Marcus R Munafò

University of Bristol, Bristol, England, United Kingdom

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Publications (333)1946.8 Total impact

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    ABSTRACT: Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. We ran a randomised controlled trial to investigate the impact of plain packaging on smoking behaviour and attitudes. In a parallel group randomised trial design, 128 daily smokers smoked cigarettes from their usual UK brand, or a plain Australian brand that was closely matched to their usual UK brand for 24 hours. Primary outcomes were number of cigarettes smoked and volume of smoke inhaled per cigarette. Secondary outcomes were self-reported ratings of motivation to quit, cigarette taste, experience of using the pack, experience of smoking, attributes of the pack, perceptions of the health warning, changes in smoking behaviour, and views on plain packaging. There was no evidence that pack type had an effect on either of the primary measures (ps > 0.279). However, smokers using plain cigarette packs rated the experience of using the pack more negatively (-0.52, 95% CI -0.82 to -0.22, p = 0.001), rated the pack attributes more negatively (-1.59, 95% CI -1.80 to -1.39, p < 0.001), and rated the health warning as more impactful (+0.51, 95% CI 0.24 to 0.78, p < 0.001). Plain cigarette packs reduce ratings of the experience of using the cigarette pack, and ratings of the pack attributes, and increase the self-perceived impact of the health warning, but do not change smoking behaviour, at least in the short term. Current Controlled Trials ISRCTN52982308 . Registered 27 June 2013.
    BMC Public Health 12/2015; 15(1):1586. DOI:10.1186/s12889-015-1586-8 · 2.32 Impact Factor
  • Angela S Attwood, Marcus R Munafò
    Journal of clinical epidemiology 07/2015; DOI:10.1016/j.jclinepi.2015.04.016 · 5.48 Impact Factor
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    ABSTRACT: Objectives: The association between smoking reduction and mental health is of particular interest given that many smokers report that smoking offers mental health benefits. We aimed to assess the association between smoking reduction and change in mental health using two different analytical approaches to determine if there was any evidence of an association. There were no prior hypotheses. Design: A secondary analysis of prospective individual level patient data from 5 merged placebo-controlled randomised trials of nicotine replacement therapy for smoking reduction. Participants: All participants were adult smokers, selected because they wanted to reduce but not stop smoking, and had smoked for at least 3 years. Participants were excluded if they were pregnant, breastfeeding, under psychiatric care, deemed to be unfit by a general practitioner, or part of a cessation programme. 2066 participants were enrolled in the trials, 177 participants were biologically validated as prolonged reducers, and 509 as continuing smokers at both 6-week and 18-week follow-ups.
    BMJ Open 05/2015; 5(5). DOI:10.1136/bmjopen-2015-007812 · 2.06 Impact Factor
  • PLoS ONE 05/2015; 10(5):e0125256. DOI:10.1371/journal.pone.0125256 · 3.53 Impact Factor
  • Lee Harrison, Sue Wilson, Marcus R Munafò
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    ABSTRACT: Two thirds of adolescents with chronic musculoskeletal pain report a concurrent sleep problem. Both musculoskeletal pain and sleep problems can have deleterious effects on physiological and psychological well-being. We explored the prevalence of sleep problems and musculoskeletal pain, using data on 3,568 adolescents from the Avon Longitudinal Study of Children. A comprehensive battery of questionnaires was administered to derive clinical phenotypes of musculoskeletal pain. Adolescents with single symptoms were compared with those reporting both musculoskeletal pain and sleep problems. Linear and logistic regression analyses were used to compare groups on pain-related variables and psychological complaints. The association between sociodemographic variables and co-morbid musculoskeletal pain and sleep problems was assessed using logistic regression. Over half the sample was female (n = 2,076, 58.2%) and the majority of European ancestry (n = 3,174, 97.7%). Only 5.5% (n = 196) of participants were identified as having a pain condition, whilst 21.2% (n = 749) reported significant a sleep problem, and 2.8% (n = 99) reported co-morbid musculoskeletal pain and sleep problems. Adolescents with co-morbid problems experienced greater pain intensity and pain-related anxiety. Other psychological complaints were also higher in those who experienced concurrent problems, including depression, fatigue, concentration and overall severity of psychological symptoms. Co-morbid sleep and pain problems were associated with a higher incidence of pain-related and psychological complaints. Sleep problems may therefore be an important modifiable risk factor for alleviating suffering in adolescents with musculoskeletal pain.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    The Clinical journal of pain 05/2015; DOI:10.1097/AJP.0000000000000252 · 2.70 Impact Factor
  • Amy E Taylor, Neil M Davies, Marcus R Munafò
    04/2015; 3(6). DOI:10.1016/S2213-8587(15)00096-0
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    ABSTRACT: The ability to accurately verify facial identity has important forensic implications, but this ability is fallible. Research suggests that anxiety at the time of encoding can impair subsequent recall, but no studies have investigated the effects of anxiety at the time of recall in an experimental paradigm. This study addresses this gap using the carbon dioxide (CO2) model of anxiety induction. Thirty participants completed two inhalations: one of 7.5% CO2-enriched air and one of medical air (i.e., placebo). Prior to each inhalation, participants were presented with 16 facial images (50% own-ethnicity, 50% other-ethnicity). During the inhalation they were required to identify which faces had been seen before from a set of 32 images (16 seen-before and 16 novel images). Identification accuracy was lower during CO2 inhalation compared to air (F(1,29) = 5.5, p = .026, ηp(2) = .16), and false alarm rate was higher for other-ethnicity faces compared to own-ethnicity faces (F(1,29) = 11.3, p = .002, ηp(2) = .28). There was no evidence of gas by ethnicity interactions for accuracy or false alarms (ps > .34). Ratings of decision confidence did not differ by gas condition, suggesting that participants were unaware of differences in performance. These findings suggest that anxiety, at the point of recognition, impairs facial identification accuracy. This has substantial implications for eyewitness memory situations, and suggests efforts should be made to attenuate the anxiety in these situations in order to improve the validity of identification. Copyright © 2015. Published by Elsevier Inc.
