An examination of spirituality, self efficacy, and smoking cessation among adults in Houston, Texas

Over the past decade there has been a growing interest in the association between spirituality and health outcomes. Little is known about the role of spirituality among adult smokers who are motivated to stop smoking. The purpose of this dissertation is to examine the relations among immutable individual differences, spirituality, and self efficacy among adults motivated to stop smoking. The first paper of this dissertation systematically reviewed literature to measure the concordance between spirituality and smoking status among adults in the United States. The second paper of this dissertation explored the association between spirituality and smoking cessation. We hypothesized that higher levels of spirituality were positively associated with smoking cessation. The third paper of this dissertation examined the association between perceived self efficacy and spirituality. We hypothesized that both high levels of self efficacy and spirituality were positively associated with smoking cessation.^ A total of 152 citations were identified based on the preliminary search of databases and reference lists. After a preliminary title- and abstract-based review, 17 full text articles were retrieved for further assessment. Of these, eight met the criteria for inclusion. Results of the systematic review suggest that there is inconsistent evidence to support or refute an association between spirituality and smoking status among adults.^ Smokers (N = 200) at least 18 years of age enrolled in a minimal contact smoking cessation intervention in Houston, Texas completed questionnaires. To examine our hypotheses we conducted cross-sectional analyses of responses to questions included in selected baseline questions and the final in-person visit three weeks post-quit day. Results of the logistic regression analyses indicated that individuals with higher levels of spirituality and self efficacy were significantly more likely to abstain from smoking. The positive association is also evident when controlling for employment, income, race, education, and nicotine dependence. The interaction between self efficacy and spirituality was not statistically significant in predicting smoking abstinence.^ Recommendations for future research and implications for smoking cessation interventions are discussed. Further research in this area would benefit from using standard measures of abstinence, recruiting larger and more diverse populations, and using longitudinal study designs.^

Behavioral decision making and the levels of change: An application of the transtheoretical model to prenatal smoking in low -income women

Despite continued research and public health efforts to reduce smoking during pregnancy, prenatal cessation rates in the United States have decreased and the incidence of low birth weight has increased from 1985 to 1991. Lower socioeconomic status women who are at increased risk for poor pregnancy outcomes may be resistant to current intervention efforts during pregnancy. The purpose of this dissertation was to investigate the determinants of continued smoking and quitting among low-income pregnant women.^ Using data from cross-sectional surveys of 323 low-income pregnant smokers, the first study developed and tested measures of the pros and cons of smoking during pregnancy. The original decisional balance measure for smoking was compared with a new measure that added items thought to be more salient to the target population. Confirmatory factor analysis using structural equation modeling showed neither the original nor new measure fit the data adequately. Using behavioral science theory, content from interviews with the population, and statistical evidence, two 7-item scales representing the pros and cons were developed from a portion (n = 215) of the sample and successfully cross-validated on the remainder of the sample (n = 108). Logistic regression found only pros were significantly associated with continued smoking. In a discriminant function analysis, stage of change was significantly associated with pros and cons of smoking.^ The second study examined the structural relationships between psychosocial constructs representing some of the levels of and the pros and cons of smoking. The cross-sectional design mandates that statements made regarding prediction do not prove causation or directionality from the data or methods analysis. Structural equation modeling found the following: more stressors and family criticism were significantly more predictive of negative affect than social support; a bi-directional relationship was found between negative affect and current nicotine addiction; and negative affect, addiction, stressors, and family criticism were significant predictors of pros of smoking.^ The findings imply reversing the trend of decreasing smoking cessation during pregnancy may require supplementing current interventions for this population of pregnant smokers with programs addressing nicotine addiction, negative affect, and other psychosocial factors such as family functioning and stressors. ^

Evaluación de conductas adictivas en personal médico y no médico en un hospital de agudos : estudio comparativo

