most interesting, cotinine levels reached a plateau at around 4-5 cigarettes/day.     

DRD2/ANKK1 TaqI polymorphism and smoking behavior of Egyptian male cigarette smokers.

Little is known about the genetic contribution to cigarette smoking and nicotine addiction in Egypt. The dopamine D2 receptor gene contains a TaqI repeat fragment length polymorphism creating two alleles with functional significance, DRD2*A1 and DRD2*A2. We investigated the relationship between these alleles and tobacco use in a study of 389 Egyptian male current smokers (mean age = 40 years; SD = 12). Participants were interviewed in 2004 on their smoking behaviors and quit attempts, and were given the Fagerstr?m Test for Nicotine Dependence (FTND). Blood samples were obtained and genotyped for DRD2 A1and A2 alleles. The frequencies of A1/A2, A1/A2, and A2/A2 genotypes were 6%, 29%, and 65%, respectively. We found no statistically significant association between genotype and age at onset of smoking, years of smoking, FTND score, or average number of cigarettes smoked per day. DRD2 genotype was associated with the number of cigarettes smoked in the past 48 hr (42.2 in A1 carriers vs. 37.6 in A2, p = .03), the previous quit duration (28% in A1 vs. 40% in A2 quit for more than 1 month, p = .05), and the depth of inhalation (82% in A1 vs. 72% in A2 inhaled the smoke deeply, p = .03). Logistic regression analysis including DRD2 genotype, FTND score, age at smoking initiation, marital status, and education as predictors showed that maximum duration of quit time was associated with FTND score (p = .003), DRD2 genotype (p = .01), marital status (p = .03), and age at smoking initiation (p = .04). These findings suggest a modest association between DRD2 genotype and quitting behavior in male cigarette smokers in Egypt.     

Gender effects of reported in utero tobacco exposure on smoking initiation, progression and nicotine dependence in adult offspring.

We examined the relationship between self-reported in utero tobacco exposure and gender on smoking initiation, progression of cigarette use (i.e., telescoping), and current levels of nicotine dependence in adult treatment-seeking smokers. Subjects (N = 298) who reported "yes" (28% of the original sample) or "no" (50% of the original sample) to in utero tobacco exposure were included in the analyses. Telescoping was calculated as the difference between the age respondents smoked their "first full cigarette" and the age when they started smoking daily. Females who reported being exposed in utero transitioned from initial to daily cigarette use more rapidly than females not exposed. The opposite effect was found for males, which may be related to our finding that in utero exposure lowered the age of cigarette experimentation in exposed compared with unexposed males. Measures of current cigarette use and dependence (i.e., Fagerstr?m Test for Nicotine Dependence, prior withdrawal, number of past year quit attempts) were significantly associated with reported in utero exposure, gender, or interactions of exposure and gender. In utero tobacco exposure may accelerate the progression from experimentation to daily use in girls, result in early tobacco experimentation among boys, and produce higher levels of nicotine dependence among adult smokers.     

Can cumulative tobacco consumption, FTND score, and carbon monoxide concentration in expired air be predictors of chronic obstructive pulmonary disease?

Between 15% and 20% of smokers develop chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine which characteristics of smoking, particularly the Fagerstr?m Test for Nicotine Dependence (FTND) score, were associated with the risk of developing COPD. Data from the IBERPOC epidemiological study were analyzed. IBERPOC was a multicenter epidemiological study including 4035 individuals aged 40-69 years, 1023 (25%) of whom were active smokers. We analyzed the association between smoking characteristics--such as the cumulative consumption of tobacco, FTND score, and expired-air carbon monoxide levels--and the diagnosis of COPD. Among the smokers, 153 (15%) were diagnosed with COPD. A cumulative tobacco consumption of more than 30 pack-years (OR=4.24, 95% CI=2.83-6.36) and the FTND score (OR=1.11, 95% CI=1.02-1.21, for each point increase) were significantly associated with the diagnosis of COPD in the model obtained by logistic regression analysis with the full sample of smokers. Cumulative consumption of tobacco was associated with the diagnosis of COPD. For each point increase in the FTND score, the probability of a smoker developing COPD increased by 11%.     

