Recent Publication Abstracts

Recent Publications by the Faculty of the Penn/Georgetown TTURC--Publications Abstracts

 

Recruiting Adolescents into Genetic Studies of Smoking Behavior.

Audrain J, Tercyak KP, Goldman P, Bush A

The goal of this study is to describe the process of establishing a longitudinal cohort to study genetic, psychological, and social predictors of adolescent smoking. Parents of eligible adolescents were approached for their consent via mail. Seventy-two percent of parents (n = 1533 of 2120) provided a response regarding their teens' participation. Among those who provided a response, 75% (1151) agreed to allow their teen to participate in the research yielding an overall parental consent rate of 54%. Compared with parents who consented to their teens' participation, parents declined were less educated (89% had greater than a high school education compared with 69% of those who did not provide consent), less likely to be Caucasian (68 versus 48 %), and less likely to report having ever experimented with smoking (71 versus 60%). The most frequently reported reasons parents gave for declining consent included lack of interest and confidentiality concerns. A logistic regression model predicting consent to participate revealed a significant race by education interaction, indicating that among Caucasian parents, those with an education beyond high school were two times more likely to provide consent compared with Caucasian parents with a high school education or less (odds ratio = 2.43; confidence interval = 1.37-4.32, P = 0.003).

Cancer Epidemiology Biomarkers & Prevention 2002; 11(3):249-52

 

Which Adolescents are Most Receptive to Tobacco Industry Marketing? Implications for Counter-Advertising Campaigns.

Audrain J, Tercyak KP, Shields A, Bush A, Espinel CF, Lerman C

This study sought to identify adolescents most receptive to tobacco advertising based on individual differences in novelty-seeking personality and other key variables. Confidential self-report surveys were completed by 1,071 high school freshmen at 5 public high schools. The survey included validated measures of novelty-seeking personality, smoking habits, peer and family smoking, and tobacco advertising receptivity. Multiple logistic regression analysis was used to evaluate the independent associations of these variables and demographics with receptivity to tobacco advertising. Of the ninth graders, 44% had moderate to high levels of advertising receptivity and 56% had minimal to low levels of receptivity. Higher levels of receptivity were associated with ever smoking (OR = 2.59, CI = 1.99-3.39) and novelty-seeking personality (OR = 2.14, CI = 1.57-2.93). The association of novelty-seeking personality and tobacco advertising receptivity was most pronounced among adolescents who had never had a puff of a cigarette. Counter-advertising messages should consider individual differences in novelty-seeking, since novelty-seekers may be most receptive to tobacco industry promotional campaigns.

Health Communication. In press.

 

Nicotine metabolism and CYP2D6 phenotype in smokers.

Caporaso NE, Lerman C, Audrain J, Boyd NR, Main D, Issaq HJ, Utermahlan B, Falk RT, Shields P

We tested the hypothesis that the polymorphic enzyme CYP2D6 is related to nicotine metabolism in 261 healthy subjects enrolling in a smoking cessation clinic. Subjects completed a questionnaire, were given dextromethorphan, and contributed a urine and blood sample. The CYP2D6 phenotype (based on a determination of dextromethorphan and metabolites in an aliquot of overnight urine) and genotype (based on characterization of CYP2D6 variant alleles by a PCR-based method on a subset) were determined. Seventeen poor metabolizers (6.5%) were observed among 261 phenotyped smokers. Nicotine and it chief metabolites, cotinine and trans-3'-hydroxycotinine were measured in the urine and adjusted for pH. All of the nicotine metabolite levels were significantly related to usual and recent smoking. Neither levels of smoking nor nicotine metabolites overall exhibited a relationship to the CYP2D6-deficient metabolizer phenotype. The ratio of nicotine:cotinine + trans-3'-hydroxycotinine, stratified by time since the last cigarette, was unrelated to gender, age, education, race (white/African American), recent alcohol or caffeine consumption, or smoking practices. Subjects in either the lowest quintile or decile metabolic ratio (ultrametabolizers) exhibited a significantly lower nicotine:cotinine + trans-3'-hydroxycotinine ratio after adjustment for recent smoking, pH, and other factors. These data suggest that the polymorphic CYP2D6 gene is not a major contributor to nicotine metabolism in tobacco smokers but may influence the disposition of nicotine in the small subset of the population who are CYP2D6 ultrametabolizers.