Objetivo: Identificar abuso, dependencia, adicciones (tabaquismo, problemas con alcohol y alimentación) y automedicación en el personal de la salud de un Hospital de agudos.- Material y Métodos: Estudio protocolizado y observacional mediante. encuesta estructurada, autoadministrada y anónima. Se realizó el análisis en 4 grupos: Médicos (M) (MS: Staff y MF: en formación), NO M: enfermeros (E) y otros (O: administración, laboratorio, farmacia, servicios generales). Se realizó un estudio comparativo con una población encuestada en el año 2004. Resultados: Se incluyeron 373 personas: 195 M (73 MS y 122 MF), 83 E y 92 O; 225 mujeres (60,3%); edad promedio grupal: 36.1 años (DS± 9.98). El 77.5% con pareja estable, el 98.1% heterosexuales y 67,3% universitarios. El 67.3% se automedicaba, el 35.1% eran tabaquistas activos; el 28.4% presentaba problemas con el alcohol y el 36.2% con la alimentación. El tabaquismo fue más frecuente entre 40-50 años (42,5%) y en E: 56.6%; MS: 21,9%; MF: 27% y O: 36.9%(p<0.05). Se incrementó la intención de abandonar el cigarrillo comparado con el año 2004 (74.6 vs 56.3%)(p<0.05). Los problemas con el alcohol fueron frecuentes entre 20 y 30 años (47.2%), en personas con pareja inestable (73.6%), sin diferencias entre los grupos y en 51.8% coexistía con tabaquismo. Los problemas de alimentación ocurrieron significativamente en MF (46,9%) comparados con MS (22.5%) (p<0.05). Se detectó automedicación en el 68.3 del Grupo O y en 48.1% del Grupo M (p<0.05). Al comparar la automedicación en las encuestas del año 2004 y 2007, se comprobó una reducción en E (87.8 vs 52.4%) y en O (77.5 vs 48.1%)(p<0.05).- Conclusiones: Se detectó elevada prevalencia de tabaquismo, problemas con el alcohol, alimentación y automedicación en todo el personal hospitalario. El tabaquismo predominó en enfermeros, los trastornos alimentarios en médicos en formación y el alcoholismo en solteros con pareja inestable.

Activation of nicotinic receptor-induced postsynaptic responses to luteinizing hormone-releasing hormone in bullfrog sympathetic ganglia via a Na+-dependent mechanism

Nicotine at very low doses (5–30 nM) induced large amounts of luteinizing hormone-releasing hormone (LHRH) release, which was monitored as slow membrane depolarizations in the ganglionic neurons of bullfrog sympathetic ganglia. A nicotinic antagonist, d-tubocurarine chloride, completely and reversibly blocked the nicotine-induced LHRH release, but it did not block the nerve-firing-evoked LHRH release. Thus, nicotine activated nicotinic acetylcholine receptors and produced LHRH release via a mechanism that is different from the mechanism for evoked release. Moreover, this release was not caused by Ca2+ influx through either the nicotinic receptors or the voltage-gated Ca2+ channels because the release was increased moderately when the extracellular solution was changed into a Ca2+-free solution that also contained Mg2+ (4 mM) and Cd2+ (200 μM). The release did not depend on Ca2+ release from the intraterminal Ca2+ stores either because fura-2 fluorimetry showed extremely low Ca2+ elevation (≈30 nM) in response to nicotine (30 nM). Moreover, nicotine evoked LHRH release when [Ca2+] elevation in the terminals was prevented by loading the terminals with 1,2-bis(2-aminophenoxy)ethane-N,N,N′,N′-tetraacetic acid and fura-2. Instead, the nicotine-induced release required extracellular Na+ because substitution of extracellular NaCl with N-methyl-d-glucamine chloride completely blocked the release. The Na+-dependent mechanism was not via Na+ influx through the voltage-gated Na+ channels because the release was not affected by tetrodotoxin (1–50 μM) plus Cd2+ (200 μM). Thus, nicotine at very low concentrations induced LHRH release via a Na+-dependent, Ca2+-independent mechanism.