Peer and parental influences on longitudinal trajectories of smoking among African Americans and Puerto Ricans.

The purpose of this study was to identify distinct trajectories of smoking behavior during a period extending from adolescence (mean age = 14 years) to young adulthood (mean age = 26 years) among African American and Puerto Rican adolescents/young adults, to examine ethnic and gender differences in group membership, and to assess the ability of peer and parental smoking to distinguish among trajectory groups. A community-based sample of 451 African American and Puerto Rican adolescents was interviewed four times during adolescence and in early adulthood, covering a span of 12 years. For both ethnic/racial groups, four distinct trajectories were identified: Nonsmokers, maturing-out smokers, late-starting smokers, and early-starting continuous smokers. Compared with Puerto Ricans, African Americans were over-represented in the nonsmoking group, whereas Puerto Ricans were over-represented in the early-starting continuous group. Females were more likely than males to be early-starting continuous smokers than late starters. Adolescents who were exposed to peer and parental smoking in early adolescence were more likely to belong to trajectory groups characterized by higher levels of smoking. These findings show that exposure to peer and parental smoking in early adolescence constitutes a risk factor for engaging in elevated levels of smoking behavior at an early age and for continued smoking into adulthood for urban African Americans and Puerto Ricans. To be most effective, smoking prevention programs should address peer group and family influences on adolescent smoking.     

Developmental trajectories of cigarette smoking from adolescence to the early thirties: personality and behavioral risk factors

The purpose of this study was to identify distinct trajectories of cigarette smoking from ages 14 to 32, and to examine adolescent personality factors that distinguish trajectories of smoking behavior. Participants (N = 975) were randomly selected and followed prospectively since 1975. Follow-up data on cigarette use and personality and behavioral attributes were collected at five points in time, using structured interviews given in private by trained interviewers. Of these subjects, 746 comprised the cohort used in this study. Growth mixture modeling identified five smoking trajectory groups: nonsmokers, occasional smokers, late starters, quitters, and heavy/continuous smokers. Adolescent personality and behavioral risk factors such as lower ego integration, more externalizing behavior, and lower educational aspirations distinguished the trajectory groups. No gender differences were noted. The findings supported the hypotheses indicating multiple distinct trajectory groups of smoking behavior. Smoking behavior appeared in early adolescence and most often continued into adulthood. Emotional difficulties (i.e., lower ego integration), externalizing behavior, and lower educational aspirations in early adolescence were associated both with smoking at an early age and with continuing to smoke into the thirties. To be more effective, smoking prevention programs should target personality and behavioral variations before smoking becomes habitual, particularly focused on characteristics reflecting behavioral problems as manifested in emotional difficulties, externalizing behavior, and low educational aspirations in early adolescence. The implications for research, prevention, and treatment are discussed.     

Assessing dimensions of nicotine dependence: an evaluation of the Nicotine Dependence Syndrome Scale (NDSS) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM)

Considerable research, ranging from survey to clinical to genetic, has utilized traditional measures of tobacco dependence, such as the Fagerstrom Test of Nicotine Dependence (FTND) and the Diagnostic and Statistical Manual (4th ed.) (DSM-IV) criteria, that focus on endpoint definitions of tobacco dependence such as heavy smoking, time to first cigarette in the morning, and smoking despite consequences. In an effort to better understand possible theories and mechanisms underlying tobacco dependence, which could be used to improve treatment and research, two multidimensional measures of tobacco dependence have been developed: the Nicotine Dependence Syndrome Scale (NDSS) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). This research used data from three randomized smoking cessation trials to examine the internal consistency and validity (convergent, concurrent and predictive) of these scales, relative to each other and the traditional measures. Results reveal that NDSS and WISDM subscales are related to important dependence criteria, but in a heterogeneous fashion. The data suggest that there are important underlying mechanisms or motives that are significantly related to different important outcomes, such as withdrawal and cessation. The FTND was most strongly related to abstinence at 1 week and 6 months post-quit, whereas the WISDM Tolerance subscale was most strongly related to abstinence at the end of treatment. The NDSS Priority subscale was consistently predictive of outcome at all three follow-up time points. There is also evidence that WISDM subscales are related to a biomarker of the rate of nicotine metabolism.     

