A review of research on smoking among United States Veterans with posttraumatic stress disorder (2006–2016)

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders diagnosed in U.S. veterans. PTSD is associated with high smoking prevalences and difficulty quitting in the general U.S. population. The current study reviewed research on smoking and PTSD in U.S. veteran samples to summarize past research and identify areas in need of additional inquiry. MEDLINE and PsycINFO searches identified papers on smoking in samples of U.S. veterans with PTSD published from January 2006 through December 2016. Thirty-four articles met all of the inclusion criteria: (a) part of the sample consisted of U.S. veterans with PTSD or PTSD symptoms, and (b) the study examined some aspect of smoking behavior. U.S. veterans with PTSD were more likely to report smoking, heavy smoking, nicotine dependence, and late-onset smoking compared to veterans without PTSD. Smoking behaviors (e.g., current smoking, heavy smoking, smoking expectancies) differed by PTSD symptoms and by combat exposure. Smoking cessation feasibility studies examined the integration of smoking treatment into PTSD clinics and found favorable outcomes. Future research on veterans with PTSD would benefit from extending topics beyond rates of smoking to better understand the treatment needs of veterans. Research on smoking-related behaviors can help identify areas to target for interventions.     

The role of stress and area‐specific self‐esteem in adolescent smoking

Stress and self‐esteem have been shown to be important risk factors for adolescent cigarette smoking, and self‐esteem has previously been implicated as a stress‐moderating and a stress‐mediating variable. This study aimed to examine the associations between stress, area‐specific self‐esteem, and adolescent smoking, and to investigate whether specific areas of self‐esteem moderate or mediate the relationship between stress and smoking. Four hundred and ninety‐five adolescents (aged 14–19) responded to a questionnaire that examined these variables. Results showed that self‐esteem in the areas of school subjects and parent relations were related to smoking. Adolescents with low self‐esteem in these areas were more likely to smoke than their high self‐esteem counterparts. Highly stressed adolescents were more likely to smoke than those with low stress. However, the relationship between stress and smoking was completely mediated by self‐esteem in the area of school subjects. No moderation was revealed. Thus, high global self‐esteem may not be sufficient to reduce the risk of smoking. To maximise benefit, prevention and intervention efforts should target self‐esteem in the areas of school subjects and parent relations. Initiatives focusing on stress are only likely to decrease smoking to the extent that they influence self‐esteem in the area of school subjects.     

“Like Drawing Into Sand”: Acceptability,Feasibility, and Appropriateness of a New e‐Mental Health Resource for Service Providers Working With Aboriginal and Torres Strait Islander People

Cross‐cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Aboriginal and Torres Strait Islander people. However, electronic resources may provide the opportunity for remote workforces to deliver structured, evidence‐based, culturally appropriate treatments with limited training burden. The aim was to develop and determine the acceptability, feasibility, and appropriateness of a new e‐mental health resource (the Australian Integrated Mental Health Initiative [AIMhi] Stay Strong App) for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. Eleven semi‐structured interviews were conducted with 15 service providers and managers from a range of rural and remote primary health care service settings in the Northern Territory. All participants were given the resource to trial for at least 1 month before being interviewed about perceived barriers and enablers, acceptability, and feasibility. Thematic analysis revealed support for the acceptability, feasibility, and appropriateness of the resource among service providers. Major themes identified included acceptability, building relationships, broad applicability, training recommendations, integration with existing systems, and constraints to implementation. This is one of the first studies to explore the acceptability of e‐mental health approaches for Aboriginal people among the remote health workforce. It is likely that e‐mental health interventions, such as the AIMhi Stay Strong App will assist services to deliver evidence‐based, structured interventions to improve well‐being for Aboriginal and Torres Strait Islander clients.     