Cancer Epidemiology Biomarkers & Prevention 2001; 10:261-3

Effects of extinction context and retrieval cues on alcohol cue reactivity among nonalcoholic drinkers.

Collins BN, Brandon TH

Pavlovian conditioning models have influenced the development of cue exposure treatments for drug abuse. However, poor maintenance of extinction performance (renewal) after treatment is a common problem. A treatment-analogue experiment tested the role of context in renewal, as well as a potential strategy for reducing renewal. Seventy-eight social drinkers completed extinction trials to reduce saliva and urge reactivity to alcohol cues and were randomly assigned to a renewal test in either the same context as extinction, a different context, or the different context containing a cue from the extinction context (E-cue). As predicted, the different context produced greater renewal than the same context and renewal was attenuated when the E-cue was present. These results offer preliminary evidence for the context dependence of extinction to alcohol cues and for the use of an extinction cue to improve the generalizability of exposure therapies.

Journal of Consulting and Clinical Psychology. 2002 Apr; 70(2): 390-7.

Nicotine dependence treatment for patients with cancer: Review and recommendations.

Cox LS, Africano NL, Tercyak KP, Taylor KL

Due to the risk of tobacco-related morbidity and mortality, treatment of nicotine dependence in cancer patients merits attention. The current review summarizes the literature examining nicotine dependence treatment in patients with cancer and provides recommendations for clinical care and future research.Background: Cancer patients who use tobacco demonstrate characteristics of strong nicotine dependence and are at increased risk for future tobacco-related morbidity and mortality. Continued smoking may contribute to poorer cancer treatment outcome and additional illness. In contrast, stopping smoking may improve quality of life and facilitate cancer treatment. Unfortunately, limited attention has been given to addressing tobacco use and treating nicotine dependence in cancer patients. Methods: The authors reviewed the current literature on smoking cessation and nicotine dependence treatment in patients with cancer. Results: Nicotine dependence treatment in patients with cancer facilitates smoking cessation. Evidence that cancer patients are motivated and able to stop smoking support tobacco use treatment intervention. Research is needed to evaluate effective intervention to aid tobacco abstinence and evaluate related health benefits for this patient population. Conclusion: Cancer patients are able to stop smoking and benefit from intervention. Treatment of nicotine dependence in cancer patients merits attention from researchers and healthcare providers. The health risks of continued smoking and clear benefits of tobacco abstinence provide an ethical imperative for treating nicotine dependence in cancer patients. Research is needed to evaluate effective intervention with the overall goal of promoting tobacco abstinence to benefit oncology treatment and patient health.

Cancer. In press

Dopamine transporter genotype as a risk factor for obesity in smokers

Epstein L, Jaroni J, Paluch R, Leddy J, Vahue H, Hawk L, Wileyto EP, Shields P, Lerman C

Objective: This study assessed the association between two polymorphisms related to dopamine function, dopamine transport (SLC6A3) and D2 dopamine receptor (DRD2), and obesity in smokers. Research Methods and Procedures: Logistic regression was used to assess the relationship between genetic polymorphisms and obesity (BMI > 30) from a sample of 505 smokers who smoked at least 10 cigarettes per day and who were participating in a study designed to examine genetic and non-genetic predictors of response to a pharmacological treatment. Results: The likelihood of obesity in blacks (N = 88) with the 10/10 SLC6A3 genotype was 4.53 times that of blacks with 9/9 or 9/10 SLC6A3 genotypes (OR = 4.53, C.I. = 1.38 – 14.93). There was no association of the SLC6A3 genotype with obesity for non-Hispanic whites (N = 417). Polymorphisms of the DRD2 genotype were not related to obesity in this sample. The likelihood of being obese decreased by 2.84% for every ten cigarettes smoked in blacks. Discussion: These results suggest that variants of the dopamine transporter gene may be related to obesity in black smokers. Possible mechanisms responsible for the association between dopamine transport and obesity in black smokers are discussed.

