Perelman School of Medicine at the University of Pennsylvania

The Center for Interdisciplinary Research on Nicotine Addiction

CIRNA

Adolescents and Young Adults Program

 

Program Goals

Smoking is the greatest source of preventable morbidity and mortality in the United States. Smoking typically begins during adolescence and continues to escalate into young adulthood where long-term smoking practices and nicotine dependence are established. A variety of new nicotine products have become available in recent years.  These novel nicotine products provide adolescents and young adults with many choices and unfortunately, multiple potential pathways to become dependent on nicotine. 

The Adolescent and Young Adult Program within the Center for Interdisciplinary Research on Nicotine Addiction focuses on (1) identifying the factors that influence the use of tobacco and nicotine containing products among adolescents and young adults, (2) identifying subpopulations at an increased risk for the use of tobacco and nicotine containing products, (3) clarifying the causal links between the use of one product and another, and (4) developing and evaluating novel behavioral and pharmacological interventions for nicotine dependence.

 

Program Team

♦  Janet Audrain-McGovern, Ph.D. 

 

Project Descriptions and Grants

The Protective Effects of Physical Activity on Adolescent Smoking Progression (National Cancer Institute; 2008-2015):

To further reduce adolescent smoking, factors that protect against adolescent smoking need to be identified and subsequently incorporated into youth smoking prevention programs.  Physical activity may be an important protective factor against youth smoking initiation and progression.  Although longitudinal studies of smoking and physical activity indicate that higher levels of physical activity reduce the odds of adolescent smoking initiation and progression, the nature of this relationship, the mechanisms explaining this protective relationship, the amount of physical activity needed to confer a protective effect, and the adolescents at risk for smoking due to their levels of physical activity remain unclear.  We addressed this gap by creating a cohort of 1,400 adolescents (age 14 years) and followed them over a four-year period (age 18 years). Socio-environmental, behavioral and psychological influences on smoking and physical inactivity were collected.  The aims of the study were to (1) clarify the nature of the relationship between smoking and physical activity, (2) evaluate the mechanisms explaining the physical inactivity and smoking relationship, (3) empirically identify distinct longitudinal paths or smoking-physical inactivity trajectories to determine optimal intervention timing and the amount of physical activity needed to protect against smoking, and (4) characterize these trajectories by socio-environmental, behavioral and psychological variables to identify adolescents at risk for smoking within the context of their physical activity habits.  Our publications listed below document the results of our investigation.  This was the first study to concurrently and comprehensively evaluate smoking and physical activity from mid to late adolescence, to elucidate and quantify the protective relationship, and to explore how theory-based mechanisms relate to critical points in the development of a smoking habit often carried into adulthood.  Results from this study can be used to inform the timing, type, amount of physical activity, target variables and important subpopulations for adolescent smoking prevention and intervention programs.

Individual Differences in the Substitutability of Physical Activity for Smoking (National Institute on Drug Abuse; 2012-2015):    

Despite human laboratory evidence documenting the reductions in cigarette craving, withdrawal symptoms and negative mood after an acute bout of physical activity, the efficacy of physical activity as a treatment for smoking cessation remains unresolved.  Rather than conclude that physical activity is a weak or ineffective smoking cessation treatment, we hypothesize that there may be individual differences in the response to physical activity that render it an effective smoking cessation treatment for some smokers, but not at all effective for others.  Behavioral Economic Theory (BET) may help identify those smokers for whom physical activity will have the strongest beneficial effects on smoking behavior.  BET suggests that the reinforcing value of one behavior can be enhanced, or reduced, based on the alternatives.  A substitute reinforcer (e.g., physical activity) can reduce the reinforcing value of an alternative (e.g., smoking) thereby decreasing the use of that reinforcer.  However, physical activity may not function as a substitute reinforcer for smoking for all smokers. The goal of this study is to evaluate whether individual differences in the relative reinforcing value of physical activity (RRVPA) moderate the effects of physical activity on the primary outcomes of craving, withdrawal, negative mood, positive mood, affective valence, and smoking reinforcement following brief abstinence.  Hypotheses will be tested using a within-subject, 2-session (physical activity vs rest), behavioral pharmacology paradigm.  Young adult smokers (n=78), ages 18-26 years old, were recruited as they have the highest smoking prevalence of any adult age group and are less likely to succeed at quitting smoking compared to older adults despite more quit attempts. This study has the potential to increase our understanding of who may benefit most from physical activity as smoking cessation treatment component and to and help inform effective smoking cessation interventions for young adult smokers.

