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

Can the Association Between Electronic-Cigarette Use and Stroke Be Interpreted as Risk of Stroke?

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

Publication year

2020

Journal title

American journal of preventive medicine

Volume

58

Issue

6

Page(s)

895-896

10.1016/j.amepre.2020.01.020

Abstract

Abstract

~

Can the blind see? Participant guess about treatment arm assignment may influence outcome in a clinical trial of bupropion for smoking cessation

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

Publication year

2008

Journal title

Journal of Substance Abuse Treatment

Volume

34

Issue

2

Page(s)

234-241

10.1016/j.jsat.2007.04.004

Abstract

Abstract

In a placebo-controlled bupropion smoking cessation trial, we examined blind integrity, the link between blind integrity and quit rates, and whether side effects and changes in nicotine withdrawal symptoms or mood were mechanisms through which blind integrity is threatened. At a 12-month follow-up, 498 participants indicated whether they thought they received bupropion, placebo, or were not sure. Potential mediators of treatment effects on treatment arm guess (i.e., side effects, withdrawal, and mood) were measured during treatment, and 7-day point prevalence cessation was assessed at the end of treatment (EOT) and at 6 and 12 months after quit date. Overall, 55% of participants guessed their randomization correctly. Compared to guessing not sure, participants who guessed they were taking bupropion were more than twice as likely to have been randomized to bupropion. Similarly, participants who guessed placebo were twice as likely to have been randomized to placebo. Treatment arm guess was associated with quit rates. Including treatment arm guess with actual treatment arm in models of quit rates significantly reduced the odds ratio for bupropion efficacy at the EOT and at 6 and 12 months after quit date. There was no evidence for mediation. In bupropion smoking cessation trials, blind failure may occur and participant guess about treatment arm assignment is associated with quit rates.

Cardiovascular disease outcomes among established cigar users 40 years and older : Findings from the population assessment of tobacco and health (PATH) study, waves 1–5 (2013–2019)

Sharma, E., Tang, Z., Lauten, K., Silveira, M. L., Delnevo, C. D., Edwards, K. C., Marshall, D., Gaalema, D. E., Zandberg, I., Graham-Glover, B., Rivers, D. L., Imoisili, O. E., Neal, K., Niaura, R. S., Bansal-Travers, M., Hyland, A., & Michael Cummings, K. (n.d.).

Publication year

2024

Journal title

Preventive Medicine Reports

Volume

37

10.1016/j.pmedr.2023.102569

Abstract

Abstract

This study examined associations between established cigar use and prevalence and incidence of cardiovascular diseases (CVD; congestive heart failure, stroke, or heart attack/needed bypass surgery) among U.S. adults, 40 years or older. Using Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health (PATH) Study, incidence (Nindividuals (Nind) = 6,692; Nobservations (Nobs) = 23,738) and prevalence (Nind = 7,819; Nobs = 33,952) of CVD outcomes were examined using weighted generalized estimating equations (WGEEs) among adults who were exclusive current/former established cigar smokers (ever cigar smokers who have smoked fairly regularly), exclusive current/former established cigarette smokers (lifetime smokers of 100 or more cigarettes), dual current/former established cigarette and cigar smokers compared with never smokers of cigars or cigarettes, adjusting for covariates. The population-averaged incidence of CVD from one wave to next among exclusive current/former established cigar smokers during a six-year period based on WGEEs was low (overall average rate of 3.0 %; 95 % CI: 1.2, 7.0). Compared with never users, exclusive current/former established cigar smokers (OR = 1.67, 95 % CI: 1.11, 2.51) and exclusive current/former established cigarette smokers (OR = 2.12, 95 % CI: 1.45, 3.09) were more likely to have any CVD outcome in unadjusted analyses. When adjusted for covariates, only exclusive current/former established cigarette use was associated with CVD outcomes (AOR = 1.60, CI: 1.07, 2.40). Results suggest that exclusive established use of cigars or duration of exclusive cigar use was not associated with lifetime CVD prevalence compared with never cigar or cigarette smokers, which is important in understanding health outcomes in cigar users.

Cardiovascular disease, Part I: Coronary artery disease and sudden death.