Obesity Research. 2002 Dec; 10 (12) 1232-1240

Skilled use of DNA polymorphisms as a tool for polygenic cancers.

Hemminki K, Shields PG

Association studies are assumed to be an efficient method of deciding whether a gene or its variant is important for cancer. Sequencing data on 30 000 human genes suggest that an average gene contains one to two single nucleotide polymorphisms (SNP), and high through-put technologies have become available for fast genotyping. Because no functional data are available for most SNPs, the result of the large-scale genotyping effort will be a huge amount of data of unknown biological significance. We discuss here the approaches in study design and reporting that will reduce the spread of false positive data and optimize scientific progress in the genotyping field.

Carcinogenesis. 2002 Mar; 23(3):379-380.

Attention-Deficit Hyperactivity Disorder (ADHD) symptoms and smoking patterns among participants in a smoking-cessation program.

Lerman C, Audrain J, Tercyak K, Hawk L, Bush A, Crystal-Mansour S, Rose C, Niaura R, Epstein LH

Previous research has suggested an increased liability to smoking among individuals with Attention-Deficit Hyperactivity Disorder (ADHD). This link is thought to be attributable, in part, to nicotine's beneficial effects on attention and performance. In the present study, we examined the association of ADHD symptoms of inattention and hyperactivity with smoking behavior in a sample of 226 male and female smokers ages 18 and older who were enrolled in a smoking-cessation program. Prior to treatment, they completed measures of ADHD symptoms and standardized measures of smoking patterns. Hierarchical linear regression models were used to characterize the smoking patterns associated with ADHD inattention and hyperactivity symptoms, controlling for potential confounder variables. Smoking for stimulation purposes and the urge to smoke to minimize withdrawal symptoms were the primary patterns associated with ADHD inattention symptoms, while hyperactivity symptoms were not associated with smoking patterns. Consistent with a self-medication hypothesis, these results suggest that smokers with frequent symptoms of inattention may use nicotine as a stimulant drug to help manage these symptoms. Future studies of the role of inattention symptoms in response to smoking treatment are warranted.

Nicotine and Tobacco Research. 2001; 3:353-9.

Elucidating the Role of Genetic Factors in Smoking Behavior and Nicotine Dependence

Lerman C, Berrettini W

Despite over a decade of intensive tobacco control efforts, a substantial proportion of the world’s population continues to smoke. With advances in molecular biology and genomics technology, attention is focusing on the genetic basis of addiction to nicotine. The hope is that by understanding better the biology of nicotine addiction, novel prevention and cessation strategies can be developed and targeted to individuals most likely to benefit. This paper provides an overview of currently available data from genetics research on smoking behavior and discusses study design issues to be addressed in order to make progress in this line of research.

American Journal of Medical Genetics (Neuropsychiatric Genetics). In press.

Interacting effects of the serotonin transporter gene and neuroticism in smoking practices and nicotine dependence.

Lerman C, Caporaso NE, Audrain J, Main D, Boyd NR, Shields PG

Individual differences in propensity to nicotine dependence appear to be mediated, in part, by genetic factors.1 The serotonin transporter gene has a functional polymorphism (5-HTTLPR) which modulates gene transcription and reuptake.2,3 A possible role in nicotine dependence is suggested by a link between 5-HTTLPR and neuroticism,4 a personality trait which has been related to smoking practices.5 In a cross-sectional study of 185 smokers, we utilized multiple linear regression modeling to examine the interacting effects of the 5-HTTLPR and neuroticism on smoking practices and nicotine dependence. Genotype was classified according to the presence or absence of the short (s) allele vs the long (l) allele of 5-HTTLPR (ie, s/s or s/l vs l/l). Models controlled for gender, age, race, and alcohol use. The 5-HTTLPR by neuroticism interaction effect was statistically significant in the models of nicotine intake (P = 0.05), nicotine dependence (P = 0.001), and smoking motivations (smoking to reduce negative mood (P = 0.01); smoking for stimulation (P = 0.01)). The results suggested that neuroticism was positively associated with these smoking practices among smokers with 5-HTTLPR S genotypes (s/s or s/l), but not among smokers with the L genotype (l/l). The 5-HTTLPR may modify the effects of neuroticism on smoking motivations and nicotine dependence. Assessment of 5-HTTLPR genotype and neuroticism may help to identify smokers who are more responsive to psychotropic medications, such as selective serotonin reuptake inhibitors (SSRIs), which are being used in smoking cessation treatment.