Response-reinforcement learning is dependent on N-methyl-d-aspartate receptor activation in the nucleus accumbens core

The nucleus accumbens, a site within the ventral striatum, is best known for its prominent role in mediating the reinforcing effects of drugs of abuse such as cocaine, alcohol, and nicotine. Indeed, it is generally believed that this structure subserves motivated behaviors, such as feeding, drinking, sexual behavior, and exploratory locomotion, which are elicited by natural rewards or incentive stimuli. A basic rule of positive reinforcement is that motor responses will increase in magnitude and vigor if followed by a rewarding event. It is likely, therefore, that the nucleus accumbens may serve as a substrate for reinforcement learning. However, there is surprisingly little information concerning the neural mechanisms by which appetitive responses are learned. In the present study, we report that treatment of the nucleus accumbens core with the selective competitive N-methyl-d-aspartate (NMDA) antagonist 2-amino-5-phosphonopentanoic acid (AP-5; 5 nmol/0.5 μl bilaterally) impairs response-reinforcement learning in the acquisition of a simple lever-press task to obtain food. Once the rats learned the task, AP-5 had no effect, demonstrating the requirement of NMDA receptor-dependent plasticity in the early stages of learning. Infusion of AP-5 into the accumbens shell produced a much smaller impairment of learning. Additional experiments showed that AP-5 core-treated rats had normal feeding and locomotor responses and were capable of acquiring stimulus-reward associations. We hypothesize that stimulation of NMDA receptors within the accumbens core is a key process through which motor responses become established in response to reinforcing stimuli. Further, this mechanism, may also play a critical role in the motivational and addictive properties of drugs of abuse.

Muscarinic stimulation of synaptic activity by protein kinase C is inhibited by adenosine in cultured hippocampal neurons

We have studied the effect of the cholinergic agonist carbachol on the spontaneous release of glutamate in cultured rat hippocampal cells. Spontaneous excitatory postsynaptic currents (sEPSCs) through glutamatergic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-type channels were recorded by means of the patch-clamp technique. Carbachol increased the frequency of sEPSCs in a concentration-dependent manner. The kinetic properties of the sEPSCs and the amplitude distribution histograms were not affected by carbachol, arguing for a presynaptic site of action. This was confirmed by measuring the turnover of the synaptic vesicular pool by means of the fluorescent dye FM 1–43. The carbachol-induced increase in sEPSC frequency was not mimicked by nicotine, but could be blocked by atropine or by pirenzepine, a muscarinic cholinergic receptor subtype M1 antagonist. Intracellular Ca2+ signals recorded with the fluorescent probe Fluo-3 indicated that carbachol transiently increased intracellular Ca2+ concentration. Since, however, carbachol still enhanced the sEPSC frequency in bis(2-aminophenoxy)ethane-N,N,N′,N′-tetra-acetate-loaded cells, this effect could not be attributed to the rise in intracellular Ca2+ concentration. On the other hand, the protein kinase inhibitor staurosporine as well as a down-regulation of protein kinase C by prolonged treatment of the cells with 4β-phorbol 12-myristate 13-acetate inhibited the carbachol effect. This argues for an involvement of protein kinase C in presynaptic regulation of spontaneous glutamate release. Adenosine, which inhibits synaptic transmission, suppressed the carbachol-induced stimulation of sEPSCs by a G protein-dependent mechanism activated by presynaptic A1-receptors.

Point mutant mice with hypersensitive α4 nicotinic receptors show dopaminergic deficits and increased anxiety

Knock-in mice were generated that harbored a leucine-to-serine mutation in the α4 nicotinic receptor near the gate in the channel pore. Mice with intact expression of this hypersensitive receptor display dominant neonatal lethality. These mice have a severe deficit of dopaminergic neurons in the substantia nigra, possibly because the hypersensitive receptors are continuously activated by normal extracellular choline concentrations. A strain that retains the neo selection cassette in an intron has reduced expression of the hypersensitive receptor and is viable and fertile. The viable mice display increased anxiety, poor motor learning, excessive ambulation that is eliminated by very low levels of nicotine, and a reduction of nigrostriatal dopaminergic function upon aging. These knock-in mice provide useful insights into the pathophysiology of sustained nicotinic receptor activation and may provide a model for Parkinson's disease.

