Raymond S Niaura
Raymond S Niaura
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Professor of Social and Behavioral Sciences
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Professional overview
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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.
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Education
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BA, Psychology (First Class Honors), McGill University, Montreal, CanadaMS, Psychology, Rutgers University, New Brunswick, NJPhD, Psychology, Rutgers University, New Brunswick, NJ
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Honors and awards
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Research Laureate, American Academy of Health Behavior (2009)University Scholar Award, McGill University (1979)
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Areas of research and study
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Alcohol, Tobacco and Driving PoliciesEvaluationsHealth DisparitiesSubstance AbuseTobacco Control
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Publications
Publications
HIV, STD, and hepatitis risk behaviors of young men before and after incarceration
AbstractGaiter, J., MacGowan, R., Wolitski, R., Margolis, A., Belcher, L., Lifshay, J., McFarlane, M., O'Leary, A., Williamson, J. M., Eldridge, G., Askew, J., Fitterling, J., Fortenberry, M., Griebler, J., Kennedy, S., McGregor, S., Sturges, J., Vardaman, J., Seal, D., … Gregorich, S. (n.d.).Publication year
2009Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
21Issue
2Page(s)
235-243AbstractHigh rates of HIV, STD and hepatitis and associated risk behaviors have been documented among persons entering correctional facilities. However, there is a paucity of data on risk behaviors after release from custody. This study documents risk behaviors and informs intervention development targeting young men leaving incarcerated settings. We enrolled and interviewed 106 men from five prisons up to 60 days prior to their release from prison and interviewed them again four times after their release (at 1-week, 1-, 3- and 6-months). At enrollment, men were 18-29 years of age. Nearly 54% identified as African American, while 27% identified as White, 10% identified as Hispanic/Latino and 10% identified as "other". Approximately 83% had been incarcerated multiple times, 37% reported a prior STD diagnosis and their mean lifetime number of sex partners was 36 (median = 20). Many reported multiple sex partners and inconsistent condom use after release. A significant decrease in condom use during vaginal sex with primary committed female partners and in oral sex with both committed and casual female partners after release from prison were reported from 1-6 months. These young men are at sexual risk of HIV, STD and hepatitis infection after release from prison. Interventions are needed to prevent this population from acquiring and transmitting HIV, STD and hepatitis.Impact of bupropion and cognitive-behavioral treatment for depression on positive affect, negative affect, and urges to smoke during cessation treatment
AbstractStrong, D. R., Kahler, C. W., Leventhal, A. M., Abrantes, A. M., Lloyd-Richardson, E., Niaura, R. S., & Brown, R. A. (n.d.).Publication year
2009Journal title
Nicotine and Tobacco ResearchVolume
11Issue
10Page(s)
1142-1153AbstractIntroduction: Bupropion and cognitive-behavioral treatment (CBT) for depression have been used as components of treatments designed to alleviate affective disturbance during smoking cessation. Studies of treatment-related changes in precessation affect or urges to smoke are needed to evaluate the proposed mechanisms of these treatments. Methods: The present report examines affective trajectories and urges to smoke prior to, on quit day, and after quitting in a sample of 524 smokers randomized to receive bupropion versus placebo and CBT versus standard smoking cessation CBT. Results: Bupropion and/or CBT did not affect the observed decreases in positive affect and increases in negative affect prior to cessation. However, on quit day, observed levels of negative affect and urges to smoke were diminished significantly among individuals receiving bupropion. Decreases in positive affect prior to quitting, lower levels of positive affect, and increased levels of negative affect and urges to smoke on quit day were each related to higher risk of smoking lapse. Depression proneness was an independent predictor of lower positive affect and higher negative affect but did not moderate the effects of bupropion on outcomes. In mediational analyses, the effect of bupropion was accounted for in part by lower negative affect and urges to smoke on quit day. Discussion: Results support the efficacy of bupropion in reducing relapse risk associated with urges to smoke and negative affect and suggest the need to better understand the role of low positive affect as a risk factor for early lapse.Maternal smoking during pregnancy and neonatal behavior : A large-scale community study
