National

Institute on

Drug

Abuse 48

Measurement in the

Analysis and

Treatment of

Smoking Behavior

U S DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration
Measurement in the

Analysis and Treatment of

Smoking Behavior

Editors:

John Grabowski, Ph.D.

Catherine S. Bell, M.S.

Division of Clinical Research

National Institute on Drug Abuse

NIDA Research Monograph 48

1983

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse

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RockviIle, Maryland 20857

For Sale in the Superintendent of Documents U S Government Printing Office

Washington, DC 20402
NIDA Research Monographs ore prepared by the research divisions of the

National Institute on Drug Abuse and published by Its Office of Science The

primary objective of the series is to provide critical reviews of research

problem areas and techniques, the content of state-of-the-art conferences, integrative research reviews and significant original research Its

dual publication emphasis is rapid and targeted dissemination to the

scientific and professional community

Editorial Advisory Board

Avram Goldstein, MD.

Addiction Research Foundation

Palo Alto, California

Jerome Joffe, MD.

University of Connecticut School of Medicine

Formington, Connecticut

Reese T. Jones, M.D.

Langley Porter Neuropsychiatric Institute

University of California

San Francisco, California

Jack Mendelson, MD

Alcohol and Drug Abuse Research Center

Harvard Medical School

McLean Hospital

Belmont, Massachusetts

Helen Newlis, Ph.D.

Rochester, New York

Lee Robins, Ph.D

Washington University School of Medicine

St Louis, Missouri

NIDA Research Monograph Series

William Pollin, M.D.

DIRECTOR, NIDA

Jack Durell, M.D.

ASSOCIATE DIRECTOR, OFFICE OF SCIENCE, NIDA

EDITOR-IN-CHIEF

Eleanor W. Waldrop

MANAGING EDITOR

Parklawn Building 5600 Fishers Lane Rackville Maryland 20857
Measurement in the

Analysis and Treatment of

Smoking Behavior
ACKNOWLEDGMENT

This monograph is based upon papers and discussion from a

conference on techniques for measurement of smoking behavior, held

August 20, 1982, in Bethesda, Maryland. Arrangements for the

conference, jointly sponsored by the National Institute on Drug

Abuse and the National Cancer Institute, were made by Prospect

Associates, under National Cancer Institute contract N01-CN-25564.

COPYRIGHT STATUS

The National Institute on Drug Abuse has obtained permission from

the copyright holders to reproduce certain previously published

material as noted in the text. Further reproduction of this

material is prohibited without specific permission of the copyright

holders. All other material in this volume except quoted passages

from copyrighted sources is in the public domain and may be used or

reproduced without permission from the Institute or the authors.

Citation of the source is appreciated.

The U. S. Government does not endorse or favor any specific

commercial product or commodity. Trade or proprietary names

appearing in this publication are used only because they are

considered essential in the context of the studies reported herein.

Library of Congress catalog card number 83-600602

DHHS publication number (ADM)83-1285

Printed 1983

NIDA Research Monographs are indexed in the Index Medicus. They

are selectively included in the coverage of American Statistics

Index, BioSciences Information Service, Chemical Abstracts, Current

Contents, Psychological Abstracts, and Psychopharmacology Abstracts.

iv
Foreword

The causal relationship between tobacco use generally, cigarette

smoking in particular, and disease is well documented in the

scientific literature. In 1982, the U.S. Surgeon General noted

that 350,000 excess deaths would be attributable each year to

tobacco use. Despite two decades of national efforts to prevent

the initiation of smoking by teenagers and other susceptible groups

and to treat the behavior of those already dependent on tobacco, 53

million Americans continue to smoke cigarettes. We still have

close to the highest per capita consumption of cigarettes in the

world.

In the past, the National Institute on Drug Abuse has examined

diverse aspects of smoking behavior (NIDA Research Monographs, No.

17--Research on Smoking Behavior; No. ES--Cigarette Smoking as a

Dependence Process; No. 26--The Behavioral Aspects of Smoking).

This volume adds a new dimension directing attention to issues,

methodologies, and technologies in smoking research design and

measurement.

The complex multifaceted aspects of smoking behavior include

research on pharmacological, physiological, behavioral, and

environmental determinants implicated in development, maintenance,

cessation, and relapse. The diversity of subject matter and

contributing factors necessitates reliance on equally varied

scientific resources. This, at times, results in conflicting

research strategies, designs, methodologies, and analytic

techniques. The present volume provides an overview of the state

of knowledge in the area and suggests general guidelines which when

applied could lead to increased validity, compatibility, and hence

comparability of data across studies. Attention to these factors

will lead to improved intervention and prevention techniques which

should eventually be reflected in reduction of tobacco-related

mortality and morbidity.

Finally, it is worthy of note that this volume represents the

result of collaborative efforts of two institutes, the National

Institute on Drug Abuse and the National Cancer Institute, and thus

emphasizes the need, desirability, and future opportunities for

joint efforts in resolution of tobacco-use related health problems.

William Pollin, M.D.

Director

National Institute on Drug Abuse

v

Preface

The National Institute on Drug Abuse (NIDA) and the National Cancer

Institute (NCI) are devoted to contributing to disease prevention

and health promotion. Basic and applied research are important to

both Institutes. Each is involved in treatment and demonstration

programs designed to further their respective goals in the health

fields. Underlying many such efforts is the need for reliable

information which emanates from field, clinical, and laboratory

research supported by the Institutes.

Elucidation of the determinants of tobacco use is, of course, an

interdisciplinary effort. Integrated research brings with it the

weaknesses, as well as the strengths, of the respective

disciplines. In addition new and innovative techniques are often

required. A variety of technological advances have evolved in

research concerning tobacco use. However, fundamental problems

still exist concerning surveys, measurement, and topography of

smoking behavior. Therefore. in August 1982. NIDA and NCI convened

a group of scientists to address these issues. It was anticipated

that the benefits of such a review would be twofold. First,

improved techniques in survey, measurement, and topographical

analysis, would significantly enhance our research programs. This

will ultimately lead to improvements in treatment, prevention, and

health promotion. The second major benefit would derive from the

successful development of a research model in cigarette smoking

with stringent criteria for outcome and evaluation variables. In

turn this model might facilitate research in other areas involving

interactive behavioral and physiological problems.

The present volume is a summary of that meeting. While problems in

measurement still exist, careful study of and attention to the

crucial methodological issues raised should significantly enhance

our research activities. In addition, this volume provides a

strong indication of future directions as well as an examination of

many significant issues relevant to improving efforts in research

devoted to health and behavior.

Marvin Snyder, Ph.D.

Director

Division of Preclinical Research

National Institute on Drug Abuse

Alcohol, Drug Abuse, and Mental

Health Administration

Joseph Cullen, Ph.D.

Deputy Director

Division of Resources,

Centers, and Community

Activities

National Cancer Institute

National Institutes of Health

vii

Contents

Foreword

William Pollin . . . . . . . . . . . . . . . . . . . . . . .

Preface

Marvin Snyder and Joseph Cullen . . . . . . . . . . . . . . .

Overview of Smoking Research Issues

Catherine S. Bell and John Grabowski . . . . . . . . . . . .

The Use of Biologic Fluid Samples in Assessing Tobacco

Smoke Consumption

Neal L. Benowitz . . . . . . . . . . . . . . . . . . . . . .

Measurement Issues in Cigarette Smoking Research: Basic

Behavioral and Physiological Effects and Patterns of Nicotine

Self-Administration

Jack E. Henningfield . . . . . . . . . . . . . . . . . . . .

Analysis of Reinforcement by Varying Smoke Component

Concentrations

Jed E. Rose .........................

Physical Indicators of Actual Tar and Nicotine Yields of

Cigarettes

Lynn T. Kozlowski . . . . . , . . . . . . , . . . . . . . . .

Measurement of Some Topographical Aspects of Smoking in

the Natural Environment

Roy W. Pickens, Steven W. Gust, Philip M. Catchings, and

Dace S. Svikis . . . . . . . . . . . . . . . . . . . . . . .

Data Collection and Questionnaire Design: Smoking Cessation

in Adults

Harry A. Lando . . . . . . . . . . . . . . . . . . . . . . .

Evaluation of Smoking Risk: Some Minimum Standards

Lee W. Frederiksen . . . . . . . . . . . . . . . . . . . . .

v

vii

1

6

27

39

50

62

74

90

ix
Survey and Evaluation Methods: Smoking Prevention Among

Children and Adolescents

Steven Paul Schinke and Lewayne D. Gilchrist . . . . . . . . 96

Issues in the Measurement of Smoking: Summary and Discussion

Edward Lichtenstein, John Grabowski, and Catherine S. Bell. . 105

Conference Participants . . . . . . . . . . . . . . . . . . . . 113

List of Monographs . . . . . . . . . . . . . . . . . . . . . . . 116

x
Overview of Smoking

Research Issues

Catherine S. Bell, M.S., and John Grabowski, Ph.D.

Historically it is evident that drug use in its varied forms has

occurred in essentially all cultures. Control of use derived from

social, religious, and legal sanctions. Occasionally a drug has

been introduced and gained broad distribution free of governing

social or legal rules, and perturbations worthy of note have

followed. Thus, for example, the widespread introduction of opium

to China by the British generated years of social, economic, and

political problems. Concomitant efforts to eliminate use were

equally noteworthy.

Similarly, tobacco was introduced to Europe from the Americas in

the 16th century. Nicotine doses administered, typically by pipe,

chewing, or sniffing appeared not to involve substantial direct

disruptive behavioral or physiological effects. Smoking behavior

in particular, however, generated great distress in some circles.

Early on, King James I put forth his Counter Blaste to Tobacco (in

1604), which derogated tobacco and the user alike. Nevertheless,

tobacco use spread, and while the dominant dosage form (e.g.,

snuff, pipe, cigarettes) was subject to change, the upward trend

continued.

Efforts to terminate use and claims of dire health consequences

increased over several centuries. Concurrently, introduction of an

inexpensive dosage form, the machine-rolled cigarette, and new

tobacco curing techniques contributed dramatically to increased

use. Thus, the two forces, economic and health, pursued each other

in an upward spiral to the present time when both have considerable

power and notoriety. The tobacco industry reaps billions of

dollars annually. In addition the Federal Government supports a

substantial, although not comparable health maintenance,

prevention, and research effort. In the midst of this is the basic

effort to better understand the phenomena associated with tobacco

use.

It is apparent that the divergent positions concerning tobacco use

have an extended history. Data have only gradually accrued to

strongly support the long hypothesized relationships between

1
tobacco use and ill health. In addition to reports from other

sources, those from behavioral pharmacology laboratories have

recently clarified the historically stated similarities between

diverse forms of drug use and tobacco use. Thus, this perspective

and current scientific wisdom now converge and point to future

needs and directions.

DESIGN ISSUES

Although examination of diverse aspects of tobacco use has been a

goal of government health and safety agencies, academic

institutions, and voluntary health agencies, there has been little

unanimity or agreement in certain areas. Thus, for example, widely

varying theoretical frameworks exist, as they do in many areas of

behavioral, biobehavioral, and biological science. This may well

be healthy and contribute to integrative models applicable to other

disorders, but only if such integration is actively pursued. In

addition, comparability of methodology and identification of

subject populations is often lacking. There currently exists a

need to identify known discrepancies or inconsistencies in research

design and analysis. Contributing to this problem are the all too

frequent research reports that fail to explain how smoking

behaviors are measured and verified. Interestingly, the

specificity and quality of measurement appear to decline as the

analysis moves from the laboratory, animal or human, to such

diverse settings as clinics and classrooms or the natural

environment. An even greater lack of measurement precision may

emerge when survey and related community intervention techniques

are employed despite increasing availability of new and appropriate

technologies. There is a general sense that inherent problems in

differing environments can be circumvented.

Loss of valuable information occurs when limited or no data are

provided concerning determinants of smoking rate, abstinence,

relapse, or shifts in tobacco dosage form used. Scientists and

clinicians alike have noted that the lack of consistent

application of measurement techniques has retarded progress in the

acquisition of systematic knowledge which could advance

understanding of smoking behavior and hence the development of

effective treatment techniques. In part, this has been due to

failure to draw attention to unifying or standardized approaches.

Nonetheless it is particularly disturbing in those areas where

laboratory research has provided tools essential to this effort.

Past problems with evaluation in smoking and tobacco research have

existed in design research and validation of treatment results.

More specifically, for example, there have been validation problems

resulting from unverified self-report of smoking behavior. Some

units of measurement have perhaps contributed to further

uncertainty. For example, preference for reporting packs of

cigarettes rather than number of cigarettes smoked may have led

2
to assumptions dictating that a difficult "breakpoint" for smoking

exists at 10 cigarettes per day based on reports of half-pack

increments. In other cases absence of essential measures may

occur. For example, failure to obtain adequate baseline data,

including brand history, and a lack of information on individual

smoking styles, e.g., topography and dosimetry issues is not

uncommon. The inability to clearly relate correlates of outcome to

independent treatment variables may also result from other problems

including: (1) lack of controls and systematic design, (2) lack of

validation of programs developed in the research setting, (3) lack

of longitudinal data, (4) small n samples with excessive

variability in resultant data, (5) or when small n designs were

appropriate, insufficient replications of measures and, (6) lack of

attention to accepted theoretical guidelines or unifying conceptual

premises. In brief, some research in smoking and tobacco use has

perhaps in one sense suffered due to its divergent origins.

Concurrently it should be clear that exceptional research of

excellence has also been forthcoming. This has been particularly

true in recent years, although measurements problems do exist.

THE SCIENCE BACKGROUND

In the way of background on these issues, it is interesting to note

that few, if any, researchers have been trained in "cigarette

smoking research." To do so would, of course, result in

researchers who have little utility or scope with respect to other

issues. Rather, and appropriately, scientists converged from

diverse extant disciplines to contribute to a better understanding

of specialized problems which have facets in biochemistry,

physiology, neurological function, individual behavior, and,

finally, rather complex aspects of social behavior. Interdisciplinary efforts have thus emerged. While it is not clear that

"smoking researchers," per se, are needed, it is essential to

develop professionals whose skills bridge the gap of traditional

disciplines. Such bridging would permit thorough analysis of

biobehavioral disorders, especially

physiological and behavioral components.

those with multifaceted

CONVERGENCE

As the area of biobehavioral smoking research began to coalesce, it

became apparent that tobacco use could on one hand be examined as

another form of drug self-administration and that on the other hand

it might have characteristics in common with other behaviorally

based disorders. Thus, a search for similarities with other

behaviors and forms of drug use might provide a useful model for

analysis and for generating successful smoking prevention and

cessation programs.

In turn, refinement of the view dictated that tobacco use be

examined in the context of repetitive, stereotypic, habitual

behaviors of all sorts, ranging from gambling, to eating behavior,

3
to dependence on alcohol and drugs, and even to excessive social

interaction needs. Indeed, it appeared that the general features

which characterized behavioral dependence were translatable across

many forms of so-called habitual behaviors.

SMOKING RESEARCH AS A BEHAVIORALLY BASED INTERDISCIPLINARY ENDEAVOR

It is evident that a plethora of clearly definable disease states

are correlated with and perhaps causally related to the use of

tobacco. Therefore, as previously noted, numerous scientific

groups became involved in the research effort from the laboratory

to treatment and prevention settings. Interestingly, objective

consideration suggests that even the disease states do not make the

smoking issues substantially different from other behavioral

problems which have often had their own associated physical ills.

However, it is the occurrence of specific disease states that has

generated the interest of many in what is fundamentally an issue of

drug self-administration.

In any case, it is clear that smoking behavior is of

interdisciplinary interest, and it is equally clear that various

scientists have developed specialized, different, and often

incompatible measures and have brought them to bear on the problems

associated with cigarette smoking and tobacco use. Unfortunately,

as has been suggested, there are areas in which standardized

strategies for research have not emerged.

Overall there is a need to identify and delineate available

measures and perhaps consider general principles if not guidelines

per se for measurement in the smoking research. The guidelines for

measurement of smoking behavior may also directly or indirectly

have some utility in defining goals for more effective prevention

and treatment strategies.

A systematic data collection strategy could provide a roughly

hierarchical sequence by which data could be obtained and results

defined and would also assure some equivalence in the data

collected. It is therefore important to determine what the minimal

level of acceptable data is in various settings or when examining

particular issues. The following provides an example: it might be

generally agreed that a study is of little value if it simply

posits the question "Do you smoke?" What, however, is the minimal

level of data to be obtained, and what makes asking any question

worthwhile, if there is an interest in approximating the notion of

dose effect or dose response? In brief, it is apparent that the

topic of interest is one which involves biobehavioral aspects and

that it is appropriate to suspect that an adequate array of

biological and behavioral measures is desirable if a study is to

have general utility. While it is clear that the degree of

precision in measurement may vary as a function of research goals,

it is equally apparent that the current level of inquiry requires

4
greater precision and strength than is frequently evident.

SUMMARY

Overall, the issue is deceptively simple. There is a need to list

the extant techniques which include some extensive recent

advances. This should be followed by a simple heirarchical

systematization of the techniques and definition of the requirments

of each category of study. As is evident in the present volume,

problems emerge in this effort. Nevertheless, it is clear that the

effort could have considerable benefit, and further that it might

serve as a model for biobehavioral research efforts. The present

volume and its contributors provide many, though not all, of the

essential ingredients, in an effort to move in this direction.

5
The Use Of Biologic Fluid

Samples In Assessing

Tobacco Smoke Consumption

Neal L. Benowitz, M.D.

INTRODUCTION

Tobacco smoke consists of a mixture of combustion gases carrying

a suspension of particulate matter. Among the many components of

the gas phase arecarbon monoxide andhydrogen cyanide. Carbon

monoxide and serum thiocyanate, the latter a metabolite of hydrogen cyanide, are potentially useful markers of smoke consumption.

The particulate phase consists of nicotine and minor tobacco alkaloids and, the remainder, termed tar. Measurements of nicotine

and its major metabolite cotinine are potentially useful markers

of nicotine exposure and intake. Quantitating tar consumption is

more difficult: indirect measurements such as measurement of

urinary excretion of polycyclic aromatic hydrocarbons and their

metabolites and of urinary mutagenic activity may prove to be

useful markers but are not yet ready to be applied to large-scale

smoking studies.

In this paper, I will focus on the use of carbon monoxide, thiocyanate, nicotine, and cotinine as markers of smoke consumption.

Factors influencing absorption of these substances from smoke,

elimination from the body, kinetic characteristics that relate to

their usefulness as markers of smoke exposure, and limitations of

their use are discussed.

Before discussing the individual compounds, it should be emphasized that 1) the relative intake of different pharmacologically

active substances differs among different tobacco products and

different smokers and 2) intake cannot be equated with exposure.

With respect to the latter, both rate of intake (dose) and rate

of elimination determine the average exposure level.. For these

reasons, selection of biochemical measurements must be dictated

by the hypotheses being tested. For example, studies of nicotine

self-administration should include measurements of nicotine and/

or cotinine. Studies of cardiovascular complications of smoking

should include measurements of carbon monoxide as well. Studies

of carcinogenesis require measurements of carcinogen exposure.

6
CARBON MONOXIDE

As estimated by smoking machines, approximately 10 to 20 ml of

carbon monoxide is delivered to the smoker's mouth with each

cigarette. Delivery to the mouth depends on the characteristics

of the cigarette, particularly ventilation and moisture content,

and how the cigarette is smoked. Carbon monoxide is absorbed in

the lungs, where it diffuses across alveolar membranes. It is

not appreciably absorbed across mucous membranes or bronchioles.

Thus, depth of inhalation and the presence or absence of pulmonary disease influence the absorption of a given dose of inhaled

carbon monoxide.

TABLE 1

Carbon monoxide

Dose 10-20 ml/cigarette

Varies with ventilation and misture

characteristics and how cigarette

is smoked

Absorption Pulmonary alveoli

Elimination Respiratory

Half-life 2-5 hours

Ventilation (activity) dependent

Measurement Spectrophotometric: Carboxyhemoglobin

Expired carbon monoxide

Within the body, carbon monoxide is bound, as is oxygen, to hemoglobin, where it can be measured as carboxyhemoglobin. Carbon

monoxide may also be bound to myoglobin and the cytochrome enzyme

system, although quantitative details of binding to the latter

sites are as yet poorly defined. Carbon monoxide is eliminated

primarily by respiration. The rate of respiration determines the

rate of elimination. Thus, the half-life of carbon monoxide

during exercise may be less than 1 hour whereas during sleep it

may be greater than 8 hours (Castleden and Cole 1974). With

sedentary activity, the half-life is usually 3 to 4 hours.

The disposition kinetics of carbon monoxide are useful in understanding the time course of carbon monoxide in the body throughout the smoking day. With a half-life averaging 4 hours, based

on pharmacokinetic principles one would predict that, with

reasonably constant dosing (that is, regular smoking rate),

carbon monoxide levels would plateau after 9 to 12 hours of

cigarette smoking. This is what we observed in circadian studies

of carboxyhemoglobin concentrations in cigarette smokers smoking

on a research ward (figure 1). There is a small increment and

decline in carboxyhemoglobin immediately after smoking individual

7
FIGURE 1

BLOOD NICOTINE AND CARBOXYHEMOGLOBIN

CONCENTRATION WHILE SMOKING USUAL BRAND,

LOW (0.4mg) AND HIGH (2.5mg) NICOTINE CIGARETTES

CLOCK TIME

Blood nicotine and carboxyhemoglobin concentrations in subjects

smoking high-nicotine (2.5 mg) and low-nicotine (0.4 mg) Kentucky

reference cigarettes and their usual brand (average nicotine

yield 1.2 mg) of cigarettes. Subjects smoked on a fixed schedule

of 1 cigarette every half-hour from 8:30 A.M. to 11:00 P.M. for a

total of 30 cigarettes per day. Blood samples were collected

just before the next scheduled cigarette (figure taken from

Benowitz et al. 1982b). © 1982, The C.V. Mosby Company.

Reprinted by permission.

8
cigarettes (not shown in figure 1), but after several hours of

smoking the magnitude of the rise and fall is small compared with

the trough values. Thus, sampling carboxyhemoglobin at the end

of a smoking day is a reasonably good indicator of the daily CO

exposure.

Because of reduced ventilation during sleep, the rate of elimination of carbon monoxide is slower at night than during the day.

With an overnight half-life of 5-9 hours (Castleden and Cole

1974), carbon monoxide persists in the body at substantial levels

throughout the night &spite no further smoking (figure 1). In

our subjects, carboxyhemoglobin concentrations averaged 4-5 percent before smoking the first cigarette of the day. Thus, the

toxic effects of carbon monoxide in smokers are not only experienced in proximity to smoking, but also persist for 24 hours of

every day. Morning carbon monoxide measurements are sensitive to

cigarette smoking, but probably provide less quantitative information about the magnitude of daily exposure than do afternoon

levels.

The usefulness of carbon monoxide as a measurement of tobacco

smoke consumption can be considered in terms of specificity,

sensitivity, and limitations. Specificity refers to the probability that a nonsmoker will be classified as a nonsmoker.

Thus, a highly specific measurement has a low rate of classifying nonsmokers as smokers. In most cases, carbon monoxide

levels, when measured at the end of the smoking day, are specific

for cigarette smoking. There is an endogenous CO concentration

(carboxyhemoglobin of about 0.7 percent) that is much lower than

that observed in cigarette smokers. However, employment in

areas with high ambient carbon monoxide concentrations, exposure

to methylene chloride, which is metabolized to carbon monoxide

(Stewart et al. 1972), or driving on busy freeways (Aronow et al.

1972) may also reduce the specificity of carbon monoxide levels,

particularly when studying light smokers. Sensitivity refers to

the probability that a smoker will be classified as a smoker.

The specificity and sensitivity of carboxyhemoglobin as a marker

of cigarette smoking has been estimated in epidemiologic studies.

Wald et al. (1981a), sampling afternoon carboxyhemoglobin levels

and using a cutoff-point of 2.0 percent, found specificity to be

99 percent and sensitivity to be 81 percent for cigarette smokers

and 35 percent for cigar and pipe smokers. Cohen and Bartsch

(1980), measuring carboxyhemoglobin in the morning and a similar

cutoff-point, found specificity to be 81 percent and sensitivity

to be 83 percent.

We are also interested in measurements that yield quantitative

information about the amount of a particular smoke component that

is consumed. Carbon monoxide measurements do yield some dose

information, particularly when sampled at the end of a smoking

day.

9
It has been shown that for individual smokers carbon monoxide

levels increase proportionately with the number of cigarettes

smoked for the first few hours of smoking (Henningfield et al.

1980). Epidemiologic studies showed significant correlations

between carboxyhemoglobin concentrations and the number of cigarettes smoked per day, with correlations ranging in different

studies from 0.27 to 0.81 (Hawkins et al. 1976; Vogt et al. 1979;

Rickert and Robinson 1981; Jaffe et al. 1981). On the average,

about 25 percent of the variance in carboxyhemoglobin could be

explained by the number of cigarettes smoked per day. The brand

of cigarette or machine yield of carbon monoxide does not significantly predict carboxyhemoglobin levels (Rickert and Robinson

1981; Jaffe et al. 1981).

The limitations in using carbon monoxide as a measurement of

tobacco smoke consumption per se are that the time of day and the

length of time since smoking the last cigarette influence carbon

monoxide levels and that there is considerable individual variation in carbon monoxide absorption and elimination characteristics, depending on smoking habits, disease states, and activity

level.

TABLE 2

Use of carbon monoxide as a measure of smoke consumption

Specificity

Sensitivity

Good

Good at steady state (afternoons)

Short term only

Cost

Limitations

Inexpensive (expired CO)

Time of day

Individual variation in absorption

and elimination (pulmonary

disease; activity)

Measurement of carbon monoxide is straightforward and inexpensive. Because alveolar carbon monoxide pressures are proportional to the concentration of carboxyhemoglobin in blood,

end-expired carbon monoxide tension accurately reflects blood

carboxyhemoglobin (Jarvis et al. 1980). Expired carbon monoxide

can be measured using an instrument (Ecolyzer, Energetics Science,

Inc., Elmsford, NY) that measures the rate of conversion of

carbon monoxide to carbon dioxide as it passes over a catalytically active electrode. Blood carboxyhemoglobin can be measured

directly and quickly using a differential spectrophotometer

(Co-oximeter, Instrumentation Laboratory, Inc., Lexington, MA).

However, the Co-oximeter is expansive to purchase and requires

considerable maintenance.

10
THIOCYANATE

As assessed by smoking machine delivery, approximately 30 to 200

μg of hydrogen cyanide are delivered to the mouth of the smoker

with each cigarette. Hydrogen cyanide is metabolized by the

liver to thiocyanate. In addition to combustion gases, certain

foods, particularly leafy vegetables and some nuts, are sources

of cyanide. Thus, thiocyanate is present in nonsmokers as well

as smokers and may be particularly high in vegetarians. Thiocyanate is also present in beer (Bottoms et al. 1982).

TABLE 3

Thiocyanate

Source is metabolism of cyanide

Hydrogen cyanide in stroke

Dietary cyanide

Absorption Respiratory

Ingestion

Elimination Renal

Half-life = 14 days

Measurement Spectrophotometric

Serum vs. saliva

Thiocyanate is distributed in extracellular fluid and is eliminated slowly by the kidneys. Due to the slow excretion, the

half-life of thiocyanate is long (about 14 days).

The long half-life of thiocyanate means that there is little

fluctuation in plasma thiocyanate concentrations within a day

or from day to day. Thus, the time of sampling is not critical.

On the other hand, a given level of thiocyanate reflects exposure

to hydrogen cyanide in tobacco smoke over several weeks preceding

the time of the sample. When a smoker stops smoking, it takes an

estimated 3 to 6 weeks for thiocyanate levels to reach that

individual's nonsmoking level.

Because of the presence of cyanide in foods, thiocyanate is not

highly specific for cigarette smoking. There is some overlap in

levels between smokers and nonsmokers. However, on the average,

smokers do have levels two to four times those of nonsmokers

(Cohen and Bartsch 1980; Vogt et al. 1979; Butts et al. 1974).

Levels of 85-100 μmoles/L have been suggested as cutoff concentrations for smoking versus nonsmoking. Sensitivity is reasonably good in that most smokers have elevated levels: however,

11
because of marked variation in levels among nonsmokers, thiocyanate concentration may not be a very good quantitative indicator of smoke exposure.

Cohen and Rartsch (1980), using a cutoff-point of 100 μM/L,

reported specificity of 81 percent and sensitivity of 93 percent

for the use of thiocyanate in detecting cigarette smokers. Butz

et al. (1974), using a cutoff-point of 85 μM/L, found 93 percent

and 98 percent specificity and sensitivity, respectively. Thus,

specificity and sensitivity for distinguishing smokers versus

nonsmokers are reasonably good. However, in the smoker who is a

light smoker or who has cut down during smoking cessation treatment, the thiocyanate level approaches levels due to dietary

sources of cyanide, making documentation of smoking status

increasingly more difficult.

Serum or plasma levels of thiocyanate correlate significantly

with the number of cigarettes per day (range of correlation

0.25-0.48) (Cohen and Bartsch 1980; Vogt et al. 1979; Rickert

and Robinson 1981), but not as well as carbon monoxide. Thiocyanate levels in smokers do not correlate with machine yields of

hydrogen cyanide. Salivary concentrations of thiocyanate may

also be used as a noninvasive biochemical marker of smoke exposure (Luepker et al. 1981). Concentrations of thiocyanate in

saliva vary as a function of salivary flow rate (Mucklow et al.

