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

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

Lerman, C., Audrain, J., Tercyak, K., Hawk, L. W., Bush, A., Crystal-Mansour, S., Rose, C., Niaura, R. S., & Epstein, L. H. (n.d.).

Publication year

2001

Journal title

Nicotine and Tobacco Research

Volume

3

Issue

4

Page(s)

353-359

10.1080/14622200110072156

Abstract

Abstract

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.

Cognitive Avoidance as a Method of Coping with a Provocative Smoking Cue : The Moderating Effect of Nicotine Dependence

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

Publication year

2001

Journal title

Journal of Behavioral Medicine

Volume

24

Issue

2

Page(s)

169-182

10.1023/A:1010762631464

Abstract

Abstract

Both nicotine dependence and coping are important determinants of smoking cessation, yet little is understood about mechanisms that link the two. This laboratory study investigated how nicotine dependence moderates execution of an avoidance coping strategy. High and low dependent smokers were exposed to a provocative smoking cue (in vivo) under two instructional sets: cognitive avoidance coping and no coping. Contrary to hypotheses, high dependent smokers reported greater increases in perceived self-efficacy to not smoke and also demonstrated greater facility in processing coping/nonsmoking-related information on a reaction time task, compared with low dependent smokers. These counterintuitive findings are discussed in terms of how nicotine dependence may affect the cognitive process of coping.

Cognitive-behavioral treatment for depression in smoking cessation

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

Publication year

2001

Journal title

Journal of consulting and clinical psychology

Volume

69

Issue

3

Page(s)

471-480

10.1037/0022-006X.69.3.471

Abstract

Abstract

Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive-behavioral smoking cessation treatment (ST; n = 93) or standard, cognitive-behavioral smoking cessation treatment plus cognitive-behavioral treatment for depression (CBT-D; n = 86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking (≥25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios = 2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD.

Does completing a craving questionnaire promote increased smoking craving? An experimental investigation

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

Publication year

2001

Journal title

Psychology of Addictive Behaviors

Volume

15

Issue

3

Page(s)

265-267

10.1037/0893-164X.15.3.265

Abstract

Abstract

The authors evaluated whether completing a multi-item assessment of smoking craving (the Questionnaire of Smoking Urges [QSU]) promoted increases in smoking craving. A sample of 39 regular smokers was randomly assigned to 1 of 3 manipulations (each of 3 min duration): (a) complete the QSU-Brief (10 items), (b) complete a noncraving questionnaire that was structurally identical to the QSU-Brief (scale-based control), and (c) a time-based control. Participants responded to an oral question assessing their degree of craving immediately before and after the manipulations. Results indicated that the QSU did not promote increases in craving compared to the 2 control conditions. Despite continuing debate over the most appropriate self-report measure of craving, investigators who use the QSU-Brief can be reasonably sure that the scores that result are not biased due to reactivity effects.

Effect of different cue stimulus delivery channels on craving reactivity : Comparing in vivo and video cues in regular cigarette smokers

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

Publication year

2001

Journal title

Journal of Behavior Therapy and Experimental Psychiatry

Volume

32

Issue

4

Page(s)

203-209

10.1016/S0005-7916(01)00035-0

Abstract

Abstract

Exposure to smoking cues reliably produces increases in craving compared to exposure to appropriately matched neutral cues. While different types of stimuli have been used as cue materials in such studies, the channel through which cues are delivered is not often varied in a systematic fashion in smoking research. This study compared the effect of exposure to active in vivo cues compared to two cues, matched for content and time, delivered via videotape on self-reported smoking craving. Results revealed that active in vivo cues produced the highest craving ratings, followed next by active video cues, and last by neutral video cues. These results suggest that craving is sensitive to stimulus delivery channel and that video presentation of smoking cues is a viable manipulation option in cue reactivity studies.