    Physiology & Behavior 04/2015; 54. DOI:10.1016/j.physbeh.2015.04.027 · 3.03 Impact Factor
  • PLoS ONE 04/2015; 10(4):e0122896. DOI:10.1371/journal.pone.0122896 · 3.53 Impact Factor
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    ABSTRACT: While nicotine replacement therapy (NRT) is an effective pharmacological smoking cessation treatment, its efficacy is influenced by adherence to and consumption of the prescribed dose. The genetic variant rs1051730 in the nicotinic receptor gene cluster CHRNA5-A3-B4 influences smoking quantity. The aim of this study was to explore the impact of rs1051730 genotype on adherence to and consumption of NRT prescription following a smoking cessation attempt. Secondary analysis of data from a pharmacogenetic smoking cessation trial. Participants (n=448) were prescribed a daily dose of NRT for four weeks post quit attempt, and monitored during weekly clinic visits. Outcome measures were NRT prescription adherence rate (%) and average daily NRT consumption (mg) at 7- and 28-days after the quit attempt. An association between rs1051730 genotype and both outcome measures was observed at 7-days after the quit date. Each copy of the minor allele corresponded to a 2.9% decrease in adherence to prescribed NRT dose (P=0.044), and a 1.0mg decrease in daily NRT consumption (P=0.026). Adjusting for number of cigarettes smoked during this period only slightly attenuated these associations. There was no clear statistical evidence of an association between genotype and adherence or consumption at 28-days. This is the first study to evaluate the impact of rs1051730 genotype on consumption of and adherence to NRT prescription during a smoking cessation attempt. We observed an association between this variant and both outcome measures at 7-days; however, this was only moderate. These findings require replication in an independent sample. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
    Drug and alcohol dependence 04/2015; 165. DOI:10.1016/j.drugalcdep.2015.03.035 · 3.28 Impact Factor
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    ABSTRACT: Fear of negative evaluation (FNE) defines social anxiety yet the process of inferring social evaluation, and its potential role in maintaining social anxiety, is poorly understood. We developed an instrumental learning task to model social evaluation learning, predicting that FNE would specifically bias learning about the self but not others. During six test blocks (3 self-referential, 3 other-referential), participants (n = 100) met six personas and selected a word from a positive/negative pair to finish their social evaluation sentences "I think [you are / George is]…". Feedback contingencies corresponded to 3 rules, liked, neutral and disliked, with P[positive word correct] = 0.8, 0.5 and 0.2, respectively. As FNE increased participants selected fewer positive words (β = -0.4, 95% CI -0.7, -0.2, p = 0.001), which was strongest in the self-referential condition (FNE × condition 0.28, 95% CI 0.01, 0.54, p = 0.04), and the neutral and dislike rules (FNE × condition × rule, p = 0.07). At low FNE the proportion of positive words selected for self-neutral and self-disliked greatly exceeded the feedback contingency, indicating poor learning, which improved as FNE increased. FNE is associated with differences in processing social-evaluative information specifically about the self. At low FNE this manifests as insensitivity to learning negative self-referential evaluation. High FNE individuals are equally sensitive to learning positive or negative evaluation, which although objectively more accurate, may have detrimental effects on mental health.
