Waterpipe smoking and nicotine exposure: a review of the current evidence.

The waterpipe, also known as shisha, hookah, narghile, goza, and hubble bubble, has long been used for tobacco consumption in the Middle East, India, and parts of Asia, and more recently has been introduced into the smokeless tobacco market in western nations. We reviewed the published literature on waterpipe use to estimate daily nicotine exposure among adult waterpipe smokers. We identified six recent studies that measured the nicotine or cotinine levels associated with waterpipe smoking in four countries (Lebanon, Jordan, Kuwait, and India). Four of these studies directly measured nicotine or cotinine levels in human subjects. The remaining two studies used smoking machines to measure the nicotine yield in smoking condensate produced by the waterpipe. Meta-analysis of the human data indicated that daily use of the waterpipe produced a 24-hr urinary cotinine level of 0.785 microg/ml (95% CI = 0.578-0.991 microg/ml), a nicotine absorption rate equivalent to smoking 10 cigarettes/day (95% CI = 7-13 cigarettes/day). Even among subjects who were not daily waterpipe smokers, a single session of waterpipe use produced a urinary cotinine level that was equivalent to smoking two cigarettes in one day. Estimates of the nicotine produced by waterpipe use can vary because of burn temperature, type of tobacco, waterpipe design, individual smoking pattern, and duration of the waterpipe smoking habit. Our quantitative synthesis of the limited human data from four nations indicates that daily use of waterpipes produces nicotine absorption of a magnitude similar to that produced by daily cigarette use.     

Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples.

Despite evidence of increasing waterpipe tobacco smoking prevalence among U.S. young adults, little is known about the knowledge, attitudes, beliefs, and smoking patterns of waterpipe users in this population. To address this lack of knowledge, two convenience samples of U.S. waterpipe users were surveyed--one from a Richmond, Virginia, waterpipe café (n=101), the other from an Internet forum called HookahForum.com (n=100). Sixty percent reported first-time waterpipe use at or before age 18. Daily waterpipe use was reported by 19%, weekly use by 41%, and monthly use by 29%. Waterpipe use was more common during the weekend (75%) than during weekdays (43%). Forty-four percent reported spending >or=60 min smoking tobacco during a waterpipe session. The majority of waterpipe users owned a waterpipe (57%) and purchased it on the Internet (71%). Many waterpipe users smoked the sweetened and flavored tobacco (i.e., maassel), and fruit flavors were the most popular (54%). Past month use of cigarettes, tobacco products other than cigarettes or waterpipe, and alcohol was 54%, 33%, and 80% respectively, and 36% reported past-month marijuana use. Most waterpipe users were confident about their ability to quit (96%), but only a minority (32%) intended to quit. Most waterpipe users believed waterpipe tobacco smoking was less harmful and addictive than cigarettes. These results are from small convenience samples; more detailed study of a larger group of randomly sampled U.S. waterpipe tobacco smokers will be valuable in understanding this behavior and developing effective strategies to prevent it.     

Cigarette and waterpipe smoking among Lebanese adolescents, a cross-sectional study, 2003-2004.

Waterpipe or "argileh" is a form of smoking other than cigarettes that is currently spreading among people of all ages. The objective of the present study was to assess tobacco smoking practices (waterpipe and/or cigarette) among public and private adolescent school students in Beirut, Lebanon. A sample of 2,443 students selected from 10 private and 3 public schools with intermediate/secondary classes filled out a self-administered anonymous questionnaire that inquired about sociodemographic characteristics, and behavior about tobacco smoking. Binary analysis was performed as well as three regression models for the relationship between exclusive cigarettes smoking, exclusive waterpipe smoking and both cigarettes and waterpipe as the dependent variables and gender, type of school, and class as the independent variables. The current prevalence of cigarettes smoking was 11.4%, and that of waterpipe smoking was 29.6%. Gender was significantly associated with cigarettes (OR=3.2, 95% CI 1.8-5.6) but not waterpipe smoking. Public school students were, respectively, 3.2 (95% CI 1.8-5.6) and 1.7 (95% CI 1.4-2.1) times more likely to be exclusive cigarettes smokers, and exclusive waterpipe smokers. Class was not significantly associated with exclusive cigarette smoking; however, students attending secondary classes were 1.3 (95% CI 1.1-1.6) times more likely to be exclusive waterpipe smokers. The reasons behind the high prevalence of both types of smoking are presented and discussed. The present study calls for school-based prevention programs and other types of interventions such as tax increases, and age-restrictions on tobacco sales. More aggressive interventions to disseminate education and awareness among parents and students altogether are warranted.     

