A multimodal approach to assessing the impact of nicotine dependence, nicotine abstinence, and craving on negative affect in smokers.

We used multimodal measurement to evaluate whether (a) nicotine dependence is associated with baseline and postquit negative affect and craving, (b) smoking relapse is associated with greater negative affect and craving than abstinence, and (c) craving is associated with negative affect. Treatment-seeking smokers were randomly assigned to either a brief behaviorally based smoking-cessation treatment condition or to a delayed treatment control condition. Participants in the treatment condition attended four assessment sessions, 4–5 days prequit (baseline), 1–2 days postquit, 3–5 days postquit, and 10–14 days postquit, while controls attended four sessions spaced over the same intervals. Retrospective questionnaires were collected at the beginning of each session, and corrugator EMG and in-session ratings were collected during viewing of affective and cigarette-related slides. The multimodal measures indicated that more dependent smokers experienced greater negative affect and craving at baseline and postquit, regardless of abstinence status. The self-report measures indicated that both relapsed and abstinent smokers reported greater negative affect and craving than control smokers. Craving was associated with negative affect across measurement modalities. These results highlight the benefits of using multimodal measures to study the impact of nicotine dependence and withdrawal on negative affect and craving. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The acute effects of nicotine on positive and negative affect in adolescent smokers.

Although adolescent cigarette smoking remains a critical public health concern, little is known about the reinforcing mechanisms governing smoking in this vulnerable population. To assess predictions derived from both positive and negative reinforcement models of drug use, the authors measured the acute effects of nicotine, as administered via tobacco cigarettes, on both positive and negative affect in a group of 15- to 18-year-old smokers. A matched group of nonsmokers served as a comparison group. Findings revealed that whereas adolescents who smoked a cigarette experienced reductions in both positive and negative affect, the observed reductions in negative affect were moderated by nicotine content of the cigarette (high yield vs. denicotinized), level of nicotine dependence, level of baseline craving, and smoking expectancies pertinent to negative affect regulation. Nonsmokers experienced no change in affect over the 10-min assessment period, and no interaction effects were observed for positive affect. Overall, the findings conform to a negative reinforcement model of nicotine effects and strongly suggest that, even among young light smokers, nicotine dependence and resultant withdrawal symptomatology may serve as motivating factors governing smoking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute nicotine reinforcement, but not chronic tolerance, predicts withdrawal and relapse after quitting smoking.

Little research has examined the association of tobacco dependence with nicotine tolerance or reinforcement in a clinical sample. Smokers preparing to quit smoking participated in laboratory sessions to assess nicotine tolerance on subjective, cardiovascular, and performance measures and to assess nicotine reinforcement using a choice procedure. Participants were then provided with individual counseling (but no medication), made a quit attempt, and were followed for 1 year to determine clinical outcome, as determined by postquit withdrawal and days to relapse. Nicotine tolerance was unrelated to either withdrawal or relapse. However, acute nicotine reinforcement was significantly related to both greater withdrawal and faster relapse. Results challenge the common assumption that nicotine tolerance is closely related to dependence but suggest that nicotine reinforcement may have theoretical and clinical significance for dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Point process analyses of variations in smoking rate by setting, mood, gender, and dependence.

The immediate emotional and situational antecedents of ad-libitum smoking are still not well understood. We reanalyzed data from ecological momentary assessment using novel point process analyses to assess how craving, mood, and social setting influence smoking rate, as well as to assess the moderating effects of gender and nicotine dependence. Smokers (N = 304) recorded craving, mood, and social setting using electronic diaries when smoking and at random nonsmoking times over 16 days of smoking. Point process analysis, which makes use of the known random sampling scheme for momentary variables, examined main effects of setting and interactions with gender and dependence. Increased craving was associated with higher rates of smoking, particularly among women. Negative affect was not associated with smoking rate, even in interaction with arousal, but restlessness was associated with substantially higher smoking rates. Women's smoking tended to be less affected by negative affect. Nicotine dependence had little moderating effect on situational influences. Smoking rates were higher when smokers were alone or with others who were smoking, and smoking restrictions reduced smoking rates. However, the presence of others who are smoking undermined the effects of restrictions. The more sensitive point process analyses confirmed earlier findings, including the surprising conclusion that negative affect by itself was not related to smoking rates. Contrary to hypothesis, men's and not women's smoking was influenced by negative affect. Both smoking restrictions and the presence of others who are not smoking suppress smoking, but the presence of others who are not smoking undermines the effects of restrictions. Point process analyses of ecological momentary assessment data can bring out even small influences on smoking rate. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Nicotine dependence subtypes among adolescent smokers: Examining the occurrence, development and validity of distinct symptom profiles.

