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Background Behavioral measures of impulsive behavior include the dimensions of behavioral disinhibition, decision-making, and lapses of attention. These behaviors are associated with a range of risky activities during adolescence, including cigarette smoking; however, few studies have evaluated their associations with tobacco treatment outcomes. The current study examined the relationship between impulsive behavior and contingency management treatment outcomes for adolescent smokers. Methods Data from two contingency management smoking cessation trials were combined (N = 189 adolescents). Participants provided breath carbon monoxide (CO) samples with incentives delivered contingent (i.e., active treatment [AT] condition) or non-contingent (i.e., control treatment [CT] condition) on CO level. Dimensions of impulsive behavior were assessed pre- and post-treatment using the Go/Stop Task, a measure of delay discounting, a continuous performance task, while self-reported impulsivity was assessed with the Barratt Impulsiveness Scale-Adolescent. Relationships between impulsive behavior and treatment outcomes (efficacy and adherence) were assessed using linear mixed effects models. Results Participants in the AT condition had significantly lower program CO levels at each treatment phase. Delay discounting in the AT condition predicted CO levels, with those discounting the most lowering their breath CO levels the least. Delay discounting also predicted program adherence across both conditions. Conclusions Delay discounting may be the most relevant dimension of impulsive behavior to predict outcomes for adolescent smokers completing CM programs, both in terms of successful reductions in smoking and program adherence. Suggestions are made to reduce the effects of delay discounting for adolescent smokers using this treatment approach.

Background Little is known about the behavioral effects of non-nicotine ingredients in electronic cigarette liquids. Propylene glycol (PG) and vegetable glycerin (VG) are the most common humectants used in electronic cigarette liquids. These ingredients may influence stimulus effects (e.g., visibility of exhalant, taste, or smell), which have played a role in the abuse liability of conventional cigarettes. In the current study, the stimulus effects of aerosol from liquids varying only in PG and VG content were assessed. Methods Sixteen electronic cigarette users completed five sessions (one practice and four testing sessions). Following one hour of nicotine deprivation, two sampling puffs from liquid formulations containing 100/0, 75/25, 50/50, 25/75, and 0/100% PG/VG concentrations were administered in random order during five assessments, each separated by 20 min. Measures included self-reported stimulus effects and breakpoint on a multiple-choice procedure with options consisting of sampled puffs or varying amounts of money. Results VG content was associated with greater reports of visibility of the exhalant (i.e., “cloud”). Liquids with only PG or VG engendered lower reports of inhalation sensations (e.g., throat hit) and greater reductions of systolic blood pressure compared to mixtures of PG and VG. There was no effect of liquid formulation on the multiple-choice procedure, but puffs were rarely chosen over even the smallest monetary option ($0.05), suggesting minimal reinforcing efficacy. Conclusions Liquids containing greater concentrations of VG are more capable of producing visible exhalant and mixtures of PG and VG engender greater airway sensory effects than either ingredient alone.

Background Cardiovascular safety is an important consideration regarding the benefits versus risks of electronic cigarette use (EC) for public health. The single‐use cardiovascular effects of EC have been well studied but may not reflect effects of ad libitum use throughout the day. We aimed to compare the circadian hemodynamic effects as well as 24‐hour biomarkers of oxidative stress, and platelet aggregation and inflammation, with ad libitum cigarette smoking (CS) versus EC versus no tobacco product use. Methods and Results Thirty‐six healthy dual CS and EC users participated in a crossover study in a confined research setting. Circadian heart rate, blood pressure and plasma nicotine levels, 24‐hour urinary catecholamines, 8‐isoprostane and 11‐dehydro‐thromboxane B2, and plasma interleukin‐6 and interleukin‐8 were compared in CS, EC, and no nicotine conditions. Over 24 hours, and during daytime, heart rate and blood pressure were higher in CS and EC compared with no tobacco product conditions ( P P Conclusions CS and EC had similar 24‐hour patterns of hemodynamic effects compared with no tobacco product, with a higher average heart rate with CS versus EC, and similar effects on biomarkers of inflammation. EC may pose some cardiovascular risk, particularly to smokers with underlying cardiovascular disease, but may also provide a harm reduction opportunity for smokers willing to switch entirely to EC. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02470754.

