The relationship between alcohol use and cigarette smoking in a sample of undergraduate college students

During the decade of the 1990s, smoking prevalence increased nearly 30% in the college student population. Although most college students initiate smoking before the age of 18, recent evidence suggests a sizable minority of undergraduates report starting smoking while in college. This study examined the concurrent use of alcohol and tobacco as well as the relationship between alcohol use and smoking initiation among a sample of undergraduate students attending a large public university in the southwestern United States. We defined three categories of smoking status for this study: never smokers (n=777), experimenters (n=158), and smokers (n=178). Both experimenters and smokers reported consuming significantly more drinks per occasion in the past 28 days and more drinks on one occasion in the past 2 weeks compared to never smokers; however, there was no significant difference between experimenters and smokers on either of these measures of consumption. The results of two multinomial logistic regression models showed that measures of alcohol consumption and drinking frequency were significantly associated with being an experimenter or smoker after controlling for demographic and other drug use covariates. Results of a logistic regression analysis revealed a significant relationship between past year drinking frequency and smoking initiation among respondents who reported that they were not smoking at all 12 months prior to their survey participation. The influence of alcohol consumption on smoking initiation among college students is discussed.     

Chronic musculoskeletal pain and cigarette smoking among a representative sample of Canadian adolescents and adults

The present investigation sought to examine the relation between specific types of chronic musculoskeletal pain and cigarette smoking among a large representative sample of adolescents and adults residing in Canada. Specifically, we examined the relations between chronic back pain, arthritis, and daily smoking status. As predicted, individuals with chronic back pain were more likely to smoke than those without chronic back pain or arthritis; this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder. An opposite, albeit less robust, association was evident for the prescence of lifetime arthritis and smoking. Future work is needed to better understand the mechanisms underlying the association between chronic pain and smoking.     

Event time-series relationship between cigarette smoking and coffee drinking

Eight subjects resided in a programmed laboratory environment for seven to twelve successive days during which time cigarettes and coffee were freely available. An event time-series analysis based upon instances in time of each substance's use revealed a relationship between cigarette smoking and coffee drinking: a coffee-drinking event tended to occur late in the inter-cigarette interval, and a cigarette-smoking event was most probable during the twenty minutes immediately following a coffee-drinking event.     

The relationship between cigarette smoking and chronic low back pain.

This study investigated the extent to which habitual cigarette smoking relates to physical and psychological indices of chronic pain. From a review of patient records, 54% of back pain patients referred for treatment of their pain admitted to smoking cigarettes. Response from a smoking questionnaire showed that 57% of the patients who smoked reported having a need to smoke when they were in pain. Most patients (91%), however, believed that smoking had no effect on their pain intensity. When smoking and nonsmoking back pain patients were compared, the smokers showed significantly higher levels of emotional distress, they tended to remain inactive, and they relied on medication more often than the nonsmoking patients. The results further suggest that pain patients are at risk for increasing smoking behavior when they are experiencing periods of heightened pain intensity.     

The relationship between sickness absence from work and pattern of cigarette smoking

In four worksites of 1248 employees, 907 were found who had worked for the employer for 12 months or more and had had a preemployment medical examination. Nonsmokers were absent from work for sickness reasons less often than smokers (3.1 hours per month compared with 3.6 for women, 3.5 compared with 3.9 for men). Among smokers who reported the amount smoked heavier smokers claimed more sickness absence than less heavy smokers. Smokers reporting one pack or more per day had twice the sickness absence of smokers who smoked half a pack or less per day. The results support other studies which show higher relative risk for sickness absence among smokers than among nonsmokers.     

Genetic correlations between smoking initiation and smoking behaviors in a twin sample

Early exposure to cigarettes is connected to increasing rate of regular use later in life. We examine genetic correlation between the age of first cigarette and later smoking related behaviors. The sample consisted of twin ages 25 to 75. Biometrical analysis was used to evaluate the heritabilities and a second analyses based on Cholesky decomposition determined the shared variance. The genetic variance ranged from 48% to 69%. Models comparing age of first cigarette to and smoking persistence, cessation, and number of cigarettes during year smoked most individually indicated a very small proportion of shared genetic variance (ranging from 0.004 to 0.056). These findings support separate genetic and unshared environmental processes for the age of first cigarette as compared to three other smoking related phenotypes. Research in substance abuse risk and prevention literature suggests that delaying initial exposure is a critical step reducing in the risk of later regular use. The interventional implications of the findings support the importance of a tailored approach to preventing smoking behavior and reducing harm in smokers.     

