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Drug Alcohol Depend. 2017 Feb 1;171:84-90. doi: 10.1016/j.drugalcdep.2016.11.023. Epub 2016 Nov 24.

Panic attack history and smoking topography.

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The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Blvd., Providence, RI 02906 USA; The Miriam Hospital, Centers for Behavioral and Preventative Medicine, 164 Summit St., Providence, RI 02906 USA; Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906 USA. Electronic address:
University of Pennsylvania Perlman School of Medicine, Department of Psychiatry, 3535 Market St., Philadelphia, PA 19103, USA. Electronic address:
Queens College, Department of Psychology and The Graduate Center, City University of New York (CUNY), 6530 Kissena Blvd., Queens, NY 11367 USA; Mailman School of Public Health, Department of Epidemiology, Columbia University, 722W 168th St, New York, NY 10032 USA. Electronic address:
University of Houston, Department of Psychology, 126 Fred J. Heyne Building, Houston, TX 77204 USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler St., Houston, TX 77230 USA. Electronic address:



Little is known about panic attacks and puffing topography, a behavioral index of the value of smoking reinforcement. This study examined smoking style during the course of smoking of a single cigarette among adult daily smokers with and without a history of panic attacks.


Participants (n=124, Mage=43.9, SD=9.7; 44.4% female) were non-treatment seeking daily smokers. Lifetime panic attack history was assessed via diagnostic assessment; 28.2% (n=35) of the sample had a panic attack history. Participants smoked one cigarette during an ad libitum smoking trial. Puff volume, duration, and inter-puff interval were measured using the Clinical Research Support System (CReSS) pocket device.


Regression analyses revealed that panic attack status was not associated with significant differences in average puff volume, duration, or inter-puff interval. Multi-level modeling was used to examine puffing trajectories. Puff-level data revealed that there was a significant quadratic time x panic effect for puff volume and duration. Those with a panic attack history demonstrated relatively sustained levels of both puff volume and duration over time, whereas those without a history of panic attacks demonstrated an increase followed by a decrease in volume and duration over time. These effects were not accounted for by the presence of general psychopathology.


Smokers with a panic attack history demonstrate more persistent efforts to self-regulate the delivery of nicotine, and thus may be at risk for continued smoking and dependence. Tailored treatment may be needed to address unique vulnerabilities among this group.


Anxiety; Panic attacks; Puff topography; Smoking motivation

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