Raymond S Niaura

Professor of Social and Behavioral Sciences

Professional overview

Dr. Raymond Niaura is a psychologist and an expert on tobacco dependence and treatment, as well as substance use and addiction to alcohol. Dr. Niaura researches the biobehavioral substrates of tobacco dependence, including factors that influence adolescent and early adult tobacco use trajectories. He also evaluates behavioral and pharmacological treatments for tobacco cessation, with a particular interest in cessation in disadvantaged population to address public health disparities in tobacco-related burdens of illness and disability.

For eight year, Dr. Niaura was the Director of Science and Training at the Schroeder Institute (SI) for Tobacco Research and Policy Studies at the Truth Initiative, where he also supervised the pre- and post-doctoral training programs. Dr. Niaura has previously taught and conducted research at Brown University, Johns Hopkins Bloomberg School of Public Health, the Georgetown Medical Center, and the School of Public Health at University of Maryland. He was also a former President of the Society for Research on Nicotine and Tobacco and is  a Deputy Editor of the Nicotine and Tobacco Research.

With grants from the National Institutes of Health, numerous foundations, and private industry, Dr. Niaura has published over 400 peer-reviewed articles, commentaries, and book chapters, including the book The Tobacco Dependence Treatment Handbook: A Guide to Best Practices.

Education

BA, Psychology (First Class Honors), McGill University, Montreal, Canada

MS, Psychology, Rutgers University, New Brunswick, NJ

PhD, Psychology, Rutgers University, New Brunswick, NJ

Honors and awards

Research Laureate, American Academy of Health Behavior (2009)

University Scholar Award, McGill University (1979)

Areas of research and study

Alcohol, Tobacco and Driving Policies

Evaluations

Health Disparities

Substance Abuse

Tobacco Control

Publications

Publications

Smoking during pregnancy and newborn neurobehavior

Law, K. L., Stroud, L. R., LaGasse, L. L., Niaura, R. S., Liu, J., & Lester, B. M. (n.d.).

Publication year

2003

Journal title

Pediatrics

Volume

111

Issue

6 I

Page(s)

1318-1323

10.1542/peds.111.6.1318

Abstract

Abstract

Objective. This was a prospective study of the effects of maternal smoking during pregnancy on newborn neurobehavior, including dose-response relationships using self-report and a bioassay of nicotine exposure. Methods. The sample included 27 nicotine exposed and 29 unexposed full-term newborn infants with no medical problems from comparable social class backgrounds. Mothers were excluded for using illegal drugs during pregnancy, using antidepressant medication, or if they consumed >3 alcoholic drinks per month. Nicotine exposure was determined by maternal self-report and cotinine in maternal saliva. The NICU Network Neurobehavioral Scale (NNNS) was administered by masked examiners in hospital to measure neurobehavioral function. NNNS scores were compared between nicotine-exposed and -unexposed groups including adjustment for covariates. Dose-response relationships with NNNS scores were computed for maternal salivary cotinine and maternal report of number of cigarettes per day during pregnancy. Results. After adjustment for covariates, the tobacco-exposed infants were more excitable and hypertonic, required more handling and showed more stress/abstinence signs, specifically in the central nervous system (CNS), gastrointestinal, and visual areas. Dose-response relationships showed higher maternal salivary cotinine values related to more stress/abstinence signs (r = .530) including CNS (r = .532) and visual stress (r = .688) and higher excitability scores (r = .617). Cigarettes per day during pregnancy was related to more stress/abstinence signs (r = .582) including CNS (r = .561) and visual stress (r = .640). Conclusions. These findings suggest neurotoxic effects of prenatal tobacco exposure on newborn neurobehavior. Dose-response relationships could indicate neonatal withdrawal from nicotine. Research directed at understanding the effects of cigarette smoking during pregnancy on infants can lead to improved public health outcome.

Stress and anxiety after 9/11: a prospective study

Bock, B., Becker, B., Partridge, R., Niaura, R. S., & Abrams, D. S. (n.d.).

