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

The impact of health warning labels for Swedish snus advertisements on young adults' snus perceptions and behavioral intentions

Mays, D., Moran, M. B., Levy, D. T., & Niaura, R. S. (n.d.).

Publication year

2016

Journal title

Nicotine and Tobacco Research

Volume

18

Issue

5

Page(s)

1371-1375

10.1093/ntr/ntv140

Abstract

Abstract

Introduction: This study examined the impact of warning labels conveying the potential harms and addictiveness of Swedish snus and the potential-reduced harms of Swedish snus among young adult nonsmokers and smokers. Methods: A convenience sample of young adults aged 18-30 residing in the United States (n = 517, 56% male, 33% smokers) participated in an online experiment. Participants completed baseline measures and were randomized to 1 of 5 experimental conditions where they viewed a Swedish snus ad with warning labels that varied by condition: (1) Control-no warning; (2) Addiction- warning conveying the addictiveness of snus; (3) Harm-warning communicating the potential harms of snus; (4) Harm Reduction-warning conveying the potential-reduced harms of snus compared with cigarettes; (5) Harm Reduction Switch-warning communicating the potential-reduced harms of snus when switching completely from cigarettes to snus. Outcomes measured included perceived harms and addictiveness of snus, thoughts about not using snus, and intentions to use snus. Results: Participants in the Harm Reduction and Harm Reduction Switch conditions perceived snus to be less harmful than cigarettes compared with the Control, Addiction, and Harm conditions. Nonsmokers in the Harm Reduction condition reported fewer thoughts about not using snus than nonsmokers in the Harm condition. Conclusions: Warnings conveying the potential-reduced harms of Swedish snus compared with cigarettes generate perceptions that snus is less harmful than cigarettes and produce fewer thoughts about not using snus among nonsmokers. Such perceptions have been associated with snus use in prior studies.

The Influence of Social Support on Smoking Cessation Treatment Adherence Among HIV+ Smokers

de Dios, M. A., Stanton, C. A., Cano, M. Á., Lloyd-Richardson, E., & Niaura, R. S. (n.d.).

Publication year

2016

Journal title

Nicotine and Tobacco Research

Volume

18

Issue

5

Page(s)

1126-1133

10.1093/ntr/ntv144

Abstract

Abstract

Introduction: The high prevalence of smoking among people living with HIV is a significant problem. Nonadherence to smoking cessation pharmacotherapy is a barrier for successfully quitting. The current study investigated the extent to which social support variables impact adherence and cessation. Methods: Participants were 444 HIV+ smokers who provided data on nicotine patch adherence, social support, and smoking. We conducted a path analysis to estimate (1) the effects of six social support indicators at baseline on nicotine patch adherence; (2) the effect of patch adherence on 7-day point prevalence smoking at 6-month follow-up; and (3) the indirect effects of social support indicators on 7-day point prevalence smoking at 6-month follow-up via patch adherence. Results: The tested model demonstrated good fit as indicated by the comparative fit index, root mean square error of approximation, and weighted root mean square residual (0.94, 0.02, and 0.51, respectively). Path analysis results indicated greater social support network contact was associated with higher levels of nicotine patch adherence (ß = .13, P = .02), greater patch adherence was associated with a lower probability of 7-day point prevalence smoking at 6-month follow-up (ß = -.47, P < .001) and greater social support network contact (ß = -.06, P = .03) had a significant indirect effect on 7-day point prevalence smoking at 6-month follow-up via patch adherence. Conclusions: Findings have implications for smoking cessation interventions that seek to capitalize on the beneficial effects of social support. Such efforts should account for the role that frequency of contact may have on nicotine patch use and other treatment-related mechanisms.

Varenicline and suicide : Reconsidered and reconciled

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

Publication year

2016

Journal title

Nicotine and Tobacco Research

Volume

18

Issue

1

10.1093/ntr/ntv247

Abstract

Abstract

~

Young adult smokers' neural response to graphic cigarette warning labels

Green, A. E., Mays, D., Falk, E. B., Vallone, D., Gallagher, N., Richardson, A., Tercyak, K. P., Abrams, D. B., & Niaura, R. S. (n.d.).

