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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.05.013 Byline: Sharon S. Allen (a), Alicia M. Allen (a), Scott Lunos (b), Dorothy K. Hatsukami (c) Keywords: Smoking cessation; Females; Menstrual cycle; Relapse; Quit date Abstract: Clinical studies are emerging which suggest that sex hormones may play a role in quit attempts and relapse. The present study aim is to determine if menstrual phase plays a role on a second self-selected quit attempt and subsequent relapse during a twenty-six week follow-up. Participants (n =138) were 29.7[+ or -]6.5 years old and smoked 16.1[+ or -]4.8 cigarettes per day. Participants were more likely to self-select a second quit date during the Follicular (F) phase (59.4%) than Luteal (L) phase (40.6%, p =0.033) and were also more likely to relapse during the F phase than the L phase (59.7% vs. 40.3%, p =0.043, respectively). Those who self-selected to quit in the L phase experienced a significantly longer time to relapse than those who chose the F phase (median of 3 days vs. 2 days, respectively; Hazard Ratio=1.599, p-value=0.014). This confirms previous work suggesting quit dates in the F phase are associated with worse smoking cessation outcomes. Additional research is needed to investigate how this relationship may vary with the use of pharmacotherapy. Author Affiliation: (a) Department of Family Medicine & Community Health, University of Minnesota, Medical School, 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414, United States (b) Biostatistics, Design, and Analysis Center, University of Minnesota, Office of Clinical Research, 717 Delaware Street SE, Minneapolis, MN 55414, United States (c) Department of Psychiatry, University of Minnesota, Medical School, 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.03.024 Byline: Alicia M. Allen (a), Sharon S. Allen (a), Jennifer Widenmier (a), Mustafa al'Absi (b) Keywords: Smoking cessation; Menstrual cycle; Craving; Cortisol; Female Abstract: Research indicates stress, craving and menstrual phase may play a role in relapse to smoking. It remains unknown how these factors may interact during cessation. This study describes the relationship between craving and cortisol concentrations by menstrual phase during ad libitum smoking and investigates the impact of this relationship on time to relapse. Five assessments of cortisol concentrations and craving levels were collected the day before smoking cessation in female smokers (n =38) during either the follicular (n =21; F) or luteal (n =17; L) phase. Craving at wake-up was significantly greater in the F phase than the L phase (2.5[+ or -]1.9 vs. 1.1[+ or -]1.4; p =0.018; respectively). Decreased levels of morning cortisol concentrations and a greater decline from morning to the nadir levels in cortisol were associated with increased craving at bedtime in the L (r =-0.68, p =0.002; r =-0.67, p =0.003; respectively), but not in the F phase. Craving at wake-up was a significant predictor of time to relapse (p =0.008). Our results indicate that menstrual phase may play a role in the relationship among craving, cortisol concentrations, and risk for relapse. Author Affiliation: (a) University of Minnesota, Medical School, Department of Family Medicine & Community Health; 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414, United States (b) University of Minnesota Medical School, 1035 University Drive, Room 236 D601, Duluth, MN, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.03.033 Byline: Patricia J. Dickmann, Marc E. Mooney, Sharon S. Allen, Karen Hanson, Dorothy K. Hatsukami Keywords: Nicotine withdrawal; Sex; Adolescence; Hormonal contraception; Birth control Abstract: While sex differences in the nicotine withdrawal (NW) symptoms and craving (NC) have been extensively described in adult cigarette smokers, few studies have investigated these phenomena in adolescents. We investigated the effect of gender and hormonal contraception (HC) on NW and NC during the first 14 days of cessation in adolescent smokers using data from a randomized, placebo-controlled, double-blind trial of the transdermal nicotine replacement therapy for smoking cessation. Analyses showed similar levels of NW severity in males and females, regardless of HC use. However, significantly higher NC was observed in females compared to males, (2.22[+ or -]0.12 vs. 1.65[+ or -]1.14; p =0.003). Further, females not using HC reported the highest level of NC (2.38[+ or -]0.16) followed by females using HC (2.08[+ or -]0.25) and males (1.71[+ or -]0.16; p =0.007). The current findings suggest that adolescent females experience similar NW severity to males, but have stronger NC. Further, the use of hormonal contraceptives may impact the severity of craving. Addressing these different symptoms in adolescents may be useful in increasing smoking cessation rates in this special population of smokers. Author Affiliation: University of Minnesota, Tobacco Use Research Center, 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2008.08.009 Byline: Sharon S. Allen (a), Alicia M. Allen (a), Cynthia S. Pomerleau (b) Keywords: Smoking; Relapse; Women; Menstrual cycle; Premenstrual symptomatology; Smoking withdrawal Abstract: Emerging evidence suggests that women have a more difficult time quitting smoking than men -- possibly due, in part, to sex hormones. The present study characterized mood, premenstrual symptomatology, and smoking withdrawal, as well as smoking behavior, in the follicular and luteal phases during ad libitum smoking in 25 women intending to quit. We also investigated the possible influence of phase-related variability in these measures on likelihood of study adherence and smoking cessation. We found that premenstrual symptomatology, as well as some measures of mood and smoking withdrawal, were significantly higher during the luteal phase than in the follicular phase. Cigarettes/day did not vary by menstrual cycle phase. Phase-related variability in premenstrual symptomatology [F(3, 20)=2.82, p =0.0650)] and urge to smoke [F(2, 21)=4.85, p =0.0186)] were associated with relapse. These data support the inference that sex hormones influence smoking cessation outcome. This knowledge may contribute to the development of more rational and effective smoking cessation interventions for women. Author Affiliation: (a) Tobacco Use Research Center, University of Minnesota, Medical School, 2701 University Avenue SE, Suite 201, Minneapolis, MN 55414, United States (b) Department of Psychiatry, University of Michigan School of Medicine, Rachel Upjohn Building, room 2137, Ann Arbor, MI 48109-5765, United States

The effect of nicotine replacement therapy and hormone therapy on weight change, energy intake, and physical activities on postmenopausal female smokers is evaluated. During short-term smoking cessation, older women using nicotine replacement gain less weight.

