Smoking journal pdf

Pharmacogenetics and ethnoracial differences in smoking. Influence of tobacco abstinence on the disposition kinetics and effects of nicotine.

Clin Pharmacol Ther ; 41 : Role of human cytochrome PA6 in C-oxidation of nicotine. Drug Metab Dispos ; 24 : Cytochrome P 2E1 and 2A6 enzymes as major catalysts for metabolic activation of N -nitrosodialkylamines and tobacco-related nitrosamines in human liver microsomes. Carcinogenesis ; 13 : Chronopharmacokinetics of nicotine. Clin Pharmacol Ther ; 60 : The CYP2A3 gene product catalyzes coumarin 7-hydroxylation in human liver microsomes. Biochemistry ; 29 : Purification and characterization of human liver microsomal cytochrome P 2A6.

Mol Pharmacol ; 40 : Am J Hum Genet ; 57 : Pharmacogenetics ; 8 : Yokoi T, Kamataki T. Pharm Res ; 15 : FEBS Lett ; : Nicotine metabolism defect reduces smoking [letter]. Evaluation of nicotine, cotinine, thiocyanate, carboxyhemoglobin, and expired carbon monoxide as biochemical tobacco smoke uptake parameters.

Int Arch Occup Environ Health ; 60 : 37 How a cigarette is smoked determines blood nicotine levels. Clin Pharmacol Ther ; 33 : 84 Saliva cotinine and recent smoking—evidence for a nonlinear relationship. Public Health Rep ; : Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev ; 18 : Pharmacology of nicotine: addiction and therapeutics. Annu Rev Pharmacol Toxicol ; 36 : Racial and ethnic differences in serum cotinine levels of cigarette smokers: Third National Health and Nutrition Examination Survey, Nicotine metabolism and intake in black and white smokers.

Smoking by blacks and whites: socioeconomic and demographic differences. Am J Public Health ; 78 : Sociodemographic characteristics of cigarette smoking initiation in the United States.

Implications for smoking prevention policy. Genetic animal models of alcohol and drug abuse. Genetic and environmental structure of the Tridimensional Personality Questionnaire: three or four temperament dimensions? J Pers Soc Psychol ; 70 : Susceptibility genes for nicotine dependence: a genome scan and followup in an independent sample suggest that regions on chromosomes 2, 4, 10, 16, 17 and 18 merit further study.

Mol Psychiatry ; 4 : Genetic Analysis Workshop Analysis of genetic and environmental factors in common diseases. Genet Epidemiol. In press Noble EP, St.

D2 dopamine receptor gene and cigarette smoking: a reward gene? Med Hypotheses ; 42 : The dopamine D2 receptor DRD2 gene: a genetic risk factor in smoking. Pharmacogenetics ; 6 : 73 Studies of the potential role of the dopamine D1 receptor gene in addictive behaviors. Mol Psychiatry ; 2 : 44 Case-control study of the D2 dopamine receptor gene and smoking status in lung cancer patients.

J Natl Cancer Inst ; 90 : Dopamine D4 receptors and the risk of cigarette smoking in African-Americans and Caucasians. Cancer Epidemiol Biomarkers Prev ; 7 : Depression and self-medication with nicotine: the modifying influence of the dopamine D4 receptor gene. Health Psychol ; 17 : 56 Evidence suggesting the role of specific genetic factors in cigarette smoking.

Health Psychol ; 18 : 14 Clarke PB. Mesolimbic dopamine activation—the key to nicotine reinforcement? Substance abuse vulnerability and D2 receptor genes. Trends Neurosci ; 16 : 83 Allelic association of the D2 dopamine receptor gene with receptor-binding characteristics in alcoholism.

Arch Gen Psychiatry ; 48 : Genetic association between dopamine transporter protein alleles and cocaine-induced paranoia. Neuropsychopharmacology ; 11 : Mol Psychiatry ; 2 : Alcohol Clin Exp Res ; 20 : A twin-pronged attack on complex traits. Nat Genet ; 17 : Genetic influences on smoking behavior. Behavior genetic approaches in behavioral medicine. Genetic and environmental contributions to smoking. Addiction ; 92 : Genetic contribution to risk of smoking initiation: comparisons across birth cohorts and across cultures.