Publication year

2016

Journal title

Addictive Behaviors Reports

Volume

3

Page(s)

28-32

10.1016/j.abrep.2016.02.001

Abstract

Abstract

Introduction: The study examined young adult smokers' neural response to graphic warning labels (GWLs) on cigarette packs using functional magnetic resonance imaging (fMRI). Methods: Nineteen young adult smokers (M age 22.9, 52.6% male, 68.4% non-white, M 4.3 cigarettes/day) completed pre-scan, self-report measures of demographics, cigarette smoking behavior, and nicotine dependence, and an fMRI scanning session. During the scanning session participants viewed cigarette pack images (total 64 stimuli, viewed 4 s each) that varied based on the warning label (graphic or visually occluded control) and pack branding (branded or plain packaging) in an event-related experimental design. Participants reported motivation to quit (MTQ) in response to each image using a push-button control. Whole-brain blood oxygenation level-dependent (BOLD) functional images were acquired during the task. Results: GWLs produced significantly greater self-reported MTQ than control warnings (p < .001). Imaging data indicate stronger neural activation in response to GWLs than the control warnings at a cluster-corrected threshold p < .001 in medial prefrontal cortex, amygdala, medial temporal lobe, and occipital cortex. There were no significant differences in response to warnings on branded versus plain cigarette packages. Conclusions: In this sample of young adult smokers, GWLs promoted neural activation in brain regions involved in cognitive and affective decision-making and memory formation and the effects of GWLs did not differ on branded or plain cigarette packaging. These findings complement other recent neuroimaging GWL studies conducted with older adult smokers and with adolescents by demonstrating similar patterns of neural activation in response to GWLs among young adult smokers.

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

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

~

Differential trends in cigarette smoking in the USA : Is menthol slowing progress?

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

Publication year

2015

Journal title

Tobacco control

Volume

24

Issue

1

Page(s)

28-37

10.1136/tobaccocontrol-2013-051159

Abstract

Abstract

Introduction: Mentholated cigarettes are at least as dangerous to an individual’s health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here, we examine correlates of menthol use, national trends in smoking menthol and non-menthol cigarettes, and brand preferences over time.Methods: We estimated menthol cigarette use during 2004–2010 using annual data on persons ≥12 years old from the National Surveys on Drug Use and Health. We adjusted self-reported menthol status for selected brands that were either exclusively menthol or nonmenthol, based on sales data. Data were weighted to provide national estimates.Results: Among cigarette smokers, menthol cigarette use was more common among 12–17 year olds (56.7%) and 18–25 year olds (45.0%) than among older persons (range 30.5% to 34.7%). In a multivariable analysis, menthol use was associated with being younger, female and of non-Caucasian race/ethnicity. Among all adolescents, the percentage who smoked non-menthol cigarettes decreased from 2004–2010, while menthol smoking rates remained constant; among all young adults, the percentage who smoked non-menthol cigarettes also declined, while menthol smoking rates increased. The use of Camel menthol and Marlboro menthol increased among adolescent and young adult smokers, particularly non-Hispanic Caucasians, during the study period.Conclusions: Young people are heavy consumers of mentholated cigarettes. Progress in reducing youth smoking has likely been attenuated by the sale and marketing of mentholated cigarettes, including emerging varieties of established youth brands. This study should inform the Food and Drug Administration regarding the potential public health impact of a menthol ban.

E-Cigarettes and smoking cessation : Insights and cautions from a secondary analysis of data from a study of online treatment-seeking smokers

Pearson, J. L., Stanton, C. A., Cha, S., Niaura, R. S., Luta, G., & Graham, A. L. (n.d.).

Publication year

2015

Journal title

Nicotine and Tobacco Research

Volume

17

Issue

10

Page(s)

1219-1227

10.1093/ntr/ntu269

Abstract

Abstract

Background: Evidence from observational studies regarding the association between electronic cigarette (e-cigarette) use and cessation is mixed and difficult to interpret. Utilizing 2 analytic methods, this study illustrates challenges common in analyses of observational data, highlights measurement challenges, and reports associations between e-cigarette use and smoking cessation. Methods: Data were drawn from an ongoing web-based smoking cessation trial. The sample was comprised of 2,123 participants with complete 3-month follow-up data. Logistic regression models with and without entropy balancing to control for confounds were conducted to evaluate the association between e-cigarette use and 30-day cigarette smoking abstinence. Results: At follow-up, 31.7% of participants reported using e-cigarettes to quit in the past 3 months. E-cigarette users differed from nonusers on baseline characteristics including cigarettes per day, Fagerström score, quit attempt in the past year, and previous use of e-cigarettes to quit. At followup, e-cigarette users made more quit attempts and employed more cessation aids than smokers who did not use e-cigarettes to quit. E-cigarette use was negatively associated with abstinence after adjustment for baseline characteristics; however, the association was not significant after additional adjustment for use of other cessation aids at 3 months. Conclusions: The magnitude and significance of the estimated association between e-cigarette use and cessation in this study were dependent upon the analytical approach. Observational studies should employ multiple analytic approaches to address threats to validity. Future research should employ better measures of patterns of and reasons for e-cigarette use, frequency of e-cigarette use, and concurrent use of cessation aids.