How Do Adolescents Process Smoking and Antismoking Advertisements? A Social Cognitive Analysis with Implications for Understanding Smoking Initiation

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

Publication year

2001

Journal title

Review of General Psychology

Volume

5

Issue

4

Page(s)

429-444

10.1037/1089-2680.5.4.429

Abstract

Abstract

Youth tobacco use has increased substantially in the United States during the past decade. This increase can be attributed, in part, to the potency of cigarette advertising and relative ineffectiveness of antismoking advertising. In this article, the authors argue that an understanding of the effects of these 2 competing forms of advertising on youth smoking is limited in current theoretical treatments and that an integrative theoretical perspective has yet to be advanced. The authors argue that the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986) offers a framework with sufficient explanatory power in this domain. Prevention and legislative interventions may benefit from this analysis, which ultimately may help to decrease youth tobacco use.

Individual differences in responses to the first cigarette following overnight abstinence in regular smokers

Niaura, R. S., Niaura, R., Shadel, W. G., Goldstein, M. G., Hutchinson, K. E., & Abrams, D. B. (n.d.).

Publication year

2001

Journal title

Nicotine and Tobacco Research

Volume

3

Issue

1

Page(s)

37-44

10.1080/14622200020032088

Abstract

Abstract

We utilized cluster analysis to identify individual differences in response to the initial effects of smoking following overnight abstinence among 183 regular smokers. Participants smoked three cigarettes (1 mg nicotine, spaced 30 min apart) in standardized fashion and completed questionnaires about their subjective responses to each cigarette. Heart rate was monitored throughout the procedure. Participants were grouped into two clusters based on their reported subjective effects and heart rate changes to the first cigarette. Clusters differed in terms of greater increases in heart rate, reports of dizziness, sweating, unpleasantness, nausea, and buzzing sensations in one group compared to the other group. The smokers showing increased responses developed greater acute tolerance to the effects of smoking subsequent cigarettes on subjective negative effects and heart rate, and experienced greater negative affect after quitting. These results are partially consistent with a nicotine sensitivity interpretation or a tolerance model of the effects of initial smoking.

Influence of antidepressant pharmacotherapy on behavioral treatment adherence and smoking cessation outcome in a combined treatment involving fluoxetine

Hitsman, B., Spring, B., Borrelli, B., Niaura, R. S., & Papandonatos, G. D. (n.d.).

Publication year

2001

Journal title

Experimental and Clinical Psychopharmacology

Volume

9

Issue

4

Page(s)

355-362

10.1037/1064-1297.9.4.355

Abstract

Abstract

The authors examined whether serum fluoxetine levels influence behavioral treatment adherence and smoking cessation outcome. Nondepressed smokers (N = 989) from 16 centers were randomized on a double-blind basis to receive either fluoxetine (30 or 60 mg) or placebo plus 9 sessions of behavioral smoking cessation treatment. Fluoxetine and norfluoxetine blood levels were assayed 1 week after the quit date. Logistic regression was used to predict treatment completion and cessation outcome, controlling for gender, age, treatment site, and degree of nicotine dependence. Higher steady-state fluoxetine blood levels (fluoxetine + norfluoxetine) predicted less likelihood of dropping out, χ2(1, N = 820) = 3.9, p < .05, and more likelihood of being abstinent, χ2(1, N = 513) = 18.1, p < .001. Attaining a higher fluoxetine blood level improved the likelihood of completing behavioral treatment and increased the probability of achieving abstinence.

Influences of gender and weight gain on short-term relapse to smoking in a cessation trial

Borrelli, B., Spring, B., Niaura, R. S., Hitsman, B., & Papandonatos, G. (n.d.).

Publication year

2001

Journal title

Journal of consulting and clinical psychology

Volume

69

Issue

3

Page(s)

511-515

10.1037/0022-006X.69.3.511

Abstract

Abstract

Few researchers have studied whether weight gain has an impact on short-term relapse to smoking. The authors of this study investigated predictors of relapse among 989 participants (60% women) in a randomized, double-blind, 10-week multicenter trial to determine the effect of fluoxetine (30 or 60 mg) versus placebo in combination with behavioral counseling for smoking cessation. Medication compliance and smoking status were biochemically verified. At Visit 2, participants were asked to set a quit date within the subsequent 2 visits. A proportional hazards regression model was used to predict risk of relapse within the first 3 months of quitting. Weight gain predicted relapse, but for men only. Female gender also predicted relapse. The results led the authors to question whether postcessation weight gain interventions should be restricted to women smokers.