    PLoS ONE 04/2015; 10(4):e0119456. DOI:10.1371/journal.pone.0119456 · 3.53 Impact Factor
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    04/2015; 2:39-45. DOI:10.1016/j.cobeha.2014.08.002
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    ABSTRACT: The serotonin-noradrenaline reuptake inhibitor (SNRI) duloxetine is an effective treatment for major depression and generalised anxiety disorder. Neuropsychological models of antidepressant drug action suggest therapeutic effects might be mediated by the early correction of maladaptive biases in emotion processing, including the recognition of emotional expressions. Sub-chronic administration of duloxetine (for two weeks) produces adaptive changes in neural circuitry implicated in emotion processing; however, its effects on emotional expression recognition are unknown. Forty healthy participants were randomised to receive either 14 days of duloxetine (60 mg/day, titrated from 30 mg after three days) or matched placebo (with sham titration) in a double-blind, between-groups, repeated-measures design. On day 0 and day 14 participants completed a computerised emotional expression recognition task that measured sensitivity to the six primary emotions. Thirty-eight participants (19 per group) completed their course of tablets and were included in the analysis. Results provide evidence that duloxetine, compared to placebo, may reduce the accurate recognition of sadness. Drug effects were driven by changes in participants' ability to correctly detect subtle expressions of sadness, with greater change observed in the placebo relative to the duloxetine group. These effects occurred in the absence of changes in mood. Our preliminary findings require replication, but complement recent evidence that sadness recognition is a therapeutic target in major depression, and a mechanism through which SNRIs could resolve negative biases in emotion processing to achieve therapeutic effects. © The Author(s) 2015.
    Journal of Psychopharmacology 03/2015; 29(5). DOI:10.1177/0269881115570085 · 2.81 Impact Factor
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    ABSTRACT: The biochemical targets for antidepressants are relatively well established, but we lack a clear understanding of how actions at these proteins translate to clinical benefits. This study used a novel rodent assay to investigate how different antidepressant drugs act to modify affective biases, which have been implicated in depression. In this bowl-digging task, rats encounter two equal value learning experiences on separate days (one during an affective manipulation, one during control conditions). This induces an affective bias which is quantified using a preference test in which both digging substrates are presented together and the individual rats' choices recorded. The assay can be used to measure affective biases associated with learning (when the treatment is given at the time of the experience) or, examine the modification of previously acquired biases (when the treatment is administered before the preference test). The rapid onset antidepressant ketamine, but not the delayed onset antidepressant, venlafaxine, attenuated the previously acquired FG7142-induced negative bias following systemic administration. Venlafaxine but not ketamine induced a positive bias when administered before learning. We then used local drug infusions and excitotoxic lesions to localise the effects of ketamine to the medial prefrontal cortex and venlafaxine to the amygdala. Using a modified protocol we also showed that positive and negative biases amplified further when the number of substrate-reinforcer associations are increased. We propose that this pattern of results could explain the delayed onset of action of venlafaxine and the rapid onset of action but lack of long term efficacy seen with ketamine.Neuropsychopharmacology accepted article preview online, 05 March 2015. doi:10.1038/npp.2015.59.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 03/2015; DOI:10.1038/npp.2015.59 · 7.83 Impact Factor
  • Biological psychiatry 03/2015; DOI:10.1016/j.biopsych.2014.12.007 · 9.47 Impact Factor
  • George Davey Smith, Marcus Munafo
    Psychiatric services (Washington, D.C.) 03/2015; 66(3):331. DOI:10.1176/ · 1.99 Impact Factor
  • Suzanne H Gage, Marcus R Munafò
    The Lancet Psychiatry 02/2015; 2(2). DOI:10.1016/S2215-0366(14)00057-1
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    ABSTRACT: One's peer group can have a strong impact on depressed mood and harmful drinking in adolescence. It remains unclear whether affiliation with deviant peers explains the link between these traits. Our study aims to (1) explore the developmental relationship between harmful drinking and depressed mood in adolescence and (2) establish to which extent affiliation with deviant peers explains this relationship. A total of 4,863 adolescents from the Avon Longitudinal Study of Parents and Children were assessed between the ages of 14 and 16 years. Harmful drinking was established using age-appropriate measures: the Semi-Structured Assessment for the Genetics of Alcoholism in mid-adolescence (age, 14 years) and the Alcohol Use Disorders Identification Test in late adolescence (age, 16 years). Depressed mood was measured by the Short Mood and Feelings Questionnaire at both ages. Affiliation with deviant peers was assessed at the age of 15 years. Harmful drinking at the age of 14 years predicted depressed mood 2 years later. This association was explained by affiliation with deviant peers and remained present even after adjustment for earlier depressed mood. Depressed mood at the age of 14 years predicted harmful drinking at the age of 16 years via affiliation with deviant peers; however, this indirect effect disappeared when adjusting for adolescents' earlier harmful alcohol use (age, 14 years). No gender differences were observed. Adolescents who engage in early harmful drinking and subsequently become affiliated with a deviant peer group may be at particular risk of later depressed mood. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of Adolescent Health 02/2015; 56(2). DOI:10.1016/j.jadohealth.2014.10.268 · 2.75 Impact Factor
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    ABSTRACT: Alcohol consumption is known to be associated with risky sexual behaviours, but this relationship may be complex and bidirectional. We explored whether alcohol consumption leads to the consumer being rated as more attractive than sober individuals. Heterosexual social alcohol consumers completed an attractiveness-rating task, in which they were presented with pairs of photographs depicting the same individual, photographed while sober and after having consumed alcohol (either 0.4 or 0.8 g/kg), and required to decide which image was more attractive. Photographs of individuals who had consumed a low dose of alcohol (equivalent to 250 ml of wine at 14% alcohol by volume for a 70 kg individual) were rated as more attractive than photographs of sober individuals. This was not observed for photographs of individuals who had consumed a low dose of alcohol. In addition to perceiving others as more attractive, a mildly intoxicated alcohol consumer may also be perceived as more attractive by others. This in turn may play a role in the relationship between alcohol consumption and risky sexual behaviour. © The Author 2015. Medical Council on Alcohol and Oxford University Press.