Internet and telephone treatment for smoking cessation : Mediators and moderators of short-term abstinence

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

Publication year

2015

Journal title

Nicotine and Tobacco Research

Volume

17

Issue

3

Page(s)

299-308

10.1093/ntr/ntu144

Abstract

Abstract

Introduction: This study examined mediators and moderators of short-term treatment effectiveness from the iQUITT Study (Quit Using Internet and Telephone Treatment), a 3-arm randomized trial that compared an interactive smoking cessation Web site with an online social network (enhanced Internet) alone and in conjunction with proactive telephone counseling (enhanced Internet plus phone) to a static Internet comparison condition (basic Internet). Methods: The analytic sample was N = 1,236 participants with complete 3-month data on all mediating variables. The primary outcome was 30-day point prevalence abstinence (ppa) at 3 months. Recognizing the importance of temporal precedence in mediation analyses, we also present findings for 6-month outcomes. Purported mediators were treatment utilization and changes in psychosocial constructs. Proposed moderators included baseline demographic, smoking, and psychosocial variables. Mediation analyses examined the extent to which between-arm differences in 30-day ppa could be attributed to differential Web site utilization, telephone counseling, and associated changes in smoking self-efficacy and social support for quitting. Effect modification analyses fitted interactions between treatment and prespecified moderators on abstinence. Results: Significant mediators of 30-day ppa were changes in smoking temptations, quitting confidence, and positive and negative partner support, which were strongly associated with increased Web site utilization. The addition of telephone counseling to an enhanced Web site further improved abstinence rates, partly via an association with increased quitting confidence. Baseline smoking rate was the only significant moderator. Conclusions: Increased treatment utilization and associated changes in several psychosocial measures yielded higher abstinence rates. Findings validate the importance of treatment utilization, smoking self-efficacy, and social support to promote abstinence.

Markov modeling to estimate the population health impact of emerging tobacco products: A proof-of-concept study

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

Publication year

2015

Journal title

Tobacco Regulatory Science

Volume

1

Issue

2

Page(s)

129-141

Abstract

Abstract

~

Maternal-fetal attachment differentiates patterns of prenatal smoking and exposure

Massey, S. H., Bublitz, M. H., Magee, S. R., Salisbury, A., Niaura, R. S., Wakschlag, L. S., & Stroud, L. R. (n.d.).

Publication year

2015

Journal title

Addictive Behaviors

Volume

45

Page(s)

51-56

10.1016/j.addbeh.2015.01.028

Abstract

Abstract

Objective: Smoking cessation during pregnancy may reflect altruistic motives on behalf of the unborn baby. We test the hypothesis that pregnancy quitters have higher maternal-fetal attachment than persistent smokers, and secondarily explore how maternal-fetal attachment differs among non-smokers, pregnancy quitters, and persistent smokers. Methods: Participants were 156 women in the Behavior and Mood in Babies and Mothers study who provided report of smoking throughout pregnancy via timeline follow back interviews, with salivary cotinine confirmation of reported cessation at 30 and 35. week gestation, and postpartum day one. Maternal Fetal Attachment Scale total and subscale scores (role-taking, differentiation of self from fetus, interaction with fetus, attributing characteristics to fetus, giving of self) were examined among non-smokers, pregnancy quitters, and persistent smokers. Results: At 30. weeks, pregnancy quitters scored higher on the 'giving of self' subscale compared to persistent smokers (21.6 ± 2.4 versus 19.9 ± 2.9; p= .004). Maternal 'giving of self' also differentiated pregnancies exposed to cigarette smoking from those without exposure from 30. weeks through delivery (19.9 ± 2.9 versus 21.2 ± 2.2; p= .002). Controlling for age, income, unemployment, gravida, and father's smoking status, 'giving of self' differentiated pregnancy quitters from persistent smokers [OR. = 5.144; 95% C.I. 1.509 - 17.538; B (SE). = 1.638 (626); p= .009]. Conclusions: Women who reported a greater desire to maintain their personal health for the health of their fetus were more likely to quit smoking during pregnancy. Implications of findings for interventions and understanding mechanisms of risk are discussed.

Mathematical modelling in tobacco control research : Protocol for a systematic review

Niaura, R. S., Feirman, S., Donaldson, E., Pearson, J., Zawistowski, G., Niaura, R., Glasser, A., & Villanti, A. C. (n.d.).

