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1.
JAMA Psychiatry ; 74(10): 1056-1064, 2017 10 01.
Article in English | MEDLINE | ID: mdl-28832876

ABSTRACT

Importance: A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States. Objective: To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content. Design, Setting, and Participants: A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016. Interventions: After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions. Main Outcomes and Measures: Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale. Results: Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η2 = 0.008; dose-by-time interaction, P = .002). Conclusions and Relevance: Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.


Subject(s)
Behavior, Addictive/psychology , Mental Disorders/psychology , Nicotine/analysis , Smoking Prevention , Tobacco Products/analysis , Tobacco Use Disorder , Adult , Female , Humans , Male , Outcome Assessment, Health Care , Smoking Cessation , Tobacco Use Cessation Devices , Tobacco Use Disorder/epidemiology , Tobacco Use Disorder/prevention & control , Tobacco Use Disorder/psychology
2.
J Stud Alcohol Drugs ; 70(4): 551-4, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19515295

ABSTRACT

OBJECTIVE: The present investigation examined self-defined serious quit attempts (lifetime) in relation to current indices of anxious arousal, anhedonic depression symptoms, anxiety sensitivity, and severity of problems experienced in past efforts to quit. METHOD: Participants in the present sample included 144 adult smokers (59.7% women; mean [SD] age = 29.48 [11.62] years) who were recruited from the Burlington, VT, community. RESULTS: After controlling for daily cigarette smoking rate, total years as a regular smoker, current alcohol-use problems, and gender, the number of past quit attempts was significantly and uniquely associated with anxious arousal symptoms, anxiety sensitivity, and severity of problems experienced in past quit attempts; however, the number of past quit attempts was not significantly associated with anhedonic depression symptoms. CONCLUSIONS: These results suggest that clinicians may benefit by assessing for affective factors as part of a smoking-assessment process and integrating them into interventions for smoking cessation.


Subject(s)
Smoking Cessation/psychology , Smoking/psychology , Stress, Psychological , Adult , Anxiety , Depression , Female , Humans , Male , Time Factors
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