Molecular Psychiatry. 2000 Mar; 5(2):189-92.

Tryptophan hydroxylase gene variant and smoking behavior.

Lerman C, Caporaso NE, Bush A, Zheng YL, Audrain J, Main D, Shields PG

Approximately 50% of the variance in smoking behavior is attributable to genetic factors. Genes in the serotonin system are plausible candidates because of serotonin's role in mood regulation. The present study examined the association of smoking behavior with a polymorphism in the TPH gene, which codes for a rate limiting enzyme in the biosynthesis of serotonin. A polymorphism in intron 7 has been linked with a variety of traits involving poor impulse control. Participants in this study were 249 Caucasian smokers and 202 nonsmokers recruited through newspaper advertisements. Smokers completed smoking history and nicotine dependence assessments. The overall frequencies of the A- and C-allele were 42% and 58%, respectively. There was no association of TPH alleles with smoking status. However, case series analysis indicated that individuals with the A/A genotype started smoking at age 15.6 years, compared with 17.3 years among smokers with other genotypes. This association was significant in a multivariate regression model controlling for age, education, body mass index (BMI), alcohol use, and medication use. This finding is consistent with previous studies relating the A-allele to impulsive behavior and suggests that it may predispose to early smoking initiation. Future family-based studies are needed to confirm this finding. Published 2001 Wiley-Liss, Inc.

American Journal of Medical Genetics (Neuropsychiatric Genetics). 2001;105:518-20.

Genetic testing: psychological aspects and implications.

Lerman C, Croyle RT, Tercyak KP, Hamann H

As the number of genes associated with inherited disease continues to grow, researchers and practitioners in behavioral medicine will encounter complex psychological issues faced by individuals at risk for these diseases. A review of the literature concerning prenatal, carrier, and predictive genetic testing suggests that the severity of psychological risks posed by research-based genetic testing is not great. However, subgroups of individuals with particular psychological traits may be more vulnerable to adverse effects. Available data do not provide evidence that genetic testing promotes changes in health-related behaviors. Thus, although there may be less of a role for mental health professionals in the psychological counseling of genetic testing participants, there is a need for research and practice to facilitate health protective behaviors.

Journal of Consulting and Clinical Psychology. 2002 June; 70 (3); 784-97.

Applying Genetic Approaches to the Treatment of Nicotine Dependence

Lerman C, Niaura R

To advance the science of tobacco control, an enhanced understanding of the bio-behavioral basis of nicotine addiction is needed. In this article, we provide an overview of data from investigations of genetic factors in smoking behavior, discuss potential bio-behavioral mechanisms and effect modifiers, and suggest avenues for pharmacogenetics research in the area of smoking cessation treatment. The evidence to date is very consistent with respect to the significance of genetic contributions to smoking behavior. However, attempts to elucidate the role of specific genetic variants have met with mixed success. Explanations for the lack of consistency in the results of genetic association studies include biases in ascertainment, ethnic admixture, lack of attention to co-variates or modifiers of genetic risk, and the need for more refined phenotypes. As the field of genetics and smoking research progresses, increasing attention is being devoted to gene-environment interactions, with particular attention to the identification of genetic variants that may modify the effects of pharmacological treatment for smoking. With advances in molecular biology and genomics technology, individualized tailoring of smoking cessation therapy to genotype is within our grasp. Such research has the potential to improve treatment outcome, therapy reducing morbidity and mortality from smoking-related disease.

Oncogene. 2002 Oct 21;21(48):7412-20.

Mediating mechanisms for the impact of bupropion in smoking cessation treatment.

