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
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. (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., 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., 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., Abrams, D. B., & Buka, S. L. (n.d.).Publication year
2008Journal title
Drug and alcohol dependenceVolume
93Issue
1Page(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. (n.d.).Publication year
2008Journal title
Health PsychologyVolume
27Issue
3Page(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. (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
AbstractMcCaffery, 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, p<0.001). Additive genetic (p=0.011), shared environment (p=0.002) and unique environment (p=0.027) components contributed to the correlation between educational attainment and smoking initiation. Educational attainment also significantly moderated the variance in smoking initiation (p<0.001), suggestive of genexenvironment interaction, although the interaction with the additive genetic, shared environmental and unique environmental components could not be resolved due to multicollinearity. In contrast, educational attainment neither correlated with nor moderated nicotine dependence, once smokers had initiated. Conclusions. Our study suggests that educational attainment is associated with smoking initiation, in part due to gene-environment correlation and genexenvironment interaction. However, once smoking initiation is taken into account, there are no effects - be they gene-environment correlation or genexenvironmental interaction - of educational attainment on nicotine dependence.Effects 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. (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. (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
AbstractGraham, 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
AbstractUhl, 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<.0003). These genes display modest overlap with genes identified in GWA studies of dependence on addictive substances and memory. Conclusions: These results support polygenic genetics for success in abstaining from smoking, overlap with genetics of substance dependence and memory, and nominate gene variants for selective influences on therapeutic responses to bupropion vs NRT. Molecular genetics should help match the types and/or intensity of anti-smoking treatments with the smokers most likely to benefit from them.Nonpharmacologic Therapy for Smoking Cessation: Characteristics and Efficacy of Current Approaches
AbstractNiaura, R. (n.d.).Publication year
2008Journal title
American Journal of MedicineVolume
121Issue
4Page(s)
S11-S19AbstractThis article reviews the most common nonpharmacologic approaches used to support smoking cessation and, where possible, provides estimates of their efficacy in controlled clinical trials. Virtually all of the approaches that have been systematically evaluated to date have demonstrated modest efficacy in increasing quit rates. A cornerstone of effective treatment is tobacco dependence counseling, for which there is a dose-response relation between the intensity of counseling (total minutes of contact) and its effectiveness. New approaches in which treatment is tailored to individual patient characteristics appear promising for the future but require further study. Also, new technologies that permit delivery of smoking interventions to a wider range of patients could have a significant impact on reducing smoking prevalence worldwide in the future. Overall, the clinical literature strongly endorses combining nonpharmacologic interventions with pharmacotherapy to optimize support for smokers who are trying to quit.Smoking cessation among patients in an emergency chest pain observation unit: Outcomes of the Chest Pain Smoking Study (CPSS)
AbstractBock, B. C., Becker, B. M., Niaura, R. S., Partridge, R., Fava, J. L., & Trask, P. (n.d.).Publication year
2008Journal title
Nicotine and Tobacco ResearchVolume
10Issue
10Page(s)