1978). Thus, a close correlation between salivary and plasma

thiocyanate concentrations depends on stimulating flow of saliva.

Serum or plasma thiocyanate levels can be measured fairly inexpensively using spectrophotometric methods (Butts et al. 1974;

Lundguist et al. 1979).

TABLE 4

Use of thiocyanate as a measure of smoke consumption

Specificity

Sensitivity

Good

Good

Long term

Cost

Limitations

Moderate

Dietary interference

Overlap nonsmokers-light smokers

Not useful to monitor short-term

changes in smoking

In summary, the use of thiocyanate levels as a marker of smoke

consumption has fairly good specificity and sensitivity in studying active smokers, has the advantage of a long half-life such

that the time of sampling is not critical, and is inexpensive to

measure. The limitations are that specificity and sensitivity

12
may be inadequate in light smokers or in smokers who have cut

down on their smoking. In addition, the long half-life of thiocyanate makes it impossible to use it to assess recent smoking

behavior. Due to other sources of cyanide, thiocyanate is not a

good quantitative indicator of consumption of tobacco smoke.

NICOTINE

As estimated by smoking machine deliveries, between 0.05 and

2.0 mg of nicotine are delivered to the mouth with each cigarette. As is the case for carbon monoxide, nicotine delivery

depends on the characteristics of the cigarette and how the

cigarette is smoked. In studies by Sutton et al. (1982) and

Herning et al. (1983), the increment in blood nicotine concentration after smoking a single cigarette was correlated poorly with

the smoking machine yield of the cigarette and was more a function of how the cigarette is smoked.

TABLE 5

Nicotine

Dose 0.1-2.0 mg/cigarette

Varies with cigarette characteristics

and how cigarette is smoked

Absorption Mucous membranes (depends on pH of smoke)

Pulmonary bronchial tree and alveoli

Enteroenteric

Elimination Metabolism primary; renal secondary

4-fold individual variation in metabolic

rate

Renal excretion pH dependent

Half-life = 2 hours

Measurement Gas chromatography

Radioimmunoassay

Blood vs. urine

Unlike carbon monoxide, nicotine is absorbed through mucous membranes in the mouth, through the bronchial tree as well as in the

pulmonary alveoli. The extent of mucosal absorption varies with

the pH of the smoke, such that more nicotine is absorbed from

relatively alkaline (cigar) smoke than from acidic (cigarette)

smoke (Armitage and Turner 1970). Nicotine is distributed

rapidly to body tissues and is rapidly and extensively metabolized by the liver. A relatively small fraction is excreted

unchanged by the kidney. Urinary excretion may vary from 2 to 25

percent of total nicotine elimination in alkaline and acid urine,

respectively (Rosenberg et al. 1980).

13
The rate of nicotine metabolism varies considerably, as much as

fourfold among some people (figure 2) (Benowitz et al. 1982a). A

given level of nicotine in the body reflects the balance between

nicotine consumption and elimination rate. Thus, comparing two

persons with the same average blood concentration of nicotine, a

rapid metabolizer may be consuming four times as much nicotine as

a slow metabolizer. To determine daily intake of nicotine

directly, both nicotine blood concentrations and nicotine elimination rate must be measured. This procedure is feasible for

small-scale studies, and is ongoing in our laboratory. However,

it is not feasible for large-scale studies.

The time course of decline of blood concentrations of nicotine is

multiexponential. Following a single cigarette or an intravenous

injection of nicotine, blood concentrations of nicotine decline

rapidly, with a half-life of 5 to 10 minutes, due to tissue

uptake (figure 3). If concentrations are followed over a longer

period of time or if multiple doses are consumed so that tissue

stores are saturated, a longer elimination half-life of about 2

hours becomes apparent (figure 4). It should be noted that many

earlier reports of nicotine half-lives of 20 to 40 minutes (Isaac

and Rand 1972; Armitage et al. 1975) were based on blood concentrations from both distribution and elimination phases and were

not truly measurements of the log-linear decline phase. The

importance of knowing the terminal half-life is that the time

course of accumulation of nicotine during the day and persistence in the body after cessation of regular smoking (such as

overnight) can be predicted.

The optimal way to assess daily exposure to nicotine is to

measure the blood concentrations throughout the smoking day.

This can be carried out in a research ward (Benowitz et al.

1982b) but is not feasible for epidemiologic studies. Pharmacokinetic considerations are useful in planning optimal sampling

of blood for measurement of nicotine concentration to estimate

average exposure levels. As predicted by a 2-hour half-life,

nicotine blood concentrations plateau after 6 to 8 hours of

regular smoking (figure 1). At that point, the fluctuation in

levels between cigarettes is relatively small compared with the

trough levels. This is in contrast to sampling after the first

few cigarettes of the day when there are marked fluctuations in

nicotine levels between cigarettes (figure 5). Afternoon plasma

levels of nicotine have been used in studies of nicotine exposure

while smoking different brands of cigarettes or consuming other

nicotine-containing products (Sutton et al. 1982; Herning et al.

1983; Armitage and Turner 1970; Gritz et al. 1981).

The measurement of blood concentration of nicotine is highly

specific for cigarette smoking unless there is an occupational

exposure to tobacco leaves (Gehlbach et al. 1975). Passive

smoking may elevate blood concentrations of nicotine slightly,

but not to the range seen with most smokers (Russell and Feyerabend 1975). Blood concentration of nicotine is a sensitive

measurement of exposure (rather than consumption) to tobaccosmoked nicotine. Exposure rather than consumption is emphasized

14
FIGURE 2

Pharmacokinetics of nicotine in 14 healthy male cigarette

smokers. Pharmacokinetic analysis was performed on plasma concentration data collected during and after constant infusion of

nicotine, 1-2 μg base/kg/min, for 60 minutes under conditions of

urinary acidification (pH<5.5). The blood nicotine concentration-time curve is shown in figure 4. Terminal half-life was

computed from plasma concentration data from 30 to 150 minutes

following the end of nicotine infusion (figure taken from Benowitz et al. 1982a). © 1982, American Society for Pharmacology

and Experimental Therapeutics. Reprinted by permission.

15
FIGURE 3

PLASMA NICOTINE.

INTRAVENOUS INJECTIONS AND CIGARETTE SMOKING

Plasma nicotine concentrations in a subject given bolus intravenous injections of nicotine, 2 μg base/kg, or inhaling from a

commercial cigarette, once every minute for 10 minutes. Nicotine

concentrations rise as or more rapidly while smoking compared

with intravenous dosing. There is a sharp decline in concentration following the end of the series of nicotine injections or

smoking, due to distribution into body tissues. The terminal

half-life phase (not shown in figure), which reflects rate of

drug elimination, becomes apparent 30-60 minutes following nicotine exposure.

16
FIGURE 4

NICOTINE

INFUSION

2 μg/kg/min

Plasma nicotine concentrations (± S.E.M.) in five subjects during

and after constant intravenous infusion of nicotine for 30 minutes. (Figure taken from Benowitz et al. 1982a.) © 1982,

American Society for Pharmacology and Experimental Therapeutics.

Reprinted by permission.

17
FIGURE 5

Mean plasma nicotine concentrations during repetitive intravenous

injections of nicotine with alkaline (pH>7) and acid (pH<5)

urine. Hatched area indicates 10 minute intervals during which

intravenous injections of nicotine, 2 μg base/kg/min, were given.

Data represent mean values for five subjects. There is considerable fluctuation in nicotine concentration following and between

series of nicotine injections (or smoking cigarettes) after the

first few exposures. With repetitive dosing, trough levels rise

and eventually (6-8 hours) plateau.

18
because of the influence of individual differences in rate of

metabolism of nicotine, as described previously. Measurement of

the blood concentration of nicotine has a major advantage in that

nicotine is the substance for which most people smoke and which

may have direct toxicity. The limitations in the use of blood

concentrations of nicotine are the fluctuation in nicotine concentrations between cigarettes and the considerable variation in

nicotine metabolism among individual smokers. In addition, the

method for measuring the low concentrations of nicotine in blood

is more difficult than for other markers.

TABLE 6

Use of nicotine as a measure of smoke consumption

Specificity

Sensitivity

Excellent

Excellent

Short-term only

Cost

Limitations

Expensive

Time of day

Individual variation in

metabolism and renal

excretion

Blood concentrations of nicotine can be measured by gas chromatography (Jacob et al. 1981), radioimmunoassay (Langone et al.

1973), and possibly high performance liquid chromatography.

Sample preparation is problematic in that contamination of

samples with even small amounts of tobacco smoke can substantially elevate the normally low concentrations of nicotine in the

blood. Thus, careful precautions against contamination during

both sample collection and processing for analysis are essential.

Because the concentrations are so low, measurement of nicotine in

blood has been difficult for many laboratories in the past, but

with currently available assays, it is feasible for large scale

epidemiologic studies. Measurement of urinary levels of nicotine

has been suggested as a marker for cigarette consumption (Wilcox

et al. 1979). This may be qualitatively useful, but quantitatively it is limited by the fact that there is variation in renal

elimination of nicotine depending on urine pH and flow rate so

that it is difficult to extrapolate from urine to blood concentrations of nicotine.

19
COTININE

Nicotine is metabolized primarily to cotinine and nicotine-k

oxide. Based on measurements of relative urinary excretion of

cotinine and nicotine-N-oxide and studies of total and renal

elimination of cotinine after intravenous infusion, we estimate

that on the average 86 percent of nicotine is converted to cotinine. The individual variation in fractional conversion of nicotine to cotinine has not yet been determined.

TABLE 7

Cotinine

Primary metabolite of nicotine

Elimination Metabolism primary, renal

secondary

Half-life = 19 hours

Measurement Gas chromatography

Radioimmunoassay

Cotinine is distributed to body tissues to a much lesser extent

than nicotine. Cotinine is eliminated primarily by metabolism

with 15 to 20 percent excreted in the urine unchanged (Benowitz

et al., submitted for publication). Urinary pH does affect the

renal elimination of cotinine; however, the effect is not as

great as for nicotine. In a small group of subjects given intravenous infusions of cotinine, interindividual variation in the

rate of cotinine metabolism was considerably less than variation

in rates of nicotine metabolism. The elimination half-life for

cotinine in 16 subjects who stopped smoking on a research ward

averaged 19.1 hours with a range of 10.9 to 37.0 hours.

Because of the relatively long half-life of cotinine, blood

concentrations of cotinine are relatively stable throughout the

smoking day, reaching a maximum at the end of the day. Because

each cigarette adds relatively little to the overall cotinine

level, sampling time with respect to smoking is not critical. A

mid- or late-day concentration reasonably reflects the average

concentration of cotinine throughout the day.

Using metabolic and pharmacokinetic data, blood concentrations of

cotinine can be used as a measure of daily consumption of nicotine. Assuming that nicotine is 86 percent converted to cotinine

and that cotinine clearance is relatively constant among people,

which seems to be the case, it can be computed that a blood

concentration of cotinine of 100 ng/ml represents an average 24

hour consumption of 12 mg nicotine (Benowitz et al., submitted

for publication). Average concentration of cotinine in the

20
blood of habitual cigarette smokers is about 300 ng/ml (Langone

and Van Vunakis 1975; Zeidenberg et al. 1977). Thus, I estimate

that the average smoker consumes about 36 mg of nicotine/day.

The range of blood concentrations of cotinine was quite wide, 5

to 900 ng/ml, presumably reflecting a wide variation in nicotine

consumption among self-reported habitual smokers. Concentrations

of cotinine in blood have been used to estimate nicotine consumption in several studies (Zeidenberg et al. 1977; Gritz et al.

1981; Hill and Marquardt 1980; Wald et al. 1981b).

TABLE 8

Use of cotinine as a measure of smoking consumption

Specificity

Sensitivity

Cost

Excellent

Excellent

Intermediate term

Moderate

Limitations ? Individual variation in

elimination rate

The specificity of cotinine as a marker for cigarette smoking is

excellent. I have found no nonsmokers with blood cotinine values

greater than 10 ng/ml. The sensitivity of cotinine also appears

to be excellent and offers the best estimate of daily nicotine

consumption. Because of its long half-life, sampling time is

less critical than for nicotine or carbon monoxide.

Measurement of cotinine is moderately costly. Both radioimmunoassay (Langone et al. 1975) and gas chromatographic assays (Jacob

et al. 1981) are readily available. Urinary cotinine ‘may also be

measured as a qualitative indicator of smoking versus nonsmoking

(Wilcox et al. 1979; Matsukura et al. 1979) but, because of individual variations in renal clearance, it is not a good quantitative predictor of blood concentration of cotinine.

SUMMARY

In summary, the source, absorption, metabolism, and disposition

kinetics of several compounds that are potential markers of

tobacco smoke consumption have been reviewed. Kinetic considerations have been applied to discuss specificity and sensitivity of

various compounds as markers of cigarette smoking status, usefulness as quantitative indicators of tobacco smoke consumption, and

optimal time for sample collection. One cannot, however, escape

the conclusion that selection of a biochemical test must be

linked to the hypothesis being tested. If only smoking versus

nonsmoking is being assessed, then carbon monoxide and/or thio21
TABLE 9

Comparison of biochemical markers of tobacco smoke consumption

Marker Specificity Sensitivity Limitations cost Advantages

Carbon monoxide Good Good short term Time of sampling Inexpensive Direct toxin

Variable absorption Noninvasive

and elimination (Expired CO)

Thiocyanate Good Good long term Dietary interference Moderate Noninvasive

Qualitative measure (Saliva)

Nicotine Excellent Excellent short Time of sampling Expensive Direct measurement

term Variable elimination of reinforcer or

rate toxin exposure

Cotinine Excellent Excellent inter- ? Variable elimination Moderate Measurement of

mediate term rate nicotine

consumption
cyanate are inexpensive measurements that provide adequate information. If self-administration of nicotine or toxic effects

potentially related to nicotine exposure are being studied, then

measurements of nicotine exposure and consumption are required.

Measurement of blood concentration of nicotine per se is necessary to document nicotine exposure: blood concentration of cotinine may be a better measure of daily nicotine consumption. To

study potentially carcinogenic effects of tobacco smoke, specific

measurements of carcinogen consumption must be developed and

validated.

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Lewis, P.J.; and Turner, D.M. Absorption and metabolism of

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Aronow, W.S.; Harris, C.N.; Isbell, M.W. et al. Effect of

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Benowitz, N.L.; Jacob III, P.; Jones, R.T.; and Rosenberg, J.

Interindividual variability in the metabolism and cardiovascular

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A.-L Cotinine metabolism and effects in humans. Submitted for

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Butts, W.C.; Kuehneman, M.; and Widdowson, GM. Automated method

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nonsmokers. Clin Chem, 20(10):1344-1348, 1974.

Castleden, C.M., and Cole, P.V. Variations in carboxyhaemoglobin

levels in smokers. Brit Med J, 4:736-738, 1974.

Cohen, J.D., and Bartsch, G.E. A comparison between carboxyhemoglobin and serum thiocyanate determinations as indicators of

cigarette smoking. Amer J Publ Health, 70:284-286, 1980.

23
Gehlbach, S.H.; Perry, L.D.; Williams, W.A.; Freeman, J.I.;

Langone, J.J.; Peta L.V.; and Van Vunakis, H. Nicotine absorption by workers harvesting green tobacco. Lancet, 1:478-480,

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Gritz, E.R.; Baer-Weiss, V.; Benowitz, N.L.; Van Vunakis, H.; and

Jarvik, M.E. Plasma nicotine and cotinine concentrations in

habitual smokeless tobacco smokers. Clin Pharmacol Ther, 30:

201-209, 1981.

Hawkins, L.H.; Cole, P.V.; and Harris, J.R.W. Smoking habits and

blood carbon monoxide levels. Environmental Research, 11:310-318,

1976.

Henningfield, J.E.; Stitzer, M.L; and Griffiths, RR. Expired

air carbon monoxide accumulation and elimination as a function of

number of cigarettes smoked. Addictive Behaviors, 5:265-272,

1980.

Herning, R.I.; Jones, R.T.; Benowitz, N.L.; and Mines, A.H. How

a cigarette is smoked determines nicotine blood levels. Clin

Pharmacol Ther, 33:84-90, 1983.

Hill, P., and Marquardt, H. Plasma and urine changes after smoking different brands of cigarettes. Clin Pharmacol Ther, 27:

652-658, 1980.

Isaac, P.F., and Rand, M.J. Cigarette smoking and plasma levels

of nicotine. Nature, 236:308-310, 1972.

Jacob III, P.; Wilson, M.; and Benowitz, N.L. Improved gas

chromatographic method for the determination of nicotine and

cotinine in biologic fluids. J Chromatogr, 222:61-70, 1981.

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Verebey, K. Carbon monoxide and thiocyanate levels in low tar/

nicotine smokers. Addictive Behaviors, 6:337-343, 1981.

Jarvis, M.J., and Russell, M.A.H. Expired air carbon monoxide: a

simple breath test of tobacco smoke intake. Brit Med J, 281:484-

485, 1980.

Langone, J.J.; Gjika, H.B.; and Van Vunakis, H. Nicotine and its

metabolites. I. Radioimmunoassay for nicotine and cotinine.

Biochemistry, 12:5025-5030, 1973.

Langone, J.J., and Van Vunakis, H. Quantitation of cotinine in

sera of smokers. Res Commun Chem Pathol Pharmacol, 10:2l-28,

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Luepker, R.V.; Pechacek, T.F.; Murray, D.M.; Johnson, C.A.; Hund,

F.; and Jacobs, D.R. Saliva thiocyanate: a chemical indicator of

cigarette smoking in adolescents. Amer J Publ Health, 71:1320-

1324, 1981.

24
Lundquist, P.; Martensson, J.; Sorbo, B.; and Ohman, S. Method

for determining thiocyanate in serum and urine. Clin Chem, 25:

678-681, 1979.

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H.; and Muranaka, H. Cotinine excretion and daily cigarette

smoking in habituated smokers. Clin Pharmacol Ther, 25:555-561,

1979.

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concentration in saliva. Clin Pharmacol Ther, 24:563-570, 1978.

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hazardous cigarettes. II. Study of cigarette yields of nicotine,

carbon monoxide, and hydrogen cyanide in relation to levels of

cotinine, carboxyhemoglobin, and thiocyanate in smokers. J Toxicology and Environmental Health, 7:391-403, 1981.

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Pharmacol Ther, 28:517-522, 1980.

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methylene chloride. Arch Environmental Health, 25:342-348, 1972.

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Saloojee, Y. Relationship between cigarette yields, puffing

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Wald, N.J.; Idle, M.; Boreham, J.; Bailey, A.; and Van Vunakis,

H. Serum cotinine levels in pipe smokers: evidence against

nicotine as cause of coronary heart disease. Lancet, 4:775-777,

1981b.

Wilcox, R.G; Hughes, J.; and Roland, J. Verification of smoking

history in patients after infarction using urinary nicotine and

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Zeidenberg, P.; Jaffe, J.H.; Kanzler, M.; Levitt, M.D.: Langone,

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during cessation of smoking. Compr Psychiat, 18:93-101, 1977.

25
ACKNOWLEDGMENTS

Research supported in part by Grants No. DA02277 and DA01696 from

the National Institute on Drug Abuse.

26
Measurement Issues in Cigarette

Smoking Research: Basic Behavioral

and Physiological Effects and Patterns of

Nicotine Self-Administration

Jack E. Henningfield, Ph.D.

INTRODUCTION

Measurement issues in cigarette smoking research encompass a

heterogeneous body of research questions and strategies.

Included are investigations into the types and amounts of

tobacco smoke constituents delivered by cigarettes, topographical analysis of puffing behavior, epidemiological studies of

smoking behavior, health-related consequences of smoking, and

investigations of cigarette smoking behavior. The primary focus

of the present paper will be on studies of the dependence

process in which drug self-administration strategies were used.

Some of the underlying principles of such strategies are

described below.

The conceptualization of drug abuse as an instance of drug

self-administration, that may be studied in the laboratory, is

one of the essential tenets of behavioral pharmacology (Thompson

and Schuster 1968; Poling and Henningfield 1982). These

strategies have now been fruitfully applied to the study of

cigarette smoking (Gritz 1980; Griffiths and Henningfield

1982). The power of such strategies lies in their potential to

reproduce, under rigorous laboratory conditions, the essential

elements of the phenomena of drug-seeking and drug-taking

behavior. A given instance of drug self-administration involves

numerous elements which are of behavioral, physiologic, pharmacologic, social, and environmental nature. The drug self-administration paradigm permits the systematic manipulation of such

variables so that the relative contribution of each can be

assessed (cf. Griffiths, Bigelow, and Henningfield 1980).

The focus of drug self-administration studies is on operant

behavior, or chains of behavior that are relatively free to

occur, not to occur, or to occur in altered form, e.g., the

procurement and smoking of cigarettes. The strength of operant

behavior is assessed by its rate or probability of occurrence.

When the maintenance of such a chain of behavior is dependent

upon the delivery of a given stimulus, that stimulus is said to

27
be functioning as a positive reinforcer, regardless of the

underlying reasons for which the stimulus holds that property,

e.g., tobacco smoke inhaled from a cigarette is the reinforcer

for the operant behavior entailed by cigarette smoking. Antecedent stimuli which signal conditions under which an instance

of operant behavior is likely to be reinforced are termed

discriminative stimuli; their power in setting the occasion for

operant behavior to occur (i.e., increasing the probability of

occurrence of the behavior) is dependent upon prior instances of

the behavior being reinforced in their presence. The prior

conditioning histories of such stimuli may be specific to the

behavioral sequence at hand and may function additively, e.g.,

the smell of tobacco smoke and the onset of early nicotine

withdrawal symptoms may each tend to set the occasion for

smoking, while the contiguous occurrence of both sets of stimuli

may produce an extremely high probability situation in which

smoking may occur. The prior histories may also be nonspecific

to the behavior at hand but equally effective at setting the

occasion for the behavior to occur. Modeling the behavior of

peers, obeying the instructional demands of perceived superiors

or role models, and adhering to social and familial norms are

generally conditioned from birth. It should come as no surprise

when these kinds of discriminative stimuli function with such

efficacy, e.g., when adolescents learn to smoke together, when

advertising strategies use the ‘Brand X Man’ or the ‘Brand Y

Woman,” and when it is discovered that smokers are not randomly

distributed across the population but, rather, tend to be

clustered into small social units of smokers and nonsmokers

(e.g. coworkers, friends, family).

In the studies described in the present paper, two general

self-administration strategies are utilized: a cigarette

smoking paradigm, and an intravenous nicotine self-administration paradigm. Data collected using these paradigms provide

an experimental basis for assessing the role of the multiple

factors involved in cigarette smoking. Some of these factors

are described below.

SOME PROBLEMS OF MEASUREMENT IN TOBACCO RESEARCH

Fundamental to any self-administration study is to provide a

standard unit of the substance to be delivered, as well as to

quantify intake. Typically, in drug self-administration

studies, a predetermined dose of drug (e.g., mg per delivery or

mg per body weight per delivery) is delivered, and the total

drug intake over time is measured (e.g., mg per hour). In

studies of cigarette smoking, however, this fundamental condition is confounded by the factors described in Figure 1. As

shown in the figure the nature and quantity of constituents in

any given puff is a function of multiple factors including

cigarette constitution, puff topography, inhalation characteristics, and so forth.

28
PRODUCTION AND FATE OF CIGARETTE SMOKE CONSTITUENTS

Figure 1. This illustration shows the complex sequence

of events whereby a tobacco cigarette, comprised of a

variety of constituents, is burned, thus yielding new

constituents. The mainstream smoke is filtered and

diluted as it passes through the cigarette and into the

mouth. Smoke from the tip of the cigarette (side

stream smoke) may be inhaled directly and thus be

higher in concentration of certain constituents.

Finally, a variable amount of the produced and puffed

smoke is inhaled into the lungs where absorption will

depend on a variety of factors.

Given the complexity of the physical and behavioral processes

involved in the production and eventual intake of tobacco smoke

constituents, it would seem that dose assessment could only

result from a profile of the various measurable parameters.

These include (1) puffing parameters (e.g., rate and volume),

(2) inhalation parameters (e.g., rate and volume), (3)

physiologic intake parameters (e.g., CO level and plasma nicotine), and (4) subjective effects parameters (e.g., self-reported strength of cigarette). All of these factors may bear

complex and dependent relationships to one another, and may be

most meaningfully addressed as elements of a profile.

Multiple variable measurement, yielding a profile of effects,

provides one solution to the issues raised above. Figure 2

shows the profile of effects determined in a study of the

effects of d-amphetamine on cigarette smoking in normal volunteers (Henningfield and Griffiths 1981). As shown in the figure, a variety of measures showed dose-related changes. The

collection of several variables permits a more meaningful analysis of the results. For instance, the CO measure confirmed

29
that subjects were not simply puffing more, but were actually

inhaling more smoke. Another approach to addressing the

problem in measurement concerning delivered and obtained doses

is to present known quantities of a pure form of the substance

under study, for instance, to deliver intravenous doses of

nicotine. However, such an approach assumes that intravenous

nicotine is functionally equivalent to nicotine delivered via

inhaled tobacco smoke.

Figure 2. For each dependent variable, the

overall man value (n = 40, 8 subjects x 5

sessions) is shown as a function of d-amphetamine

dose. The dashed line indicates the 95%

confidence interval for placebo. The y axis

shows the units of measurement appropriate to the

dependent variables indicated in individual

graphs. (© The c. v. Mosby Company. From

Clinical Pharmacology and Therapeutics, Vol. 30,

No. 4, 1981. Reprinted with permission.)

EQUIVALENCE OF IV NICOTINE TO TOBACCO SMOKE

Before studies of nicotine self-administration were conducted,

some of the effects of nicotine given intravenously or in the

form of research cigarette smoke were compared using biological

assay procedures (cf. Finney 1962). Subjects were given a range

of doses of nicotine, intravenously and in the form of inhaled

30
tobacco smoke. Drug dosing was double-blind, following an

initial "dose run-up" study done with each subject to verify the

safety of the doses. Before, during, and after drug administration, a variety of subjective and physiologic variables were

measured. The research staff also made behavioral observations

about the subjects (the procedures used and the results obtained

have been described in greater detail elsewhere: Henningfield et

al. 1983a).

The main findings of this study were that nicotine produced

similar profiles of effects given via the intravenous route or

in the form of inhaled tobacco smoke: Dose-related increases in

scores on scales of drug dose strength, drug liking, and euphoria (MEG scale of the Addiction Research Center Inventory),

decreases in desire to smoke, increased heart rate and blood

pressure (the high iv dose produced an initial bradycardia), and

decreased skin temperature. Peak subjective effects occurred

within the first minute of administration of nicotine (or

completion of the cigarette) and declined to negligible levels

within a few minutes. There were some differences between iv

and inhaled nicotine: Inhaled nicotine was more effective at

decreasing the desire to Smoke, and intravenous nicotine was

identified as a euphoriant producing a "rush" similar to that

produced by cocaine or morphine (though of much shorter

action). A subsequent study (Henningfield et al. 1983b) showed

that nicotine produced early effects on other physiologic

measures that corresponded with the changes in heart rate and

subjective response observed in the former study. For instance,

pupil diameter first increased, then decreased, and returned to

saline levels within a few minutes of injection. The more

recent study also showed that mecamylamine pretreatment blocked

physiologic responses to nicotine and attenuated subjective

effects of nicotine (mecamylamine is a ganglionic blocker used

as an antihypertensive medication).

This series of studies confirmed findings from earlier studies

that nicotine produces many of the effects of cigarette smoking

(cf. review by Gritz 1980), and the findings showed that

nicotine’s profile would contribute to its role as a pharmacologic mediator of compulsive cigarette smoking, i.e., by

reinforcing the behavior of tobacco smoke self-administration.

Further, these findings support the validity of using intravenous nicotine self-administration as a model to study pharmacologic aspects of cigarette smoking.

SELF-ADMINISTRATION OF INTRAVENOUS NICOTINE BY HUMAN SUBJECTS

The findings of the study summarized above were consistent with

those of other investigators (cf. reviews by Gritz, 1980;

Griffiths and Henningfield, 1982) suggesting that nicotine is

the critical pharmacologic mediator of the behavior of cigarette

smoking. To further study the role of nicotine in the

31
dependence process of cigarette smoking, a series of studies was

conducted in which intravenous nicotine was available in place

of cigarettes. Some of the issues of scientific importance that

can be addressed by the self-administration approach include the

following: (1) Can nicotine, in the absence of the vast array

of stimuli involved in cigarette smoking, serve as a positive

reinforcer and thereby maintain self-administration? (2) How

does nicotine compare to other psychoactive drugs which have

been studied in self-administration paradigms? (3) How do patterns of nicotine self-administration compare to patterns maintained by cigarette smoke? (4) How is the behavior of nicotine

self-administration affected by pharmacologic manipulations?

General Methods

Subjects resided on the research ward for the 6- to 12- week

duration of studies. Experimental sessions were 3 hours and

were scheduled 1 to 3 days apart. Prior to a session, the

subject was catheterized in a forearm vein using a standard

intravenous infusion set. Automatically activated syringe pumps

were used for injections. Dose volume and infusion duration

were 1 ml and 10 sec, respectively. During sessions the subjects sat in a reclining chair in isolation and had access to a

radio and magazines. Cigarette smoking was not permitted for 1

hour prior to or during sessions.