Publication year

2003

Journal title

Medicine and Health Rhode Island

Volume

86

Issue

11

Page(s)

340-341

Abstract

Abstract

~

The Modified Reasons for Smoking Scale : Factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers

Berlin, I., Singleton, E. G., Pedarriosse, A. M., Lancrenon, S., Rames, A., Aubin, H. J., & Niaura, R. S. (n.d.).

Publication year

2003

Journal title

Addiction

Volume

98

Issue

11

Page(s)

1575-1583

10.1046/j.1360-0443.2003.00523.x

Abstract

Abstract

Aims: To assess the validity of the French version of the Modified Reasons for Smoking Scale (MRSS), and to identify which smoking patterns differentiate male and female smokers, which are related to tobacco dependence (as assessed by the Fagerström Test for Nicotine Dependence, FTND), to mood (Beck Depression Inventory II), to affect (Positive and Negative Affect Schedule) and which are predictors of successful quitting. Participants: Three hundred and thirty smokers [(mean ±SD) aged 40±9 years, 145 (44%) women, mean FTND score: 6.2±2], candidates for a smoking cessation programme and smoking at least 15 cigarettes/day. Findings: Factor analysis of the 21-item scale gave the optimal fit for a sevenfactor model, which accounted for 62.3% of the total variance. The following factors were identified: 'addictive smoking', 'pleasure from smoking', 'tension reduction/relaxation', 'social smoking', 'stimulation', 'habit/automatism' and 'handling'. The 'addictive smoking' score increased in a dose-dependent manner with number of cigarettes smoked per day: the 'habit/automatism' score was significantly higher, with more than 20 cigarettes per day than with ≤20 cigarettes per day. The reasons for smoking were different for males and females: females scored higher on 'tension reduction/relaxation', 'stimulation' and 'social smoking'. A high level of dependence (FTND≥6) was associated with significantly higher scores only on 'addictive smoking', the association being stronger in females. Time to first cigarette after awakening was associated with higher 'addictive smoking' and 'habit/automatism' (P < 0.001). In a multivariate logistic regression, failed quitting was predicted by higher habit/automatism score (odds ratio = 1.44, 95% CI = 1.06-1.95, P = 0.02) and greater number of cigarettes smoked per day (odds ratio = 1.03, 95% CI = 1.01-1.06, p = 0.03). Conclusions: The questionnaire yielded a coherent factor structure: women smoked more for tension reduction/relaxation, stimulation and for social reasons than men: addictive smoking and automatic smoking behaviour were similar in both sexes and were associated strongly with a high level of nicotine dependence; the 'habit/automatism' score predicted failure to quit over and above cigarettes per day.

The Smoking Effects Questionnaire for adult populations : Development and psychometric properties

Rohsenow, D. J., Abrams, D. B., Monti, P. M., Colby, S. M., Martin, R., & Niaura, R. S. (n.d.).

Publication year

2003

Journal title

Addictive Behaviors

Volume

28

Issue

7

Page(s)

1257-1270

10.1016/S0306-4603(02)00254-X

Abstract

Abstract

Outcome expectancies are central to a social learning model of smoking and of smoking cessation. The Smoking Effects Questionnaire (SEQ) was developed for use in general adult populations. Items were administered to 257 smokers and ex-smokers including worksite employees, hospital visitors, and clients entering smoking cessation treatment. Principal components analysis (PCA) found seven components with good reliability that were reduced into scales of four or five items each with internal consistencies above α=.80. The final measure has 33 items. The scales were divided by secondary factor analysis into three negative effect and four positive effect scales. The SEQ showed good construct and concurrent validity in comparison with measures of similar constructs and with other smoking variables. Women expected fewer negative physical effects and attributed more importance to positive stimulating effects from smoking but otherwise were comparable to men in expected effects of smoking. More dependent smokers ascribed more importance to negative physical effects and positive stimulating effects than did less dependent smokers but did not differ significantly on other expectancy domains. Both true/false scoring and importance ratings of effects produced mostly comparable results so that either scoring method could be used. Treatment implications were discussed. This brief scale is likely to be useful in a variety of research and clinical settings.

The tobacco dependence treatment handbook: A guide to best practices

Abrams, D. S., Niaura, R. S., Brown, R., Emmons, K., Goldstein, M., & Monti, P. (n.d.).