1523-1531AbstractThis study examines the efficacy of a smoking cessation intervention on abstinence rates and motivation to quit smoking. Participants were adult smokers (N = 543) who presented to the emergency department with chest pain and who were admitted to an observation unit for 24-hour observation to rule out myocardial infarction. Participants were randomly assigned to either usual care or a tailored intervention employing motivational interviewing and telephone follow-up. All individuals choosing to quit were offered nicotine patch therapy. Follow-up assessments were conducted at 1, 3 and 6 months. Abstinence (7-day point prevalence) rates were significantly greater among participants receiving the tailored intervention compared with those given usual care (OR = 1.62, 95% CI [1.05-2.50]). The largest difference occurred at 1 month: 16.8% of usual care and 27.3% of the tailored intervention group were abstinent, with differences decreasing over time. One-third of participants who were quit at month 6 were late quitters whose initial abstinence began after the 1-month follow up. In addition to treatment assignment, psychosocial variables including motivation to quit, confidence, reduced temptation to smoke in response to negative affect, and the perception that their chest pain was related to their smoking, were significant predictors of cessation. Tailored interventions are effective in promoting initial quit attempts for emergency chest pain patients admitted to an observation unit. Additional intervention may be needed to assist late quitters and to prevent relapse.The effectiveness of covering smoking cessation services for medicare beneficiaries
AbstractJoyce, G. F., Niaura, R., Maglione, M., Mongoven, J., Larson-Rotter, C., Coan, J., Lapin, P., & Morton, S. (n.d.).Publication year
2008Journal title
Health Services ResearchVolume
43Issue
6Page(s)
2106-2123AbstractObjective. To examine whether reimbursement for Provider Counseling, Pharmacotherapies, and a telephone Quitline increase smoking cessation relative to Usual Care. Study Design. Randomized comparison trial testing the effectiveness of four smoking cessation benefits. Setting. Seven states that best represented the national population in terms of the proportion of those ≥65 years of age and smoking rate. Participants. There were 7,354 seniors voluntarily enrolled in the Medicare Stop Smoking Program and they were followed-up for 12 months. Intervention(s). (1) Usual Care, (2) reimbursement for Provider Counseling, (3) reimbursement for Provider Counseling with Pharmacotherapy, and (4) telephone counseling Quitline with nicotine patch. Main Outcome Measure. Seven-day self-reported cessation at 6- and 12-month follow-ups. Principal Findings. Unadjusted quit rates assuming missing data=smoking were 10.2 percent (9.0-11.5), 14.1 percent (11.7-16.5), 15.8 percent (14.4-17.2), and 19.3 percent (17.4-21.2) at 12 months for the Usual Care, Provider Counseling, Provider Counseling + Pharmacotherapy, and Quitline arms, respectively. Results were robust to sociodemographics, smoking history, motivation, health status, and survey nonresponse. The additional cost per quitter (relative to Usual Care) ranged from several hundred dollars to $6,450. Conclusions. A telephone Quitline in conjunction with low-cost Pharmacotherapy was the most effective means of reducing smoking in the elderly.The efficacy and safety of varenicline for smoking cessation using a flexible dosing strategy in adult smokers: A randomized controlled trial
AbstractNiaura, R., Hays, J. T., Jorenby, D. E., Leone, F. T., Pappas, J. E., Reeves, K. R., Williams, K. E., & Billing, C. B. (n.d.).Publication year
2008Journal title
Current Medical Research and OpinionVolume
24Issue
7Page(s)
1931-1941AbstractObjective: To determine whether self-regulated flexible dosing with varenicline tartrate is safe and effective for smoking cessation. Research design and methods: 320 healthy, motivated-to-quit smokers (≥10 cigarettes/day) aged 18-65 years, entered a multicenter, randomized, double-blind, placebo-controlled study - conducted between December 26, 2001 and June 24, 2003 - with a 12-week treatment phase and 40-week, double-blind, non-treatment follow-up. Treatment consisted of varenicline or placebo in fixed doses (Week 1: titrated from 0.5 to 1.0 mg/day) followed by a self-regulated flexible schedule (Weeks 2-12: 0.5-2.0 mg/day). Main outcome measures: Primary outcomes included carbon monoxide-confirmed continuous abstinence rate (CAR) from smoking for Weeks 4 through 7, 9 through 12, and 9 through 52. Secondary outcomes included CAR from Weeks 9 through 24, 7-day point prevalence of abstinence, safety assessments, and measures of craving, withdrawal, and smoking reward. Results: Superior CARs were observed in varenicline-treated (n = 157) versus placebo participants (n = 155) for Weeks 4 through 7 (38.2 vs. 11.6%), 9 through 12 (40.1 vs. 11.6%), 9 through 24 (28.0 vs. 9.0%), and 9 through 52 (22.3 vs. 7.7%) (all p < 0.001). Seven-day point prevalence was higher in varenicline-treated than placebo participants at Weeks 12 (46.5 vs. 14.2%; p < 0.001), 24 (32.5 vs. 13.5%; p < 0.001), and 52 (28.0 vs. 13.5%; p = 0.001). Overall, medication compliance was high, although varenicline-treated, but not placebo, participants tended to taper down their dosage over time. Total treatment-emergent AEs were 77.1% (varenicline: 121/157) and 65.8% (placebo: 102/155). Few AEs led to treatment discontinuation (varenicline: 11/157, 7.0% and placebo: 7/155, 4.5%). Participants were primarily healthy Caucasians, so more research is necessary to determine how applicable these findings are to other populations. Conclusions: A self-regulated, flexible dosing regimen of varenicline is well tolerated, with superior effectiveness versus placebo for smoking cessation.The prospective contribution of hostility characteristics to high fasting glucose levels