J Subst Abuse ; 5 : Association between alcohol use and smoking in adolescent and young adult twins: a bivariate genetic analysis. Alcohol Clin Exp Res ; 21 : Familial transmission of substance use disorders.

Arch Gen Psychiatry ; 55 : Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking: a report from the Collaborative Study on the Genetics of Alcoholism.

A scale to differentiate between types of smoking as related to the management of affect. Int J Addictions ; 4 : McKennell AC. Smoking motivation factors. Br J Soc Clin Psychol ; 9 : 8 Frith CD.

Smoking behaviour and its relation to the smoker's immediate experience. Br J Soc Clin Psychol ; 10 : 73 The classification of smoking by factorial structure of motives. J R Stat Soc A ; : Pharmacological and non-pharmacological smoking motives: a replication and extension. Addiction ; 89 : Parrott AC. Individual differences in stress and arousal during cigarette smoking.

Psychopharmacology Berl ; : Cigarette smoking: effects upon self-rated stress and arousal over the day. Addict Behav ; 18 : Testing a model for the genetic structure of personality: a comparison of the personality systems of Cloninger and Eysenck. J Pers Soc Psychol ; 66 : Vulnerability to psychopathology in nicotine-dependent smokers: an epidemiologic study of young adults. Am J Psychiatry ; : Psychosocial and personality differences in chippers and regular smokers.

Addict Behav ; 19 : Personality and the inheritance of smoking behavior: a genetic perspective. Behav Genet ; 25 : Nicotine withdrawal in women. Fagerstrom KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment.

Addict Behav ; 3 : Br J Addict ; 86 : Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. J Behav Med ; 12 : Drug Alcohol Depend ; 34 : Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers.

Tob Control ; 5 : 52 Shiffman S. Psychopharmacology Berl ; 97 : Nicotine exposure among nondependent smokers. Arch Gen Psychiatry ; 47 : Nicotine elimination and tolerance in non-dependent cigarette smokers.

Smoking typology profiles of chippers and regular smokers. J Subst Abuse ; 6 : 21 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Psychiatr Clin North Am ; 16 : 21 Involvement of tobacco in alcoholism and illicit drug use.

Br J Addict ; 85 : Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort [published erratum appears in JAMA ;]. JAMA 6; : Edwards G, Gross MM. Alcohol dependence: provisional description of a clinical syndrome. Br Med J ; 1 : Edwards G. The alcohol dependence syndrome: a concept as stimulus to enquiry. Br J Addict ; 81 : Addiction ; 91 : Comparative epidemiology of dependence on tobacco, alcohol, controlled substances and inhalants: basic findings from the National Comorbidity Survey.

Exp Clin Psychopharmacology ; 2 : Indicators of nicotine addiction among women—United States, Symptoms of substance dependence associated with use of cigarettes, alcohol, and illicit drugs - United States, Prevalence of tobacco dependence and withdrawal.

Addiction ; 88 : Stanton WR. Addict Behav ; 20 : Intermittent smokers: a descriptive analysis of persons who have never smoked daily.

Am J Public Health ; 88 : 86 Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial.

Smoking, smoking cessation, and major depression. Depression and the dynamics of smoking. A national perspective. Depressive symptoms and cigarette smoking among Latinos in San Francisco. Am J Public Health ; 80 : Investigation of mechanisms linking depressed mood to nicotine dependence. Addict Behav ; 21 : 9 Ever-smoking, quitting, and psychiatric disorders: evidence from the Durham, North Carolina, Epidemiological Catchment Area.

Tob Control ; 3 : Nicotine dependence, major depression, and anxiety in young adults. Nicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry ; 50 : 31 Inhibition of monoamine oxidase B in the brains of smokers. Brain monoamine oxidase A inhibition in cigarette smokers.