Publication year

2015

Journal title

BMJ open

Volume

5

Issue

4

10.1136/bmjopen-2014-007269

Abstract

Abstract

Introduction: Tobacco control researchers have recently become more interested in systems science methods and mathematical modelling techniques as a means to understand how complex inter-relationships among various factors translate into population-level summaries of tobacco use prevalence and its associated medical and social costs. However, there is currently no resource that provides an overview of how mathematical modelling has been used in tobacco control research. This review will provide a summary of studies that employ modelling techniques to predict tobacco-related outcomes. It will also propose a conceptual framework for grouping existing modelling studies by their objectives. Methods and analysis: We will conduct a systematic review that is informed by Cochrane procedures, as well as guidelines developed for reviews that are specifically intended to inform policy and programme decision-making. We will search 5 electronic databases to identify studies that use a mathematical model to project a tobacco-related outcome. An online data extraction form will be developed based on the ISPOR-SMDM Modeling Good Research Practices. We will perform a qualitative synthesis of included studies. Ethics and dissemination: Ethical approval is not required for this study. An initial paper, published in a peer-reviewed journal, will provide an overview of our findings. Subsequent papers will provide greater detail on results within each study objective category and an assessment of the risk of bias of these grouped studies.

Outcomes of a tailored intervention for cigarette smoking cessation among latinos living with HIV/AIDS

Stanton, C. A., Papandonatos, G. D., Shuter, J., Bicki, A., Lloyd-Richardson, E. E., De Dios, M. A., Morrow, K. M., Makgoeng, S. B., Tashima, K. T., & Niaura, R. S. (n.d.).

Publication year

2015

Journal title

Nicotine and Tobacco Research

Volume

17

Issue

8

Page(s)

975-982

10.1093/ntr/ntv014

Abstract

Abstract

Introduction: Tobacco use has emerged as a leading killer among persons living with HIV, with effective approaches to tobacco treatment still unknown. HIV infection is nearly 3 times as prevalent in Latinos than in non-Latino Whites. This study reports the results of a randomized trial comparing a tailored intervention to brief counseling for smoking cessation among Latino smokers living with HIV (LSLWH). Methods: LSLWH (N = 302; 36% female, 10% employed full-time, 49% born in United States) were randomized to 4 in-person sessions of a tailored intervention (Aurora) or 2 in-person sessions of brief advice (enhanced standard care [ESC]). Both groups received 8 weeks of nicotine replacement therapy (NRT) patch. Biochemically validated 6-and 12-month 7-day point-prevalence abstinence (PPA) rates were compared, along with secondary outcomes (e.g., reduction to light smoking, NRT adherence). Results: Seven-day PPA rates reached 8% versus 11% at 6 months and 6% versus 7% at 12 months, for Aurora and ESC, respectively, with no between-group differences (p values >.40). Significant changes from baseline to 6 and 12 months among intervention targets were noted (percentage reduction in heavy smoking and dependence; increases in knowledge and self-efficacy). Baseline smoking frequency, older age, and higher intensity of patch use during the trial emerged as significant predictors of abstinence at 6 months. Conclusions: There was no evidence that the tailored intervention improved cessation rates. Interventions that encourage use of, and adherence to, empirically validated cessation aids require further development to reduce tobacco-related death and disease in this vulnerable population.

Pharmacokinetic-pharmacodynamic modeling of the effect of varenicline on nicotine craving in adult smokers

Ravva, P., Gastonguay, M. R., Faessel, H. M., Lee, T. C., & Niaura, R. S. (n.d.).

Publication year

2015

Journal title

Nicotine and Tobacco Research

Volume

17

Issue

1

Page(s)

106-113

10.1093/ntr/ntu154

Abstract

Abstract

Introduction: Varenicline has been shown to significantly reduce craving and several aspects of smoking reinforcement in clinical trials, compared with placebo. This is the first report describing the concentration-effect relationship of varenicline on relief of craving. Methods: The pharmacokinetics (PK) and pharmacodynamics (PD) of a single 2 mg dose of varenicline were investigated in 40 smokers in a randomized, crossover study comparing the effect of varenicline with placebo on ameliorating abstinence-and cue-induced craving and withdrawal symptoms. Subjects were asked to complete self-reported questionnaires (Smoking Urges Scale and Minnesota Nicotine Withdrawal Scale [MNWS]) and blood samples were simultaneously collected for measurement of varenicline concentrations. Only the data from the 4-hr postdose abstinence period (just prior to the cue session) were analyzed. Data were described by a 2-compartment PK model and a linear PD model with first-order onset/offset rate constants describing the placebo response "kinetics." Response was described as the net effect of the baseline, placebo, and drug responses. Results: Varenicline significantly decreased mean craving score when compared with placebo and the magnitude of this response was related to varenicline concentration. The time-course and magnitude of both placebo and varenicline craving response were characterized by a large degree of unexplained variability. Simulations were used to illustrate the expected craving response over time and its associated random variability after chronic dosing. Conclusions: Craving reduction is associated with increased varenicline concentrations. The relatively rapid onset of this effect within 4 hr postdose suggests that, smokers may experience some craving relief after acute administration of varenicline.