Tonic nicotinic modulation of serotoninergic transmission in the spinal cord

The spinal serotoninergic projection from the raphe magnus has been shown to modulate nociceptive inputs, and activation of this projection mediates nicotine-elicited analgesia. Here, we investigate the interactions between cholinergic and serotoninergic systems in the spinal cord, by conducting serotonin [5-hydroxytryptamine (5-HT)] efflux experiments on mouse spinal slices. At least three spinal populations of nicotinic receptors are distinguished that affect 5-HT release. The first could be directly located on serotoninergic terminals, is insensitive to nanomolar concentrations of methyllicaconitine (MLA), and may be subjected to a basal (not maximal) cholinergic tone. The second is tonically and maximally activated by endogenous acetylcholine, insensitive to nanomolar concentrations of MLA, and present on inhibitory neurons. The last is also present on inhibitory neurons but is sensitive to nanomolar concentrations of MLA and not tonically activated by acetylcholine. Multiple nicotinic acetylcholine receptor populations thus differentially exert tonic or not tonic control on 5-HT transmission in the spinal cord. These receptors may be major targets for nicotine effects on antinociception. In addition, the presence of a tonic nicotinic modulation of 5-HT release indicates that endogenous acetylcholine plays a role in the physiological regulation of descending 5-HT pathways to the spinal cord.

Cholinergic agonists stimulate secretion of soluble full-length amyloid precursor protein in neuroendocrine cells.

The Abeta peptide of Alzheimer disease is derived from the proteolytic processing of the amyloid precursor proteins (APP), which are considered type I transmembrane glycoproteins. Recently, however, soluble forms of full-length APP were also detected in several systems including chromaffin granules. In this report we used antisera specific for the cytoplasmic sequence of APP to show that primary bovine chromaffin cells secrete a soluble APP, termed solAPPcyt, of an apparent molecular mass of 130 kDa. This APP was oversecreted from Chinese hamster ovary cells transfected with a full-length APP cDNA indicating that solAPPcyt contained both the transmembrane and Abeta sequence. Deglycosylation of solAPPcyt showed that it contained both N- and O-linked sugars, suggesting that this APP was transported through the endoplasmic reticulum-Golgi pathway. Secretion of solAPPcyt from primary chromatin cells was temperature-, time-, and energy-dependent and was stimulated by cell depolarization in a Ca2+-dependent manner. Cholinergic receptor agonists, including acetylcholine, nicotine, or carbachol, stimulated the rapid secretion of solAPPcyt, a process that was inhibited by cholinergic antagonists. Stimulation of solAPPcyt secretion was paralleled by a stimulation of secretion in catecholamines and chromogranin A, indicating that secretion of solAPPcyt was mediated by chromaffin granule vesicles. Taken together, our results show that release of the potentially amyloidogenic solAPPcyt is an active cellular process mediated by both the constitutive and regulated pathways. solAPPcyt was also detected in human cerebrospinal fluid. Combined with the neuronal physiology of chromaffin cells, our data suggest that cholinergic agonists may stimulate the release of this APP in neuronal synapses where it may exert its biological functions. Moreover, vesicular or secreted solAPPcyt may serve as a soluble precursor of Abeta.