Lerman C, Roth D, Kaufmann V, Audrain J, Hawk L, Liu A, Niaura R, Epstein L

Several studies have documented the effectiveness of bupropion for smoking cessation, yet little is known about the mechanisms by which it facilitates abstinence. In this placebo-controlled randomized trial. We examined whether bupropion's effects on cessation were mediated by changes in withdrawal and/or negative or positive affect (PA). Two hundred and fifty-one smokers received 10-week treatment with bupropion or placebo, plus behavioral counseling. Changes in affect and withdrawal symptoms from pre-quit to 1 week post quit were examined as mediating variables in structural equation models. Cotinine-verified 7-day point prevalence cessation rates at the end of treatment (8-weeks post quit date) were 48% for bupropion and 29% for placebo (P=0.001). There were significant treatment effects on withdrawal and negative affect (NA); however, only change in NA predicted cessation. In a path model, change in NA was a significant mediator of bupropion's effects on cessation. However, the proportion of variance accounted for by this mediator was small, suggesting that other unmeasured factors play an important role. Laboratory-based paradigms may be useful to identify other mediators of bupropion's effects, thereby pointing to mechanisms of effect that can be bolstered in future treatment studies.

Drug and Alcohol Dependence. 2002; 67(2): 219-223.

Pharmacogenetic Investigation of Smoking Cessation Treatment

Lerman C, Shields P, Wileyto EP, Audrain J, Pinto A., Hawk L, Krishnan S, Niaura R, Epstein L

Background: Despite the efficacy of bupropion for smoking cessation, smokers exhibit variability in treatment outcome. The CYP2B6 gene has been implicated in bupropion kinetics and nicotine metabolism, and is a plausible candidate for pharmacogenetic studies of treatment response. Objectives: To investigate whether a functional genetic polymorphism in the CYP2B6 gene predicts smoking outcomes in a placebo-controlled randomized trial. Methods: 426 smokers of European Caucasian ancestry provided blood samples and received bupropion (300 mg/day for 10 weeks) or placebo, plus counseling. Smoking status, abstinence symptoms and side effects were recorded weekly, and smoking status was verified at the end of treatment and at 6-month follow-up. Results: Smokers with a decreased activity variant of CYP2B6 reported greater increases in cravings for cigarettes following the target quit date and had higher relapse rates. These effects were modified by a significant gender x genotype x treatment interaction, suggesting that bupropion attenuated the effects of genotype among female smokers. Conclusion: Smokers with the CYP2B6 variant may be more vulnerable to abstinence symptoms and relapse. Bupropion may attenuate these effects, especially among females. Additional trials are warranted to confirm these results, as are studies to explore the neurobiological mechanisms. Such research could ultimately enable practitioners to select the optimal type and dose of medication for individual smokers.

Pharmacogenetics. 2002; 12: 8. 627-634.

Nicotine delivery from smoking bidis and a non-additive cigarette.

Malson J, Lee EM, Moolchan ET, Pickworth WB

The present study was conducted to determine whether smoking bidis, an additive-free cigarette, and conventional cigarettes caused similar biochemical, physiological and subjective effects. This was an open-label, within-subject design. In each session, subjects (n = 10) smoked a single cigarette: an unfiltered Natural American Spirit, an unfiltered Irie bidi, an unfiltered Sher bidi, or one of the participant's own brand. The presentation of the cigarettes was randomized. Before and up to 1 h after smoking, biochemical markers [plasma nicotine levels and exhaled carbon monoxide (CO)] and physiological effects of nicotine (heart rate and blood pressure) were measured. After smoking, subjects completed two standardized tests of cigarette liking and cigarette sensations. American Spirit (32.1 ng/ml) and Irie bidi (26.0 ng/ml) cigarettes increased plasma nicotine more than the participant's own brand (18.5 ng/ml). Subjects smoked longer and took more puffs to consume the American Spirit(R) (452.8 s, 14 puffs) and Sher bidi (354.4 s, 14 puffs) than the participant's own brand (297.4 s, 10 puffs). In spite of differences in nicotine delivery, participants rated all cigarettes as similar in nicotine content. Overall, the results indicate that bidis and the additive-free cigarette delivered nicotine, CO and (presumably) other toxic components of tobacco smoke in equal or greater amounts than conventional cigarettes. These results do not support an emerging belief that bidi cigarettes are safer than conventional brands.

