title: Increasing progesterone levels are associated with smoking abstinence among free-cycling women smokers who receive brief pharmacotherapy.
abstract: BACKGROUND
  Preclinical and human laboratory research suggests that (a) progesterone may decrease drug reward, craving, and smoking behavior, and (b) estradiol may enhance drug reward and smoking behavior. A modest majority of treatment research examining the relationship between menstrual cycle phase and outcomes suggests that the luteal menstrual phase, with its uniquely higher progesterone levels, is associated with better cessation outcomes. However, no studies to date have examined the effects of naturally occurring variation in progesterone and estradiol levels on medication-assisted smoking cessation. The present study sought to fill this notable gap in the treatment literature.
  
  
  METHODS
  Weekly plasma progesterone and estradiol levels were obtained from nicotine-dependent female smokers enrolled in a 4-week cessation trial. Participants (N = 108) were randomized to receive a 4-week course of either varenicline (VAR) tablets and placebo patches or placebo tablets and nicotine patches. Plasma samples were obtained 1 week before their cessation attempt and weekly during medication administration. Abstinence was assessed weekly.
  
  
  RESULTS
  Weekly hormone data replicated commonly observed menstrual cycle patterns of progesterone and estradiol levels. Importantly, increases in progesterone level were associated with a 23% increase in the odds for being abstinent within each week of treatment. This effect was driven primarily by nicotine patch-treated versus VAR-treated females.
  
  
  CONCLUSIONS
  This study was the first to identify an association between progesterone level (increasing) and abstinence outcomes in free-cycling women smokers who participated in a medication-based treatment. Furthermore, the potential benefits of progesterone may vary across different pharmacotherapies. Implications of these findings for smoking cessation intervention are discussed.
authors.affiliation: Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC; Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; saladinm@musc.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Saladin
authors.affiliation: Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC;
authors.forename: Erin A
authors.initials: EA
authors.lastname: McClure
authors.affiliation: Department Public Health Sciences, Medical University of South Carolina, Charleston, SC;
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Baker
authors.affiliation: Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC;
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carpenter
authors.affiliation: Department Public Health Sciences, Medical University of South Carolina, Charleston, SC;
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Ramakrishnan
authors.affiliation: Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Substance Abuse Treatment Center, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hartwell
authors.affiliation: Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Youth Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC;
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D001552:Benzazepines / Q000008:administration & dosage*; D004958:Estradiol / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D008597:Menstrual Cycle; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D011374:Progesterone / Q000097:blood / Q000378:metabolism*; D011810:Quinoxalines / Q000008:administration & dosage*; D016540:Smoking Cessation / Q000379:methods*; D057968:Transdermal Patch; D016896:Treatment Outcome; D000068580:Varenicline; D016387:Women's Health
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D011374:Progesterone; D004958:Estradiol; D009538:Nicotine; D000068580:Varenicline