Goldstein, M., & Niaura, R. S. (n.d.). (A. Stoudemire & B. Fogel, Eds.).

Publication year

1995

Page(s)

19-38

Abstract

Abstract

~

Cardiovascular disease, Part II: Coronary artery disease and sudden death and hypertension

Niaura, R. S., & Goldstein, M. (n.d.). (A. Stoudemire & B. Fogel, Eds.).

Publication year

1995

Page(s)

39-56

Abstract

Abstract

~

Cardiovascular Outcomes among Combustible-Tobacco and Electronic Nicotine Delivery System (ENDS) Users in Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) Study, 2013–2019

Niaura, R. S., Mahoney, M. C., Rivard, C., Kimmel, H. L., Hammad, H. T., Sharma, E., Halenar, M. J., Sargent, J., Cummings, K. M., Niaura, R., Goniewicz, M. L., Bansal-Travers, M., Hatsukami, D., Gaalema, D., Fong, G., Gravely, S., Christensen, C. H., Haskins, R., Silveira, M. L., … Hyland, A. (n.d.).

Publication year

2022

Journal title

International journal of environmental research and public health

Volume

19

Issue

7

10.3390/ijerph19074137

Abstract

Abstract

Background: Prior studies have not clearly established risk of cardiovascular disease (CVD) among smokers who switch to exclusive use of electronic nicotine delivery systems (ENDS). We compared cardiovascular disease incidence in combustible-tobacco users, those who transitioned to ENDS use, and those who quit tobacco with never tobacco users. Methods: This prospective cohort study analyzes five waves of Population Assessment of Tobacco and Health (PATH) Study data, Wave 1 (2013–2014) through Wave 5 (2018–2019). Cardiovascular disease (CVD) incidence was captured over three intervals (Waves 1 to 3, Waves 2 to 4, and Waves 3 to 5). Participants were adults (40+ years old) without a history of CVD for the first two waves of any interval. Change in tobacco use status, from exclusive past 30 day use of any combustible-tobacco product to either exclusive past 30 day ENDS use, dual past 30 day use of ENDS and combustible-tobacco, or no past 30 day use of any tobacco, between the first two waves of an interval was used to predict onset of CVD between the second and third waves in the interval. CVD incidence was defined as a new self-report of being told by a health professional that they had congestive heart failure, stroke, or a myocardial infarction. Generalized estimating equation (GEE) analyses combined 10,548 observations across intervals from 7820 eligible respondents. Results: Overall, there were 191 observations of CVD among 10,548 total observations (1.7%, standard error (SE) = 0.2), with 40 among 3014 never users of tobacco (1.5%, SE = 0.3). In multivariable models, CVD incidence was not significantly different for any tobacco user groups compared to never users. There were 126 observations of CVD among 6263 continuing exclusive combustible-tobacco users (adjusted odds ratio [AOR] = 1.44; 95% confidence interval (CI) 0.87–2.39), 15 observations of CVD among 565 who transitioned to dual use (AOR = 1.85; 0.78–4.37), and 10 observations of CVD among 654 who quit using tobacco (AOR = 1.18; 0.33–4.26). There were no observations of CVD among 53 who transitioned to exclusive ENDS use. Conclusions: This study found no difference in CVD incidence by tobacco status over three 3 year intervals, even for tobacco quitters. It is possible that additional waves of PATH Study data, combined with information from other large longitudinal cohorts with careful tracking of ENDS use patterns may help to further clarify this relationship.

Catechol-O-Methyltransferase (COMT) Gene Variants Predict Response to Bupropion Therapy for Tobacco Dependence

Niaura, R. S., Berrettini, W. H., Wileyto, E. P., Epstein, L., Restine, S., Hawk, L., Shields, P., Niaura, R., & Lerman, C. (n.d.).