AbstractStroud, L. R., Paster, R. L., Goodwin, M. S., Shenassa, E., Buka, S., Niaura, R. S., Rosenblith, J. F., & Lipsitt, L. P. (n.d.).Publication year
2009Journal title
PediatricsVolume
123Issue
5Page(s)
e842-e848AbstractOBJECTIVE. To investigate the influence of prospectively measured smoking during pregnancy on aspects of neonatal behavior in a large community sample. METHODS. Participants were mothers and infants from the Providence, Rhode Island, cohort of the National Collaborative Perinatal Project enrolled between 1960 and 1966. Mothers with pregnancy/medical complications and infants with medical complications and/or born premature or of low birth weight were excluded. The final sample included 962 mother-infant pairs, 23% of whom were black. Maternal smoking was measured prospectively at each prenatal visit. Neonatal behavior was assessed by using the Graham-Rosenblith Behavioral Examination of the Neonate. Items from the examination were reduced to 3 subscales: irritability, muscle tone, and response to respiratory challenge. RESULTS. Sixty-two percent of the sample reported smoking during pregnancy, with 24% of smokers reporting smoking 1 pack per day or more. We found a significant influence of maternal smoking exposure (none, moderate/less than 1 pack per day, heavy/1 pack per day or more) on irritability and muscle tone in the neonate, with exposed infants showing greater irritability and hypertonicity. Effects remained significant after controlling for significant covariates: maternal socioeconomic status, age, and race and infant birth weight and age. Posthoc tests suggested particular effects of heavy smoking on increased infant irritability and both moderate and heavy smoking exposure on increased muscle tone. CONCLUSIONS. In a large community sample, exposure to maternal smoking was associated with increased irritability and hypertonicity in neonates. Exposure to maternal smoking did not influence neonatal response to respiratory challenge. This study is the largest-scale investigation to date of the effects of maternal smoking (heavy and moderate) on examiner-assessed neonatal behavior. Given the associations between both maternal smoking and infant irritability and later behavioral dysregulation, results have important implications for early identification and intervention with at-risk offspring.Maternal Smoking during Pregnancy and Newborn Neurobehavior : Effects at 10 to 27 Days
AbstractStroud, L. R., Paster, R. L., Papandonatos, G. D., Niaura, R. S., Salisbury, A. L., Battle, C., Lagasse, L. L., & Lester, B. (n.d.).Publication year
2009Journal title
Journal of PediatricsVolume
154Issue
1Page(s)
10-16AbstractObjective: To examine effects of maternal smoking during pregnancy on newborn neurobehavior at 10 to 27 days. Study design: Participants were 56 healthy infants (28 smoking-exposed, 28 unexposed) matched on maternal social class, age, and alcohol use. Maternal smoking during pregnancy was determined by maternal interview and maternal saliva cotinine. Postnatal smoke exposure was quantified by infant saliva cotinine. Infant neurobehavior was assessed through the NICU Network Neurobehavioral Scale. Results: Smoking-exposed infants showed greater need for handling and worse self-regulation (P < .05) and trended toward greater excitability and arousal (P < .10) relative to matched, unexposed infants (all moderate effect sizes). In contrast to prior studies of days 0 to 5, no effects of smoking-exposure on signs of stress/abstinence or muscle tone emerged. In stratified, adjusted analyses, only effects on need for handling remained significant (P < .05, large effect size). Conclusions: Effects of maternal smoking during pregnancy at 10 to 27 days are subtle and consistent with increased need for external intervention and poorer self-regulation. Along with parenting deficits, these effects may represent early precursors for long-term adverse outcomes from maternal smoking during pregnancy. That signs of abstinence shown in prior studies of 0- to 5-day-old newborns did not emerge in older newborns provides further evidence for the possibility of a withdrawal process in exposed infants.Mediators of the relationship between nicotine replacement therapy and smoking abstinence among people living with HIV/AIDS
AbstractStanton, C. A., Lloyd-Richardson, E. E., Papandonatos, G. D., De Dios, M. A., & Niaura, R. S. (n.d.).Publication year
2009Journal title
AIDS Education and PreventionVolume
21Issue
SUPPL. 3Page(s)
