Andrea H. Weinberger

Introduction: Even treatments showing proven efficacy leave the majority of female smokers unable to quit. In response, there has been a special call for novel behavioural treatments, particularly those which target barriers to quitting faced by women. Significant barriers for women who smoke include perceived “risks” associated with cessation (e.g. managing stress and cravings). The purpose of this treatment development study is to test a novel, individualised smoking intervention for female smokers targeting risk perceptions. Methods: Twenty treatment-seeking female daily cigarette smokers were randomly assigned to receive either standard counseling based on the Mayo Clinic’s “Smoke Free and Living It” manual or a new manualised treatment based on individual perceived risks of quitting. Primary outcomes were point prevalence smoking abstinence at the end of treatment and at a 1 month follow-up, and changes in smoking from baseline to 1 month follow-up. Results: The manualised perceived risk treatment demonstrated good acceptability and more participants receiving this treatment were abstinent at the end of the trial than participants in the standard counseling condition. Among participants who did not quit smoking, those receiving the perceived risk counseling reported a greater reduction in smoking at the 1 month follow-up (Cohen’s d = 0.67). Conclusions: This initial study demonstrated that an intervention targeting perceived risks of quitting was feasible to administer, acceptable to female smokers, and showed promise with regard to smoking outcomes, thus warranting further testing through Stage II clinical trials. Reducing perceived risks of quitting may represent a critical target for smoking treatment development.

Aims To determine smoking transitions in a representative sample of US adults. Design Longitudinal study using data from the N ational E pidemiologic S urvey on A lcohol and R elated C onditions (wave 1, 2001–02; wave 2, 2004–05). Setting The general US adult population. Participants A total of 33 309 adults (53.6% female) classified as wave 1 current daily, current non‐daily, former daily, former non‐daily or never smokers. Measurements Smoking transitions were determined from waves 1 and 2 data. Findings Smoking status remained stable for the majority of current daily (79.8%), former daily (95.8%), former non‐daily (96.3%) and never (97.1%) smokers. Among current non‐daily smokers, 54.5% quit smoking while 22.5% increased to daily smoking. Current daily smokers who were older [30–44, odds ratio (OR) = 0.62; 95% confidence interval (CI) = 0.49–0.78; 45+, OR = 0.75; 95% CI = 0.61–0.93] and unmarried (OR = 0.80, 95% CI = 0.66–0.96) were less likely to report smoking cessation. Current daily smokers who were H ispanic (OR = 2.15, 95% CI = 1.65–2.81) and college educated (OR = 1.27, 95% CI = 1.05–1.53) were more likely to report smoking cessation. Relapse in former daily smokers was greater in women (OR = 1.44, 95% CI = 1.01–2.06) and lower in older adults (OR = 0.44; 95% CI = 0.27–0.74). Smoking initiation occurred less in women (OR = 0.65; 95% CI = 0.49–0.87) and H ispanic adults (OR = 0.57; 95% CI = 0.36–0.91) and more in unmarried adults (OR = 1.84; 95% CI = 1.37–2.47) and adults with less education (OR = 1.63; 95% CI = 1.09–2.44). Conclusions From 2001 to 2005, smoking status was extremely stable in the US population. Specific gender, race and educational groups need increased prevention and intervention efforts.

Transdermal nicotine patch (TNP) is 1 of the most commonly used smoking cessation treatments; however, the efficacy of TNP by sex is not yet clear. The purpose of the current review was to synthesize how sex has been considered in published clinical trials of TNP for smoking cessation. The specific aims of the study were to examine the inclusion of sex in analyses of cessation outcomes, TNP-related variables (compliance, side effects), and quit-related variables (withdrawal, cravings); to review the consideration of sex-related variables (menstrual cycle phase, pregnancy); and to identify needs for future research. Potential articles published through December 31, 2013 were identified through a MEDLINE search of the terms "clinical trial," "nicotine patch," and "smoking cessation." Forty-two studies used all 3 terms and met the inclusion criteria. Approximately half of the studies reported that they considered sex in smoking cessation outcomes, with 15 studies finding no difference by sex and 7 studies finding better outcomes for men versus women. Only 5 studies reported data on outcomes by sex in their publications. No studies reported analysis of TNP compliance or withdrawal by sex. In the 1 study that examined side effects by sex, more women than men reported discontinuing TNP because of skin irritation. No study examined the association of cessation outcomes with menstrual cycle phase. There is a need to include sex in research on TNP, as well as other pharmacological and behavioral smoking treatments, to clarify the picture of treatment efficacy for women compared with men.

