Dr. Reuven Dar of Tel Aviv University’s psychology department conducted two studies. In the latest study, he and his colleagues looked at the smoking habits and cravings of flight attendants working for the Israeli airline El Al. They monitored each attendant on two flights—one was 10 to 13 hours and the other 3 to 5 hours. The participants were asked questions about their cravings at points throughout the flights.

They found that the length of the flight didn’t significantly impact their craving levels, as their cravings were about the same on both the longer and shorter flights. Cravings were actually higher at the end of the shorter flights than the longer ones, suggesting that the cravings increased as the flight came to an end. 

In the earlier 2005 study, the researchers studied Jewish smokers who were forbidden to smoke on the Sabbath. He interviewed the participants three days a week at the end of the day—on the Sabbath, on a regular weekday, and on a weekday when they were asked to refrain from smoking.

Dr. Dar found that cravings were very low on the morning of the Sabbath, when participants knew they couldn’t smoke. Cravings increased toward the end of the day, when smokers anticipated the next day. Cravings on the normal weekday were just as high as the day they refrained from smoking, suggesting that smoking doesn’t have very much to do with being deprived of nicotine.

After taking both of these studies into consideration, the researchers believe that while nicotine affects people physiologically, it doesn’t create biological withdrawal symptoms as heroin does. Instead of the body “needing” nicotine, people continue smoking because a habit has been established, and they crave cigarettes in response to cues that are associated with smoking.

Looking at smoking as “mind over matter” could help provide more efficient treatments for quitting smoking that focus on the psychological aspects of smoking rather than the physical elements.

Source: Science Daily, Smoking Mind Over Smoking Matter: Surprising New Study Shows Cigarette Cravings Result from Habit, Not Addiction, July 13, 2010

Study Finds Smoking More Psychological than Physical Addiction is a post from: Drug Addiction Treatment

With funding from NHS Nottingham City, the researchers plan to challenge the social acceptance of smoking in Nottingham’s Aspley ward, which has the third highest rate in England. Fifty-three percent of Aspely residents smoke, compared to the national average of twenty-one percent. Smoking is a main reason for premature death in Aspley.

Professor Ann McNeill, of the UK Centre for Tobacco Control Studies at the University, and her colleagues wanted to find out why so many people in Aspley smoke, and to study the effect of social challenges—such as high unemployment rates and low incomes—on smoking rates in the community.

The researchers hope to use this information to develop a community-lead approach to reducing smoking in Aspley, creating a positive environment where young people don’t start smoking and people who want to quit smoking are given the support they need.

They interviewed 100 people on the street and held focus groups consisting of current smokers, former smokers, and non-smokers of all ages to discuss the differing attitudes toward smoking.

From these interviews and focus groups, they found that smoking was the social norm, and was strongly associated with unemployment, boredom, and stress. It was also seen as a social activity, allowing people in the community to identify with one another.

They found that there was a general lack of health awareness in regard to healthy eating, alcohol consumption, and smoking, but residents had a great amount of sympathy for people who were seen as disadvantaged and addicted to smoking.

People seemed to accept the negative consequences of smoking, but dismissed government warnings for the most part. They also generally believed that there needs to be more education about the dangers of smoking for children, which should begin in elementary school.

Many smokers and non-smokers considered cigarettes a “little luxury” that disadvantaged people could enjoy. While most smokers wanted to quit smoking, it was often put off until the timing or mental state was right.

Finally, most people thought that smoking cessation services needed to be more flexible and accessible to those in poorer areas.

Professor McNeill said that they also identified a strong sense of community, which could be used to promote their anti-smoking efforts. The researchers felt that they would have more success by allowing problems to be addressed at a local level.

Marilyn Antoniak, a fellow researcher, said that by working with community members, they hope to send positive messages to smokers to encourage them to use the local support to help them cut down and eventually stop smoking. The two-year project is an example of “action research,” where researchers use the local community to address social issues.