To increase understanding of the etiology and epidemiology of nicotine dependence among adolescent smokers, the present study examined the occurrence and development of distinct nicotine dependence symptom profiles in a sample of adolescent smokers. A total of 25 secondary schools throughout the Netherlands participated in a 1-year longitudinal study. Multiple dimensions of nicotine dependence were assessed, at two time points, among 641 adolescents (aged 14–17 years) who were classified as smokers. Results showed 4 distinct, yet stable, nicotine dependence subtypes that could be characterized by quantitative as well as qualitative differences. The symptom profiles were similar for males and females but differentially associated with previously identified correlates of nicotine dependence, namely parental smoking, peer smoking, and depressive mood. Finally, differential links of the 4 subtypes were found with regard to smoking uptake and cessation. The finding of qualitative different subgroups of adolescent smokers may have important implications for intervention efforts regarding nicotine dependence and smoking cessation. Such efforts may need to be tailored to the specific subgroups’ needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of nicotine on negative affect among more impulsive smokers.

In the present study, the authors tested the hypothesis that nicotine would provide greater relief from negative affect for more impulsive smokers than for less impulsive smokers. Euthymic adult smokers (N=70) participated in 2 laboratory sessions, during which they underwent a negative mood induction (music + autobiographical memory), then smoked either a nicotinized or de-nicotinized cigarette. Mixed-effects regression yielded a significant Impulsivity × Condition (nicotinized vs. de-nicotinized) × Time interaction. Simple effects analyses showed that heightened impulsivity predicted greater negative affect relief after smoking a nicotinized cigarette but not after smoking a de-nicotinized cigarette. These data suggest that nicotine may be a disproportionately powerful negative reinforcer for highly impulsive smokers, promoting higher levels of nicotine dependence and inhibiting smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do smokers know what we're talking about? The construct validity of nicotine dependence questionnaire measures.

Few studies have examined whether nicotine dependence self-report questionnaires can predict specific behaviors and symptoms at specific points in time. The present study used data from a randomized clinical trial (N = 608; M. E. Piper et al., 2007) to assess the construct validity of scales and items from 3 nicotine dependence measures: the Fagerstr?m Test for Nicotine Dependence (T. F. Heatherton, L. T. Kozlowski, R. C. Frecker & K.-O. Fagerstr?m, 1991), the Nicotine Dependence Syndrome Scale (S. Shiffman, A. J. Waters, & M. Hickcox, 2004), and the Wisconsin Inventory of Smoking Dependence Motives (M. E. Piper et al., 2004). Scales from these measures were used to predict participants' reports on real-time measures of withdrawal symptoms and smoking behavior and retrospective self-report questionnaires to assess convergent and discriminative validity. The nicotine dependence measures' scales and items generally predicted the real-time measures of similar constructs, but the percent of variance accounted for was low. The nicotine dependence measures did, however, show evidence of discriminative validity. Thus, this study provides modest support for the construct validity of these nicotine dependence scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Silver acetate interactions with nicotine and non-nicotine smoke components.

Oral topical silver-containing formulations were marketed in the 1970s and 1980s as smoking deterrents, based on the finding that when using such formulations, an unpleasant taste occurs upon smoking. This approach has not been widely adopted, however, in part because of a lack of efficacy data. The advent of new pharmacologic treatments for smoking cessation renews the possibility that such a taste aversion approach may be a useful adjunct to smoking cessation treatment. This study explored the basic mechanistic question of whether topical oral silver acetate solution interacts with nicotine as opposed to non-nicotine smoke constituents. We recruited 20 smoking volunteers to rate nicotine-containing or denicotinized cigarettes, as well as the Nicotrol nicotine vapor inhaler and sham (air) puffs. In two sessions, subjects rated the sensory and hedonic qualities of puffs after rinsing their mouths with either silver acetate solution or deionized water (placebo). Silver acetate relative to placebo solution substantially reduced liking and satisfaction ratings for the usual brand and denicotinized cigarettes; in contrast, for the nicotine inhaler these ratings were unaffected by the silver-based treatment. These results support the conclusion that silver acetate not only renders the taste of cigarette smoke less appealing, but also that the compound appears to interact selectively with non-nicotine smoke constituents. Moreover, these data suggest silver acetate would be compatible with buccal nicotine delivery systems (e.g., nicotine lozenge or gum). Combined use of taste aversion with nicotine replacement therapy could provide the smoker with additional assistance to resist relapse. Further exploration is warranted of the use of silver-based preparations as a short-term adjunct to smoking cessation treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smokers' expectancies for smoking versus nicotine.