Are waterpipe users interested in quitting?

Waterpipe smoking has increased dramatically worldwide in recent years, with an estimated 100 million daily users. Research on this traditional Middle Eastern tobacco use method is in its infancy, and little is known about users' cessation-related attitudes and experiences. A random sample of 268 narghile (waterpipe) smokers (40% female; mean age = 30 years; range = 18-68) was obtained from cafes and restaurants in Aleppo, Syria. The majority of users (86.5%) believed they could quit using waterpipes at any time, but that belief was inversely related to perceived dependence, with only 48.7% of those who thought they were "very hooked" believing they could quit. Interest in quitting was expressed by 28.4% of subjects, with the majority (89.2%) reporting health concerns as a primary reason, and 59.2% having made an unsuccessful quit attempt in the past year. In a logistic regression model, independent predictors of interest in quitting included being married, having smoked for fewer years, not increasing the frequency of smoking over time, and having family members who do not smoke a waterpipe and disapprove of its use. Results indicate that a sizable percentage of waterpipe users express interest in quitting and have tried unsuccessfully in the past to quit. Waterpipe use needs to be considered in developing effective tobacco use cessation programs in the Middle East.     

Characteristics of U.S. waterpipe users: a preliminary report.

Waterpipe smoking, a traditional method of tobacco use, has experienced a resurgence in the Middle East and Indian subcontinent in recent years. Despite growing evidence of its dependence potential and health-damaging effects, waterpipe use has spread beyond these regions to many other countries, including the United States. Because little is known about waterpipe use in the United States, we surveyed convenience samples of users from two U.S. cities, Richmond, Virginia (n = 109), and Memphis, Tennessee (n = 34). Respondents in both cities were primarily young adults, a majority (75%) were men, and most were college students or had a college degree. Initial and current use usually occurred in a social context, with a group of friends in a cafe or restaurant or at home. Most respondents had smoked waterpipe for 2 or fewer years, and 67% currently smoked at least once a month (22% smoked at least once per week and 10% smoked daily). Most believed waterpipe use to be less addictive and harmful than cigarette smoking, believed they could quit use at any time, but had no plans or desire to quit. A majority of respondents used other tobacco products such as cigarettes, and 35% of those who did not smoke cigarettes said they would "probably" or "definitely" smoke one in the next year. Multivariate correlates of greater frequency of use included younger age at first use, ownership of a waterpipe, use occurring primarily with groups of friends, and the perception of being "hooked." Waterpipe users in these two convenience samples from the United States were young and educated, tended to experiment with multiple forms of tobacco, were unaware of the potentially harmful and addictive properties of waterpipe use, and planned to continue use in the future. Educational efforts are needed to increase awareness of the potential hazards of this increasingly popular form of tobacco use.     

Waterpipe-associated particulate matter emissions.

Waterpipe tobacco smoking is increasingly common worldwide, and evidence about its harmful effects to smokers is emerging. However, no studies have investigated the potential exposure of nonsmokers to waterpipe smoke. We measured particulate matter (PM) emissions (PM2.5, PM10) before and during laboratory sessions in which 20 individuals used a waterpipe to smoke tobacco and 20 individuals smoked a cigarette (10 for each particle-size/smoking-method), as well as 10 waterpipe and 10 cigarette smoldering sessions (i.e., without a smoker). A TSI-SidePak aerosol monitor obtained PM2.5, PM10 background, smoking, and maximum levels. Mean PM2.5 rose 447% for waterpipe (from 48 microg/m3 background to 264 microg/m3 smoking), and by 501% for cigarettes (from 44 microg/m3 to 267 microg/m3), whereas mean PM10 rose by 563% for waterpipe (from 55 microg/m3 to 365 microg/m3), and by 447% for cigarettes (from 52 microg/m3 to 287 microg/m3) (p<.05 for all). The increase in PM during cigarette smoking was due primarily to PM2.5, given that the proportion of PM2.5 from total PM10 increase was 95% compared with 70% for waterpipe (p<.05). Maximum PM2.5 was 908 microg/m3 for waterpipe and 575 microg/m3 for cigarettes, whereas maximum PM10 was 1052 microg/m3 for waterpipe and 653 microg/m3 for cigarettes. Mean PM2.5 and PM10 smoldering levels did not differ from background for waterpipe but were significantly higher for cigarettes (PM2.5: 33-190 microg/m3; PM10: 42-220 microg/m3). Policymakers considering clean air regulations should include waterpipe tobacco smoking, and the public should be warned about this source of smoke exposure.     

Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic

Objective: To conduct a comprehensive review regarding global waterpipe use, in order to identify current knowledge, guide scientific research, and promote public policy.

Data sources: A Medline search using as keywords "waterpipe", "narghile", "arghile", "shisha", "hookah", "goza", "hubble bubble" and variant spellings (for example, "hooka"; "hukka") was conducted. Resources compiled recently by members of GLOBALink were used.

Study selection: Every identified published study related to waterpipe use was included.

Data synthesis: Research regarding waterpipe epidemiology and health effects is limited; no published studies address treatment efforts. Waterpipe use is increasing globally, particularly in the Eastern Mediterranean Region, where perceptions regarding health effects and traditional values may facilitate use among women and children. Waterpipe smoke contains harmful constituents and there is preliminary evidence linking waterpipe smoking to a variety of life threatening conditions, including pulmonary disease, coronary heart disease, and pregnancy related complications.

Conclusions: More scientific documentation and careful analysis is required before the spread of waterpipe use and its health effects can be understood, and empirically guided treatment and public policy strategies can be implemented.

     

The nicotine dependence syndrome scale: a multidimensional measure of nicotine dependence.

We report the development of a new multidimensional questionnaire to measure nicotine dependence, based on Edwards's syndromal conceptualization of dependence. We present three studies. In study 1, we administered the Nicotine Dependence Syndrome Scale (NDSS) to 317 smokers in a smoking cessation study. Factor analysis of the NDSS revealed five factors: Drive (craving and withdrawal, and subjective compulsion to smoke), priority (preference for smoking over other reinforcers), tolerance (reduced sensitivity to the effects of smoking), continuity (regularity of smoking rate), and stereotypy (invariance of smoking). A single overall score based on the first principal component, NDSS-T, was retained as a single core measure of dependence. The NDSS showed promising psychometric properties: NDSS-T and factor scores showed strong associations with dependence-relevant measures, even when we controlled for scores on the Fagerstr?m Tolerance Questionnaire (FTQ); and the NDSS predicted urges when smoking, withdrawal in acute abstinence, and outcome in cessation. The five factor scores showed differential patterns of correlations with external validators, supporting the multidimensionality of the measure. In study 2, we revised the NDSS to expand some subscales and administered it to 802 smokers in a cessation study. The same five factors were extracted, the internal reliability of some subscales was improved, and the factor scores again showed associations with dependence-relevant validators, which were largely maintained when we controlled for FTQ scores. In study 3, with 91 smokers in a cessation trial, we established that the test-retest reliability of the subscales was adequate. Thus, the NDSS presents a valid multidimensional assessment of nicotine dependence that may expand on current measures.     

Initial symptoms of nicotine dependence in adolescents

OBJECTIVES: It has been assumed that nicotine dependence has a slow onset and occurs only after prolonged daily use of tobacco. A cohort of young adolescents was followed to determine when the first symptoms of nicotine dependence occur with respect to the duration and frequency of tobacco use. DESIGN: A cohort of 681 seventh grade students (age 12-13 years) from seven schools in two small cities in central Massachusetts was followed over one year. Detailed information regarding tobacco use was obtained in individual confidential interviews conducted in school three times over the year. The latency time to the onset of symptoms of nicotine dependence was measured from the time a subject first smoked at a frequency of at least once per month. RESULTS: 22% of the 95 subjects who had initiated occasional smoking reported a symptom of nicotine dependence within four weeks of initiating monthly smoking. One or more symptoms were reported by 60 (63%) of these 95 subjects. Of the 60 symptomatic subjects, 62% had reported experiencing their first symptom before smoking daily or began smoking daily only upon experiencing their first symptom. DISCUSSION: The first symptoms of nicotine dependence can appear within days to weeks of the onset of occasional use, often before the onset of daily smoking. The existence of three groups of individuals-rapid onset, slower onset, and resistant-distinguishable from one another by their susceptibility to nicotine dependence, is postulated.     

Harm perception of nicotine products in college freshmen.