65-80AbstractCigarette smoking is highly prevalent among people living with HIV/AIDS and poses unique health risks. Smoking cessation programs tailored to this population have documented improved smoking outcomes with nicotine replacement therapy (NRT). The current study examined 6-month abstinence rates from a randomized clinical trial targeting 412 HIV-positive adult current smokers (51% European American, 19% African American, and 17% Hispanic American) and tested whether psychosocial variables, such as self-efficacy and decisional balance, mediated the relationship between NRT and long-term abstinence. Meeting criteria for complete mediation, 6-month smoking abstinence rates improved significantly with increases in these mediators, and the association of NRT and smoking abstinence was no longer significant once changes in self-efficacy and decisional balance were taken into account. Failure to translate gains in self-efficacy among African Americans into improved abstinence rates accounted for racial/ ethnic differences among participants. Specific psychosocial factors, such as self-efficacy, may be particularly amenable to change in cessation interventions and should be addressed with greater awareness of how cultural and social contextual factors impact treatment response among people living with HIV/AIDS.Motivation and patch treatment for HIV+ smokers : A randomized controlled trial
AbstractLloyd-Richardson, E. E., Stanton, C. A., Papandonatos, G. D., Shadel, W. G., Stein, M., Tashima, K., Flanigan, T., Morrow, K., Neighbors, C., & Niaura, R. S. (n.d.).Publication year
2009Journal title
AddictionVolume
104Issue
11Page(s)
1891-1900AbstractAims To test the efficacy of two smoking cessation interventions in a HIV positive (HIV+) sample: standard care (SC) treatment plus nicotine replacement therapy (NRT) versus more intensive motivationally enhanced (ME) treatment plus NRT. Design Randomized controlled trial. Setting HIV+ smoker referrals from eight immunology clinics in the northeastern United States. Participants A total of 444 participants enrolled in the study (mean age = 42.07 years; 63.28% male; 51.80% European American; mean cigarettes/day = 18.27). Interventions SC participants received two brief sessions with a health educator. Those setting a quit date received self-help quitting materials and NRT. ME participants received four sessions of motivational counseling and a quit-day counseling call. All ME intervention materials were tailored to the needs of HIV+ individuals. Measurements Biochemically verified 7-day abstinence rates at 2-month, 4-month and 6-month follow-ups. Findings Intent-to-treat (ITT) abstinence rates at 2-month, 4-month and 6-month follow-ups were 12%, 9% and 9%, respectively, in the ME condition, and 13%, 10% and 10%, respectively, in the SC condition, indicating no between-group differences. Among 412 participants with treatment utilization data, 6-month ITT abstinence rates were associated positively with low nicotine dependence (P = 0.02), high motivation to quit (P = 0.04) and Hispanic American race/ethnicity (P = 0.02). Adjusting for these variables, each additional NRT contact improved the odds of smoking abstinence by a third (odds ratio = 1.32, 95% confidence interval = 0.99-1.75). Conclusions Motivationally enhanced treatment plus NRT did not improve cessation rates over and above standard care treatment plus NRT in this HIV+ sample of smokers. Providers offering brief support and encouraging use of nicotine replacement may be able to help HIV+ patients to quit smoking.Parental smoking and adolescent smoking initiation : An intergenerational perspective on tobacco control
AbstractGilman, S. E., Rende, R., Boergers, J., Abrams, D. B., Buka, S. L., Clark, M. A., Colby, S. M., Hitsman, B., Kazura, A. N., Lipsitt, L. P., Lloyd-Richardson, E. E., Rogers, M. L., Stanton, C. A., Stroud, L. R., & Niaura, R. S. (n.d.).Publication year
2009Journal title
PediatricsVolume
123Issue
2Page(s)
e274-281AbstractOBJECTIVE. Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation. METHODS. We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation. RESULTS. Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use. CONCLUSIONS. Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.Parenting practices, parent smoking, and friend smoking influences on stages of adolescent smoking
AbstractStanton, C., Papandonatos, G., Lloyd-Richardson, E., Su, S., Kazura, A., & Niaura, R. S. (n.d.).Publication year
2009Journal title
Adolescent & Family HealthVolume
4Issue
2Page(s)
71-85Abstract~Personality, psychiatric disorders, and smoking in middle-aged adults
AbstractKahler, C. W., Daughters, S. B., Leventhal, A. M., Rogers, M. L., Clark, M. A., Colby, S. M., Boergers, J., Ramsey, S. E., Abrams, D. B., Niaura, R. S., & Buka, S. L. (n.d.).Publication year
2009Journal title
Nicotine and Tobacco ResearchVolume
11Issue
7Page(s)