Publication year

2007

Journal title

Biological Psychiatry

Volume

61

Issue

1

Page(s)

111-118

10.1016/j.biopsych.2006.04.030

Abstract

Abstract

Background: Although bupropion is efficacious for smoking cessation, only a minority of smokers are able to quit. Pharmacogenetic research may improve treatment outcomes through discovery of DNA sequences predictive of successful pharmacotherapy for subgroups of smokers. We investigated variants in the catechol-O-methyltransferase (COMT) gene in a smoking cessation trial of bupropion. Methods: A double-blind, placebo-controlled, 10-week trial of bupropion and counseling (with a 6-month follow-up period) was conducted at two university-based smoking cessation research programs. Abstinence was biochemically verified at the end of treatment and at 6 months after the target quit date. Results: At the end of the treatment phase, statistically significant interaction effects indicated that COMT haplotypes of two SNPs (rs737865 and rs165599) predicted the efficacy of bupropion compared with placebo. This interaction effect was attenuated at 6-month follow-up. Conclusions: COMT haplotypes at rs737865 and rs165599 may predict a favorable outcome for bupropion treatment for smoking cessation. European-American smokers with a G allele at both SNPs may not benefit from bupropion treatment. Small numbers of some COMT haplotypes limit interpretation of response. If study findings are confirmed in additional large studies, COMT genotyping could be applied to identify likely responders to bupropion treatment for smoking cessation.

Change in amount smoked and readiness to quit among patients undergoing lung cancer screening

Niaura, R. S., Deros, D. E., Hagerman, C. J., Kramer, J. A., Anderson, E. D., Regis, S., McKee, A. B., McKee, B. J., Stanton, C. A., Niaura, R., Abrams, D. B., Ramsaier, M., Fallon, S., Harper, H., & Taylor, K. L. (n.d.).

Publication year

2021

Journal title

Journal of Thoracic Disease

Volume

13

Issue

8

Page(s)

4947-4955

10.21037/jtd-20-3267

Abstract

Abstract

Background: There is mixed evidence regarding whether undergoing computed tomography lung cancer screening (LCS) can serve as a "teachable moment" that impacts smoking behavior and attitudes. The study aim was to assess whether the standard procedures of undergoing LCS and receiving free and low-cost evidence-based cessation resources impacted short-term smoking-related outcomes. Methods: Participants were smokers (N=87) who were registered to undergo lung screening and were enrolled in a cessation intervention trial. We conducted two phone interviews, both preceding trial randomization: the first interview was conducted prior to lung screening, and the second interview followed lung screening (median =12.5 days post-screening) and participants' receipt of their screening results. The interviews assessed demographic characteristics, interest in evidence-based cessation intervention methods, and tobacco-related characteristics, including cigarettes per day and readiness to quit. Participants received minimal evidence-based cessation resources following the pre-lung screening interview. Results: Participants were 60.3 years old, 56.3% female, and reported a median of 40 pack-years. Participants were interested in using several evidence-based strategies, including counseling from a healthcare provider (76.7%) and receiving nicotine replacement therapy (69.8%). Pre-lung screening, 25.3% smoked =10 cigarettes per day, and 29.9% were ready to quit in the next 30 days. We conducted two McNemar binomial distribution tests to assess change from pre- to post-screening. At the post-lung screening assessment, approximately three-quarters reported no change on these variables. However, 23.3% reported smoking fewer cigarettes per day, whereas 4.7% reported smoking more cigarettes per day (McNemar P=0.002), and 17.2% reported increased readiness to quit, whereas 6.9% reported decreased readiness to quit (McNemar P=0.078). Conclusions: Following receipt of cessation resources and completion of lung screening, most participants reported no change in smoking outcomes. However, there was a significant reduction in cigarettes per day, and there was a trend for increased readiness to quit. This setting may provide a potential "teachable moment" and an opportunity to assist smokers with quitting. However, more proactive and intensive interventions will be necessary to capitalize on these changes and to support abstinence in the long-term.

Changes from 2017 to 2018 in e-cigarette use and in ever marijuana use with e-cigarettes among US adolescents : analysis of the National Youth Tobacco Survey

Farsalinos, K., Barbouni, A., & Niaura, R. S. (n.d.).

