Neural bases of risky decisions involving nicotine vapor versus monetary reward.

Substantial effort has gone into neuroimaging studies of neural mechanisms underlying addiction. Human studies of smoking typically either give monetary reward during an fMRI task or else allow subjects to smoke outside the scanner, after the session. This raises a fundamental issue of construct validity, as it is unclear whether the same neural mechanisms process decisions about nicotine that process decisions about money. To address this, we developed a novel MR-compatible nicotine vaping device, such that access to nicotine vapor could be controlled and monitored. We recruited heavy smokers (Money: 45 subjects, 13 females and 32 males; Nicotine: 21 subjects, 4 females and 17 males) to perform a gambling task with nicotine and monetary reward on separate days. We collected BOLD fMRI data while they performed the task inside the scanner and analyzed it using general linear modeling, with inference based on cluster-size correction. This allowed a direct comparison between the neural mechanisms of choosing and receiving immediate drug vs. monetary reward. We found substantial differences in the neural mechanisms that underlie risky choices about money vs. drug reward, including a reversal of the well-known error effects in the medial prefrontal cortex.

Adolescent tolerance for deviance, cigarette smoking trajectories, and premature mortality: A longitudinal study.

Cigarette smoking is a well-established cause of excess morbidity and mortality in the United States and globally. The current study builds on the existing literature by examining how smoking trajectories might be a mechanism through which adolescent tolerance for deviance predicts premature all-cause and tobacco-specific mortality. Participants were from a cohort-sequential study conducted in the Midwestern United States of the natural history of cigarette smoking from adolescence through midlife that collected nine waves of data from 1980 to 2011. For the current study, we selected participants who were measured at least once at age 18 or older and who did not die before age 24 (n = 7575). Participants' tolerance for deviance was assessed in adolescence, smoking trajectory group was based on self-reported smoking status during the first six waves of data collection, and cause of death for deceased participants (n = 222) was obtained from the National Death Index. Mediation analyses using the joint significance test were conducted separately for all-cause mortality and tobacco-specific mortality. Adolescent tolerance for deviance significantly predicted smoking trajectory group over and above the influence of covariates. Adolescents with higher tolerance for deviance were more likely to belong to any smoking trajectory group compared to abstainers, and membership in a smoking trajectory group characterized by early onset and heavy, persistent smoking was related to premature all-cause and tobacco-specific mortality. Finally, smoking trajectory group was a significant mediator of the relation between adolescent tolerance for deviance and all-cause mortality.

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults.

OBJECTIVE: To test the effect of exposure to the US Food and Drug Administration's proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes towards smoking. DESIGN AND METHODS: A two-session web-based study was conducted with 2192 young adults 18-25-years-old. During session one, demographics, smoking behaviour, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current US Surgeon General's text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes. RESULTS: Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p = .004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current US Surgeon General's text warnings (p = .014), but there was no difference compared to those who viewed text-only warnings. CONCLUSION: Graphic health warnings on cigarette packages can influence young adult smokers' implicit attitudes towards smoking.

Dual Trajectories of Cigarette Smoking and Smokeless Tobacco Use From Adolescence to Midlife Among Males in a Midwestern US Community Sample.

INTRODUCTION: Identifying trajectories of tobacco use is critical for understanding its natural history and targeting interventions, but research on trajectories of smokeless tobacco and dual use of smokeless tobacco and cigarettes is very limited. This study identified tobacco use trajectories from adolescence to midlife and tested correlates of trajectory group membership. METHODS: This study included all male participants in a longitudinal study who reported cigarette smoking or smokeless tobacco use in 1987, 1993, 1999, 2005, or 2011 (N = 2230). Group-based trajectory analyses were conducted with zero-inflated Poisson models. Analysis of covariance was used to test adolescent health beliefs associated with trajectory group membership. RESULTS: Five smoking trajectory groups were identified: (1) consistent abstinence from cigarettes; (2) late onset intermittent, then cessation; (3) early onset regular, then cessation; (4) delayed onset regular, then cessation; and (5) consistent regular. Four smokeless tobacco trajectory groups were identified: (1) early onset, then cessation; (2) consistent abstinence from smokeless tobacco; (3) late onset, escalating; and (4) consistent regular. The proportion of participants in trajectory groups representing dual use was low. Adolescent beliefs favorable to smoking and smokeless tobacco were associated with membership in consistent regular use groups. CONCLUSIONS: The prevalence of dual use of cigarettes and smokeless tobacco was low, and there was little evidence to suggest switching between tobacco products. Participants who held more positive beliefs about smoking and smokeless tobacco as adolescents were more likely to be consistent regular users of cigarettes and smokeless tobacco into adulthood.