Prospective evaluation of associations between prenatal cortisol and adulthood coronary heart disease risk : The New England family study

Stinson, L. J., Stroud, L. R., Buka, S. L., Eaton, C. B., Lu, B., Niaura, R. S., & Loucks, E. B. (n.d.).

Publication year

2015

Journal title

Psychosomatic Medicine

Volume

77

Issue

3

Page(s)

237-245

10.1097/PSY.0000000000000164

Abstract

Abstract

Objective: Increasing evidence suggests that early life factors may influence coronary heart disease (CHD) risk; however, little is known about the contributions of prenatal cortisol. Objectives were to prospectively assess the associations of maternal cortisol levels during pregnancy with offspring's 10-year CHD risk during middle age. Methods: Participants were 262 mother-offspring dyads from the New England Family Study. Maternal free cortisol was assessed in third-trimester maternal serum samples. Ten-year CHD risk was calculated in offspring at a mean age of 42 years, using the validated Framingham risk algorithm incorporating diabetes, systolic and diastolic blood pressure, total and high-density lipoprotein cholesterol, smoking, age, and sex. Results: In multivariable-adjusted linear regression analyses adjusted for age and race/ethnicity, high versus low maternal cortisol tertile was associated with 36.7% (95% confidence interval [CI] = 8.4% to 72.5%) greater mean 10-year CHD risk score in women. There was no association in men (-2.8%, 95% CI = -23.8% to 24.0%). Further adjustment for in utero socioeconomic position showed 26.1% (95% CI = -0.5% to 59.9%) greater CHD risk in women. Adjustment for maternal age and size for gestational age had little effect on findings. Conclusions: Maternal prenatal cortisol levels were positively associated with 10-year CHD risk among female, and not male, offspring. Adjusting for socioeconomic position during pregnancy reduced effect size in women, suggesting that it may be a common prior factor in both maternal cortisol and CHD risk. These findings provide evidence that targeting mothers who have elevated prenatal cortisol levels, including elevated cortisol in the setting of low socioeconomic position, may potentially reduce long-term CHD risk in their offspring.

The importance of science-informed policy and what the data really tell us about e-cigarettes

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

Publication year

2015

Journal title

Israel Journal of Health Policy Research

Volume

4

Issue

1

10.1186/s13584-015-0021-z

Abstract

Abstract

A possible future end-game for cigarettes is explored in the context of the historical progress made to date by tobacco control. Despite good progress, there remains an urgent need to increase the use of proven tobacco control policies and practices for prevention and cessation. The problem is worse than previously thought and the 50th anniversary United States Surgeon General's report indicates the overwhelming majority of avoidable deaths are caused by combusting of tobacco, primarily cigarettes. The report highlights for the first time the addition of a harm minimization strategy to enhance proven tobacco control efforts and thus much more rapidly speed the obsolescence of cigarettes. Harm minimization can be two pronged. First, it can boost proven tobacco control polices to make cigarettes more expensive and less appealing and accessible to maximize the fact that cigarettes are orders of magnitude the most harmful of all tobacco delivery systems. Second, harm minimization can support use of substantially less harmful but appealing alternatives to substitute for lethal cigarettes for those users who are unable or unwilling to quit smoking. A future end-game might prudently manage emerging new products like e-cigarettes to help boost the difference in harm between them and lethal cigarettes. Harm minimization could help to accelerate the end of the century-long dominance of the cigarette in what has been called "the golden holocaust". Rather than these emerging delivery devices being used to replace lethal cigarettes in what might be termed a David versus Goliath strategy to disrupt the status quo, there is also legitimate concern that these new products could undermine historically successful tobacco control efforts, especially youth prevention, if allowed free reign. What can the data really tell us about the potential for e-cigarettes to be helpful or harmful? The emerging but limited scientific evidence and the inherent methodological constraints in study designs, points to the need for caution in prematurely interpreting results in a manner that could mislead policymakers.

The other combustible products : Prevalence and correlates of little cigar/cigarillo use among cigarette smokers

Cohn, A., Cobb, C. O., Niaura, R. S., & Richardson, A. (n.d.).