This study compared smokers' expectancies for the full act of smoking with those for nicotine per se by means of a word association task. Smokers (N = 201) were randomized to receive instructions to complete either "Smoking makes one ____." or "Nicotine makes one ____." with as many words as possible within 30 s. Results indicated that smokers held similar expectancies for smoking and nicotine; however, negative consequences (e.g., health risks) were more associated with smoking than with nicotine, and addiction expectancies were more associated with nicotine than with smoking. These findings suggest that smokers have a more realistic conceptualization of nicotine's role in smoking than had been indicated from earlier surveys. These findings have important implications for both nicotine-based and behavioral interventions, as well as for experimental designs that rely upon the perceived manipulation of nicotine content. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine dependence, depression, and the moderating role of goal cognitions.

The authors examined the moderating role of goal cognitions in the process of nicotine dependence in young adult smokers. A college sample of 85 male and 78 female smokers completed measures of nicotine dependence and psychological distress. They also provided cognitive evaluations for goals related to smoking cessation on scales measuring self-efficacy, value, planning, self-reward, self-criticism, self-monitoring, social comparison, and positive and negative goal-based arousal. As has been previously established, depression had a direct and significant effect on nicotine dependence. Moreover, significant interactions between goal cognitions and depression provided evidence for the hypothesized moderating effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daily Processes in Stress and Smoking: Effects of Negative Events, Nicotine Dependence, and Gender.

The author used a multilevel daily process design to examine relations among daily negative events, perceived stress, smoking, and smoking urges. The moderating effects of gender and nicotine dependence were also explored. Fifty-one adult community-residing smokers recorded negative events, perceived stress, cigarette smoking, and urges to smoke 4 times daily for 14 days. Analyses of within-person relations showed that participants smoked more cigarettes and experienced more urges to smoke on occasions with higher numbers of negative events and higher levels of perceived stress. These relations were stronger for men than for women. Nicotine dependence did not interact with events or stress in predicting smoking or urges. These findings build on laboratory studies and cross-sectional surveys by showing that in naturalistic settings, occasions with negative events and perceived stress are associated with smoking and urges to smoke. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of night smoking, sleep disturbance, and their co-occurrence on smoking outcomes.

Recent evidence suggests that smoking during the night is an indicator of nicotine dependence and predicts smoking cessation failure. Night smokers are likely to experience disturbance to their sleep cycle when they wake to smoke, but we are not aware of the prevalence of night smokers' self-reported sleep disturbance. Because sleep disturbance also predicts smoking cessation failure, we examined how the pre-cessation risk factors of night smoking and sleep disturbance, and their co-occurrence, predict smoking cessation failure in a 6-week double-blind randomized controlled trial examining whether naltrexone augments the efficacy of the nicotine patch (O'Malley et al., 2006). Smokers (N = 385) completed the Pittsburgh Sleep Quality Index (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) and a single item of waking at night to smoke pre-cessation. Smoking status was determined at weeks 1, 6, 24, and 48 weeks after quitting. The two main findings were: (a) night smokers reported significantly greater sleep disturbance than nonnight smokers; and (b) smokers with co-occurring night smoking and sleep disturbance experienced significantly greater risk for smoking than smokers with neither risk factor. Results suggest that individuals who both wake during the night to smoke and report clinically-significant sleep disturbance represent a high-risk group of smokers. Future smoking cessation treatment might incorporate strategies related to managing these smokers' sleep habits and physiological dependence on nicotine in order to bolster their cessation outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Refining the tobacco dependence phenotype using the Wisconsin Inventory of Smoking Dependence Motives.