    Alcohol and alcoholism (Oxford, Oxfordshire). Supplement 02/2015; 50(3). DOI:10.1093/alcalc/agv010
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    ABSTRACT: Inhalation of 7.5% carbon dioxide increases anxiety and autonomic arousal and provides a novel experimental model of anxiety with which to evaluate pharmacological and psychological treatments for anxiety. To date several psychotropic drugs including benzodiazepines, SSRIs and SNRIs have been evaluated using the 7.5% CO2 model; however, it has yet to be used to evaluate psychological interventions. We compared the effects of two core psychological components of mindfulness-meditation (open monitoring and focused attention) against general relaxation, on subjective, autonomic and neuropsychological outcomes in the 7.5% CO2 experimental model. 32 healthy screened adults were randomized to complete 10 min of guided open monitoring, focused attention or relaxation, immediately before inhaling 7.5% CO2 for 20 min. During CO2-challenge participants completed an eye-tracking measure of attention control and selective attention. Measures of subjective anxiety, blood pressure and heart rate were taken at baseline and immediately following intervention and CO2-challenge. OM and FA practice reduced subjective feelings of anxiety during 20-min inhalation of 7.5% CO2 compared to relaxation control. OM practice produced a strong anxiolytic effect, whereas the effect of FA was more modest. Anxiolytic OM and FA effects occurred in the absence of group differences in autonomic arousal and eye-movement measures of attention. Our findings are consistent with neuropsychological models of mindfulness-meditation that propose OM and FA activate prefrontal mechanisms that support emotion regulation during periods of anxiety and physiological hyper-arousal. Our findings complement those from pharmacological treatment studies, further supporting the use of CO2 challenge to evaluate future therapeutic interventions for anxiety. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 02/2015; 63. DOI:10.1016/j.jpsychires.2015.02.001 · 4.09 Impact Factor
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    ABSTRACT: Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N=58) using a modified visual probe task from one week prior to quit day. Both groups received 21mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. No attentional bias towards smoking cues was found in the sample at baseline (mean difference=3ms, 95% CI=-2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference=-9ms, 95% CI=-20, 2). There was no difference between groups in change in craving (p=0.89) and prolonged abstinence at four weeks (risk ratio=1.00, 95% CI=0.70, 1.43). Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. UK Clinical Trials ISRCTN 54375405. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 02/2015; DOI:10.1016/j.drugalcdep.2015.01.041 · 3.28 Impact Factor

Publication Stats

9k Citations
1,946.80 Total Impact Points


  • 2005–2015
    • University of Bristol
      • School of Experimental Psychology
      Bristol, England, United Kingdom
  • 2013
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2001–2013
    • University of Oxford
      • • Department of Psychiatry
      • • Wellcome Trust Centre for Human Genetics
      • • Clinical Genetics Research Group
      Oxford, England, United Kingdom
  • 2011
    • University of Bath
      • Department of Psychology
      Bath, ENG, United Kingdom
  • 2008–2011
    • University of Cambridge
      • Department of Psychiatry
      Cambridge, ENG, United Kingdom
  • 2007–2011
    • University of Birmingham
      • Department of Primary Care Clinical Sciences
      Birmingham, ENG, United Kingdom
    • Massachusetts General Hospital
      • Tobacco Research and Treatment Center
      Boston, Massachusetts, United States
    • Brown University
      Providence, Rhode Island, United States
  • 1998–2003
    • University of Southampton
      Southampton, England, United Kingdom