Publication year

2015

Journal title

Nicotine and Tobacco Research

Volume

17

Issue

12

Page(s)

1473-1481

10.1093/ntr/ntv022

Abstract

Abstract

Background: Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. Methods: A geographically diverse sample of current cigarette smokers were included in analyses (n = 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics. Results: Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. Conclusions: A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.

Authoritative parenting and cigarette smoking among multiethnic preadolescents : The mediating role of anti-tobacco parenting strategies

Stanton, C. A., Highland, K. B., Tercyak, K. P., Luta, G., & Niaura, R. S. (n.d.).

Publication year

2014

Journal title

Journal of pediatric psychology

Volume

39

Issue

1

Page(s)

109-119

10.1093/jpepsy/jst087

Abstract

Abstract

Introduction Parenting has been shown to affect smoking among children in U.S. majority groups, but less is known about this association among multiethnic urban populations. Our study examines the role of parenting on smoking among a highly diverse sample. Methods Health surveys were collected from eighth graders (N = 459) in 2 low-income urban schools. Structural equation models examined the direct and indirect effects of authoritative parenting on lifetime smoking. A moderated mediation analysis examined whether indirect effects of authoritative parenting vary among racial/ethnic groups. Results Authoritative controlling parenting, characterized by limit setting, was positively associated with anti-tobacco parenting. Anti-tobacco parenting was inversely associated with smoking, mediating the relationship between controlling parenting and smoking. There was no evidence that mediation was moderated by race/ethnicity. Conclusions Parent training, which focuses on setting rules and expectations, can be an important and universal element of smoking prevention programs targeted to youth in diverse communities.

Delivering on its promises : The PROMIS® smoking initiative item banks

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

Publication year

2014

Journal title

Nicotine and Tobacco Research

Volume

16

Issue

SUPPL.3

Page(s)

S261-S262

10.1093/ntr/ntu094

Abstract

Abstract

~

Effects of sequential fluoxetine and gender on prequit depressive symptoms, affect, craving, and quit day abstinence in smokers with elevated depressive symptoms : A growth curve modeling approach

Minami, H., Kahler, C. W., Bloom, E. L., Prince, M. A., Abrantes, A. M., Strong, D. R., Niaura, R. S., Miller, I. W., Palm Reed, K. M., Price, L. H., & Brown, R. A. (n.d.).

Publication year

2014

Journal title

Experimental and Clinical Psychopharmacology

Volume

22

Issue

5

Page(s)

392-406

10.1037/a0037156

Abstract

Abstract

Although the important roles of postquit affect and withdrawal symptoms in the process of smoking cessation have been well established, little is known about the relations between prequit affective trajectories and cessation outcome on the target quit date (TQD). This study examined whether a 16-week course of fluoxetine initiated 8 weeks prequit ("sequential" fluoxetine) improved TQD abstinence relative to placebo through its effects on prequit depressive symptoms, affect (withdrawal-relevant negative affect, general negative affect, and positive affect), and craving to smoke among 206 smokers with elevated depressed symptoms. The moderating effects of gender were also examined. In total, 83 smokers (40%) failed to achieve abstinence on TQD, with no difference between treatment conditions or gender. Overall structural equation models showed that fluoxetine had significant indirect effects on TQD abstinence through changes in prequit withdrawalrelevant negative affect and craving, but not depressive symptoms. However, multigroup analyses revealed gender differences. Sequential fluoxetine reduced prequit depressive symptoms, withdrawal-relevant negative affect, and craving only among women. Reduction in prequit depressive symptoms and craving among women, and withdrawal-relevant negative affect among men was associated with TQD abstinence. Moreover, exploratory analysis showed negative trend-level indirect effects of fluoxetine on TQD abstinence via increased side effects, regardless of gender. This study demonstrated the importance of considering gender when examining treatment efficacy. Identifying ways to further reduce prequit depressive symptoms and craving for women and withdrawal-relevant negative affect for men whereas alleviating side effects may help smokers with elevated depressed symptoms achieve the first smoking cessation milestone.

Efficacy of sequential use of fluoxetine for smoking cessation in elevated depressive symptom smokers

Brown, R. A., Abrantes, A. M., Strong, D. R., Niaura, R. S., Kahler, C. W., Miller, I. W., & Price, L. H. (n.d.).

