Acute responses to nicotine and smoking: implications for prevention and treatment of smoking in lower SES women.

Compared with men, smoking reward and reinforcement in women tend to be less sensitive to nicotine but more sensitive to the nonpharmacological aspects of cigarette smoking (e.g. cues). Drawing mostly on findings from our laboratory, including new analyses of existing data, we explored whether characteristics possibly related to socioeconomic status (SES) may moderate acute responses to nicotine or smoking in women. Effects of nicotine in nonsmokers and in smokers were thought to identify factors that may be involved in the onset of nicotine dependence and in persistence of dependence, respectively. In nonsmokers, impulsive personality, prior marijuana use, and DRD2 and DRD4 genotypes may moderate nicotine responses in men but apparently not in women. However, the DRD4 gene may alter smoking reinforcement in response to negative mood in women but not men, a finding that could help explain smoking persistence in low SES women. Increasing women smoker's quit motivation via monetary reinforcement for abstinence may enhance the efficacy of nicotine patch during a quit attempt, at least in the short run. These findings clearly are tentative and require replication and extension in larger samples. A potentially more promising area of research concerns the recent finding from animal research that nicotine may enhance the reinforcing value of other reinforcers unrelated to smoking. Such an effect could increase our understanding of why quitting smoking is so difficult, why lapses after a quit attempt strongly predict failure of that attempt, and why nicotine replacement therapy aids cessation. Although speculative, low SES smokers may find smoking particularly hard to give up if doing so results in an overall decline in reinforcement, but they may gain more relative benefit from nicotine replacement therapy during quit attempts.