Dr. Jeanelle de Gruchy, Deputy Director of Public Health at NHS Nottingham City, said that this kind of research is important in understanding why the smoking rate is so high in some communities. Once more is understood about the reasons behind smoking, researchers can more effectively provide an environment that prevents smoking and helps people quit.

Source: Science Daily, A Community Approach to Kicking the Habit, June 29, 2010

Researchers Plan to Use Community to Help Reduce Smoking in Nottingham is a post from: Drug Addiction Treatment

Dave writes that the problem with “light addictions” like this is that the more we use them, the more we’re training our brains to rely on unhealthier forms of stress relief.

He notes that caffeine is listed among all the other drug dependencies in the medical disease classifications; however, it is not considered a drug of abuse like nicotine.

Bill tells Dave that he went through rehab in the “Golden Age of Smoking,” when everyone in treatment was constantly drinking coffee and smoking throughout meetings. He noticed that most drug rehab centers are now offering help with nicotine cessation, as well as offering decaf.

Studies like the National Institute of Health’s report from Drs. Friend and Pagano consistently show that smokers who quit using tobacco when they quit drinking also have lower levels of further alcohol use than those who continue smoking, says Dave, adding that the relationship between alcohol and smoking is compelling. He writes that giving up the “light” addiction of tobacco gives you better odds of not succumbing to the addictive use of harder, more emotionally destructive drugs.

Bill adds that he’s read studies that show that 60-95% of alcoholics are also dependent on nicotine, and Dave replies that he would like to see standard addiction treatment merged with the wellness retreat center models of lifestyle change that have long been used with cardiac and cancer patients and other survivors of life-threatening diseases. These programs are designed for a post-rehab residency of seven to 14 days, and directly go after the lifestyle stressors and their imbalance that underlie the “light” addictions.

“Light” Addictions May Be More Serious Than Previously Thought is a post from: Drug Addiction Treatment

“We found that those teens who gravitate toward novel experiences were especially drawn to cigarettes described as having an appealing, sweet flavor, such as cherry,” says lead author Kenneth Manning with Colorado State University.

Science Daily reports that the study, published in the December issue of the journal Tobacco Control, was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.

Past research has found that high-sensation-seeking youth are more likely to smoke cigarettes than their low-sensation-seeking peers, Manning notes. But until now, no studies have looked at how novel, sweet-tasting cigarettes might impact this group of thrill seekers. The authors proposed that the influence of cigarette flavor descriptors lies in their ability to alter the “arousal potential” of a cigarette brand’s marketing communications (such as its packaging). Arousal potential refers to the degree to which a stimulus (like the description of a cigarette’s flavor) is capable of gaining attention and exciting the nervous system.

To test this theory, the researchers divided 253 high school students into two groups to evaluate three pictures of cigarette packages: Camel, American Spirit, and a fictitious brand, “Onyx.” The first group viewed packages that included traditional cigarette descriptions such as “domestic blend,” and the second group of teens viewed packages with the cigarettes described as “cherry.” Following exposure to each package, the study participants responded to several questions regarding the appeal of the brand (i.e., beliefs about how enjoyable it would be, overall evaluation, and trial intention).

To determine their sensation-seeking tendencies, the students responded to measures such as “I would like to explore strange places” and “I like friends who are exciting and unpredictable.”

Sensation-seeking varies over a continuum, explains Manning. “In our study, we essentially divided half of the students into the high group and the other half into the low group based on their overall sensation-seeking scores.”

Results indicated that the appeal of the brands across the belief, attitude, and trial intention measures depended on both the sensation-seeking tendency of the student and whether the student had viewed the brand packages with the traditional or sweet flavor descriptions. In particular, among students who were classified as high-sensation seekers, the cigarette brands were significantly more appealing to those exposed to the packages that included the sweet flavor descriptors than to those who had viewed the packages with the traditional descriptions.

