Impulsivity, Risk Taking, Stress and Nicotine Abstinence in Young Adult Smokers

描述（由申请人提供）：虽然年轻成人吸烟率在过去十年中有所下降，但仍有相当一部分年轻成人继续吸烟。在30岁之前戒烟似乎可以显著降低与吸烟相关的早期死亡率，而在年轻时继续吸烟则与癌症风险增加、肺功能较差和神经认知缺陷有关。针对这一人群的戒烟计划通常产生较低的持续戒烟率，这表明需要改进治疗方法，以改善戒烟障碍，如冲动和冒险。研究结果表明，冲动型吸烟者在实现持久戒烟方面遇到了更大的困难，这可能是因为他们在停止吸烟后似乎经历了更高水平的渴望。此外，在参加研究试验的青少年中，压力引起的戒烟前风险增加与持续戒烟率较低有关[（Schepis等人，出版中）]。压力暴露也可能介导冲动性和戒烟效果较差之间的关系，因为有证据表明压力暴露会增加冲动性。因此，本申请将评估尼古丁戒断和非戒断的年轻成年烟草吸烟者在参与个性化图像应激源之前和之后的冲动性、冒险、尼古丁渴望和戒断之间的关系（Sinha等人，1999年）。[参与者还将完成6天复发模拟范例，提供临床和生态学相关终点。本申请的具体目的是：（1）评价尼古丁戒断对年轻成年吸烟者的冲动反应、冒险行为、尼古丁渴望和尼古丁戒断症状中压力诱导变化的影响;（2）确定压力暴露后年轻成年吸烟者的[特质]冲动性和冒险行为对吸烟相关过程的影响;[和（3）评估在复发模拟范例中，反应抑制和风险承担的压力相关变化对维持禁欲能力的影响。]这一行为科学跟踪奖快速转变（PAR-09-239）的应用可以通过首次使用实验范式来调查尼古丁戒断和非戒断年轻成年吸烟者的冲动，冒险，尼古丁渴望和尼古丁戒断的压力相关变化，为烟草研究领域做出创新贡献。该提案与NIDA的既定使命具有很强的相关性，因为其重点是发现在研究不足和潜在弱势人群中持续使用烟草的潜在原因，即冲动和/或风险倾向的年轻成年吸烟者。这一应用的公共卫生效益可能是显著的，因为它可以改善这些群体的戒烟治疗，限制与吸烟相关的发病率和死亡率。 公共卫生相关性：年轻人吸烟是导致早逝的主要原因，也是一个重大的社会经济负担。许多年轻的成年吸烟者希望戒烟，但大多数人在实现持久戒烟方面遇到了明显的困难。因此，这项建议具有很大的公共卫生意义，因为它可能揭示更高水平的冲动和冒险行为如何阻止一些年轻人戒烟，从而为这些人提供更好的治疗。

DESCRIPTION (provided by applicant): While rates of young adult tobacco smoking have decreased in the past decade, a substantial minority of young adults continue to smoke. Achieving cessation before reaching 30 years of age appears to significantly reduce the early mortality associated with smoking, whereas continued smoking through young adulthood is associated with increased cancer risk, poorer pulmonary functioning and neurocognitive deficits. Cessation programs aimed at this population have generally produced low rates of sustained abstinence, signalling the need for improved treatments aimed at ameliorating impediments to abstinence, such as impulsivity and risk taking. Findings indicate that impulsive smokers have greater trouble achieving lasting cessation, perhaps through elevated levels of craving they appear to experience after ceasing tobacco use. Furthermore, stress-induced pre-cessation increases in risk taking were associated with lower rates of sustained cessation among adolescents taking part in a research trial [(Schepis et al., in press)]. Stress exposure may also mediate the relationship between impulsivity and poorer smoking cessation outcome, as evidence indicates that stress exposure increases impulsivity. Thus, this application will evaluate the relationships among impulsivity, risk taking, nicotine craving and withdrawal in nicotine abstinent and non-abstinent young adult tobacco smokers before and after participating in a personalized imagery stressor (Sinha et al., 1999). [Participants will also complete a 6-day relapse analogue paradigm, providing a clinically and ecologically relevant endpoint.] The specific aims of this application are to: (1) evaluate the influence of nicotine abstinence on stress-induced changes in impulsive responding, risk-taking, nicotine craving and nicotine withdrawal symptoms in young adult smokers; (2) identify the effects of [trait] impulsivity and risk taking on smoking-related processes among young adult smokers following stress exposure; [and (3) evaluate the effects of stress-related changes in response inhibition and risk taking on ability to maintain abstinence in a relapse analogue paradigm.] This Behavioral Science Track Award for Rapid Transition (PAR-09-239) application could make an innovative contribution to the tobacco research field through the first use of an experimental paradigm to investigate stress-related changes in impulsivity, risk taking, nicotine craving and nicotine withdrawal in nicotine abstinent and non-abstinent young adult smokers. This proposal has strong relevance for the stated mission of NIDA, given its emphasis on uncovering a potential cause of continued tobacco use in an understudied and potentially vulnerable population, young adult smokers who are impulsive and/or risk prone. The public health benefit of this application could be significant, as it could lead to improved cessation treatments in these groups, limiting the morbidity and mortality associated with tobacco smoking. PUBLIC HEALTH RELEVANCE: Young adult smoking is a major cause of early death and a significant socioeconomic burden. Many young adult smokers wish to quit, but most experience notable difficulty achieving lasting cessation. Thus, this proposal has great public health relevance, as it may uncover how higher levels of impulsivity and risk taking prevent some young adults from quitting smoking, leading to better treatments for these individuals.