Publication year

2003

Abstract

Abstract

~

Adolescents' reactions to the imagery displayed in smoking and antismoking advertisements

Shadel, W. G., Niaura, R. S., & Abrams, D. B. (n.d.).

Publication year

2002

Journal title

Psychology of Addictive Behaviors

Volume

16

Issue

2

Page(s)

173-176

10.1037/0893-164X.16.2.173

Abstract

Abstract

This study compared adolescents' unbiased perceptions of the images displayed in smoking and antismoking advertising. Twenty-nine adolescents (ages 11-17) were shown images taken from both advertising types; all images were digitally edited so that no product information appeared in them. Participants described each image in a free-response format and rated each image on self-report dimensions. Content analyses of free-response descriptions and analyses of self-reports revealed that adolescents viewed images taken from cigarette advertisements more positively compared with images taken from antismoking advertisements. These findings suggest that 1 reason for the potency of cigarette advertising, compared with antismoking advertising, is the inherent positive appeal of the images displayed. Antismoking advertising may be more effective at limiting adolescent smoking if the images displayed have a more positive valence.

Applying genetic approaches to the treatment of nicotine dependence

Lerman, C., & Niaura, R. S. (n.d.).

Publication year

2002

Journal title

Oncogene

Volume

21-48

Issue

6

Page(s)

7412-7420

10.1038/sj.onc.1205801

Abstract

Abstract

To advance the science of tobacco control, an enhanced understanding of the bio-behavioral basis of nicotine addiction is needed. In this study, 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 covariates 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, thereby reducing morbidity and mortality from smoking-related disease.

Bupropion for pharmacologic relapse prevention to smoking - Predictors of outcome

Hurt, R. D., Wolter, T. D., Rigotti, N., Hays, J. T., Niaura, R. S., Durcan, M. J., Gonzales, D., Sachs, D. P., Johnston, J. A., & Offord, K. P. (n.d.).

Publication year

2002

Journal title

Addictive Behaviors

Volume

27

Issue

4

Page(s)

493-507

10.1016/S0306-4603(01)00188-5

Abstract

Abstract

The aim of this study was to identify predictors of successful relapse prevention in smokers receiving long-term sustained-release bupropion. Smokers (N=784) who were interested in stopping smoking were enrolled in a 7-week, open-label bupropion phase. Abstinent subjects at the end of treatment and eligible to proceed (N=429) were randomized to active bupropion or placebo through Week 52 and then followed for an additional year. The best overall predictor of less relapse to smoking was assignment to active bupropion. In aggregate, the results indicate that bupropion can be prescribed to diverse populations of smokers with expected comparable results. There was a medication effect that was independent of any predictor except older age and those who gained no or minimal weight during the open-label phase. Predictors of successful relapse prevention included lower baseline smoking rates, a Fagerström Tolerance Questionnaire score of

Depressive symptoms and readiness to quit smoking among cigarette smokers in outpatient alcohol treatment

Hitsman, B., Abrams, D. B., Emmons, K. M., Shadel, W. G., Niaura, R. S., Borrelli, B., Brown, R. A., Swift, R. M., Monti, P. M., Rohsenow, D. J., & Colby, S. M. (n.d.).

Publication year

2002

Journal title

Psychology of Addictive Behaviors

Volume

16

Issue

3

Page(s)

264-268

10.1037/0893-164X.16.3.264

Abstract

Abstract

The authors examined whether length of alcohol abstinence and depressive symptoms were related to motivational readiness to consider smoking cessation among patients in alcohol treatment. Participants were adults (N = 253) enrolled in a smoking cessation trial. Controlling for gender, depressive symptoms, and nicotine dependence, hierarchical regression analysis of readiness scores revealed a significant interaction of days since last drink and depressive symptoms. It was found that a greater number of days since last drink was associated with greater readiness, but only among patients with low scores on the Center for Epidemiologic Studies Depression Scale (L. S. Radloff, 1977). The findings suggest that alcoholic smokers with low depressive symptoms are more receptive to quitting smoking after sustained alcohol abstinence.