NICOTINE FADING AND SELF-MONITORING FOR CIGARETTE ABSTINENCE OR CONTROLLED SMOKING

This study compared four treatment approaches to cigarette smoking: (1) a nicotine fading procedure, in which subjects changed their cigarette brands each week to ones containing progressively less nicotine and tar; (2) a self-monitoring procedure in which subjects plotted their daily intake of nicotine and tar; (3) a combined nicotine fading/self-monitoring procedure; and (4) a slightly modified American Cancer Society Stop Smoking Program. Thirty-eight habitual smokers were assigned to one of the treatment groups. The study had two goals: (1) to achieve a clinically significant percentage of abstinence, and (2) to reduce the nonabstainers' smoking to a “safer” level by having them smoke low tar and nicotine cigarettes. The 18-month followup results showed that the nicotine fading/self-monitoring group was the most successful: 40 per cent were abstinent and all who had not quit were smoking cigarettes lower in tar and nicotine than their baseline brands. Half the nonabstainers had decreased their rate of smoking relative to baseline while the other half had increased. Furthermore, the fading/self-monitoring group achieved the largest reductions from baseline in daily nicotine and tar intake (61% and 70% respectively). The results suggest that the study's goals were achieved and that the nonaversive combined procedure could be used to treat not only habitual smokers but also smokers with severe cardiovascular and respiratory problems, because it does not have some of the inherent limitations of the successful aversive smoking cessation procedures.     

Prevalence,Correlates and Perceptions Towards Cigarette Smoking Among Male and Female in School Adolescents (Aged 11–18 Years) in South Africa: Results from the 2008 GYTS Study

The aim of this study was to estimate the prevalence and identify correlates of current cigarette use among 8,470 school-going adolescents (aged 11 to 18 years) in South Africa. A cross-sectional study was carried out in 2008 in South Africa within the framework of the Global Youth Tobacco Survey (GYTS). Overall prevalence of current cigarette smoking was 16.5%. Significantly more males (22.8%) than females (10.5%) were current smokers (p < .001). Cigarette smoking among boys and girls was positively associated with parental and/or peer smoking and greater risk perception, and among girls smoking attitudes variables (having more friends among girls, greater attractiveness of boys and weight change) and various higher exposure to smoking advertising and promotion activities were positively associated with cigarette smoking. However, antismoking advertising and community and family education were positively associated with current smoking, while only having school or community special groups or classes for students who want to stop smoking was protective of smoking. Cigarette smoking and other tobacco use is a significant public health problem in South Africa. Public health efforts aimed at preventing adolescent cigarette/tobacco use should incorporate knowledge on the associated factors related to smoking.     

Opinion leadership in a computer‐mediated environment

This paper investigates the characteristics of opinion leaders within the computer‐mediated environment, analyses the differences between online opinion leaders and online non‐leaders and examines the implications of opinion leadership theory for e‐commerce. This study finds that opinion leaders in computer‐mediated environments possess significantly higher levels of enduring involvement, innovativeness, exploratory behaviour and self‐perceived knowledge than non‐leaders. Online opinion leaders also possess greater computer skills, have used the internet for a longer period of time and use the internet more frequently for longer sessions than non‐leaders. Copyright © 2005 John Wiley & Sons, Ltd.     

Cigarette Smoking, Anxiety, and Depression

This review provides a detailed analysis of anxiety and depression as they relate to each stage of the cigarette smoking cycle: initiation, maintenance, and cessation with an emphasis on nicotine withdrawal. An analysis of the literature confirms that cigarette smoking is highly comorbid with anxiety disorders and clinical depression, and that this relationship appears to be moderated by factors such as age of the smoker, type of disorder, and level of nicotine dependence. Studies also offer evidence to suggest a relationship between smoking and both subclinical anxiety and depression. Research findings have not revealed whether common factors influence the development of anxiety, depression, and smoking, whether anxiety and depression lead to smoking, or whether the reverse is true. Nevertheless, a current understanding of the links among smoking, anxiety, and depression confirms current prevention and cessation techniques, as well as suggests new directions for research and clinical practice.     

Nature and Role of Change in Anxiety Sensitivity During NRT-Aided Cognitive-Behavioral Smoking Cessation Treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M _age = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.