Author(s): Harvanko, Arit M; St Helen, Gideon; Nardone, Natalie; Addo, Newton; Benowitz, Neal L | Abstract: Background and aimsRelative pharmacological effects of e-cigarettes and cigarettes during 24nhours of ad-libitum use have not been described. In this study, 24-hour blood plasma nicotine concentrations and 48-hour subjective effects with use of cigarettes and e-cigarettes were measured among dual users.DesignTwo-arm within-subject cross-over design with preferred e-cigarette or cigarette ad-libitum use over 48nhours.SettingHospital research ward in San Francisco, California, USA.ParticipantsThirty-six healthy dual users of e-cigarettes and cigarettes (nn=n8, 25% females).MeasurementsTwenty-four-hour blood plasma nicotine and cotinine concentrations and 48-hour self-reported nicotine withdrawal symptoms and rewarding effects.FindingsAnalyses used analysis of variance (ANOVA)-based mixed models with order of product (e-cigarette or cigarette) and product type (combustible cigarette or type of e-cigarette) as fixed effects, and subject as a repeated effect. During a 24-hour period, e-cigarettes produced lower nicotine exposure than cigarettes for the majority of users, although 25% received more nicotine from e-cigarettes, which was predicted by more frequent e-cigarette use or greater dependence. Compared to cigarette smoking, nicotine exposure for variable-power tank users was similar, while cig-a-like (t(30) n=n2.71, Pn=n0.011, dn=n0.745) and fixed-power tank users (t(30) n=n3.37, Pn=n0.002, dn=n0.993) were exposed to less nicotine. Cigarettes were rated higher than e-cigarettes on some desirable subjective effects (e.g. psychological reward, t(322) n=n7.24 Pnln0.001, dn=n0.432), but withdrawal symptom reduction was comparable. No differences were found between e-cigarette types, but Bayes factors indicate that these measures were insensitive.ConclusionsDuring a 24-hour period in a hospital setting in the United States, nicotine exposure for dual users of e-cigarettes and cigarettes was similar when using cigarettes or variable-power tank devices only but was lower for those using cig-a-like or fixed-power devices only. Despite lower nicotine levels, all types of e-cigarette were effective in preventing withdrawal symptoms. E-cigarettes were rated less rewarding than cigarettes.

Introduction Electronic cigarettes are widely variable devices, typically with user definable liquid and device parameters. Yet, little is known about how regular users manipulate these parameters. There is also limited understanding of what factors drive electronic cigarette use and liquid purchasing, and whether two common ingredients, propylene glycol and vegetable glycerin, alter the subjective effects of these devices. Methods During the spring of 2016 522 adults, who reported daily use of electronic cigarettes containing nicotine, completed a survey on electronic cigarettes. Survey questions included an electronic cigarette dependence questionnaire, questions on tobacco and electronic cigarette use, and device and liquid preferences. Results Fifty-nine percent of respondents reported using another tobacco product, which was positively associated with level of nicotine dependence. On average, devices were set to 28.3 (SD = 24.2) watts. Ability to change device voltage, and level of resistance typically used, was significantly associated with level of nicotine dependence. Amount of liquid consumed, nicotine concentration, and milligrams of nicotine used per week, were positively associated with nicotine dependence. Participants rated ‘good taste’ as the most important consideration when using and purchasing liquids, and propylene glycol is associated with undesirable effects and vegetable glycerin with desirable effects. Conclusions These data indicate that electronic cigarette users utilize a wide range device parameter settings and liquid variables, and that individuals with greater nicotine dependence favor voltage control devices, and lower resistance heating elements. Taste is a key factor for electronic cigarette selection, and concentrations of propylene glycol and vegetable glycerin may have a significant impact on the reinforcing effects of liquids.