Maternal transmission of nicotine dependence : Psychiatric, neurocognitive and prenatal factors

Niaura, R. S., Bock, B., Lloyd, E. E., Brown, R., Lipsitt, L. P., & Buka, S. (n.d.).

Publication year

2001

Journal title

American Journal on Addictions

Volume

10

Issue

1

Page(s)

16-29

10.1080/105504901750160420

Abstract

Abstract

This paper reviews the literature on maternal influences on smoking behaviors of offspring from the perspective of neuropsychiatric deficits that may be transmitted from mother to child. In particular, we review what is known regarding associations between: (1) in-utero exposure to smoking, (2) adolescent neurocognitive functioning and psychiatric comorbidity, and (3) the patterns of smoking and progression of nicotine dependence. Furthering our knowledge of these differences in susceptibility to nicotine dependence among youth will provide additional avenues for prevention and intervention efforts targeted toward those at high risk for dependence.

Naltrexone and cue exposure with coping and communication skills training for alcoholics : Treatment process and 1-year outcomes

Monti, P. M., Rohsenow, D. J., Swift, R. M., Gulliver, S. B., Colby, S. M., Mueller, T. I., Brown, R. A., Gordon, A., Abrams, D. B., Niaura, R. S., & Asher, M. K. (n.d.).

Publication year

2001

Journal title

Alcoholism: Clinical and Experimental Research

Volume

25

Issue

11

Page(s)

1634-1647

10.1111/j.1530-0277.2001.tb02170.x

Abstract

Abstract

Background: Promising treatments for alcoholics include naltrexone (NTX), cue exposure combined with urge-specific coping skills training (CET), and communication skills training (CST). This study investigated the effects of combining these elements as treatment adjuncts. Methods: A 2 × 2 design investigated the effects of CET combined with CST, as compared with an education and relaxation control treatment, during a 2-week partial hospital program (n = 165) followed by 12 weeks of NTX (50 mg/day) or placebo during aftercare (n = 128). Drinking outcomes were assessed at 3, 6, and 12 months after discharge from the partial hospital. Process measures included urge, self-efficacy (confidence about staying abstinent in risky situations), and self-reported coping skills. Medically eligible alcohol-dependent patients were recruited. Results: Among those compliant with medication on at least 70% of days, those who received NTX had significantly fewer heavy drinking days and fewer drinks on days that they drank than those receiving placebo during the medication phase but not during the subsequent 9 months. CET/CST-condition patients were significantly less likely to report a relapse day and reported fewer heavy drinking days at the 6- and 12-month follow-ups than patients in the control treatment. Interactions of medication with behavioral treatments were not significant. Process measures showed that NTX resulted in lower weekly urge ratings, and those in CET/CST used more of the prescribed coping skills after treatment, reported fewer cue-elicited urges, and reported more self-efficacy in a posttest role-play test. Drinking reductions at 3, 6, and 12 months correlated with more use of coping skills, lower urge, and higher self-efficacy. Conclusions: The results suggest the probable value of keeping alcoholics on NTX for longer periods of time and the importance of increasing compliance with NTX. They also support the earlier promising effects of CET and CST as adjuncts to treatment programs for alcoholics by maintaining treatment gains over at least a year. The value of the urge-specific and general coping skills and of self-efficacy and urge constructs was demonstrated in their association with drinking outcomes.

Promoting smoking cessation in the rehabilitation setting

Guilmette, T. J., Motta, S. I., Shadel, W. G., Mukand, J., & Niaura, R. S. (n.d.).

Publication year

2001

Journal title

American Journal of Physical Medicine and Rehabilitation

Volume

80

Issue

8

Page(s)