833-841AbstractIntroduction: A number of personality traits have been associated with cigarette smoking. Current smokers generally show higher levels of negative emotionality and lower levels of behavioral constraint than former smokers and those who never smoked. However, prior investigations have not examined thoroughly whether these smoking-personality associations are unique to smoking status or simply reflect the fact that these personality traits tend to be elevated across numerous forms of psychopathology. Likewise, prior studies have not addressed whether personality shows differential associations with smoking based on the presence or absence of lifetime psychiatric disorders. Methods: The present study examined these questions using data from 472 current, 311 former, and 324 never-smokers aged 34-44 years. Results: Current smokers reported being more reactive to stress, more aggressive, more alienated, and less harm avoidant than both former smokers and never-smokers, whereas former smokers and never-smokers showed similar personality profiles overall. Psychiatric disorder history did not interact with smoking status in predicting personality. Controlling for differences in four major lifetime psychiatric disorders (major depression, alcohol dependence, drug dependence, and conduct disorder) reduced the differences in personality traits associated with smoking status. However, smoking status continued to relate uniquely and significantly to higher levels of negative emotionality and behavioral undercontrol with the most robust effect observed for trait alienation. Discussion: These results provide the most comprehensive depiction to date of interrelations among personality, psychopathology, and smoking and suggest an important role of personality in smoking that is not redundant with or conditional upon lifetime psychopathology.Prevalence and characteristics of multiple psychiatric disorders in cardiac rehabilitation patients
AbstractSerber, E. R., Todaro, J. F., Tilkemeier, P. L., & Niaura, R. S. (n.d.).Publication year
2009Journal title
Journal of Cardiopulmonary Rehabilitation and PreventionVolume
29Issue
3Page(s)
161-168AbstractPURPOSE: Anxiety and depressive disorders have been established as independent risk factors for the development of and recovery from coronary heart disease (CHD). However, few studies have reported on the prevalence and personal characteristics of comorbid psychiatric disorders (PD) among cardiac populations. This project examined the prevalence of comorbid depressive and anxiety disorders among men and women with CHD commencing cardiac rehabilitation (CR) and the demographic, medical, and psychosocial characteristics among those meeting multiple PD criteria. METHODS: Participants were 143 CHD patients (M age, 61 years; SD, 11.2; 70% men, 91% Caucasian, 64% married) entering CR who were evaluated via a semistructured, psychiatric interview to assess both current and lifetime prevalence rates of PD. Demographic, medical, and psychosocial variables were also assessed. RESULTS: Approximately 45% met criteria for at least 1 anxiety disorder, and 20% met criteria for either major depressive disorder or dysthymic disorder either at the time of evaluation or in their lifetime. Across all participants, 26% met criteria for ≥2 PD. Of those with a depressive disorder, 76% also met criteria for at least 1 anxiety disorder. Participants with comorbid PD were of younger age and female and reported less education (P < .01). Comorbidity was also associated with self-reported overall diminished physical, emotional, and social quality of life, depression, and anxiety. CONCLUSION: Comorbid PD are highly prevalent in the CR setting and are associated with specific demographic characteristics and reduced quality of life. These data offer additional support that routine screening for PD is warranted in outpatient cardiac settings.Regular exercise as a protective factor in relapse following smoking cessation treatment
AbstractAbrantes, A. M., Strong, D. R., Lloyd-Richardson, E. E., Niaura, R. S., Kahler, C. W., & Brown, R. A. (n.d.).Publication year
2009Journal title
American Journal on AddictionsVolume
18Issue
1Page(s)
100-101Abstract~Smoking abstinence and reinstatement effects in adolescent cigarette smokers
AbstractColby, S. M., Leventhal, A. M., Brazil, L., Lewis-Esquerre, J., Stein, L. A., Rohsenow, D. J., Monti, P. M., & Niaura, R. S. (n.d.).Publication year
2009Journal title
Nicotine and Tobacco ResearchVolume
12Issue
1Page(s)