Before and after each session, basic vital signs were collected

by the research staff. Subjects then also completed three

questionnaires: (1) A short form (40 items) of the Addiction

Research Center Inventory (ARCI) which contains empirically

derived scales sensitive to the effects of several classes of

psychoactive drugs. (2) The Single Dose Questionnaire (SDQ)

which contains a scale of drug liking and a drug identification

list with the street names of 10 common psychoactive drugs. (3)

A newly developed form with rating scales of drug dose strength,

and desire to smoke a cigarette. Additionally, 1 minute after

each injection the liked and disliked effects of the injection

were rated by the subject on 100 nun line visual analogue

scales. An operant test panel with two levers and attendant

stimulus lights were located near the subject’s reclining chair.

Prior to the study, the safety of the nicotine dose levels was

verified by injecting the subjects with each of the possible

doses at 1 hour intervals in an ascending sequence. They were

told that only doses from among this sequence, or placebo, would

be available during the self-administration study, but they were

given no information regarding the specific nicotine dose

available during any session nor the schedule of its availability. In some studies, sessions were preceded by oral administration of mecamylamine. Subjects were told that any lever

pressing or drug taking was voluntary; they were not asked OK

encouraged to take injections.

32
Studies were conducted following review and approval of the

study plan by the Institutional Review Board. To further ensure

the safety of subjects, (a) a one-minute time-out followed each

injection, (b) there was a programmed maximum limit on the

number of injections available during successive thirty minute

intervals, (c) a research nurse observed the subject and the

subject’s continuous electrocardiogram display and was free to

abort the session at his or her discretion, and (d) the subject

was free to abort the session at any time.

RESULTS

In the initial study of nicotine self-administration, subjects

were presented with one dose of nicotine or saline during

sessions; ten responses on one lever produced drug, while

responding on the other lever had no programmed consequence

(Henningfield et al. 1983c). Figure 3 shows patterns of nicotine injections taken under such conditions. All of the six

subjects tested self-administered both nicotine and saline;

however, nicotine injections occurred in regular patterns,

whereas saline injections occurred with wide variablility in

pattern and frequency, both within and across subjects.

Patterns of nicotine self-administration were similar to those

of humans smoking cigarettes and to animals self-administering

psychomotor stimulants (Griffiths et al. 1980). In some of the

subjects, comparison of nicotine- to saline-maintained lever

pressing suggested that nicotine was serving as a positive

reinforcer, while in other subjects it appeared that nicotine

was serving as an aversive stimulus relative to saline. Unlike

the study of single dose nicotine administration in which desire

to smoke was decreased in dose-related fashion, desire to smoke

was not reliably decreased in this study. However, the behavior

of smoking (cigarettes smoked and puffs taken) was decreased

following sessions in which nicotine was self-administered as

compared to sessions in which saline was available.

A subsequent study examined the effects of systematic withinsubject manipulations of nicotine dose in human and squirrel

monkey subjects when ten lever presses were required per

intravenous nicotine injection (Goldberg and Henningfield

1983). With the human subjects nicotine and saline were

presented concurrently, while with the animal subjects saline

and nicotine were presented across sessions. The results of the

study were similar in both species.

In the Goldberg and Henningfield study, all subjects self-administered both nicotine and saline. Nicotine injections exceeded

saline injections in three of the four humans and three of the

four monkeys tested, indicating that nicotine was serving as a

positive reinforcer for these subjects. The highest dose of

nicotine decreased injection rates, though amount of nicotine

33
I.V. NICOTINE INJECTIONS

Figure 3. Intravenous nicotine self-administration by cigarette smokers. The vertical marks

indicate injections obtained by each subject

during a 3-hr session. For subjects BE, KO and

LA, the data shown are those from a

representative session at the 1.5 mg per

injection dose: for subjects SK, KU and PE, the

data are from the only session in which the 1.5

mg dose was available. The actual unit dose for

each subject , expressed as ug nicotine per kg

body weight, is indicated on the right side of

each record.

obtained per session was relatively unchanged. With the human

subjects, as injection dose increased from 0.75 to 1.5 mg, there

was little change in number of injections taken per 3 hour

session. However, when dose was increased to 3.0 mg, number of

injections per session decreased. This is interesting since

studies of the effects of nicotine yield in cigarettes on

cigarette smoking behavior have shown little effect on rate of

cigarette consumption except when nicotine yield of the

cigarettes was in excess of 2 mg per cigarette (Griffiths et al.

1980).

Self-administration studies in animals and humans with opioid

agonists (e.g., morphine) have shown that pretreatment with

antagonist drugs (e.g., naltrexone) decreases the reinforcing

efficacy of the opioid, relative to placebo (Griffiths et al.

1980). These results suggest that nicotine self-administration

might also be reduced by pretreatment with an antagonist.

Studies of intravenous nicotine self-administration by animals

have shown that the reinforcing efficacy of nicotine is reduced

by pretreatment of the animals with mecamylamine (e.g., Spealman

and Goldberg 1982).

34
To assess the effects of mecamylamine on nicotine self-administration behavior, a subject was pretreated with mecamylamine

or placebo, 1 hour before 3-hour sessions. Nicotine, in 3 mg

doses (IV) and saline were concurrently available by pressing

either of two levers (the nicotine and saline levers were

alternated each day, and the subject was told that pressing on

either lever could produce any of a previously given range of

doses of nicotine or placebo).

MECAMYLAMINE (mg)

Figure 4. Mean values (n = 3 sessions) and

S.E.M. of dependent variables when the available

nicotine dose was constant across sessions (3.0

mg) and the presession mecamylamine dose was

varied from 0 to 10 mg. The shaded bars indicate

the mean visual line analogue scores obtained 1

minute following each of the first three injections of a session. The striped bars indicate

the percent of total number of injections during

a session that were nicotine injections.

Figure 4 shows that mecamylamine pretreatment produced a doserelated blockade of the subjectively liked effects and of the

reinforcing effects of nicotine. Liking scores on a 100 mm

visual line analogue scale were decreased by nicotine (0 mm = no

effect and 100 mm = very strong positive effect). The preference for nicotine, as compared to saline, was decreased by

mecamylamine administration.

35
IMPLICATIONS

These studies suggest that measurement issues can be surmounted

by systematically applying the methods of behavioral pharmacology and biological assay procedures. Use of multiple

measures helped to resolve issues arising from any single

measure (e.g., the relationship between nicotine’s effects on

desire to smoke versus the behavior of smoking). Studies with

intravenous nicotine showed that nicotine, in its own right, is

an abusable drug, and that nicotine produces physiologic,

subjective, and behavioral effects which are generally similar

whether nicotine is delivered intravenously or via tobacco smoke

inhalation. Subjective effects are qualitatively similar to

those produced by abused drugs such as cocaine. Certain effects

onset within seconds and offset within minutes. Mecamylamine

selectively attenuates interoceptive effects, though higher

doses block physiologic responses to nicotine. The fundamental

implication of the self-administration study is that nicotine

was voluntarily taken in place of cigarettes, in the absence of

the vast array of stimuli (social, taste, etc.) normally concommitant to nicotine taking by cigarette smoking, thereby indicating that nicotine may function as a positive reinforcer.

Taken together, these results show that cigarette smoking is

appropriately categorized as an instance of drug dependence in

which nicotine is the key pharmacologic mediator of the

behavior. A caveat, applicable to all forms of drug dependence,

is that the pharmacologic mediator is only one of many components involved in the acquisition, maintenance, and elimination

of the dependence proccess. However, knowlege concerning the

role of a pharmacologic mediator provides a rational basis for

pharmacologic aids for the treatment of the behavior. For

instance, a nicotine substitution treatment (e.g., nicotine

containing chewing gum) or a nicotine blocking treatment (e.g.,

mecamylamine) may be of use.

The emerging conceptualization of cigarette smoking is that

cigarette smoking may be regarded as an instance of voluntary toxin

self-administration. Unlike other forms of toxin self-administration, however, in which knowledge of the toxic effects of

the substance (e.g., dioxin in drinking water, or asbestos in

air) is frequently sufficient for the behavior to change, in the

case of cigarette smoking, the toxins (specifically, tar, CO and

particulate matter) are accompanied by a psychoactive compound

that reinforces the behavior of self-administration. It is

clear that any serious attempt to reduce the disease and

suffering caused by cigarette smoking will need to consider

these issues (U. S. Department of Health and Human Services,

1983).

36
REFERENCES

Finney, D. J. Probit Analysis: A Statistical Treatment of the

Sigmoid Response Curve. Cambridge: University Press, 1962.

Goldberg, S. R., and Henningfield, J. E. Behavior maintained by

intravenous nicotine injections in squirrel monkey and human

subjects. Manuscript in preparation, 1983.

Griffiths, R. R. Henningfield, J. E.; and Bigelow, G. E. Human

cigarette smoking: Manipulation of number of puffs per bout,

interbout interval and nicotine dose. J Pharmacol Exp Ther,

220: 256-265, 1980.

Griffiths, R.R.; Bigelow; G. E.; and Henningfield, J. E. Similarities in animal and human drug taking behavior. In: Mello,

N. K., ed. Advances in Substance Abuse: Behavioral and

Blological Research. Greenwich, CT: Jai Press, 1980, pp. 1-90,

Griffiths, R.R., and Henningfield, J.E. Pharmacology of cigarette smoking behavior. Trends in Pharm Sci, 3: 260-263, 1982.

Gritz, E.R. Smoking behavior and tobacco abuse. In: Mello, N.

K., ed. Advances in Substance Abuse: Behavioral and Biological Research. Greenwich, CT: Jai Press, 1980, pp. 91-158.

Henningfield, J. E.; and Griffiths, R. R. Cigarette smoking and

subjective response: Effects of d-amphetamine. Clin Pharmacol

Ther, 30: 497-505, 1981.

Henningfield, J. E.; Miyasato, K.; and Jasinski, D. R.

Intravenous nicotine and inhaled tobacco smoke compared in human

volunteers. Manuscript in preparation, 1983a.

Henningfield, J. E.; Miyasato, K.; and Jasinski, D. R. Rapid

physiologic effects of nicotine in humans and selective blockade

of behavioral effects by mecamylamine. Problems of drug

Dependence 1982, National Instituteon Drug Abuse Research

Monograph. Washington, D. C.: Supt. of Docs., U. S. Govt.

Print. Off., 1983b.

Henningfield, J. E.; Miyasato, K.: and Jasinski, D. R.

Cigarette smokers self-administer intravenous nicotine. Pharm

Biochem Behav, 1983c (in press).

Poling, A. D., and Henningfield, J. E. Behavioral pharmacology

and principles of drug action. In: Breuning, S., and Poling,

A. D., eds. Drugs and Mental Retardation. Springfield:

Charles C. Thomas, Publisher, 1982, pp. 86-137.

Spealman, R. D., and Goldberg, S. R. Maintenance of

schedule-controlled behavior by intravenous injections of

nicotine in squirrel monkeys. J Pharmacol Exp Ther, 223:

402-408, 1982.

37
Thompson, T.T., and Schuster, C. R. Behavioral Pharmacology.

Englewood Cliffs, NJ: Prentice-Hall, Inc., 1968. 1968

U. S. Department of Health and Human Services, public Health

service. Why People Smoke Cigarettes. Washington, D. C.:

supt. of Docs., U. S. Govt. Print. Off., PHS Publication No.

(PHS) 83-50195, 1983.

38
Analysis of Reinforcement

by Varying Smoke Component Concentrations

Jed E. Rose, Ph.D.

Since nicotine is thought to be one of the principal reinforcing

constituents in tobacco, a logical way to classify smokers may be

to distinguish those who are dependent on nicotine from those who

smoke for other reasons, e.g., other components of tobacco,

sensory/motor aspects of the habit, or social reasons (Russell et

al. 1974). The role of nicotine in cigarette smoking has been

studied by examining smokers' reactions to cigarettes of different

nicotine deliveries or to nicotine preload. By observing

compensatory charges in smoking behavior in response to variable

nicotine delivery (titration) it was hoped that the reinforcing

role of nicotine would be highlighted. The empirical findings have

typically demonstrated statistically significant, but often slight,

compensatory changes in response to varying nicotine yields (Ashton

and Stepney 1982; Gritz 1980).

The methodology about to be described was designed to study the

reinforcing actions of nicotine in smokers in a way that would

overcome two conceptual problem inherent in most nicotine

titration studies. The first problem is that if nicotine is a

reinforcer for smoking, smokers would not be expected to like

low-nicotine cigarettes, and in that case it would not be

reasonable to expect them to smoke for example, 10 times more of a

0.1 mg nicotine cigarette than of a 1.0 mg nicotine cigarette

(which would be required for complete titration of nicotine

intake).

The second problem is that even if titration does occur, it would

be consistent with the view that nicotine is aversive rather than

reinforcing and that smokers are obtaining other reinforcers from

the cigarette (Russell 1979). Although the titration paradigm may

be useful from a practical standpoint for investigating smokers'

responses to altered yield cigarettes, it is not an appropriate

methodology for the study of nicotine's reinforcing value.

METHOD

The new methodology to be described here explores variations in

nicotine preference In which the concentration of nicotine in each

puff of smoke is under the subject's control. In this choice

procedure, subjects utilize a smoke-mixing apparatus to adjust the

nicotine concentration in cigarette smoke on a puff-by-puff basis

39
and select an optimal nicotine delivery. The rewarding and/or

aversive properties of nicotine at a specific time can be inferred

by the nicotine level chosen.

The smoke-mixing device (figure 1)1 consists of a two-barreled,

glass cigarette holder, constructed from a three-way stopcock, that

blends smoke from two, sources: a high- and a low-nicotine

cigarette, roughly equivalent in other respects (e.g., tar

delivery, carbon monoxide). For this purpose, we have employed the

University of Kentucky Reference cigarettes: 2A1, 0.45 mg

nicotine, 36.4 mg tar; 2R1, 2.45 mg nicotine, 35.8 mg tar. As in

blending hot and cold water with a faucet, subjects may turn a knob

and vary the ratio of smoke drawn from the two cigarettes and,

hence, the nicotine concentration of the smoke inhaled. The mixing

of smoke takes place within the modified Teflon stopcock, also

shown in figure 1. The center core of the stopcock was first

drilled out, and then three slits were cut to allow the inside to

communicate with the exterior. One of these slits, the largest

(approximately 3 mm wide), connects to the mouthpiece and allows

smoke to travel unimpeded into the smoker's mouth. The other two

slits, located on the opposite side of the stopcock, are much

narrower (approximately 1.2 mm wide). These two smaller slits are

offset with respect to each other, so) that when one is perfectly

aligned with one channel of the cigarette holder, the other is not,

and vice versa. Intermediate rotations of the stopcock cause

partial aligment of each slit with the corresponding channel in

varying degrees. At a given setting, same smoke is drawn through

each side of the mixer. The precise ratio depends on the alignment

of the slits, which is controlled in turn by the adjuster (vernier)

knob operated by the subject. The overall draw resistance

present& by both slits is negligible compared to that of a

cigarette.

The flow of smoke through each side of the holder is measured by

differential pressure transducers (Statham Model PM6TC±2.5-350),

which sense the pressure difference across the restriction tuba in

each barrel. The diameter of this tube (1.6 mm) is sufficient to

prevent accumulation of smoke residue and presents a small, fixed

draw resistance. The use of differential pressure. measurements

across a constant resistance is necessary so that variations in the

length of the cigarette as it burns do not affect the relationship

between flow and pressure measured by the transducer. This system

is similar to those used previously in studies of smoking

topography (Creighton et al. 1978; Rawbone et al. 1978). The

output from the transducers leads to a polygraph to be recorded,

and measuring the height of the puff profile on each channel yields

the flow through that side. Two additional polygraph channels

record the volume of smoke taken in through each channel, after

intermediate circuitry has linearized and integrated the signals

from the pressure transducers. Calibration records were produced

by independent determination of flows using a vacuum pump and

Gilmont spherical float flow meters. The estimate of nicotine

delivery (Nic) of the smoke mixture is computed as follows:

40
SMOKE MIXING DEVICE

Figure 1

Smoke-mixing device used to assess smokers’ nicotine preference. The knob controls the positions of mixing

slits which blend high and low nicotine smoke to achieve intermediate nicotine deliveries.

Tar delivery is held constant with the research cigarettes employed. The mixture setting chosen with

each puff is measured with pressure transducers that monitor the flow of smoke through each barrel

of the mixer.

Copyright 1982 Psychonomic Society, Inc.

Reprinted by permission of the author.
Nic (mixture) = Volume (Side 1)Nic 1 + Volume (Side 2)Nic 2

Volume (Side 1) + Volume (Side 2)

Nic 1 and Nic 2 are the nicotine deliveries for the two types of

cigarettes employed.

There are two main sources of error to be considered in this

measurement. The first is random variations in nicotine delivery

between puffs from cigarettes of a given type. This error includes

variations in nicotine concentration accompanying changes in the

rate of puffing or volume (Creighton and Lewis 1978). The

magnitude of this error is probably Less than ±10% in the range of

puff parameters commonly encountered; however, observed puff

volumes and interpuff intervals could be used in a retrospective

analysis to improve the estimates of per-puff nicotine deliveries.

The second source of error is the systematic increase in the

concentration of smoke products across puffs from a single

cigarette due to the rod filtration effect (Russell et al. 1979;

Wiley and Wickham 1974: Young et al. 1991). This factor can be

corrected, for it is known precisely how nicotine deliveries vary

across the length of the particular cigarettes employed, and it can

be minimized by restricting smoking to the distal halves of the

cigarettes used. The burn rates of the two types of University of

Kentucky research cigarettes are very similar over a wide range of

mixture settings, so that the lengths and relative contributions of

each cigarette to total nicotine delivery remain nearly constant

across the length of the cigarettes.

A simpler measure of nicotine preference may also be employed: the

relative ratio of smoke drawn through the high nicotine side. This

latter measure more clearly reflects the behavior of the subject

(in adjusting the knob position) and is less sensitive to

inaccuracies in determining absolute nicotine deliveries per puff.

Positively reinforcing aspects of nicotine would be unambiguously

demonstrated by the choice of a mixture delivering more than 50%

smoke from the high nicotine side, and, conversely, an aversion to

nicotine would be clearly evidenced by a selection of the lowest

nicotine delivery. Selection of a 50-50 mixture would indicate

either indifference to nicotine or a positive preference for that

intermediate nicotine level. Selection of mixtures delivering

between 0 and 50% from the high nicotine side are similarly

ambiguous in that they would be consistent either with a mild

aversion to nicotine or simply a preference for a positiveliy

reinforcing, but lower concentration, of that substance.

Inasmuch as smoking abstinence has been shown to be a potent

variable influencing subsequent smoking (Kumar et al. 1977;

Henningfield and Griffiths 1973), our first goal in the behavioral

application of the smoke mixer was to measure variations in

nicotine preference resulting from smoking abstinence and

satiation. In analogy to the work of Gabanac (1971), who showed

that food-deprived subjects preferred more concentrated sugar

solutions than satiated subjects, it was predicted that if

cigarette deprivation produced a nicotine "hunger," subsequent

preference for nicotine should likewise increase.

42
Subjects

Twenty smokers, who regularly consumed at least a pack a day, and

whose customary brand of cigarette delivered (by FTC method) over

0.5 mg, were recruited for the study. Subjects included 12 males

and 3 females, with an average age of 38 years.

Procedure

Subjects' nicotine preference was assessed under two, conditions:

Deprivation, in which subjects abstained from smoking for

approximately 2 hours (1 hour before entering the laboratory and an

additional 50 minutes after arriving): and Satiation, in which

subjects smoked two cigarettes of their own brand in the 20 minutes

immediately prior to the nicotine preference test.

During the nicotine preference test, subjects were instructed

simply to find their preferred nicotine concentration, using the

mixing device to blend smoke with each puff from the high and low

nicotine research cigarettes. They were free to use any cues for

finding their optimal nicotine mixture, including the immediate

sensory impact of nicotine (Cain 1980), or the pharmacologic

effects which occur within seconds of inhalation (Russell and

Feyerabend 1979). To the extent subjects desired the higher

nicotine smoke, they could adjust the mixture to as high as 2.45

mg. (Mean nicotine delivery of subjects' habitual brands was 1.60

mg.) For half of the subjects, the high-nicotine cigarette was

placed in the left barrel of the mixer, and for the other half the

positions of the high- and low-nicotine cigarettes were reversed.

A replication of each condition was presented (an a different day),

and since the results from the days within a condition did not

differ, the data were averaged across replications. Two behavioral

measures of smoking were compared between Deprivation and Satiation

conditions: 1) average nicotine preference (averaged across all

puffs taken in the preference test); and 2) number of puffs taken

during the test. Additionally, after each puff subjects used two

ten-pint scales to rate the perceived "strength" and

"desirability" of the smoke.

RESULTS AND DISCUSSION

Figure 2 depicts the results, which show subjects' preference for

significantly higher nicotine concentrations in the Deprivation

condition than in Satiation (t=2.23, p<.04). Further, subjects who

selected consistently higher nicotine levels in Deprivation than

Station in both replications (n=9), chose a mixture in

Deprivation that was not only greater than the low-nicotine extreme

but also significantly higher than the 50-50 indifference point

(t=2.42, p<.05). This constitutes direct evidence confirming

nicotine's role as a desired ingredient in cigarette smoke.

Ingesting high-nicotine smoke was more reinforcing after A period

of cigarette deprivation, when nicotine levels ware presumably low.

Smoking abstinence indeed seems to evoke a hunger for nicotine in

43
Figure 2

Mean nicotine preference and number of puffs taken during test smoking period after two hours'

smoking abstinence (Deprivation) and after smoking two cigarettes (Satiation).

Significant elevations in both smoking parameters occurred after cigarette deprivation.
at least some smokers. For the same subjects, the level of

nicotine selected during Satiation was marginally lower than the

indifference point (t=2.22, p=.06), suggesting that nicotine

aversion may have influenced preference in Satiation (see figure 3).

The assessment of nicotine's aversive qualities depends in part

upon whether the criterion for aversion is the choice of a mixture

below the indifference point or selection of the lowest nicotine

level possible. Subjects also took significantly more puffs after

a period of cigarette deprivation than when satiated (t=2.73,

p<.02). Subjects thus increased nicotine intake after smoking

abstinence in two ways: taking more puffs as well as increasing the

nicotine {mixture of each puff. The increase in puffing was, of

course, not a specific measure of nicotine-seeking (unlike the

mixture adjusment) and may have reflected deprivation for

non-nicotine factors in the smoking habit, such as oral or

manipulative reinforcement.

In the Satiation condition suppression of smoking was not complete.

This may have been due to the fact that the two cigarettes

presented in Satiation were insufficient to reverse the effects of

almost 2 hours' Deprivation, during which many subjects would have

smoked as many as three or four cigarettes. Alternatively, there

may be an extremely rapid recovery from the satiating effects of

cigarette smoking, storming from the very short distributional half

life of nicotine (Benowitz et al. 1982).

In order to identify characteristics of smokers who were more

responsive to the Deprivation manipulation, additional statistical

analyses were conducted. The magnitude of increase in nicotine

preference with Deprivation was found to be positively correlated

(r=.61, p<.O1) with the subject's age. In contrast, subjects whose

puffing behavior was most affected by the experimental maniplation

tended to report smoking most in social situations (r=.63, p<.01).

The fact that puffing and nicotine preference were correlated with

different subject characteristics suggests that these two factors

may represent different types of reinforcement gained from smoking.

The subjective judgments of strength and desirability also differed

between experimental conditions. Puffs were rated as significantly

Less strong (t=2.25, p<.04) and more desirable (t=2.38, p<.03)

following Deprivation. Desirability ratings from each subject did

not correlate with nicotine delivery (t=0 and .05 for Deprivation

and Satiation, respectively, p>.5), suggesting that many other

factors affect the subjective enjoyment of smoking, or,

alternatively, that each subject's ratings varied nonlinearly with

nicotine delivery. Goldfarb et al. (1976) and Pose (1983) also

reported the absence of a correlation between satisfaction ratings

and nicotine delivery, whereas strength ratings were positively

correlated with nicotine. In the present study, subjects generally

displayed a positive correlation between nicotine content of each

puff and perceived strength (t=4.36 and 6.23 for Deprivation and

Satiation, respectively, p<.001). me fact that subjects rated

puffs as weaker in Deprivation, even though the nicotine levels

chosen were higher than in Satiation, suggests that smoking

deprivation induces a substantial downward shift in the sensitivity

45
Figure 3

Nicotine preference of subjects who consistently chose higher nicotine levels after cigarette deprivation

(responders) and those who were unaffected by this manipulation (nonresponders). After deprivation,

responders selected smoke mixtures containing significantly more than SO% high nicotine smoke,

which demonstrates the positively reinforcing qualities of nicotine in this condition.
to nicotine. The slopes of regression lines relating perceived

strength and nicotine content did not differ across conditions

(t=.98, p>.3), so the shift in strength ratings represents a

uniform bias rather than a change in discriminability per se.

Perhaps this shift reflects a comparison between the perceived

qualities of the smoke and the desired level of nicotine as

determined by internal cues. Also involved may be the

responsiveness of receptors mediating the common chemical sense,

located in the pharynx and sublaryngeal regions (Cain 1980), or the

sensitivity of CNS receptors for nicotine (Abood et al. 1979). The

relative importance of central versus peripheral stimulation in

discriminating nicotine's reinforcing effects has not as yet been

firmly established. Further studies which identify the factors

affecting nicotine preference and satiation should significantly

clarify the psychopharmologic basis of cigarette smoking.

Although primarily designed to study nicotine preference, the smoke

mixing methodology can be applied to the investigation of other

factors important in smoking reinforcement. For example, "tar" has

been suggested to play an important role in modulating the sensory

and pharmacologic effects of inhaled nicotine, and conceivably

contains additional constituents important in their own right

(Goldfarb et al. 1975). By placing in the smoke mixer cigarettes

of equal nicotine delivery but high and low in tar delivery,

preference for tar concentration may be measured. Technical

refinements will allow the construction of cigarettes with

alterations in the delivery of more specific ingredients.

Preference for any constituent of tobacco smoke may thus be

explored with the present methodology, if cigarettes are available

with high and low yields for that particular component.

REFERENCES

Abood L.G.; Lowy K.; Tometsko A.; and McNeil M. Evidence for a

noncholinergic Site for nicotine's action in brain: psychopharmacological, electrophysiological and receptorbinding studies.

Arch Int Pharmacodyn, 237:213, 1979.

Ashton, H., and Stepney R. Smoking Psychology and Pharmacology.

London: Tavistock Publications, 1972.

Benowitz, N.L.; Jacob, P., III; Jones, R.T.; and Rosenberg, J.

Interindividual variability in the metabolism and cardiovascular

affects of nicotine in man. J Pharmacol Exp Ther, 221:368, 1932.

Cabanac, M. Physiological role of pleasure. Science,

173:1103-1107, 1971.

Cain, W.S. Sensory attriutes of cigarette smoking. In: Banbury

Report No. 3: A Safe Cigarette? G. B. Cori and F.G. Bock, Eds.

New York: Cold Spring Harbor Laboratory, 1980.

47
Creighton, D.E.; Noble, M.J.; and Whewell, R.T. Instruments to

measure, record and duplicate human smoking patterns. In: Thornton,

R.E. ed. Smoking Behaviour: Physiological and Psychological

Influences. Edinburgh: Churchill Livingstone, pp. 277-293, 1970.

Goldfarb, T.; Gritz, E.R.; Jarvik, M.E.; and Stolerman, I.P.

Reactions to cigarettes as a function of nicotine and "tar".

Clin Pharmacol Ther, 19:767-772, 1976

Gritz, E.R. Smoking behavior and tobacco abuse In: Advances in

Substance Abuse, V. 1. New York: JAI Press, p. 91-158, 1990.

Henningfield J.E., and Griffiths, R.R. A preparation for the

experimental analysis of human cigarette smoking behavior.

Beh Res Methods & Instrumentation, 11:538-544, 1979.

Kumar, R.; Cooke E.C.; Lader, M.H.; and Russell, M.A.H. Is

nicotine important in tobacco smoking? Clin Pharmacol Ther

21:520-529, 1977.

Rawbone, R.G.; Murphy, K., Tate, M.E.; and Kane, S.J. The

analysis of smoking parameters: Inhalation and absorption of

tobacco smoke in studies of human smoking behavior. In:

Thornton, R.E., ed. Smoking Behaviour: Physiological and

Psychological Influences. Edinburgh: Churchill Livingstone,

pp. 171-194, 1978.

Rose, J.E. Discriminability of nicotine in tobacco smoke.

Addictive Behaviors (in press), 1983.

Russell, M.A.H. Tobacco dependence: is nicotine rewarding or

aversive? In: Krasnegor, N.A., ed. Cigarette Smoking as a

Dependence Process National Institute on Drug Abuse Research

Monograph 23. Washington, D.C.: Supt. of Docs., U.S. Govt.

Print. Off, 1979, p. 100-122.

Russell, M.A.H., and Feyerabend, C. Cigarette smoking; a

dependence on high-nicotine boli. Drug Metabolism Reviews,

8:29-57, 1378.