The effect of short-term abstinence on weight gain and energy intake and physical activity amongst postmenopausal women was observed. The levels of kilocalorie and carbohydrate intakes were higher amongst non-smokers than smokers, with no significant or noticeable change in physical activities.

A new study investigates the effect of short-term smoking cessation on energy intake and expenditure of women experiencing different stages of the menstrual cycle.

Introduction: Accumulating evidence has linked depressive symptoms and sex hormones to risk for relapse; however, the specific mechanisms involved in these associations remain unknown. This randomized crossover study assessed physiological response to nicotine by menstrual phase in female smokers with and without depressive symptoms following acute smoking abstinence. Methods: Females, ages 18–40 years with regular menstrual cycles, not on exogenous hormones or psychotropic medications, who reported smoking ≥5 cigarettes/day were enrolled. Participants were stratified into 2 groups: no depressive symptoms (NDS; n = 23) and depressive symptoms (DS; n = 24). After 4 days of biochemically verified smoking abstinence, participants completed 2 laboratory sessions in the follicular (F) and luteal (L) phases. Participants used nicotine nasal spray at Time 0, and blood pressure, heart rate, and serum nicotine were measured at Time −1, 5, 10, 20, 30, 45, 60, and 90min. Results: Participants (n = 47) were 29.1±6.8 years old and smoked an average of 12.5±5.1 cigarettes/day. The NDS group had more pronounced menstrual phase differences (F > L) in diastolic blood pressure, heart rate, and maximum concentrations of nicotine compared with the DS group (p < .05). Conclusions: This study observed an interaction between sex hormones and depressive symptoms such that those without depressive symptoms had a greater menstrual phase difference in the physiological response to nicotine. These data offer additional support for the role of sex hormones in the physiological response to nicotine, which may play a role in menstrual phase effects on smoking cessation. [ABSTRACT FROM PUBLISHER]

Aims To examine if menstrual phase affects relapse in women attempting to quit smoking. Design An intent-to-treat randomized smoking cessation trial where women were assigned to quit smoking in either the follicular (F) or luteal (L) menstrual phase and were followed for up to 26 weeks. They were assessed for relapse by days to relapse and relapse phase to determine if those who begin a quit attempt during the F phase were more successful than those who begin during the L phase. Setting Tobacco Use Research Center, University of Minnesota, Minneapolis, Minnesota. Participants A total of 202 women. Measurements Latency to relapse from continuous and prolonged abstinence, point prevalence, phase of relapse, first slip within the first 3 and 5 days post-quit date, subject completion rates and symptomatology (i.e. withdrawal and craving). Findings The mean days to relapse from continuous abstinence and relapse from prolonged abstinence for the F group were 13.9 and 20.6 days, respectively, and 21.5 and 39.2 days, respectively, for the L group. Using point prevalence analysis at 14 days, 84% of the F group had relapsed compared with 65% of the L group [χ2 = 10.024, P = 0.002; odds ratio (OR) = 2.871, 95% confidence interval (CI), 1.474–5.590]. At 30 days, 86% of the F group relapsed, compared with 66% of the L group (χ2 = 11.076, P = 0.001; OR = 3.178, 95% CI, 1.594–6.334). Conclusion Women attempting to quit smoking in the F phase had less favorable outcomes than those attempting to quit in the L phase. This could relate to ovarian hormones, which may play a role in smoking cessation for women. [ABSTRACT FROM AUTHOR]

Objective: Physicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for tobacco treatment among 3rd year U.S. medical students. Methods: Third year medical students (N = 1065, 49.3% male) from 10 U.S. medical schools completed a survey in 2009–2010 assessing student characteristics, including demographics, tobacco treatment knowledge, and self-efficacy. Tobacco curricula characteristics assessed included amount and type of classroom instruction, frequency of tobacco treatment observation, instruction, and perception of preceptors as role models. Results: Greater tobacco treatment knowledge, self-efficacy, and curriculum-specific variables were associated with 5A intentions, while younger age, tobacco treatment self-efficacy, intentions, and each curriculum-specific variable were associated with greater 5A behaviors. When controlling for important student variables, greater frequency of receiving 5A instruction (OR = 1.07; 95%CI 1.01–1.12) and perception of preceptors as excellent role models in tobacco treatment (OR = 1.35; 95%CI 1.04–1.75) were significant curriculum predictors of 5A intentions. Greater 5A instruction (B = .06 (.03); p < .05) and observation of tobacco treatment (B = .35 (.02); p < .001) were significant curriculum predictors of greater 5A behaviors. Conclusions: Greater exposure to tobacco treatment teaching during medical school is associated with both greater intentions to use and practice tobacco 5As. Clerkship preceptors, or those physicians who provide training to medical students, may be particularly influential when they personally model and instruct students in tobacco dependence treatment. [ABSTRACT FROM AUTHOR]