Introduction Many electronic cigarette manufacturers have begun offering liquids containing “nicotine salts,” which are formed when an acid is mixed in a solution with free-base nicotine. Type of salt could play a significant role in the abuse liability of electronic cigarette liquids. As a first step to understanding nicotine salts, this study sought to identify the types of acids present in 23 commercially available electronic cigarette liquids. Aims and Methods Twenty-three electronic cigarette liquids advertised as containing nicotine salts were purchased for analysis. These liquids were tested for the presence of 11 different organic acids that were deemed likely to be used in a nicotine salt formulation. Liquids were analyzed using a combination of liquid chromatography–mass spectrometry and gas chromatography–mass spectrometry methods, then compared to authentic acid standards for identification. Results Six of the 11 possible acids were identified in the liquids, from most to least common: lactic, benzoic, levulinic, salicyclic, malic, and tartaric acid. Acid(s) could not be identified in one of the liquids. Though most liquids contained only one type, three of the liquids contained multiple acids. Conclusions These data demonstrate that several types of salts/acids are currently being used in electronic cigarette liquids. The type and concentration of salt(s) used in these liquids may differentially alter sensations in the throat and upper airway, and overall pharmacology of the aerosols by altering liquid pH and from flavor and sensory characteristics of the acids themselves. Implications This study demonstrates that at least six different types of acids are being used to create the nicotine salts in electronic cigarette liquids, with the acids lactic, benzoic, and levulinic being the most frequently identified. Identification of these acids can serve as the foundation for future research to determine if type of nicotine salt alters pharmacological and toxicological effects of electronic cigarettes.

The heated tobacco product (HTP) IQOS was authorized for sale in the US in 2019. We investigated how young adults with experience using multiple tobacco products reacted to, perceived, and developed interest in IQOS, informing policies that might prevent HTPs from becoming ubiquitous. We used a novel qualitative method in which 33 young adult tobacco users in California (fall 2019) &ldquo, unboxed&rdquo, an IQOS device, tobacco sticks, and marketing materials and narrated their impressions and opinions. We conducted content and thematic analyses of participants&rsquo, reactions, sensory experiences, and interest. Multiple attributes influenced appeal for participants, including sleek electronic design, novel technology, perceived harmfulness, complexity, and high cost. The &ldquo, no smoke&rdquo, claim and heating technology suggested that smoking IQOS was safer than smoking cigarettes. Public health programs should closely monitor HTP marketing and uptake, particularly as &ldquo, reduced exposure&rdquo, claims were authorized in July 2020. Evidence-based regulations (e.g., requiring plain packaging for tobacco sticks), actions addressing IQOS&rsquo, unique attributes (e.g., regulating device packaging to reduce high-tech appeal), and public education might help to counter the appeal generated by potentially misleading IQOS marketing tactics.

Introduction Adolescence is a critical time when the majority of tobacco users initiate smoking. Contingency management for adolescent smoking cessation has shown promise in previous studies, but efficacy following removal of contingencies is not well understood. This study examined a remote form of contingency management among non-treatment-seeking adolescent smokers. Methods Participants (N = 127) submitted breath carbon monoxide (CO) three times daily throughout a 42-day program. For this randomized trial, participants in the active condition (n = 63) were reinforced for providing CO measurements on schedule and below a set criterion, whereas those in the control condition (n = 64) were reinforced for providing CO measurements on schedule. Self-reported smoking and urinary cotinine levels were collected at several timepoints. Results Active condition showed greater within-group reductions in CO levels relative to control condition, but not at 3- or 6-month follow-up. Active condition reported significantly less smoking during treatment compared to control condition, but not at follow-up. There were no significant differences for urinary cotinine. Overall treatment adherence was low, with only 37% and 51% of possible CO samples being submitted among active and control, respectively. Poor treatment adherence may explain the disparity between CO and cotinine results, and poor follow-up treatment efficacy. Conclusions This study replicates feasibility of a remote form of contingency management for adolescent smoking. CO results suggest active condition reduced smoking within group, but treatment adherence and posttreatment efficacy was poor. Future research should focus on increasing adherence for this type of program among adolescent smokers. Implications This study demonstrates feasibility of a remote form of contingency management therapy for smoking cessation among adolescents, while providing posttreatment efficacy data. Within-group efficacy of this form of treatment is suggested, but treatment adherence and follow-up efficacy were poor. This study underscores the need for further development of contingency management therapy for adolescent smoking cessation, which emphasizes better treatment adherence and posttreatment efficacy.