Psychoactive smoke [news]. Smoking and major depression. A causal analysis. Arch Gen Psychiatry ; 50 : 36 Istvan J, Matarazzo JD. Tobacco, alcohol, and caffeine use: a review of their interrelationships. Psychol Bull ; 95 : Schiffman S, Balabanis M. Associations between alcohol and tobacco. Alcohol and tobacco: from basic science to clinical practice. Are smokers with alcohol disorders less likely to quit? Breslau N. Psychiatric comorbidity of smoking and nicotine dependence.

Behav Genet ; 25 : 95 Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers. J Subst Abuse Treat ; 14 : Relationship between alcohol and tobacco dependencies among alcoholics who smoke.

Addiction ; 90 : A prospective, high-risk study of the relationship between tobacco dependence and alcohol use disorders. The consumption of tobacco, alcohol, and coffee in Caucasian male twins: a multivariate genetic analysis. J Subst Abuse ; 8 : 19 Heavy consumption of cigarettes, alcohol and coffee in male twins. J Stud Alcohol ; 58 : Alcohol sensitivity and smoking history in men and women.

Alcohol Clin Exp Res ; 19 : Educational attainment and racial differences in cigarette smoking. J Natl Cancer Inst ; 87 : Siegel D, Faigeles B. Smoking and socioeconomic status in a population-based inner city sample of African-Americans, Latinos and whites. J Cardiovasc Risk ; 3 : Education and prevalence of smoking in Italian men and women. Although Peto et al. If relative risk is higher, then our results understate the proportion of Americans who underestimate this relative risk. It is worth noting that although one might imagine that it is difficult to estimate risk rates because of complex functional forms, interactions of smoking with other risk factors, cohort effects, and other complications, research suggests that in fact, risk rates are largely robust to some potential complexities [ 53 — 55 ].

Thus, most people vastly overestimated this absolute risk. Only 5. A large majority, In contrast, a large majority of respondents Relative risk was computed by dividing each respondent's answer to the question about 1, smokers by his or her answer to the question about 1, nonsmokers. Note that re-computing all analyses reported below treating these people as having missing data on the relative risk measure had negligible impact on the reported results.

Only about 1. Mean perceived relative risk was Thus, relative risk tells a very different story about the prevalent errors in risk perceptions than does attributable risk: most people overestimated the latter, whereas most people underestimated the former. Study 3 suggests that the perceived risk of lung cancer may have declined among current and former smokers between and Which of these measures is an appropriate focus for claims about public risk perceptions and their accuracy?

Many possible patterns of risk perception use are possible in any population. The most heterogeneous pattern would be one in which some people decide whether to smoke or quit based upon their perceptions of the attributable risk, while others make this decision with reference to perceptions of relative risk, and still others make their decisions based on perceptions of absolute risk, with the three groups being of roughly equal size.

The most homogeneous case is that in which everyone uses just one of these risk perceptions to make their behavioral choices regarding smoking. By gauging which risk perceptions have how much impact for how many people, we can begin to understand whether smoking behavior overall in a population is driven mostly by perceptions that overestimate risk, mostly by perceptions that underestimate risk, or by a mixture of perceptions that sometimes overestimate and other times underestimate.

The data of all three studies allowed us to explore whether perceptions of attributable risk, relative risk, and absolute risk inspire people to quit smoking by comparing current and former smokers. If perceptions of health risks are indeed a principal motivator of smoking cessation, then perceived risk should be lower among people who currently smoke than among people who used to smoke but have quit.

Based upon this assumption, the better a risk perception measure predicts whether a person has quit smoking, the more likely that risk perception is to have driven quitting decisions. GAMs are especially useful for estimating models containing two highly correlated predictors as we have here because relaxing the assumption of linearity prevents model misspecification, allowing for better isolation of the unique relations of different risk perceptions with other variables.

Using this flexible approach, we first estimated a model in which relative and attributable risk predicted quitting more precisely, having quit. It might seem appealing to estimate GAMs predicting quitting using all three measures, but non-independence among the three measures of perceived risk makes that impossible. Increasing perceived relative risk was associated with decreased log-odds of remaining a smoker. Movement from the 25 th percentile to the 75 th percentile weighted of relative risk increased the probability of quitting by In contrast, over the range of the bulk of the data where the majority of the rugmarks on the x-axis are located , the relation between attributable risk and quitting was fairly flat see bottom-left panel of S2 Fig.

