Gender differences in tobacco withdrawal are of considerable clinical importance, but research findings on this topic have been mixed. Methodological variation in samples sizes, experimental design, and measures across studies may explain the inconsistent results. The current study examined whether male (n = 101) and female (n = 102) smokers (≥15 cigarettes/day) differed in abstinenceinduced changes on a battery of self-report measures (withdrawal, affect, craving), cognitive performance tasks (attention, psychomotor performance), and physiological responses (heart rate, blood pressure, brain electroencephalogram). Participants attended 2 counterbalanced laboratory sessions, 1 following 12 hr of abstinence and the other following ad libitum smoking. Results showed that women reported greater abstinence-induced increases in negative affect, withdrawal-related distress, and urge to smoke to relieve withdrawal distress. In contrast, both genders reported similar abstinence-induced changes in positive affect and urge to smoke for pleasure. Men and women exhibited generally similar abstinence-induced changes in physiological and cognitive performance measures. In addition, gender did not moderate the association between withdrawal symptoms and baseline measures of smoking behavior and dependence. Abstinence-induced changes in withdrawal distress mediated the effect of gender on latency until the 1st cigarette of the day at trend levels (p < .10). These findings suggest that there are qualitative gender differences in the acute tobacco withdrawal syndrome that may underlie gender-specific smoking patterns. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResearch suggests that women are less likely than men to successfully quit smoking. Recent meta-analyses of smoking cessation trials showed lower abstinence rates for women than men, regardless of whether individuals received group or individual counseling (Wetter, Kenford, et al., 1999), nicotine replacement therapy (Cepeda-Benito, Reynoso, & Erath, 2004;Wetter, Kenford, et al., 1999) or placebo nicotine patch (Wetter, Kenford, et al., 1999), or bupropion sustained release or placebo (Collins et al., 2004;Scharf & Shiffman, 2004). Although there is debate over whether women's quit rates are lower than men's at the population level (Gritz, Nielsen, & Brooks, 1996) or whether differences are large enough to be clinically significant (Killen, Fortmann, Varady, & Kraemer, 2002), it is important to identify gender-specific processes underlying tobacco addiction so that interventions can be tailored to gender.In recent years, researchers have investigated several variables that might differentially impact smoking behavior in men and women. These include attitudes toward cessation (Etter, Prokhorov, & Perneger, 2002), concerns about weight gain (Borrelli, Spring, Niaura, Hitsman, & Papandonatos, 2001), depressive and anxious symptomatology (Borrelli, Bock, King, & Pinto, 1996), nicotine reinforcement (Perkins, Donny, & Caggiula, 1999), mens...

Objective-To examine the eVects of four brands of commercially available moist snuV and non-tobacco mint "snuV" on plasma nicotine concentration, heart rate, blood pressure, and subjective measures. Intervention-Four brands of moist snuV and a non-tobacco mint snuV were tested. Subjects reported to the laboratory for five experimental sessions. After baseline measurement of dependent variables, each subject placed 2 g of one of the brands of snuV (or one Skoal Bandits pouch) between the cheek and gum for 30 minutes. The subjects remained in the experimental laboratory for an additional 60 minutes. Subjects-Ten volunteers who were daily users of smokeless tobacco. Main outcome measures-Plasma nicotine concentration, cardiovascular eVects, and subjective eVects. Results-Large amounts of nicotine were delivered rapidly to the bloodstream. The amount of nicotine absorbed and the rate of absorption were related to the pH of the snuV product in aqueous suspension. Cardiovascular and subjective eVects were related to the amount of nicotine absorbed. Conclusions-SnuV products are capable of rapidly delivering high doses of nicotine, which can lead to dependence. Long-term use of snuV can lead to a number of adverse health eVects including oral cancers, cardiovascular diseases, and gingival diseases. For these reasons, it is important that the public health community considers oral snuV use as a burden on public health in the same way that cigarette smoking is recognised. (Tobacco Control 1999;8:387-392)

ABSTRACT. Objectives. To determine the safety and efficacy of the nicotine patch and gum for adolescents who want to quit smoking.Design. Double-blind, double-dummy, randomized, 3-arm trial with a nicotine patch (21 mg), nicotine gum (2 and 4 mg), or a placebo patch and gum; all participants received cognitive-behavioral group therapy.Setting. Inner-city, outpatient clinic on the East Coast. Subjects. Thirteen-to 17-year-old adolescents who smoked >10 cigarettes per day (CPD), scored >5 on the Fagerströ m Test of Nicotine Dependence, and were motivated to quit smoking.Intervention. Twelve weeks of nicotine patch or gum therapy with cognitive-behavioral therapy, with a follow-up visit at 6 months (3 months after the end of treatment).Main Outcome Measures. Safety assessed on the basis of adverse event reports for all 3 groups, prolonged abstinence, assessed through self-report and verified with exhaled carbon monoxide (CO) levels of <6 ppm, in intent-to-treat analyses, and smoking reduction (CPD and thiocyanate concentrations) among trial completers.Results. A total of 120 participants were randomized (72% white, 70% female; age: 15.2 ؎ 1.33 years; smoking: 18.8 ؎ 8.56 CPD; Fagerströ m Test of Nicotine Dependence score: 7.04 ؎ 1.29) from 1999 to 2003. Participants started smoking at 11.2 ؎ 1.98 years of age and had been smoking daily for 2.66 ؎ 1.56 years; 75% had at least 1 current psychiatric diagnosis. Mean compliance across groups was higher for the patch (mean: 78.4 -82.8%) than for the gum (mean: 38.5-50.7%). Both the patch and gum were well tolerated, and adverse events were similar to those reported in adult trials. Changes in mean saliva cotinine concentrations throughout treatment were not statistically significant. Intent-to-treat analyses of all randomized participants showed CO-confirmed prolonged abstinence rates of 18% for the active-patch group, 6.5% for the active-gum group, and 2.5% for the placebo group; the difference between the active-patch and placebo arms was statistically significant. There was no significant effect of patch versus gum or gum versus placebo on cessation outcomes. Abstinence rates at the 3-month follow-up assessment were sustained but were not significantly associated with treatment group. Mean smoking rates, but not CO or thiocyanate concentrations, decreased significantly in all 3 arms but not as a function of treatment group.Conclusions. Nicotine patch therapy combined with cognitive-behavioral intervention was effective, compared with placebo, for treatment of tobacco dependence among adolescent smokers. Decreases in the numbers of cigarettes smoked appeared to be offset by compensatory smoking. Additional study of nicotine gum, with enhanced instructional support, is needed to assess its efficacy among adolescent smokers. Pediatrics 2005; 115:e407-e414. URL: www.pediatrics.org/cgi/doi/10.1542/ peds.2004-1894; treatment, adolescent, tobacco, nicotine patch, nicotine gum, cessation, smoking reduction.ABBREVIATIONS. CPD, cigarettes per day; NRT, nicotine replacement ther...

Assessment of substance, school, and delinquency factors is important in identifying individuals at high risk for continued involvement with marijuana. Prevention and/or intervention efforts should focus on these areas of risk.

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