560-562

10.1097/00002060-200108000-00002

Abstract

Abstract

Cigarette smoking is a known risk factor in patients with ischemic and hemorrhagic stroke. Smoking also increases the risk of cardiovascular disease, chronic bronchitis, emphysema, peptic ulcers, and cancer of several organs among middle-aged individuals and the elderly. In the elderly, smoking has also been associated with a general decline in physical functioning as a result of the increased incidence of chronic illnesses. The prevalence of smoking among community-dwelling adults aged 65 to 74 yr has been estimated to be 18% for men and 15% for women. More than 30% of Americans who are hospitalized each year are smokers. Although there are no published studies that have established the prevalence of smoking in a rehabilitation population, these data and our own clinical experience suggest that smoking continues to be a significant health problem for many persons who enter the inpatient rehabilitation setting. Because most hospitals have adopted a smoke-free policy, hospitalization itself may initiate a period of nonsmoking in patients who were smokers at the time of their admission. In addition, some smokers choose to quit smoking after stroke or other medical crisis caused by the health risks associated with cigarette smoking. However, research has also revealed a rather low-smoking cessation rate (30%) among smokers who have had a transient ischemic attack despite the health benefits associated with smoking cessation. Given the significant health risks associated with cigarette smoking, particularly in the elderly and those with cerebrovascular compromise, the effects of smoking on the patient's health should be discussed with the patient during inpatient rehabilitation. Unfortunately, given the current healthcare demands of reducing lengths of hospitalization and the focus on functional outcomes, health promotion issues, such as smoking cessation, nutrition, exercise, may not receive the attention that they deserve. Despite these constraints, we believe that the inpatient rehabilitation setting provides an opportunity for a "teachable moment" to introduce the idea of smoking cessation to the active smoker or to encourage continued smoking cessation and relapse prevention to those patients who have not smoked since their admission to the acute care hospital. If instituted in an effective manner, we believe that there could be significant healthcare benefits in establishing a formal smoking cessation or relapse prevention program in the rehabilitation setting.

Sex differences in cardiovascular reactivity to physical appearance and performance challenges

Stroud, L. R., Niaura, R. S., & Stoney, C. M. (n.d.).

Publication year

2001

Journal title

International Journal of Behavioral Medicine

Volume

8

Issue

3

Page(s)

240-250

10.1207/S15327558IJBM0803_6

Abstract

Abstract

We examined sex differences in cardiovascular reactivity to a novel body image speech task and to three performance-oriented challenges: serial subtraction, handgrip, and mirror tracing tasks. Forty-nine men and 64 women completed the four tasks while heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were measured. The speech was perceived as requiring more emotionality and empathy for success, whereas the performance tasks were perceived as requiring greater competitiveness. As predicted, women showed greater heart rate reactivity to the body image speech, but men showed greater blood pressure reactivity to the subtraction, grip, and mirror tracing tasks. Results underscore the importance of contextual factors in influencing sex differences in stress responses; women may be more physiologically vulnerable to challenges in the domain of physical appearance, whereas men may react to competitive, performance-oriented challenges.

Smoking

Niaura, R. S., & Goldstein, M. (n.d.). (E. Topol, M. Bristow, R. Califf, J. Isner, P. Prsytowsky, P. Serruys, J. Swain, J. Thomas, & P. Thompson, Eds.; 2nd ed.).

Publication year

2001

Abstract

Abstract

~

Statistical analysis of randomized trials in tobacco treatment : Longitudinal designs with dichotomous outcome

Niaura, R. S., Hall, S. M., Delucchi, K. L., Velicer, W. F., Kahler, C. W., Ranger-Moor, J., Hedeker, D., Tsoh, J. Y., & Niaura, R. (n.d.).

Publication year

2001

Journal title

Nicotine and Tobacco Research

Volume

3

Issue

3

Page(s)

193-202

10.1080/14622200110050411

Abstract

Abstract

This article considers two important issues in the statistical treatment of data from tobacco-treatment clinical trials: (1) data analysis strategies for longitudinal studies and (2) treatment of missing data. With respect to data analysis strategies, methods are classified as 'time-naïve' or longitudinal. Time-naïve methods include tests of proportions and logistic regression. Longitudinal methods include Generalized Estimating Equations and Generalized Linear Mixed Models. It is concluded that, despite some advantages accruing to 'time-naïve' methods, in most situations, longitudinal methods are preferable. Longitudinal methods allow direct effects of the tests of time and the interaction of treatment with time, and allow model estimates based on all available data. The discussion of missing data strategies examines problems accruing to complete-case analysis, last observation carried forward, mean substitution approaches, and coding participants with missing data as using tobacco. Distinctions between different cases of missing data are reviewed. It is concluded that optimal missing data analysis strategies include a careful description of reasons for data being missing, along with use of either pattern mixture or selection modeling. A standardized method for reporting missing data is proposed. Reference and software programs for both data analysis strategies and handling of missing data are presented.