Movement across the interquartile range of attributable risk increased the probability of quitting negligibly, by only 0. To more formally gauge and compare these relations, we estimated a set of nested GAMs.

First, we estimated a model predicting quitting using only attributable risk and then observed the improvement in goodness of fit of the model when we added relative risk as a predictor. Next, we estimated a model predicting quitting using only relative risk and then estimated the improvement in goodness of fit when attributable risk was added as a predictor.

Thus, relative risk perceptions appear to have been related to decisions to quit smoking, whereas perceptions of attributable risk were not. To explore whether absolute risk outperforms relative risk, we estimated a GAM in which quitting was predicted by both measures. As shown in the right panels of S2 Fig , relative risk was again sensibly related to quitting with probability of remaining a smoker declining smoothly as perceived risk increased , whereas absolute risk was not.

Movement across the interquartile range of absolute risk was associated with a As shown in columns two and three of Table 4 as well as S3 and S4 Figs , these same results were replicated in Studies 2 and 3. There may be an illusion hidden in these results. The results supported the above conclusions even more strongly for details of these approaches and results, see S6 Appendix.

Next, we explored whether certainty moderated the associations of risk perceptions with quitting behavior. Among the high certainty respondents, the probability of quitting increased over the interquartile range of relative risk by In Study 3, among high certainty individuals While a desire to quit does not automatically translate to smoking cessation, a strong desire to quit is predictive of subsequent quitting behavior, and is a necessary condition for quitting [ 57 ].

Movement from the 25 th to the 75 th percentile of relative risk raised the probability of wanting to quit by Movement across the interquartile range of attributable risk slightly lowered desire to quit by 1. Movement across the interquartile range of relative risk increased desire to quit by The data from Studies 2 and 3 yielded similar results see columns five and six of Table 4. This further supports the contention that people think in terms of relative risk perceptions.

We observed the expected results when we used the three measures in Study 3 to explore whether perceived risk was greater among people who ever smoked than among people who never smoked.

Also as expected, people who never smoked perceived higher attributable risk of smoking than did people who ever smoked see the last two columns in Table 2 : 1 3. Respondents who never smoked thought smokers were 32 percentage points more likely than nonsmokers to get lung cancer, on average see columns 11 and 12 of Table 2. Thus, these individuals perceived a higher attributable risk than did current and former smokers Likewise, respondents who never smoked also perceived higher relative risk than did current and former smokers compare the last two columns of Table 3 with the ninth and tenth columns of that table.

As expected, perceptions of relative risk were strongly associated with status as a never smoker vs. Movement across the interquartile range of relative risk yielded a Movement across the interquartile range of attributable risk yielded a decrease in the probability of being a smoker of only 0. Movement across the interquartile range of relative risk when controlling for absolute risk was associated with a In contrast, movement across the interquartile range of absolute risk when controlling for relative risk produced only an 8.

Taken together, this evidence suggests that while Americans have overestimated the absolute risk and risk difference of lung cancer associated with cigarette smoking, Americans have generally underestimated the relative risk.

Furthermore, this evidence suggests that people may think more about smoking health risks in terms of relative risk than in terms of absolute risk or risk difference. The relations we saw here may result from the influence of health risk beliefs on decisions to quit smoking, decisions to start smoking, and regret about smoking, or these relations may occur because people rationalize their smoking status by adjusting their risk perceptions, or from some other process.

Having seen here that these are possibilities, we look forward to future research exploring them to characterize the basis for the relations we observed. Communication of risk has been a difficult task for medical professionals, and our findings encourage consideration of a different approach to communicating health risks than has been typical on American cigarette packages and in other prominent health communications [ 58 , 59 ].