This underscores a key point of the FDA ban — that flavors make cigarettes and other tobacco products more appealing to youth, and are created to attract and allure kids into lifelong addiction. “By enhancing the arousal potential associated with tobacco brands, sweet flavor descriptors boost the appeal of these products among high-sensation seekers,” the authors conclude.

The FDA encourages consumers to report continuing sales of flavored cigarettes through a special tobacco hotline (1-877-CTP-1373) and web site (www.fda.gov/flavoredtobacco).

Parents and consumers can learn more about the risks of flavored tobacco products by clicking here.

Thrill-Seeking Teens Susceptible to Sweet-Tasting Cigarettes is a post from: Drug Addiction Treatment

Science Daily reports that only 15 percent of those committed to never smoking at the start of a longitudinal study experimented with cigarettes over three years of follow-up. Over the same time, 45 percent of those who were deemed susceptible at first went on to experiment.

"Susceptibility to smoking is a measurable characteristic that predicts transition to smoking. Our results suggest that prevention efforts tailored to an adolescent’s susceptibility status may be more effective among Mexican-American youth," said senior author Anna Wilkinson, Ph.D., assistant professor in M.D. Anderson’s Department of Epidemiology.

Research shows that Mexican-American adolescents are more inclined to experiment than other groups, and experimentation is likely to lead to a permanent habit, so the authors note that understanding susceptibility offers an opportunity for early intervention.

Susceptibility reflects the lack of a firm commitment to not smoke in the future assessed by a positive answer to at least one of three questions: whether they expect to try a cigarette soon, if they would smoke a cigarette offered by a friend, and whether they expect to be smoking in a year.

Wilkinson and colleagues followed 964 Mexican-origin girls and boys ages 11 to 13 from the Houston metro area who had never smoked for three years after initial assessment.
Without baseline susceptibility taken into account, the study identified significant predictors of experimentation, including being male, 13 years old, having low subjective social status, having some positive expectations about smoking, at least one school detention, and living with someone who smokes.

When the researchers added the adolescents’ baseline susceptibility status to the model, it became the strongest predictor of experimentation, causing a 2.6-fold increase in risk, and all other influences accept age and living with a smoker were no longer statistically significant.

While previous studies had demonstrated the importance of susceptibility among other ethnic groups, this study was the first to examine its role leading to experimentation among Mexican-American youth. The study’s findings are consistent with those of other ethnic groups. "Our results suggest that being susceptible to smoking is not ethnic-specific," Wilkinson said.

Future studies need to focus on understanding and targeting risk factors for susceptibility to prevent experimentation and habitual smoking, the authors note.

Separate approaches need to be considered for those who are committed to never smoking, because 15 percent of them go on to experiment. Culturally sensitive approaches that rely more on peer influence might work well for this group, Wilkinson said.

The longitudinal study was made possible by the Mexican-American Cohort Study, an effort that has recruited more than 12,000 families to better understand factors that influence Mexican-American health over time. The cohort is funded by Texas Tobacco Settlement funds and M. D. Anderson.

This research was funded by a grant from the National Cancer Institute, the Duncan Family Institute for Cancer Prevention and Risk Assessment at M. D. Anderson and by the Caroline W. Law Fund for Cancer Prevention.

Co-authors with Wilkinson are first author Amy Spelman, Margaret Spitz, M.D., and Melissa Bondy, Ph.D., all of M. D. Anderson’s Department of Epidemiology; Alexander Prokhorov, M.D., Ph.D., of M. D. Anderson’s Department of Behavioral Science; Steven Kelder, Ph.D., of the Division Epidemiology at The University of Texas School of Public Health in Houston; and Ralph Frankowski, Ph.D., of the Division of Biostatistics, also at the UT School of Public Health.