Publication year

2021

Journal title

Addiction

Volume

116

Issue

1

Page(s)

139-149

10.1111/add.15162

Abstract

Abstract

Aims: To examine changes from 2017 to 2018 in e-cigarette use and ever marijuana use with e-cigarettes among US adolescents. Design: Analysis of data from the 2017 and 2018 National Youth Tobacco Survey (NYTS), cross-sectional surveys of US middle school (grades 6–8) and high school (grades 9–12) students. Setting: United States. Participants: US adolescent population from middle school, with mean age = 12.7 [standard deviation (SD) = 1.0] years, and high school, with mean age = 16.1 (SD = 1.3) years. Measurements: Analysis of e-cigarette use and ever use of marijuana with e-cigarettes according to frequency of use and smoking status, comparing 2017 with 2018. Frequent smoking and e-cigarette use was defined as use for ≥ 20 of the past 30 days. Findings: Past 30 days e-cigarette use was reported by 33.1% [95% confidence interval (CI) = 29.1–37.4%] of ever/no past 30 days smokers, 68.6% (95% CI = 64.1–72.7%) of past 30 days smokers and 7.2% (95% CI = 6.3–8.2%) of never smokers in 2018 and by 19.3% (95% CI = 16.1–23.1%), 53.0% (95% CI = 46.9–58.9%) and 3.3% (95% CI = 2.7–4.4%) in 2017, respectively (all P < 0.001). Prevalence of past 30 days e-cigarette use was higher among frequent smokers (69.8%, 95% CI = 62.3–76.5% in 2018; 53.8%, 95% CI = 44.1–63.2% in 2017, P < 0.001) and lower among never smokers. Most of the latter were infrequent users, while frequent and daily e-cigarette use was 18- and 24-fold lower compared with ever smokers, respectively. Approximately half of past 30 days and 70% of frequent e-cigarette users reported ever marijuana use with e-cigarettes in both years. Past 30 days smokers were more likely to report past 30 days e-cigarette use [odds ratio (OR) = 15.79, 95% CI = 12.58–19.83 in 2018; OR = 16.11, 95% CI = 12.44–20.86 in 2017) compared with adolescents reporting no past 30 days smoking. Conclusions: Among US adolescents, e-cigarette use increased in all smoking groups in 2018 compared with 2017. Frequent and daily e-cigarette use was far lower in never-smokers compared with ever-smokers. High prevalence of ever marijuana use with e-cigarettes was observed.

Changes in Biomarkers of Tobacco Exposure among Cigarette Smokers Transitioning to ENDS Use : The Population Assessment of Tobacco and Health Study, 2013–2015

Anic, G. M., Rostron, B. L., Hammad, H. T., van Bemmel, D. M., Valle-Pinero, A. Y., Christensen, C. H., Erives, G., Faulcon, L. M., Blount, B. C., Wang, Y., Wang, L., Bhandari, D., Calafat, A. M., Kimmel, H. L., Everard, C. D., Compton, W. M., Edwards, K. C., Goniewicz, M. L., Wei, B., … Chang, C. M. (n.d.).

Publication year

2022

Journal title

International journal of environmental research and public health

Volume

19

Issue

3

10.3390/ijerph19031462

Abstract

Abstract

Limited data are available for how biomarkers of tobacco exposure (BOE) change when cigarette smokers transition to using electronic nicotine delivery systems (ENDS). Using biomarker data from Waves 1 (2013–2014) and 2 (2014–2015) of the PATH Study, we examined how mean BOE concentrations, including metabolites of nicotine, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOCM) and metals, changed when 2475 adult smokers transitioned to using ENDS or quit tobacco products. Exclusive smokers who transitioned to dual use had a significant decrease in NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), but not nicotine metabolites, most PAHs, metals, or VOCMs. Exclusive smokers who became dual users had significant reductions in total nicotine equivalents, NNAL, and 2CyEMA (acrylonitrile metabolite), but only in those who reduced cigarettes per day (CPD) by >=50%. Smokers who transitioned to exclusive ENDS use had significant reductions in most TSNAs, PAHs, and VOCMs; however, nicotine metabolites did not decrease in dual users who became exclusive ENDS users. Smokers who quit tobacco use had significant decreases in nicotine metabolites, all TSNAs, most PAHs, and most VOCMs. Cigarette smokers who became dual users did not experience significant reductions in most BOEs. Reductions were impacted by changes in CPD. However, transitioning from smoking to no tobacco or exclusive ENDS use was associated with reduced exposure to most BOEs measured. Future analyses could incorporate additional waves of PATH data and examine changes in biomarker exposure by ENDS device type and CPD.