There are a large number of studies that show that the design of and warnings on cigarette packs can influence perceptions of the risks of smoking [ 60 — 68 ]. However, much constructive work can perhaps still be done by informing individuals about how much smoking increases their health risks. If the findings reported here are correct in suggesting that people use perceptions of relative risk when deciding whether to quit smoking, and if relative risk is indeed underestimated by most current and former smokers, corrective steps in this regard might be consequential.

This may be why quantitative information about relative risk on cigarette packages in Australia e. Future research could explore these possibilities with experiments gauging the effects of different ways of describing risks on cigarette packages and other health communication mediums like television advertisements, poster campaigns, and doctor-patient communication [ 70 ].

Perceptions of relative risk might be changed best by making such direct statements. But it may also be that such perceptions can be changed even more effectively by inducing affective reactions or in other non-quantitative ways, while simultaneously maximizing trust in the source of the information [ 71 , 72 ]. It is important to bear in mind that even successful efforts to change risk perceptions may not produce changes in behavior, so it will be important for future investigations to assess whether risk perception changes are translated into action [ 73 ].

In addition to their applied value, the findings reported here are interesting in basic psychological terms.

By distinguishing between absolute, attributable, and relative risk, the present findings encourage future study with such measures to understand how people make many types of risky decisions and, more generally, how people trade off probabilities when making choices. And many important questions remain regarding risk perceptions involving smoking, such as how people arrive at their perceptions of relative, attributable, and absolute risk, and when and why some people use one measure rather than another to make behavioral decisions.

Future studies of these sorts of issues seem merited, both in the smoking and other domains. Various findings reported here resonate with findings of some past studies. For example, Viscusi [ 2 ] and Borland [ 69 ] found that people overestimated the absolute risk of smoking. Khwaja et al. When Weinstein et al. Boney-McCoy et al. This is consistent with the evidence reported here that when considered alone, absolute risk perceptions are related to quitting in the same way.

However, when controlling for relative risk, the relation of quitting to absolute risk perceptions was close to zero in the present data. Viscusi et al. The present evidence that people seem to think in terms of relative risk rather than attributable or absolute risk resonates with research on effective ways to communicate risks to patients [ 77 , 78 ]. For example, Malenka et al. A preference for thinking about health risks in terms of relative risk is also apparent in news media stories.

Similarly, medical journal articles tend to focus on reports of relative risk rather than attributable risk [ 87 ]. With enough probing, open-ended data gathering might reveal whether people naturally use language evoking absolute risk, attributable risks, or relative risk levels, or a non-numeric representation, and such evidence is worthwhile to collect in future research [ 37 , 88 ]. Future work should also incorporate how much life is lost when calculating risk see Viscusi [ 38 ] for a discussion of how this might affect an understanding of these results.

Because lung cancer is one of the best-known health risks of smoking [ 11 ], Americans may be less likely to underestimate the relative risk of lung cancer than of other diseases that are known to be caused by smoking.

If we had asked survey questions about heart disease, oral cancers, or stroke instead of lung cancer, the prevalence of underestimation of relative risk may have been even greater than was observed for lung cancer.

Correcting these misunderstandings may decrease the expected smoking rate even more. Future studies can explore these possibilities. Differentiating perceived relative risk from perceived attributable risk may be useful in other health domains as well. For example, Meltzer and Egleston [ 89 ] reported that patients with diabetes vastly overestimated their own absolute risk of experiencing various complications.

But perhaps their perceptions of relative risk are more accurate. However, educational efforts can present risk rates in various different ways, and some presentation approaches can cause misunderstandings [ 93 , 92 ]. The present evidence bolsters the conclusions of some past studies suggesting that future research may be most successful when presenting relative risk information to yield better quality decisions [ 94 — 99 ].

Krosnick, Principal Investigator. The authors thank Geoffrey Fong and Paul Slovic for very helpful suggestions. The authors acknowledge the excellent research assistance of Virginia Lovison. Supervision: JAK. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Most Americans recognize that smoking causes serious diseases, yet many Americans continue to smoke. Prior studies of perceptions of the magnitude of risk A number of past studies have attempted to measure perceptions of the magnitude of the risk of smoking in representative samples of American adults, but their methodologies entailed a series of limitations, as we outline next.