Changing implicit attitudes toward smoking: results from a web-based approach-avoidance practice intervention.

Implicit attitudes have been shown to predict smoking behaviors. Therefore, an important goal is the development of interventions to change these attitudes. This study assessed the effects of a web-based intervention on implicit attitudes toward smoking and receptivity to smoking-related information. Smokers (N = 284) were recruited to a two-session web-based study. In the first session, baseline data were collected. Session two contained the intervention, which consisted of assignment to the experimental or control version of an approach-avoidance task and assignment to an anti-smoking or control public service announcement (PSA), and post-intervention measures. Among smokers with less education and with plans to quit, implicit attitudes were more negative for those who completed the approach-avoidance task. Smokers with more education who viewed the anti-smoking PSA and completed the approach-avoidance task spent more time reading smoking-related information. An approach-avoidance task is a potentially feasible strategy for changing implicit attitudes toward smoking and increasing receptivity to smoking-related information.

Predictors of health behaviors after the economic downturn: a longitudinal study.

Economic declines and their associated stress, shortage of financial resources, and changes in available time can impair health behaviors. This study tested the association between change in working hours, change in employment status, and financial strain and health behaviors measured after the 2008 recession after controlling for pre-recession levels of the health behaviors. The moderating influences of demographic factors and pre-recession levels of the health behaviors on the association between change in working hours and employment status and financial strain and the health behaviors were also tested. Participants (N = 3984) were from a longitudinal study of a U.S. Midwestern community-based sample. Regression analyses tested the unique relations between change in hours worked per week, change in employment status, and financial strain and five health behaviors over and above demographic factors and pre-recession levels of the same behavior. Models included predictor by covariate interactions. Participants who reported higher levels of financial strain engaged in lower levels of all but one of the five health behaviors, but there were no significant main effects of a change in the number of hours worked per week or change in employment status. Significant interactions revealed moderation of these relations by demographic characteristics, but findings differed across health behaviors. Financial strain negatively affected engagement in multiple healthy behaviors. Promoting the maintenance of healthy behaviors for disease prevention is an important public health goal during times of economic decline.

Association between work-family conflict and smoking quantity among daily smokers.

INTRODUCTION: Recent work demonstrated a direct relation between work-family conflict and likelihood of smoking. This study furthered this area of research by (a) testing the association between work-family conflict and smoking quantity and (b) testing demographic, workplace, and home factors as moderators of this relation. METHODS: Participants (N = 423) were daily smokers from a Midwestern community-based sample. Ordinal regression analysis tested work-to-home and home-to-work conflict as predictors (after controlling for demographic characteristics, home factors, and workplace factors) of smoking quantity. Additionally, we tested whether the demographic, home, and workplace factors moderated the effects of work-to-home conflict and home-to-work conflict on smoking quantity. RESULTS: Males (OR = 8.81, p = .005), older participants (OR = 1.09, p = .012), those with less educational attainment (OR = 1.87, p = .001), those who reported lower levels of workplace smoking restrictions (OR = 0.87, p = .019), and those who reported higher levels of work-to-home conflict (OR = 1.39, p = .026) smoked more cigarettes per day. There was no significant main effect of home-to-work conflict on smoking quantity (OR = 1.46, p = .099). A significant interaction (OR = 0.55, p = .043) revealed that home-to-work conflict was associated with smoking quantity for females but not for males. CONCLUSIONS: After controlling for demographic characteristics and potential confounders, work-to-home conflict had a negative impact on smoking quantity for all participants, and home-to-work conflict was associated with smoking quantity for women. Workplace wellness programs to reduce smoking among employees should take into account the direction of conflict and how the effect of the conflict on smoking behavior may vary based on other factors.

