Toward an ontology of identity-related constructs in addiction, with examples from nicotine and tobacco research.

BACKGROUND AND AIMS: We aimed to create a basic set of definitions and relationships for identity-related constructs, as part of the Addiction Ontology and E-Cigarette Ontology projects, that could be used by researchers with diverse theoretical positions and so facilitate evidence synthesis and interoperability. METHODS: We reviewed the use of identity-related constructs in psychological and social sciences and how these have been applied to addiction with a focus on nicotine and tobacco research. We, then, used an iterative process of adaptation and review to arrive at a basic set of identity-related classes with labels, definitions and relationships that could provide a common framework for research. RESULTS: We propose that 'identity' be used to refer to 'a cognitive representation by a person or group of themselves', with 'self-identity' referring to an individual's identity and 'group identity' referring to an identity held by a social group. Identities can then be classified at any level of granularity based on the content of the representations (e.g. 'tobacco smoker identity', 'cigarette smoker identity' and 'vaper identity'). We propose distinguishing identity from 'self-appraisal' to capture the distinction between the representation of oneself (e.g. as an 'ex-smoker') and (i) the importance and (ii) the positive or negative evaluation that we attach to what is represented. We label an identity that is appraised as enduring as a 'core identity', related to 'strong identity' because of the appraisal as important. Identities that are appraised positively or negatively involve 'positive self-appraisal' and 'negative self-appraisal' respectively. This allows us to create 'logically defined classes' of identity by combining them (e.g. 'positive core cigarette smoker identity' to refer to a cigarette smoker self-identity that is both positive and important). We refer to the totality of self-identities of a person as a 'composite self-identity'. CONCLUSIONS: An ontology of identity constructs may assist in improving clarity when discussing theories and evidence relating to this construct in addiction research.

Toward an ontology of tobacco, nicotine and vaping products.

BACKGROUND AND AIMS: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. METHODS: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper-level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. RESULTS: Overlapping, but distinct classes were developed: 'tobacco-containing product', 'nicotine-containing product' and 'vaping device'. Subclasses of tobacco-containing products are 'combustible tobacco-containing product', 'heated tobacco product' and 'smokeless tobacco-containing product'. Subclasses of combustible tobacco-containing product include 'cigar', 'cigarillo', 'bidi' and 'cigarette' with further subclasses including 'manufactured cigarette'. Manufactured cigarettes have properties that include 'machine-smoked nicotine yield' and 'machine-smoked tar yield'. Subclasses of smokeless tobacco product include 'nasal snuff', 'chewing tobacco product', and 'oral snuff' with its subclass 'snus'. Subclasses of nicotine-containing product include 'nicotine lozenge' and 'nicotine transdermal patch'. Subclasses of vaping device included 'electronic vaping device' with a further subclass, 'e-cigarette'. E-cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e-liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. CONCLUSIONS: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice.

Evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers at homeless centres: protocol for a multi-centre cluster-randomized controlled trial in Great Britain.

BACKGROUND AND AIMS: Smoking is extremely common among adults experiencing homelessness, but there is lack of evidence for treatment efficacy. E-cigarettes are an effective quitting aid, but they have not been widely tested in smokers with complex health and social needs. Here we build upon our cluster feasibility trial and evaluate the offer of an e-cigarette or usual care to smokers accessing a homeless centre. DESIGN, SETTING AND PARTICIPANTS: Multi-centre two-arm cluster-randomized controlled trial with mixed-method embedded process and economic evaluation in homeless centres in England, Scotland and Wales. Adult smokers (18+ years; n = 480) accessing homeless centres and who are known to centre staff and willing to consent. INTERVENTION AND COMPARATOR: Clusters (n = 32) will be randomized to either an e-cigarette starter pack with weekly allocations of nicotine containing e-liquid for 4 weeks [choice of flavours (menthol, fruit and tobacco) and strengths 12 mg/ml and 18 mg/ml] or the usual care intervention, which comprises very brief advice and a leaflet signposting to the local stop smoking service. MEASUREMENTS: The primary outcome is 24-week sustained carbon monoxide-validated smoking cessation (Russell Standard defined, intention-to-treat analysis). SECONDARY OUTCOMES: (i) 50% smoking reduction (cigarettes per day) from baseline to 24 weeks; (ii) 7-day point prevalence quit rates at 4-, 12- and 24-week follow-up; (iii) changes in risky smoking practices (e.g. sharing cigarettes, smoking discarded cigarettes) from baseline to 4, 12 and 24 weeks; (iv) cost-effectiveness of the intervention; and (v) fidelity of intervention implementation; mechanisms of change; contextual influences and sustainability. CONCLUSIONS: This is the first study, to our knowledge, to randomly assign smokers experiencing homelessness to an e-cigarette and usual care intervention to measure smoking abstinence with embedded process and economic evaluations. If effective, its results will be used to inform the larger-scale implementation of offering e-cigarettes throughout homeless centres to aid smoking cessation.

Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health.

BACKGROUND: Intentional consumption of alcohol-based hand gels has been reported especially amongst non-UK national, alcohol dependent, homeless individuals in London. Whilst alcohol misuse is known to be associated with impaired cognitive functioning and mental health problems, the effects of additional ingestion of alcohol gel are unknown. OBJECTIVES: To explore cognitive and psychological functioning in users who intentionally ingest alcohol gel compared with ethyl-alcohol only misusers and controls. METHODS: Male, Central and Eastern European alcohol only misusers, (n = 14; mean age 39 years), alcohol gel users (n = 14; mean age 43 years) and controls (n = 12; mean age 31 years) were recruited from a London Homeless Service during 2013/14. Alcohol misusers, alcohol gel users and controls were compared on the Forwards and Backwards Digit Span Test; Block Design test; Retrospective and Prospective Memory Questionnaire (PRMQ) and the Hospital and Anxiety Depression Scale (HADS). RESULTS: Alcohol gel users performed significantly worse on the Block Design task (p < .01) and PRMQ (p < .01) relative to both alcohol only and control groups, and significantly worse on the digit span relative to controls (p = .01). Both alcohol misusing groups scored comparatively on digit span backwards (p < .01), with both groups performing significantly worse than controls. The alcohol gel group reported significantly higher levels of anxiety relative to controls (p = .02). CONCLUSIONS: Whilst there could be constitutional differences between alcohol misusers who additionally abuse alcohol gel, the findings suggest that alcohol gel ingestion may have a greater impact on psychological functioning than traditional alcohol misuse.

The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers.

Electronic cigarette (e-cigarette) use is becoming increasing popular among smokers, and there is a plethora of devices available. Nicotine delivery is clearly important for reducing tobacco craving and withdrawal symptoms, but other sensorimotor aspects of e-cigarettes (such as visual appearance) may contribute to this effect. This study explored whether it is important for an e-cigarette to visually resemble a tobacco cigarette in order to reduce craving and withdrawal symptoms. Sixty-three cigarette smokers (40% female, aged 18-65 years) who were not current e-cigarette users were randomly allocated to take ten 3-s puffs from either a white or a red first-generation e-cigarette following overnight abstinence. Current craving (urge to smoke) and nicotine withdrawal symptoms (using the Mood and Physical Symptoms Scale [MPSS]) were measured before and 10 min after use. Linear regression revealed higher craving and withdrawal symptoms in the red condition versus the white condition, but only among those who were e-cigarette naive (craving: B = .76, p = .009; withdrawal symptoms: B = 2.18, p = .009), not among those with e-cigarette experience (craving: B = -.08, p = .89; withdrawal symptoms: B = .24, p = .81), and these effects differed between groups (p = .04 and 0.01 for craving and withdrawal symptoms, respectively). In conclusion, cigarette-like appearance was associated with lower craving and withdrawal symptoms, but only for those with no prior e-cigarette experience. This effect, putatively mediated via classical conditioning or expectancies, may aid understanding of smokers' initial preferences for "cigalike" e-cigarette devices.

Recreational cocaine use is associated with attenuated latent inhibition.