[Correction Notice: An erratum for this article was reported in Vol 118(2) of Journal of Abnormal Psychology (see record 2009-06385-018). In the article “Refining the Tobacco Dependence Phenotype Using the Wisconsin Inventory of Smoking Dependence Motives,” by Megan E. Piper, Daniel M. Bolt, Su-Young Kim, Sandra J. Japuntich, Stevens S. Smith, Jeff Niederdeppe, Dale S. Cannon, and Timothy B. Baker (Journal of Abnormal Psychology, 2008, Vol. 117, No. 4., pp. 747–761), the funding information was incomplete. The complete information is as follows: This research was conducted at the University of Wisconsin—Madison and was supported by Transdisciplinary Tobacco Use Research Center grants P50DA019706 from the National Institute on Drug Abuse and P50CA084724 from the National Cancer Institute. Stevens S. Smith was supported by National Cancer Institute grant 1R03CA126406, and Megan E. Piper was supported by an institutional Clinical and Translational Science Award (University of Wisconsin—Madison; KL2 Grant 1KL2RR025012-01).] The construct of tobacco dependence is important from both scientific and public health perspectives, but it is poorly understood. The current research integrates person-centered analyses (e.g., latent profile analysis) and variable-centered analyses (e.g., exploratory factor analysis) to clarify the latent structure of nicotine dependence and to guide distillation of the phenotype. Using data from 4 samples of smokers, latent profiles were derived using the Wisconsin Inventory of Smoking Dependence Motives subscale scores. Across all 4 samples, results revealed a unique latent profile that had relative elevations on 4 subscales (Automaticity, Craving, Loss of Control, and Tolerance). Variable-centered analyses supported the uniqueness of these 4 subscales as they constituted a distinct common factor and were the strongest predictors of relapse and other dependence criteria. Conversely, the remaining 9 motives carried little unique predictive validity regarding dependence. Applications of a factor mixture model further supported the presence of a unique class of smokers in relation to a common factor underlying the 4 subscales. The results suggest that a pattern of smoking that is heavy, pervasive, automatic, and relatively unresponive to instrumental contingencies is a necessary and sufficient condition for severe nicotine dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mood influences on acute smoking responses are independent of nicotine intake and dose expectancy.

Acute responses to smoking are influenced by nicotine and by nonpharmacological factors such as nicotine dose expectancy and sensory effects of smoke inhalation. Because negative mood increases smoking reinforcement, the authors examined whether these effects may be altered by mood context. Smokers (n=200) participated in 2 sessions, negative or positive mood induction, and were randomized to 1 of 5 groups. Four groups comprised the 2×2 balanced placebo design, varying actual (0.6 mg vs. 0.05 mg yield) and expected nicotine dose (expected nicotine vs. denicotinized [denic]) of cigarettes. A fifth group was a no-smoking control. Smoking, versus not smoking, attenuated negative affect, as well as withdrawal and craving. Negative mood increased smoking reinforcement. However, neither actual nor expected nicotine dose had much influence on these responses; even those smokers receiving and expecting a denic cigarette reported attenuated negative affect. A follow-up comparison suggested that the sensory effects of smoke inhalation, but not the simple motor effects of smoking behavior, were responsible. Thus, sensory effects of smoke inhalation had a greater influence on relieving negative affect than actual or expected nicotine intake. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Piper et al. (2008).

Reports an error in "Refining the tobacco dependence phenotype using the Wisconsin Inventory of Smoking Dependence Motives" by Megan E. Piper, Daniel M. Bolt, Su-Young Kim, Sandra J. Japuntich, Stevens S. Smith, Jeff Niederdeppe, Dale S. Cannon and Timothy B. Baker (Journal of Abnormal Psychology, 2008[Nov], Vol 117[4], 747-761). In the article “Refining the Tobacco Dependence Phenotype Using the Wisconsin Inventory of Smoking Dependence Motives,” by Megan E. Piper, Daniel M. Bolt, Su-Young Kim, Sandra J. Japuntich, Stevens S. Smith, Jeff Niederdeppe, Dale S. Cannon, and Timothy B. Baker (Journal of Abnormal Psychology, 2008, Vol. 117, No. 4., pp. 747–761), the funding information was incomplete. The complete information is as follows: This research was conducted at the University of Wisconsin—Madison and was supported by Transdisciplinary Tobacco Use Research Center grants P50DA019706 from the National Institute on Drug Abuse and P50CA084724 from the National Cancer Institute. Stevens S. Smith was supported by National Cancer Institute grant 1R03CA126406, and Megan E. Piper was supported by an institutional Clinical and Translational Science Award (University of Wisconsin—Madison; KL2 Grant 1KL2RR025012-01). (The following abstract of the original article appeared in record 2008-16252-003.) The construct of tobacco dependence is important from both scientific and public health perspectives, but it is poorly understood. The current research integrates person-centered analyses (e.g., latent profile analysis) and variable-centered analyses (e.g., exploratory factor analysis) to clarify the latent structure of nicotine dependence and to guide distillation of the phenotype. Using data from 4 samples of smokers, latent profiles were derived using the Wisconsin Inventory of Smoking Dependence Motives subscale scores. Across all 4 samples, results revealed a unique latent profile that had relative elevations on 4 subscales (Automaticity, Craving, Loss of Control, and Tolerance). Variable-centered analyses supported the uniqueness of these 4 subscales as they constituted a distinct common factor and were the strongest predictors of relapse and other dependence criteria. Conversely, the remaining 9 motives carried little unique predictive validity regarding dependence. Applications of a factor mixture model further supported the presence of a unique class of smokers in relation to a common factor underlying the 4 subscales. The results suggest that a pattern of smoking that is heavy, pervasive, automatic, and relatively unresponive to instrumental contingencies is a necessary and sufficient condition for severe nicotine dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of nicotine dose and nicotine dose expectancy on the cognitive and subjective effects of cigarette smoking.