Three studies Our three studies explored five main questions: 1 How many people overestimate and underestimate absolute risk, attributable risk, and relative risk of lung cancer due to smoking? Actual risk We used data reported by Peto et al. Download: PPT. Table 1. Table 2. Table 3. Comparing risk measures Which of these measures is an appropriate focus for claims about public risk perceptions and their accuracy? Table 4. Desire to quit. Smoking onset.

Discussion Summary and implications Taken together, this evidence suggests that while Americans have overestimated the absolute risk and risk difference of lung cancer associated with cigarette smoking, Americans have generally underestimated the relative risk. Resonance with other findings Various findings reported here resonate with findings of some past studies.

Implications regarding other domains of risk perception. Implications for health education. Supporting information. S1 Fig. Proportions of Americans who failed to assert that smoking is dangerous to human health: Gallup Organization Surveys. S2 Fig. S3 Fig. S4 Fig. Generalized Additive Models predicting the probability of being a current smoker vs. S5 Fig. S1 Appendix. Measuring risk.

S2 Appendix. Literature on the relation of health risk perceptions with quitting smoking. S3 Appendix. Survey methodology. S4 Appendix. S5 Appendix. Keywords: smoking, tobacco, addiction.

Introduction The continued popularity of tobacco smoking appears to defy rational explanation. Health impact of smoking and the benefits of stopping Tobacco smoking increases the risk of contracting a wide range of diseases, many of which are fatal. Table 1. Main causes of death from tobacco smoking and benefits of stopping. Cause of death from smoking Benefit of stopping smoking Coronary heart disease and stroke Preventable if cessation occurs in early adulthood; at least partially reversible thereafter Cancers of the lung and upper airways Preventable if cessation occurs in early adulthood; further increase in risk prevented thereafter Chronic obstructive pulmonary disease Preventable if cessation occurs in early adulthood; further decline in lung function slowed thereafter Miscarriage and underdevelopment of foetus Preventable if cessation occurs early in pregnancy; risk is mitigated by stopping at any time in pregnancy.

Open in a separate window. Table 2. Estimates of tobacco smoking prevalence in world regions. Psychological, pharmacological and social factors involved in smoking and smoking cessation The natural history of smoking can be modelled as states and factors that influence the transition between these.

Figure 1. Smoking initiation Important factors predicting initiation in western societies are: having friends who smoke, having parents who smoke, low social grade, tendency to mental health problems and impulsivity Action on Smoking and Health, b. Smoking cessation For most smokers, cessation requires a determined attempt to stop and then sufficient resolve in the following weeks and months to overcome what are often powerful urges to smoke.

Interventions to combat smoking There is extensive evidence on interventions that can reduce smoking prevalence, either by reducing initiation or promoting cessation. Table 3. Effective interventions for combating smoking.

Population-level interventions Increasing the financial cost of smoking through tax increases and control of illicit supply on average reduces overall consumption with a typical price elasticity globally of 0.

Individual-level interventions to promote smoking cessation Brief advice Brief advice to stop smoking from a physician and offer of support to all smokers, regardless of motivation to quit, has been found in randomised trials to increase rate of quitting by an average of 2 percentage points of all those receiving it, whether or not they were initially interested in quitting Stead et al. Pharmacotherapy Using a form of nicotine replacement therapy NRT: transdermal patch, chewing gum, nasal spray, mouth spray, lozenge, inhalator, dissolvable strip for at least 6 weeks from the start of a quit attempt increases the chances of long-term success of that quit attempt by about 3—7 percentage points if the user is under the care of a health professional or provided as part of a structured support programme Stead et al.

Behavioural support There is good evidence that behavioural interventions of many kinds, delivered though several modalities can help smokers to stop.

Smoking cessation support for pregnant smokers In pregnant smokers, there is some evidence that NRT can help promote smoking cessation but evidence for an effect sustained to end of pregnancy is not conclusive Sterling et al. Reducing the harm from tobacco and nicotine use Smokers who report that they are reducing their cigarette consumption smoke only 1—2 fewer cigarettes per day on average than when they say they are not Beard et al.

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