Changes in eating inventory scores following obesity treatment

Clark, M. M., Marcus, B. H., Pera, V., & Niaura, R. S. (n.d.).

Publication year

1994

Journal title

International Journal of Eating Disorders

Volume

15

Issue

4

Page(s)

401-405

10.1002/eat.2260150411

Abstract

Abstract

Eating Inventory scores may predict compliance, attrition, and outcome to obesity treatment. Research documenting change on the Eating Inventory subsequent to treatment is limited. In Study 1, 29 obese patients demonstrated significant improvement on all three factors of the Eating Inventory (Cognitive Restraint, Disinhibition, and Hunger) following a 26‐week multidisciplinary weight management program. In Study 2, a second sample of 18 obese patients also demonstrated significant improvement on all three factors on the Eating Inventory following treatment. These results provide initial guidelines for the amount of change that patients may demonstrate on the Eating Inventory following treatment.

Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014

Villanti, A. C., Mowery, P. D., Delnevo, C. D., Niaura, R. S., Abrams, D. B., & Giovino, G. A. (n.d.).

Publication year

2016

Journal title

Tobacco control

Volume

25

Page(s)

ii14-ii20

10.1136/tobaccocontrol-2016-053329

Abstract

Abstract

Introduction National data from 2004 to 2010 showed that despite decreases in non-menthol cigarette use prevalence, menthol cigarette use prevalence remained constant in adolescents and adults and increased in young adults. The purpose of the current study was to extend these analyses through 2014. Methods We estimated the prevalence of menthol cigarette smoking in the USA during 2004-2014 using annual cross-sectional data on persons aged ≥12 years from the National Survey on Drug Use and Health. Self-reported menthol status for selected brands that were either exclusively menthol or non-menthol were adjusted based on retail sales data. Data were weighted to provide national estimates. Results Although overall smoking prevalence has decreased, the proportion of past 30-day cigarette smokers using menthol cigarettes was higher (39%) in 2012-2014 compared to 2008-2010 (35%). Youth smokers remain the most likely group to use menthol cigarettes compared to all other age groups. Menthol cigarette prevalence has increased in white, Asian and Hispanic smokers since 2010. Menthol cigarette prevalence exceeded non-menthol cigarette prevalence in youth and young adult smokers in 2014. Among smokers, menthol cigarette use was positively correlated with co-use of cigars. Menthol cigarette and smokeless tobacco co-use also increased from 2004 to 2014. Conclusions The youngest smokers are most likely to use menthol cigarettes. Among smokers, increases in overall menthol cigarette use and menthol cigarette use in whites, Asians and Hispanics since 2010 are of concern. There is tremendous urgency to limit the impact of menthol cigarettes on public health, particularly the health of youth and young adults.

Changes in Tobacco Dependence and Association With Onset and Progression of Use by Product Type From Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study

Strong, D. R., Pierce, J. P., White, M., Stone, M. D., Abrams, D. B., Glasser, A. M., Wackowski, O. A., Cummings, K. M., Hyland, A., Taylor, K., Edwards, K. C., Silveira, M. L., Kimmel, H. L., Compton, W. M., Hull, L. C., & Niaura, R. S. (n.d.).

Publication year

2023

Journal title

Nicotine and Tobacco Research

Volume

25

Issue

11

Page(s)

1781-1790

10.1093/ntr/ntad107

Abstract

Abstract

Introduction: This study examined trajectories of tobacco dependence (TD) in relationship to changes in tobacco product use, and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. Aims and Methods: Data were analyzed from the first three waves from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 wave 1 (2013–2014) adult current established tobacco users aged 18 or older who completed all three interviews and had established use at ≥2 assessments. Mutually exclusive groups included: users of cigarettes only, e-cigarettes only, cigars only, hookah only, any smokeless only, cigarette + e-cigarette dual users, and other multiple product users. A validated 16-item scale assessed TD across product users. Results: People who used e-cigarettes exclusively at wave 1 had small increases in TD through wave 3. Wave 1 multiple product users’ TD decreased across waves. TD for all other wave 1 user groups remained about the same. For wave 1 cigarette only smokers, switching to another product was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all product users. Conclusions: Except for wave 1 e-cigarette only users (who experienced small increases in TD), TD among U.S. tobacco product users was stable over time, with daily users less likely to vary from baseline. Implications: The level of TD among most U.S. tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users experienced small increases in levels of TD over time, perhaps due to increases in quantity or frequency of their e-cigarette use or increasing efficiency of nicotine delivery over time.