This study examined the association of sociodemographic characteristics and smoking behaviors (i.e., cigarette, cigar, and waterpipe) with nicotine product harm perception in college freshmen. Students were asked to compare the perceived harmfulness of 11 nicotine-delivering products with that of a regular cigarette. Data were from a cross-sectional Internet survey conducted during the spring 2004 semester at a private university (N = 411). Binomial logistic regression was used to determine the association between sociodemographic and behavioral factors with nicotine product harm perception. A statistically significant association was found between nicotine product harm perception and sex, race, income, citizenship, and smoking behavior (p< or =.05). Regarding the three medicinal nicotine replacement therapies, 19.6% of respondents incorrectly perceived the nicotine patch to be as harmful as or more harmful than a regular cigarette; corresponding values were 24.1% for nicotine gum and 52.9% for nicotine inhaler. Respondents incorrectly perceived the following smoked tobacco products to be less harmful than regular cigarettes: ultra-light cigarettes (40.4%), waterpipe (37%), light cigarettes (35.2%), cigarillos (17.4%), and cigars (16.9%). Regarding smokeless nicotine products, 89.3% of respondents incorrectly perceived dip and chew to be as harmful as or more harmful than regular cigarettes; corresponding values were 36.2% for nicotine lollipops and 35.2% for nicotine water. Our findings reveal misperceptions about nicotine product harmfulness and underscore the importance of developing a science base to inform policies and educate consumers about these products.     

Nicotine dependence symptoms among adolescents with psychiatric disorders: using a Rasch model to evaluate symptom expression across time.

Little is known about the longitudinal course of symptoms of nicotine dependence among adolescents following interventions designed to affect smoking behavior, particularly among high-risk samples. We used an item-response modeling strategy to examine how well nicotine dependence symptoms cohere to a latent construct, the stability of the construct over time, and the sensitivity of the nicotine dependence symptoms to changes in smoking patterns among adolescents with comorbid psychopathology. Assessments occurred prior to cessation treatment delivered within a randomized clinical trial and again at 6 and 12 months after treatment. We used a Rasch item-response modeling approach to examine nicotine dependence as measured by a structured Adolescent Nicotine Dependence Interview (ANDI) and by the Modified Fagerstr?m Tolerance Questionnaire (mFTQ). These analyses provided support for a unidimensional latent measurement model that can be used to organize symptoms of nicotine dependence obtained from ANDI and mFTQ measures. The derived measure showed good construct validity with significant relationships to smoking levels and salivary cotinine levels. The typical symptom patterns and the relative severity of nicotine dependence symptoms remained stable over multiple assessments. Changes in smoking levels were related longitudinally to changes in nicotine dependence, and changes in nicotine dependence were related to changes in motivation to quit and readiness to change smoking behavior. Several behavioral symptoms were sensitive to change in smoking rate over time, whereas core symptoms of physiological dependence did not evidence significant changes. Results suggest that DSM-IV and mFTQ measures of nicotine dependence provide complementary information when assessing nicotine dependence levels among adolescents with psychiatric disorders.     

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.     

The role of psychiatric disorders in the relationship between cigarette smoking and DSM-IV nicotine dependence among young adults.

This study set out to evaluate the association between cigarette smoking and nicotine dependence (Diagnostic and Statistical Manual of Mental Disorders [4th ed.]) (DSM-IV), and to determine whether psychiatric disorders may signal greater sensitivity to nicotine dependence at similar levels of smoking exposure. Drawing on the young adult sample (aged 18-25 years) from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), we conducted logistic regression analyses. Smokers with major depression, alcohol use disorders, or specific phobia had a higher risk of meeting DSM-IV criteria for nicotine dependence than did those without these disorders. When examining smoking quantity, we found that rates of nicotine dependence were similar for those with and without major depression among nondaily smokers, yet among daily smokers, rates of nicotine dependence were consistently higher among those with major depression than among those without. Alcohol dependence elevated the risk of nicotine dependence at low to moderate levels of use. However, no difference in risk for nicotine dependence was observed between alcohol-dependent and nondependent individuals smoking more than a pack a day. Increased risk of nicotine dependence among those with a specific phobia was consistent across the range of current smoking levels. These findings add to the growing literature documenting dependence in nondaily smokers and demonstrate that although chronic smoking is often a key feature in dependence, psychiatric disorders may signal greater sensitivity to nicotine dependence symptoms at substantially lower levels of smoking exposure.     

Smoke constituent exposure and smoking topography of adolescent daily cigarette smokers.

