Associations between posttraumatic stress disorder symptom clusters and cigarette smoking.

Understanding the relationship between Posttraumatic stress disorder (PTSD) and cigarette smoking has been difficult because of PTSD's symptomatic heterogeneity. This study examined common and unique lifetime cross-sectional relationships between PTSD symptom clusters [Re-experiencing (intrusive thoughts and nightmares about the trauma), Avoidance (avoidance of trauma-associated memories or stimuli), Emotional Numbing (loss of interest, interpersonal detachment, restricted positive affect), and Hyperarousal (irritability, difficulty concentrating, hypervigilance, insomnia)] and three indicators of smoking behavior: (1) smoking status; (2) cigarettes per day; and (3) nicotine dependence. Participants were adult respondents in the National Epidemiologic Survey of Alcohol and Related Conditions with a trauma history (n = 23,635). All four symptom clusters associated with each smoking outcome in single-predictor models (ps <. 0001). In multivariate models including all of the symptom clusters as simultaneous predictors, Emotional Numbing was the only cluster to retain a significant association with lifetime smoking over and above the other clusters, demographics, and Axis-I comorbidity (OR = 1.30, p < .01). While Avoidance uniquely associated with smoking status and nicotine dependence in multivariate models, these relations fell below significance after adjusting for demographics and comorbidity. No clusters uniquely associated with cigarettes per day. Hyperarousal uniquely related with nicotine dependence over and above the other clusters, demographics, and Axis-I comorbidity (OR = 1.51, p < .001). These results suggest the following: (a) common variance across PTSD symptom clusters contribute to PTSD's linkage with smoking in the American population; and (b) certain PTSD symptom clusters may uniquely associate with particular indicators of smoking behavior. These findings may clarify the underpinnings of PTSD-smoking comorbidity and inform smoking interventions for trauma-exposed individuals.

Associations between depressive symptom dimensions and smoking dependence motives.

Depressive symptoms are heterogeneous and can be parsed into four subdimensions (i.e., positive affect [PA], negative affect [NA], somatic features [SF], and interpersonal problems [IP]) that may have unique associations with the motivation to smoke. This study explored associations between depressive symptom dimensions and 13 theoretically distinct domains of smoking dependence motivation in current cigarette smokers (N = 212; 53% female, mean [M] age = 24 years). Results demonstrated substantial variability in the pattern of motivational correlates across depressive dimensions. Low PA exhibited the narrowest motivational profile, associating with only the tendency to prioritize smoking over other reinforcers. NA demonstrated a broader profile, associating with smoking for affect regulation and cognitive enhancement as well as prioritizing smoking. SF associated with prioritizing smoking and smoking because of cue exposure, craving, and weight control. IP demonstrated the broadest profile, associating with 7 of 13 motivational domains. These findings may assist the tailoring cessation interventions for smokers with depressive symptoms.

Anhedonia associated with stimulant use and dependence in a population-based sample of American adults.

Prior research suggests an association between anhedonia--diminished interest or pleasure in rewarding activities--and stimulant use in selected samples. However, it is unclear whether this association generalizes to the overall population and is consistent across stimulant drug types (amphetamine vs. cocaine) and outcome characteristics (any lifetime use vs. dependence). Questions also remain as to whether the anhedonia-stimulant relationship is unique from covariance with depressed mood, psychiatric disorders, and nonstimulant substance use. The current study addressed these questions by examining anhedonia-stimulant relationships in a cross-sectional population-based sample of 43,093 American adults. Results indicated that lifetime anhedonia and depressed mood each were positively associated with lifetime stimulant use and lifetime dependence among those who reported stimulant use. Anhedonia-stimulant relationships were consistent across amphetamine- and cocaine-related outcomes and distinct from covariance with depressed mood, which exhibited no association over and above the effect of anhedonia. After adjusting for demographic, psychiatric, and nonstimulant substance use characteristics, anhedonia-stimulant associations remained significant, although effect sizes were partially attenuated. Lifetime anhedonia was also more prevalent among respondents who initiated use but did not eventually progress to dependence in comparison with individuals who never once used a stimulant drug. Anhedonia appears to be uniquely associated with lifetime use of cocaine and amphetamines and lifetime progression from use to dependence in the American population. Albeit cross-sectional in nature, these findings add further support to the generalizability and specificity of the anhedonia-stimulant relationship. Future research utilizing longitudinal and experimental designs are warranted to clarify the underpinnings of this association.

Epidemiology, determinants, and consequences of cigarette smoking in African American women: an integrative review.

Tobacco smoking is a national public health problem that has been associated with numerous adverse health effects, including increased disease and cancer rates. Previous review articles on smoking in specific demographic populations have focused on smoking in women and on smoking in African Americans, but have not considered the dual roles of ethnicity and gender in smoking behavior. African American women (AAW) are an important subgroup to study because they are distinct from non-AAW and their male African American counterparts on biopsychosocial factors that are relevant to smoking behavior. The purpose of the present review paper is to integrate and summarize the current literature on the epidemiology, determinants, and consequences of cigarette smoking among AAW, by contrasting them to relevant comparison groups (non-AAW and African American men). Evidence suggests that AAW are generally more likely to be light smokers and initiate smoking later. The prevalence rates of AAW smokers have decreased over the past 25years, yet AAW are disproportionately affected by several smoking-related illnesses when compared to their ethnic and gender comparison groups. AAW smokers are distinct from relevant comparison groups in metabolic sensitivity to nicotine, aspects of smoking topography, and several psychosocial factors that influence smoking. Although a small literature on smoking in AAW is emerging, further empirical research of AAW smokers could inform the development of tailored interventions for AAW.