Chapter 4. Nicotine Addiction: Past and Present

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

Publication year

2010

Abstract

Abstract

~

Characteristics and predictors of readiness to quit among emergency medical patients presenting with respiratory symptoms

Bock, B. C., Jennings, E., Becker, B. M., Partridge, R., & Niaura, R. S. (n.d.).

Publication year

2011

Journal title

International Journal of Emergency Medicine

Volume

4

Issue

1

10.1186/1865-1380-4-24

Abstract

Abstract

Purpose: To examine behavioral factors that lead patients to consider quitting smoking and features associated with readiness to quit among adults who are seeking treatment in the emergency department (ED) for respiratory symptoms. Methods: A toal of 665 adult smokers seeking treatment in an ED for respiratory symptoms and respiratory illness answered survey questions during the ED visit. Results: Patients self-reported "readiness to quit" was broadly distributed among this patient population. Patients with COPD, pneumonia or asthma perceived higher risks from smoking than other patients with respiratory complaints. Over half of all participants had scores indicative of depression. Regression analysis showed that prior efforts to quit, confidence, perceived importance of quitting and decisional balance were each significantly predictive of readiness to quit, accounting for 40% of the variance. Conclusions: While many of these patients appear unaware of the connection between their symptoms and their smoking, patients with diagnosed chronic respiratory illness perceived higher risks from their smoking. In patients who do not perceive these risks, physician intervention may increase perceived risk from smoking and perceived importance of quitting. Interventions designed for the ED setting targeting this patient population should consider screening for depressive symptoms and, when appropriate, making referrals for further evaluation and/or treatment. Medications that can help alleviate depression and withdrawal symptoms while quitting smoking, such as bupropion, may be particularly useful for this subset of patients, as depression is a substantial barrier to quitting.

Characteristics of smokers reached and recruited to an internet smoking cessation trial : A case of denominators

Graham, A. L., Bock, B. C., Cobb, N. K., Niaura, R. S., & Abrams, D. B. (n.d.).

Publication year

2006

Journal title

Nicotine and Tobacco Research

Volume

8

Issue

SUPPL. 1

Page(s)

S43-48

10.1080/14622200601042521

Abstract

Abstract

The Internet can deliver smoking cessation interventions to large numbers of smokers. Little is known about the feasibility, reach, or efficacy of Internet cessation interventions. Virtually no data exist on who enrolls in cessation programs or on differences between those who complete enrollment and those who do not. This paper reports recruitment and enrollment findings for the first 764 participants in an ongoing randomized controlled trial that tested the efficacy of a widely disseminated Internet smoking cessation service (www.QuitNet.com) alone and in conjunction with telephone counseling. Study participants were recruited through Internet search engines using an active user sampling protocol. During the first 16 weeks of the study, 28,297 individuals were invited. Of those, 11,147 accepted the invitation, 5,557 screened eligible, 3,614 were recruited, 1,489 provided online informed consent, and 764 were confirmed eligible and enrolled. Of those who were at least curious about a cessation trial (n=11,147), 6.9% enrolled. Of those who were eligible and recruited (n=3,614), 21.1% enrolled. Depending on the denominator selected, results suggest that 7% to 21% of smokers interested in cessation will enroll into a research trial. Internet recruitment provides unique challenges and opportunities for managing sample recruitment, analyzing subsamples to determine generalizability, and understanding the characteristics of individuals who participate in online research.

Characteristics of U.S. Substance abuse treatment facilities offering HIV services : Results from a national survey

Niaura, R. S., Cohn, A., Stanton, C., Elmasry, H., Ehlke, S., & Niaura, R. (n.d.).