19-28AbstractIntroduction: The study objectives were to examine smoking abstinence and reinstatement effects on subjective experience and cognitive performance among adolescent smokers. Methods: Adolescents (aged 14-17 years, 60 daily smokers and 32 nonsmokers) participated. Participants completed baseline assessments (Session 1) and returned to the laboratory 1-3 days later to repeat assessments (Session 2); half of the smokers were randomly assigned to 15-17 hr tobacco abstinence preceding Session 2. Results: During Session 2, abstaining smokers reported significantly greater increases in withdrawal symptoms, smoking urges, and negative affect compared with smokers who did not abstain and compared with nonsmokers. Smoking reinstatement reversed abstinence effects, returning to baseline levels for smoking urges and negative affect. Abstaining smokers showed significantly enhanced cognitive performance on two of six tasks (two-letter search compared with nonabstaining smokers; serial reaction time compared with nonsmokers); smoking reinstatement resulted in significant decrements on these two tasks relative to nonabstaining smokers. Discussion: Effects of smoking abstinence and reinstatement on self-report measures are consistent with earlier research with adolescent as well as adult smokers and may help to elucidate the motivational underpinnings of smoking maintenance among adolescent smokers. Effects found on cognitive performance were contrary to hypotheses; further research is needed to understand better the role of cognitive performance effects in smoking maintenance among adolescents.Stress response and the adolescent transition : Performance versus peer rejection stressors
AbstractStroud, L. R., Foster, E., Papandonatos, G. D., Handwerger, K., Granger, D. A., Kivlighan, K. T., & Niaura, R. S. (n.d.).Publication year
2009Journal title
Development and PsychopathologyVolume
21Issue
1Page(s)
47-68AbstractLittle is known about normative variation in stress response over the adolescent transition. This study examined neuroendocrine and cardiovascular responses to performance and peer rejection stressors over the adolescent transition in a normative sample. Participants were 82 healthy children (ages 7-12 years, n = 39, 22 females) and adolescents (ages 13-17, n = 43, 20 females) recruited through community postings. Following a habituation session, participants completed a performance (public speaking, mental arithmetic, mirror tracing) or peer rejection (exclusion challenges) stress session. Salivary cortisol, salivary alpha amylase (sAA), systolic and diastolic blood pressure (SBP, DBP), and heart rate were measured throughout. Adolescents showed significantly greater cortisol, sAA, SBP, and DBP stress response relative to children. Developmental differences were most pronounced in the performance stress session for cortisol and DBP and in the peer rejection session for sAA and SBP. Heightened physiological stress responses in typical adolescents may facilitate adaptation to new challenges of adolescence and adulthood. In high-risk adolescents, this normative shift may tip the balance toward stress response dysregulation associated with depression and other psychopathology. Specificity of physiological response by stressor type highlights the importance of a multisystem approach to the psychobiology of stress and may also have implications for understanding trajectories to psychopathology.Transdisciplinary Tobacco Use Research Centers : research achievements and future implications.
AbstractBaker, T. B., Cummings, K. M., Hatsukami, D. K., Johnson, C. A., Lerman, C., Niaura, R. S., & O'Malley, S. S. (n.d.).Publication year
2009Journal title
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and TobaccoVolume
11Issue
10Page(s)
1231-1244Abstract~Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men. The Unique Contribution of Anxiety Among Psychologic Factors
AbstractShen, B. J., Avivi, Y. E., Todaro, J. F., Spiro, A., Laurenceau, J. P., Ward, K. D., & Niaura, R. S. (n.d.).Publication year
2008Journal title
Journal of the American College of CardiologyVolume
51Issue
2Page(s)
113-119AbstractObjectives: This study investigated whether anxiety characteristics independently predicted the onset of myocardial infarction (MI) over an average of 12.4 years and whether this relationship was independent of other psychologic variables and risk factors. Background: Although several psychosocial factors have been associated with risk for MI, anxiety has not been examined extensively. Earlier studies also rarely addressed whether the association between a psychologic variable and MI was specific and independent of other psychosocial correlates. Methods: Participants were 735 older men (mean age 60 years) without a history of coronary disease or diabetes at baseline from the Normative Aging Study. Anxiety characteristics were assessed with 4 scales (psychasthenia, social introversion, phobia, and manifest anxiety) and an overall anxiety factor derived from these scales. Results: Anxiety characteristics independently and prospectively predicted MI incidence after controlling for age, education, marital status, fasting glucose, body mass index, high-density lipoprotein cholesterol, and systolic blood pressure in proportional