Differentiating stages of smoking intensity among adolescents : Stage-specific psychological and social influences

Lloyd-Richardson, E. E., Papandonatos, G., Kazura, A., Stanton, C., & Niaura, R. S. (n.d.).

Publication year

2002

Journal title

Journal of consulting and clinical psychology

Volume

70

Issue

4

Page(s)

998-1009

10.1037/0022-006X.70.4.998

Abstract

Abstract

Researchers' understanding of the impact of sociocultural and psychological factors on the various stages of adolescent smoking uptake is limited. Using national data, the authors examined transitions across smoking stages among adolescents (N = 20,747) as a function of interpersonal, familial, and peer domains. Peer smoking was particularly influential on differentiating regular smoking, whereas alcohol use was most influential on earlier smoking. Although significant, depression and delinquency were attenuated in the context of other variables. Higher school grade was more likely to differentiate regular smoking from earlier smoking stages, whereas African American ethnicity and connectedness to school and family were protective of smoking initiation. Results lend support for an interactional approach to adolescent smoking, with implications for stage-matched prevention and intervention applications.

Does 'unlearning' ever really occur : Comment on Conklin & Tiffany [1]

Niaura, R. S. (n.d.).

Publication year

2002

Journal title

Addiction

Volume

97

Issue

3

Page(s)

357

10.1046/j.1360-0443.2002.0055a.x

Abstract

Abstract

~

Effects of gender on relapse prevention in smokers treated with bupropion SR

Gonzales, D., Bjornson, W., Durcan, M. J., White, J. D., Johnston, J. A., Buist, A. S., Sachs, D. P., Rigotti, N. A., Niaura, R. S., Hays, J. T., & Hurt, R. D. (n.d.).

Publication year

2002

Journal title

American journal of preventive medicine

Volume

22

Issue

4

Page(s)

234-239

10.1016/S0749-3797(02)00419-1

Abstract

Abstract

Background: Recent data suggest that women smokers respond differently than men to cessation pharmacotherapies, particularly nicotine replacement therapy (NRT). Lower abstinence and higher relapse rates are often reported for women treated with NRT. Gender effects for those treated with non-nicotinic, bupropion-hydrochloride sustained release for relapse prevention have not been studied. Methods: Data from a multicenter relapse-prevention (RP) trial of bupropion (November 1995-June 1998) were analyzed for gender differences. Men and women smokers (N=784) were treated with open-label bupropion for 7 weeks. Those abstinent at Week 7 (n=432) were enrolled in the double-blind relapse-prevention phase and randomized to placebo or continued bupropion for 45 additional weeks. Results: Differences in point-prevalence abstinence rates between men (61.8%) and women (55.6%) in open-label bupropion (Week 7) were not significant. In the RP-phase Week 52, continuous abstinence rates for men and women were 37.8% and 36.4% (bupropion) and 36.6% and 29.9% (placebo), respectively; point-prevalence abstinence rates for men and women were 54.1% and 55.9% (bupropion) and 42.9% and 41.3% (placebo), respectively. Abstinence rates and time to relapse were superior for both men and women who received longer treatment. Gender differences within treatment groups were not significant. Median time to relapse was equal for men and women within each treatment group: Week 32 for bupropion and Week 20 for placebo.Conclusions: Our data suggest that bupropion is a promising pharmacotherapy for preventing relapse, particularly for women.

Hostility, the metabolic syndrome, and incident coronary heart disease

Niaura, R. S., Todaro, J. F., Stroud, L., Spiro, A., Ward, K. D., & Weiss, S. (n.d.).

Publication year

2002

Journal title

Health Psychology

Volume

21

Issue

6

Page(s)

588-593

10.1037/0278-6133.21.6.588

Abstract

Abstract

This investigation examined the impact of hostility and the metabolic syndrome on coronary heart disease (CHD) using prospective data from the Normative Aging Study. Seven hundred seventy-four older, unmedicated men free of cardiovascular disease were included in the study. The total Cook-Medley Hostility (Ho) Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption, and total dietary calories were used to predict incident CHD during a 3-year follow-up interval. Multivariate analysis indicated that only Ho positively predicted and high-density lipoprotein cholesterol level negatively predicted incident CHD. Ho's effects on CHD may be mediated through mechanisms other than factors that constitute the metabolic syndrome.