Initial Attitude Predicts Smoking among Mexican-American Youth is a post from: Drug Addiction Treatment

Science Daily reports that in the past eight to ten years, smoking tobacco with a waterpipe, also called a hookah or shisha, has grown in popularity in the United States, especially among adults aged 18 to 24. The belief among some waterpipe users is that this method of smoking tobacco delivers less tar and nicotine than regular cigarette smoking and has fewer adverse health effects.

“The results are important because they provide concrete, scientific evidence that contradicts the oft-repeated myth that waterpipe tobacco smoking does not involve users inhaling the same harmful chemicals that cigarette smokers do,” said principal investigator Thomas Eissenberg, Ph.D., professor in the VCU Department of Psychology.

“We hope that these results will be used by physicians and public health officials to inform waterpipe tobacco smokers that they risk tobacco-induced nicotine addiction and cardiovascular disease,” he said.

According to Eissenberg, no previous single study has compared the human toxicant exposure associated with waterpipe and cigarette smoking under controlled, laboratory conditions.

Between 2008 and 2009, Eissenberg, together with Alan Shihadeh, Sc.D., associate professor at the American University of Beirut in Lebanon, compared the toxicant exposure associated with waterpipe smoking and cigarette smoking among 31 participants between the ages of 18 and 50. Each participant completed two 45-minute sessions, one in which they smoked tobacco using a waterpipe and the other in which they smoked a single cigarette. The level of nicotine and carbon monoxide in the participants’ blood was measured, as was heart rate, puff number, and puff volume.

They found that on average, the levels of carbon monoxide to which participants were exposed were higher when they were smoking a waterpipe than when they were smoking a cigarette. Specifically, the peak waterpipe COHb level—amount of carbon monoxide found bound to red blood cells—was three times that observed for cigarettes. However, they observed that the peak nicotine levels did not differ, but there was exposure to nicotine through both methods of tobacco smoke. Examining the number and volume of each puff showed that compared with smoking a cigarette, waterpipe tobacco smoking involved inhalation of about 48 times more smoke.

In previous work, Shihadeh had conducted studies that demonstrated that waterpipe tobacco smoke contains compounds that cause cancer and other disease, so the large amount of smoke inhaled when using a waterpipe was a concern for the research team.

Eissenberg, who is director of the VCU Clinical Behavioral Pharmacology Laboratory and a researcher with the VCU Institute for Drug and Alcohol Studies, and Shihadeh, who is director of the American University of Beirut Aerosol Research Laboratory, are continuing their laboratory studies of waterpipe tobacco smoking to examine what other dangerous chemicals are inhaled when individuals and groups engage in this behavior.

They hope that future large-scale studies of the health effects of tobacco use will examine waterpipe smokers separately, to determine the extent to which waterpipe tobacco smoking can be linked to tobacco-caused disease.

This work was supported by grants from the U.S. Public Health Service.

Smoking Tobacco through Waterpipe Just as Harmful as Cigarettes is a post from: Drug Addiction Treatment

“Secondhand smoke in children is not just bad for respiratory issues, as has been previously described by other researchers,” said John Anthony Bauer, Ph.D., the study’s senior co-author and principal investigator at Nationwide Children’s Hospital & Research Institute at Ohio State University in Columbus.

“Our data support the view that cardiovascular effects of secondhand smoke in children are important, particularly for the very young and those who are obese. We had not investigated the impact of obesity in previous studies,” he continued.

Bauer and colleagues recruited American boys and girls, including 52 toddlers (ages 2 to 5 years) and 107 adolescents (ages 9 to 18 years). The study included black, white, and Hispanic children, including obese toddlers and adolescents.

The researchers found that there was a link between the amount of secondhand smoke exposure and a marker of vascular injury in toddlers, and this link was two times greater in toddlers who were obese. They also found that obese adolescents exposed to secondhand smoke had two times the evidence of vascular injury compared to normal-weight adolescents.

In addition, toddlers had four times the risk of secondhand smoke exposure when compared to adolescents, despite having similar reported home exposures. Toddlers exposed to secondhand smoke had a 30 percent reduction in circulating vascular endothelial progenitor cells, a cell type involved in repair and maintaining a healthy blood vessel network.