Avaliação do efeito de polimorfismos genéticos com a dependência à nicotina

Introdução: A identificação de variantes genéticas que predispõem a maior susceptibilidade à dependência à nicotina pode ser importante para a prevenção e o tratamento do tabagismo. No contexto de medicina personalizada, os principais objetivos do presente estudo foram avaliar se polimorfismos nos genes CHRNA2, CHRNA3, CHRNA5 e CHRNB3 estão associados com o nível de dependência em indivíduos fumantes e com o resultado do tratamento antitabágico. Métodos: Estudo de coorte com 1049 pacientes fumantes que receberam tratamento farmacológico (vareniclina, vareniclina e bupropiona, bupropiona e/ou terapia de reposição nicotínica). O sucesso na cessação tabágica foi considerado para os pacientes que completaram 6 meses de abstinência contínua. O teste de Fagerström para a dependência à nicotina (FTND) e o escore de consumo situacional Issa foram utilizados para avaliar a dependência à nicotina. A escala de conforto PAF foi utilizada para avaliar o conforto do paciente durante o tratamento. Os polimorfismos CHRNA2 rs2472553, CHRNA3 rs1051730, CHRNA5 rs16969968, CHRNA5 rs2036527 e CHRNB3 rs6474413 foram genotipados pela análise da curva de melting. Resultados: As mulheres portadoras dos genótipos GA e AA para os polimorfismos CHRNA5 rs16969968 e rs2036527 obtiveram maior taxa de sucesso no tratamento antitabagismo: 44,0% e 56,3% (rs16969968), 41,5% e 56,5% (rs2036527), respectivamente; em comparação com as mulheres portadoras do genótipo GG: 35,7% (rs16969968) e 34,8% (rs2036527), (P=0,03; n=389; P=0,01; n=391). Os genótipos GA ou AA para os rs16969968 e rs2036527 foram associados com maior OR para o sucesso em mulheres (OR=1,63; IC 95%=1,04-2,54; P=0,03 e OR=1,59; IC 95%=1,02-2,48; P=0,04; respectivamente), em um modelo multivariado. Não foi encontrada associação dos polimorfismos no gene CHRNA5 com o escore de FTND. Para os polimorfismos CHRNA2 rs2472553, CHRNA3 rs1051730 e CHRNB3 rs6474413 não foram encontradas associações significativas com os fenótipos estudados. Conclusão: Os polimorfismos rs16969968 e rs2036527 no gene CHRNA5 foram associados com maior taxa de sucesso no tratamento antitabagismo em mulheres. Estes resultados podem contribuir com avanços na terapêutica baseada em medicina personalizada

Esquemas cognitivos, sintomas de ansiedade e depressão em mulheres de um Programa de Cessação de Tabagismo

O tabagismo é um problema de saúde pública em todo o mundo. Entre as mulheres, devido ao aumento da prevalência comparada aos homens, o tabagismo feminino tem merecido atenção. Para o enfrentamento, é necessário entender o fenômeno e criar estratégias mais adequadas que incluam aspectos emocionais e sociais da dependência do tabagismo. Este estudo buscou descrever os esquemas cognitivos, sintomas de ansiedade e depressão de 112 mulheres que procuraram tratamento para cessação do tabagismo e sua relação com o insucesso do tratamento. A coleta de dados incluiu roteiro de entrevista estruturada e escalas validadas para a população brasileira que têm o objetivo de avaliar os esquemas cognitivos, sintomas de ansiedade e de depressão, e aspectos da dependência do cigarro. O conhecimento de fatores emocionais envolvidos no tabagismo e sua cessação podem ser úteis às ações de apoio à mudança comportamental do fumante. Objetivo: Descrever o perfil psicológico de mulheres que buscam cessação do tabagismo quanto aos esquemas cognitivos, sintomas de ansiedade e depressão antes e depois do tratamento com Terapia Cognitivo- Comportamental em grupo, e analisar fatores que contribuem para o desfecho de cessação. O desenho do estudo foi longitudinal e transversal. Para avaliar os esquemas cognitivos, o Questionário de Esquemas de Young em sua forma curta foi utilizado. Os grupos de terapia cognitivo-comportamental foram realizados concomitantes ao cuidado usual por médicos do estudo. Esses profissionais foram treinados no protocolo do estudo e o seguimento foi realizado por telefone por um membro do estudo independente e cego. Resultados: Os resultados forneceram evidências de que esquemas cognitivos tiveram relação significativa com os sintomas de depressão e ansiedade, com a adesão e os resultados do tratamento (cessação do tabagismo)

Reduction of tobacco smoke components yield in commercial cigarette brands by addition of HUSY, NaY and Al-MCM-41 to the cigarette rod