Stopping smoking : A hazard for people with a history of major depression?

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

Publication year

2001

Journal title

Lancet

Volume

357

Issue

9272

Page(s)

1900-1901

10.1016/S0140-6736(00)05089-3

Abstract

Abstract

~

Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation : A randomized, controlled trial

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

Publication year

2001

Journal title

Annals of internal medicine

Volume

135

Issue

6

Page(s)

423-433

10.7326/0003-4819-135-6-200109180-00011

Abstract

Abstract

Background: Smoking relapse is common after successful pharmacologic treatment for smoking cessation. No previous studies have examined long-term drug therapy used expressly for prevention of smoking relapse. Objective: To evaluate the efficacy of bupropion to prevent smoking relapse. Design: Randomized, placebo-controlled trial. Participants: 784 healthy community volunteers who were motivated to quit smoking and who smoked at least 15 cigarettes per day. Intervention: The participants received open-label, sustained-release bupropion, 300 mg/d, for 7 weeks. Participants who were abstinent throughout week 7 of open-label treatment were randomly assigned to receive bupropion, 300 mg/d, or placebo for 45 weeks and were subsequently followed for an additional year after the conclusion of the medication phase. Participants were briefly counseled at all follow-up visits. At the end of open-label bupropion treatment, 461 of 784 participants (58.8%) were abstinent from smoking. Measurement: Self-reported abstinence was confirmed by an expired air carbon monoxide concentration of 10 parts per million or less. Results: The point prevalence of smoking abstinence was significantly higher in the bupropion group than in the placebo group at the end (week 52) of drug therapy (55.1% vs. 42.3%, respectively; P = 0.008) and at week 78 (47.7% vs. 37.7%; P = 0.034) but did not differ at the final (week 104) follow-up visit (41.6% vs. 40.0%). The median time to relapse was significantly greater for bupropion recipients than for placebo recipients (156 days vs. 65 days; P = 0.021). The continuous abstinence rate was higher in the bupropion group than in the placebo group at study week 24 (17 weeks after randomization) (52.3% vs. 42.3%; P = 0.037) but did not differ between groups after week 24. Weight gain was significantly less in the bupropion group than in the placebo group at study weeks 52 (3.8 kg vs. 5.6 kg; P = 0.002) and 104 (4.1 kg vs. 5.4 kg; P= 0.016). Conclusions: In persons who stopped smoking with 7 weeks of bupropion treatment, sustained-release bupropion for 12 months delayed smoking relapse and resulted in less weight gain.

Symptoms of depression and survival experience among three samples of smokers trying to quit

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

Publication year

2001

Journal title

Psychology of Addictive Behaviors

Volume

15

Issue

1

Page(s)

13-17

10.1037/0893-164X.15.1.13

Abstract

Abstract

Symptoms of depression have been associated with increased smoking prevalence and failure to quit smoking in several cross-sectional and population-based studies. Few studies, however, have prospectively examined the ability of current symptoms of depression to predict failure to quit smoking in treatment-motivated smokers. Pretreatment depressed mood was assessed by 3 different methods in 3 separate samples, 2 of which comprised smokers receiving combined pharmacological and behavioral treatments and a 3rd in which smokers received self-help materials only. In all studies, time in days from quit day until the 1st cigarette was ascertained to document survival. Survival analyses showed that in all 3 studies survival time was significantly and negatively related to measures of even very low levels of pretreatment depressed mood. Results were replicated across 3 independent samples and were robust and uniformly clear, indicating that low levels of depressive symptoms assessed at baseline predict time to 1st cigarette smoked after attempted quitting.