Mediating mechanisms for the impact of bupropion in smoking cessation treatment

Niaura, R. S., Lerman, C., Roth, D., Kaufmann, V., Audrain, J., Hawk, L., Liu, A., Niaura, R., & Epstein, L. (n.d.).

Publication year

2002

Journal title

Drug and alcohol dependence

Volume

67

Issue

2

Page(s)

219-223

10.1016/S0376-8716(02)00067-4

Abstract

Abstract

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.

Multicenter trial of fluoxetine as an adjunct to behavioral smoking cessation treatment

Niaura, R. S., Spring, B., Borrelli, B., Hedeker, D., Goldstein, M. G., Keuthen, N., Depue, J., Kristeller, J., Ockene, J., Prochazka, A., Chiles, J. A., & Abrams, D. B. (n.d.).

Publication year

2002

Journal title

Journal of consulting and clinical psychology

Volume

70

Issue

4

Page(s)

887-896

10.1037/0022-006X.70.4.887

Abstract

Abstract

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-behavioral therapy, and biologically verified 7-day self-reported abstinence follow-ups were conducted at 1, 3, and 6 months posttreatment. Analyses assuming missing data counted as smoking observed no treatment difference in outcomes. Pattern-mixture analysis that estimates treatment effects in the presence of missing data observed enhanced quit rates associated with both the 60-mg and 30-mg doses. Results support a modest, short-term effect of fluoxetine on smoking cessation and consideration of alternative models for handling missing data.

Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder

Kahler, C. W., Brown, R. A., Ramsey, S. E., Niaura, R. S., Abrams, D. B., Goldstein, M. G., Mueller, T. I., & Miller, I. W. (n.d.).

Publication year

2002

Journal title

Journal of abnormal psychology

Volume

111

Issue

4

Page(s)

670-675

10.1037/0021-843X.111.4.670

Abstract

Abstract

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.

Patterns of change in depressive symptoms during smoking cessation : Who's at risk for relapse?

Burgess, E. S., Brown, R. A., Kahler, C. W., Niaura, R. S., Abrams, D. B., Goldstein, M. G., & Miller, I. W. (n.d.).

Publication year

2002

Journal title

Journal of consulting and clinical psychology

Volume

70

Issue

2

Page(s)

356-361

10.1037/0022-006X.70.2.356

Abstract

Abstract

The authors examined patterns of change in depressive symptoms during smoking cessation treatment in 163 smokers with past major depressive disorder (MDD). Cluster analysis of Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) scores identified 5 patterns of change. Although 40% of participants belonged to clusters characterized by increasing depressive symptoms during quitting (rapid increasers, n = 31, and delayed increasers, n = 35), almost 47% were in clusters characterized by decreasing symptoms (delayed decreasers, n = 24, and rapid decreasers, n = 52). Both rapid and delayed increasers had especially poor smoking cessation outcomes. Results suggest that among smokers with an MDD history there is substantial heterogeneity in patterns of depressive symptoms during quitting and that patterns involving increased symptoms are associated with low abstinence rates.

Pharmacogenetic investigation of smoking cessation treatment

Niaura, R. S., Lerman, C., Shields, P. G., Wileyto, E. P., Audrain, J., Pinto, A., Hawk, L., Krishnan, S., Niaura, R., & Epstein, L. (n.d.).

Publication year

2002

Journal title

Pharmacogenetics

Volume

12

Issue

8

Page(s)

627-634

10.1097/00008571-200211000-00007

Abstract

Abstract

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. We investigated whether a functional genetic polymorphism in the CYP2B6 gene predicts smoking outcomes in a placebo-controlled randomized trial. Four hundred and twenty-six 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. 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. We conclude that 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.

Physician recruitment for a community-based smoking cessation intervention.

Park, E. R., MacDonald Gross, N. A., Goldstein, M. G., DePue, J. D., Hecht, J. P., Eaton, C. A., Niaura, R. S., & Dube, C. E. (n.d.).