Stages of adolescent cigarette smoking acquisition: Measurement and sample profiles

A stage model of adolescent cigarette smoking acquisition was developed and an instrument to measure the stages was created. Internal validity was obtained based on principal component analysis, item analysis, and coefficient alpha. Three distinct components were labeled precontemplation, decision-making, and maintenance. The scales had reliability coefficients ranging from .86 to .94. External validity was obtained by relating the scale scores to measures of smoking behavior and intent to smoke. A cluster analysis resulted in nine distinct clusters, including profiles representing precontemplation, contemplation, decision-making, action, and maintenance stages. Further validity was obtained for the clusters by comparing groups on the perceived positive and negative consequences of smoking, and the derived pleasure from smoking.     

Good relationship between saliva cotinine kinetics and plasma cotinine kinetics after smoking one cigarette

This study investigated the relationship between plasma and saliva cotinine kinetics after smoking one cigarette and the relationship between cotinine kinetics and estimated nicotine intake, which was calculated as mouth level exposure (MLE) of nicotine, from smoking two test cigarettes with different nicotine yields. This study was conducted in 16 healthy adult Japanese smokers, who did not have null nor reduced-activity alleles of CYP2A6, with a quasi-randomized crossover design of smoking a low-tar cigarette or a high-tar cigarette. Saliva cotinine showed similar concentration profiles to plasma cotinine, and all of the calculated pharmacokinetic parameters of cotinine showed the same values in plasma and saliva. The C_max and AUC of cotinine showed almost the same dose-responsiveness to the estimated MLE of nicotine between plasma and saliva, but the t_max and t_1/2 of cotinine were not affected by the estimated MLE of nicotine in either plasma or saliva. The results show that saliva cotinine kinetics reflects plasma cotinine kinetics, and measurement of saliva cotinine concentration gives the same information as plasma cotinine on the nicotine intake. Thus, saliva cotinine would be a good and less-invasive exposure marker of cigarette smoke, reflecting the plasma cotinine concentration and kinetics.     

Marijuana use and cessation of tobacco smoking in adults from a community sample

Tobacco smokers are more likely to use marijuana than those who do not smoke tobacco. Little is known about how marijuana use affects the probability of tobacco smoking cessation. This analysis was based on 431 adults less than 45 years of age who reported recent tobacco smoking in the 1981 baseline interview in the household-based Baltimore Epidemiologic Catchment Area study and were re-interviewed 13 years later. At baseline, 41% of the tobacco smokers reported ever use of marijuana, 27% reported use of marijuana in the previous 30 days, and 9% reported daily use of marijuana for 2 weeks or more in the last 30 days. Marijuana users in the past 30 days at baseline were more likely than nonusers to still be using tobacco at follow-up after adjusting for race, educational level and marital status (OR = 1.94, 95% CI = 1.03, 3.63). Daily use of marijuana at baseline was even more strongly related to continued tobacco smoking 13 years later. Difficulty in tobacco cessation might be considered one of the most important adverse effects of marijuana use. Clinicians working with patients who are trying to stop tobacco smoking may be aided by routinely assessing marijuana use history, particularly with the recent increase in co-smoking of marijuana and tobacco.     