Russell, M.A.H.; Peto, J.; and Patel, U.A. The classification of

smoking by factorial structure of motives. J Roy Statist Soc A

137:313-333, 1974.

Russell, M.A.H.; Sutton, S.R.; Feyerabend, C.; and Cole, P.V.

Addiction Research Unit titration studies, In: Thornton R.E., ed.

Smoking Behaviour: Physiological and Psychological Influences.

Edinburgh: Churchill Livingstone, pp. 336-348, 1978.

48
Wiley, R.M., and Wickham, J.E. The fabrication and application of

a puff-by-puff smoking machine. Tobacco Science, 18:67-69, 1974.

Young, J.C.; Robinson, JD.; and Rickert, W.S. A study of chemical

deliveries as a function of cigarette butt length. Beitrage zur

Tabakforschung International, 11:87-95, 1981.

FOOTNOTE

1. This paragraph, the following two paragraphs which describe the

smoke-mixing device, and figure 1 are reprinted from Rose, J.E.;

Lafer, R.L.; and Jarvik, M.E. A smoke-mixing device for measuring

nicotine preference. Behavior Research Methods & Instrumentation

14(6), 501-503, 1982. Copyright 1982 Psychonomic Society, Inc.

They are reprinted by permission.

49
Physical Indicators of Actual Tar

and Nicotine Yields of Cigarettes

Lynn T. Kozlowski, Ph.D.

By the late 1960s, cigarette tar was becoming officially dangerous to the

health of smokers (e.g., USPHS 1964). Those who refused to stop

smoking were encouraged to smoke lower tar and nicotine cigarettes. In

1967, the Federal Trade Commission (FTC) established a laboratory to

conduct standardized assays of the tar and nicotine yields of cigarettes.

This standard smoking-machine procedure provided the yardstick by

which all cigarettes were to be measured. Lower tar cigarettes, by

definition, deliver lower tar when smoked in the standard fashion of one

2 second long, 35 ml puff each minute until a fixed butt length IS

reached. Except for small differences in rules for butt length, this

machine procedure is the internationally standard way to smoke

cigarettes in the analytical laboratory (Coresta 1969; ISO 1977).

Whenever and wherever (world-wide), one sees official tar and nicotine

yields, whether in a United States Surgeon General’s Report or on a

billboard, one can assume that the brand in question has undergone this

exact smoking regimen.

THE CRADLE OF THE STANDARDIZED SMOKING MACHINE TEST

Interestingly, the origin of the 2 sec, 35 ml puff/mm regimen IS generally

not known. Although my research has explored limitations of standard

smoking-machine assays (Kozlowski et al. 1980b; Kozlowski 1981a;

Kozlowski 1981b; Kozlowski et al. 1982b), I had not tried to trace the

origins of the puffing regimen. It has been assumed that average

human smoking behavior somehow provided the basis for the procedure.

Further, it has been assumed that the standards derived from the

smoking of the stronger, shorter, and less-filtered cigarettes of 20 to 30

years ago.

The standard regimen appears to have been born in the laboratory of the

American Tobacco Company (ATC), Richmond, Virginia, in the 1930s

(Bradford et al. 1936). AT the time, ATC dominated the manufacture of

cigarettes in the United States (Overton 1981). The Bradford et al.

article proposed to create a standardized smoking machine procedure

“in the interest of economy of research, and harmony among the various

investigators” (p. 836).

In a book published to promote an ATC brand at the 1939 New York

World’s Fair, Flannagen (1938) describes a tour of the ATC analytical

laboratory. The author appears to have seen the Bradford et al.

equipment in action: “Fascinated, I soon learned [from his guides] some

interesting facts about smoking cigarettes. The average puff, for

50
instance, contains 35 cubic centimeters of smoke, and the smoke moves

through the cigarette at the rate of 17 cubic centimeters per second.

The normal time between puffs is 60 seconds.... All of these human

phenomena and others were reproduced faithfully by the machine” (p.

78).

Inspecting the original Bradford et al. paper, however, one finds the

empirical basis for these “average” and “normal” values of smoking

behavior lies in a study by Pfyl (1933). In 7 subjects, Pfyl had found puff

volumes of from 29 to 61 ml (Mean = 42.3, SD = 10.4). (Though

commonly described as puff volumes, Pfyl’s values were for air intake

into the cigarette during a puff; Schur and Rickards (1957) found that an

air intake of 35 ml was equivalent to a smoke gas phase volume, i.e.,

the modern smoking machine’s puff volume, of 42 ml--a 20% difference.)

Pfyl set his own smoking machine to take a 2 sec, 40 ml puff twice a

minute. Bradford et al. commented that Pfyl’s smokers probably smoked

more vigorously than normal because of the experimental setting, and

the authors close their article by stating “The present writers’ arbitrarily

selected rate IS a 35-cc. puff of 2-second duration taken once a minute”

[emphasis added] (p. 839). Earlier in their article, the authors do give

some rationale for the selection of their machine settings: 1) a puff

should not be larger than the capacity of the mouth, but “should be large

enough to produce a generous smoke,” (p. 838), 2) the time between puffs

should be long enough to allow the coal to return to a free-burning

condition, and 3) the puff should neither be too rapid nor too slow.

For those Interested in smoking behavior, the standard assay lacks the

empirical, objective pedigree that has been assumed. Standard tar and

nicotine assays were born in the tobacco science laboratory out of a

need to precisely quantify cigarette smoke. Bradford et al. (1936) and

their colleagues in tobacco science should not be faulted for devising a

procedure to meet their own special needs. It has long been clear that

smoke yields depend on the exact manner in which a cigarette is smoked.

To do analytical research on cigarette smoke, an agreed upon standard

smoking procedure was mandatory so that conditions could be

reproducible from laboratory to laboratory and from experiment to

experiment. The idea, then, was not to come up with a model of average

human smoking behavior, but rather to arrive at a reasonable, fixed and

reproducible way of putting cigarettes through their paces so that

chemical and physical properties could be examined (see Wynder and

Hoffmann 1967).

Note that the standard procedure was created primarily to compare

quite similar cigarettes when smoked in exactly the same way. Between

the 1930s and the 1950s, most cigarettes were 70 mm long. The modern

cigarette market has all but forgotten the early best-sellers and includes

mainly filter cigarettes (both ventilated and unventilated) that are 80

mm (in boxes), 85 mm (in softpack), 100, or even 120 mm long. The

complex issues of varying smoking habits, the behavioral pharmacology

and behavioural toxicology of smoking, and reduced-risk smoking were

not salient at the outset of the standard assays. The smoking and health

industry had not attained the prestige and Influence of the present day.

51
AVERAGE SMOKING BEHAVIOR AND STANDARD YIELDS

The writings on smoking machine tests before 1960 show that little

effort was made to determine “average” puffing values for a

representative sample of smokers. Puffing measures were mainly taken

on convenient samples (e.g., Schur and Rickards 1957). A detailed

review of measurements of average human smoking behavior will not be

attempted. Moody (1980) provides a brief review of earlier findings, and

his own study employs the largest sample of smokers (517 adult medical

patients). HIS laboratory procedures find average puff durations of 2.12

sec (SD = 0.881, puff volumes of 43.5 ml (SD = 21.91, puff intervals of

25.8 sec (SD = 17.1). One can estimate from this research that the

standard puff IS 20% smaller, 6% faster, and 133% less frequent than

that of the “average” smoker in the laboratory. Of course, as noted by

Bradford et al. (1936), the behavioral laboratory does appear to lead to

more intensive smoking than do more natural smoking conditions (e.g.,

Russell et al. 1982). There are probably as many “average” smoking

behaviors as there are distinct psychological settings for smoking. For

example, poorer, older male smokers are more intense smokers per

cigarette than are richer, younger males (Moody 1980).

Even if a valid or accurate estimate of average smoking behavior IS

attainable, it does not follow that it would be sufficiently reliable or

precise to give many smokers information about their own idiosyncratic

tar and nicotine yields from a given brand. The ideal average smoker

may always be an inadequate stand-m for individual smokers; an average

value tells you about the behavior of other members of the population to

the extent that the other members of the population cluster in close

proximity to the average. From Moody (1980), one can estimate that

68% of smokers have puff volumes that are between 21.6 and 65.4 ml;

the coefficients of variation are substantial: 41.5% for puff duration,

50.3% for puff volume, and 66.2% for puff interval. The variability of

human smoking behavior IS large enough that standard yields do not, on

their own, provide a good indication of actual yields to individual

smokers (Green 1978; Kozlowski 1981b). A valid average tar and

nicotine yield might, however, be useful for epidemiological studies on

dose-disease relationships in large samples of smokers (Kozlowski et al.

1982c).

OTHER PROBLEMS WITH THE STANDARD SMOKING MACHINE

To understand the deficiencies of standard tar and nicotine assays, it

helps to understand the strategies involved in the construction of loweryield cigarettes. The standard procedure, one discovers, provides the

hurdles, while design variants provide ways around the hurdles. For the

most part, standard tar and nicotine yields are altered in only two ways.

Cigarettes are constructed to either a) burn faster and therefore have

fewer puffs taken during the standard one puff per minute procedure or

b) produce lower concentration smoke per puff. Table 1 outlines some

common manufacturing techniques for reducing standard tar and nicotine

yields.

52
Number of Puffs

Remember that the standard procedure does not specify a number of

puffs to be taken on the cigarette, but rather a puffing-rate. Changes in

total burn-time seem to have been a major strategy responsible for yield

reductions between 1967 and 1975 (Kozlowski et al. 1980b). Dropping

just one puff from a 20 mg tar cigarette can reduce the yield by 2 to 3

mg.

Tobacco manufacturers, themselves, argued that the FTC cigarette tests

should make systematic use of information about puff variations from

brand to brand: “...the failure to report results both on an average per

puff and average per cigarette basis would create bias and have

unwarranted adverse competitive effects.” (American Tobacco Company,

Brown & Williamson Tobacco Corporation, Liggett and Myers Tobacco

Company, Philip Morris Incorporated, and R.J. Reynolds Tobacco

Company, December 20, 1966, p. 10). (See also Keith and Newsome

1958). When one appreciates that a standard procedure caused 6.9 puffs

to be taken on one filter king size (85 mm) cigarette and 11.5 puffs on

another filter king size (85 mm) cigarette (a difference of 66.6%, Jenkins

et al. 1979), it IS unfortunate that the warning by the tobacco companies

was not heeded. If 120 mm cigarettes are considered, machine puffs

ranged from 6.9 to 16.3 (a difference of 136%) (Jenkins et al. 1979): This

means that a pack-a-day, puff-per-minute smoker of the 16.3 puff

cigarette would be taking 136% more puffs per day than would the same

kind of smoker of the 6.9 puff cigarette, yet nominally they would both

be pack-a-day smokers.

TABLE 1

REDUCING STANDARD TAR AND NICOTINE YIELDS

A. REDUCE NUMBER OF PUFFS PER CIGARETTE BY

1. decreasing length of available tobacco column with

a. longer overwraps

b. longer filters

2. increasing the burn-rate of column with

a. chemical additives

b. higher porosity paper

c. less tobacco (wt/vol)

B. REDUCE CONCENTRATION PER PUFF BY

1. increasing filter-efficiency with

a. ventilated-filters

b. longer filters

c. denser filters

2. increasing porosity of cigarette paper

3. decreasing tobacco leaf (wt/vol) with

a. reconstituted sheet tobacco

b. puffed tobaccos

c. flavorings and additives

4. increasing the use of lower-yields tobacco strains

53
The Behavioral Problem of Vent-Blocking

Unquestionably, the most dramatic yield reductions in recent cigarettes

are due to the effects of filter ventilation. The modern ultra-low-yield

cigarette (< 6 mg tar) IS a ventilated-filter cigarette. On a 1 mg tar

cigarette a vented filter can cause each puff to be diluted by about 80%

with ambient air (Kozlowski 1981c). In addition to affording all the

traditional opportunities for compensatory smoking (e.g., more

cigarettes, larger puffs, more frequent puffs), vented-filter cigarettes

can have the air intake holes on the filters blocked by smokers’ lips or

fingers (Kozlowski 1983). Kozlowski et al. (1982b) found that about 40%

of them sample of long-term smokers of vented cigarettes blocked the

vents to a substantial degree. Table 2 shows how dramatically holeblocking, coupled with somewhat larger and more frequent puffs, can

increase tar, nicotine, and carbon monoxide yields on selected “lowest”

yield cigarettes from three countries. Whereas smokers are free to

block filter vents, smoking-machine rules rigidly specify the amount of

filter inserted into the holder: Air intake holes can not be blocked by

the “smoker” in the course of a standard assay.

TABLE 2

EFFECTS OF INTENSIVE SMOKING ON LOWEST YIELDS

COUNTRY STANDARD ASSAY INTENSIVE ASSAY

TAR NIC C O TAR NIC CO

U.K. 1 0.1 1 29 2.2 21

CANADA 1 0.1 2 15 1.1 24

U.S. 1 0.1 2 12 0.8 18

The intensive procedure was a 2.4 sec, 47 ml puff every 44 sec;

all values are in mg; for more data and details about brands,

see Kozlowski et al.

Addiction. Reprinted by permission.

(1982b). © 1982, British Journal of

GOING BEYOND THE STANDARD ASSAY

The standard tar and nicotine numbers result from an artificial and

unsatisfying “method of convenience.” Standard ratings offer more to

the tobacco scientist than the behavioral scientist, yet they are often

taken at face value by behavioral scientists, as i they were almost

perfect predictors of actual yields achieved by a given smoker of a given

cigarette (e.g., Foxx and Brown 1979).

Armed with reasonable standards, the tobacco science field over the

years has become invested in maintaining the settings of a 2 sec, 35 ml

puff, once a minute. Tampering with the standard puffing procedure, it

has been argued, would disrupt the continuity and historical

comparability of much of tobacco science. Despite the weaknesses of

such arguments, it might be more realistic to propose that an improved

54
procedure should be added alongside the sanctified standard, rather than

to urge the complete abandonment of the standard. The spent cigarette

butt of a filter cigarette is in a unique position to supply information

about the actual yield of tar and nicotine from that cigarette “Yield”

here refers essentially to mainstream smoke, or, in other words, the

smoke drawn through the filter as a result of puffing.

The study of tar and nicotine deliveries should not be mistaken for the

study of the burden of tar and nicotine in the smoker’s body. Exposure at

critical tissue sites IS dependent on myriad factors (e.g., inhalation,

levels of drug-metabolizing enzymes), and it is unrealistic to expect that

any measure of how much smoke has issued from the smoker end of a

cigarette can be anything but a rough indicator of pharmacologically or

toxicologically significant exposure.

USING PHYSICAL EVIDENCE TO DETECT ACTUAL YIELDS

The remainder of this paper focuses on what can be learned from the

tracks of smoke (tar stains) left behind in cigarette filters. Even a

novice can read these tracks, to get an idea of the actual tar and

nicotine yields of cigarettes. A skilled reader of sign, using a camera or

equipment for chemical analysis, can achieve a more objective, yet still

unobstrusive, measure of what has been delivered through the smoker

end of a cigarette. Cigarette filters can provide useful information

about how an individual cigarette has been smoked, and the physical

evidence of these filters can help in the estimate of the actual tar and

nicotine deliveries of cigarettes. The resultant measures are

approximate indicators of behaviors and yields that are difficult to

estimate in any more practical and less expensive way. Filter analyses

can provide a summary indication of the puffing behavior that has

occurred, but these analyses may say little about how the smoke was

used after the puffs were taken.

USING STAIN PATTERN TO DETECT HOLE-BLOCKING

About 40% of current hole blockers seemed to be unaware that they did

block the vents (Kozlowski et al. 1982b). Those who were aware of

blocking the holes appeared to think their actions served mostly to make

the cigarette easier to light and more flavorful, and these smokers (and

many researchers) were ignorant of the powerful effects on tar, nicotine,

and carbon monoxide yields (see Table 2).

Most ventilated filters have air-intake holes that feed the diluting air

directly into the cellulose acetate filter. In these cigarettes, when the

holes are blocked, a bull’s-eye tar stain pattern will be seen in the

smoker end the filter, surrounded by a ring of unstained filter (see Figure

1). Insofar as the vents are blocked, the tar stain extends to the edge of

the filter and, in the extreme, forms a uniform field of tar stain on the

end of the filter. If the filter vents were blocked by a pinch of the

fingers that occluded the same opposing set of holes on each puff, the

tar stain would form a band between the blocked holes. Blocking on a

few puffs would likely cause a somewhat irregular tar stain, with a

darker central region. Incidentally, lipstick stains over the vent holes

also give physical evidence of hole-blocking.

55
FILTER SECTIONS

SIDE VIEW END VIEW

FIGURE 1 - shows the progressive staining of the proximal end

(A & D) of the filter downstream from the perforation line (C)

as the number of holes blocked increases from one in filter 1,

to a partial block in filter 2, and a complete block in filter

3. B is the distal end of the filter. Kozlouski et al. 1980a.

© 1982, American Public Health Association. Reprinted by

permission.

Photographic records can be made of the stain patterns, to aid in scoring

the spent filters. At the present time, it is best to try to sort a smoking

episode into one of three categories: 1) the holes were extensively

blocked, 2) the holes were not at all blocked, 3) the holes were partially

or occasionally blocked. The discrimination is most reliable between the

first and second categories; avoiding the approaching coal can cause

finger-blocking on the last few puffs and, hence, an intermediate stain

pattern (Lombardo et al. 1983). More precise quantification will have to

await the development of techniques for scanning and scoring carefullycontrolled photographs of butts.

Knowledge of hole-blocking can inform smokers and researchers of

egregious misuse of a low-yield cigarette If the vents have not been

blocked, it does not ensure that the cigarette was not oversmoked in

some more traditional manner. A pamphlet (Kozlowski 1982) has been

prepared, to explain to consumers some of the complex risks involved

with switching to low-yield cigarettes.

56
USING STAIN INTENSITY TO DETECT ACTUAL YIELDS

Chemical assays for residual nicotine in spent filters have been used to

provide estimates of “mouth level exposure” or yields (e.g., Forbes et al.

1976; Kozlowski 1976). These estimates depend on the assumption of a

constant filter efficiency. Filter efficiency refers roughly to the

percentage of smoke ingredient presented to the filter that is trapped in

the filter. Knowing the filter efficiency and the amount of nicotine (or

other marking ingredient) trapped in the filter, one can calculate the

amount of nicotine that passed through the filter. Unfortunately, filter

efficiency can be altered, especially by factors that Influence puff

velocity (e.g., Creighton and Lewis 1978). The faster the puff velocity,

the less efficient the filter. (Note that the Moody 1980, study would

have a puff velocity of 20.5 ml/sec, whereas the standard assay has a

17.5 ml/sec puff velocity--a 17% difference.) Since blocking vent holes

causes an increase in puff velocity through the filter and a resultant and

substantial drop in filter efficiency, evidence of hole-blocking should

disqualify a butt from this method of estimating yields.

A color-matching technique (called the CMT scale) IS being developed,

employing the same general principles as the butt-nicotine estimates of

mouth-level exposure. The CMT scale IS also dependent on the

assumption of constant filter efficiency, and, because of this intrinsic

limitation, it is likely, at best, to provide ballpark estimates of tar and

nicotine yields, rather than pinpoint figures. Tar stains are visible and

the intensity of the “color” of a tar stain Increases as the amount of tar

Increases.

Kozlowski (1981b) proposed that visible differences in tar stains could be

used to detect how much a smoker had puffed on a given cigarette, and

showed that individuals could tell faultlessly that a 12-puff butt was

darker than a 6-puff. Kozlowski et al. (1982a) showed that individuals

can make even finer discriminations of tar variations, if they rate

“lightness or darkness in color” by comparing butts to a scale made up of

colored papers.

The original CMT scale was created by matching specially smoked butts

with colored papers from the Pantone by Letraset Color-matching

System. Three prototype butts were prepared: one resulting from a

light smoke (a 2 sec, 25 ml puff/120 sec), one from a standard smoke, and

one from a heavy smoke (a 2.5 sec, 45 ml puff/20 sec). A best-selling

filter cigarette (standard yield: 0.9 mg nicotine, 16 mg tar, in about 10

puffs) was used in all phases of this project. The optimal, though not

perfect, matches were, respectively, a pale yellow (Pantone 127 U), a

greenish brown (Pantone 117 U), and a brown (Pantone 139 U). The

“light,” “standard,” and “heavy” colors were mounted at points designated

as 2, 5, and 8 on a 0 to 10 scale (see Kozlowski et al. 1982a, for details

and a picture of the instrument).

To supply filters for rating, 5 to 16 approximately standard puffs were

taken on cigarettes of the same brand. This puff manipulation was

designed to produce a substantial, but reasonable, manipulation of tar

yields. The difference in yields from 5 to 16 puffs was estimated to be

18 mg tar and 1 mg nicotine. Eleven adults gave each filter a score on

57
the CMT scale. Table 3 shows a summary of the results (the data have

been smoothed somewhat by averaging scores across subjects and across

adjacent pairs of puff numbers). The raters were clearly able to do the

task (Linear regression, Puffs = 3.1 (Rating) -6.0; r = .996). Correlations

between numbers of puffs and CMT score for the individual participants

were .99, .98, .97, .96, (N : 4), .90, .83, .82 (Ps < .05, 2 tailed) and .73

(p < .10).

TABLE 3

EFFECT OF NUMBER OF PUFFS TAKEN ON CMT SCORES

STANDARD PUFFS TAKEN

CMT SCORE 5-6 7-8 9-10 11-12 13-14 15-16

MEAN 3.6 4.5 4.9 5.5 6.2 6.9

S.D. 1.0 1.0 0.8 1.0 0.8 0.7

Kozlowski et al. 1982a. © 1982, American Public Health

Association. Reprinted by permission.

Hopefully, the CMT scale can be developed to provide smokers with, in

effect, a speedometer and an odometer to aid them in monitoring their

own tar and nicotine yields. The CMT scale can be combined with

information about the range of possible yields from a brand and, at the

same time, give smokers some means of gauging where they fall within

that range.

Since this scale IS based on a printer’s color-matching system, it could be

practically applied as part of cigarette packaging, match-book covers, or

supplementary pamphlets on tar and nicotine yields. Apart from giving

the consumer some information on actual yields, there may be additional

benefits in avoiding a presentation of yields that gives only one rating

number per brand. The mode of presenting tar information using a CMT

system shows graphically that actual yields depend on amount smoked.

A FINAL COMMENT

For anyone Interested in human smoking behavior, the standard smokingmachine tests for tar and nicotine yields are so Inadequate that it is easy

to propose improvements. It is not easy, however, to know how much

these improvements might actually help cigarette consumers and

smoking researchers; and, in the long run, it is even harder to know how

these new hurdles might be gotten round by future changes in either

cigarettes construction or smoking-machine procedures.

58
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R.C. Estimating the yield to smokers of tar, nicotine, and carbon

monoxide from the “lowest-yield” ventilated-filter cigarettes. Br J

Addict, 77:159-165, 1982b.

Kozlowski, L.T.; Frecker, R.C.; and Lei, H. Nicotine yields of

cigarettes, plasma nicotine in smokers, and public health. Prevent

Med, 11:240-244, 1982c.

Lombardo, T.; Davis, C.J.; and Prue, D.M. When low tar cigarettes yield

high tar: cigarette filter ventilation hole blocking and its

detection. Addict Behav, 8:67-69, 1983.

Moody, P.M. The relationships of quantified human smoking behavior

and demographic variables. Soc Sci Med, 14A:49-54, 1980.

Overton, J. Diversification and international expansion: The future of

the American tobacco manufacturing industry with corporate

profiles on the “Big Six”. In: Finger, W.R., ed. The Tobacco

Industry in Transition: Policies for the 1980s. Lexington, Mass:

Lexington Books, 1981.

60
Pfyl, B. Zur bestimmung des nicotins im tabakrauch. II. Normung des

kunstlichen verauchens der tabakerzeugnisse. Zeitschrift fur

Untersuchung der Lebensmittel, 66:501-510, 1933.

Russell, M.A.H.; Sutton, S.R.; Iyer, R.; Feyerabend, C.; and Vesey, C.J.

Long-term switching to low tar low-nicotine cigarettes. Brit J

Addict, 77:145-158, 1982.

Schur, M.O., and Rickards, J.C. Design and operation of a multiple

cigarette smoking machine. Tob Sci, 1:13-26, 1957.

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Service. Washington, D.C.: Public Health Service Publication

Number 1103, 1964.

Wynder, E.L., and Hoffmann, D. Tobacco and Tobacco Smoke. Studies

in Experimental Carcinogenesis. New York:

1967, 730 pp.

Academic Press,

61
Measurement of Some

Topographical Aspects of

Smoking in the Natural

Environment

Roy W. Pickens, Ph.D., Steven W. Gust, Ph.D.,

Philip M. Catchings, Ph.D., and Date S. Svikis, B.A.

A major problem in smoking research has been measurement of the

behavior. Instead of a simple response as originally assumed, smoking appears to be a relatively complex behavior. It is composed of

a number of different responses, which include frequency (number of

cigarettes smoked per day, number of puffs per cigarette), durational (puff duration, cigarette duration, interpuff interval, intercigarette interval), and volumetric (puff volume, inhalation volume) components. Together these components comprise a topography

that determines the individual’s actual smoke exposure (Frederiksen et al. 1977).

In smoking research it is important to employ as many measures of

smoking topography as possible in estimating smoke exposure (Griffiths and Henningfield 1982). Measurement of a single aspect of

smoking will not suffice for most research studies. Different individuals may have identical values on certain topographical measures

but differ widely on others and therefore have different levels of

actual smoke exposure. It is also important to employ multiple

topographical measures in studies of factors controlling smoking

behavior, because at least some of the responses comprising smoking behavior appear to be functionally interrelated. When one component of smoking behavior is experimentally manipulated, changes

occurring in that component may be partially offset by compensatory

changes in other components of the behavior (Gust et al. in press).

Precise measurement of smoking topography is therefore essential to

any scientific study of smoking behavior.

For this reason previous studies of smoking topography have been

confined largely to the experimental laboratory. This has been due

primarily to lack of suitable recording devices for measurement of

multiple components of smoking topography in the natural environment (Frederiksen et al. 1979). Previous studies of smoking topography in the natural environment have been limited almost entirely

to single measures of smoking behavior collected by self-report

records, or to a limited number of multiple measures of smoking

behavior determined by direct observation. For the experimental

analysis of smoking behavior, however, self-report records are not

62
sufficiently precise and direct observation is impractical. While

attempts to determine the effects of experimental manipulations on

smoking behavior in the natural environment have also employed biochemical measures to track smoking behavior (Moss and Prue 1982),

such measures have lacked the sensitivity and specificity that is

required to measure cigarette-to-cigarette changes in smoking behavior. In addition, such measures have shown considerable variability between subjects and consequently have not proven reliable in

predicting individual smoking rates.

We have recently developed a small, portable, solid-state device

that can be used in the natural environment to obtain several measures of smoking topography. This device is about the size and

weight of a small transistor radio and can be easily clipped onto a

belt or carried in a coat pocket or purse. It will measure and

record individual puff durations, interpuff intervals, cigarette

durations, and intercigarette intervals, and will also count both

cigarettes/day and puffs/cigarette. The device employs microelectronic technology and can measure time intervals as short as 0.1

sec and as long as 18.1 hours in each of its 2048 memory cells.

Assuming 10 puffs per cigarette, the device has the capacity for

precisely measuring all frequency and durational aspects of smoking

topography for over 100 individual cigarettes over a two-day period. This report describes the operation of the device and computer software that has been developed to facilitate its use.

Studies on accuracy and reliability of the device will also be

reported.

AMBULATORY SMOKING RECORDER

The recorder is an electronic device that precisely measures the

duration of consecutive puffs and pauses that occur in cigarette

smoking. Short pauses separate puffs occurring during the smoking

of a single cigarette, while longer pauses separate puffs into individual cigarettes. By measuring the duration of these puffs and

pauses, it is possible to obtain all of the topographical measures

of smoking described above. In brief, the device functions as follows. Constant-rate pulses from a time-base generator are counted

until onset of a puff. When the puff begins, the number of pulses

accumulated in the counter is stored in a memory cell, the counter

is reset, and counting of pulses from the time-base generator resumes. When the puff ends, the number of counts accumulated in the

counter since the start of the puff is stored in another memory

cell, the counter is reset, and counting resumes. This continues

until onset of the next puff, when the number of counts accumulated

is stored in yet another memory cell, etc. Thus, both the onset

and termination of a puff cause accumulated counts to be stored in

memory cells, with the number of counts appearing in each cell corresponding to the duration of the smoking event. Timing continues

in this fashion until the battery supplying power to the device is

exhausted (56 hrs minimum) or all memory cells have been utilized

(2048).

Specifically, the recorder consists of a standard cigarette holder

that is connected via plastic tubing to a small metal box (1 x 4 x

63
5 in) which the subject carries either in hand or attached to a

waist belt. The weight of the device is approximately one pound.