Objective Based on previous observational studies that have suggested self-regulated caffeine use by older adults may enhance reaction time performance and vigilance on cognitive tasks, the current study sought to examine whether this effect held true for young adults as well. Methods One hundred and four young adults from two major metropolitan areas, ages 18–29 years, not meeting the criteria for a current psychiatric disorder, completed several cognitive tasks related to decision-making (Cambridge Gamble Task), response inhibition and reaction time (stop-signal task), and vigilance and reaction time (Rapid Visual Information Processing). Caffeine usage was self-reported using a reliable quantity and frequency questionnaire. Results Self-reported caffeine usage was not significantly associated with any of the cognitive measures used in this study after controlling for age, gender, cigarette smoking, alcohol use, cannabis use, and gambling frequency. Conclusions These data suggest that self-regulated caffeine usage may not have a significant impact on reaction time, vigilance, response inhibition, or decision-making in young adults, or that these effects are contingent upon other variables not accounted for in the current study. Copyright © 2015 John Wiley & Sons, Ltd.

It is unknown whether first-generation electronic cigarettes reduce smoking urges and withdrawal symptoms following a 24 h deprivation period. This study tested whether a first-generation electronic cigarette reduces smoking urges and withdrawal symptoms in cigarette smokers. Following 24 h of tobacco deprivation, using a within-subjects design, eight nontreatment seeking tobacco cigarette smokers (3 females) administered 10 puffs from a conventional cigarette or a first-generation electronic cigarette containing liquid with 0, 8 or 16 mg/ml nicotine. Conventional cigarettes ameliorated smoking urges and electronic cigarettes did not, regardless of nicotine concentration. First-generation electronic cigarettes may not effectively substitute for conventional cigarettes in reducing smoking urges, regardless of nicotine concentration.

Background and aims: Past research suggests that sleep problems are associated with increased risky decision-making. Similarly, gambling disorder and alcohol use disorder are also associated with increased risky decision-making. Individuals with gambling disorder or alcohol use disorder have also reported higher rates of sleep problems compared to normal healthy controls. As such, we sought to examine whether sleep problems play a role in the development of alcohol use disorder or gambling disorder. Methods: One hundred and forty-one individuals who gamble and use alcohol, yet do not meet criteria for gambling disorder or alcohol use disorder, were assessed to determine the correlation between sleepiness, amount of sleep obtained, decision-making, and alcohol or gambling behaviors. Results: Our results suggest that inconsistent sleep patterns may be associated with increased frequency of alcohol use and gambling. We did not, however, find a significant correlation between sleep factors and decision-making. Discussion: Further research is needed to examine the specific relationship between sleep patterns and alcohol use and gambling frequency. Overall these data suggest that sleepiness or sleep and risky decision-making is not a significant factor in gambling and alcohol use behaviors in individuals not meeting criteria for alcohol use disorder or gambling disorder.

Compulsive buying (CB) is a potentially devastating problem involving repetitive urges to shop and uncontrolled spending behaviors. Prevalence of CB in the general population has been estimated at 5.8%. This epidemiological study aims to better understand the prevalence and characteristics of college students who meet criteria for CB. During the spring of 2011, an online survey examining CB (using a clinically validated screening instrument, the Minnesota Impulse Disorders Interview), stress and mood states, psychiatric comorbidity, and psychosocial functioning was emailed to 2108 University students. Overall survey response rate was 35.1% (n=2108). Our data indicated that 3.6% (n=67) of college students surveyed met criteria for CB with significantly more women affected (4.4%, n=48) than men (2.5%, n=19). Relative to students not meeting criteria for CB, college students who met criteria for CB endorsed significantly greater psychiatric comorbidity, lower grade point averages, increased stress, and poorer physical health. Presence of CB is likely associated with a variety of problems in college students. These data may warrant increased screening of CB in college students to establish early interventions.