hazards models. The adjusted relative risk (95% confidence interval [CI]) of MI associated with each standard deviation increase in anxiety variable was 1.37 (95% CI 1.12 to 1.68) for psychasthenia, 1.31 (95% CI 1.05 to 1.63) for social introversion, 1.36 (95% CI 1.10 to 1.68) for phobia, 1.42 (95% CI 1.14 to 1.76) for manifest anxiety, and 1.43 (95% CI 1.17 to 1.75) for overall anxiety. These relationships remained significant after further adjusting for health behaviors (drinking, smoking, and caloric intake), medications for hypertension, high cholesterol, and diabetes during follow-up and additional psychologic variables (depression, type A behavior, hostility, anger, and negative emotion). Conclusions: Anxiety-prone dispositions appear to be a robust and independent risk factor of MI among older men.Can the blind see? Participant guess about treatment arm assignment may influence outcome in a clinical trial of bupropion for smoking cessation
AbstractSchnoll, R. A., Epstein, L., Audrain, J., Niaura, R. S., Hawk, L., Shields, P. G., Lerman, C., & Wileyto, E. P. (n.d.).Publication year
2008Journal title
Journal of Substance Abuse TreatmentVolume
34Issue
2Page(s)
234-241AbstractIn 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.Chronic cigarette smoking and the microstructural integrity of white matter in healthy adults : A diffusion tensor imaging study
AbstractPaul, 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
2008Journal title
Nicotine and Tobacco ResearchVolume
10Issue
1Page(s)
137-147AbstractResults 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 smoking and the lifetime alcohol involvement continuum
AbstractKahler, 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
2008Journal title
Drug and alcohol dependenceVolume
93Issue
1-2Page(s)
111-120AbstractGreater 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.Depressive Symptoms and Cigarette Smoking in Twins From the National Longitudinal Study of Adolescent Health
AbstractMcCaffery, J. M., Papandonatos, G. D., Stanton, C., Lloyd-Richardson, E. E., & Niaura, R. S. (n.d.).Publication year
2008Journal title
Health PsychologyVolume
27Issue
3 SUPPL.Page(s)
S207-S215AbstractObjective: To our knowledge, no prior twin studies have examined genetic and environmental contributions to the association of depressive symptoms and cigarette smoking in adolescence. Design: Genetic and environmental contributions to the covariation of depressive symptoms and cigarette smoking were estimated among 287 monozygotic and 441 dizygotic adolescent twin pairs from the National Longitudinal Study of Adolescent Health. Main outcome measures: Depressive symptoms were measured using an 18-item modified version of the Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977). Smoking involvement was defined using an ordinal scale based on smoking recency and frequency. Results: Depressive symptoms and smoking were significantly correlated in both males and females. Twin modeling indicated that, in females, the correlation was attributable in part to common genetic factors and in part to environmental factors not shared among twins, or nonshared environment. In males, the correlation between depressive symptoms and smoking was solely attributable to nonshared environment. Conclusions: Nonshared environmental correlations in males and females lend support to a direct causal relationship between depressive symptoms and smoking in adolescence. However, the additional common genetic vulnerability in females suggested that common genetic factors also contribute, particularly among adolescent females.Educational attainment and the heritability of self-reported hypertension among male vietnam-era twins
AbstractMcCaffery, J. M., Papandonatos, G. D., Lyons, M. J., & Niaura, R. S. (n.d.).Publication year
2008Journal title
Psychosomatic MedicineVolume
70Issue
7Page(s)
781-786AbstractObjective: To investigate the potential for gene = environment interaction in hypertension by examining the extent to which educational attainment modifies the heritability of hypertension in male twins. Prior twin and family studies have established that hypertension runs in families and is heritable. In addition, epidemiological research indicates that the prevalence of hypertension differs by socioeconomic factors, such as educational attainment. Methods: Twin structural equation modeling was used to examine educational attainment as a moderator of heritability of hypertension. Participants were 4301 monozygotic and 3414 dizygotic male Vietnam-era twins who provided data on both education (in years) and self-report of physician diagnosis of hypertension or medication usage. Results: Heritability was 17 points lower among co-twins concordant for educational attainment of ≤14 years (0.46, 95% CI = 0.32-0.57) relative to co-twins concordant for >14 years of education (0.63, 95% CI = 0.54-0.71). The significant moderation of the heritability (p =.04) was confirmed in twin models examining educational attainment as a continuous moderator of hypertension. Conclusions: These results demonstrate that the expression of genetic vulnerability to hypertension can vary as a function of environmental factors, including education level, and that nongenetic pathways may differentially contribute to risk among those with fewer years of education.Educational attainment, smoking initiation and lifetime nicotine dependence among male Vietnam-era twins