“The changes we detected in these groups of children are similar to changes that are well recognized risks for heart disease in adults,” Bauer said. “This suggests that some aspects of adult heart disease may be initiated in early childhood, where prevention strategies may have great long-term impact.”

Bauer and colleagues determined the extent of secondhand smoke exposures and, via blood samples, analyzed vascular injury markers and inflammation for each child. They also measured the numbers of circulating vascular endothelial progenitor cells. They obtained height, weight, blood pressure, and socioeconomic information for each child studied.

Many forms of cardiovascular disease start in childhood, and at least a quarter of children in the United States are exposed to secondhand smoke. Researchers tried to determine if children exposed to secondhand smoke had measurable changes in markers of cardiovascular disease and if some children, particularly obese children, were at greater risk of these problems.

“We do know that secondhand smoke as well as smoking causes increased oxidation and inflammation,” Bauer said. “Separately, other studies within the past few years have shown that obesity is a physiological condition of chronic low-grade inflammation, and that this can lead to vascular damage. We think that the two factors together (e.g., smoke exposures plus obesity) may interact to amplify the degree of inflammation or vascular cell damage that occurs.”

Bauer and colleagues looked at a cross-section of children at one point in time. Whether these differences progress or change over time as the children grow is unknown.

“Our findings add to the importance of eliminating smoking and related exposures, especially for children, and obese children may need to be even more protected from these exposures,” Bauer said.

Co-authors are Judith Groner, M.D.; Hong Huang, M.D., Ph.D.; Bing Han, Ph.D.; and Bethany Hashiguchi, M.S. The National Institutes of Health funded the study.

Secondhand Smoke Exposure Worse for Toddlers and Obese Children is a post from: Drug Addiction Treatment

Science Daily reports that studies have consistently found that prenatal cigarette smoke exposure is associated with increased rates of behavior problems, irritability, attention-deficit/hyperactivity disorder, the risk of violent offenses, conduct disorder, adolescent onset of drug dependence, and the risk for criminal arrest in offspring. This study adds another potential negative outcome to the list of reasons for mothers to stop smoking while pregnant.

Most of the effects of tobacco either during pregnancy or on postnatal outcomes are attributed to nicotine. However, smoking is associated with reduced monoamine oxidase A (MAO-A) activity, enzymes that degrade brain neurotransmitters in smokers. Prenatal smoke exposure-induced low MAO-A activity in fetal life may dysregulate brain neurotransmission, creating a potential vulnerability to develop behavioral disorders later in life. This dysregulation can occur with or without interaction with nicotine’s effect on the developing brain.

French scientists compared blood biomarkers of MAO-A activity in smoking and non-smoking pregnant women and in the cord blood of their newborns. They also assessed the newborns’ comfort level during their first 48 hours of life. They found that MAO-A activity is reduced both in pregnant smokers and in their newborns. The newborns of smoking mothers also showed significantly more discomfort than those of non-smoking mothers, potentially related to MAO-A inhibition.

Corresponding author Dr. Ivan Berlin explained that this paper’s findings "may have implications for future research because it proposes a biological explanation for the previously demonstrated relationship between smoking during pregnancy and behavioral disorders in the offspring."

"We know that maternal smoking can negatively affect a newborn in many ways, such as contributing to low birth weight. Berlin and colleagues provide new evidence that the newborns of mothers who smoke experience more behavioral discomfort, and they suggest a mechanism that helps to explain the cause of this discomfort," commented Dr. John Krystal, Editor of Biological Psychiatry.

Although additional studies are needed, this work highlights the importance of targeting pregnant women for help to stop smoking

Maternal Smoking Can Increase Level of Discomfort in Newborns is a post from: Drug Addiction Treatment

The Associated Press reports that the results do not prove that the drug works but encouraged some experts. Dr. Frank Vocci, director of medications development at the National Institute on Drug Abuse, said it “clearly shows promise” and merits a definitive study. The NIDA has given $8 million for the research so far.