The relationship between chronic ethanol exposure and cigarette smoking in the laboratory and the natural environment

Few studies have examined the association between ethanol use and cigarette smoking topography. In particular, no study has objectively investigated the relationship between chronic ethanol exposure and cigarette smoking. The aim of this study was to quantify the relationship between cigarette smoking and past and current ethanol use. Male and female cigarette smokers (n=77) between the ages of 30 and 65 years were recruited and grouped as a function of their past and current ethanol use. Group 1 (n=18) included subjects who were ethanol abstinent for the 3 months prior to the study and had no history of alcohol abuse (as defined by DSM-III criteria). Group 2 (n=19) included subjects who were current regular ethanol users and had no history of alcohol abuse. Group 3 (n=20) included subjects who were ethanol abstinent and had a history of alcohol abuse. Group 4 (n=20) included current regular ethanol users with a history of alcohol abuse. A history of alcohol abuse was associated with an intensified pattern of cigarette smoking. Significant differences were observed for total daily smoke exposure, cigarette number, puff number, total puff and inhalation volume, and the nicotine, tar and carbon monoxide yields of the cigarettes smoked. Increased expired-air carbon monoxide and serum cotinine levels were also observed. Current ethanol use was not associated with an increased cigarette smoking pattern. These data suggest that alcohol abusers are at greater risk of contracting cigarette-related pathology.Supported by National Institute on Drug Abuse Research Grant No. DA 05013 and DA 02988     

The relationship between pregnancy intention and change in perinatal cigarette smoking: An analysis of PRAMS data

This study examined the relationship between pregnancy intention and change in perinatal cigarette smoking from a large national sample of women in the United States, the 2004–2008 Pregnancy Risk Assessment Monitoring System (PRAMS). The study sample consisted of 49,510 female smokers. Smoking rates and quantities were captured prior to pregnancy, the last 3 months of pregnancy, and postpartum. Changes in smoking were compared between pregnancies classified as intended, mistimed, and unwanted. Regardless of pregnancy intention status, most behavior change happened before the final 3 months of pregnancy. Overall, most women were able to quit or reduce smoking. However women with unwanted pregnancies had 0.86 times the adjusted odds of quitting/reducing cigarette smoking compared to women with intended or mistimed pregnancies (95% CI: 0.78, 0.95). Findings suggest early smoking cessation interventions lead to greater change in smoking, regardless of pregnancy intention, although change is more difficult for women with unwanted pregnancies.     

Radiographic findings in cotton textile workers and the relationship to cigarette smoking

A group of 140 cotton textile workers from Shanghai, Shandong, Guangxi, and Beijing have had their chest radiographs taken using similar requirements. Most had come from the preparatory departments of cotton mills and had a history of exposure to cotton dust for at least 20 years. As controls, 140 healthy individuals with no dust exposure were matched with respect to sex, age, and smoking history. All the radiographs were read according to the ILO International Pneumoconiosis Classification, and the manifestations belonging to categories 0/0 and 0/1 were grouped as "normal," whereas categories 1/0, 1/1, and 1/2 and above as "abnormal." There was no significant difference in X-ray abnormalities between cotton textile workers and controls (P greater than 0.05). But when the data on the cotton textile workers and controls were combined, an appreciable difference in the incidence of radiographic abnormalities was found between smokers and non-smokers (P less than 0.001). Cotton dust exposure may induce nonspecific interstitial pulmonary changes, but these changes were exaggerated by cigarette smoking. These two factors appeared to have an additive effect on the pulmonary X-ray findings.     

Predictors of cigarette smoking by young adults and readiness to change.

A survey on cigarette smoking of a sample of 406 students aged 16/17 years from a Swiss city was carried out in 1995, and the sample was reinvestigated in 1998. Measures were taken of gender, age, school attendance (vocational or other), negative feelings, perception of danger. parental smoking, and reasons for smoking or not smoking at Time 1. Time-2 measures included stages-of-change in smoking cessation and nicotine addiction. Negative feelings at ages 16/17 were predictive of nicotine addiction at ages 19/20, and highly predictive for starting smoking within this period. Frequent smoking and relaxation as a reason for smoking was more likely for sustained smokers than for quitters. The results suggest that if adolescents begin to smoke in order to cope with negative feelings they continue to do so and increase their smoking. Cessation can probably be promoted by advice to reduce the frequency of smoking.     

Some correlates between cigarette smoking and alcohol use.

Based on parallels that have been noted between cigarette smoking and alcohol use, recent advances in alcoholism treatment strategies are extrapolated to cigarette smoking treatment. These include: training individuals in self-control strategies, particularly training to deal with stressful situations in alternative ways; continued exploration of the possibility of controlled smoking treatments and determination of the type(s) of individual(s) best suited to such a treatment goal; and, examining variables other than simple abstinence to determine treatment effectiveness.     