The association between implicit and explicit attitudes toward smoking and support for tobacco control measures.

INTRODUCTION: This study examined the association between implicit and explicit attitudes toward smoking and support for tobacco control policies. METHODS: Participants were from an ongoing longitudinal study of the natural history of smoking who also completed a web-based assessment of implicit attitudes toward smoking (N = 1,337). Multiple regression was used to test the association between covariates (sex, age, educational attainment, parent status, and smoking status), implicit attitude toward smoking, and explicit attitude toward smoking and support for tobacco control policies. The moderating effect of the covariates on the relation between attitudes and support for policies was also tested. RESULTS: Females, those with higher educational attainment, parents, and nonsmokers expressed more support for tobacco control policy measures. For nonsmokers, only explicit attitude was significantly associated with support for policies. For smokers, both explicit and implicit attitudes were significantly associated with support. The effect of explicit attitude was stronger for those with lower educational attainment. CONCLUSIONS: Both explicit and implicit smoking attitudes are important for building support for tobacco control policies, particularly among smokers. More research is needed on how to influence explicit and implicit attitudes to inform policy advocacy campaigns.

Attention deficit/hyperactivity disorder symptoms and depression symptoms as mediators in the intergenerational transmission of smoking.

BACKGROUND: Attention deficit/hyperactivity disorder and depression have been found to be comorbid with smoking behaviors, and all three behavioral syndromes have been shown to be familially transmitted. The present paper reports on the results of analyses testing whether child attention deficit/hyperactivity disorder and depression symptoms were mediators in the intergenerational transmission of cigarette smoking. METHOD: Path analyses using bootstrapped mediation procedures were conducted on data from a community sample of 764 families (one or both parents and one adolescent offspring) from the Indiana University Smoking Survey. Parents reported on their smoking behaviors, ADHD, and depression and their child's ADHD, while offspring reported on their smoking behaviors and depression. RESULTS: Although fathers' and mothers' smoking status, depression, and ADHD were not significantly correlated with boys' smoking initiation, there was a significant mediated (indirect) pathway from mothers' depression to boys' smoking initiation through boys' depression. Several parental variables were significantly correlated with smoking initiation in girls, and the pathways from mothers' smoking status, mothers' ADHD, and fathers' smoking status to girls' smoking initiation were significantly mediated by girls' ADHD. CONCLUSIONS: For adolescent girls, the intergenerational transmission of ADHD appears to be important in understanding the intergenerational transmission of cigarette smoking. Sex differences in the intergenerational transmission of psychopathology as it leads to smoking initiation were also discussed.

Smoking behaviors and attitudes during adolescence prospectively predict support for tobacco control policies in adulthood.

INTRODUCTION: Several cross-sectional studies have examined factors associated with support for tobacco control policies. The current study utilized a longitudinal design to test smoking status and attitude toward smoking measured in adolescence as prospective predictors of support for tobacco control policies measured in adulthood. METHODS: Participants (N = 4,834) were from a longitudinal study of a Midwestern community-based sample. Hierarchical multiple regression analyses tested adolescent smoking status and attitude toward smoking as prospective predictors (after controlling for sociodemographic factors, adult smoking status, and adult attitude toward smoking) of support for regulation of smoking in public places, discussion of the dangers of smoking in public schools, prohibiting smoking in bars, eliminating smoking on television and in movies, prohibiting smoking in restaurants, and increasing taxes on cigarettes. RESULTS: Participants who smoked during adolescence demonstrated more support for discussion of the dangers of smoking in public schools and less support for increasing taxes on cigarettes but only among those who smoked as adults. Those with more positive attitudes toward smoking during adolescence demonstrated less support as adults for prohibiting smoking in bars and eliminating smoking on television and in movies. Moreover, a significant interaction indicated that those with more positive attitudes toward smoking as adolescents demonstrated less support as adults for prohibiting smoking in restaurants, but only if they became parents as adults. CONCLUSIONS: This study's findings suggest that interventions designed to deter adolescent smoking may have future benefits in increasing support for tobacco control policies.