The development of a decisional balance measure of physician smoking cessation interventions

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

Publication year

2001

Journal title

Preventive Medicine

Volume

33

Issue

4

Page(s)

261-267

10.1006/pmed.2001.0879

Abstract

Abstract

Background. Decreasing the prevalence of smoking is an important health care goal, and there is evidence that physicians' advice to quit is an important motivator for patients. However, fewer than half of smokers report that they have ever been advised to quit. This study was conducted to develop a decisional balance measure for physician delivery of smoking cessation interventions. Methods. This study included a convenience sample of 155 primary care physicians. A decisional balance measure was developed using item generation and development, pilot testing, and principal components analyses. Validity was established by relating the decisional balance measure to a previously validated item of counseling behavior and to physician stage of readiness to deliver smoking cessation counseling. Results. Based on principal components analyses and item analyses, the final measure consisted of 10 Pro and 10 Con items with coefficient α of 0.83 and 0.86. The Pros and Cons scales were significantly associated with self-reported counseling to patients who smoke and to stage of readiness to deliver smoking cessation counseling. Conclusions. A decisional balance measure of physician smoking cessation interventions can be used to assist investigators in developing effective interventions to enhance the delivery of smoking cessation interventions in primary care settings.

The prevalence of cigarette smoking in an acute inpatient physical medicine and rehabilitation population

Motta, S. I., Mukand, J., Guilmette, T. J., Mukand, J., Shadel, W. G., Niaura, R. S., Mukand, J., & Guilmette, T. J. (n.d.).

Publication year

2001

Journal title

Substance Abuse

Volume

22

Issue

3

Page(s)

187-192

10.1080/08897070109511458

Abstract

Abstract

The purpose of this study was to determine the prevalence of cigarette smoking among patients before and after discharge from an acute inpatient physical medicine and rehabilitation unit and. to assess smokers’ interest in and desire for smoking cessation. A consecutive sample of inpatients (n = 233) admitted over a 5‐month period to a regional rehabilitation inpatient center for acute rehabilitation treatment was surveyed for their smoking patterns. Ten percent of patients admitted to rehabilitation were active smokers prior to their hospitalization. In spite of reporting high motivation to stop smoking, half were not interested in participating in a smoking cessation program if one were offered to them. Following discharge from inpatient rehabilitation, 54% of a small sample of patients who could be contacted had resumed smoking (all within 4 weeks of being home). Given the prevalence of smoking in this population and its adverse consequences on health and quality of life, we suggest that rehabilitation professionals actively address this health problem during the patient's hospitalization.

An idiographic approach to understanding personality structure and individual differences among smokers

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

Publication year

2000

Journal title

Cognitive Therapy and Research

Volume

24

Issue

3

Page(s)

345-359

10.1023/A:1005567405173

Abstract

Abstract

We present a social-cognitive theory which requires an idiographic assessment of individual differences in personality structure among smokers, and contrast this approach to traditional nomothetic trait approaches. A sample of 15 regular smokers completed idiographic assessment procedures designed to tap into three cognitive structures (smoker self-schema, abstainer ideal-possible self, abstainer ought-possible self) which are proposed to regulate individual differences in smoking behavior, coping behavior, and finally smoking cessation. Support for the idiographic approach was found. The three cognitive structures were distinguishable from one another, and had properties that self-schema are proposed to hold, and intraindividual patterns of schematic responding across situations were stable and predictable phenomena. These findings are not consistent with a nomothetic trait approach. We discuss the implications of these results for individual-differences assessment among smokers and suggest avenues for future research.

Are adolescent smokers dependent on nicotine? A review of the evidence

Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (n.d.).

Publication year

2000

Journal title

Drug and alcohol dependence

Volume

59

Issue

SUPPL. 1

Page(s)

83-95

10.1016/S0376-8716(99)00166-0

Abstract

Abstract

This paper reviews the empirical literature on adolescent nicotine dependence, withdrawal, and their associated features. Data documenting nicotine dependence scores, diagnoses, and individual features among adolescents are reviewed in detail and compared to observations based on adult smokers. These data are derived from a broad variety of sources, including national surveys, school-based surveys, and smoking cessation studies. Overall, results indicate that one to three out of five adolescent smokers is dependent on nicotine, with some adolescent groups clearly at higher risk for dependence (those who are incarcerated, in vocational schools, daily smokers, and/or heavy smokers). Across studies, data consistently indicate that a large majority (two-thirds or more) of adolescent smokers report experiencing withdrawal symptoms during attempts to quit or reduce their smoking. Craving or strong desire to smoke was the most commonly reported withdrawal symptom in every study reviewed. Although analyses of concurrent validity generally support the dependence and withdrawal findings among adolescents, data on the predictive validity of measures used are needed. Moreover, studies of adolescent tobacco withdrawal rely almost exclusively on retrospective self-report data. Recommendations for enhancing methodology and advancing our understanding of adolescent nicotine dependence and withdrawal are offered. Copyright (C) 2000 Elsevier Science Ireland Ltd.