The drug is called NicVAX and is a vaccine designed to “immunize” smokers against the nicotine rush that fuels their addiction. The treatment keeps nicotine from reaching the brain, taking the “buzz” out of smoking and hopefully making it easier to give up. Some nicotine still gets in, possibly easing withdrawal, which is the main reason people trying to quit relapse.

This approach—attacking dependency in the brain—is different than just replacing nicotine, as the gum, lozenges, patches, and nasal sprays do.

The study involved 301 longtime smokers in Minneapolis, Omaha, San Francisco, Los Angeles, Boston, New York City and Madison, Wisconsin. Participants were given four or five shots within six months, at one of two doses, or placebo shots. Neither they nor their doctors knew who got what.

Initial shots “prime” the immune system. Later doses make it produce antibodies, which latch onto nicotine in the bloodstream and keep it from crossing the blood-brain barrier and maintaining the addiction.

One year into the study (six months after volunteers received the last shot) 14 percent taking the lower dose and 16 percent taking the higher dose of five shots had quit. Only 6 percent of those given four shots or the fake vaccine had quit.

“These quit rates are comparable to what’s seen in other studies for things that are considered to work,” said the lead researcher, Dr. Stephen Rennard of the University of Nebraska.

“These are impressive preliminary data,” said Dr. Sidney C. Smith Jr., a cardiologist at the University of North Carolina at Chapel Hill and past heart association president. Getting people to quit smoking “may well be at the top of the list” for improving public health, said Smith. An estimated 1.3 billion people worldwide smoke, and it’s a leading cause of cancer and heart disease.

However, some doctors were not as impressed. “I’m a little underwhelmed,” said Dr. Timothy Gardner, a heart association spokesman and cardiologist at Christiana Care Health System in Newark. He “would think we could expect better” with such a novel approach, and he found it hard to understand why five shots worked and four did not.

The Food and Drug Administration has granted the vaccine fast-track status, meaning it will get prompt review.

New Drug Shows Promise in Helping People Quit Smoking is a post from: Drug Addiction Treatment

Tanski, an assistant professor of pediatrics at Dartmouth Medical School, said that “bad guys” are more often smokers in movies, but that there are usually more “good guys” than “bad guys.” “Episode for episode, youth who saw negative characters smoking were more likely to start smoking, but since overall there is so much more exposure to ‘good guy’ smoking, the net effect is similar,” she said.

The study also found that low-risk teens, based on sensation-seeking behavior, are more strongly influenced by “bad guy” smoking. “This suggests that it’s alluring for ‘good’ kids to emulate the ‘bad’ characters on the movie screen,” said Tanski.

Tanski and colleagues at Dartmouth College and Medical School have been studying the connection between popular culture and risky behavior in adolescents. They have published several journal articles documenting the link between exposure to smoking and drinking in movies and teens using the substances.

In May 2009, two members of the team published a research letter that reported declining trends in both occurrences of smoking in movies and smoking among US eighth graders between 1996 and 2007. The authors state, “Movie smoking represents only one of several factors that contribute to youth smoking trends, including the marketing of tobacco, price of cigarettes, restrictions imposed by the Master Settlement Agreement in 1999, and state prevention programs…Nonetheless, the downward trend in movie smoking is consistent with an influence on downward trends in adolescent smoking.”

Tanski acknowledges that although there is a downward trend, smoking still occurs in many movies that teens watch, particularly given the accessibility to “older” movies through movie channels and video rental services. “Parents should limit movie viewing and specifically restrict access to R-rated movies, which tend to contain more smoking,” she said. “When teens do see movies or TV shows that contain smoking, parents should talk with them in an effort to discourage initiation of smoking.”

Cigarette Smoking in Movies Influences Teens is a post from: Drug Addiction Treatment