Stress, Appetite, and Smoking Relapse

描述（由申请人提供）：越来越多的证据表明，对戒烟后体重增加的担忧增加了戒烟的意愿，戒烟后体重增加与吸烟复发有关。长期吸烟会引起许多神经生物学上的变化，而戒烟与食欲的变化有关。阐明与这些禁欲效应相关的生物行为机制对于识别体重增加的高危人群和计划适当的治疗突发事件至关重要。我们研究的长期目标是描述食欲调节和烟草成瘾的神经生物学机制之间的相互作用。该项目的具体目标是确定在吸烟期间和戒烟早期测量的食欲调节肽（即瘦素、胃饥饿素、GLP-1、神经肽Y和食欲素）水平在多大程度上预测戒烟期间食欲、饮食摄入、体重和复发的后续变化。我们还将研究戒断诱导的肾上腺皮质和心血管对压力的钝化反应在多大程度上预测食欲、饮食摄入、体重的变化，以及在戒烟尝试的前三个月复发的情况。这个应用程序是我们研究压力在吸烟复发中的作用的重点项目的延续，同时考虑到压力的影响不是在真空中起作用的，并且需要清楚地识别压力影响与其他动机和情绪状态的相互作用。我们已经完成了研究，确定了吸烟者和非吸烟者对个体和情境因素敏感的应激反应的特定心理生物学模式。我们最近完成了一系列研究，检查了短期戒烟后下丘脑-垂体-肾上腺皮质对压力的反应变化，并评估了这些变化在多大程度上预测了早期复发。综合工作和文献为指导拟方案的发展提供了相关的方向。

DESCRIPTION (provided by applicant): Converging evidence indicates that concern about weight gain after abstinence increases reluctance to attempt smoking cessation, and that post-cessation weight gain is associated with smoking relapse. Chronic smoking causes numerous neurobiological changes, and smoking abstinence is associated with changes in appetite. Elucidating biobehavioral mechanisms associated with these effects of abstinence is critical in identifying those at high risk for weight gain and for planning appropriate treatment contingencies. The long-term goal of our research is to delineate the interactions of neurobiological mechanisms responsible for appetite regulation and tobacco addiction. The specific goal of this project is to determine the extent to which levels of appetite-regulating peptides (i.e., leptin, ghrelin, GLP-1, neuropeptide Y, and orexin) measured during smoking and during the early phase of abstinence predict subsequent changes in appetite, dietary intake, weight, and relapse during smoking cessation. We will also examine the extent to which abstinence-induced blunted adrenocortical and cardiovascular responses to stress predict changes in appetite, dietary intake, weight, and relapse over the first three months of a cessation attempt. This application is a continuation of our focused program investigating the role of stress in smoking relapse while taking into account that the effects of stress do not operate in vacuum, and that there is a need to clearly identify interactions of stress effects with other motivational and mood states. We have completed studies identifying specific psychobiological patterns of the stress response sensitive to individual and situational factors in smokers and non-smokers. We recently completed a series of studies that examined changes in hypothalamic-pituitary- adrenocortical responses to stress following short-term smoking abstinence and evaluated the extent to which these changes predict early relapse. The composite work and literature have provided relevant directions to guide the development of the proposed program. PUBLIC HEALTH RELEVANCE: Tobacco addiction/dependence is the leading preventable cause of cancer and cardiovascular diseases. Evidence indicates that weight gain occurring after smoking abstinence increases reluctance to attempt smoking cessation, especially among women. There is also evidence that post-cessation weight gain is associated with smoking relapse. We plan to determine the extent to which changes in appetite-related peptides and stress response during early abstinence predict subsequent weight gain and smoking relapse. Gaining a better understanding of these factors will be essential in designing interventions to address weight gain and stress effects during cessation, and to subsequently reduce smoking relapse rates. Reducing smoking relapse will have a direct public health impact in reducing the burden of smoking-related diseases.