Cognitive social learning and related perspectives on drug craving

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

Publication year

2000

Journal title

Addiction

Volume

95

Issue

8

Page(s)

S155-S163

10.1080/09652140050111726

Abstract

Abstract

Many modern theories of drug use and dependence assign central prominence to the role of craving in drug use and relapse. However, some continue to debate whether drug craving has any motivational significance in terms of drug-using behaviors. Cognitive social learning theory adds additional perspective by imbedding craving within a network of cognitive processes that, as they inter-relate, influence drug use and relapse. This paper reviews tenets of cognitive social learning theory as they relate to craving, focusing on theoretical models that have attempted to explain how craving fits our understanding of the process of drug relapse. In addition, cognitive social learning theory complements theories that emphasize more biological or information processing aspects of addictive behaviors. Studies of addiction that have assessed elements of social learning theory suggest the following: (1) there exists an inverse relationship between efficacy and craving; (2) there appears to be an association between affect and craving, but the precise nature and strength of this association is unclear; (3) the relationship between outcome expectations and craving is largely unknown; and (4) correspondingly little is known about relationships between coping and craving. More empirical study is needed to address the strengths and limitations of cognitive social learning theory as it relates to our understanding the motivational significance of drug craving.

Combined affects of exercise and smoking cessation on serum lipids in women

Niaura, R. S., Napolitano, M., & Marcus, B. (n.d.).

Publication year

2000

Journal title

American Journal of Medicine and Sports

Volume

2

Page(s)

108-116

Abstract

Abstract

~

Comorbidity, smoking behavior and treatment outcome

Niaura, R. S., Keuthen, N. J., Niaura, R. S., Borrelli, B., Goldstein, M., DePue, J., Murphy, C., Gastfriend, D., Reiter, S. R., & Abrams, D. S. (n.d.).

Publication year

2000

Journal title

Psychotherapy and Psychosomatics

Volume

69

Issue

5

Page(s)

244-250

10.1159/000012403

Abstract

Abstract

Background: A sizeable sector of the population continues to smoke cigarettes despite our efforts to prevent and treat this addiction. We explored the relationships between lifetime comorbidity, psychiatric symptomatology, smoking behavior and treatment outcome to better understand vulnerability to smoking and treatment response. Methods: One hundred and twenty smokers at two sites were enrolled in a multicenter, double-blind, randomized, 10-week smoking cessation trial with fluoxetine and behavioral treatment. The Structured Clinical Interview for DSM-III-R and Hamilton Depression Rating Scale were administered prior to treatment initiation. Self-report measures were used to assess psychiatric symptoms throughout treatment and during a 6-month follow-up period. Results: Overall 62.3% of our sample were diagnosed with a lifetime mood, anxiety or substance use disorder despite stringent study exclusion criteria. Lifetime comorbidity was shown to be related to higher smoking rates and nicotine dependence, depressed mood and greater self-report of anxiety and stress. Lifetime comorbidity, however, alone or in combination with treatment condition, failed to predict treatment outcome (at posttreatment or follow-up). Baseline depression scores (Beck Depression Inventory, BDI) were related to treatment outcome only for smokers without a positive history of any psychiatric disorder or depression, with lower BDI scores more frequent in those who were abstinent. Conclusions: High prevalence rates of lifetime psychiatric illness and substance use disorders are reported for chronic smokers. Subsyndromal psychiatric symptoms may play a role in smoking behavior in combination with diagnosable disorders. Clinicians need to carefully assess both psychiatric diagnoses and symptoms in chronic smokers to optimize patient-treatment matching. Copyright (C) 2000 S. Karger AG, Basel.