Publication year

2016

Journal title

Psychiatric Services

Volume

67

Issue

6

Page(s)

692-695

10.1176/appi.ps.201500078

Abstract

Abstract

Objective: Substance use disorders are common among persons with HIV/AIDS. This study examined the prevalence and correlates of the provision of four HIV services in a national sample of substance abuse treatment facilities. Methods: Data were from the 2011 National Survey of Substance Abuse Treatment Services. Results: Prevalence estimates indicated that 28% of facilities offered HIV testing, 26% early intervention, 58% HIV/AIDS education, and 8% special programs for HIV/AIDS. Facilities offering inpatient substance abuse care were more than six times as likely to offer HIV testing but not more likely to offer any other type of HIV service. Facilities offering methadone treatment were 2.5 times more likely to offer HIV services. Conclusions: Given the high rates of substance use among persons with HIV, the prevalence of facilities offering HIV services was low in most domains, with different barriers identified in multivariable models. Integrating comprehensive HIV prevention, testing, and support services into programs that address substance abuse is needed.

Chronic cigarette smoking and the microstructural integrity of white matter in healthy adults : A diffusion tensor imaging study

Paul, R. H., Grieve, S. M., Niaura, R. S., David, S. P., Laidlaw, D. H., Cohen, R., Sweet, L., Taylor, G., Clark, C. R., Pogun, S., & Gordon, E. (n.d.).

Publication year

2008

Journal title

Nicotine and Tobacco Research

Volume

10

Issue

1

Page(s)

137-147

10.1080/14622200701767829

Abstract

Abstract

Results from recent studies suggest that chronic cigarette smoking is associated with increased white matter volume in the brain as determined by in vivo neuroimaging. We used diffusion tensor imaging to examine the microstructural integrity of the white matter in 10 chronic smokers and 10 nonsmokers. All individuals were healthy, without histories of medical or psychiatric illness. Fractional anisotropy (FA) and trace were measured in the genu, body, and splenium of the corpus callosum. FA provides a measure of directional versus nondirectional water diffusion, whereas trace provides a measure of nondirectional water diffusion. Lower FA and higher trace values are considered to reflect less brain integrity. Voxel-based morphometry was used to define volumes in each of these regions of the corpus callosum. Chronic smokers exhibited significantly higher FA in the body and whole corpus callosum and a strong trend for higher FA in the splenium compared with nonsmokers. FA did not differ between groups in the genu, and neither trace nor white matter volumes differed between groups in any of the regions of interest. When subdivided by Fagerström score (low vs. high), the low Fagerström group exhibited significantly higher FA in the body of the corpus callosum compared with the high Fagerström group and the nonsmokers. These results suggest that, among healthy adults, lower exposure to cigarette smoking is associated with increased microstructural integrity of the white matter compared with either no exposure or higher exposure. Additional studies are needed to further explore differences in white matter integrity between smokers and nonsmokers.

Cigarette packaging and health warnings : The impact of plain packaging and message framing on young smokers

Mays, D., Niaura, R. S., Evans, W. D., Hammond, D., Luta, G., & Tercyak, K. P. (n.d.).

Publication year

2015

Journal title

Tobacco control

Volume

24

Issue

E1

Page(s)

e87-e92

10.1136/tobaccocontrol-2013-051234

Abstract

Abstract

Objective This study examined the impact of pictorial cigarette-warning labels, warning-label message framing and plain cigarette packaging, on young adult smokers’ motivation to quit. Methods Smokers aged 18–30 years (n=740) from a consumer research panel were randomised to one of four experimental conditions where they viewed online images of four cigarette packs with warnings about lung disease, cancer, stroke/heart disease and death, respectively. Packs differed across conditions by warningmessage framing (gain vs loss) and packaging (branded vs plain). Measures captured demographics, smoking behaviour, covariates and motivation to quit in response to cigarette packs. Results Pictorial warnings about lung disease and cancer generated the strongest motivation to quit across conditions. Adjusting for pretest motivation and covariates, a message framing by packaging interaction revealed gain-framed warnings on plain packs generated greater motivation to quit for lung disease, cancer and mortality warnings ( p

Cigarette smoking and the lifetime alcohol involvement continuum

Kahler, C. W., Strong, D. R., Papandonatos, G. D., Colby, S. M., Clark, M. A., Boergers, J., Niaura, R. S., Abrams, D. B., & Buka, S. L. (n.d.).