Publication year

2002

Journal title

The Journal of family practice

Volume

51

Issue

1

Page(s)

70

Abstract

Abstract

OBJECTIVE: Our goal was to describe a strategy to recruit a population-based sample of physicians into a trial to test an approach to disseminate physician-delivered smoking cessation interventions. STUDY DESIGN: The 3-phase population-based recruitment trial included: (1) a print-based promotional appeal, (2) in-person presentations with by the principal investigator (PI), and (3) follow-up calls by the PI and paid physician recruiters. Participation requirements were kept minimal to facilitate recruitment. POPULATION: All primary care physicians statewide were targeted; 3 counties were chosen as intervention areas and 2 counties as control areas. A subsample of physicians was targeted in the larger control areas through a matching process. OUTCOME MEASURED: We measured physician recruitment rate. RESULTS: Eighty-one percent (n=259) of all eligible physicians were successfully recruited into our study. CONCLUSIONS: The full multistep process was important in getting participation agreement. By using an intensive recruitment strategy and minimizing research demands, it is possible to recruit community-based primary care physicians for research projects that will help them enhance the preventive services they provide to their patients.

Response to social stress, urge to smoke, and smoking cessation

Niaura, R. S., Niaura, R., Shadel, W. G., Britt, D. M., & Abrams, D. B. (n.d.).

Publication year

2002

Journal title

Addictive Behaviors

Volume

27

Issue

2

Page(s)

241-250

10.1016/S0306-4603(00)00180-5

Abstract

Abstract

Motivational theories of drug use have assigned negative affect a central role in determining drug urges and drug relapse. The purpose of this study was to examine the effects of social stress on smoking urges in a controlled laboratory setting, and the relation of these responses to short-term (3-month) smoking cessation outcomes. Prior to a clinic-based smoking cessation program, 76 (64% female) smokers were assessed for their affective, cognitive, and physiological responses during the Borkovec social anxiety induction procedure. These responses were used to predict smoking urges immediately after the procedure and to predict abstinence at 3-month follow-up posttreatment. As expected, during the induction, urge to smoke was positively associated with anxiety ratings and negatively associated with self-efficacy to resist smoking. However, only heart rate increase and behavioral social skill (observed by independent judges) predicted smoking abstinence at 3 months. These results suggest that subjective affective and efficacy responses during a stressful social encounter are associated with smoking urges; however, urges and these responses may be related in different ways to the probability of smoking cessation.

Smoking cessation : Progress, priorities, and prospectus

Niaura, R. S., & Abrams, D. B. (n.d.).

Publication year

2002

Journal title

Journal of consulting and clinical psychology

Volume

70

Issue

3

Page(s)

494-509

10.1037/0022-006X.70.3.494

Abstract

Abstract

The authors review developments in understanding smoking cessation interventions over the past decade. Noteworthy is the unprecedented growth of research and knowledge that has left a deeper understanding of how best to use new and existing behavioral and pharmacologic tools and strategies to help smokers quit. The status of public-health-level interventions is evaluated, questions are raised concerning their efficacy, and suggestions are offered for further refinement of these intervention strategies. Development of cessation guidelines is reviewed, and the state of knowledge concerning behavioral and pharmacologic interventions is summarized. The authors also present agendas for behavioral and pharmacologic research related to smoking cessation and discuss individual difference factors among smokers that may prove to be important in designing new and refining existing treatments.

The DRD4 VNTR polymorphism influences reactivity to smoking cues

Hutchison, K. E., LaChance, H., Niaura, R. S., Bryan, A., & Smolen, A. (n.d.).

Publication year

2002

Journal title

Journal of abnormal psychology

Volume

111

Issue

1

Page(s)

134-143

10.1037/0021-843X.111.1.134

Abstract

Abstract

Recent research has indicated that craving for tobacco can be reliably elicited by exposure to smoking cues, suggesting that cue-elicited craving for tobacco may be a useful phenotype for research on genetic factors related to nicotine dependence. Given the potential role of dopamine in cue-elicited craving, the authors examined whether the DRD4 VNTR polymorphism is associated with cue-elicited craving for tobacco. Participants who were homozygous or heterozygous for the 7 repeat (or longer) allele were classified as DRD4 L, and all other participants were classified as DRD4 S. Participants were exposed to smoking cues before smoking either high-nicotine cigarettes or control cigarettes. Analyses suggested that participants in the L group demonstrated significantly greater craving, more arousal, less positive affect, and more attention to the smoking cues than did the participants in the S group.