The cigarette holder (Tar Gard, #1274, Venturi Corp.) is screwed

into one end of a 7/8-in length of 3/8-in diameter brass tubing,

with the other end of the brass tubing holding the cigarette that

is to be smoked. A 1/4-in length of stainless steel tubing is soldered into a hole drilled into the side of the brass tubing. One

end of a 24-in length of plastic tubing (1/16-in I.D., 1/8-in O.D.,

1/32-in wall) is attached to the stainless steel tubing, and the

other end of the plastic tubing is attached to a pressure switch

(Model 505-3, 0.5-in pressure to activate, Coventry Corp.) located

inside the metal box. In addition to the pressure switch, the

metal box contains a rechargeable nickel-cadmium battery (4.8 volts,

.75 amp hrs, Gould Battery Corp.), and printed circuit boards containing microelectronic hardware necessary for measurement and

storage of the durations of the successive smoking events.

To obtain the time measurements, the output of a 3.58 MHz quartz

crystal (ECG 358) is fed through oscillator/dividers (FM5369) into

counters (CD4040) to yield a 1/4 Hz (slow) and 10 Hz (fast) time

base. A separate counter controls a series of multiplexers (74C1571

which direct the time-base output to sequential memory cells. The

memory cells are 16 x 2048 bits of random access low-power CMOS

memory (6514B5261). Initially, only the output from the fast time

base (10 counts/sec) is directed into the memory cells; however,

after 409.6 sec the output from the slow time base (1/4 counts/set)

is directed into the memory cells. Thus, during the first 6 min,

50 sec of an interval, the resolution of the device is .1 sec,

while after this time the resolution is 4 sec. Of each 16-bit data

word, the upper 2 bits serve as flags to indicate whether the event

was a puff or pause, and whether the time base was in the fast or

slow mode. The remaining 14 bits of the 16-bit word are reserved

for interval timing function. Initialization of the memory cells

and retrieval of data from the device is under software control

through interface with an Apple II Plus microcomputer via a 6522

Parallel Interface board (John Bell Engineering, Inc., Part No.

79-295) and ribbon cable.

SOFTWARE SUPPORTING RECORDER

The software is written in Pascal programming language and requires

an Apple microcomputer with 64K of RAM memory, a Thunderclock Plus

card for time-keeping function, and two disk drives for data storage and program execution.

The primary software program has three functions: (1) to establish

and maintain data files for individual research subjects; (2) to

initialize and retrieve data from memory cells of the device; and

(3) to display and analyze data obtained. In the first function,

the program allows for Pascal-formatted diskettes to be initialized

for use in data recording, subject names to be added and deleted to

a master directory file, and diskette numbers to be assigned to

subjects for data recording. In the second function, the program

initializes (sets to zero) the memory cells of the device prior to

64
subject issue and records the time of initialization in the subject’s file. When the recorder is returned by the subject, the

program writes the collected data to a diskette file and writes the

time of the data collection in the subject’s file. In the third

function, the program displays data from a diskette file to a

screen monitor or printer, allows the experimenter to designate

memory cells that are to be interpreted by the computer as the

start and end of individual cigarettes, and performs a summary analysis of the data (see below). Since a certain amount of pressure

switch chatter will occasionally occur with such a system (usually

towards the end of a puff), the program allows a minimum pause

value to be specified which will result in pauses less than a given

value being combined with adjoining puff values. For example, we

have found that pause cutoff values of 0.5 sec will accurately eliminate most problems associated with switch chatter, giving a more

accurate number of puffs per cigarette and a more accurate measure

of puff time. Presently, the program is undergoing a revision to

permit the automatic delineation of cigarettes from raw puff/pause

data, with pauses longer than a given value being considered by the

computer as intercigarette intervals.

A sample of the summarized data obtained from one subject is shown

in figure 1. The subject’s name has been removed for anonymity.

The raw data collected was stored as Record 1 on Disk 002A. The

recorder was initialized at 16:44 (4:44 pm) on May 15, 1983, and

the minimum pause duration for data analysis was set at 1.0 sec.

The first column shows cigarette number; the second column shows

the starting time of the cigarette; the third column shows the seconds spent in smoking the cigarette (cigarette interval); the fourth

and fifth columns show the memory cells that delineate the cigarette event based on data entered earlier by the experimenter after

inspection of a printout of the raw data (not shown); the sixth

column shows number of puffs per cigarette; the seventh column

shows the total duration in seconds of all puffs taken on the cigarette (total puffing time); the eighth column shows total pause duration in seconds for the cigarette; the ninth and tenth columns

show the mean puff and pause durations, respectively, in seconds

for each cigarette; the eleventh and twelfth columns show intercigarette times in seconds and minutes, respectively. Following

the individual cigarette data, mean values for the entire session

(in this case 48 hrs) are given along with standard errors.

Other software has been developed for testing the timing accuracy

of the device and for determining the status of memory cells in the

device.

65
FIGURE 1. Printout of summarized topographical data

from subject using the Ambulatory Smoking Recorder.

(See text for description of record.)

66
TESTING OF THE DEVICE

Timing Accuracy of Device

To determine the timing accuracy of the device, electronic programming equipment was programmed to input electronic pulses of known

duration to the device for comparison with data output from the

device. The duration of intervals fed into the recording device

was of the range that is typical of smokers’ puff durations. A

precision time-base in conjunction with a predetermining counter

(Coulbourn Instruments S51-10 and S43-30, respectively), opened and

closed a switch connected to the digital memory unit of the recording device at intervals set by the experimenter. When the timer

was set at 1.0 second, the switch closure changed every second,

resulting in intervals of 1 second “on” and 1 second “off” which

the recording device interpreted as “puff” and “interpuff” intervals, respectively. The digital memory unit’s accuracy was tested

by recording a minimum of 50 consecutive time intervals at the following timer settings: 3.0, 2.0, 1.0, 0.9, 0.8, 0.7, 0.6, 0.5,

0.4, 0.3, 0.2, and 0.1 seconds. In addition, the device was tested

with 30 consecutive 20.0-second intervals. No differences were

found between input and output values. (Steven Morgan, personal

communication).

Validity of Device

To determine if the device was yielding results representative of

the subject’s actual smoking behavior, a study was conducted comparing the topograhical data collected by the smoking recorder with

similar data collected simultaneously by trained observers. Eight

paid volunteers? all patients on the Clinical Investigations Unit,

University of Minnesota Hospitals? served as subjects. Subjects

were observed while smoking one cigarette twice each day for eight

days. The morning session took place at approximately 9:30, the

afternoon session at approximately 2:30. Subjects were observed

through a one-way mirror while they smoked in a sound-attenuating,

ventilated test chamber. An observer was present during all 16

observation sessions. A total of four observers were employed,

each monitoring at least two subjects while they each smoked at

least two cigarettes. During each test session the observer electronically timed the duration of the cigarette interval (measured

from the time a flame was held to the end of the cigarette until

the time the cigarette was extinguished). The observer also manually closed a pushbutton switch for the duration that the cigarette

was laced in the subject’s mouth and observed to glow (puff duration).

For eight of the 16 observation sessions, the subjects used the

smoking recorder in smoking (once each day, either in the morning

or afternoon). Whether or not the recorder was used in the morning

or afternoon was determined by a counterbalanced design. During

observation sessions a chart recorder (Esterline Angus Corp.) with

a chart speed of 12-in/min was used to record smoking topography.

One channel of the recorder was connected to the pushbutton switch

67
operated by the observer. A second channel, used only during observations in which the subject used the smoking recorder, was connected to the pressure switch of the smoking recorder.

There was no significant difference between the simultaneously

collected measures. There was 100% agreement between observer and

smoking recorder data for number of cigarettes smoked and mean number of puffs per cigarette. However, across subjects, the durations measured by the observers for puff interval were slightly

larger than those measured by the smoking recorder (1.66 sec vs.

1.54 sec, respectively). The durations of interpuff intervals were

also longer for observers than for the recorder (19.17 sec vs.

18.72 sec, respectively). Across the eight subjects, the mean discrepancy per puff between the recorder and the observational data

was 0.12 seconds. Therefore, the puff durations measured by the

observers were on the average 8% larger. For interpuff intervals,

the mean discrepancy was 0.45 seconds. Therefore, the interpuff

intervals measured by the observers were on the average 2% larger.

To analyze further the discrepancies obtained between observer and

recorder data, observers were asked to monitor a more discrete stimulus than the glow of a cigarette tip. Three observers monitored

the duration of illumination of a small, red stimulus light (.75-in

diameter red dome covering a #327 lamp located atop a 2 x 3 x S-in

metal box in the subject chamber). The observers closed a switch

when the light was illuminated and released the switch when the

light was extinguished. The on-off pattern of the light was programmed to replicate a typical smoking pattern. One channel of an

event recorder charted the on-off pattern of the stimulus light;

another channel recorded the on-off pattern of the observers’

switch.

Absolute discrepancies between channels were calculated for each

on-off data pair. The mean discrepancy for light-on was .09 seconds (relative to .14 seconds for puffs in the previous study) and

the mean discrepancy per light-off was .12 seconds (relative to .34

seconds for pauses in the previous study). Thus, even on a simple

observational task, significant rater error was found. Rater error

could be expected to increase as the discrimination between “on”

and “off” became more difficult, as in observing the glowing tip in

cigarette smoking (Steven Morgan, personal communication).

Effects of Use of the Recorder on Smoking Behavior

To determine the effects of using the smoking recorder on the subjects’ smoking behavior, the smoking pattern of eight subjects was

monitored over eight consecutive days while they lived as inpatients on the Clinical Investigations Unit of University of Minnesota Hospitals. Subjects were required to record to the nearest

minute the exact time when each cigarette was lit, using forms provided. On four of the eight days, the subject used the smoking

recorder in smoking all cigarettes. The order of the days using

the device was counterbalanced across subjects. Twice each day the

subjects were observed while smoking a cigarette in the test cham68
ber (described above). An observer recorded the time and duration

of each cigarette and manually closed an electrical switch for the

duration of each puff, recording the event on an event recorder.

Using the smoking recorder resulted in a small, but statistically

significant decrease in the number of cigarettes smoked per day.

When using the recording device, subjects smoked an average of

21.33 cigarettes per day; without the device, subjects smoked an

average of 25.72 cigarettes per day (t = 3.93. df = 62, p < 0.001).

Furthermore, this trend was consistent across subjects, with each

subject smoking more cigarettes on non-use days. Observations made

in the laboratory on days with and without the recorder were compared to determine the effect of the smoking recorder on smoking

topography. There was a statistically significant main effect of

recorder use on number of puffs per cigarette and mean total puffing time per cigarette. When using the smoking recorder subjects

tended to take slightly more puffs per cigarette (15.8 vs. 13.3)

and to have a slightly longer mean total puffing time per cigarette

(26.2 seconds vs. 22.1). While use of the recorder was expected to

reduce number of cigarettes smoked (as almost all such procedures

have been found to do in behavioral research), the increase in number of puffs per cigarette and mean total puffing time may reflect

a titration effect, in which reduction in number of cigarettes per

day is compensated for by an increase in the number of puffs taken

per cigarette and by an increase in total puffing time per cigarette. This is supported by the finding that use of the recorder

had no significant effect on total daily smoke exposure (derived by

multiplying number of cigarettes per day by number of puffs per

cigarette by mean puff duration).

Self-Report/Recorder Agreement in the Natural Environment

In previous studies the accuracy and reliability of the smoking recorder was tested in a hospital environment. In the present study,

testing of the device was extended to the natural environment. Subjects were issued the smoking recorder on Monday evening and instructed to use the recorder in smoking all cigarettes until returning to the laboratory at the same time two days later. Subjects

were asked to keep a written record of the time each cigarette was

smoked. The record was kept on a bright blue 3 X S-in card that

was folded and inserted beneath the cellophane wrapper of the subject’s cigarette pack. Subjects were asked to record the time to

the nearest minute that each cigarette was lit.

A high degree of agreement was found between the subjects’ selfreport records and data obtained from the smoking recorder. Figure

2 shows the difference in minutes between self-report and recorder

data for a representative subject in the study. The bar graph

shows the magnitude and direction of the difference between selfreport and recorder measures. For each cigarette, specific values

obtained by self-report and recorder are shown above and below each

graph point. Values obtained with the smoking recorder were rounded

to the nearest minute. As shown in the figure, there was close

agreement between smoking times indicated on the self-report form

69
FIGURE 2 Comparison of self-report and recorder values for

cigarette starting times.

70
and smoking times indicated by analysis of the data from the smoking recorder over the entire 48-hr period of the study. At least

some of the discrepancy could be related to the subject’s tendency

to round the self-report value to the nearest 5-min period, although

the subject was specifically instructed not to do so.

While smoking recorder and self-report data agreed closely concerning the starting time of each cigarette, the smoking recorder data

can also be analyzed to provide additional information about cigarette smoking. For example, all of the data shown in Figure 1 were

obtained as part of the present study. Thus, in addition to information on number of cigarettes smoked and cigarette starting time,

which both self-report and smoking recorder can provide, the smoking recorder can provide topographical data on cigarette duration,

number of puffs per cigarette, total puff time per cigarette, intercigarette interval, etc.

SOME PRELIMINARY FINDINGS

Recent research from our laboratory suggests that situational and

mood factors may affect smoking topography in the natural environment. Subjects were issued the Ambulatory Smoking Recorder and

asked to use the device in smoking all cigarettes in the natural

environment over a 10-day period. (Subjects returned to the laboratory every two days for data retrieval and to obtain a recharged

battery.) Subjects were also asked to record the time, situation,

and internal state associated with each cigarette. When smoking

topography was compared for the most frequently occurring situations and mood states, large differences were found. Figure 3

shows total smoke exposure (total puffing time) for a single subject smoking the same brand of cigarette in different situations/

activities. Each data point represents the mean value for one

cigarette. Horizontal lines indicate the mean value for all cigarettes in each situation. As can be seen, rather consistent effects

were found within each situation, and total smoke exposure (total

puffing time) differed widely across situations. Similar effects

have been found for subjects smoking under different mood states.

These results suggest that situation as well as mood may influence

smoking pattern in the natural environment (Steven Morgan, personal

communication).

APPLICATIONS OF THE DEVICE

The need for methodology to study smoking topography in the natural

environment is particularly acute for a number of reasons. Firstly,

smoking appears to be controlled by a number of situational and

internal factors not readily amenable to laboratory control. With

availability of the proper technology, the natural environment

would afford the ideal site for such studies. Secondly, the validity of results from laboratory studies of smoking behavior needs to

be ascertained. Attempts should be made to determine if findings

from laboratory studies will generalize to the natural environment.

Thirdly, the analysis of smoking topography in the natural environment may shed light on factors related to smoking treatment suc71
SUBJECT 4

Activities

FIGURE 3. Total puff time per cigarette for subject when smoking

in various situations (activities). Each dot represents the mean

value for a single cigarette. Dashed lines represent mean value

for all cigarettes smoked under each condition.

72
cess. Differences in smoking topography may explain why various

groups of smokers have different rates of treatment success.

Fourthly, such measures could provide a sensitive and inexpensive

estimate of smoke exposure, thereby providing a useful adjunct to

biochemical and other measures in estimating exposure to the toxins

in cigarette smoke. Finally, since smoking appears to be a form of

drug dependence, the study of smoking behavior in the natural environment may provide data relevant to other drug dependencies, where

studies in the natural environment are more difficult to conduct.

REFERENCES

Frederiksen, L.W.; Miller, P.M.; and Peterson, G.L. Topographical

components of smoking behavior. Addict Behav, 2:55-61, 1977.

Frederiksen, L.W.; Martin, J.E.; and Webster, J.S. Assessment of

smoking behavior. J of Appl Behav Anal, 12:653-664, 1979.

Griffiths, R.R., and Henningfield J. Experimental analysis of

human cigarette smoking behavior. Fed Proc, 41:234-240, 1982.

Gust, S.; Pickens, R.; and Pechacek, T. Relation of puff volume to

other topographical measures of smoking. Addict Behav, in press.

Morgan, S. Personal communication.

Moss, R., and Prue, D. Research on nicotine regulation. Behav Ther,

13:31-46, 1982.

ACKNOWLEDGEMENTS

The microelectronic circuit employed in the smoking recorder was

designed by Mr. Jack Herrlin, an electronics design engineer for a

local computer/electronics company who served as consultant on the

project. Mr. Jim Payne, a graduate student in electrical engineering, also provided technical consultation on the device. The software for the recorder was developed primarily by Mr. Jogesh Warrior,

a graduate student in Electrical Engineering at the University of

Minnesota, who was also a research assistant in our laboratory.

Programming assistance was provided by Mr. Shlomo Malin. The accuracy and reliability of the smoking recorder have been tested for

the past 2-1/2 years under funding provided by a NIDA research

grant (DA 02413, “Topographical Analysis of Smoking Behavior,” Roy

W. Pickens, Principal Investigator, and Terry F. Pechacek, Co-Principal Investigator Testing of the smoking recorder in the natural

environment was conducted as part of a related research project (DA

02988, “Nicotine Withdrawal and Smoking Treatment Outcome,” Dorothy

K. Hatsukami, Principal Investigator, and Roy W. Pickens, Co-Principal Investigator). We thank Dr. Steven Morgan, Department of

Psychiatry, University of Minnesota, for allowing us to present

some of his data (figure 3) here.

73
Data Collection and Questionnaire Design: Smoking Cessation

in Adults

Harry A. Lando, Ph.D.

Data collection and questionnaire design are significant to

both researchers and clinical practitioners in the field of adult

smoking cessation. Unfortunately, minimal standards for data

collection are typically neglected by public service and

proprietary programs and all too often are neglected by

researchers as well. The purpose of the current paper is not

to recommend new standards in this area. Instead, discussion

will focus upon some existing standards that profitably can be

applied in research and public service settings. Unfortunately,

extensive recommendations have been made in the past (e.g.,

International Union Against Cancer 1976; National Interagency

Council on Smoking and Health 1974) with little apparent effect

upon actual practice.

A major reason for failure to adhere to recommended standards may

be the fact that it is inconvenient to do so, especially for

public service and proprietary programs. One possibility would

be to develop a uniform one- to two-page questionnaire that could

be used by both researchers and practitioners. This

questionnaire would solicit information that is considered

essential in both contexts. Construction of such a uniform

questionnaire would in no way preclude collection of additional

information (as will be discussed below). It would, however,

provide commonalities in comparing subjects across both settings

and types of programs.

Previous standards may have provided relatively little incentive

for implementation, especially in public service settings. The

standards may in fact have been seen as somewhat coercive (e.g.,

these are the appropriate criteria , and any deviations from these

criteria are indicative of unsound methodology). The standards

may also have been viewed as overly extensive (the NICSH

recommendations required approximately 35 pages of text).

One possible approach in encouraging sound principles of data

collection might be to construct a simple and convenient

questionnaire with adequate reliability and validity. The

questionnaire should solicit minimal information that is

considered essential in both laboratory and field contexts. The

appeal of such a questionnaire might be considerably enhanced by

74
including a brief interpretive section that would allow smokers

to score their own responses. The continued popularity of the

Smoker’s Self-Testing Kit (Ikard et al. 1969), despite limited

evidence for validity, is testimony to the attractiveness of this

type of approach.

NATIONAL CENTER FOR HEALTH EDUCATION GUIDELINES

The National Center for Health Education Code of Practice and

Standards for the Evaluation of Group Smoking Cessation Program

provide an excellent starting point in formulating

recommendations for data collection. These guidelines have been

adopted by such major public service and proprietary agencies as

the American Cancer Society, the American Health Foundation, the

American Heart Association, the Five-Day Plan to Stop Smoking,

and SmokEnders. However, at present it is unclear that these

guidelines are being followed in practice.

The NCHE guidelines are surprisingly stringent in a number of

respects. The criterion for success is complete abstention from

all forms of tobacco for a period of 1 year following treatment.

The Code of Practice notes that common definitions are needed to

provide both protection and assurance for smokers seeking

assistance in quitting. Almost all previous interventions, both

research and public service, have subscribed to a less rigorous

criterion in defining success.

The NCHE code of Practice also calls for conscientious recordkeeping. All smokers who are unavailable to followup must be

listed as smoking for purposes of evaluation. Furthermore,

participants include all of those smokers who attend at least the

first treatment session following orientation. This is a very

important point. Proprietary programs, in advertising

extravagant claims of success, appear in many cases to include

only those who complete treatment.

The NCHE guidelines assert that not only criteria for success,

but also accounting for program participants, followup, and

method of reporting outcome must all be standard. Definitions

are provided for terms, including in-term quitter, attrition

rate, long-term quitter, and recidivist. Although other outcome

measures may be reported in addition to complete abstention for

at least 1 year (e.g., abstinence for less than 1 year, switching

to pipes or cigars), the term “success” is not to be to be used

in conjunction with such measures.

Evaluation is to include: number of participants, number and/or

percentage who quit at the end of the intervention, and number

and/or percentage completing treatment who do not relapse. It is

also appropriate to state number and/or percentage of

participants entering the program who quit and did not relapse

during a 12-month period thereafter.

Because all participants who cannot be located at followup must

be counted as failures for purposes of data analysis, this

75
provides a strong incentive to reach as many participants as

possible. The guidelines call for collection of sufficient

identifying characteristics for each participant to permit

contacting them at all followup intervals. Name, address, and

telephone number should be recorded, and employment address and

telephone number should also be noted where applicable. Although

not part of the NCHE standards, it is strongly recommended that

names, addresses, and telephone numbers of close friends or

relatives be solicited as well. These individuals can be

contacted to confirm self-reported abstinence and can provide

information on the whereabouts of participants who might

otherwise be lost to followup. Lando and McGovern (1982) found

these additional sources extremely helpful in locating

participants at long-term followups.

The NCHE standards permit followup by either mailed

questionnaires or telephone interviews. No provision is included

for independent validation of self-reported abstinence. Records

are to note data on tobacco use in any form for all participants

at beginning and termination of treatment and at l-year followup.

At this latter point, it should also be determined whether

participants smoked during the past year.

Detailed instructions are provided for calculating long-term

success rates. Participants who relapse, who refuse to respond,

or who are not located at followup are all counted as smoking.

Programs that do not report on their total enrollment are to

collect and report data for no fewer than 500 participants per

year. These should be all participants entering treatment

starting at a given point and continuing until the minimum total

(or some larger number) has been attained.

Basic identifying data are to be collected prior to the first

treatment session as part of registration to insure inclusion

of all participants. Dates of sessions and participants’

attendance are to be recorded. Information regarding smoking

rate and use of tobacco in any other form is also to be collected

at registration. Each case record must include identifying

information needed for purposes of followup.

American Lung Association Questionnaire

The American Lung Association in its Guide for Clinic Leaders

provides standardized forms and questionnaires for data

collection. Local chapters of the American Lung Association are

to maintain records for all clinics including name of

association, starting date of clinic, number of participants, and

name of clinic leader. An intake questionnaire, end of clinic

questionnaire, and 12-month followup questionnaire are also

provided, A sample letter is included for participants who

cannot be reached by telephone for followup. In addition, a

cumulative tally form is enclosed for recording information on

all participants through 12-month followup.

At intake, participants are asked current brand of cigarettes and

76
level of smoking. They report identifying characteristics of

their brand (e.g., length, filtered vs. unfiltered, mentholated

vs. unmentholated). Information is solicited concerning age of

smoking onset, heaviest smoking consumption, and number and

method of previous attempts to quit. Use of tobacco in other

forms is also examined.

Participants report their longest period without smoking since

they began regular tobacco use. Furthermore, in addition to

information relating directly to smoking, participants are asked

about supportiveness of spouse, children, friends, and coworkers

as well as about prevalence of smoking among these categories of

individuals. They are asked about their own perceived readiness

to quit and about the number of clinic sessions they plan to

attend. Finally, they list basic demographic information

including age, sex, race, level of education, occupation, and

marital status.

Questionnaires administered at the end of treatment require

participants to report most and least helpful elements in

treatment. Current cigarette consumption is assessed, together

with use of tobacco in other forms. Evaluations of clinic

leaders and recommendations for improving the program are

solicited.

Twelve-month followup interviews are limited to minimum essential

data (projected time per interview is approximately 3 minutes).

Participants are asked whether they have smoked in the previous

month and if so about level of smoking. They are asked about

cigarette use since the termination of the clinic. Smokers

are to indicate cigarette consumption, brand, and brand

characteristics. All participants indicate date of last

cigarette. Use of other forms of tobacco is again assessed.

Finally, participants are asked to recall any elements from the

clinic that may have been especially helpful.

Evaluation

The NCHE guidelines and American Lung Association questionnaires

provide an excellent beginning in formulating recommendations for

data collection and questionnaire design. Especially encouraging

is the emphasis upon including all participants in reporting

outcomes (dropouts and participants who are not located must be

counted in computing abstinence rates) and upon l-year followup

as a minimum period for evaluating success. Conscientious

implementation of NCHE guidelines should be a major factor in

increasing the meaningfulness and comparability of data reported.

The guidelines are realistic and do not appear to impose an

excessive response burden upon public service or proprietary

organizations. As noted above, the requirement that

nonrespondents be counted as treatment failures provides a strong

incentive for careful recordkeeping and concerted efforts to

locate all participants. The major criticism of the guidelines

is that they fail to provide for independent validation of self77
reported smoking. Although this could be a touchy issue outside

of the laboratory, it seems most unfortunate to prescribe

rigorous standards for data collection and evaluation and yet to

overlook obvious questions concerning the validity of such data.

A minimum step might be to obtain permission of participants to

contact close friends and/or relatives for confirmation of

reported smoking status. Although the accuracy of informant data

is by no means certain, such data would allow at least some

measure of independent validation of self-reports. More

attractive would be the use of biochemical validation, although

admittedly this level of assessment may be problematic outside

the research setting.

Biochemical validation would be appropriate for those

organizations that seek acceptance of their reported outcomes by

the scientific community. Such validation would not be required

for all participants, nor would it be required for all clinics.

A representative sampling of clinics in varying locations should

provide a meaningful estimate of the accuracy of self-reports.

There are laboratories that are equipped to perform biochemical

analyses for outside organizations. The cost of such analyses

would be relatively modest (especially if limited to a random

sample of those participants reporting abstinence at follow-up)

and easily could be defrayed by a small charge for treatment to

all participants. Comments on biochemical validation procedures

are contained elsewhere in this monograph (e.g., Benowitz, this

volume).

BASIC MEASUREMENT ISSUES

At first glance, the assessment of smoking behavior appears to be

a very simple matter. Smoking is readily observable and occurs

in discrete units. But what is the best unit of measurement?

Tallies can be kept of cigarettes, of actual puffs, or of amount

of tar and nicotine ingested (McFall 1978). Furthermore, these

records can be kept on an hourly basis, a daily basis, or even a

monthly basis. Most investigators have emphasized number of

cigarettes smoked per day. As McFall points out, there is

nothing magical about this particular measure. Certainly it

overlooks a great deal of important information. However, it

does have the advantage of providing a common standard of

comparison.

Discussion of assessment issues in smoking has focused primarily

on determining the outcome of structured interventions. Two

fundamental indices have been used: rate, using days as the unit

of time and typically expressed in percentage of baseline

smoking; and abstinence, the number or percentage of subjects

abstaining altogether (Lichtenstein and Danaher 1976). Despite

the fact that abstinence is a nominal scale datum which

necessitates less powerful, nonparametric statistical procedures,

it does have several important advantages over rate. It is less

susceptible to reactivity effects of self-monitoring, less likely

to require transformations in the data due to a marked skewness

78
in the distribution of outcome, and it is a better indicator of

clinically significant, as opposed to statistically significant,

treatment effects.

Reactivity is likely when subjects in treatment self-monitor

their smoking rates because of the implicit assumption that these

rates will decrease (Lando 1981). Self-monitored smoking rates

tend to be lower than subjects' prior estimates of their smoking

behavior. Smoking rates are also likely to be susceptible to

changes in self-monitoring procedures. It is obviously desirable

that data collection procedures remain constant. Otherwise,

changes in rate may be partly a reflection of changes in

measurement. On the other hand, the major concern with

abstinence data is not how the self-report data are obtained, but

the possibility that subjects might not be telling the truth.

A crucial issue relates to the selection of a method or methods

of assessment. This issue is addressed by McFall (1978) in a

comprehensive and useful discussion. Possible measures include

self-reports, controlled laboratory observations, unobtrusive

naturalistic measurements, collaborator reports, and correlates

of smoking behavior. Each of these methods has potential

advantages and disadvantages.

The most cons-only used measure has been self-report. The obvious

advantage is that the subject is in a better position than anyone

else to observe his or her own smoking behavior continually.

Unfortunately, there is no assurance that the subject will be

accurate or even honest. False reporting has been documented in

a number of studies. Self-reports can also be reactive, as

noted previously. The fact that many Studies have relied solely

upon unverified self-reports as a measure of outcome is therefore

a cause for concern.

Observing smoking under controlled laboratory conditions is a

more precise method, but it also presents significant problems.

Smoking behavior observed in the laboratory may be quite

different from smoking that occurs under more natural conditions.

Unobtrusive naturalistic measurement presents another

possibility. McFall (1978) suggests the monitoring of samples of

cigarette butts as one example. The butts could be collected in

several locations and would provide both an indirect check upon

self-reported smoking and some indication of within-subject

changes in smoking over time. One of the few studies to use

cigarette butts as a measure of smoking was that of Auger et al.

(1972). Unobtrusive measurement procedures suffer from several

shortcomings, including difficulty, expense, impracticality in

many situations, and potential invasion of privacy.

Collaborator reports have been used increasingly in recent years.