AbstractShen, B. J., Countryman, A. J., Spiro, A., & Niaura, R. (n.d.).Publication year
2008Journal title
Diabetes CareVolume
31Issue
7Page(s)
1293-1298AbstractOBJECTIVE - To assess whether psychological constructs of hostility, anger, type A behavior pattern, and depressive symptom severity 1) were associated with concurrent and prospective fasting glucose levels and 2) whether this association was moderated by marital status. RESEARCH DESIGN AND METHODS -Participants were 485 healthy men ([mean ± SD] age 59 plusmn 7 years) without a history of heart disease, diabetes, or taking related medications in the Veterans Affairs Normative Aging Study. Their fasting glucose levels between 1986 and 1995 were examined. Hierarchical linear regressions were conducted to investigate whether hostility, anger, type A behavior, and depressive symptoms were associated with concurrent fasting glucose levels as well as fasting glucose 9 years later, controlling for standard sociodemographic and biomedical covariates, including baseline fasting glucose, age, education, marital status, BMI, total cholesterol, and systolic blood pressure. RESULTS - Although none of the psychological variables were associated with concurrent fasting glucose, Cook-Medley hostility (β = 0.105), anger (β = 0.091), and type A behavior (β = 0.152) each were associated with prospective fasting glucose 9 years later, controlling for standard covariates. Depressive symptom severity was not associated with either concurrent or follow-up glucose levels. Further analysis showed that marital status moderated the effects of these characteristics on follow-up fasting glucose such that hostility, anger, and type A behavior were significant only among those who were not married (β = 0.348, 0.444, 0.439, respectively; all P <0.001). CONCLUSIONS - Hostility, anger, and type A behavior appear to be independent risk factors for impaired glucose metabolism among unmarried older men.The relationship between early life stress and microstructural integrity of the corpus callosum in a non-clinical population
AbstractPaul, R., Henry, L., Grieve, S. M., Guilmette, T. J., Niaura, R., Bryant, R., Bruce, S., Williams, L. M., Richard, C. C., Cohen, R. A., & Gordon, E. (n.d.).Publication year
2008Journal title
Neuropsychiatric Disease and TreatmentVolume
4Issue
1Page(s)
193-201AbstractBackground: Previous studies have examined the impact of early life stress (ELS) on the gross morphometry of brain regions, including the corpus callosum. However, studies have not examined the relationship between ELS and the microstructural integrity of the brain. Methods: In the present study we evaluated this relationship in healthy non-clinical participants using diffusion tensor imaging (DTI) and self-reported history of ELS. Results: Regression analyses revealed significant reductions in fractional anisotropy (FA) within the genu of the corpus callosum among those exposed to the greatest number of early life stressors, suggesting reduced microstructural integrity associated with increased ELS. These effects were most pronounced in the genu of the corpus callosum compared to the body and splenium, and were evident for females rather than mates despite no differences in total ELS exposure between the sexes. In addition, a further comparison of those participants who were exposed to no ELS vs. three or more ELS events revealed lower FA in the genu of the corpus callosum among the ELS-exposed group, with trends of FA reduction in the body and the whole corpus callosum. By contrast, there were no relationships between ELS and volumetric analysis of the CC regions. The two group did not differ significantly on measures of current depression, stress or anxiety. Conclusion: Our results reveal that greater exposure to ELS is associated with microstructural alterations in the white matter in the absence of significant volumetric changes. Importantly, our results indicate that exposure to ELS is associated with abnormalities on DTI despite the absence of clinically significant psychiatric symptoms. Future studies are needed to determine whether specific types of ELS are more likely to impact brain structure and function.The role of negative affect in risk for early lapse among low distress tolerance smokers