INTRODUCTION: Evidence has linked chronic cocaine use with various cognitive deficits; however few studies have investigated the effects of recreational (non-dependent) use. The present study aimed to assess whether recreational users show deficits in latent inhibition (LI: a measure of delayed learning of an association between 2 stimuli, one of which has been previously exposed (PE) without consequence and thus deemed irrelevant). METHODS: Using a quasi-experimental between groups design, recreational cocaine users (n = 21), poly-drug users (n = 17) and drug-naive controls (n = 18) were compared on a LI task. Questionnaires assessing psychological health and drug use were also completed. RESULTS: There was a statistically significant interaction between condition (PE vs non PE) and group (cocaine, polydrug and control); cocaine users scored lower in the PE condition compared to polydrug users and controls, indicating quicker learning. CONCLUSIONS: Recreational cocaine users show attenuated LI reflecting reduced ability to filter out irrelevant stimuli enabling faster learning of a PE irrelevant and novel stimuli association. This does not appear to be a result of schizotypy and/or other drug use. Thus even at recreational levels, cocaine use may be sufficient to affect inhibitory attentional processes.

First- versus second-generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms.

AIMS: To (1) estimate predictors of first- versus second-generation electronic cigarette (e-cigarette) choice; and (2) determine whether a second-generation device was (i) superior for reducing urge to smoke and withdrawal symptoms (WS) and (ii) associated with enhanced positive subjective effects. DESIGN: Mixed-effects experimental design. Phase 1: reason for e-cigarette choice was assessed via questionnaire. Phase 2: participants were allocated randomly to first- or second-generation e-cigarette condition. Urge to smoke and WS were measured before and 10 minutes after taking 10 e-cigarette puffs. SETTING: University of East London, UK. PARTICIPANTS: A total of 97 smokers (mean age 26; standard deviation 8.7; 54% female). MEASUREMENTS: Single-item urge to smoke scale to assess craving and the Mood and Physical Symptoms Scale (MPSS) to assess WS. Subjective effects included: satisfaction, hit, 'felt like smoking' and 'would use to stop smoking' (yes versus no response). FINDINGS: Equal numbers chose each device, but none of the predictor variables (gender, age, tobacco dependence, previous e-cigarette use) accounted for choice. Only baseline urge to smoke/WS predicted urge to smoke/WS 10 minutes after use (B =0.38; P <0.001 and B =0.53; P <0.001). E-cigarette device was not a significant predictor. Those using the second-generation device were more likely to report satisfaction and use in a quit attempt (χ(2) = 12.10, P =0.001 and χ(2) = 5.53, P =0.02). CONCLUSIONS: First- and second-generation electronic cigarettes appear to be similarly effective in reducing urges to smoke during abstinence, but second-generation devices appear to be more satisfying to users.

'Vaping' profiles and preferences: an online survey of electronic cigarette users.

AIMS: To characterize e-cigarette use, users and effects in a sample of Electronic Cigarette Company (TECC) and Totally Wicked E-Liquid (TWEL) users. DESIGN AND SETTING: Online survey hosted at the University of East London with links from TECC/TWEL websites from September 2011 to May 2012. MEASUREMENTS: Online questionnaire. PARTICIPANTS: One thousand three hundred and forty-seven respondents from 33 countries (72% European), mean age 43 years, 70% male, 96% Causasian, 44% educated to degree level or above. FINDINGS: Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. Seventy-two percent of participants used a 'tank' system, most commonly, the eGo-C (23%). Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine (0 mg) containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, 'time to first vape' was significantly longer than 'time to first cigarette' (t1104 = 11.16, P < 0.001) suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers (χ(2) 1 = 133.66, P < 0.0007) although few other differences emerged between these groups. Compared with males, females opted more for chocolate/sweet flavours (χ(2) 1 = 16.16, P < 0.001) and liked the e-cigarette because it resembles a cigarette (χ(2) 3 = 42.65, P < 0.001). CONCLUSIONS: E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking.

The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition.

Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine via inhaled vapour. Few studies have evaluated acute effects on craving and mood, and none have explored effects on cognition. This study aimed to explore the effects of the White Super e-cigarette on desire to smoke, nicotine withdrawal symptoms, attention and working memory. Eighty-six smokers were randomly allocated to either: 18 mg nicotine e-cigarette (nicotine), 0mg e-cigarette (placebo), or just hold the e-cigarette (just hold) conditions. Participants rated their desire to smoke and withdrawal symptoms at baseline (T1), and five (T2) and twenty (T3) minutes after using the e-cigarette ad libitum for 5 min. A subset of participants completed the Letter Cancellation and Brown-Peterson Working Memory Tasks. After 20 min, compared with the just hold group, desire to smoke and some aspects of nicotine withdrawal were significantly reduced in the nicotine and placebo group; the nicotine e-cigarette was superior to placebo in males but not in females. The nicotine e-cigarette also improved working memory performance compared with placebo at the longer interference intervals. There was no effect of nicotine on Letter Cancellation performance. To conclude, the White Super e-cigarette alleviated desire to smoke and withdrawal symptoms 20 min after use although the nicotine content was more important for males. This study also demonstrated for the first time that the nicotine e-cigarette can enhance working memory performance. Further evaluation of the cognitive effects of the e-cigarette and its efficacy as a cessation tool is merited.

Neuropsychological effects associated with recreational cocaine use.

RATIONALE: Recent evidence suggests that recreational cocaine use is on the increase, with the UK reporting one of the highest levels of use in the EU (EMCDDA 2010). Nevertheless, very few studies have addressed the neuropsychological effects associated with non-dependent recreational cocaine use. OBJECTIVES: The current study aimed to assess whether recreational cocaine users show neuropsychological deficits on a battery of tests, previously shown to be sensitive to cocaine-dependent and psychosis-prone individuals. Schizotypal traits were also measured. METHODS: Recreational cocaine users (n = 17) were compared with controls (n = 24) on drug use patterns, the General Health Questionnaire, the Brief Schizotypal Personality Questionnaire (SPQ-B) and four neuropsychological tasks: spatial working memory, intra/extra-dimensional set shifting, the Stocking of Cambridge and the rapid visual processing. RESULTS: Relative to controls, recreational cocaine users produced significantly more errors on the intra/extra-dimensional set shift task and completed fewer stages, made significantly more six box stage errors on the spatial working memory task, and made significantly more errors and fewer hits, with overall poorer detection rates on the rapid visual processing task. Recreational cocaine users reported significantly higher scores on the cognitive perceptual and disorganised thinking SPQ-B subscales and total SPQ-B scores compared to controls. CONCLUSIONS: Recreational cocaine users displayed impairments on tasks tapping sustained attention, attentional shifting and spatial memory and reported higher schizotypal trait expression. These findings are consistent with the emerging literature suggesting subtle cognitive deficits, putatively reflecting underlying dopaminergic dysfunction, in non-dependent, recreational cocaine users.

The effects of cigarette smoking and abstinence on auditory verbal learning.

Smoking has been associated with both enhanced and impaired cognitive performance; across a variety of domains, but there is limited evidence demonstrating the effects on verbal learning. The current study assessed the effect of smoking and abstinence on verbal learning, immediate memory and retention using the Auditory Verbal Learning Test (AVLT). Three groups: 20 smokers, 20 abstaining smokers and 20 non-smoking adults were assessed on the AVLT on two occasions. At session one, abstaining smokers refrained from smoking for 12 h (pre-cigarette), whilst smokers had continued to smoke to satiety. Session two commenced after a 15-min break when both smoking groups were instructed to smoke a cigarette, followed by administration of the second version of the AVLT (post-cigarette). Abstaining smokers showed significant deficits in learning compared to smokers during the pre-cigarette session. Following re-initiation of smoking in the abstaining smokers, these learning decrements were no longer evident. There were trends towards significant group findings in immediate memory and retention during the pre-cigarette session, which again were no longer evident in the post-cigarette session. These findings provide further evidence that smoking abstinence affects verbal learning and furthermore smoking simply restores cognitive performance to pre-abstinence levels.