Investigators sometimes ask subjects to provide the names of

close friends or relatives who are in a position to observe their

smoking and can be contacted periodically for reports (cf. Lando

1981). This strategy was recommended both as a check upon selfreports and as an additional means of locating subjects at

79
followup. Again, however, the use of collaborators is no

guarantee of accuracy. Recruitment of friends as observers can

lead to increased reactivity. Cooperation may be very difficult

to obtain, performance many be sloppy, and there may be obvious

bias. Because the collaborators are often close friends of the

subjects, their reports my be no more objective than those of

the subjects themselves. McFall (1978) suggests that the

extremely high correlations often obtained between subjects and

collaborators may be a reflection of collusion more than

accuracy. Because there is no simple means of ascertaining the

validity of collaborator reports, additional checks upon the

accuracy of subjects’ self-reports are highly desirable.

Correlates of smoking behavior are a very promising possibility.

Investigators have attempted to establish valid indirect measures

of smoking for a number of years, and such measures receive

considerable attention in this volume.

QUESTIONNAIRE DESIGN

The American Lung Association intake and followup questionnaires

provide a useful starting point in considering issues of

questionnaire design. They constitute a package that can be

conveniently used by local associations and that allows

collection of appropriate minimal information. A standardized

form such as the American Lung Association intake questionnaire

would represent a substantial improvement over current practice

in that clinics could report a common data set. The American Lung

Association materials are also attractive in their brevity and

ease of administration.

A major difficulty at this point in recommending questionnaire

design is that it is by no means clear what kinds of information

are crucial. Furthermore, questionnaire content my differ

according to the purpose of the user. Researchers may be

interested in issues that are of minimal concern to clinical

practitioners and vice versa. The current paper will not attempt

to specify the final form of a questionnaire for either research

or clinical use. However, suggestions will be drawn from the

literature for types of items that might be included.

Essential information relating to subject characteristics could

prove extremely valuable in comparing smokers who enroll in

various types of programs. Obviously, two treatments each of

which produce 30 percent long-term abstinence my not be

equivalent in effectiveness if smoking history characteristics of

enrollees in the two program are radically different. A

consensus at this point might be that information should be

obtained concerning age, sex, number of years as a smoker,

current daily rate of smoking, previous quit attempts and

duration of abstinence, and brand smoked (NICSH 1974).

Data on occupation, education, and income may also be useful in

characterizing subject samples and in comparing smokers who

enroll in various programs. The vast majority of formal smoking

80
cessation treatments have been strongly weighted toward

participation from middle and upper middle socioeconomic strata.

Assessment of socioeconomic indicators is likely to focus

additional attention on the need to reach underserved

populations. It is also possible that systematic differences

exist in the types of participants recruited by various programs.

An obvious example would be that a commercial clinic requiring an

investment of several hundred dollars is extremely unlikely to

enroll subjects from lower class backgrounds.

An important concern is related to inclusion of potential

predictor variables. A minimal questionnaire might be limited to

a few items assessing subject and smoking history

characteristics. Such a questionnaire could be standardized

along the lines of the intake measure construct&i by the American

Lung Association. Researchers (and practitioners) who are

interested in predicting outcome could solicit additional

information.

What are some likely predictor variables? The answer to this

question may be important not only in anticipating probable

outcome, but also in assigning individuals to particular

treatments. Standardized data collection over numerous programs

and a substantial subject pool should provide considerable

information. This in turn might facilitate effective tailoring

of treatments to the needs of the individual.

Predictor variables that have been identified to date are

generally based upon relatively small numbers of subjects. With

this limitation in mind, a number of such variables can be

suggested. Repeated use of a standardized questionnaire

containing these items would allow much more confidence in their

validity. It appears quite likely that certain categories of

items will prove highly related and that factor analyses will

provide more streamlined predictive measures.

Even the minimal information obtained through the American Lung

Association questionnaire should allow some prediction of

outcome. Roth subjects’ age and smoking rates have sometimes

correlated with reduced consumption in previous studies.

Furthermore, number and duration of previous quit attempts appear

to be predictive as well. Supportiveness of others and

prevalence of smoking in home and work environments might also be

important. Other predictor variables contained in the American

Lung Association questionnaire may include subjects’ age, sex,

race, marital status, level of education, and occupation.

Perceived readiness to quit is another questionnaire item that

could correlate significantly with outcome.

The predictive power of the American Lung Association measure

might be improved, however , if on some items subjects were

allowed a greater range of choices. Thus, as one example, rather

than simply indicating whether individuals in the environment are

either supportive or nonsupportive of quit attempts, it might be

more useful to allow subjects to report varying levels of support.

81
Many other potential predictor variables have been identified in

the literature. An especially useful indicator might be

perceived ability to resist smoking urges in specific situations.

Condiotte and Lichtenstein (1981) have published a very promising

instrument. Preliminary data suggest clearly that subjects are

quite capable of anticipating situations in which they are likely

to experience difficulty. This type of measure could provide an

important link between assessment and treatment intervention.

Knowledge of circumstances under which subjects are apt to

experience difficulty may facilitate tailoring of treatment

programs to the needs of individual participants. It should be

noted that the Condiotte and Lichtenstein questionnaire is

somewhat lengthy (47 items). Preliminary data suggest that a

substantial reduction in the number of items would be quite

feasible.

A simple eight-item questionnaire developed by Fagerstrom (1978)

to assess physiological correlates and dependence might also be

of considerable interest. Preliminary validity data are

encouraging. It might be especially interesting to assess the

correlations between this paper-and-pencil instrument and both

topographical and biochemical indicators of smoking exposure.

The single item assessing time from awakening to first cigarette

could provide a rough indication of dependency.

Other questions that might be included appear almost infinite.

Several studies have found that negative affect smokers (those

who smoke in response to tension, anger, depression, or other

negative emotions) are less likely to remain abstinent (cf.

Pomerleau et al. 1978). Items indicative of Type A behaviors

(impatience, overwork, competitiveness, aggressiveness) might

also be predictive of unsuccessful outcome. Subjects who are

able to state only limited tangible expected benefits from

quitting may be poor candidates for abstinence.

Life events measures (e.g., what types of stressful circumstances

are present either currently or in the recent past) may correlate

with abstinence. Relevant stressors could include such events as

a recent move, a divorce, a change in job status, or the loss of

a close friend or relative. Attributions for previous

unsuccessful abstinence attempts could also be quite important.

obviously, subjects who attribute a previous failure to a

particular set of conditions should have a plan of attack for

coping with similar conditions in the future. A consideration of

prior withdrawal symptoms may provide an additional indicator of

both expected outcome and of types of problems in remaining

abstinent. A measure published by Shiffman and Jarvik (1976)

contains a number of items that might be used in assessing

withdrawal.

Attention might also focus specifically upon actual relapse

episodes. Issues to be considered might include the course of

relapse, where the episode occurred, and the subject's emotional

82
and physical states at the time. Information relating to

presence of other people, interpersonal conflict, social

pressure, stress, and withdrawal symptoms all could be of value

in predicting and preparing for future crisis situations.

Alcohol consumption associated with a relapse could be especially

significant (cf. Marlatt and Gordon 1980; Shiffman 1981).

There are other miscellaneous predictive items suggested by the

literature. For example, use of alcohol and other drugs,

caffeine intake, and participation in psychotherapy may all be

associated with outcome. General health status may be important,

as well as physician advice to quit. Presence of young children

in the home has been identified as another possible factor

related to abstinence. Number of driving accidents has

correlated negatively with outcome. Success in changing another

major personal habit could be a positive indicator.

Current or anticipated pregnancy appears to be an obvious item to

include for female smokers. Information on prior attendance at

formal cessation programs may be important. Concerns with weight

gain could suggest problems in remaining abstinent. Moderate to

high physical activity levels, on the other hand, might be a

positive factor. Subjects’ “want/should” ratio (Marlatt and

Gordon 1980) and perceived pressure from others to quit might be

other important points to consider.

Future Directions

Public service clinics may limit themselves to relatively minimal

intake data provided by questionnaires such as that currently

employed by the American Lung Association. Researchers may adopt

instruments that are considerably more involved. At the level of

both research and clinical application, use of standardized

questionnaires could contribute much to our knowledge.

It would be especially valuable if self-report measures were

shown to correlate with other dimensions including topography and

biochemical exposure. An obvious strategy would be to include

questionnaire items assessing these other dimensions.

Unfortunately, there is little evidence that subjects can

accurately report topography, much less biochemical intake. Even

so, it is possible that a paper-and-pencil measure could provide

a rough indicator of the other dimensions. Future research might

provide a useful formula for estimating topography and biological

exposure from self-report data.

If questionnaire measures can eventually receive son-e validation

at the levels of topography and physiological assessment, an

important element of convergent validation will have been

attained. One strategy might be to train subjects to be better

observers of their own smoking behavior. Frederiksen and his

colleagues (e.g., Frederiksen et al. 1976) have successfully

taught smokers to monitor a number of topographical factors and

even to discriminate differing levels of carton monoxide uptake.

Promising instruments designed to supplement self-report are

83
discussed elsewhere in this monograph. Pickens (this volume) has

constructed a device that can measure important components of

smoking topography in the natural environment. Kozlowski and his

colleagues (Kozlowski 1981; Kozlowski et al. 1982) describe an

innovative technique which enables smokers to estimate their

actual tar and nicotine intake by examining the appearance of

spent cigarette filters. All of these methods should contribute

significantly to more precise measurement.

ADDITIONAL ISSUES IN DATA COLLECTION AND CLINIC EVALUATION

The National Center for Health Education guidelines provide a

sound basis for evaluating smoking cessation treatments, as was

discussed previously. These guidelines are not complete,

however, and additional information should be obtained to allow

optimal assessment of interventions. Clinics should routinely

note numbers of smokers who inquire about treatment, as well as

those participants actually attending an initial orientation

session. Requirements for participation also should be those

smokers who make preliminary inquiries or that impose highly

stringent screening criteria could report very high abstinence

rates and yet still be quite limited in generalizability.

Both practitioners and researchers should maintain cumulative

records of all participants in treatment. Maintenance of

cumulative data sets could provide vital information in

evaluating trends in outcome. In the author’s own research,

computer records have been established for all smokers who have

entered treatment during the previous 6 years. The need for

cumulative records is underscored by the fact that it often has

been difficult to secure adequate subject samples for evaluation

of treatments. This problem has been compounded by the use of

group treatment formats in which group process variables

sometimes outweigh specific treatment effects (Lando 1978).

Not only would cumulative data sets be useful in evaluating

overall effectiveness of interventions, they may also serve to

help isolate potential predictor variables (large-scale subject

samples might be of considerable benefit in validating proposed

assessment devices). In addition, this would facilitate analysis

of subject characteristics for purposes of assigning participants

to appropriate treatment conditions. Thus far, most work related

to tailoring interventions to the needs of individual smokers has

been disappointing. This may be due in part to assignment

criteria that are either totally intuitive or that are based upon

very limited subject samples.

Minimal statistical power is lacking in many published studies,

especially when the major criterion is a dichotomous abstinencenonabstinence outcome. One means of compensating for

unsatisfactory power in individual studies may be to replicate

promising interventions in successive program. Thus, in the

author’s research, an apparently effective broad-spectrum

treatment encompassing oversmoking and maintenance has become a

standard against which to compare other interventions. It

84
thereby has been possible to compute both average effectiveness

and variability in outcome for this method. Results to date with

this broad-spectrum intervention have consistently reached or

slightly exceeded 40 percent abstinence at 12-month followup.

Confidence in the validity and generalizability of these results

is enhanced by numerous replications in both research and public

service settings.

Collection of long-term followup data is obviously essential.

Although a 12-month followup period now appears generally

accepted as a minimum standard, soliciting of additional data

beyond this point is relatively inexpensive and may prove

extremely useful. Subject addresses and telephone numbers

(together with those of informants) should be kept up-to-date.

This should enable contact with a minimum of 90 percent of

initial subjects even after a period of several years (cf. Lando

and McGovern 1982).

Long-term data collection in public service settings might be

facilitated by construction of simple followup assessment kits

containing appropriate questionnaires and a schedule for their

distribution (it was previously recommended that an attractive

and convenient intake measure be developed for public service

use. Ideally, this measure could be self-scoring to increase

subjects' interest.) Such a followup assessment kit could

substantially increase the likelihood of adequate data being

reported by public service programs. In addition to followup

questionnaires, the kits would contain detailed instructions for

contacting nonrespondents.

Long-term followups could address several key questions that have

received little attention. One issue might be the subsequent

smoking history of subjects who fail to achieve abstinence in

cessation programs. Might such participants be more resistant to

subsequent change attempts? Is it possible that future smoking

history for nonabstinent subjects could differ systematically as

a function of the initial treatment? At this point, we simply do

not know. Two programs could conceivably achieve identical

short-term outcomes and yet differ dramatically in later

abstinence attempts initiated by unsuccessful participants.

Schachter (1982) has argued that cumulative success rates are

high both for people desiring to lose weight and to quit smoking.

If the net effect of a treatment is to discourage future

abstinence efforts for the majority of participants, the value of

that treatment must be subject to serious question. This may be

a particular concern for programs reporting 10 to 20 percent 12-

month abstinence. Conceivably, these programs could produce a

negative overall impact. Long-term followup assessment should

focus not only on incidence of smoking but also upon change

attempts among nonabstinent participants. Paradoxically,

treatments that are viewed most favorably could be more likely to

discourage further quit &tempts on the part of continuing

smokers who come to view themselves as confirmed failures.

85
Self-efficacy measures (Bandura 1977; Condiotte and Lichtenstein

1981) might also be useful at followup as well as during

treatment. Such measures could be informative both in camparing

clinics and in predicting subsequent (successful) abstinence

attempts. Clinics that place their sole emphasis upon abstinence

may risk greater reductions in self-efficacy among nonabstinent

participants than do clinics that appear to allow for

intermediate results. In this context, it is possible that

nicotine fading procedures may be recommended even if research

definitively indicates that switching to low tar and nicotine

cigarettes is ineffective in reducing risk. Nonabstinent

nicotine fading subjects may see themselves as having achieved

tangible progress in overcoming their smoking habit. This

perception might in turn predict future efforts to abstain (of

course, the reverse is also possible: nonabstinent participants

may be more prone simply to continue what they perceive to be a

safer style of smoking).

In addition to collecting data on subsequent smoking history and

self-efficacy, investigators might do well to monitor relapse

episodes in subjects who achieve initial abstinence. Such

monitoring could improve understanding of major risk factors.

This improved understanding could in turn facilitate the

development of stronger inoculation strategies. Of particular

interest might be any reported coping strategies by subjects who

are successful in dealing with stressful situations and by those

who are unsuccessful.

CONCLUSIONS AND ADDITIONAL RECOMMENDATIONS

Bernstein (1978) has argued that service providers as well as

researchers should see careful data collection and description of

treatment techniques as a fundamental part of their

responsibility. Lichtenstein (personal communication) has

suggested that interventions be required to meet specific

standards for accreditation. This possibility may merit further

attention. In the meantime, better dissemination of existing

standards for evaluating treatments (e.g., definitions of longterm abstinence rates) might be of value in helping the general

public to make more informed choices among available treatment

programs. Unfortunately, although several major providers have

endorsed the NCHE guidelines, it is not generally clear that they

are following these guidelines in practice.

If both practitioners and researchers adopt certain standardized

practices in data collection and questionnaire design, it may

even be possible to pool data sets for purposes of some analyses.

Perhaps the Office on Smoking and Health or some other central

resource could serve as a depository or referral source for data

that meet specific guidelines. These data sets would be

available to researchers and would provide a much larger

cumulative subject pool than would otherwise be possible. The

requirement that guidelines be met for inclusion of data might

serve as a further incentive to adhere to rigorous standards.

These data Sets could represent a rich archival source for

86
investigators in dealing with such issues as isolation of

predictor variables and tailoring of treatment to invidual

smokers.

An obvious starting point would be to adopt a standardized

minimal intake questionnaire. The questionnaire could be

developed along the lines of that currently used by the American

Lung Association (again, this would in no way preclude collection

of additional information). The adoption of a questionnaire,

together with adherence to NCHE guidelines in tabulating and

reporting outcome, would provide considerable information. It

would be possible to compare characteristics of smokers who tend

to enroll in various types of interventions. It would also be

possible to achieve much more meaningful comparisons of outcomes

for different treatments.

Numerous suggestions have been presented for data collection and

questionnaire design. These suggestions should be considered in

the context of procedures discussed elsewhere in this volume for

both topographical and physiological assessment. It now appears

possible to achieve relatively sophisticated assessment of

smoking patterns at fairly minimal cost. Inexpensive and

unobtrusive monitoring devices have been described that are

capable of measuring tobacco intake in the natural environment.

Precise laboratory procedures are available for observation of

smoking topography. These procedures can be supplemented by

training subjects to be much more sensitive observers of their

own smoking in the natural environment.

Future questionnaires are likely to be considerably more

sophisticated than those currently available. Self-report items

may provide information relevant to dimensions of both topography

and physiological exposure. A combination of self-report,

topographical, and physiological indices might allow more

accurate estimation of the extent to which individual smokers are

“at risk.” Such information potentially could be used by smokers

who are either unable or unwilling to abstain in achieving

clinically significant reductions in exposure. As noted above,

accurate guidelines for defining categories of smokers (e.g.,

“light smoker,” “moderate smoker,” “heavy smoker”) must consider

far more than just average number of cigarettes smoked per day.

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Pomerleau, O.F., Adkins, D., and Pertschuk, M. Predictors of

outcome and recidivism in smoking cessation treatment. Addict

Behav, 3:65-70, 1978.

Schachter, S. Recidivism and self-cure of smoking and obesity.

Am Psychol, 37:436-444, 1982.

Shiffman, S.M. Relapse following smoking cessation: A

situational analysis. J Consult Clin Psychol, 50:71-86, 1982.

Shiffman, S.M., and Jarvik, M.E. Trends in withdrawal symptoms

in abstinence from cigarette smoking. Psychopharmacology, 50:35-

39, 1976.

89
Evaluation of Smoking Risk: Some

Proposed Minimum Standards

Lee W. Frederiksen, Ph.D.

The topic of this paper is the assessment of smoking in

organizational settings. While the assessment of smoking in such

settings (e.g., worksite) is not fundamentally different from

assessment in other settings (e.g., treatment clinics or

classrooms), this perspective, as well as the special

characteristics of the research environment, serves as the

background for discussion.

This discussion will concentrate on minimum standards. What are

the requirements on the smoking researcher, if he or she wants to

meet minimum scientific standards of acceptability? Development of

innovative programs does not necessarily require extensive

measurement considerations initially, but if replicable and

reliable efforts are to be undertaken, minimum standards are

clearly desirable.

Assessment in organizational settings is primarily concerned with

reduction of health risks. This concern often, but not always,

translates into some level of smoking cessation. These are similar

concerns to those existing in any treatment situation. whether it

be a hospital clinic, a classroom, or a self-help project.

These concerns are, however, somewhat different from those of

researchers interested strictly in a laboratory analysis of

behavior and pertinent physiological and pharmacological research.

Some of the standards that are appropriate in treatment

interventions are not necessarily appropriate for all laboratory

studies. However, it is clear that a variety of measures developed

in the laboratory should be applied in the natural environment.

ASSUMPTIONS

Two fundamental assumptions provide starting points for developing

minimal standards for assessment/evaluation. One of those starting

points involves the issue of why we are interested in smoking

90
behavior. The other assumption is that the reason for scientific

study of smoking behavior is the potential health risk related to

tobacco use. This is contrasted to a view that would characterize

smoking as wrong on moral, political, religious, or any other

grounds. In short, in the organizational setting the primary

criterion is smoking risk and not smoking behavior per se.

As has been stated by a number of researchers, the reason for their

initial interest in smoking behavior is that it was a behavior

consisting of a simple, innocuous response for which a frequency

measure was appropriate. Smoking is, of course, an interesting

behavior from a whole range of perspectives, but in the

organizational setting the concern must be with both the behavior

and the associated health and safety risks. There are design and

analysis implications when it comes to measurement criteria and the

significance of research outcomes in organizational settings.

Those who are involved in risk reduction and smoking cessation in

organizational settings have taken a view that emphasizes this

aspect of the issue. An example of the level and areas of concern

may be useful: Individual A has never used tobacco products in any

form. Individual B has a long history of smoking; he has smoked

one cigar a week for 20 years (after Sunday dinner) which was not

inhaled. Individual C is also a smoker, consuming 2 1/2 packs of

high tar, high nicotine, high CO cigarettes each day. From a

smoking versus nonsmoking distinction, Individual A is clearly

different from Individuals B and C. However, from a purely health

risk standpoint, it is likely that A and B are more similar and

markedly different from Individual C. It is clear that simple

binary distinctions between smoking and nonsmoking do not capture

the full range of risk and are consequently of little value by

themselves.

The second starting point is our view of smoking behavior. In

times past, many of us working in smoking research tended to view

it as a relatively simple, straightforward behavior: either the

individual smoked or didn't smoke. Smoking rate (number of

cigarettes per unit time) was considered to be an adequate

descriptor of smoking behavior. A few investigators did examine

and discuss the substance used; however, even this was extremely

rare (cf. Frederiksen et al. 1979).

In recent years, it has become increasingly clear that this is a

far too simplistic picture. Considerable variation exists among

long been assumed that situational factors could affect smoking

products and the manner in which they are consumed. While it has

rate, the evidence of recent years has also demonstrated that

smoking topography can be affected by a host of variables such as

physical characteristics of the cigarette, perhaps pharmacological

interaction with other substances such as alcohol and coffee,

cigarette deprivation, social factors, and instruction given to the

smoker (cf. Frederiksen et al. 1981). The picture that has emerged

is of a complex multiply determined behavior sensitive to a variety

of environmental and pharmacological variables.

91
Overall it becomes apparent that while our concern is "risk," an

adequate description of smoking must involve the assessment of what

is smoked, the rate or temporal pattern of that consumption, and

smoking topography (puff rate, puff size, interpuff interval, puff

volume, etc.) (Frederiksen et al. 1979; Frederiksen and Martin

1979). While details of this argument are not reviewed here, it

has received some recent empirical support. In a recent study,

designed to predict alveolar carbon monoxide levels, it was found

that the best predictor was a combination of three variables.

Using a stepwise multiple regression procedure, the predictors

(accounting for 36% of the total variance) included one

topographical variable (interpuff interval), one variable

describing substance smoked (carbon monoxide yield), and one

variable describing smoking rate (Burling et al. 1983).

It is apparent that we have delineated numerous specific variables

which might provide an adequate description of smoking behavior.

However, no single variable provides an adequate description. The

interrelationships among the variables are not clear. Further, we

do not understand all the factors affecting any particular

variable. This suggests a need for caution and puts a premium on

comprehensive assessment under known, standardized conditions.

With this background, minimum standards for the adequate assessment

of smoking behavior in organizational settings can be examined.

MINIMUM STANDARDS OF MEASUREMENT

Basic standards of scientific research must be applied to

laboratory, treatment, and prevention efforts regardless of the

setting in which they are implemented. Thus, for example, in

organizational settings it is essential that the methods used for

assessment of smoking behavior be held constant across experimental

conditions. The rationale for this view is fairly evident. Since

different smoking assessment procedures have been demonstrated to

be differentially reliable and yield different results (e.g.,

Frederiksen et al. 1975), it behooves the investigator to hold them

constant across assessment. This point may be sufficiently

obvious, but investigators do not adhere to this simple

requirement. It is not uncommon for some reports to include

retrospective baselines or self-monitored smoking rates during

baseline and treatment conditions, with telephone followup on the

proportion of smokers abstinent (Frederiksen et al. 1979). Clearly

these are not directly comparable measures. If the investigators

are changing measures from phase to phase, they are systematically

biasing their data across conditions.

Another issue of importance is that there should be some analysis

of measurement reliability at each assessment point. Here, again,

the rationale seems simple and straightforward. Yet, with

surprising frequency, studies make no attempt to validate a

smoker's self-report. While historically there may have been

practical reasons making such validation difficult, the advent of

biochemical measures seems to have made such validation more simple.

92
In a review of treatment and behavioral research studies

(Frederiksen et al. 1979), it was noted that only 20 percent of the

studies reviewed took measurement reliability at more than one

point. For example, measurement reliability might only be

undertaken during followup. or only during baseline, but not

regularly and consistently throughout the study. Given the

inherent method variance in smoking measurement, changing measures

in mid-study necessarily provides distorted and essentially

unusable data.

Techniques presented by investigators in other chapters In this

volume describe useful, reliable, and important tools for obtaining

information which will assist in changing tobacco use behavior and

yield concomitant reductions in risk. Thus, for example, given the

ready availability of carbon monoxide measurement! reliability

assessments from a confederate, or automatic smoking machines, it

seems incomprehensible that reliability checks should not be

conducted at each assessment period.

A basic requirement is that data should be reported to identify the

proportion of individuals who are currently not smoking. Not

smoking is defined as a smoking rate of zero for a specified period

of time (probably a minimum of one week). Further, the length of

time that individuals have not been smoking should also be

determined. This recommendation recognizes abstinence as total

absence of smoking behavior over a specified period of time. It

reflects the common practice of lumping smokers with nonsmokers to

get an "average smoking rate" and also suggests that there be a

minimum time of nonsmoking to be calculated as abstinence.

It is relatively clear that smoking is a continuum. A person who

smokes two and a half packs of high-nicotine/high-tar cigarettes is

not the same as someone who smokes three low-nicotine/low-tar

cigarettes a week. These behaviors constitute different patterns

with different levels of risk. However, it appears obvious that at

some point on that continuum the smoker moves over into a different

kind of category, and that is total abstinence. Therefore it is

tremendously important that at the point of abstinence the

individuals be examined separately. Shifts in data emerge for

subjects as a function of individual behavioral change, but these

data may not be reflected in group data. Thus the goal is to track

individual patterns, not aggregate percentages.

Finally, total abstinence is meant to be total. Some investigators

have used abstinence criteria of less than one cigarette in a week

or less than one in a month. It is suggested that the best course

for use is to set a minimum period of time (for example, at least

one week) and if the person is not smoking at all they are

abstinent at that point. In any case, the length of time that is

used for abstinence criteria must be specified. It should, of

course, be noted that the "one week" requirement is indeed a

minimum standard and should not be associated with sustained

abstinence.

93
An essential measurement issue is that data for current smokers

should be presented in a way that allows for a determination of

smoking rate (episodes per unit time) and the substance used

(cigarette brand, etc.). This recommendation is to indicate the

minimum level of data. These data should not be presented as an

index that obscures the independent determination of these two

variables, although such an index could be presented in addition to

the individualized variables. It is not immediately apparent that

there is a need to further standardize the time interval over which

rate should be determined nor what data should be presented about

the substance. However, as more data are collected in various

research efforts it may become clear that considerable refinement

is necessary.

In a review of published smoking research, Frederiksen et al.

(1979) found only 20 percent of the studies were sufficiently

detailed to permit determination of not only the rate at which

people were smoking, but also what tobacco products they were

smoking. While it is becoming more common for investigators to

report these data, they are, unfortunately, often reported as an

index. For example the cigarette pack yield of tar or nicotine or

carbon monoxide is multiplied by the average rate to produce

indices. The disadvantage is that it is not clear what these

indices represent.

Further research is also required to permit precise specification

of the time periods over which rates should be integrated. That

is, it is necessary to determine whether the time base for rate

measures should be hourly, daily, weekly, etc. Similarly the

minimum number of units necessary for calculation of rate, i.e.,

how long the behavior should be recorded, is not readily apparent.

Continued effort in delineating the measurement parameters is

essential, and a precise statement on this dimension at present is

impractical.

An important issue is that, whenever possible, a description of

current smokers should also include an assessment of smoking

topography. Here again, it is not possible to specify exactly

under which conditions topography assessment should be made or

which topographical variables should be recorded (cf. Ossip-Klein

et al. 198 ). 3 Experimental study is essential, but at this point

it is evident that at least some topographical variables should be

assessed. Further these should be presented in a way that allows

for the separation of topography from the variables of rate and

substance. While the topography may also be combined with these

other variables into an index, the measures should, when reported,

be separable so that comparison with other studies is feasible.

COMMENT

It is suspected that these suggested criteria may be unsatisfying

to some, since they don't clearly delineate categories of smokers

and do not provide closure on which specific measures to use.

Rather, they put an emphasis on two points. One is the quality of

94
the data that we are collecting on smoking cessation. Are there

reliable, consistent data that that can be interpreted, broken

down, separated out, and looked at in other ways? In many cases it

is evident that the data are not reliable. and improvement in this

area is essential. Researchers, clinicians, or health educators

must comply with the minimum requirements of measurement. The

second point concerns the detail of the information. It should be

obvious that an aggregate smoking and nonsmoking distinction is far

too gross, as is smoking rate or simple reports of substance

smoked. Therefore the essential element is a need for more

detailed analysis or more detail in analysis. The extent to which

this occurs will determine the extent to which treatment efforts

will move forward.

Despite the critical comments contained herein, there is an

optimistic note in this proposal. That is, it does give us a

criterion or a direction in which to look if clear and comparable

measures of smoking are to evolve.

REFERENCES

Burling, T.A.; Lovett, S.B.; Richter, W.T. and Frederiksen, L.W.

Alveolar carbon monoxide: The relative contributions of daily

cigarette rates, cigarette brand, and smoking topography.

Addictive Behaviors, 8, 23-26, 1983.