The relationship between cigarette use, nicotine dependence, and craving in laboratory volunteers.

Data from epidemiological studies suggest that individual differences in cigarettes per day (CPD) and duration of smoking account for only a small portion of the variance in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) nicotine dependence. However, DSM-IV may be an insensitive measure of nicotine dependence; other measures might better reflect the true nature of the relationship between use and dependence. This paper describes the relationship between cigarettes per day (CPD) and years smoking and the severity of nicotine dependence as measured by the Nicotine Dependence Syndrome Scale (NDSS). Furthermore, we assessed the validity of individual differences in nicotine dependence by determining whether they related to cue-evoked craving during abstinence. Data were pooled from five laboratory studies of 489 regular (i.e., 15+ CPD) smokers. In contrast to previously reported data demonstrating a relatively strong relationship between CPD and dependence in chippers (Shiffman & Sayette, 2005), CPD and years smoking accounted for a statistically significant, but small (<6%), portion of the variance in nicotine dependence in daily smokers. Individual differences in both CPD and years smoking had little or no relationship with craving. However, the magnitude of craving was significantly related to the degree of nicotine dependence even after controlling for use variables and excluding craving-related items on the NDSS. These data suggest that among moderate to heavy daily smokers, meaningful individual differences in nicotine dependence are observed independent of differences in current daily cigarette consumption and duration of smoking. Further research into the sources of this variance is critical to understanding the process of and risk for nicotine dependence.     

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.     

Higher nicotine and carbon monoxide levels in menthol cigarette smokers with and without schizophrenia.

This study examined whether smoking menthol cigarettes was associated with increased biochemical measures of smoke intake. Expired carbon monoxide (CO) and serum nicotine and cotinine were measured in 89 smokers with schizophrenia and 53 control smokers immediately after smoking an afternoon cigarette. Serum nicotine levels (27 vs. 22 ng/ml, p = .010), serum cotinine levels (294 vs. 240 ng/ml, p = .041), and expired CO (25 vs. 21 ppm, p = .029) were higher in smokers of menthol compared with nonmenthol cigarettes, with no differences in 3-hydroxycotinine/cotinine ratios between groups when controlling for race. Backward stepwise linear regression models showed that, in addition to having a diagnosis of schizophrenia, smoking menthol cigarettes was a significant predictor of nicotine and cotinine levels. Individuals with schizophrenia or schizoaffective disorder smoked more generic or discount value brands (Basic, Doral, Monarch, USA, Wave, others) compared with control smokers (28% vs. 6%, p = .002) but did not smoke more brands with high nicotine delivery as estimated by the U.S. Federal Trade Commission method. Although rates of mentholated cigarette smoking were not higher in smokers with schizophrenia overall, they were significantly higher in non-Hispanic White people with schizophrenia compared with controls of the same ethnic/racial subgroup (51% vs. 28%, p<.0001). The higher exhaled CO in menthol smokers suggests that the higher nicotine levels are at least partly related to increased intake of smoke from menthol cigarettes, although menthol-mediated inhibition of nicotine metabolism also may be a factor. Menthol is an important cigarette additive that may help explain why some groups have lower quit rates and more smoking-caused disease.     

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerstrom Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.


     

What fraction of young adults are at risk for future smoking, and who are they?