OBJECTIVES Individuals who regularly gamble, regularly consume alcohol, or meet criteria for an alcohol-use disorder or pathological gambling may make riskier decisions on cognitive tasks. What remains unclear in the literature is whether these decision-making deficits precede or result from these addictive behaviors. This study aimed to determine whether risky decision making on a cognitive task is predictive of increasing gambling behaviors and alcohol use. METHODS Fifty-eight young adults (aged 18-29 years) free from Axis I disorders and reporting no symptoms of at-risk gambling behavior or alcohol consumption, who were participating in a longitudinal study of impulsivity, were grouped as either high-risk decision makers (n = 29) or low-risk decision makers (n = 29) by using the Cambridge Gamble Task. Subjects were assessed at 1-year follow-up to examine gambling frequency, alcohol consumption, at-risk alcohol-use criteria, alcohol-use disorder criteria, at-risk gambling criteria, and pathological gambling criteria. RESULTS High-risk decision makers were found to be more likely to meet at-risk criteria for alcohol use after 1 year. Decision-making group membership was not significantly correlated with frequency of gambling or development of pathological gambling or alcohol-use disorder over 1 year. CONCLUSIONS A variable measuring risky decision making on the Cambridge Gambling Task may be able to predict who is more likely to increase alcohol use per session later in life.

Previous research has shown a relationship between impulsive personality and the subjective and reinforcing effects of d-amphetamine. Impulsive personality, however, is comprised of multiple dimensions. The association between different dimensions of impulsive personality and the subjective and reinforcing effects of d-amphetamine is unknown. The objective of this study was to assess the independent contributions of the "sensation-seeking" and "impulsivity" dimensions of the impulsive sensation-seeking subscale of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) to the subjective and reinforcing effects of d-amphetamine. Forty healthy emerging adults varying in scores on the sensation-seeking and impulsivity dimensions of the ZKPQ participated in a double-blind, placebo-controlled, randomized study comprised of 4 2-day blocks. Each 2-day block consisted of a sample day and self-administration day. Subjective effects and physiological measurements were taken prior to, and hourly for 3 hr following, dose administration. On sample days participants were given 8 capsules containing 0, 1, or 2 mg d-amphetamine. On self-administration days participants were able to earn capsules containing the same dose of d-amphetamine that was administered on the previous sample day by responding on a Modified Progressive Ratio Task. The "sensation-seeking" dimension was positively associated with drug taking on the Modified Progressive Ratio Task, subjective effects (e.g., "good effect"), and heart rate. However, no clear relationship between the "impulsivity" dimension and outcome measures was observed. In conclusion, these data suggest that the narrow sensation-seeking dimension of impulsive sensation-seeking is associated with initial drug liking and drug taking behavior and may be a key predictor of drug use initiation. (PsycINFO Database Record

Based on previous observational studies that have suggested self-regulated caffeine use by older adults may enhance reaction time performance and vigilance on cognitive tasks, the current study sought to examine whether this effect held true for young adults as well.One hundred and four young adults from two major metropolitan areas, ages 18-29 years, not meeting the criteria for a current psychiatric disorder, completed several cognitive tasks related to decision-making (Cambridge Gamble Task), response inhibition and reaction time (stop-signal task), and vigilance and reaction time (Rapid Visual Information Processing). Caffeine usage was self-reported using a reliable quantity and frequency questionnaire.Self-reported caffeine usage was not significantly associated with any of the cognitive measures used in this study after controlling for age, gender, cigarette smoking, alcohol use, cannabis use, and gambling frequency.These data suggest that self-regulated caffeine usage may not have a significant impact on reaction time, vigilance, response inhibition, or decision-making in young adults, or that these effects are contingent upon other variables not accounted for in the current study.