Little is known about the smoking cessation and smoking relapse behavior of adults with alcohol use disorders (AUDs) and drug use disorders (DUDs). The current study used longitudinal data from a representative sample of the US adult population to examine changes in smoking over 3 years for men and women with and without AUD and DUD diagnoses. Participants were current or former daily cigarette smokers at Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions who completed the Wave 2 assessment 3 years later (n = 11,973; 46% female). Analyses examined the main and gender-specific effects of AUD and DUD diagnoses on smoking cessation and smoking relapse. Wave 1 current daily smokers with a current AUD (OR = .70, 95% CI = .55, .89), past AUD (OR = .73, 95% CI = .60, .89), current DUD (OR = .48, 95% CI = .31, .76), and past DUD (OR = .62, 95% CI = .49, .79) were less likely to have quit smoking at Wave 2 than those with no AUD or DUD diagnosis. Wave 1 former daily smokers with a current AUD (OR = 2.26, 95% CI = 1.36, 3.73), current DUD (OR = 7.97, 95% CI = 2.51, 25.34), and past DUD (OR = 2.69, 95% CI = 1.84, 3.95) were more likely to have relapsed to smoking at Wave 2 than those with no AUD or DUD diagnosis. The gender by diagnosis interactions were not significant. Current and past AUDs and DUDs were associated with a decreased likelihood of quitting smoking, while current AUDs, current DUDs, and past DUDs were associated with an increased likelihood of smoking relapse.

Introduction: Cardiac rehabilitation (CR) outcomes are measured in terms of cardiovascular disease (CVD) risk factor reductions, and these predict long-term cardiac status. This report examines whether reported tobacco use has differential effects on successful cardiovascular risk factor modification, especially for women who have greater smoking-related CVD consequences than men. Methods: A retrospective cohort analysis was conducted on 1138 adults (74% male) with diagnosed CVD who participated in ≥7 weeks of a comprehensive CR program. Eleven CVD risk factors were assessed at CR entry and completion. Tobacco use was assessed by self-report at CR entry. The primary outcomes were attainment of goal levels for each risk factor. Results: Fewer current and former tobacco users reached the preset goal for maximal exercise capacity. Fewer women than men reached the preset goal for high-density lipoprotein cholesterol (HDL). Women who were current or former tobacco users were less likely to meet the target goals for triglycerides and more likely to meet target goals for total cholesterol and non-HDL cholesterol. Conclusions: This preliminary study suggests the importance of identifying the effect of tobacco use and gender on CR outcomes and the need to evaluate modification of key cardiovascular risk factors for subgroups of cardiac patients.

Currently, 8.5% of the US population meets criteria for alcohol use disorders, with a total cost to the US economy estimated at $234 billion per year. Alcohol and tobacco use share a high degree of comorbidity and interact across many levels of analysis. This review begins by highlighting alcohol and tobacco comorbidity and presenting evidence that tobacco increases the risk for alcohol misuse and likely has a causal role in this relationship. We then discuss how knowledge of alcohol and tobacco interactions can be used to reduce alcohol use, focusing on whether (a) smoking status can be used as a clinical indicator for alcohol misuse, (b) tobacco policies reduce alcohol use, and (c) nicotinic-based medications can be used to treat alcohol use disorders.

Aims  Although depression and smoking are correlated highly, the relationship of major depressive disorder (MDD) to smoking cessation and relapse remains unclear. This study compared changes in smoking for current and former smokers with and without current and life‐time MDD over a 3‐year period.Design  Analysis of two waves of longitudinal data from the National Institute on Alcohol Abuse and Alcoholism's National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001–02; wave 2, 2004–05).Setting  Data were collected through face‐to‐face interviews from non‐institutionalized United States civilians, aged 18 years and older, in 50 states and the District of Columbia.Participants  A total of 11 973 adults (54% male) classified as current or former daily smokers at wave 1 and completed wave 2.Measurements  Classification as current or former smokers at wave 1 and wave 2.Findings  Smoking status remained stable for most participants. Wave 1 current daily smokers with current MDD [odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.03, 1.85] and life‐time MDD (OR = 1.52, 95% CI: 1.15, 2.01) were more likely than those without the respective diagnosis to report continued smoking at wave 2. Wave 1 former daily smokers with current MDD (OR = 0.44, 95% CI: 0.26, 0.76) were less likely to report continued abstinence at wave 2. None of the gender × MDD diagnosis interactions were significant. Patterns of results remained similar when analyses were limited to smokers with nicotine dependence.Conclusions  Current and life‐time major depressive disorders are associated with a lower likelihood of quitting smoking and current major depressive disorder is associated with greater likelihood of smoking relapse.

Little is known about the relationship between Major Depressive Disorder (MDD) and smoking‐related behaviors such as cue‐induced urges to smoke. The purpose of this pilot study was to examine: (1) differences in smoking cue reactivity by MDD history and (2) the association of a diagnosis of MDD, current depressive symptoms, and smoking variables to cue‐induced urges to smoke. Participants (N = 52) were n = 31 smokers with no MDD history and n = 21 smokers with past MDD. Participants completed a 2‐hour laboratory session during which they were exposed to neutral (eg, pencils) and smoking cues (eg, cigarettes) after smoking one of their preferred brand cigarettes (Satiated Condition) and when it had been 1 hour since they smoked (Brief Deprivation Condition). Cue‐induced urges increased with exposure to smoking cues and this increase did not significantly differ by diagnosis group. Current symptoms of depression, but not a diagnosis of MDD, were significantly and positively related to cue‐induced cravings in satiated adult smokers. The association between depression symptoms and smoking urges was not significant in the Brief Deprivation Condition. Smoking cue reactivity may be a useful procedure for studying aspects of smoking behavior in adults with depression. (Am J Addict 2012;21:136–144)