Recent evidence indicates that higher smoking rates among young adults in the United States may be related in part to increased initiation during young adulthood. The tobacco industry, restricted from overtly targeting adolescents, appears to be focusing on young adults. Thus it is important to estimate the percentage and identify the characteristics of the young adult population (aged 18-29 years) at risk for future smoking. This group would include all current established smokers (smoked at least 100 cigarettes in their lifetime), current experimenters, former established smokers, and former experimenters at risk for smoking again, as well as never-smokers who do not rule out future smoking. Using data from the population-based 2002 California Tobacco Survey (N = 9,364 young adults aged 18-29 years), we designated groups of young adults at risk and identified factors associated with risk. Altogether, 86.7+/-1.5% of current and former established smokers were at risk for future smoking, and 59.6+/-4.3% of former established smokers were at risk. Over half (52.2+/-2.0%) of all experimenters but only 9.0+/-1.2% of never-smokers were at risk. Overall, 43.0+/-1.2% of the young adult population was at risk. Although different demographic and other factors were associated with risk among former established smokers, experimenters, and never-smokers, three factors were consistently associated in each group: Younger age, not having a smoke-free home, and going to bars and clubs. We conclude that the group of young adults at risk for future smoking is sizable and presents a fertile target for tobacco industry efforts to promote smoking. Counter-efforts might include promotion of smoke-free environments.     

Sex-based and hormonal contraception effects on the metabolism of nicotine among adolescent tobacco-dependent smokers.

Variations in nicotine metabolism influence smoking patterns. Differences between sexes or related to sex hormones may affect nicotine metabolism. Because smoking initiation starts during adolescence, observations gathered from adolescent smokers might broaden our understanding of such sex-based differences. We tested the hypothesis that nicotine metabolism--as indexed primarily by the ratio of trans-3'-hydroxycotinine (3HC) to cotinine--is more rapid among adolescent girl smokers compared with boys and that regular use of hormonal contraceptives influences nicotine and cotinine metabolism. We also hypothesized that more rapid nicotine metabolism is associated with higher nicotine dependence as indexed by smoking frequency and morning urgency. Plasma samples of nicotine, cotinine, and 3HC concentrations were obtained from 120 adolescents (36 boys). Plasma nicotine and cotinine concentrations were similar in boys and girls. Median plasma 3HC concentrations were 44.45 ng/ml for girls versus 35.74 ng/ml for boys (p = .025), and median plasma 3HC-cotinine ratios were significantly higher in girls than in boys (0.317 vs. 0.253, p = .025). After stratifying girls into two groups based on use versus nonuse of hormonal contraception, plasma 3HC-cotinine ratios in girls using hormonal contraception (0.47) were substantially higher (p<.0001) than in boys (0.25) and were significantly higher than in girls not using hormonal contraception (0.28). Controlling for cigarettes smoked per day, ethnicity, and age did not modify these results. Although plasma nicotine, cotinine, or 3HC concentrations were significantly lower in less dependent adolescent smokers, nicotine and cotinine metabolite ratios were similar. This study showed that hormonal contraception in adolescent girls may accelerate cotinine metabolism, an effect likely related to induction of cytochrome P450 2A6 and independent of ethnicity and cigarette consumption. Prospective controlled studies are needed to further evaluate the role of hormonal contraception in patterns of adolescent smoking and nicotine metabolism.     

Tobacco craving predicts lapse to smoking among adolescent smokers in cessation treatment.

Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean age = 14.9 years [SD = 1.3]; mean cigarettes/day = 18.0 [SD = 7.6]; mean Fagerstr?m Test for Nicotine Dependence score = 6.8 [SD = 1.34]; 65% female), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p = .013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p<.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.     

Salivary cotinine concentration versus self-reported cigarette smoking: Three patterns of inconsistency in adolescence.

The present study examined the extent and sources of discrepancies between self-reported cigarette smoking and salivary cotinine concentration among adolescents. The data are from household interviews with a cohort of 1,024 adolescents from an urban school system. Histories of tobacco use in the last 7 days and saliva samples were obtained. Logistic regressions identified correlates of three inconsistent patterns: (a) Pattern 1-self-reported nonsmoking among adolescents with cotinine concentration above the 11.4 ng/mg cutpoint (n = 176), (b) Pattern 2-low cotinine concentration (below cutpoint) among adolescents reporting having smoked within the last 3 days (n = 155), and (c) Pattern 3-high cotinine concentration (above cutpoint) among adolescents reporting not having smoked within the last 3 days (n = 869). Rates of inconsistency were high among smokers defined by cotinine levels or self-reports (Pattern 1 = 49.1%; Pattern 2 = 42.0%). Controlling for other covariates, we found that reports of nonsmoking among those with high cotinine (Pattern 1) were associated with younger age, having few friends smoking, little recent exposure to smokers, and being interviewed by the same interviewer as the parent and on the same day. Low cotinine concentration among self-reported smokers (Pattern 2) was negatively associated with older age, being African American, number of cigarettes smoked, depth of inhalation, and exposure to passive smoke but positively associated with less recent smoking and depressive symptoms. High cotinine concentrations among self-reported nonsmokers was positively associated with exposure to passive smoke (Pattern 3). The data are consonant with laboratory findings regarding ethnic differences in nicotine metabolism rate. The inverse relationship of cotinine concentration with depressive symptoms has not previously been reported. Depressed adolescent smokers may take in smaller doses of nicotine than nondepressed smokers; alternatively, depressed adolescents may metabolize nicotine more rapidly.     