Frederiksen, L.W.; Epstein, L.H.; and Kosevsky, B. Reliability and

controlling effects on three procedures for self-monitoring

smoking. The Psychological Record, 25, 255-264, 1975.

Frederiksen, L.W.; Martin, J.E.; and Webster, J.S. Assessment of

smoking behavior. J Applied Behavior Analysis. 12, 653-664,

1979.

Frederiksen, L.W.; Richter, W.T.; Burling, T.A. The assessment of

smoking topography: Current status. In R.H. Shipley (Chair),

New directions in the measurement of smoking behavior.

Symposium presented at the meeting of the Association for

Advancement of Behavior Therapy, November 1981, Toronto

Frederiksen, L.W., and Martin, J.E. Carbon monoxide and smoking

behavior. Addictive Behaviors, 4, 21-30, 1979.

Ossip-Klein, D.J.; Martin, J.E.; Lomaz, B.D.; Prue, D.M.; and Davis,

C.J. Assessment of smoking topography generalization across

laboratory, clinical, and naturalistic settings. Addictive

Behaviors, 8, 11-17, 1983.

95
Survey and Evaluation Methods:

Smoking Prevention Among

Children and Adolescents

Steven Paul Schinke, Ph.D., and Lewayne D. Gilchrist, Ph.D.

There has in recent years been a marked increase in survey and

evaluative research on tobacco smoking among children and

adolescents in the United States. Scientists and lay persons alike

may wonder why these populations are of interest since children and

adolescents are not supposed to smoke tobacco. Youths under the

age of 16 are ostensibly banned from buying tobacco products nearly

everywhere. Yet never before have so many children and adolescents

smoked cigarettes; and the average age at which they begin gets

younger each year (United States Public Health Service, 1982). The

main reason for studying youths in regard to tobacco use is that

even during childhood girls and boys experiment with cigarettes.

Worse yet and adding grist to the cause for smoking-related survey

and evaluative research is that experimental adolescent smokers

grow up to be tobacco-dependent individuals (Lichtenstein and Brown

1980). As such, young persons risk the disease consequences

associated with long-term tobacco use. Another just as disquieting

reason for studying children and adolescents is that tobacco

smoking has immediate and untoward physical consequences for young

people per se. All these reasons are valid and equally compelling

stimuli for empirical research with youthful populations at risk

for tobacco smoking.

Still, and in spite of a growing body of data, exactly what

constitutes smoking or "being a smoker" during childhood and

adolescence is unclear. The vagaries of youth together with

impediments to assessing this socially disapproved act yield

several definitions of tobacco use. A chapter on tobacco smoking

among children and adolescents in the 1979 Surgeon General's Report

notes, "Such terms as 'regular smoker,' 'occasional smoker,'

'experimental smoker,' and 'nonsmoker' vary from one study to the

next" (Evans et al. 1979, p. 7). The lack of correspondence

between studies is exacerbated by ill-defined criteria for placing

youth in each category of tobacco use. Many reports do not

operationalize and specify the labels used (O'Rourke 1980). Common

and uniform definitions of tobacco consumption categories are

needed.

96
Studying children and adolescents with respect to tobacco use is a

formidable task. Childhood and especially adolescence in America

are not well demarked. Societal sanctions against precocious

tobacco use cause young persons to engage in patterns of smoking

that greatly differ from adult usage. For adolescents, more than

for older cohorts in this country, smoking may for some groups

represent a "rite de passage." The practice gets confused with

values that have nothing to do with tobacco dependence. Finally,

girls and boys show wide variability in attitudes and practices

involving tobacco.

This paper considers such issues in conducting tobacco use surveys

and in evaluating smoking prevention and intervention research with

American youth. The authors review what is known about the

peculiarities of nonadults who smoke. They compare and contrast

methods to determine tobacco consumption among members of the

target age groups. These tasks are accomplished in three major

sections. The following sections cover issues of defining

childhood and adolescence, disparate smoking patterns, and

weaknesses of self-reported data. Discussion of each issue

includes recommendations for future surveys and evaluations of

young persons' smoking. Taken as a whole, these recommendations

should provide direction toward more precise and homogeneous

research on tobacco smoking among American children and adolescents

and, of particular importance, provide comparability of results

across research reports.

DEFINING CHILDHOOD AND ADOLESCENCE

The first issue faced in survey and evaluative research with

children and adolescents is defining the age group to study. Who

is a child? Common and anecdotal definitions of childhood are

fairly in agreement that children are small and infantile people,

primarily dependent on adults. Indeed, legal terminology calls

anyone under the age of majority--18 to 21 years in most regions--a

child since she or he is still under her or his parents' care and

responsibility (Gilchrist and Schinke, in press). A theoretical

treatise on child development lately indicated the generic notion

of childhood as not helpful for research purposes. Irving Sigel, a

developmental psychologist, observed a "growing trend toward

eschewing the term child, which is an age-based concept" (1980, p.

348) The present authors concur. Childhood is best expressed as

a developmental epoch, such as might be identified with school

grade.

Deciding who is an adolescent in the United States is more

difficult. Elsewhere the authors suggest adolescence ought not be

equated with "teenage" (Schinke 1981; Schinke and Gilchrist, in

press-b). Physiological, social, and psychological changes

occurring in the transition from childhood to adulthood far exceed

the 13th and 19th years. Again. school grade is a more reliable

indicator of developmental maturity than age (Radius et al. 1980;

Revill and Drury 19801. The developmental literature (Flavell

1977; Greenberg& et al. 1975; Mussen et al. 1979) depicts

adolescence as three stages: early adolescence (school grades 6

97
through 8), middle adolescence (school grades 9 through 12), and

late adolescence (college and employment). Smoking behavior at

each stage differs. Surveys document that off-and-on

experimentation is characteristic of early adolescence (Pederson et

al. 1981). Habitual smoking does not typically emerge until middle

adolescence (Evans 1976). Late adolescent smokers are not unlike

adults (Bosse et al. 1980).

An overview of the literature and the work of the authors suggest

that for tobacco smoking research, childhood should be defined as

beginning with birth and extending until a point prior to middle

school, generally through the end of fifth grade. Examples of

contemporary tobacco smoking research with such populations would

be the examinations of the effects of ambient or sidestream smoke

on preschool children who spend considerable time with their

parents.

Another example would be primary prevention research with school

children before the high-risk middle-school years. Regarding

research on adolescent tobacco smoking, young people beyond high

school should be considered adults. Younger subjects are best

described in terms of school grade. Cognitive and behavioral

capacities that differentiate early adolescence from middle

adolescence warrant consideration when designing surveys and

evaluations aimed at American youth.

DISPARATE SMOKING PATTERNS

Because of negative social sanctions on smoking and because

children and adolescents in this country have limited access to

cigarettes, youthful smoking patterns are uneven. Among

fifth-grade children and eighth-grade adolescents. the authors have

learned that many youths will smoke eight to ten cigarettes in an

evening, then not smoke again for several days running (Schinke and

Gilchrist, in press-a). Some adolescents will smoke two packs a

week, with the bulk of cigarettes consumed during 24 to 36 hours

over the weekend. Can these youths be defined in the same way as

young people who smoke a consistent four or five cigarettes a day?

One approach to the question is to examine the physiological

consequences of each consumption pattern. At present, little

research has been done on the consequences or the disease risk

associated with disparate patterns of tobacco use among children

and adolescents (Office on Smoking and Health 1982).

Clearly, more investigations need to examine the physiological

implications of massed doses of tobacco smoking on young people's

still maturing bodies (Frederiksen and Martin 1979). An impediment

to such work is that the topography of tobacco use widely differs

between adults and nonadults. Standard topographical analyses for

adult smokers are: number of puffs per cigarette, puff duration,

length of time from first puff to last, total intake volume, ratio

of intake volume to number of puffs, and interpuff interval

(Epstein et al. 1981). Whether or not children and adolescent

smokers inhale as deeply as and frequently as adult smokers is not

known. If regularity is used to distinguish smokers from

98
experimenters, a problem arises. Presumably, youths who smoke

without inhaling suffer fewer physiological consequences than those

who smoke more sporadically but inhale deepy. Some analogues can

be derived from research with adult populations, but the

generalizability of such findings is limited.

For children and adolescents more than for adults, demographic

factors influence smoking habits and tobacco consumption.

Variations in the tobacco smoking of youthful subgroups and

cultures necessitate highly specific samples (Clausen 1968). The

smoker's gender warrants special consideration. Nationally,

cigarette consumption has risen among young women while decreasing

among young men (Bachman et al. 1981). Ethnicity too affects

childhood and adolescent tobacco use. Hunter et al. (1980) found

white 16- to 17-year-olds smoked twice as much as black youths the

same age. Geographic differences also come into play. As an

example, Hunter et al. (1980) learned that one in four adolescent

subjects in southern Louisiana reported regular tobacco chewing.

In all likelihood, these youths would be expected to evidence

spuriously low rates of tobacco smoking when compared with youths

from areas where tobacco chewing is uncommon.

Several approaches may be taken to resolving problems of analysis

which reside in differences emanating from the sources and factors

mentioned above. Less weight should be given to the quantity

(i.e., absolute number) of cigarettes young people smoke. Instead,

more attention ought to be put on the timing and situational

patterns of youths' tobacco consumption. Researchers must a priori

sketch the features that clearly identify their child and

adolescent subject samples. Every report that springs from

research with nonadults ought to carefully delimit the generality

of findings on what was perhaps a sui generic sample of young

persons. Key descriptive features that should be detailed are the

youths' developmental profiles in terms of their cognitive and

physical maturation and their racial characteristics and family

backgrounds.

Investigators should grow acquainted with previous research done

with their youthful sample. Earlier surveys and interventive

programs may dramatically skew children's and adolescents'

responses to current assessments and evaluative research (Glasgow

et al. 1981). Effects of attention, placebo, and experimenter

expectancy are particularly acute with children and adolescents

(Schinke et al. in press). Taking into account the idiosyncracies

of every youthful sample demands extra care. Far from burdensome,

such preliminary steps have manifold payoffs by focusing subsequent

research and by controlling factors which may confound the external

validity of whatever results from the research.

WEAKNESSES OF SELF-REPORT

The bulk of survey and evaluative investigations with children and

adolescents have exclusively relied on self-reported tobacco use

and abstinence. Lack of honesty, poor recall, and desirable

response bias, however, plague self-reports and can yield inchoate

data. The flaws of self-reported smoking are magnified with

99
children and adolescents. O'Rourke (1980) speaks to the issue:

"In the light of the possible negative implications to individuals,

especially to youth by their parents, different studies using

similar groups may find different rates of smoking behavior but

which may, in fact, be a function of how well the confidentiality

of the respondent was protected" (p. 163).

Fear of discovery is not the only trouble with self-reports of

children's and adolescents' smoking. For largely developmental

reasons, young people may not know how to classify their own

smoking behavior. As an illustration, self-report criteria from

Pederson et al. (1981) in research with fourth and sixth graders

would have been inadequate for fifth and sixth graders in the

present investigators' sample. Pederson et al. considered their

respondents "regular smokers" if the young persons said they

"usually" smoked cigarettes "just about every day." Youths were

called "occasional smokers" if they reported smoking cigarettes

"once in a while but not every day" (Pederson et al. 1981, p.

143). Qualifiers of "usually," "just about," and "once in a while"

permit too much leeway for children and adolescents who must relate

the terms to their own behavior. Youths under age 15 are

vulnerable to misinterpreting imprecise language (Duke et al.

1980). Cognitive operations of abstract thinking are generally not

mastered until late adolescence (Gilchrist 1981). Before that

time, young people have difficulty pairing overt actions with

symbolic words. Moreover, children's and adolescents' ability to

recall patterns of recent behavior is notoriously poor (Schinke et

al., in press-b).

To better separate indistinct categories of tobacco use,

researchers have lumped young persons into fewer, self-defined

groups. Thirteen- to 17-year-olds in a national household survey

done by Yankelovich et al. (1977) were thus grossly grouped as

smokers or nonsmokers regardless of patterns of cigarette use.

Lotecka et al. (1981) asked high school students "to identify

themselves as a Smoker, Non-Smoker, or Ex-Smoker" (p. 524). Not

surprisingly, the team found their third group to be quite

heterogeneous and noted, "The definitions with Ex-smokers (sic)

were blurred at times with some individuals unsure about their

status" (Lotecka et al. 1981, p. 524).

For the sake of unified and compatible research on childhood and

adolescent tobacco smoking, objective definitions are needed. The

definitions ought to be specific enough for direct translation into

survey and evaluation protocols. Definitions of youthful smoking

must nonetheless apply to diverse and varied research on the

incidence, effects, concomitants, prevention, and cessation of

tobacco use among children and adolescents. These ends can be

served neither by simple bipolar categories nor by elaborate

nosologies of youths' tobacco smoking. Rather, researchers must

strike a balance between the two poles.

In search of a harmonious yet broadly applicable definition of

tobacco use by children and adolescents, the authors drew from the

literature and from their own evaluative research. Most

100
influential were definitions from the Bogalusa Heart Study (Hunter

et al. 1980) and those from the authors' primary prevention efforts

with fifth- and sixth-grade boys and girls (Schinke and Gilchrist,

in press-a; Schinke et al., in press). Combined, the young samples

from these projects total about 3,500 8- to 17-year-olds of both

sexes. Definitions produced by interdigitation of the survey and

evaluative research cover seven nonexlusive categories of youthful

tobacco smoking. These are:

Nonsmoker. A child or an adolescent who has never intentionally

puffed on a cigarette.

Experimenter. A child or an adolescent who on at least one

occasion but less then once weekly during the most recent month

lit, held, puffed, or inhaled any form of tobacco.

Ex-experimenter. A child or an adolescent experimenter in a prior

month who did not intentionally puff on any form of tobacco in the

most recent month.

Adopter. A child or an adolescent who once or more a week during

the most recent month intentionally inhaled tobacco smoke.

Increased adopter. An adopter who previously smoked less often

than during the most recent month.

Decreased adopter. An adopter who previously smoked more often

than during the most recent month.

Ex-adopter. An adopter in a prior month who has not lit, held,

puffed, or inhaled any form of tobacco in the most recent month.

Figure 1 lays out a schematic presentation of these definitional

categories plotted across the life span with respect to tobacco

consumption and disease risk.

The seven categories defined above offer distinct advantages to

tobacco smoking research with children and adolescents. The

definitions are responsive to any youthful age group and tobacco

substance. They permit investigators to move young persons from

one category to another as their smoking behavior shifts. The

categories can be assigned on the basis of self-reported,

observational, and biochemical data. As depicted in figure 1, the

definitions have implications for theory building. The graphed

categories reveal how young people maintain, decrease, and increase

one facet of cancer disease risk by altering their tobacco use.

The definitions allow survey and evaluative researchers to specify

and delineate a homogenous study sample. In all likelihood such

homogeneity will make data gathering more focused and will presage

improved surveys, prevention programs, and treatment efforts.

Last, the seven inclusive definitions will foster better

communications among smoking investigators. When a number of

scientists adopt the seven groupings of childhood and adolescent

tobacco users and nonusers, normative data can be amassed and

exchanged.

101
FIGURE 1. Schematic presentation of seven categorical definitions of children and

adolescent tobacco users and nonusers.
SUMMARY

Past behavioral research on the special characteristics of tobacco

smoking among children and adolescents is fraught with definitional

ambiguities. More precise benchmarks of these age groups will

facilitate mutually advantageous investigations. Researchers ought

to agree on their target age cohorts. Too, investigators should

account for the peculiar tobacco smoking patterns of children and

adolescents who are research subjects. Finally, researchers should

reach a consensus on how they categorize various kinds of young

nonsmokers, smokers, and exsmokers. Recommendations put forth here

are an attempt toward common parameters for researching tobacco use

among American children and adolescents.

REFERENCES

Bachman, J.G.; Johnston, L.D.; and O'Malley, P.M. Smoking,

drinking, and drug use among American high school students:

Correlates and trends, 197511979. Amer J Public Health, 71,

59-69, 1981.

Bosse, R.; Garvey, A.J.; and Glynn, R.J. Age and addiction to

smoking. Addictive Behaviors, 5, 341-351, 1980.

Clausen, J.A. Adolescent antecedents of cigarette smoking: Data

from the Oakland growth study. Social Science and Medicine,

1, 357-382, 1968.

Duke, P.M.; Litt, I.F.; and Gross, R.T. Adolescents' selfassessment of sexual maturation. Pediatrics, 66, 918-920, 1980.

Epstein, L.H.; Ossip, D.G.; Coleman, D.; Hughes, J.; and Wiist, W.

Measurement of smoking totography during withdrawal or

deprivation. Behavior Therapy, 12, 507-519, 1981.

Evans, R.I. Smoking in children: Developing a social

psychological strategy of deterrence. Preventive Medicine,

5, 122-127, 1976.

Evans, R.I.; Henderson, A.; Hill, P.; and Raines, B. Smoking in

children and adolescents. In U.S. Department of Health,

Education, and Welfare, Public Health Service, Smoking and

Health: A Report of the Surgeon General. Washington, D.C.:

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Flavell, J.H. Cognitive Development. Englewood Cliffs, N.J.:

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Frederiksen, L.W:, and Martin, J.E. Carbon monoxide and smoking

behavior. Addictive Behaviors, 4, 21-30, 1979.

Gilchrist, L.D. Social competence in adolescence. In S.P. Schinke

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Glasgow, R.E.; McCaul, K.D.; Freeborn, V.B.; and O'Neill, K.

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104
Issues in the Measurement

of Smoking: Summary and

Discussion

Edward Lichtenstein, Ph.D., John Grabowski, Ph.D., and

Catherine S. Bell, M.S.

Investigators were attracted to the experimental analysis of

smoking behavior for diverse reasons. The perceived simplicity of

measurement appealed to some clinical investigators who had been

dealing with less quantifiable phenomena. For others, smoking

behavior and related or pharmacological issues provided a logical

area for examination of related problems. From a clinical

perspective, the goal was to eliminate or reduce tobacco use, and

it appeared that the behavior could be measured by simply asking

smokers how many cigarettes they smoked per day. Other scientists

and clinicians were interested in aspects of tobacco use or

nicotine effects insofar as a model existed for examining a

commonly administered and well understood pharmacological agent.

Analysis of tobacco use provides an opportunity for researchers to

examine behavioral pharmacological mechanisms and perhaps

contribute to the basis for therapeutic intervention.

A substantial data base reflects the fact that smoking behavior,

despite its seeming simplicity, is as varied and as difficult an

analysis problem as most human activities. As this volume attests,

smoking is a complex biobehavioral process and can not be

adequately delineated by any single question or indicator. It has

become apparent that behavioral, physical, and biochemical

indicators must be considered when developing research protocols.

One goal of this discussion will be to further delineate the issues

that must be considered by investigators with diverse goals.

Clinicians and researchers are necessarily consumers of smoking

measurement technology. Depending on the specific areas of study,

much interest lies in evaluating the effectiveness of preventive

and cessation interventions; studying the acquisition and

maintenance processes involved in smoking behavior; or examining

physiological and behavioral correlates of pharmacochemical

effects. The investigator who is implementing intervention

programs attempts to assure that subjects who say they are not

smoking are being truthful. Other investigators are interested in

issues which include the effects of shifts to a lower tar/nicotine

cigarette, the relative reinforcing effectiveness of nicotine,

105
individual differences among smokers with respect to disease

states, topography, frequency, metabolism, or other

characteristics. Different questions require emphasis on different

measures, although similarities in requirements do exist.

Much of the material presented in this volume can be organized

around three major questions or areas that concern various segments

of the smoking research community. The first area involves

determination of current smoking or abstinence. This simple

question is for some purposes the most critical issue. The second

issue is related to dosage or exposure to tobacco (nicotine), its

metabolites and tobacco combustion products. This involves the

measurement of tobacco use, including rate, topography, and

chemical intake. The third area involves identifying

characteristics of tobacco users, for example those of the

"dependent smoker." This entails examining physiological and

pharmacological correlates of behavioral patterns and delineating

relationships.

DETERMINING SMOKING AND NONSMOKING

Measuring nonsmoking is the major concern of intervention programs,

be they cessation or prevention. Most have an abstinence focus.

The key dependent variable for evaluation of the intervention

procedure is the proportion of subjects not smoking at a specified

time. Clearly it is equally important to attend to individual data

and assure that they coincide with group differences or

similarities.

Self-report has been a major tool for determining nonsmoking in

intervention studies. Issues of some importance for analysis of

the behavior are those related to patterns and topography.

Obtaining systematic and reliable data can be difficult, but it is

useful for the researcher to determine, for example, whether the

subject's cigarette is smoked "half-way" or to the filter.

Similarly, it is helpful to determine whether cigarette smoking

occurs in bouts or is spaced evenly throughout the day. When

smoking has ceased the appropriate questions must be carefully

stated and the focus of the response must be clearly determined.

Thus, for example, the period of time during which no smoking has

occurred is important whether it be one day, one week, or one

year. Whether a shift from one to another tobacco product has

occurred must be determined. Technical issues in the process can

be resolved if questions are properly devised and if the procedures

for collecting information are carefully implemented.

Truthfulness is a major issue concerning self-reports of both

smoking rates and nonsmoking. Demand characteristics, social

pressure, or incentives for abstinence (Goeckner 1979) may lead

adolescents or adults to deception about their smoking status and

aspects of rate or topography. Objective, chemical measures are

sought to rule out this possibility. Especially useful in this

regard would be a table of the various chemical measures and the

state-of-the-art consensus as to their relative strengths and

weaknesses. Fortunately Benowitz advances toward this goal by

106
providing a useful formulation which considers the sensitivity,

costs, and limitations for each of four biological fluids. The

invasiveness of each procedure should be considered as another

comparison dimension. Expired air (carbon monoxide) and saliva

(thiocyanate, nicotine) are easily obtained even in classroom and

nonclinical settings. Urine and blood may be difficult or

impossible to obtain in many field studies. The need for more

invasive procedures differs as a function of the focus of the

study. Clearly no study should be undertaken for which highly

invasive measures are necessary. However, studies should not

preclude use of procedures because of inconvenience or additional

analytical tasks. If appropriate measures are not possible, the

investigators should modify the research question so that

appropriate measures are at their disposal. As was noted in

presentations and discussion, various factors including the need

for medical oversight, the existence of stringent criteria

governing human subject involvement, and increasing budgetary

requirements must be evaluated. Further it must be considered that

one or another study may not be feasible if appropriate measures

can not be obtained.

A relatively simple and inexpensive technique for determining

abstinence is the use of significant others to record data. The

use of others to augment self-report may contribute an extra

measure of validity (e.g., Lichtenstein et al. 1973) but should not

be relied on as infallible, and potential risks of the procedure

must be recognized. Another technique, the so-called "bogus pipe

line," has been reported to increase accuracy of self-report among

adolescents (Evans et al. 1981), but it suffers from potential

ethical problems, as well as confounding of results from a number

of sources.

It is clear, overall, that techniques exist to measure current

rates of smoking and subsequently of abstinence for individuals

involved in smoking research projects. The critical issue is

whether or not the consuming scientist properly uses the available

technology. In this vein, it is equally apparent that even at the

level of abstinence there is a need to utilize the available

chemical analysis techniques if data are to be accepted as valid

and/or reliable.

MEASURING SMOKING OR DOSAGE

The measurement of actual tobacco use as well as the transition to

abstinence can be extremely important for studies intended to

examine diverse issues. Thus, for example, the focus of analysis

might be the behavior of smoking as a case of drug selfadministration, the examination of the physiologic state of

patients with cardiovascular problems, or the effectiveness of a

cessation program. Whatever the purpose, precision in measurement

is an essential adjunct to the study's primary goal. As previously

noted, necessary data can not be ignored simply because they are

difficult to obtain. The question that arises is which data are

necessary or of interest. As indicated in the previous section,

questionnaires can be used to obtain essential data.

107
Critical questions concerning type and numbers of cigarettes,

patterns of smoking, and the like must be asked. These questions

should, whenever possible, be derived from other sources (rather

than being developed anew for each study) and should be compatible

with measures used by other researchers. Chemical measures have

clear advantages in verifying gross discrepancies between the

verbal report and actual use levels. The purpose ultimately is to

determine the exposure to products of combustion as well as the

nicotine dosage and their levels in the body in relation to

reported tobacco use. The specific combination of measures may

vary, but breadth of data appears necessary from a health risk

perspective. In addition, it is useful to determine exposure to

those compounds or gases known or believed to be toxic, such as

tars, nicotine, carbon monoxide, and hydrogen cyanide. It is worth

noting that tars seem the most difficult to measure in standard

smoking studies and there is little available information, although

crude physical indicators of tar intake may be used.

The papers in this volume indicate that much progress has been made

in measuring nicotine, cotinine, carbon monoxide, and saliva

thiocyanate, although the task remains complex, On one hand

analysis of obtained fluids reflects levels at a given point. On

the other hand appropriate measures can provide a strong indication

of recent use, and these data can be examined in terms of

self-report measures. Individual differences in rates of intake

and elimination must be considered in estimating overall exposure

levels as well as matters of frequency or recency.

Questionnaire-based smoking rates are the self-report approximation

of exposure or dosage but have the clear disadvantage of

unreliability if they are not linked to objective chemical

measures. However, self-reported rates are convenient for

descriptive or statistical purposes. For example, they permit the

use of more powerful parametric statistical analysis (Lichtenstein

and Danaher 1976). Unfortunately, compared to reports of

abstinence, they are subject to more reporting biases (Pechachek

1979). Self-reported smoking rates tend to be only moderately

correlated with biochemical indicators. This may in part be due to

differences in intake and elimination but also may reside in

erroneous reporting. Nevertheless, it must be remembered that

self-reported rates have been useful in establishing rough

dose-response relationships between smoking and disease.

Concurrently, it must be recalled that further opportunities for

efforts of the magnitude required to establish such statistical

relationships are unlikely to occur.

One major interest in obtaining precise measures of dosage or

intake is to test hypotheses about the nature of smoking behavior

patterns including analysis of titration, or so-called "nicotine

regulation," and the relative reinforcing and aversive properties

of nicotine. Dosage issues may also be of considerable practical

importance in determining aspects of exposure and perhaps in

developing treatment strategies. Plasma cotinine appears to be the

dosage measure of choice for nicotine intake if precision is

required, and it is useful as a marker due to its longer half life.

108
Experimental analysis of nicotine regulation and associated

physiological effects requires the capability of manipulating as

well as measuring nicotine intake. The capability to measure

successive puffs or cigarettes in the laboratory provides different

levels of precision for different purposes. Comparison with

standardized nicotine doses administered intravenously indicates

the equivalence of intravenous nicotine to tobacco smoke. This

permits special parallel laboratory studies and provides a basis

for comparison with other drugs. Thus, at this level, the analysis

of smoking serves to verify basic premises about the behavior, the

"product," and the relation to other similarly administered or

similar drugs. Topographical measurement using portable devices in

the natural environment extends the opportunities for further

understanding of smoking and its determinants. Topography measures

can serve as indirect indicators and thus, for example, puff rate,

puff duration, and especially puff volume can contribute to

estimating nicotine intake. Perhaps more important is that these

behavioral measures can serve in examining questions about social

variables and other environmental determinants modulating smoking

behavior. An interesting and possibly useful application for the

new measurement techniques may be in the maintenance of controlled

smoking which has been described as an alternative to abstinence

(Frederiksen and Simon 1978; Foxx and Brown 1979). In these cases

chemical measures of dosage can serve to measure compensation which

maintains nicotine or CD levels in the face of reduced cigarette

consumption. Some (e.g., Frederiksen and Simon) but not all (Foxx

and Brown 1979) controlled smoking studies have included

appropriate measures. Another group for which precision of

topographical measurement is essentially nonexistent is that of

adolescents. The measuring devices could be used to further our

understanding of the intermittent or "unusual" non-chronic patterns

of smoking which often characterize members of this and other

groups. More generally, any studies which report reduction in

smoking rates as a positive outcome should provide chemical

measures of dosage.

Another neglected issue in examining dosage is, of course, the

measurement of smokeless tobacco use. Adult and adolescent use of

these less traditional forms of tobacco is on the rise and an

increasing source of concern (Christen 1980). Plasma nicotine or

cotinine, and probably urinary cotinine, could index use of chewing

or dipping tobacco (Gritz et al. 1981). For adolescents in school

settings,-however, a noninvasive procedure is needed, but none is

currently available. If a subject both smokes cigarettes and uses

chewing tobacco, biochemical measurement of one or the other

becomes very difficult. This is a particular problem for young

adolescents who may be experimenting with both routes of

administration. It also becomes an issue in treatment programs

when alternative routes of use occur after smoking ceases.

MEASURING CHARACTERISTICS OF SMOKERS

Characteristics of smokers may be of interest for several reasons.

The need arises in part to permit comparison of data from different

studies. One of the problems that plagues the field is the

109
difficulty of comparing results from different programs since the

comparability of subjects cannot be ascertained. Inherent in this

effort is the need to identify functional subsets of smokers as

defined by smoking patterns and individual characteristics. This

might permit prediction of differential response to different kinds

of interventions.