AbstractNiaura, R. S., McCaffery, J. M., Papandonatos, G. D., Lyons, M. J., Koenen, K. C., Tsuang, M. T., & Niaura, R. (n.d.).Publication year
2008Journal title
Psychological MedicineVolume
38Issue
9Page(s)
1287-1297AbstractBackground. Smoking initiation and persistence are clearly associated with factors commonly thought to be environmental in origin, including socio-economic status. However, twin models that incorporate gene-environment correlation and gene x environment interaction have not been applied to elucidate the genetic or environmental role that socio-economic status plays in smoking initiation and nicotine dependence. Method. Twin structural equation modelling was used to examine gene-environment correlation and gene x environment interaction of one index of socio-economic status, educational attainment, with smoking initiation and nicotine dependence among 5119 monozygotic and 4295 dizygotic male-male Vietnam-era twins from the Vietnam Era Twin Registry, a national registry of twin pairs who served in the military during the Vietnam era. Results. Educational attainment correlated significantly with smoking initiation (r=-0.27, pEffects of progression to cigarette smoking on depressed mood in adolescents : Evidence from the National Longitudinal Study of Adolescent Health
AbstractMunafò, M. R., Hitsman, B., Rende, R., Metcalfe, C., & Niaura, R. S. (n.d.).Publication year
2008Journal title
AddictionVolume
103Issue
1Page(s)
162-171AbstractAims: To investigate the relationship between smoking status and continuously distributed depressed mood among a cohort of adolescents. Design: Quasi-experimental design, selecting the subset of adolescents who reported never having smoked a cigarette at baseline, some of whom progressed subsequently to smoking at follow-up approximately 1 year later. Setting: Data were drawn from the National Longitudinal Study of Adolescent Health, an ongoing study designed to assess the health status of adolescents, and explore the causes of adolescent health-related behaviours. Participants: Nationally representative sample of adolescents from the USA (n = 12 149), including a subsample who reported never having smoked a cigarette at baseline (n = 5475), aged on average 15 years at baseline and of predominantly European ancestry. Measurements: Logistic and linear regression models controlling for potential confounders to explore the relationship between smoking status and depressed mood measured using the Centers for Epidemiological Studies Depression Scale (CES-D). Findings: Various relationships between smoking status and depressed mood were observed, with a general trend for these effects to be greater among females. Smoking status at baseline did not significantly predict CES-D score at follow-up, although this effect approached significance in females (P = 0.077). Among never smokers at baseline, level of depressed mood at baseline predicted subsequent progression to smoking initiation (P = 0.022) but not progression to regular smoking (P = 0.229). Among never smokers at baseline, progression to smoking initiation during the follow-up period was associated with higher CES-D scores at follow-up, even after adjusting for baseline depressed mood (P < 0.001), with this effect greater for females than for males. Among those who initiated smoking, progression to regular smoking was associated with higher CES-D score at follow-up among females (P = 0.001), but not males (P = 0.966). Conclusions: These data appear to support a complex model of the relationship between depressed mood and smoking status which includes elements of both confounding and causal models. The relationship between cigarette smoking and depression may be a factor in the development of subsequent dependence.HIV-positive smokers considering quitting : Differences by race/ethnicity
AbstractLloyd-Richardson, E. E., Stanton, C. A., Papandonatos, G. D., Betancourt, R. M., Stein, M., Tashima, K., Morrow, K., & Niaura, R. S. (n.d.).Publication year
2008Journal title
American Journal of Health BehaviorVolume
32Issue
1Page(s)
