The effect of reproductive hormones on women’s daily smoking across the menstrual cycle

Background Women attempt to quit smoking less often than men and are less likely to maintain abstinence. Reproductive hormones have been postulated as a reason for this sex difference, though this remains to be clarified. Research suggests that estradiol and progesterone may influence nicotine addiction, though various methodologies have led to inconsistent findings. The current study aimed to directly examine the effect of reproductive hormones on women’s smoking behavior. Methods Over the course of one menstrual cycle, twenty-one female smokers recorded the number of cigarettes smoked in a day, as well as their perceived need for and enjoyment of cigarettes smoked. Additionally, they provided 12 urine samples for the measurement of the urinary metabolites of estradiol (estrone-3-glucuronide, E1G) and progesterone (pregnanediol glucuronide, PdG). Multilevel modeling was used to examine the effects of hormone levels as well as hormone change on smoking outcomes. Results When PdG levels were low, they were inversely associated with daily cigarettes smoked. Furthermore, E1G level was negatively associated with both self-reported need for and enjoyment of cigarettes smoked but not the number of cigarettes smoked. Examining the effect of hormonal change on smoking outcomes revealed a significant interaction between change in PdG and E1G on number of cigarettes smoked such that only a simultaneous drop or increase in both hormones was associated with a greater number of cigarettes. Hormonal change effects on need for and enjoyment of cigarettes were not significant. Conclusions The present study suggests that (1) elevated progesterone levels lessen the propensity to smoke in women, (2) estrogen levels influence women’s subjective experience of smoking, and (3) simultaneous drops or increases in these hormones are associated with increased smoking.

A comparison of the smoking outcomes of self-reported and agency-notified child abuse in a population-based birth cohort at 30-year-old-follow-up

Introduction Retrospective studies show a strong association between self-reported child abuse and subsequent tobacco use. Prospective studies using reports to statutory agencies are less common with limited information on people in their 30s. In addition, there have been no comparisons of the effect of self- and agency-reported abuse on smoking. We therefore assessed the effect on the prevalence and persistence of smoking at the 30-year-old follow-up of prospective agency notifications of child abuse compared to retrospective self-reports of maltreatment in the same birth cohort. Methods There were 2443 young adults with data on smoking and child abuse at 30-year-old follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire (CTQ) and linked to notifications of child maltreatment to statutory agencies. Results The prevalence of self- and agency-reported maltreatment was 600 (24.7%) and 142 (5.8%) respectively. At follow-up, 565 participants smoked (23.1 %) but only 91 (3.8%) smoked 20 or more cigarettes a day. Of the 206 participants who smoked at 14 years, 101 were still smoking at follow-up. On adjusted analyses, both self- and agency-reported maltreatment showed a significant association with the prevalence and persistence of smoking from 14 years old. However, associations were weaker for some of the agency-notified child maltreatment subtypes possibly because of lower numbers. Conclusions Child maltreatment is associated with both an increased prevalence and persistence of smoking at 30-year-old follow-up irrespective of reporting source. This is despite self- and agency-reported maltreatment possibly representing different populations. Smoking cessation programmes should therefore target both groups. Implications Retrospective studies show an association between self-reported child abuse and subsequent tobacco use. Prospective studies of reports to statutory agencies are less common with limited information on people in their 30s. In addition, there have been no comparisons of self- and agency-reported abuse on smoking outcomes even though they may represent different populations. We therefore compared the effect of both on smoking outcomes at 30-year-old follow-up of 2443 adults from the same birth cohort. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with the prevalence and persistence of smoking. Smoking prevention and cessation programmes should therefore target both groups.

An Evaluation of Potential Unintended Consequences of a Nicotine Product Standard: A Focus on Drinking History and Outcomes

Background A nicotine product standard reducing the nicotine content in cigarettes could improve public health by reducing smoking. This study evaluated the potential unintended consequences of a reduced-nicotine product standard by examining its effects on (1) smoking behaviors based on drinking history; (2) drinking behavior; and (3) daily associations between smoking and drinking. Methods Adults who smoke daily (n=752) in the United States were randomly assigned to smoke very low nicotine content (VLNC) versus normal nicotine content (NNC; control) cigarettes for 20 weeks. Linear mixed models determined if baseline drinking moderated the effects of VLNC versus NNC cigarettes on Week 20 smoking outcomes. Time-varying effect models estimated the daily association between smoking VLNC cigarettes and drinking outcomes. Results Higher baseline alcohol use (versus no-use or lower use) was associated with a smaller effect of VLNC on Week 20 urinary total nicotine equivalents (ps<.05). No additional moderation was supported (ps>.05). In the subsample who drank (n=415), in the VLNC versus NNC condition, daily alcohol use was significantly reduced from Week 17-20 and odds of binge drinking were significantly reduced from Week 9-17. By Week 7 in the VLNC cigarette condition (n=272), smoking no longer predicted alcohol use but remained associated with binge drinking. Conclusions We did not support negative unintended consequences of a nicotine product standard. Nicotine reduction in cigarettes generally impacted smoking behavior for individuals who do not drink or drink light-to-moderate amounts in similar ways. Extended VLNC cigarette use may improve public health by reducing drinking behavior. Implications There was no evidence that a very low nicotine content product standard would result in unintended consequences based on drinking history or when considering alcohol outcomes. Specifically, we found that a very low nicotine standard in cigarettes generally reduces smoking outcomes for those who do not drink and those who drink light-to-moderate amounts. Furthermore, an added public health benefit of a very low nicotine standard for cigarettes could be a reduction in alcohol use and binge drinking over time. Finally, smoking very low nicotine content cigarettes may result in a decoupling of the daily associations between smoking and drinking.