The Association between Membership in the Sandwich Generation and Health Behaviors: A Longitudinal Study.

The current study examined the association between membership in the sandwich generation, defined as providing care to both children and parents or in-laws, and five health behaviors: checking the food label for health value when buying foods, using a seat belt, choosing foods based on health value, exercising regularly, and cigarette smoking. Participants (N=4943) were from a longitudinal study of a midwestern community-based sample. Regression analyses tested the unique effect of sandwich generation membership on health behaviors above and beyond demographic factors and prior levels of the same behavior. Compared to other caregivers and noncaregivers, multigenerational caregivers were less likely to check food labels and to choose foods based on health values. Multigenerational caregivers were less likely than noncaregivers and those who cared for children only to use seat belts, and they smoked marginally more cigarettes per day than those groups. Multigenerational caregivers were less likely than noncaregivers and those who cared for parents/in-laws only to exercise regularly. Thus, in general, healthy behaviors were diminished for multigenerational caregivers.

Implicit and explicit attitudes predict smoking cessation: moderating effects of experienced failure to control smoking and plans to quit.

The current study tested implicit and explicit attitudes as prospective predictors of smoking cessation in a Midwestern community sample of smokers. Results showed that the effects of attitudes significantly varied with levels of experienced failure to control smoking and plans to quit. Explicit attitudes significantly predicted later cessation among those with low (but not high or average) levels of experienced failure to control smoking. Conversely, however, implicit attitudes significantly predicted later cessation among those with high levels of experienced failure to control smoking, but only if they had a plan to quit. Because smoking cessation involves both controlled and automatic processes, interventions may need to consider attitude change interventions that focus on both implicit and explicit attitudes.

The Intergenerational Transmission of Implicit and Explicit Attitudes Toward Smoking.

This study examined the intergenerational transmission of implicit and explicit attitudes toward smoking, as well as the role of these attitudes in adolescents' smoking initiation. There was evidence of intergenerational transmission of implicit attitudes. Mothers who had more positive implicit attitudes had children with more positive implicit attitudes. In turn, these positive implicit attitudes of adolescents predicted their smoking initiation 18-months later. Moreover, these effects were obtained above and beyond the effects of explicit attitudes. These findings provide the first evidence that the intergenerational transmission of implicit cognition may play a role in the intergenerational transmission of an addictive behavior.

Multiple trajectories of cigarette smoking and the intergenerational transmission of smoking: a multigenerational, longitudinal study of a Midwestern community sample.

OBJECTIVE: To investigate the relation between developmental phenotypes of parental smoking (trajectories of smoking from adolescence to adulthood) and the intergenerational transmission of smoking to their adolescent children. DESIGN: A longitudinal, multigenerational study of a midwestern community sample followed individuals from adolescence into adulthood and was combined with Web-based assessment of participants' spouses and adolescent children. Mixture modeling identified multiple trajectories of smoking, and path analyses related these trajectories to adolescents' smoking (beyond both parents' current smoking). Potential mediations were parental education and adolescents' personality characteristics. MAIN OUTCOME MEASURE: The outcome measure was adolescent smoking. RESULTS: A parent's smoking trajectory had a unique effect on their adolescent's smoking, beyond both parents' current smoking and the parent's educational attainment. However, although adolescents' personality characteristics were related both to adolescent smoking and to their parents' smoking, these characteristics could not explain the effects of the parent's smoking trajectory. CONCLUSION: Parents whose smoking had an early onset, steep acceleration, high levels of smoking, and persistence over time had the highest risk for intergenerational transmission of smoking to their adolescent children.