Momentary smoking context as a mediator of the relationship between SES and smoking

There is a well-established socioeconomic gradient in smoking behavior: those with lower socioeconomic status smoke more. However, much less is known about the mechanisms explaining how SES is linked to smoking. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behavior by differential exposure to places where smoking is allowed. Exposure to smoking restrictions was assessed in real-time using Ecological Momentary Assessment methods. A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether a smoker's momentary context mediated the relationship between socioeconomic status (educational attainment) and cigarettes smoked per day (CPD). Momentary context was operationalized as the proportion of random assessments answered in locations where smoking was allowed versus where smoking was not allowed. Data were analysed using multilevel regression (measurements nested within participants) with a lower level mediation model (2-1-1 mediation). Although no significant direct effect of SES on CPD were observed, there was a significant indirect effect of SES on CPD via the momentary context. Compared to participants with higher education, lower educated participants were more likely to encounter places where smoking was allowed, and this in turn, was associated with a higher number of CPD. These findings suggest that SES is associated with smoking at least partially via differential exposure to smoking-friendly environments, with smokers from lower SES backgrounds accessing more places where smoking is allowed. Implications for current smoke-free legislation are discussed.     

The relationship between smoking machine derived tar yields and biomarkers of exposure in adult cigarette smokers in the US

Comprehensive data on human exposure to smoke constituents from different machine-measured tar yield cigarettes is limited. Methods: This study used a stratified, cross-sectional, multi-center design to estimate biomarkers of exposure (BOE) from nicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), pyrene, CO, acrolein, and 1,3-butadiene and their relationship to tar yield categories of cigarette in adult smokers in the U.S. 3625 adults smokers were enrolled into four tar categories 2.9 mg (T1), 3.0–6.9 mg (T2), 7.0–12.9 mg (T3), and 13.0 mg (T4). Biomarkers were measured in blood (carboxyhemoglobin, 4-aminobiphenyl-hemoglobin (4-ABP-Hb)-adducts, serum cotinine) and 24 h urine (nicotine and five metabolites, calculated as nicotine equivalents (NE), NNAL, 1-OH-pyrene, 3-HPMA, MHBMA and DHBMA). Data were analyzed using analysis of covariance (ANCOVA). Results: Tar was a significant factor for most biomarkers in the ANCOVA models. The largest least square mean differences between tar categories was 35% for NE per day, 28% for NE per cigarette, 36% for serum cotinine, 42% for NNAL per day, 29% for NNAL per cigarette, 26% for 1-OHP, 24% for COHb, 14% for 3-HPMA and 40% for 4-ABP-Hb. Variability in BOE ranged from 41% to 154% CV. Conclusions: There was a statistically significant effect of machine-measured tar yield on most BOE, which were generally lower with lower tar yield.     

Relationship between weight status and delay discounting in a sample of adolescent cigarette smokers

Obesity and cigarette smoking are often cited separately as the top two preventable causes of death in the United States; however, little research has explored the factors associated with being both obese and a smoker. Delay discounting is a behavioral characteristic that may underlie both of these conditions/behaviors. Delay discounting describes the extent to which an individual discounts the value of an outcome because of a delay in its occurrence. Higher rates of discounting are often considered as an index of impulsivity and have been linked with obesity and cigarette smoking. No research to date has explored delay discounting in a sample of obese smokers. For this study, adolescent smokers classified as obese (body mass index >95th percentile) and healthy weight (body mass index between the 5th and 85th percentiles) were compared on a laboratory assessment of delay discounting. Obese smokers discounted significantly more by delay than healthy weight smokers. This difference remained statistically significant even after controlling for demographic variables that differed across groups. These findings suggest that the relationships between delay discounting and obesity and cigarette smoking may be additive, such that extreme discounting might proportionally increase the risk of becoming an obese smoker. However, future prospective study is needed to fully determine the veracity of this hypothesis.     