Nicotine and Tobacco Research. 2002; 4(4):485-490.

Bidis-hand-rolled, Indian cigarettes: Effects on physiological, biochemical and subjective measures.

Malson JL, Pickworth WB

Bidis, hand-rolled cigarettes imported from India, have become increasingly popular among US teenagers. These cigarettes are perceived as a safer, more natural alternative to conventional cigarette smoking. The present study was conducted to determine whether the acute effects of bidis and conventional cigarettes are similar. Undergraduate cigarette smokers with a history of bidi smoking were tested in two experimental sessions, using a within-subject design. Subjects smoked both a bidi and a conventional cigarette. Physiological and biochemical measures, subjective evaluations, and smoking behavior characteristics were obtained before, during, and after smoking each experimental cigarette. Although time to smoke and puffs per cigarette were significantly higher after the bidi, physiological and biochemical effects of bidi smoking were similar to those of smoking conventional cigarettes. Bidis were rated less satisfying than the conventional cigarette. However, there were no significant differences between the cigarettes in other subjective measures. Our results do not support the belief that bidis are a safe alternative to conventional cigarettes. Furthermore, bidi smoking, like conventional cigarette smoking, may lead to nicotine dependence

Pharmacology, Biochemistry, & Behavior. 2002 May; 72(1-2): 443-7.

Comparison of the nicotine content of tobacco used in bidis and conventional cigarettes.

Malson JL, Sims K, Murty R, Pickworth WB

OBJECTIVE: To compare the nicotine content of 12 unfiltered brands of bidi cigarettes (hand rolled cigarettes imported from India) with 8 popular brands of filtered and unfiltered US and conventional cigarettes from India. MAIN OUTCOME MEASURES: Identical laboratory procedures were used to determine nicotine content (in duplicate) and physical characteristics. RESULTS: The nicotine concentration in the tobacco of bidi cigarettes (21.2 mg/g) was significantly greater than the tobacco from the commercial filtered (16.3 mg/g) and unfiltered cigarettes (13.5 mg/g). CONCLUSIONS: Bidi cigarettes contain higher concentrations of nicotine than conventional cigarettes. Therefore, it is logical to presume that bidi smokers are at risk of becoming nicotine dependent. These findings belief a popular belief among US teens that bidis are a safe alternative to commercial cigarettes

Tobacco Control. 2001; 10:181-3.

Molecular epidemiology of smoking and lung cancer.

Shields PG

Lung cancer is the single most common cause of death, and almost all of it is due to tobacco smoking. Before the widespread use of cigarettes in this century, lung cancer was a rare illness. Tobacco smoke is a complex mixture of numerous mutagens and carcinogens. Over the last 40 years, the type of cigarettes most frequently used has been changing, namely the increased use of low tar and nicotine cigarettes. This has been accompanied by an increased risk of lung cancer due to a smokers' need to maintain blood nicotine levels, which in turn causes the need for smoking more cigarettes per day and deeper inhalation. This phenomena has led to the increasing rates of lung adenocarcinoma, compared to squamous cell carcinoma. It also probably explains, in part, the greater risk of lung cancer in women compared to men (in addition to some biological differences). The study of lung cancer involves many types of biomarkers, including those that measure exposure, the biologically effective dose and harm. The use of these has allowed us to understand many parts of lung carcinogenesis. Genetic susceptibilities play a large role in lung cancer risk. They govern smoking behavior (affecting dopamine reward mechanisms due to nicotine and nicotine metabolism), carcinogen metabolism and detoxification, DNA repair, cell cycle control and other cellular responses. The need for the study of lung cancer is highlighted by the need to improve cessation rates and reduce exposure among persons who cannot quit smoking, for better prevention strategies for former smokers and an understanding of environmental tobacco smoke risk.

Oncogene. 2002 Oct; 21 (45): 6870-6.

Tobacco smoking, harm reduction, and biomarkers.