AbstractAbrantes, A. M., Strong, D. R., Lejuez, C. W., Kahler, C. W., Carpenter, L. L., Price, L. H., Niaura, R., & Brown, R. A. (n.d.).Publication year
2008Journal title
Addictive BehaviorsVolume
33Issue
11Page(s)
1394-1401AbstractIndividual differences in the ability to tolerate negative affect due to psychological and/or physical discomfort (e.g., distress tolerance) are emerging as an important predictor of smoking cessation outcomes. The purpose of this study was to build on existing evidence by exploring the relationship between levels of distress tolerance (DT) and negative affect on quit date in relation to risk for early lapse. Eighty-one smokers (48% female; M age = 42.6 years) who completed laboratory-based, behavioral distress tolerance tasks prior to an unaided quit attempt were categorized into low, average, and high persistence on the tasks. Low persistence smokers were significantly more likely to lapse on the assigned quit day. Among smokers able to achieve abstinence on quit day, low persistence smokers demonstrated higher levels of negative affect and urges compared to high persistence smokers. Further, negative affect-related risk for early lapse was strongest among those with low persistence. These findings suggest that smokers low in distress tolerance may be particularly vulnerable to very early lapse to smoking and that increases in negative affect may contribute to the risk for early lapse in this high-risk group of smokers.Advice on using over-the-counter nicotine replacement therapy-patch, gum, or lozenge-to quit smoking
AbstractKozlowski, L. T., Giovino, G. A., Edwards, B., DiFranza, J., Foulds, J., Hurt, R., Niaura, R., Sachs, D. P., Selby, P., Dollar, K. M., Bowen, D., Cummings, K. M., Counts, M., Fox, B., Sweanor, D., & Ahern, F. (n.d.).Publication year
2007Journal title
Addictive BehaviorsVolume
32Issue
10Page(s)
2140-2150AbstractAlthough the use of over the counter (OTC) nicotine replacement therapy (NRT) is effective for smoking cessation, many concerns and misunderstandings persist that may reduce the effectiveness of NRT. Clinical practice and public health experts responded to a questionnaire that explored challenges associated with promoting proper NRT use and gathered recommendations on overcoming these challenges. Two predominant themes emerged including the identification of policies and practices that hinder NRT use, and smokers' views regarding NRT use. To address these needs, a two-part consensus statement about the use of OTC NRT to quit smoking was developed. The first part of the consensus statement identifies policy issues. The second part of the consensus statement was developed for smokers to reduce misperceptions and concerns about NRT by providing information on safety and the most effective use of NRT. The statement integrates state of the art clinical practice guidelines in a patient-centered format and presents information for policy makers to effectively support quit attempts.Are emergency chest pain patients ready to quit smoking?
AbstractBock, B. C., Becker, B. M., Partridge, R., & Niaura, R. (n.d.).Publication year
2007Journal title
Preventive cardiologyVolume
10Issue
2Page(s)
76-82AbstractThis study examined predictors of readiness to quit smoking among emergency chest pain patients admitted to the observation unit (OU) to rule out myocardial infarction. While in the OU, patients (n=543) completed surveys assessing smoking history, nicotine dependence, readiness to quit, and other relevant variables. Participants smoked an average of 18.8 (SD=12.6) cigarettes per day. More than half (58%) had made at least 1 serious quit attempt > or = 24 hours) in the past year. Most had never used nicotine replacement medications. Nicotine dependence, perceived risk from smoking, and patient perceptions that smoking might be related to their chest pain were significantly associated with readiness to quit (P<.05). Results indicate that a significant proportion of OU patients think they are at relatively low risk from smoking and, although motivated to quit, are not using medications appropriately to assist quit attempts. There is a need for intervention and education with this population of patients.Bupropion and cognitive-behavioral treatment for depression in smoking cessation
AbstractBrown, R. A., Niaura, R., Lloyd-Richardson, E. E., Strong, D. R., Kahler, C. W., Abrantes, A. M., Abrams, D., & Miller, I. W. (n.d.).Publication year