The Impact of Flavoring on the Reinforcing and Rewarding Value of E-Cigarettes (Food and Drug Administration; 2015-2016):

The percentage of young adults who had used an e-cig in the past 30 days increased from 6% in 2009 to 41% in 2013.  While an e-cig delivers lower levels of known toxins than a traditional, combusted cigarette, both deliver nicotine, fostering an additional route to nicotine dependence.  Young adults tend to view new products, such as e‑cigs favorably if they come in flavors.  Flavoring is widely available among different e-cig brands, highly advertised, and an important motivation for e-cig use. While not yet investigated, flavorings may increase the subjective rewarding value and the reinforcing value (absolute and relative) of e-cigs containing nicotine.  The rewarding value is a hedonic rating or a subjective level of liking for a flavored e-cig with nicotine.  Reinforcement is the motivation to smoke a flavored e-cig with nicotine and is reflected in the effort expended to use the flavored product and the level of consumption.  An investigation into the rewarding and reinforcing value of flavored e-cigs containing nicotine will begin to clarify why there is a preference for flavored versus unflavored e-cigs.  Greater rewarding and reinforcing value of flavored e-cigs may promote continued use and greater exposure to nicotine, ultimately fostering nicotine dependence in young adults.  These hypotheses will be tested in young adult smokers (n=30) ages 18-30 years old using a within-subjects design.  The relative reinforcing value of flavoring will be assessed through a validated behavioral choice task, which will determine the participants’ motivation and willingness to expend effort to use a flavored e-cigarette vs an unflavored e-cigarette.  The absolute reinforcing value of flavoring will be measured in a subsequent ad-libitum smoking paradigm whereby participants will be given the opportunity to self-administer one of two sweet flavored e-cigs with nicotine, or an e-cig with nicotine during a laboratory session.  The primary contrast is between an e-cig with nicotine, but no flavoring and an e-cig with nicotine and flavoring (fruit, dessert).

 

Selected Publications

Audrain-McGovern J, Lerman C, Wileyto EP, Rodriguez D, Shields P. Interacting effects of genetic predisposition and depression on adolescent smoking progression. American Journal of Psychiatry.  2004; 161(7):1224-1230.

Audrain-McGovern J, Rodriguez D, Cuevas J, Rodgers K, Patterson F. Identifying and characterizing adolescent smoking trajectories. Cancer Epidemiology, Biomarkers, and Prevention. 2004; 13(12):2023-2034.

Audrain-McGovern J, Rodriguez D, Wileyto EP, Schmitz KH, Shields PG.  Effect of team sport participation on genetic predisposition to adolescent smoking progression. Archives of General Psychiatry. 2006; 63(4):433-441.

Audrain-McGovern J, Rodriguez D, Kassel JD.  Adolescent smoking and depression: Evidence of self-medication and peer smoking mediation. Addiction. 2009; 104(10):1743-1756.

Audrain-McGovern J, Rodriguez D, Epstein LH, Cuevas J, Rodgers K, Wileyto EP. Does delay discounting play an etiological role in smoking or is it a consequence of smoking? Drug and Alcohol Dependence. 2009; 103(3):99-106.

Audrain-McGovern J, Rodriguez D, Rodgers K, Cuevas J.  Declining alternative reinforcers link depression to young adult smoking. Addiction.  2011; 106(1):178-187

Audrain-McGovern J, Rodriguez D, Leventhal AM, Cuevas J, Rodgers K, Sass J. Where’s the pleasure in that? Low hedonic capacity predicts smoking onset and escalation. Nicotine and Tobacco Research. 2012; 14(10):1187-1196).

Audrain-McGovern J, Rodriguez D, Cuevas J, Rodgers K, Sass J,  Riley T. Reward expectations lead to smoking uptake among depressed adolescents. Drug and Alcohol Dependence. 2012; 120(1-3):181-189.

Audrain-McGovern J, Rodriguez D, Rodgers K, Cuevas J, Sass J. Longitudinal variation in adolescent physical activity patterns and the emergence of tobacco use. Journal of Pediatric Psychology. 2012; 37(6):622-633.

Audrain-McGovern J, Rodriguez D, Cuevas J, Sass J. Initial insight into why physical activity may help prevent adolescent smoking uptake. Drug and Alcohol Dependence. 2013; 132(3):471-478.

Audrain-McGovern J, Rodriguez D, Leventhal AM.  Gender differences in the relationship between affect and adolescent smoking uptake. Addiction.  2015; 110(3): 519-529.

Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, Stone MD, Khoddam R, Samet JM, Audrain-McGovern J.  Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA. 2015; 314(7):700-7.