The effect of bupropion sustained-release on cigarette craving after smoking cessation

Durcan, M. J., Deener, G., White, J., Johnston, J. A., Gonzales, D., Niaura, R. S., Rigotti, N., & Sachs, D. P. (n.d.).

Publication year

2002

Journal title

Clinical Therapeutics

Volume

24

Issue

4

Page(s)

540-551

10.1016/S0149-2918(02)85130-X

Abstract

Abstract

Background: Most (>50%) smokers who attempt to stop smoking relapse within the first year of abstinence. The effect of continued use of pharmacotherapy for smoking cessation on relapse rates is unknown. Bupropion sustained-release (SR) is the first non-nicotine-based therapy that is effective for achieving abstinence from smoking. Objective: This analysis explored the factors involved in relapse to smoking in patients who had successfully stopped smoking using bupropion SR. These patients were participants in a double-blind, placebo-controlled trial of bupropion SR for the prevention of relapse to smoking. Methods: Participants who had stopped smoking with 7 weeks of open-label bupropion SR were randomly assigned to receive double-blind treatment with either bupropion SR or placebo for 45 weeks. The primary efficacy outcome of the main study was the rate of relapse to smoking. The analyses presented here examine the levels of reported cigarette craving and, in those participants who returned to smoking, the reasons associated with relapse, using patient-completed questionnaires. Results: Craving was cited most frequently as a factor contributing to relapse in those participants receiving placebo (cited by 49.2% of relapsers) but significantly less frequently by participants receiving bupropion SR (cited by 22.4% of relapsers) (P < 0.05). Results from patients' diaries showed no differences between bupropion SR and placebo in terms of "craving in the past 24 hours" but significantly lower scores for "craving right now" for bupropion SR at weeks 11 and 12 (P < 0.05). Results at scheduled visits showed that "craving in the past 24 hours" was significantly less with bupropion SR compared with placebo at weeks 12, 20, and 48, and "craving right now" was significantly less with bupropion SR compared with placebo at weeks 12, 16, 20, 24, 48, and 52 (P < 0.05). Conclusions: Craving continues to be a significant concern for individuals even after they have successfully stopped smoking. Bupropion SR appears to reduce reported cravings, which may contribute to the overall reduction in the rate of relapse observed with this pharmacotherapy.

The effects of controlled smoking on heart period variability : Investigating possible development of short-term tolerance using spectral analysis

Nabors-Oberg, R. E., Niaura, R. S., Sollers, J. J., & Thayer, J. F. (n.d.).

Publication year

2002

Journal title

IEEE Engineering in Medicine and Biology Magazine

Volume

21

Issue

4

Page(s)

65-70

10.1109/MEMB.2002.1032641

Abstract

Abstract

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A content analysis of smoking craving

Shadel, W. G., Niaura, R. S., Brown, R. A., Hutchison, K. E., & Abrams, D. B. (n.d.).

Publication year

2001

Journal title

Journal of Clinical Psychology

Volume

57

Issue

1

Page(s)

145-150

10.1002/1097-4679(200101)57:1&lt;145::AID-JCLP15&gt;3.0.CO;2-2

Abstract

Abstract

The purpose of this study was to conduct a content analysis of smoking craving in order to investigate more precisely the subjective nature of the construct with the goal of informing assessment. Thirty-two smokers interested in cessation treatment provided free response written descriptions of the level of craving they normally experience. These responses were analyzed for subjective content along five theoretical domains: physiological, affective, cognitive, behavioral, and synonyms (of craving). Although there were no differences in the relative proportion of broad content terms smokers used to describe their craving (e.g., cognitive versus affective), this analysis revealed considerable diversity in the specific terms smokers used. Some smokers described their craving in purely physiological terms whereas others used primarily cognitive terms, and still others used affective terms. To assume that smoking craving is qualitatively similar across persons, then, may mask important variations that define the individual experience of craving.