2007Journal title
Nicotine and Tobacco ResearchVolume
9Issue
7Page(s)
721-730AbstractThis study is a randomized, double-blind, placebo-controlled clinical trial examining the effects of an intensive cognitive-behavioral mood management treatment (CBTD) and of bupropion, both singularly and in combination, on smoking cessation in adult smokers. As an extension of our previous work, we planned to examine the synergistic effects of CBTD and bupropion on smoking cessation outcomes in general and among smokers with depression vulnerability factors. Participants were 524 smokers (47.5% female, Mage=44.27 years) who were randomized to one of four 12-week treatments: (a) standard, cognitive-behavioral smoking cessation treatment (ST) plus bupropion (BUP), (b) ST plus placebo (PLAC), (c) standard cessation treatment combined with cognitive-behavioral treatment for depression (CBTD) plus BUP, and (d) CBTD plus PLAC. Follow-up assessments were conducted 2, 6, and 12 months after treatment, and self-reported abstinence was verified biochemically. Consistent with previous studies, bupropion, in comparison with placebo, resulted in better smoking outcomes in both intensive group treatments. Adding CBTD to standard intensive group treatment did not result in improved smoking cessation outcomes. In addition, neither CBTD nor bupropion, either alone or in combination, was differentially effective for smokers with single-past-episode major depressive disorder (MDD), recurrent MDD, or elevated depressive symptoms. However, findings with regard to recurrent MDD and elevated depressive symptoms should be interpreted with caution given the low rate of recurrent MDD and the low level of depressive symptoms in our sample. An a priori test of treatment effects in smokers with these depression vulnerability factors is warranted in future clinical trials.Bupropion efficacy for smoking cessation is influenced by the DRD2 Taq1A polymorphism: Analysis of pooled data from two clinical trials
AbstractDavid, S. P., Strong, D. R., Munafò, M. R., Brown, R. A., Lloyd-Richardson, E. E., Wileyto, P. E., Evins, E. A., Shields, P. G., Lerman, C., & Niaura, R. (n.d.).Publication year
2007Journal title
Nicotine and Tobacco ResearchVolume
9Issue
12Page(s)
1251-1257AbstractWe analyzed pooled data from two comparable randomized placebo-controlled clinical trials of bupropion pharmacotherapy for smoking cessation for which data on DRD2 Taq1A genotype were available. A total of 722 smokers across the two trials were randomized to 10 weeks of sustained-release bupropion hydrochloride or placebo. General estimating equation analysis demonstrated a significant gene × drug interaction (B = 0.87, SE = 0;0.34, p = .009). Smokers with the A2/A2 genotype using bupropion were more than three times as likely, relative to placebo, to be abstinent at end of treatment (35.2% vs. 15.1%; OR = 3.25, 95% CI 2.00-5.28) and at 6 months of follow-up (26.7% vs. 12.2%; OR = 2.81, 95% CI 1.66-4.77), which was attenuated by 12 months (16.3% vs. 10.7%; OR = 1.70, 95% CI 0.95-3.05). We found no significant benefit of bupropion relative to placebo on smoking cessation outcomes at any time point in participants with A1/A1 or A1/A2 genotypes. These data suggest that bupropion may be effective for smoking cessation only in a subgroup of smokers with the DRD2 Taq1 A2/A2 genotype.Catechol-O-Methyltransferase (COMT) Gene Variants Predict Response to Bupropion Therapy for Tobacco Dependence
AbstractBerrettini, W. H., Wileyto, E. P., Epstein, L., Restine, S., Hawk, L., Shields, P., Niaura, R., & Lerman, C. (n.d.).Publication year
2007Journal title
Biological PsychiatryVolume
61Issue
1Page(s)
111-118AbstractBackground: Although bupropion is efficacious for smoking cessation, only a minority of smokers are able to quit. Pharmacogenetic research may improve treatment outcomes through discovery of DNA sequences predictive of successful pharmacotherapy for subgroups of smokers. We investigated variants in the catechol-O-methyltransferase (COMT) gene in a smoking cessation trial of bupropion. Methods: A double-blind, placebo-controlled, 10-week trial of bupropion and counseling (with a 6-month follow-up period) was conducted at two university-based smoking cessation research programs. Abstinence was biochemically verified at the end of treatment and at 6 months after the target quit date. Results: At the end of the treatment phase, statistically significant interaction effects indicated that COMT haplotypes of two SNPs (rs737865 and rs165599) predicted the efficacy of bupropion compared with placebo. This interaction effect was attenuated at 6-month follow-up. Conclusions: COMT haplotypes at rs737865 and rs165599 may predict a favorable outcome for bupropion treatment for smoking cessation. European-American smokers with a G allele at both SNPs may not benefit from bupropion treatment. Small numbers of some COMT haplotypes limit interpretation of response. If study findings are confirmed in additional large studies, COMT genotyping could be applied to identify likely responders to bupropion treatment for smoking cessation.Consistency of self-reported smoking over a 6-year interval from adolescence to young adulthood