Publication year

2014

Journal title

Nicotine and Tobacco Research

Volume

16

Issue

2

Page(s)

197-207

10.1093/ntr/ntt134

Abstract

Abstract

Introduction: Fluoxetine, a selective serotonin reuptake inhibitor, was examined in the treatment of smokers with elevated depressive symptoms. Specifically, this randomized, open-label clinical trial was designed to evaluate the efficacy of three logical, real-world alternatives for providing smoking cessation treatment to smokers with elevated depressive symptoms. Methods: In a sample of 216 smokers (mean Center for Epidemiological Studies Depression Scale score = 11.41), participants were randomly assigned to (a) transdermal nicotine patch (TNP), beginning on quit date and continuing for 8 weeks thereafter; (b) standard administration of antidepressant pharmacotherapy with fluoxetine (20 mg), beginning 2 weeks before quit date and continuing for 8 weeks following quit date + TNP (ST-FLUOX); or (c) sequential administration of fluoxetine (20 mg), beginning 8 weeks before quit date and continuing for 8 weeks following quit date + TNP (SEQ-FLUOX). All participants received 5 sessions of brief behavioral smoking cessation treatment. Results: Findings indicate that SEQ-FLUOX resulted in significantly higher point prevalence abstinence than ST-FLUOX at 6-month follow-up (OR = 2.35; 95% CI = 1.10-5.02, p < .03), a difference that was reduced at the 12-month assessment. Furthermore, sequential fluoxetine treatment, compared with standard fluoxetine treatment, resulted in significantly lower levels of depressive symptoms throughout smoking cessation treatment (p < .025) and significantly lower nicotine withdrawal-related negative affect (p < .004) immediately after quitting. Conclusions: Findings suggest that if one is going to prescribe fluoxetine for smoking cessation in smokers with elevated depressive symptoms, it is best to begin prescribing fluoxetine well before the target quit date.

Impact of tobacco control policy on quitting and nicotine dependence among women in five European countries

Allen, J. A., Gritz, E. R., Xiao, H., Rubenstein, R., Kralikova, E., Haglund, M., Heck, J., Niaura, R. S., Vallone, D. M., Hashibe, M., Dresler, C., Allwright, S., Bengtsson, S. S., Stucker, I., & Tamang, E. (n.d.).

Publication year

2014

Journal title

Tobacco control

Volume

23

Issue

2

Page(s)

173-177

10.1136/tobaccocontrol-2011-050391

Abstract

Abstract

Objective: To describe differences in and factors associated with former smoking and nicotine dependence among women in Ireland, Sweden, France, Italy and the Czech Republic. Methods: A cross-sectional, random digit dial telephone survey of 5000 women, aged 18 years and older, conducted in 2008. Analyses were conducted using logistic regression models. Results: Respondents from Ireland and Sweden had statistically significantly higher odds of having quit smoking within the 5 years before survey administration compared with respondents from the Czech Republic. Current smokers from Ireland, Sweden, France and Italy are more nicotine dependent than those from the Czech Republic. Conclusions: Respondents from countries with stronger tobacco control policies were more likely to have quit smoking compared with those living in the Czech Republic. However, respondents in countries with some of the strongest policies (Ireland, Sweden, France and Italy) had higher odds of smoking within 30 min of waking, an established indicator of nicotine dependence. More research in this area is warranted, but this study suggests that now that the Czech Republic is beginning to implement strong tobacco control policy, they will probably achieve a rapid decline in population-level smoking. Ireland, Sweden, France, Italy and other countries with established, strong tobacco control policies would do well to consider what additional programmes they can put in place to help their highly nicotine-dependent population of smokers successfully quit.

Influences of tobacco advertising exposure and conduct problems on smoking behaviors among adolescent males and females

Mays, D., Gilman, S. E., Rende, R., Luta, G., Tercyak, K. P., & Niaura, R. S. (n.d.).

Publication year

2014

Journal title

Nicotine and Tobacco Research

Volume

16

Issue

6

Page(s)

855-863

10.1093/ntr/ntu018

Abstract

Abstract

Introduction: Adolescents with conduct problems are more likely to smoke, and tobacco advertising exposure may exacerbate this risk. Males' excess risk for conduct problems and females' susceptibility to advertising suggest gender-specific pathways to smoking. We investigated the associations between gender, conduct problems, and lifetime smoking and adolescents' exposure to tobacco advertising, and we examined prospective relationships with smoking behaviors. Methods: Adolescents completed baseline (2001-2004; n = 541) and 5-year follow-up (2007-2009; n =320) interviews for a family study of smoking risk. Baseline interviews assessed conduct problems and tobacco advertising exposure; smoking behavior was assessed at both timepoints. Generalized linear models analyzed gender differences in the relationship between conduct problems, advertising exposure, and smoking behavior at baseline and longitudinally. Results: At baseline, among males, conduct problems were associated with greater advertising exposure independent of demographics and lifetime smoking. Among females at baseline, conduct problems were associated with greater advertising exposure only among never-smokers after adjusting for demographics. In longitudinal analyses, baseline advertising exposure predicted subsequent smoking initiation (i.e., smoking their first cigarette between baseline and follow-up) for females but not for males. Baseline conduct problems predicted current (i.e., daily or weekly) smoking at follow-up for all adolescents in adjusted models. Conclusions: The findings of this study reinforce that conduct problems are a strong predictor of subsequent current smoking for all adolescents and reveal important differences between adolescent males and females in the relationship between conduct problems, tobacco advertising behavior, and smoking behavior. The findings suggest gender-specific preventive interventions targeting advertising exposure may be warranted.