This study investigated the independent and interactive effects of nicotine dose and nicotine dose expectancy on smoking outcomes using a 2 (given nicotine vs. placebo) × 2 (told nicotine vs. placebo) Balanced Placebo Design (BPD). Smokers (N = 148) completed the Rapid Visual Information Processing Task (RVIP) and measures of smoking urge, mood, and cigarette ratings (e.g., satisfying) after smoking a nicotine or placebo cigarette crossed with instructions that the cigarette contained either nicotine or no nicotine. Nicotine cigarettes (0.6 mg nicotine) produced better sustained attention performance than placebos as indicated by RVIP reaction time, hits, and sensitivity (A′). Nicotine cigarettes also produced better mood and greater rewarding subjective effects of the cigarettes on 11 of 11 dimensions compared to placebos. Nicotine instructions resulted in fewer RVIP false alarms, better mood, and greater rewarding subjective effects of the cigarettes on 9 of 11 dimensions compared to placebo instructions. Nicotine dose by nicotine dose expectancy interactions were also observed for urge and tension-anxiety, such that the dose expectancy manipulation produced differential effects only among those who smoked placebo cigarettes. In contrast a significant interaction for self-reported vigor-activity demonstrated that the dose expectancy manipulation produced effects only among those who smoked nicotine cigarettes. This study provides additional evidence that nicotine improves cognitive performance, and provides initial evidence that denicotinized cigarettes smoked under the guise that they contain nicotine influence cognitive performance, albeit with less robust effects than nicotine. These data may inform the development of expectancy-based interventions for tobacco dependence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Possible effects of smoke-free inpatient units on psychiatric diagnosis and treatment

BACKGROUND: The author undertook to review the effects of abstinence from smoking and how those effects might influence the diagnosis and treatment of psychiatric disorders when patients are required to temporarily refrain from smoking (e.g., on inpatient wards) or when patients decide to stop smoking permanently. METHOD: Computerized data bases and reference lists of existing articles were searched for prior publications from three areas: (1) the association of smoking and psychiatric disorders, (2) the effects of nicotine withdrawal, and (3) the role of nicotine in psychiatric disorders. RESULTS: Withdrawal-induced increases in anxiety, depression, insomnia, irritability, restlessness, and weight and decreases in heart rate could affect the ability to evaluate alcohol/drug withdrawal, anxiety disorders, etc. Withdrawal effects could mimic medication side effects or increase the blood levels of several psychiatric medications. Whether these effects occur frequently or are of clinical magnitude has not been tested in studies of psychiatric patients. CONCLUSION: Psychiatrists should consider the effects of abstinence from smoking when diagnosing and treating patients who enter smoke-free inpatient units or who stop smoking during outpatient treatment.     

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)     

Depressive thinking: Shifts in construct accessibility or in schematic mental models?

Alternative explanations for depression-related changes in thinking were examined. Forty-one depressed patients and 40 controls completed sentence stems involving social approval or personal achievement such as "If I could always be right then others would me." The view that depressive thinking primarily reflects a generalized increase in accessibility of negative constructs predicts patients will give more negative completions (e.g., "dislike"). Alternatively, depression could affect the interrelationships between constructs: Use in depression of schematic mental models implying closer dependence of personal worth-acceptance on success-approval predicts patients may give more positive completions (e.g., "like"). Results supported the latter prediction and suggest that depressive thinking reflects changes in high-level mental models used to interpret experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress and smoking in adolescence: A test of directional hypotheses.

The authors conducted a comparative test of the hypotheses that (a) stress is an etiological factor for smoking and (b) cigarette smoking causes increases in stress (A. C. Parrott, 1999). Participants were a sample of 1,364 adolescents, initially surveyed at mean age 12.4 years and followed at 3 yearly intervals. Measures of negative affect, negative life events, and cigarette smoking were obtained at all 4 assessments. Latent growth modeling showed negative affect was related to increase in smoking over time; there was no path from initial smoking to change in negative affect. Comparable results were found for negative life events, with no evidence for reverse causation. Results are discussed with respect to theoretical models of nicotine effects and implications for prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)