Adolescent smoking prevalence is a major health concern, with 24.4% reporting smoking in the past 30 days and 15.8% considered daily smokers. The purpose of this study was to characterize biobehavioral nicotine dependence, smoke constituent exposure and smoking topography in adolescent daily smokers. Relationships among biological markers of nicotine dependence (nicotine boost, carbon monoxide [CO] boost and cotinine levels) with existing self-report measures (modified Fagerstr?m Tolerance Questionnaire [mFTQ] and the motivations for smoking scale) were examined. Gender differences were characterized. Fifty adolescents 13-18 years old were recruited for the study, 50% female. CO, plasma nicotine levels pre- and postcigarette, cotinine, and smoking topography were measured during a smoking bout with participant's usual cigarette. Average CO boost, pre- to postcigarette was 7.2 + 3.6 ppm, baseline cotinine level averaged 224.0 +/- 169.6 ng/ml and nicotine boost averaged 23.4 +/- 21.7 ng/ml. Mean puffs per cigarette was 14.2 +/- 6.3. Males had significantly higher total puff volumes, but similar smoke constituent exposure to females, and higher handling of cigarettes as smoking motive. In regression analysis, 35% of variance in tobacco use, as indicated by baseline cotinine concentration, was explained by maximum puff duration, postcigarette CO level, and nicotine dependence, as measured by the mFTQ. Results indicated adolescents had considerable smoke constituent exposure and nicotine dependence suggesting the importance of appropriate smoking cessation treatment.     

Psychosocial predictors of nicotine dependence in Black and Puerto Rican adults: a longitudinal study.

This study examined the psychosocial predictors of nicotine dependence in Blacks and Puerto Ricans. A longitudinal, prospective study design was employed. Data on five psychosocial domains were obtained from a four-wave study of tobacco use and smoking behavior; data were analyzed using logistic regression. Participants (N = 475) included adult Blacks and Puerto Ricans initially recruited from urban public schools in New York City and interviewed when they were mean age 14 years, and then again when they were mean ages 19, 24, and 26 years. Structured interviews were administered at four points in time over a period of 12 years. Nicotine dependence was measured using a DSM-IV adapted version of the Composite International Diagnostic Interview nicotine dependence measure. Logistic regression analyses showed that factors in each of five psychosocial domains (personality, drug use behavior, family, peer, and environment) significantly predicted nicotine dependence. The pattern of results was similar for both Black and Puerto Rican samples. Factors that protected against nicotine dependence included achievement, ego-integration, and a positive school climate. The findings indicate that a variety of risk factors contribute to the occurrence of nicotine dependence. When examining the causes of nicotine dependence, it is important to investigate an array of biopsychosocial and environmental factors.     

A twin study of smoking, nicotine dependence, and major depression in men.

This study examined the nature of the relationship among lifetime major depression, smoking, and nicotine dependence. Subjects were 8,169 male twins from the Vietnam Era Twin Registry. Biometrical modeling demonstrated a genetic influence on daily smoking, nicotine dependence, and major depression, and a family environmental influence on daily smoking. Genetic factors influencing nicotine dependence also strongly influenced major depression. We also compared probands with a history of major depression (n = 398) from pairs discordant for major depression, their nondepressed cotwins (n = 364), and controls (n = 1,863) on a number of secondary smoking outcomes. Major depression was associated with current daily smoking and certain nicotine withdrawal symptoms. Individuals with a familial vulnerability for major depression, even without a personal history of major depression, were more likely to smoke despite a serious illness and to report nervousness, restlessness, difficulty concentrating, and depressed mood during past quit attempts. Among the 237 monozygotic pairs discordant for major depression, depressed probands were more likely to have a lifetime history of nicotine dependence than were cotwins. Findings extend Kendler and colleague's (1993) study of female twins by demonstrating in men that shared genetic factors predispose not only to major depression and daily smoking but also to major depression and nicotine dependence.     

Adolescent smoking trajectories and nicotine dependence.

The present study correlates empirically constructed prospective adolescent smoking trajectories with indicators of nicotine dependence assessed in adolescence and in adulthood. Excluding individuals who reported no smoking during repeat assessment (nonadopters), we identified five smoking trajectory groups: experimenters (n=116, 48.5%), late increasers (n=39, 16.3%), early increasers (n=37, 15.5%), quitters (n=22, 9.2%), and persistent smokers (n=25, 10.5%). Higher frequency of nicotine dependence symptoms in adolescence occurred in the quitters and persistent smokers groups, who smoked at higher levels relative to the experimenters, late increasers, and early increasers groups, who reported a similar frequency of nicotine dependence symptoms and smoked at low levels. Lifetime nicotine dependence was assessed in adulthood in lifetime daily smokers using the Fagerstr?m Test for Nicotine Dependence (FTND) and the Nicotine Dependence Scale (NDS). Lifetime FTND levels were similar across trajectory groups. Relative to experimenters, all remaining smoking trajectory groups had higher NDS levels that were similar to one another. These results suggest that higher levels of adolescent nicotine dependence were associated with heavier smoking trajectory groups, and that regardless of trajectory group membership, smoking more than a few cigarettes per week throughout adolescence resulted in similar levels of lifetime nicotine dependence as measured by the FTND and NDS.     