Shields PG

The only known way to reduce cancer risk in smokers is complete cessation, but many smokers are unable or unwilling to quit. Consequently, tobacco companies are now marketing products that purport to reduce carcinogen exposure, with the implication that such products provide a safer way to smoke. Moreover, researchers are exploring ways to reduce the amount of cigarette smoke carcinogens to which the smokers are exposed. Although these methods are, in theory beneficial, it is possible that the perceived availability of "safe" ways to smoke will cause some former smokers to resume smoking and some current smokers to delay quitting. Thus, the extent of exposure reduction and the impact on public health of these methods need to be considered carefully. However, risk reduction and its relation to exposure are not simple to estimate. The way people smoke and the way they respond to carcinogen exposure are both highly variable, as evidenced by the previous history of smokers who switched to light, or low-tar cigarettes. This can actually increase risk in some smokers. The evaluation of exposure reduction will therefore need to be multidisciplinary and include in vitro cell culture studies, animal studies, human clinical studies, and epidemiologic studies. Biomarkers will be critical for rapidly evaluating the effects of new strategies or products to reduce exposure to tobacco smoke carcinogens. No single biomarker will likely satisfy our assessment needs, and so a panel of biomarkers should be used that includes biomarkers of exposure, biologically effective dose, and potential harm. In addition, usefulness of new products will need to be tested in people of different susceptibilities (i.e., who vary in behavior, sex, age, genetics, and prior tobacco use). Even if the new products are shown to be effective at reducing lung carcinogens, they should not be used alone but rather be incorporated into a comprehensive tobacco control program.

Journal of the National Cancer Institute. 2002 Oct; 94 (19): 1435-44.

Psychosocial Correlates of Alternate Tobacco Product Use During Early Adolescence.

Tercyak KP, Audrain J

Background. The objective was to assess psychosocial correlates of alternate tobacco product (chew/snuff, cigar, pipe, bidi, kretek) use. Methods. Measures of alternate tobacco product use, cigarette smoking, environmental smoking exposure, and depression were included in a school-based self-report survey completed by 1,107 ninth graders. Results. The current (past 30 days) use rate for one or more alternate tobacco products was 8.3% and the current use rate for cigarettes was 11%; 45% of current cigarette smokers also used alternate tobacco products. After controlling for demographic factors and current cigarette smoking, adolescents exposed to peers who smoke and those with greater depressive symptoms were two to three times more likely to currently use an alternate tobacco product than adolescents without exposure to peer smoking and those with lesser depressive symptoms. Conclusions. Social and psychological associations with alternate tobacco product use should be further evaluated as this information could be helpful in developing anti-tobacco messages targeted to high-risk youth.

Preventive Medicine. 2002; 35: 193-8.

Personality differences associated with smoking experimentation among adolescents with and without comorbid symptoms of ADHD.

Tercyak KP, Audrain- McGovern J

This study evaluated differences in adolescent personality (novelty-seeking, harm avoidance, and reward dependence), lifetime cigarette smoking, and symptoms of Attention-Deficit/ Hyperactivity Disorder (ADHD) among 1,051 youths enrolled in several public high schools in middle Atlantic towns in the United States in 2000 and 2001. Psychological and behavioral data were obtained via self-report on the Temperament and Character Inventory (personality), standard epidemiological survey items (smoking), and the Current Symptoms Scale (ADHD). The results indicated that adolescent ever smokers with high-normal symptoms of ADHD had the highest novelty seeking scores compared to all other study groups. These data highlight the greater vulnerability to smoking that is associated with novelty seeking and symptoms of inattention and hyperactivity. To the extent that novelty seeking and ADHD share cognitive and / or behavioral elements that may negatively impact upon youths’ ability to attend to tobacco control communications, additional research on ways to adjust the delivery and content of smoking prevention and intervention program messages to meet the needs of these adolescents is warranted.

Substance Use and Misuse. In Press.