AbstractStanton, C. A., Papandonatos, G., Lloyd-Richardson, E. E., & Niaura, R. (n.d.).Publication year
2007Journal title
AddictionVolume
102Issue
11Page(s)
1831-1839AbstractAims: To examine the reliability of self-report cigarette smoking questions by describing recanting (denial of previous smoking reports) in a nationally representative sample of US adolescents followed throughout young adulthood. Predictors of recanting across stages of smoking uptake/progression are examined. Design: A total of 12 985 respondents to cigarette smoking questions during in-home interviews at waves I and III (6 years apart) of the National Longitudinal Study of Adolescent Health (Add Health). The sample survey procedures of Stata 9.0 were used to produce nationally representative estimates, with standard errors adjusted for both clustering at the school level and stratification by geographical region. Measurements: Recanting probabilities determined by reports of stages of smoking uptake/progression at each time-point were predicted by race/ethnicity, parental education, household income, poverty level, depression and peer daily smoking. Findings: Stage-specific results indicated that recanting is higher when the earlier smoking was less frequent/intense. Recanters were older, from lower-income households and had higher baseline depression levels. Non-Hispanic black youth were significantly more likely to recant previous smoking compared to non-Hispanic white youth, even in multivariate models controlling for socio-demographic variables. Predictors of recanting differed by level of tobacco involvement. The greater likelihood of non-Hispanic black respondents to deny previous smoking may be a reflection of less intense or more intermittent use of tobacco that leads to recall differences over time. Conclusions: Racial/ethnic subgroups and/or respondents endorsing depressive symptoms may be more vulnerable to misclassification during interpretation of national survey data and subsequently not identified properly for prevention/intervention programs.Effects of acute nicotine abstinence on cue-elicited ventral striatum/nucleus accumbens activation in female cigarette smokers: A functional magnetic resonance imaging study
AbstractDavid, S. P., Munafò, M. R., Johansen-Berg, H., MacKillop, J., Sweet, L. H., Cohen, R. A., Niaura, R., Rogers, R. D., Matthews, P. M., & Walton, R. T. (n.d.).Publication year
2007Journal title
Brain Imaging and BehaviorVolume
1Issue
3Page(s)
43-57AbstractTo achieve greater understanding of the brain mechanisms underlying nicotine craving in female smokers, we examined the influence of nicotine non-abstinence vs. acute nicotine abstinence on cue-elicited activation of the ventral striatum. Eight female smokers underwent an event-related functional magnetic resonance imaging (fMRI) paradigm presenting randomized sequences of smoking-related and non-smoking related pictures. Participants were asked to indicate by a key press the gender of individuals in smoking-related and non-smoking related pictures (gender discrimination task), to maintain and evaluate attention to the pictures. There was a significant effect of smoking condition on reaction times (RT) for a gender discrimination task intended to assess and maintain attention to the photographs-suggesting a deprivation effect of acute nicotine abstinence and a statistical trend indicating greater RTs for smoking cues than neutral cues. BOLD contrast (smoking vs. non-smoking cues) was greater in the non-abstinent vs. acutely abstinent conditions in the ventral striatum including the nucleus accumbens (VS/NAc). Moreover, a significant positive correlation was observed between baseline cigarette craving prior to scanning and VS/NAc activation (r = 0.84, p = 0.009), but only in the non-abstinent condition. These results may either be explained by ceiling effects of nicotine withdrawal in the abstinent condition or, may indicate reduced relative activation (smoking vs. neutral contrast) in the VS/NAc in the abstinent vs. non-abstinent conditions in this group of female smokers.