Tobacco retail environment and smoking: a systematic review of geographic exposure measures and implications for future studies

Introduction To review the geographical exposure measures used to characterize the tobacco environment in terms of density of and proximity to tobacco outlets, and its association with smoking-related outcomes. Methods We used PubMed and Google Scholar to find articles published until December 2019. The search was restricted to studies which 1) measured the density of and/or proximity to tobacco outlets and 2) included associations with smoking outcomes. The extraction was coordinated by several observers. We gathered data on the place of exposure, methodological approaches, and smoking outcomes. Results Forty articles were eligible out of 3,002 screened papers. Different density and proximity measures were described. 47.4% density calculations were based on simple counts (number of outlets within an area). Kernel Density Estimations and other measures weighted by the size of the area (outlets/sq km), population, and road length were identified. 81.3% of the articles which assessed proximity to tobacco outlets used length distances estimated through the street network. Higher density values were mostly associated with higher smoking prevalence (76.2%), greater tobacco use and smoking initiation (64.3%); and lower cessation outcomes (84.6%). Proximity measures were not associated with any smoking outcome except with cessation (62.5%). Conclusion Associations between the density of tobacco outlets and smoking outcomes were found regardless of the exposure measure applied. Further research is warranted to better understand how proximity to tobacco outlets may influence on smoking outcomes. This systematic review discusses methodological gaps in the literature and provides insights for future studies exploring the tobacco environment. Implications Our findings pose some methodological lessons to improve the exposure measures on the tobacco outlet environment. To solve these methodological gaps is crucial to understanding the influence of the tobacco environment on the smoking outcomes. Activity spaces should be considered in further analyses since individuals are exposed to tobacco beyond their residence or school neighbourhood. Further studies in this research area demand density estimations weighted by the size of the area, population, or road length; or measured using Kernel Density Estimations. Proximity calculations should be measured through the street network and should consider travel times apart from the length-distance.

Prospective and Daily Effects of Cannabis Use on Smoking Outcomes During a Self-Guided Quit Attempt

Introduction Past research suggests that cannabis use is a risk factor for relapse in people trying to quit smoking. Most people attempt to quit smoking without any assistance (ie, self-guided quitters), yet no one has examined the association between cannabis use and relapse among self-guided quitters. The current study examines how cannabis use might contribute to poorer smoking outcomes in a sample of self-guided quitters. Aims and Methods Data were taken from a study of unaided smoking cessation in 62 single-smoker couples. Quitters and their Partners completed baseline questionnaires and a 21-day ecological momentary assessment. This article examines Quitters’ and Partners’ past-year cannabis use reported at baseline and daily cannabis use during the ecological momentary assessment as predictors of prospective and daily smoking outcomes. Results We found very little evidence that past-year cannabis use was associated with poorer smoking outcomes. However, Quitters reported greater smoking on days when they or their Partners reported cannabis use. Conclusions This study produced evidence to support daily Quitter and Partner cannabis use as a risk factor for poor smoking outcomes. Smoking cessation programs might benefit from targeting cannabis use as well as taking a couples-oriented approach to treatment. Implications This article examined how cannabis use impacts smoking outcomes in a sample of self-guided quitters using prospective and daily diary analyses. We found very little evidence that past-year cannabis use was associated with poorer smoking outcomes. However, Quitters reported greater smoking on days when they or their Partners reported cannabis use. Findings suggest that smoking cessation programs might benefit from targeting cannabis use, as well as taking a couples-oriented approach to treatment.

Pilot investigation of the effect of carvedilol on stress-precipitated smoking-lapse behavior

Introduction: Separate α1- and β-adrenergic antagonists have shown efficacy in reducing nicotine-motivated behaviors in rodents and humans, supporting a role for the noradrenergic system in mediating the reinforcing properties of drugs of abuse. However, the effect of the combined α1- and β-adrenergic antagonist, carvedilol, on stress-related smoking is unknown. Methods: Using a well-established human laboratory model of stress-precipitated smoking-lapse behavior, we examined whether carvedilol (0 or 50 mg/day; between subject, n=17 per group), administered to steady-state, would attenuate the ability to resist smoking following stress imagery (vs. neutral imagery) and reduce subsequent smoking self-administration in nicotine-deprived smokers ( n = 34 total). Tobacco craving, withdrawal, and physiologic reactivity were also assessed. Results: Latency to start smoking and number of cigarettes smoked during the self-administration period did not differ by medication condition. Counter to our hypothesis, tobacco craving demonstrated a medication × time effect, with greater craving in the carvedilol condition. Systolic blood pressure and heart rate demonstrated lower values in the carvedilol versus placebo group, consistent with known effects of carvedilol. Conclusion: While carvedilol attenuated physiologic reactivity consistent with its clinical indication, beneficial effects on smoking outcomes were absent in this preliminary investigation and may suggest possible worsening. Future work may benefit from discerning the single versus combined effects of α1- and β-adrenergic antagonism on smoking outcomes.