واکنش پذیری به نشانه های مصرف سیگار در افراد سیگاری نوجوانان

Abstract This study examined reactivity to smoking cues in adolescent smokers (n=12) and nonsmokers (n=32), between 14 and 19 years of age. Participants were presented with videotaped smoking and neutral cues in a counterbalanced order. Subjective and physiological responses to each cue type were obtained. Findings indicated that smokers reported greater desire to smoke cigarettes in response to smoking cues, relative to neutral cues, when the smoking cues were presented first. Smokers also reported greater dominance (i.e., sense of control) during smoking-cue presentations, but only when these cues were presented second. Finally, smokers' heart rate was faster during the initial portion of the smoking-related video, relative to the neutral cue. Overall, this study demonstrates the feasibility of conducting laboratory-based cue-reactivity studies with adolescent smokers. Findings suggest that adolescents smokers show similar patterns of responding to smoking cues as adult smokers, although effects were not particularly robust in this sample and subjective effects were dependent on cue order.

1. Introduction Nicotine use among adolescents is an area of considerable public health concern. Recent estimates suggest that 17% of high-school seniors smoke daily (Johnston, O'Malley, & Bachman, 2002), and that 80% of adult smokers become addicted to tobacco by age 18 (American Health Association, 1995). As with adults, craving is a prominent symptom of nicotine withdrawal (see Colby, Tiffany, Shiffman, & Niaura, 2000), and craving appears to contribute to ongoing smoking and relapse among adolescents McNeill et al., 1986 and Stanton et al., 1996. While there has been substantial research on craving in adult smokers, few studies have examined craving in adolescent smokers. The present laboratory study is a preliminary evaluation of whether smoking-related cues would elicit craving and associated physiological reactivity in a group of adolescent smokers. Ultimately, this type of cue-reactivity assessment could be useful for determining the nature of craving during adolescence, as well as evaluating methods to reduce craving. Adult smoking-cue-reactivity studies have utilized various paradigms to examine subjective and physiological reactions to salient smoking-related stimuli (see review by Carter & Tiffany, 1999). In the current study, we presented cues that were ostensibly salient for adolescent smokers. In particular, we developed a smoking-related videotape that depicted adolescents smoking in various situations, as well as a control videotape of adolescents drinking water. The primary hypothesis was that adolescent smokers would exhibit differential subjective and physiological reactivity between smoking-related and neutral videotaped cues.

. Results 3.1. Sample characteristics The average participant was 17.9 years old (range=14–19). Ninety-one percent of the sample was Caucasian, 66% female. There were no significant differences between the smoker and nonsmoker groups on age, gender, or race. Among smokers, 92% reported daily smoking, and 83% reported that they were “hooked” on cigarettes. The average number of daily cigarettes smoked was 12.7 (range=4–20), and the average score on the mFTQ was 3.9. Finally, smokers reported higher baseline craving ratings on the QSU-brief than nonsmokers (P<.0001). 3.2. Cue-reactivity measures 3.2.1. Craving Smokers reported significantly greater desire to smoke than nonsmokers, F(1,40)=67.05, P<.0001. There was also a significant Group×Order×Cue interaction for desire, F(1,40)=6.47, P<.02. As the nonsmokers provided desire to smoke ratings that were extremely truncated (i.e., all mean values less than 2 on a 100-point scale), Fig. 1 displays the desire ratings for the smokers only. Smokers who viewed the smoking video first reported higher desire scores in response to the smoking video, relative to the neutral video, while the opposite pattern was observed among smokers who viewed the smoking cue second. Smokers also reported that smoking would help them control things better, relative to nonsmokers, F(1,40)=30.99, P<.0001. There were no other significant effects for the control item. Desire to smoke ratings (and standard errors) as a function of cue presentation ... Fig. 1. Desire to smoke ratings (and standard errors) as a function of cue presentation order among smokers. Desire to smoke was rated on a 0- to 100-point visual analog scale. There was a significant Group×Order×Cue interaction, F(1,40)=6.47, P<0.02. Figure options 3.2.2. Valence There was a significant group main effect for valence, with smokers reporting significantly lower pleasure than nonsmokers, F(1,40)=11.72, P<.001. There was also a trend-level effect for cue type; the smoking cue was associated with lower valance ratings than the neutral cue, F(1,40)=3.73, P=.06. There was also a significant Group×Order interaction, F(1,40)=6.03, P<.02. Nonsmokers reported lower valence in response to both cue types when the smoking cue was presented first, whereas smokers reported lower valence in response to both cue types when the neutral cue was presented first. 3.2.3. Arousal There was a trend in which smokers reported higher levels of arousal than nonsmokers, F(1,40)=3.80, P<.06. There was also a trend-level Group×Cue interaction, F(1,40)=3.72, P=.06. Smokers reported greater arousal when presented with the smoking cue; nonsmokers reported relatively greater arousal when presented with the neutral cue. 3.2.4. Dominance There was a trend-level effect in which smokers reported decreased dominance during cue presentations relative to nonsmokers, F(1,40)=3.50, P<.07. There was also a significant Group×Order×Cue interaction, F(1,40)=5.56, P<.05. Smokers who were presented with the smoking cue second, reported increased dominance during smoking-cue exposures, relative to neutral cues. For nonsmokers, there were no differences in dominance ratings as a function of cue type or order. 3.2.5. Heart rate For heart rate, there was a significant main effect for cue type, F(1,40)=8.08, P<.007, with an overall slower heart rate during the smoking cue. There was also a significant Order×Cue interaction, F(1,40)=5.59, P<.05, with larger heart rate differences between smoking and neutral cues when the smoking cue was presented second. The secondary analyses of heart rate during the initial 4 s of each trial revealed a trend-level Group×Cue interaction, F(1,40)=3.02, P=.09. As shown in Fig. 2, smokers showed a faster heart rate during the initial seconds of the smoking cue, relative to the neutral cue; there was no difference between cue types among nonsmokers. This heart rate acceleration is consistent with effects observed in a number of adult smoking-cue-reactivity studies (see Carter & Tiffany, 1999). Heart rate deviation (beats per minute) from baseline during smoking and neutral ... Fig. 2. Heart rate deviation (beats per minute) from baseline during smoking and neutral cues among smokers and nonsmokers.