The effect of two zeolites, HUSY, NaY and a mesoporous synthesized Al-MCM-41 material on the smoke composition of ten commercial cigarettes brands has been studied. Cigarettes were prepared by mixing the tobacco with the three powdered materials, and the smoke obtained under the ISO conditions was analyzed. Up to 32 compounds were identified and quantified in the gas fraction and 80 in the total particulate matter (TPM) condensed in the cigarettes filters and in the traps located after the mouth end of the cigarettes. Al-MCM-41 is by far the best additive, providing the highest reductions of the yield for most compounds and brands analyzed. A positive correlation was observed among the TPM and nicotine yields with the reduction obtained in nicotine, CO, and most compounds with the three additives. The amount of ashes in additive free basis increases due to the coke deposited on the solids, especially with Al-MCM-41. Nicotine is reduced with Al-MCM-41 by an average of 34.4% for the brands studied (49.5% for the brand where the major reduction was obtained and 18.5 for the brand behaving the worst). CO is reduced by an average of 18.6% (ranging from 10.3 to 35.2% in the different brands).

Comparison between the mainstream smoke of eleven RYO tobacco brands and the reference tobacco 3R4F

In this study 11 commercial roll-your-own (RYO) tobacco brands sold in Spain and the reference tobacco 3R4F have been smoked and several components of the mainstream tobacco smoke have been analyzed. Cigarettes were prepared using commercial tubes, and were smoked under smoking conditions based on the ISO 3308. The gaseous and condensed fractions of the smoke from RYO brands and 3R4F have been analyzed and compared. RYO tobaccos, as opposed to 3R4F, present lower amounts of condensed products in the traps than in the filters. In general, RYO tobaccos also provide lower yields of most of the compounds detected in the gas fraction. The yield of CO is between 15.4 and 20.4 mg/cigarette. In most of the cases studied, RYO tobaccos deliver higher amounts of nicotine than the 3R4F tobacco. On average, the yield of the different chemical families of compounds appearing in the particulate matter retained in the cigarette filters tends to be around three times higher than those obtained from 3R4F, whereas similar values have been obtained in the particulate matter retained in the traps located after the filters. It can be concluded that RYO tobaccos are not less hazardous than the reference tobacco, which may be contrary to popular belief.

Cessação tabágica em adolescentes : situação em Portugal e revisão da evidência

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Crenças e atitudes dos adolescentes associadas ao uso de substâncias psicoativas: álcool, tabaco e outras substâncias psicoativas ilegais

A adolescência é usualmente marcada por mudanças ao nível do corpo, do pensamento, das atitudes e da vida social que tornam os jovens mais vulneráveis a desenvolver comportamentos irracionais e impulsivos como o consumo de substâncias psicoativas. Neste sentido, o principal objetivo deste estudo é compreender as crenças e atitudes que motivam os jovens adolescentes a usar substâncias como álcool, tabaco e outras substâncias psicoativas. Para tal, foi escolhida uma amostra por conveniência entre os estudantes de três escolas pertencentes ao Instituto Politécnico de Portalegre, nomeadamente a Escola Superior de Educação de Portalegre, a Escola Superior de Tecnologia e Gestão de Portalegre e a Escola Superior de Saúde de Portalegre. A amostra é constituída por 193 estudantes, sendo que a idade dos participantes oscila entre os 18 anos e os 25 anos. Deste modo, foi aplicado o questionário HIT-D&A que permite medir as crenças e atitudes dos jovens, associadas ao uso de substâncias psicoativas como o álcool, o tabaco e outras substâncias psicoativas ilegais. Os resultados evidenciaram que as principais substâncias psicoativas consumidas pelos jovens são o álcool, seguindo-se o tabaco e a marijuana. Outra conclusão é a existência de diferenças significativas entre os dois géneros, sendo que os rapazes apresentam uma média superior face às raparigas de forma estatisticamente significativa. Embora não haja diferenças estatisticamente significativas entre faixas etárias, conclui-se que há mais consumos de substâncias psicoativas entre os jovens mais velhos. No que respeita às médias das três escolas analisadas, estas são superiores na Escola Superior de Tecnologia e Gestão de Portalegre. Os resultados também mostraram a existência de uma forte associação entre as três distorções cognitivas (centração no eu, culpar os outros e assumir o piro e minimizar e etiquetar) e os consumos das várias substâncias psicoativas.