Objective: Trichotillomania (TTM), or compulsive hair pulling, is a common psychiatric disorder characterized by psychosocial impairment and reduced quality of life. The aim of this retrospective study was to characterize the impact of age at TTM onset on clinical variables and neuropsychological function using a variety of clinical and neurocognitive measures. Method: The study sample included 98 adult treatment-seeking individuals with a DSM-IV diagnosis of TTM. Correlates were explored by grouping participants into childhood-onset (onset at ≤ 11 years old, n = 42) or later-onset (≥ 12 years old, n = 56) TTM and via linear regression. All subjects underwent a semistructured clinical interview with a psychiatrist and completed a variety of paper-pencil tests regarding TTM severity and quality of life. A subset (n = 44) of subjects underwent neurocognitive testing assessing motor inhibition and set-shifting compared to a sample (n = 27) of age- and gender-matched healthy controls. Data were collected from September 2006 through July 2011. Results: Postpubertal age at onset was significantly associated with greater TTM symptom severity. Clinically, the later-onset group pulled their hair for a significantly greater amount of time daily (P = .008), had higher clinician-rated TTM severity on the Clinical Global Impressions–Severity of Illness scale (P = .042), and had higher patient-rated severity on the Massachusetts General Hospital Hairpulling Scale (P = .022) compared to healthy controls. On the neurocognitive tasks, later-onset TTM was characterized by stop-signal impairments (P = .020) and relatively spared set-shifting, consistent with previous studies in the literature. In contrast, the childhood-onset manifestation was associated with set-shifting deficits in stages of the task completed and total errors adjusted (both P < .001) but relatively spared stop-signal performance compared to healthy controls. Conclusion: Results indicate that childhood-onset of TTM is common, as confirmed by the fact that 42.9% of our sample met childhood-onset criteria, and may differ neurobiologically from the prototypical later-onset form. Future neurobiological and treatment studies should measure age at onset and explore further these putative differences. Trial Registration ClinicalTrials.gov identifiers: {"type":"clinical-trial","attrs":{"text":"NCT00354770","term_id":"NCT00354770"}}NCT00354770 and {"type":"clinical-trial","attrs":{"text":"NCT00775229","term_id":"NCT00775229"}}NCT00775229

OF THESIS EFFECTS OF REPEATED CUE EXPOSURE ON CANNBIS CRAVING Craving is a key element of the cannabis withdrawal syndrome that has been associated with continued use and relapse. Although cue-induced cannabis craving has been established in single laboratory sessions, procedures to sustain craving over multiple sessions are needed. The purpose of the present study was to determine if cue-induced craving responses could be elicited in the same subjects across multiple sessions. It was hypothesized that exposure to cannabis cues would produce more robust craving responses than exposure to neutral cues and that elicited craving responses will be sustained across multiple cue exposures. Five experimental cue exposure sessions (1 neutral and 4 cannabis) were conducted. Craving was assessed with the Marijuana Craving Questionnaire (MCQ) Short Form, Visual Analog Scale (VAS), Subject-Rated Physiological Questionnaire, blood pressure, and heart rate. Results revealed significant effects of initial cannabis cue exposure on VAS craving responses and Subject-Rated Physiological measures relative to the neutral cue exposure condition. No significant differences were found on MCQ composite scores or physiological measures. Craving responses following initial cannabis cue exposure were not maintained across sessions. There is a need for a better understanding of the factors that contribute to continued drug use despite quit attempts.

Odds ratios were not significantly different by gender, age, or education years. Frequency of use was low, with a mean of 5.4 times/year. Conclusions: A clinically significant proportion of treatment seeking substance users reported infrequent synthetic cannbinoid use. Less than full-time employment and Black race may be risk factors for use; marijuana smoking did not appear to increase risk. Asking about use can identify patients who may benefit from continued monitoring, however more extensive toxicology screening is not supported. Financial Support: Supported by: National Institutes on Drug Abuse (DA009236), National Institutes on Drug Abuse (T32DA007294-19).

being significant (p=0.015). Patients reporting substance use were also less likely to be consistent condom users. Conclusions: This study suggests that adolescents self-referring to an adolescent health clinic are likely to engage in multiple risk behaviors and involvement in sexual risky behavior is related to substance use. Therefore, there is a significant need for medical providers to screen adolescents for both sexual risk behaviors and substance use, which provides an opportunity for comprehensive care. Financial support: NIDA R34DA031806.