Smoking during the night: prevalence and smoker characteristics.

We report on the smoking patterns and characteristics of individuals who smoke at night. We also explore the relationship between night smoking, nicotine dependence, and cessation outcomes. Participants (N = 691) were heavy smokers enrolled in cessation research clinics. Data were from three studies. Using ecological momentary assessment, participants monitored their smoking (ad libitum, day and night) on electronic diaries (EDs) during a 2-week baseline period and for 4 weeks following a target quit day. A total of 41% of smokers recorded at least one episode of night smoking. Within this group, night smoking occurred on 26% of nights, averaging two episodes per night. ED data correlated with a single self-report item assessing the frequency of night smoking. Night smoking was associated with greater nicotine dependence and daily caffeine consumption. It also predicted risk for lapsing beyond traditional measures of nicotine dependence. Night smoking is common, is associated with nicotine dependence, and it represents additional risk for cessation failure. People who smoke at night may need nicotine replacement therapy overnight. Future research should determine whether treatments that improve sleep quality also improve cessation outcomes in night smokers.     

Association of retrospective early smoking experiences with prospective sensitivity to nicotine via nasal spray in nonsmokers

Greater sensitivity to early exposure to tobacco smoking may predict higher risk of becoming nicotine dependent. The most common measure of this sensitivity is the retrospective self-report Early Smoking Experiences (ESE) questionnaire. We examined the relationship between responses to the retrospective ESE and prospectively assessed sensitivity to nicotine via nasal spray in young adult nonsmokers (N = 58) with modest lifetime smoking experience (>0 but < or =10 lifetime uses). Nicotine spray (0 vs 10 microg/kg) was used due to ethical and practical concerns with administering tobacco smoke to nonsmokers. Responses to cigarette smoking on the retrospective ESE items of pleasant, unpleasant, nausea, relaxed, dizzy, and buzzed were compared with prospectively assessed nicotine spray effects (NSE) on the same responses. ESE responses were also compared with subjective spray ratings of nicotine reward (e.g., "liking") and perception (e.g., "feel the effects"), cardiovascular activity, and nicotine reinforcement via a nicotine spray choice procedure. Results showed that the retrospective ESE items of dizzy and buzzed were each associated with greater prospective NSE dizzy and buzzed responses to nasal spray nicotine. However, the other four ESE items were unrelated to the corresponding NSE items. Responses to some ESE items were also related to prospective nicotine spray reward and perception, but no ESE item was related to the cardiovascular or reinforcing effects of nicotine spray. These findings show that two of six retrospective ESE items, dizzy and buzzed, predicted the same prospectively assessed responses to acute nicotine via spray in young adult nonsmokers and may reflect a stable and reliable response to nicotine intake.     

Dimensions of depressive symptoms and smoking cessation.

Because different psychopathologic components of depressive symptoms may have distinct etiologies, examining their differential effects on smoking cessation may elucidate mechanisms underlying the smoking-depression relationship. Negative affect (NA), somatic features (SF), low positive affect/anhedonia (PA), and interpersonal disturbance (IP) have been identified as unique dimensions of depression that can be measured using the Center for Epidemiologic Studies Depression Scale (CESD). This study examined common and unique associations between CESD subscales and baseline smoking characteristics, nicotine withdrawal, and relapse in 157 participants enrolled in a smoking cessation trial for heavy social drinkers. Each dimension was univariately associated with negative and positive reinforcement smoking motives. Only SF had unique relations with tolerance smoking motives and univariate associations with nicotine dependence severity. Only PA predicted cessation-related changes in withdrawal symptoms on quit day. Analyses predicting abstinence at 8, 16, and 26 weeks post quit date showed that NA, SF, and PA each univariately predicted relapse, ps< or =.0083. Only low PA predicted poorer outcomes incrementally to the other dimensions, even when controlling for level of nicotine dependence, smoking frequency, and history of major depression, p = .0018. Interventions targeting anhedonia and low positive affect may be useful for smokers trying to quit.