A latent class typology of young women smokers.

AIMS: Despite aggressive anti-smoking campaigns, smoking rates are increasing among young women, suggesting the need for new approaches to reach this population. Segmenting audiences can facilitate targeting interventions to specific populations, based on association of smoking behaviors with other health behaviors and psychological and social antecedents. Using latent class analysis, we sought to profile patterns of behavioral, attitudinal and cognitive variables related to tobacco use among young women. DESIGN: This study is part of an ongoing Midwestern longitudinal self-report survey of the natural history of cigarette smoking. PARTICIPANTS: Participants were 18-25-year-old women smokers (n = 443). MEASUREMENTS: Variables included a comprehensive range of demographic characteristics, smoking-related variables and general attitudinal variables. FINDINGS: Three distinct classes emerged with the following characteristics: (1) working women who tended to smoke daily but reported high levels of positive affect and life satisfaction (n = 212); (2) light-smoking college students who exercised regularly, began smoking after high school and quit successfully at follow-up 5 years later (n = 86); and (3) heavy smokers who were more likely to have children, report high levels of negative affect and smoke for addictive reasons, for stimulation and to control affect (n = 145). Differences in smoking cessation at a 5-year follow-up were significant across the classes (18.1%, 34.4% and 13.0% had quit for at least 6 months, respectively). CONCLUSIONS: The psychosocial and behavioral profiles of these classes can potentially be used to tailor smoking interventions more effectively within this population.

Prospective predictors of long-term abstinence versus relapse among smokers who quit as young adults.

OBJECTIVES: We sought to identify prospective predictors of long-term abstinence versus relapse among individuals who quit smoking as young adults. METHODS: Participants from an ongoing longitudinal study of smoking who had quit for at least 1 year between the ages of 18 and 24 years (n=327) were divided into those who later reported not smoking for more than 5 years (long-term abstinence) or reported current smoking, defined as smoking at least monthly (relapse). Logistic regression was used to examine odds ratios (ORs) of prospective predictors of long-term abstinence versus relapse. RESULTS: Overall, 67% of participants maintained long-term abstinence and 33% relapsed. The strongest predictor of avoiding relapse was marrying a nonsmoker (adjusted OR [AOR]=0.07; 95% confidence interval [CI]=0.03, 0.21). Other predictors included making 1 lifetime quit attempt (AOR=0.13; 95% CI=0.04, 0.44), having as a young adult only 1 parent who smoked (AOR=0.23; 95% CI=0.06, 0.93), and working in a completely smoke-free building (AOR=0.13; 95% CI=0.03, 0.58). CONCLUSIONS: The factors related to smoking in the social environment played the largest role in predicting long-term abstinence versus relapse.

What is addiction? Age-related differences in the meaning of addiction.

In a sample of families from a midwestern community study of cigarette smoking, we examined adolescents' and adults' definitions of "addiction", and related these definitions to their perceived addictiveness of cigarette smoking. Both adolescents and adults viewed addiction as multi-faceted, including both appetitive aspects and compulsive aspects. However, for adolescents, the two dimensions were equally important to the overall meaning of addiction, whereas for adults, the compulsive dimension was more important than was the appetitive dimension. The two dimensions of addiction were related to the perceived addictiveness of smoking, but differently for adolescents and adults. For adolescents, the appetitive dimension was a significant predictor whereas, for adults, the compulsive dimension was significant (and appetitive scores were predictive only at high levels of endorsement of the compulsive factor). These findings have potential implications for prevention programs for adolescents. Adolescents may perceive messages about "addiction" as communicating that the behavior in question has appetitive value in addition to a potential for inducing loss of control, and this may weaken the effectiveness of these messages.