The relationship between cigarette smoking and impulsivity: A review of personality,behavioral, and neurobiological assessment

Impulsivity is a multi-dimensional construct that broadly encompasses impaired self-regulation. Studies comparing substance users and non-users, including cigarette smokers, consistently find that users are more impulsive than non-users. However, identifying the role of impulsivity in cigarette smoking initiation, maintenance, and relapse has been challenging because of variation in how impulsivity is defined and whether it is assessed as (1) a stable personality trait, (2) a behavior (either trait or state), or (3) a neurobiological process. Personality and behavioral assessments are typically weakly correlated or uncorrelated, but both types of impulsivity have been related to brain activity in the prefrontal cortex (PFC) and associated areas. This article provides a narrative review of research pertaining to the relationship between impulsivity and cigarette smoking, including smoking initiation, maintenance, and relapse, with respect to these three methods of impulsivity assessment. This review revealed that impulsivity is associated with all stages of tobacco use. Regarding initiation, research involving adolescents suggests that differences between adult smokers and non-smokers in self-reported impulsivity appear to pre-date smoking initiation, whereas behavioral impulsivity has not been as consistently associated with adolescent smoking. Conversely, chronic exposure to nicotine and acute nicotine deprivation may also increase impulsivity. Regarding maintenance and relapse, urgency, an aspect of impulsivity that refers to the tendency to act impulsively when experiencing negative affect, seems to play a particularly important role. In future research, investigators should define impulsivity precisely and provide a rationale for the type of assessment used. Targeting impulsivity reduction may facilitate successful smoking cessation.     

A prospective examination of the relationships between PTSD, exposure to assaultive violence, and cigarette smoking among a national sample of adolescents

Research demonstrates robust associations among posttraumatic stress disorder (PTSD), exposure to assaultive violence (i.e., sexual assault, physical assault, and witnessed violence), and cigarette smoking among adults and adolescents. Whether exposure to assaultive violence confers risk for cigarette smoking over and above the effects of PTSD and non-assaultive traumatic events (e.g., motor vehicle accidents) is unclear. The current study prospectively measured PTSD, assaultive violence exposure, non-assaultive traumatic event exposure, and cigarette smoking three times over approximately three years among a nationally representative sample of adolescents (N=3614, age range 12-17 at Wave 1). Results revealed that multiple exposure to assaultive violence at Wave 1 was a consistent and robust prospective predictor of cigarette smoking at Waves 2 and 3. By contrast, PTSD diagnoses and non-assaultive traumatic event exposures at Wave 1 only predicted cigarette smoking at Wave 2, but not at Wave 3. Theoretical and clinical implications are discussed.     

Correlates of smoking cessation in a nationally representative sample of U.S. adults

Persistent cigarette smoking is associated with significant morbidity and mortality. Correlates of difficulty quitting smoking include psychopathology, such as major depressive disorder, and problems with other substances, such as alcoholism. In addition, socio-demographic risk (e.g. poverty) and protective (e.g. living in a region with stringent tobacco laws) influences can modify risk for persistent cigarette smoking. Using data on 17,919 individuals with a lifetime history of smoking 100 or more cigarettes, from a nationally representative U.S. sample, we examine the constellation of risk and protective factors that correlate with smoking cessation (defined as remaining smoke-free in the past 12 months) across four cohorts: young (18-31 years), intermediate-aged (32-43 years), middle-aged (44-60 years) and older (61-99 years) adults. Using survival analyses, we demonstrate that in addition to a history of DSM-IV nicotine dependence, which is negatively associated with smoking cessation, living below the poverty line is also associated with persistent smoking across all age cohorts. Residents over the age of 31 years living on the U.S. West Coast are less likely to be persistent smokers as well. Major depressive disorder is associated with persistent smoking, but interestingly, only in middle-aged and older adults. Alcoholism and a family history of substance use problems are both correlated with persistent smoking but only in older adults. Here, we find evidence for psychopathology that may hinder successful quit attempts during the developmental period when a majority of quit attempts are made (early to mid-40's). However, our analyses also highlight the important benefits of effective tobacco legislation on the U.S. West Coast and urge policy makers to actively consider addressing issues surrounding tobacco taxation and the impact of poverty on tobacco use, in addition to the risks posed by co-occurring psychiatric problems and other substance use disorders.