Considerable disagreement exists concerning the role of personality

or attitudinal variables as determinants of smoking. However,

there is implicit agreement among investigators that smokers vary

in the extent of dependence on pharmacological reinforcing

properties and related behavioral dependence. There has been

little effort to measure this dimension via psychometric or

questionnaire instruments. One possible exception, noted by Lando,

is Fagerstrom's Tolerance Scale (Fagerstrom 1578). This eight-item

measure is fairly crude from a psychometric point of view, but it

appears to have considerable construct validity. The basic idea of

scaling the dependence dimension is worth pursuing, and

Fagerstrom's scale identifies key behaviors that may reflect the

degree of dependence. It should be noted, however, that an

unpublished study by Lichtenstein and his coinvestigators suggests

the scale has weak internal consistency and modest concurrent

validity.

In general, characteristics of smokers can be measured by

combinations of questionnaire instruments and biochemical or

behavioral (topography) measures. Plasma cotinine may be the best

measure of tobacco use although nicotine may reflect acute changes

most accurately. Topographical data, including indicants of

overall patterns (e.g. daily), combined with chemical measures to

validate questionnaire data would likely generate useful

information.

COST-BENEFIT CONSIDERATIONS

The three major questions on areas under discussion may be viewed

as having different measurement requirements. Indeed it might be

argued that each potential hypothesis requires choices with respect

to measurement and the precision required. A cost-benefit

dimension is also involved in the choice of measure. Given the

necessary conceptual and technical base, precision can usually be

obtained, but the cost may be substantial. For example, it is

often a critical measurement goal to assess nicotine dosage. There

is widespread recognition that the number of cigarettes smoked

(assuming that is validly measured) is an imprecise measure.

Knowledge of official nicotine yields of the cigarette smoked

provides little additional information of actual dosage

self-administered.

Although cotinine provides the most precise, valid measure of

nicotine dosage, it is very expensive and moderately invasive since

it requires blood or urine samples. Many investigators, depending

on their hypotheses, may require less precision or may trade some

degree of precision and validity for a less costly or less invasive

measure, such as alveolar carbon monoxide or saliva thiocyanate.

110
Similarly some topographical measures are more difficult or more

costly than others, and choices concerning precision will be

necessary. However, it is evident that some effort to verify

questionnaire data through use of chemical and topographical

measures is extremely useful, if not essential.

Problems concerning validation using chemical and topographical

measures exist in many areas of smoking research, but they are

particularly evident in studies of adolescent smoking. Adolescents

present some difficult measurement issues. They tend to smoke

episodically, sometimes trying a few cigarettes, then not smoking

for weeks or months. They also tend to smoke less frequently. In

addition adolescents tend to be less reliable when providing

self-report data. As a group, adolescents thus provide an

excellent example of a case where data collected without

verification may be of limited value.

Unfortunately, biochemical indicators are less sensitive to lower

dosage levels likely to be self-administered by adolescents. It is

not clear that carbon monoxide or thiocyanate levels are useful in

experimental or occasional adolescent smokers except perhaps to

verify infrequent smoking. It is clear that precise noninvasive

techniques are essential for this population and it would be useful

for those engaged in developing biochemical measures to follow

patterns other than those characterized by chronic tobacco use.

Arguments that a chemical measure, despite its insensitivity, might

serve to produce a bogus pipeline effect (Evans et al. 1977) are

not particularly convincing. The bogus pipeline effect may

reassure the investigator, but is probably too fragile and in any

case invokes ethical reservations. In addition its utility will be

reduced as general knowledge of the phenomenon evolves.

In summary, the chapters in this volume provide a useful overview

of strategies and methods for measurement of smoking behavior.

Both the laboratory investigator and the field researcher should

profit from the material herein. It is important to remember that

it was not very long ago that self-report was the only measure of

smoking behavior appearing in the literature. Progress in

measurement has been very substantial and surely will continue.

Both the experimental analysis of smoking behavior and the

evaluation of intervention efforts will profit from such progress.

REFERENCES

Antonuccio, D.O., and Lichtenstein, E. Peer modeling influences on

smoking behavior of heavy and light smokers. Addictive

Behaviors, 5:299-306, 1980.

Benowitz, Neal L. The Use of Biological Fluid Samples In assessing

Tobacco smoke consumption. In: Grabowski, J., and Bell, C.,

eds. Measurement in the Analysis and Treatment of Smoking

Behavior. National Institute on Drug Abuse Research Monograph

48 DHHS. Pub. No. (ADM) 83-1285. Washington, D.C.: Supt. of

Docs., U.S. Govt. Print. Off., 1983. pp. 6-26.

111
Christen, A.G. The case against smokeless tobacco: Five facts for

the health professional to consider. J Amer Dental Assoc,

19:464-469, 1980.

Evans, R.I.; Rozelle, R.M.; Maxwell, S.E.; Raines, B.E.; Dill, S.E.;

Guthrie, T.J.; Henderson, A.H.; and Hill, P.C. Social modeling

films to deter smoking in adolescents: Results of a three-year

field investigation. J Applied Psychology, 66:399-414, 1981.

Evans, R.I.; Hansen, W.E.; and Mittelmark, M.D. Increasing the

validity of self-reports of smoking behavior in children.

J Applied Psychology, 62:521-523, 1977.

Fagerstrom, K-O. Measuring degree of physical dependence to tobacco

smoking with reference to individualization of treatment.

Addictive Behaviors, 3:235-241, 1978.

Foxx, R.M., and Brown, R.A. Nicotine fading and self-monitoring

for cigarette abstinence of controlled smoking. J Applied

Behavior Analysis, 12:111-125, 1979.

Frederiksen, L.W., and Simon, S.J. Modification of smoking

topography: A preliminary analysis. Behavior Therapy,

9:146-949, 1978.

Goeckner, D.J. A multifaceted approach to smoking modification:

Training in alternate response strategies. Dissertation

Abstracts International, 40(1-B): 450, 1979. (University

Microfilms No. 7915354.)

Gritz, E.; Baer-Weiss, V.; Benowitz, N.L.; Van Vunakis, H.; and

Jarvik, M. Plasma nicotine and cotinine concentrations in

habitual smokeless tobacco users. Clin Pharm Ther, 30(2):

201-209, 1981.

Lando, H. Data collection and questionnaire design: Smoking

cessation in adults. In, Grabowski, J., and Bell, C., eds.

Measurement in the Analysis and Treatment of Smoking Behavior.

National Institute on Drug Abuse Research Monograph 48 DHHS

Pub. No. (ADM) 83-1285. Washington, D.C.: Supt. of Docs., U.S.

Govt. Print. Off., 1983. pp. 74-89.

Lichtenstein, E., and Danaher, B.G. Modification of smoking

behavior. A critical analysis of theory, research and

practice. In Hersen, M., Eisler, R.M., and Miller, P.M., eds.

Progress in Behavior Modification. New York: Academic Press,

1976.

Lichtenstein, E.; Harris, D.E.; Birchler, G.R.; Wahl, J.M.; and

Schmahl, D.P. Comparison of rapid smoking, warm, smoky air and

attention placebo in the modification of smoking behavior.

J Consulting Clin Psychology 40:92-98, 1973.

Pechacek T.F. Modification of smoking behavior. In:

Health: A Report of the Surgeon General. DHEW Publication No.

Smoking and

(PHS) 79-50066. Washington, D.C.: U.S. Government Printing

Office, 1979.

112
Working Group on

Measurement Issues in Smoking/Tobacco Research

August 20, 1982

Building 31, Conference Room 6

National Institutes of Health

Bethesda, Maryland

PARTICIPANTS

Josephine D. Arasteh, Ph.D.

Health Scientist Administrator

Human Learning and Behavior Branch

National Institute of Child Health

and Human Development

Landow Building, Room 7C18

7910 Woodmont Avenue

Bethesda, Maryland 20205

Catherine S. Bell, M.S.

Program Director for Behavioral

Smoking Projects

Behavioral Medicine Branch

Division of Resources, Centers,

and Community Activities

National Cancer Institute

Blair Building, Room 629

Silver Spring, Maryland 20910

Neil L. Benowitz, M.D.

Associate Professor of Medicine

Department of Medicine

University of California

San Francisco General Hospital

1001 Potrero Avenue

San Francisco, California 94110

John A. Cooper, Ph.D.

Assistant Director for Extramural

Activities

National Cancer Institute

Landow Building, Room 8C41

7910- Woodmont Avenue

Bethesda, Maryland 20205

Joseph W. Cullen, Ph.D.

Deputy Director

Division of Resources, Centers,

and Community Activities

National Cancer Institute

Building 31, Room 4A32

Bethesda, Maryland 20205

Bernard Fox. Ph.D.

Manager of Social Science

Biometry Branch

Division of Cancer Cause and

Prevention

National Cancer Institute

Landow Building, Room 4C04

7910 Woodmont Avenue

Bethesda, Maryland 20205

Lee Prederiksen, Ph.D.

Associate Professor

Department of Psychology

Virginia Polytechnic

and State University

Blacksburg, Virginia 24061

Tom Glynn, Ph.D.

Research Psychologist

Division of Research

National Institute on Drug Abuse

Parklawn Building, Row 931

5600 Fishers Lane

Rockville, Maryland 20857

John Grabowski, Ph.D.

Research Psychologist

Clinical Behavioral Branch

Division of Research

National Institute on Drug Abuse

Parklawn Building, Room 921

5600 Fishers Lane

Rockville, Maryland 20857

Neil E. Grunberg, Ph.D.

Assistant Professor

Department of Medical Psychology

Uniformed Services University of

the Health Sciences

4301 Jones Bridge Road

Bethesda, Maryland 20814

113
Richard Hawks, Ph.D.

Acting Chief

Research Technology Branch

Division of Research

National Institute on Drug Abuse

Parklawn Building, Room 942

5600 Fishers Lane

Rockville, Maryland 20857

Jack E. Henningfield, Ph.D.

Pharmacologist

National Institute on Drug Abuse

Addiction Research Center

P.O. Box 5200

Baltimore, Maryland 21224

Thomas J. Kean, M.P.H.

Special Assistant

Cancer Communications Network

National Cancer Institute

Building 31, Room 4B39

Bethesda, Maryland 20205

Lynn T. Kozlowski, Ph.D.

Senior Research Scientist

Clinical Institute

Addiction Research Foundation

33 Russell Street

Toronto, Ontario M5S2S1

CANADA

Norman A. Krasnegor, Ph.D.

Chief

Human Learning and Behavior Branch

National Institute of Child Health

and Human Development

Landow Building, Room 7C18

7910 Woodmont Avenue

Bethesda, Maryland 20205

Harry A. Lando, Ph.D.

Professor

Department of Psychology

Iowa State University

Ames, Iowa 50011

Sandra M. Levy, Ph.D.

Chief

Behavioral Medicine Branch

Division of Resources, Centers.

and Community Activities

National Cancer Institute

Blair Building, Room 632

Silver Spring, Maryland 20910

Edward Lichtenstein, Ph.D.

Professor

Department of Psychology

University of Oregon

Eugene, Oregon 97403

Murray Loew, Ph.D.

Associate Professor

Department of Electrical

Engineering and Computers

School of Engineering and

Applied Science

The George Washington University

Washington, D.C. 20052

Joanne Luoto, M.D., M.P.H.

Acting Director

Office on Smoking and Health

Park Building, Room 110

Rockville, Maryland 20857

Margaret E. Mattson. Ph.D.

Project Officer, Behavioral Studies

Clinical Trials Branch

National Heart. Lung, and Blood

Institute

Federal Building, Room 6A12

Bethesda, Maryland 20205

Thomas B. Owen, Ph.D.

Program Director for Smoking

and Health

Special Programs Branch

National Cancer Institute

Landow Building, Room 8C16

7910 Woodmont Avenue

Bethesda, Maryland 20205

Sydney R. Parker, Ph.D.

Acting Chief

Prevention, Education, and

Manpower Branch

National Heart, Lung, and

Blood Institute

Westwood Building, Room 6A11

5333 Westbard Avenue

Bethesda, Maryland 20205

114
Terry F. Pechacek, Ph.D.

Assistant Professor

Director of Smoking Research

Laboratory of Physiological Hygiene

School of Public Health

University of Minnesota

Stadium Gate 20

611 Beacon Street, S.E.

Minneapolis, Minnesota 55455

Roy W. Pickens, Ph.D.

Professor

Department of Psychiatry

Box 392 Mayo

University of Minnesota

Minneapolis, Minnesota 55455

Nancy McCormick Pickett

Special Assistant

Off ice of Cancer Communications

National Cancer Institute

Building 31, Room 4B39

Bethesda, Maryland 20205

Edward J. Roccella, Ph.D., M.P.R.

Deputy Chief

Health Education Branch

National Heart, Lung, and Blood

Institute

Building 31, Room 4A18

Bethesda, Maryland 20205

Jed E. Rose. Ph.D.

Assistant Research Psychologist

Psychopharmacology Research Unit

Veterans Administration

Medical Center, Brentwood

530/151D

Research Trailer 350

Los Angeles, California 90073

Steven Paul Schinke, Ph.D.

Director of Social Services

Child Development and Mental

Retardation Center

University of Washington

Seattle, Washington 98195

Elaine J. Stone, Ph.D., M.P.H.

Health Scientist Administrator

Preventive Cardiology Branch

National Heart, Lung, and Blood

Institute

Federal Building, Room 6A12

Bethesda, Maryland 20205

Ronald W. Wilson

Director

Division of Environmental Epidemiology

National Center for Health Statistics

Center Building, Room 2-27

3700 East-West Highway

Hyattsville, Maryland 20782

115
National

Institute on

monograph series

While limited supplies last, single copies of the monographs may

be obtained free of charge from the National Clearinghouse for

Drug Abuse Information (NCDAI). Please contact NCDAI also for

Information about availability of coming issues and other

publications of the National Institute on Drug Abuse relevant to

drug abuse research.

Additional copies may be purchased from the U.S. Government

Printing Office (GPO) and/or the National Technical Information

Service (NTIS) as indicated. NTIS prices are for paper copy.

Microfiche copies, at $4.50, are also available from NTIS.

Prices from either source are subject to change.

Addresses are:

NCDAI

National Clearinghouse for Drug Abuse Information

Room 1OA-43

5600 Fishers Lane

Rockville, Maryland 20857

GPO NTIS

Superintendent of Documents National Technical Information

U.S. Government Printing Office Service

Washington, D.C. 20402 U.S. Department of Commerce

Springfield, Virginia 22161

1 FINDINGS OF DRUG ABUSE RESEARCH. Not available from NCDAI.

Vol. 1: GPO out of stock NTIS PB #272 867/AS $32.50

Vol. 2: GPO out of stock NTIS PB #272 868/AS $29.50

2 OPERATIONAL DEFINITIONS IN SOCIO-BEHAVIORAL DRUG USE RESEARCH

1975. Jack Elinson, Ph.D., and David Nurco, Ph.D., eds. Not

available from NCDAI.

GPO out of stock NTIS PB #246 338/AS $16

3 AMINERGIC HYPOTHESES OF BEHAVIOR: REALITY OR CLICHE? Bruce J.

Bernard, Ph.D., ed.

GPO Stock #017-024-00486-3 $6.50 NTIS PB #246 687/AS $16

116
4 NARCOTIC ANTAGONISTS: THE SEARCH FOR LONG-ACTING PREPARATIONS.

Robert Willette, Ph.D., ed.

GPO out of stock NTIS PB #247 096/AS $8.50

5 YOUNG MEN AND DRUGS: A NATIONWIDE SURVEY. John A. O'Donnell,

Ph.D., et al.

GPO Stock #017-024-00511-8 $6.50 NTIS PB #247 446/AS $16

6 EFFECTS OF LABELING THE "DRUG ABUSER": AN INQUIRY. Jay R.

Williams, Ph.D.

GPO Stock #017-024-00512-6 $4.75 NTIS PB #249 092/AS $8.50

7 CANNABINOID ASSAYS IN HUMANS. Robert Willette, Ph.D., ed.

GPO Stock #017-024-00510-0 $6.00 NTIS PB #251 905/AS $14.50

8 Rx: 3x/WEEK LAAM - ALTERNATIVE TO METHADONE. Jack Blaine, M.D.,

and Pierre Renault, M.D., eds.

Not available from GPO NTIS PB #253 763/AS $14.50

9 NARCOTIC ANTAGONISTS: NALTREXONE PROGRESS REPORT. Demetrios

Julius, M.D., and Pierre Renault, M.D., eds.

GPO Stock 1017-024-00521-5 $7.00 NTIS PB #255 833/AS $17.50

10 EPIDEMIOLOGY OF DRUG ABUSE: CURRENT ISSUES. Louise G. Richards,

Ph.D., and Louise B. Blevens, eds.

GPO Stock #017-024-00571-1 $6.50 NTIS PB 1266 691/AS $22

11 DRUGS AND DRIVING. Robert Willette, Ph.D., ed. Reviews

research on effects of drugs on psychomotor performance, focusing

on measures of impairment by different drugs at various levels.

GPO Stock #017-024-00576-2 $5.50 NTIS PB #269 602/AS $16

12 PSYCHODYNAMICS OF DRUG DEPENDENCE. Jack D. Blaine, M.D., and

Demetrios A. Julius, M.D., eds. Theoretical and clinical papers

concerned with the intrapsychic determinants of drug addiction.

GPO Stock #017-024-00642-4 $5.50 NTIS PB #276 084/AS $17.50

13 COCAINE: 1977. Robert C. Petersen, Ph.D., and Richard C.

Stillman, M.D., eds. Reports the extent and limits of current

knowledge about cocaine, its use and misuse.

GPO Stock #017-024-00592-4 $6.00 NTIS PB #269 175/AS $19

14 MARIHUANA RESEARCH FINDINGS: 1976. Robert C. Petersen, Ph.D.,

ed. Technical papers on which the 6th Marihuana and Health report

to Congress was based.

GPO out of stock NTIS PB #271 279/AS $22

15 REVIEW OF INHALANTS: EUPHORIA TO DYSFUNCTION. Charles Wm.

Sharp, Ph.D., and Mary Lee Brehm, Ph.D., eds. Review of inhalant

abuse, including an extensive bibliography.

GPO Stock #017-024-00650-5 $7.50 NTIS PB 6275 798/AS $28

117
16 THE EPIDEMIOLOGY OF HEROIN AND OTHER NARCOTICS. Joan Dunne

Rittenhouse, Ph.D., ed. Task Force report on research

technologies and implications for studying heroin-narcotic use.

GPO Stock #017-024-00690-4 $6.50 NTIS PB #276 357/AS $20.50

17 RESEARCH ON SMOKING BEHAVIOR. Murray E. Jarvik, M.D., Ph.D.,

et al., eds. Includes epidemiology, etiology, consequences of

use, and approaches to behavioral change. From a NIDA-supported

UCLA conference.

GPO Stock #017-024-00694-7 $7.50 NTIS PB #276 353/AS $29.50

18 BEHAVIORAL TOLERANCE: RESEARCH AND TREATMENT IMPLICATIONS.

Norman A. Krasnegor, Ph.D., ed. Theoretical and empirical studies

of nonpharmacologic factors in development of drug tolerance.

GPO Stock #017-024-00699-8 $5.50 NTIS PB #276 337/AS $16

19 THE INTERNATIONAL CHALLENGE OF DRUG ABUSE. Robert C. Petersen,

Ph.D., ed. Papers from the VI World Congress of Psychiatry .

GPO Stock #017-024-00822-2 $7.50 NTIS PB #293 807/AS $28

20 SELF-ADMINISTRATION OF ABUSED SUBSTANCES: METHODS FOR STUDY.

Norman A. Krasnegor, Ph.D., ed. Techniques used to study basic

processes underlying abuse of drugs, ethanol, food, and tobacco.

GPO Stock 1017-024-00794-3 $6.50 NTIS PB 1288 471/AS $22

21 PHENCYCLIDINE (PCP) ABUSE: AN APPRAISAL. Robert C. Petersen,

Ph.D., and Richard C. Stillman. M.D., eds. For clinicians and

researchers, assessing the problem of PCP abuse.

GPO Stock 1017-024-00785-4 $7.00 NTIS PB #288 472/AS $25

22 QUASAR: QUANTITATIVE STRUCTURE ACTIVITY RELATIONSHIPS OF

ANALGESICS, NARCOTIC ANTAGONISTS, AND HALLUCINOGENS. Gene

Barnett, Ph.D.; Milan Trsic, Ph.D.; and Robert Willette, Ph.D.;

eds. Reports from an interdisciplinary conference on molecular

drug-receptor interactions.

GPO Stock #017-024-00786-2 $8.00 NTIS PB #292 265/AS $35.50

23 CIGARETTE SMOKING AS A DEPENDENCE PROCESS. Norman A.

Krasnegor, Ph.D., ed. Discusses factors involved in the onset,

maintenance, and cessation of the cigarette smoking habit.

Includes an agenda for future research.

GPO Stock #017-024-00895-8 $6.00 NTIS PB #297 721/AS $19

24 SYNTHETIC ESTIMATES FOR SMALL AREAS: STATISTICAL WORKSHOP

PAPERS AND DISCUSSION. Jos. Steinberg, ed. Papers from a workshop on statistical approaches that yield needed estimates of

data for States and local areas. Not available from NCDAI.

GPO Stock #017-024-00911-3 $8.00 NTIS PB #299 009/AS $23.50

25 BEHAVIORAL ANALYSIS AND TREATMENT OF SUBSTANCE ABUSE. Norman

A. Krasnegor, Ph.D., ed. Papers on commonalities and

implications for treatment of dependency on drugs, ethanol, food,

and tobacco.

GPO Stock #017-024-00939-3 $5.00 NTIS PB #80-112428 $22

118
26 THE BEHAVIORAL ASPECTS OF SMOKING. Norman A. Krasnegor, Ph.D.,

ed. Reprint of the behavioral section of the 1979 Report of the

Surgeon General on Smoking and Health; introduction by editor.

GPO out of stock NTIS PB #80-118755 $17.50

27 PROBLEMS OF DRUG DEPENDENCE, 1979: PROCEEDINGS OF THE 41ST

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. L.S. Harris, Ph.D., ed. Not available from NCDAI.

GPO Stock #017-024-00981-4 $9.00 NTIS PB #80-175482 $37

28 NARCOTIC ANTAGONISTS: NALTREXONE PHARMACOCHEMISTRY AND

SUSTAINED-RELEASE PREPARATIONS. Robert Willette, Ph.D., and

Gene Barnett, Ph.D., eds. Papers report research on sustainedrelease and long-acting devices for use with the narcotic antagonist naltrexone.

GPO Stock #017-024-01081-2 $7.00 NTIS PB #81-238875 $23.50

29 DRUG ABUSE DEATHS IN NINE CITIES: A SURVEY REPORT. Louis A.

Gottschalk, M.D., et al. Epidemiologic study providing data on

drug-involved deaths and procedures for their investigations.

Not available from NCDAI.

GPO Stock #017-024-00982-2 $6.50 NTIS PB #80-178882 $17.50

30 THEORIES ON DRUG ABUSE: SELECTED CONTEMPORARY PERSPECTIVES.

Dan J. Lettieri, Ph.D.; Mollie Sayers; and Helen Wallenstein

Pearson, eds. Volume presents summaries of the major contemporary theories of drug abuse by each of 43 leading theorists.

GPO Stock #017-024-00997-1 $10.00 Not available from NTIS

31 MARIJUANA RESEARCH FINDINGS: 1980. Robert C. Petersen, Ph.D.,

ed. The text of the 8th Marijuana and Health report to Congress

and the background scientific papers on which it was based.

GPO out of stock NTIS PB #80-215171 $20.50

32 GC/MS ASSAYS FOR ABUSED DRUGS IN BODY FLUIDS. Rodger L. Foltz,

Ph.D.; Allison F. Fentiman, Jr., Ph.D.; and Ruth B. Foltz. A

collection of methods for quantitative analysis of several

important drugs of abuse by gas chromatography- mass spectrometry.

GPO Stock #017-024-01015-4 $6.00 NTIS PB #81-133746 $19

33 BENZODIAZEPINES: A REVIEW OF RESEARCH RESULTS, 1980. Stephen

I. Szara, M.D., D.Sc., and Jacqueline P. Ludford, M.S., eds.

A RAUS (Research Analysis and Utilization System) Review Report

on the abuse liability of the benzodiazepine "tranquilizers."

GPO Stock #017-024-01108-8 $5.00 NTIS PB #82-139106 $13

34 PROBLEMS OF DRUG DEPENDENCE, 1980: PROCEEDINGS OF THE 42ND

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

DEPENDENCE, INC. Louis S. Harris, Ph.D., ed.

GPO Stock #017-024-01061-8 $8.00 NTIS PB #81-194847 $34

119
35 DEMOGRAPHIC TRENDS AND DRUG ABUSE, 1980-1995. Louise G.

Richards, Ph.D., ed. Estimates of probable extent and nature of

nonmedical drug use, 1980-1995, based on age structure and other

characteristics of U.S. population.

GPO Stock #017-024-01087-1 $4.50. NTIS PB #82-103417 $13

36 NEW APPROACHES TO TREATMENT OF CHRONIC PAIN: A REVIEW OF MULTIDISCIPLINARY PAIN CLINICS AND PAIN CENTERS. Lorenz K.Y. Ng. M.D.,

ed. A sharing of ideas among active practitioners in the treatment of pain.

GPO Stock #017-024-01082-1 $5.50. NTIS PB #81-240913 $19

37 BEHAVIORAL PHARMACOLOGY OF HUMAN DRUG DEPENDENCE. Travis

Thompson, Ph.D., and Chris E. Johanson, Ph.D., eds. Presents a

growing body of data, systematically derived, on the behavioral

mechanisms involved in use and abuse of drugs.

GPO Stock #017-024-01109-6 $6.50 NTIS PB #82-136961 $25

38 DRUG ABUSE AND THE AMERICAN ADOLESCENT. Dan J. Lettieri,

Ph.D., and Jacqueline P. Ludford, M.S., eds. A RAUS Review

Report, emphasizing use of marijuana: epidemiology, sociodemographic and personality factors, family and peer influence,

delinquency, and biomedical consequences.

GPO Stock #017-024-01107-0 $4.50 NTIS PB #82-148198 $14.50

39 YOUNG MEN AND DRUGS IN MANHATTAN: A CAUSAL ANALYSIS.

Richard R. Clayton, Ph.D., and Harwin L. Voss, Ph.D. Examines

the etiology and natural history of drug use, with special focus

on heroin. Includes a Lifetime Drug Use Index.

GPO Stock #017-024-01097-9 $5.50 NTIS PB #82-147372 $19

40 ADOLESCENT MARIJUANA ABUSERS AND THEIR FAMILIES. Herbert

Hendin, M.D., Ann Pallinger, Ph.D., Richard Ulman, Ph.D., and

Arthur Carr, Ph.D. A psychodynamic study of adolescents

involved in heavy marijuana use, to determine what interaction between family and adolescent gives rise to drug abuse.

GPO Stock #017-024-01098-7 $4.50 NTIS PB #82-133117 $13

41 PROBLEMS OF DRUG DEPENDENCE, 1981: PROCEEDINGS OF THE 43RD

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. A broad review of

current research. Includes treatment issues; chemistry and

pharmacology of abused drugs; efficacy and dependence liability

of new compounds.

Not available from GPO NTIS PB #82-190760 $41.50

42 THE ANALYSIS OF CANNABINOIDS IN BIOLOGICAL FLUIDS. Richard L.

Hawks, Ph.D., ed. Presents varied approaches to sensitive,

reliable, and accessible quantitative assays for the chemical

constituents of marijuana, for basic researchers in biomedical

and forensic science.

GPO Stock #017-024-01151-7 $5 NTIS PB #83-136044 $16

120
43 PROBLEMS OF DRUG DEPENDENCE, 1982: PROCEEDINGS OF THE 44TH

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

DEPENDENCE. INC. Louis S. Harris. Ph.D.. ed. A collection of

papers which together record a year's advances in drug abuse

research; also includes reports on tests of new compounds for

efficacy and dependence liability.

GPO Stock #017-024-01162-2 $8.50 NTIS PB No. to be assigned

IN PREPARATION

44 MARIJUANA EFFECTS ON THE ENDOCRINE AND REPRODUCTIVE SYSTEMS.

Monique C. Braude, Ph.D., and Jacqueline P. Ludford, M.S., eds.

A RAUS Review Report of animal studies and preclinical and

clinical studies of effects of cannabinoids on human endocrine

and reproductive functions.

45 PAIN MECHANISMS AND MANAGEMENT: A REVIEW OF RESEARCH, 1983.

Roger M. Brown, Ph.D.; Theodore M. Pinkert, M.D., J.D.; and

Jacqueline P. Ludford, M.S., eds. A RAUS Review Report on the

anatomy, physiology, and neurochemistry of pain and its

management.

46 BEHAVIORAL INTERVENTION TECHNIQUES IN DRUG ABUSE TREATMENT.

John Grabowski, Ph.D.; Maxine L. Stitzer, Ph.D., and Jack E.

Henningfield, Ph.D., eds. Reports on a variety of behavioral

contingency management procedures used in research/treatment

environments.

IN PRESS

47 PREVENTING ADOLESCENT DRUG ABUSE: INTERVENTION STRATEGIES.

Thomas J. Glynn, Ph.D.; Carl G. Leukefeld, D.S.W.; and

Jacqueline P. Ludford, M.S., eds. A RAUS Review Report on a

variety of approaches to prevention of adolescent drug abuse, how

they can be applied, their chances for success, and needed future

research.

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121
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Alcohol, Drug Abuse, and Mental

Health Administration

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