Effects of low nicotine content cigarettes on smoke intake.

Cigarettes with selective reductions in nicotine delivery have been considered as potential tools to prevent or treat nicotine dependence or to reduce harm by virtue of reduced nicotine and nitrosamine delivery. An important question is whether individuals smoke these products more intensively, as has been shown to occur with ventilated-filter cigarettes. To investigate this issue, we compared conventional highly ventilated filter cigarettes, having very low tar and nicotine yields when smoked by Federal Trade Commission method (1 mg tar, 2 mg carbon monoxide [CO],.2 mg nicotine), with low nicotine content cigarettes, manufactured from a genetically modified strain of tobacco, which had higher tar but lower nicotine yield (14 mg tar, 13 mg CO,.02 mg nicotine). A total of 16 cigarette smokers participated in two 8-hr sessions (order counterbalanced) during which they smoked each type of cigarette ad libitum. Expired-air CO, plasma nicotine, and smoking topography measures were collected. Subjects showed significant increases in smoking when using the highly ventilated filter cigarettes, and puff volume was significantly greater than with the low nicotine content cigarettes. Subjects achieved an expired-air CO level 74% as high as with the low nicotine content cigarettes; the latter produced CO levels similar to those measured at baseline when subjects smoked their habitual brands of cigarettes. Plasma nicotine levels obtained when subjects smoked the highly ventilated filter cigarettes also were significantly higher than when they smoked the low nicotine content cigarettes. These results indicate that the delivery of substantial amounts of smoke, with selective reductions in nicotine yield, appears to prevent compensatory smoking behavior. Further studies should determine whether similar results are obtained in naturalistic environments.     

Cigarettes, alcohol, and depression: characterizing head and neck cancer survivors in two systems of care.

Tobacco exposure is a key risk factor for head and neck cancer, and continued smoking after diagnosis negatively affects outcomes. The present study examined tobacco smoking, nicotine dependence, alcohol use, and depression in survivors of head and neck cancer. Subjects at least 6 months post-initial diagnosis of head and neck cancer (N=694) drawn from three VA otolaryngology clinics (n=309, VA patients) and a university-based otolaryngology clinic (n=385, non-VA patients) were administered questionnaires and standardized rating instruments for nicotine and alcohol dependence and for depression. Additional clinical information was extracted from chart reviews. Despite high rates of prior smoking, less than one-quarter of all subjects continued to smoke. After controlling for significant confounding variables, we found that VA patients were more likely to be current smokers (OR=1.9, 95% CI=1.3-3.0), but current VA smokers did not differ significantly from non-VA smokers on the Fagerstr?m Test for Nicotine Dependence criterion (p=.69). The VA patients were more likely to screen positive for problem drinking on the Alcohol Use Disorder Identification Test (OR=2.1, 95% CI=1.3-3.7). After adjusting for other variables, we found no statistical difference between the groups in depression scores on the Geriatric Depression Scale-Short Form. The study provides data on smoking, alcohol use, and depression in head and neck cancer survivors indicating that VA patients are at increased risk for continued smoking and problem drinking relative to non-VA patients. Head and neck cancer patients benefit from aggressive smoking cessation efforts by the VA, but many patients need specialized services that integrate smoking interventions with treatment of comorbid alcoholism.