Maternal smoking during pregnancy and infant stress response : Test of a prenatal programming hypothesis

Stroud, L. R., Papandonatos, G. D., Rodriguez, D., McCallum, M., Salisbury, A. L., Phipps, M. G., Lester, B., Huestis, M. A., Niaura, R. S., Padbury, J. F., & Marsit, C. J. (n.d.).

Publication year

2014

Journal title

Psychoneuroendocrinology

Volume

48

Page(s)

29-40

10.1016/j.psyneuen.2014.05.017

Abstract

Abstract

Background: Maternal smoking during pregnancy (MSDP) is associated with early and long-term neurobehavioral deficits; however mechanisms remain unknown. We tested the hypothesis that MSDP programs the hypothalamic pituitary adrenocortical (HPA) axis of the offspring leading to adverse outcomes. In an intensive, prospective study, we investigated associations between MSDP and infant cortisol stress response and explored whether alterations in cortisol response were mediated by epigenetic modulation of the placental glucocorticoid receptor gene (NR3C1). Methods: Participants were 100 healthy mother-infant pairs (53% MSDP-exposed; 42% female) from a low income, racially/ethnically diverse sample (55% minorities). MSDP was assessed by timeline followback interview verified by saliva and meconium cotinine. Infant cortisol responses to a neurobehavioral exam were assessed seven times over the first postnatal month. Methylation of placental NR3C1 promoter exon 1F was assessed using bisulfite pyrosequencing in a subsample (n= 45). Results: MSDP-exposed infants showed significantly and persistently attenuated basal and reactive cortisol levels over the first postnatal month vs. unexposed infants. Exploratory analyses revealed that MSDP was associated with altered methylation of the placental NR3C1 promoter; degree of methylation of the placental NR3C1 was associated with infant basal and reactive cortisol over the first postnatal month and mediated effects of MSDP on infant basal cortisol. Conclusions: Results provide initial support for our hypothesis that MSDP programs offspring HPA (dys)regulation. Epigenetic regulation of placental GR may serve as a novel underlying mechanism. Results may have implications for delineating pathways to adverse outcomes from MSDP.

Parental smoking exposure and adolescent smoking trajectories

Mays, D., Gilman, S. E., Rende, R., Luta, G., Tercyak, K. P., & Niaura, R. S. (n.d.).

Publication year

2014

Journal title

Pediatrics

Volume

133

Issue

6

Page(s)

983-991

10.1542/peds.2013-3003

Abstract

Abstract

OBJECTIVE: In a multigenerational study of smoking risk, the objective was to investigate the intergenerational transmission of smoking by examining if exposure to parental smoking and nicotine dependence predicts prospective smoking trajectories among adolescent offspring. METHODS: Adolescents (n = 406) ages 12 to 17 and a parent completed baseline interviews (2001-2004), and adolescents completed up to 2 follow-up interviews 1 and 5 years later. Baseline interviews gathered detailed information on parental smoking history, including timing and duration, current smoking, and nicotine dependence. Adolescent smoking and nicotine dependence were assessed at each time point. Latent Class Growth Analysis identified prospective smoking trajectory classes from adolescence into young adulthood. Logistic regression was used to examine relationships between parental smoking and adolescent smoking trajectories. RESULTS: Four adolescent smoking trajectory classes were identified: early regular smokers (6%), early experimenters (23%), late experimenters (41%), and nonsmokers (30%). Adolescents with parents who were nicotine-dependent smokers at baseline were more likely to be early regular smokers (odds ratio 1.18, 95% confidence interval 1.05-1.33) and early experimenters (odds ratio 1.04, 95% confidence interval 1.04-1.25) with each additional year of previous exposure to parental smoking. Parents' current non-nicotine-dependent and former smoking were not associated with adolescent smoking trajectories. CONCLUSIONS: Exposure to parental nicotine dependence is a critical factor influencing intergenerational transmission of smoking. Adolescents with nicotine-dependent parents are susceptible to more intense smoking patterns and this risk increases with longer duration of exposure. Research is needed to optimize interventions to help nicotine-dependent parents quit smoking early in their children's lifetime to reduce these risks.