Publication year

2008

Journal title

Drug and alcohol dependence

Volume

93

Issue

1-2

Page(s)

111-120

10.1016/j.drugalcdep.2007.09.004

Abstract

Abstract

Greater understanding of how alcohol use relates to the initiation, progression, and persistence of cigarette smoking is of great significance for efforts to prevent and treat smoking and excessive drinking and their substantial combined iatrogenic effects on health. Studies investigating the relationship between levels of alcohol involvement and smoking have typically been limited by analytic approaches that treat drinking behavior and alcohol use disorder diagnoses as separate phenomena rather than as indicators of a single latent alcohol involvement dimension. The purposes of the present study were (a) to create a lifetime index of alcohol involvement that integrates information about alcohol consumption and alcohol problems into a single measure and (b) to relate this index to initiation of smoking, progression from initiation to daily smoking, progression from initiation to dependence, and persistence of smoking. Rasch model analyses of data from 1508 middle-aged (34-44 years) adults showed that creating an additive index of lifetime alcohol involvement was psychometrically supported. Significant quadratic effects of alcohol involvement on initiation, progression, and persistence of smoking demonstrated that there were specific regions of the alcohol involvement continuum that were particularly strongly related to increased smoking. These results provide the most comprehensive depiction to date of the nature of the relationship between lifetime alcohol involvement and lifetime cigarette smoking and suggest potential avenues for research on the etiology and maintenance of smoking and tobacco dependence.

Cigarettes: The Rise and Decline But Not Demise of the Greatest Behavioral Health Disaster of the 20th Century

Abrams, D. S., Glasser, A., Villanti, A., & Niaura, R. S. (n.d.). (R. Kaplan, M. Spittel, & D. David, Eds.).

Publication year

2015

Page(s)

143-168

Abstract

Abstract

~

Clustering of risk behaviors and classification performance in modeling adolescent risk : The example of the association between E-cigarette use and cigarette smoking

Selya, A., Niaura, R. S., & Kim, S. (n.d.).

Publication year

2025

Journal title

Drug and alcohol dependence

Volume

273

10.1016/j.drugalcdep.2025.112716

Abstract

Abstract

Background: Adolescent behavioral risks are highly correlated, complicating interpretation of narrowly-focused research (e.g. 2–3 variables). We explore methodological issues when interpreting a narrowly-focused association (typically using a causal-inference framework) vs. a wider approach incorporating many correlated risk factors (using a less-common predictive-inference framework), using the currently-relevant example of adolescent e-cigarette use and cigarette smoking. Methods: Data were drawn from the Adolescent Behaviors and Experiences (ABES) study, national survey of U.S. youth, and behavioral risks were grouped into categories of e-cigarette use, cigarette smoking, other tobacco use, alcohol and cannabis use, illicit drug use, mental health, violence, other risky behaviors, and parental monitoring. Three exploratory data analyses (Spearman correlation, non-metric multidimensional scaling, and divisive hierarchical clustering) examined clustering/grouping across variables. Logistic regressions examined 1) the association between e-cigarette use and smoking and 2) the reverse-direction association, after successively adjusting for groups of risk factors. Ten-fold cross-validation was performed to evaluate predictive validity. Results: In three exploratory data analyses, e-cigarette use and cigarette smoking were correlated, but each was more closely related to other variables (alcohol and cannabis use vs. other tobacco use and illicit drugs, respectively). Logistic regression models showed similar odds ratios for the forward- and reverse-direction models, but cross-validation testing showed that the reverse-direction model had better classification performance. Conclusions: A narrow focus on adolescent risk behaviors with a causal-inference framework can result in erroneous interpretation in the presence of many correlated risk factors. A wider predictive-inference perspective can help inform better screening strategies and potential intervention targets.

Cognitive and affective probes of the HPA axis : a SPECT study.

Niaura, R. S., Ottowitz, W. E., Dougherty, D. D., Sirota, A. D., Niaura, R., Rauch, S. L., & Brown, W. A. (n.d.).

Publication year

2004

Journal title

Brain and cognition

Volume

54

Issue

2

Page(s)

138-140

Abstract

Abstract

~

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 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.