Racial Differences in Circadian and Sleep Mechanisms for Nicotine Dependence, Craving, and Withdrawal

Three specific aims will determine: contributions of sleep timing and sleep quality and quantity to racial disparities in smoking status (Aim 1), objective sleep characteristics and smoking behavior among blacks and whites who smoke cigarettes (Aim 2), and whether sleep restriction modifies craving and withdrawal in racially diverse smokers (Aim 3). Specifically, we will utilize self-report questionnaires, objective measures of sleep quality and timing (actigraphy) and circadian phase (dim light melatonin onset), as well as ecological momentary assessment of cigarette use, smoking urges, cravings, and withdrawal symptoms to identify circadian and sleep characteristics that are most strongly associated with smoking status, heaviness of smoking and dependence among blacks and whites. Finally, we will test whether acute sleep restriction (4 hours of time-in-bed) versus sleep extension (10 hours of time-in-bed) modifies craving and withdrawal symptoms following cessation in black and white smokers. If successful, the results of this study will result in identification of circadian dysfunction and insufficient sleep as mechanisms that underlie the association between sleep and cigarette smoking behaviors and dependence in diverse populations. Moreover, these findings are likely to inform clinicians of the importance of sleep and sleep timing on cigarette smoking behaviors and dependence that will help in the development of novel interventions to reduce morbidity and mortality caused by tobacco use.

Sub-Study 1

Inclusion criteria

• 18 years or older
• Able to read and speak English
• Non-Hispanic African American (Black) or non-Hispanic white race
• Daily smoker (5 or more cigarettes a day for the past one year and having smoked more than 100 cigarettes in lifetime) or non-smoker (smoked fewer than 100 cigarettes in a lifetime and no smoking-not even a puff- in the last year)
• Currently residing in Alabama

Exclusion criteria

• Non-English speaking
• Lives in restricted environment that does not allow smoking
• Pregnant or lactating
• Daily or exclusive use of other tobacco products (e.g., cigars, e-cigarettes) if a smoker; if non-smoker, any other tobacco product use is exclusionary
• Currently receiving smoking cessation treatment or using electronic cigarettes or other tobacco to try and quit smoking cigarettes
• Participants would work outside normal 7 a.m. to 6 p.m. hours
• Former smokers

Sub-study 2

Inclusion criteria

• 18 years or older
• Able to read and speak English
• Non-Hispanic African American (Black) or non-Hispanic white race
• Daily smoker defined as smoking 5 or more cigarettes a day for the past one year and having smoked more than 100 cigarettes in lifetime, as well as by an expired Carbon Monoxide (CO )cut-off of Carbon Monoxide (CO)>10ppm and positive cotinine test to ensure daily smoking OR non-smoker defined as smoking fewer than 100 cigarettes in a lifetime and no smoking-not even a puff- in the last year, as well as by an expired Carbon monoxide (CO) cut-off of Carbon Monoxide (CO)<3 ppm and negative cotinine test.
• Currently residing in Alabama

Exclusion criteria

• Non-English speaking
• Lives in restricted environment that does not allow smoking
• Pregnant or lactating
• Testing positive on urine drug screen test at baseline - any drugs other than Tetrahydrocannabinol (THC) not allowed
• Daily or exclusive use of other tobacco products (e.g., cigars, e-cigarettes) if a smoker; if non-smoker, any other tobacco product use is exclusionary
• Currently receiving smoking cessation treatment or using electronic cigarettes or other tobacco to try and quit smoking cigarettes
• Participants would work outside normal 7 a.m. to 6 p.m. hours
• Former smokers
• History of a medical condition (e.g., bipolar disorder, migraine, or seizure disorder) that might be exacerbated by sleep deprivation as a result of Study 3
• History of a serious lung/breathing disease that prevents one from walking or holding their breath for 10 seconds (in order to complete Carbon Monoxide breath test)
• Cognitive impairment such that participant is unable to provide informed consent
• Acutely suicidal, manic, acutely intoxicated, or otherwise not stable enough to provide informed consent
• Living outside of the Birmingham metro area (> 20 miles away from University of Alabama at Birmingham Main Campus)

Sub-study 3

Inclusion criteria

• 18 years or older
• Able to read and speak English
• Non-Hispanic African American (Black) or non-Hispanic white race
• Daily smoker defined as smoking 5 or more cigarettes a day for the past one year and having smoked more than 100 cigarettes in lifetime, as well as by an expired Carbon Monoxide (CO) cut-off of Carbon Monoxide (CO)>10ppm and positive cotinine test to ensure daily smoking
• Currently residing in Alabama

Exclusion criteria

• Non-English speaking
• Lives in restricted environment that does not allow smoking
• Pregnant or lactating
• Daily or exclusive use of other tobacco products (e.g., cigars, e-cigarettes) if a smoker; if non-smoker, any other tobacco product use is exclusionary
• Currently receiving smoking cessation treatment or using electronic cigarettes or other tobacco to try and quit smoking cigarettes
• Participants would work outside normal 7 a.m. to 6 p.m. hours
• Former smokers
• History of a medical condition (e.g., bipolar disorder, migraine, or seizure disorder) that might be exacerbated by sleep deprivation as a result of Study 3
• Currently taking any psychiatric medications, pain medications (i.e., opioids), or sleep medications (e.g., Ambien, trazodone, melatonin pills, Cannabidiol (CBD) products)
• History of a serious lung/breathing disease that prevents one from walking or holding their breath for 10 seconds
• Testing positive on urine drug screen test at baseline - any drugs other than Tetrahydrocannabinol (THC) not allowed
• Has an apnea-hypopnea index (AHI) score of > 15 on home sleep testing that was conducted during sub-study 2
• Uses Continuous positive airway pressure (CPAP) machine to sleep at night
• Cognitive impairment such that participant is unable to provide informed consent
• Acutely suicidal, manic, acutely intoxicated, or otherwise not stable enough to provide informed consent
• Living outside of the Birmingham metro area (> 20 miles away from University of Alabama at Birmingham Main Campus)