Interacting Effects of Depression and Tobacco Advertising Receptivity on Adolescent Smoking

Tercyak KP, Goldman P, Smith A, Audrain J

Objective: To evaluate the independent effects of exposure to others who smoke and receptivity to tobacco advertising on adolescent smoking practices and the moderating influence of depression on these relation- ships. Methods: Participants were 1,123 high school freshmen who completed a self-report survey as part of a longitudinal investigation of the biobehavioral predictors of adolescent smoking adoption. Sixty percent of freshmen reported that they were never smokers (i.e., never tried or experimented with smoking, even a few puffs), and 40% reported being ever smokers (i.e., ever smoked at least a partial or whole cigarette). Results: In logistic regression models, the adjusted likelihood of ever smoking was greater for students re- porting exposure to peer smoking. Further, a significant interaction was detected between receptivity to tobacco advertising and depression; specifically, adolescents with a high receptivity to tobacco advertising and clinically significant depressive symptoms were more likely to smoke than adolescents without these symptoms. Conclusions: Our data support the hypothesis that adolescents with both high advertising receptivity and depressed moods are most vulnerable to experiment with smoking. Tailoring prevention and intervention efforts to encompass tobacco advertising's effects and the role of depression could lead to a reduction in youth smoking.

Journal of Pediatric Psychology. 2002; 27(2):145-54.

Association of Attention-Deficit/Hyperactivity Disorder Symptoms With Levels of Cigarette Smoking in a Community Sample of Adolescents

Tercyak KP, Lerman C, Audrain J

Objective: Research on the association of attention-deficit/hyperactivity disorder (ADHD) with cigarette smoking has primarily occurred within samples of clinically referred youths. This paper reports the association of ADHD symptoms with smoking practices in a community sample of adolescents. Method: Confidential self-report surveys were completed by 1,066 tenth-grade students enrolled in five public high schools who were taking part in a longitudinal study of biobehavioral predictors of adolescent smoking adoption. A well- standardized measure of ADHD inattention and hyperactivity-impulsivity symptoms, as well as demographic and social risk factors, were examined in relation to three levels of cigarette smoking: (.1) never having smoked, (2) ever having smoked, and (3) current smoking (having smoked a cigarette within the past 30 days). Results: Regarding lifetime cigarette use, approximately 43% of students had ever smoked. Among those who had ever smoked, approximately 31 % of students were current smokers. Ever having smoked was associated with family (odds ratio [OR] = 2.49, confidence interval [CI] = 1.85,3.36) and peer smoking (OR = 4.05, CI = 3.07,5.33) and clinically significant ADHD inattention symptoms (OR = 3.39, CI = 1.53, 7.54). Current smoking was also associated with peer smoking (OR = 2.99, CI = 1.72,5.20) and clinically significant ADHD inattention symptoms (OR = 2.80, CI = 1.20, 6.56). Conclusion: Clinically significant ADHD symptoms should be taken into account when identifying adolescents at risk to smoke, since those with problematic inattention may be more likely to experiment with smoking and to become regular tobacco users.

Journal of the American Academy of Child & Adolescent Psychiatry. 2002 Jul; 41(7):799-805.

Carry-over effects can modulate emotional Stroop effects.

Waters AJ, Sayette M., Wertz J

The emotional Stroop task has been widely used to examine attentional bias in a variety of psychological disorders. In one format of this task, words are presented to participants in a mixed randomized or quasi-randomized sequence. We present data from two independent studies involving smokers, the results of which show that words appearing after smoking-related items in the mixed sequence are responded to more slowly than words appearing after neutral items. These carry-over effects may reduce the size of emotional Stroop effects on the mixed Stroop task. We discuss the implications of these carry-over effects for research using the emotional Stroop task.

Cognition and Emotion. In press.

Attentional bias predicts outcome in smoking cessation.

Waters AJ, Shiffman S, Sayette MA, Paty JA, Gwaltney CG, Balabanis MH

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. There is evidence that responses to smoking-related cues may precipitate relapse. We used a modified emotional Stroop task – which measures the extent to which smoking-related words disrupt performance on a reaction time task – to index the distracting effects of smoking-related cues. Smokers (N = 158), who were randomized to high-dose nicotine patch (35 mg) or placebo patch, completed the Stroop task on the first day of a quit attempt. Smokers using active patch exhibited less attentional bias, making fewer errors on smoking-related words. Smokers who showed greater attentional bias (slowed reaction time on the first block of smoking words) were significantly more likely to subsequently lapse in the short-term, even when controlling for self-reported urges at the test session. In sum, attentional bias measures may tap an important component of dependence.

Health Psychology. In Press.