3-15AbstractObjective: To better characterize smoking in HIV-positive individuals and to identify critical components of a targeted smoking cessation intervention for multiethnic HIV-positive smokers. Methods: Differences in baseline characteristics of 444 HIV-positive smokers were examined by race, and a multivariate linear regression model evaluated factors associated with nicotine dependence in an HIV-positive population, with a particular emphasis on race/ethnic differences. Results: Low smoking self-efficacy and higher contemplation of quitting were predictive of greater nicotine dependence. An interaction between age and race was noted, with older Hispanic Americans less likely to be nicotine dependent. Conclusions: Efforts should be made to tailor smoking cessation intervention content to HIV-positive racial/ethnic minority groups.Lifetime characteristics of participants and non-participants in a smoking cessation trial : Implications for external validity and public health impact
AbstractNiaura, R. S., Graham, A. L., Papandonatos, G. D., DePue, J. D., Pinto, B. M., Borrelli, B., Neighbors, C. J., Niaura, R., Buka, S. L., & Abrams, D. B. (n.d.).Publication year
2008Journal title
Annals of Behavioral MedicineVolume
35Issue
3Page(s)
295-307AbstractBackground: Detailed information about the characteristics of smokers who do and do not participate in smoking cessation treatment is needed to improve efforts to reach, motivate, and treat smokers. Purpose: The aim of this study is to explore a broad range of characteristics related to participation in a smoking cessation trial. Methods: Eligible smokers were recruited from a longitudinal birth cohort. Participants and non-participants were compared on a broad range of sociodemographics, smoking, psychiatric and substance abuse disorders, personality, and prospective measures from early childhood. Eligible smokers were compared to a matched regional subsample of the Behavioral Risk Factor Surveillance System (BRFSS). Results: Few differences were observed, most of which were statistically significant but not clinically meaningful. Compared to non-participants, participants were more likely to be single, have lower income, be more nicotine-dependent, be more motivated to quit, and have higher levels of depressed mood and stress even after covariance of gender, income, and marital status. Sociodemographic differences between participants and the BRFSS sample reflect the skew toward lower socioeconomic status in the original birth cohort. Conclusions: The encouraging conclusion is that smokers who enroll in cessation trials may not differ much from non-participants. Information about treatment participants can inform the development of recruitment strategies, improve the tailoring of treatment to individual smoker profiles, help to estimate potential selection bias, and improve estimates of population impact.Molecular genetics of successful smoking cessation : Convergent genome-wide association study results
AbstractNiaura, R. S., Uhl, G. R., Liu, Q. R., Drgon, T., Johnson, C., Walther, D., Rose, J. E., David, S. P., Niaura, R., & Lerman, C. (n.d.).Publication year
2008Journal title
Archives of General PsychiatryVolume
65Issue
6Page(s)
683-693AbstractContext: Smoking remains a major public health problem. Twin studies indicate that the ability to quit smoking is substantially heritable, with genetics that overlap modestly with the genetics of vulnerability to dependence on addictive substances. Objectives: To identify replicated genes that facilitate smokers' abilities to achieve and sustain abstinence from smoking (hereinafter referred to as quit-success genes) found in more than 2 genome-wide association (GWA) studies of successful vs unsuccessful abstainers, and, secondarily, to nominate genes for selective involvement in smoking cessation success with bupropion hydrochloride vs nicotine replacement therapy (NRT). Design: The GWA results in subjects from 3 centers, with secondary analyses of NRT vs bupropion responders. Setting: Outpatient smoking cessation trial participants from 3 centers. Participants: European American smokers who successfully vs unsuccessfully abstain from smoking with biochemical confirmation in a smoking cessation trial using NRT, bupropion, or placebo (N=550). Main Outcome Measures: Quit-success genes, reproducibly identified by clustered nominally positive single-nucleotide polymorphisms (SNPs) in more than 2 independent samples with significant P values based on Monte Carlo simulation trials. The NRT-selective genes were nominated by clustered SNPs that display much larger t values for NRT vs placebo comparisons. The bupropion-selective genes were nominated by bupropion-selective results. Results: Variants in quit-success genes are likely to alter cell adhesion, enzymatic, transcriptional, structural, and DNA, RNA, and/or protein-handling functions. Quit-success genes are identified by clustered nominally positive SNPs from more than 2 samples and are unlikely to represent chance observations (Monte Carlo P