Association of withdrawal features with nicotine dependence as measured by the Fagerström Test for Nicotine Dependence (FTND)

Sleep Quality and Nicotine Dependence Among Lebanese University Residents and Fellows: A Cross-Sectional Study

Background and objectives Sleep quality and nicotine addiction are important public health issues with significant negative impacts on individual well-being and the performance of healthcare professionals. This study aims to determine the prevalence and association of nicotine dependence and poor sleep quality among residents and fellows enrolled in the Lebanese University. Methods A cross-sectional study using the snowball-sampling technique was conducted in Lebanon between January and March 2023. Data were collected through an online survey that included information on socio-demographic characteristics, nicotine dependence, and sleep quality. A total of 350 residents and fellows were included in the study. Bivariate analysis and multivariable logistic regression were carried out to identify the factors associated with sleep quality. Adjusted odds ratio and 95% confidence intervals were reported. Results One quarter (25.1%) of the residents and fellows were smokers; among them, 44.3% smoked I Quit Ordinary Smoking (IQOS), 14.8% smoked cigarettes, 10.2% smoked waterpipe (WP), 12.5% smoked cigarettes and WP, and 18.2% smoked IQOS and WP. According to the Pittsburgh Sleep Quality Index (PSQI), 34.3% of participants had poor sleep quality. Smokers had 12.5 times higher odds of experiencing poor sleep quality compared to non-smokers (adjusted odds ratio ORadj = 12.58 with 95% confidence interval [CI] of 7.07-22.36; p-value <0.001). In addition, smoking a combination of two types of tobacco products (cigarettes with WP or IQOS with WP) posed the highest risk of poor sleep quality, with an adjusted odds ratio of 31.54 (95% CI of 9.15-45.74, p-value <0.001). Elevated Fagerström Test for Nicotine Dependence (FTND) and Lebanon Waterpipe Dependence Scale (LWDS-11) scores indicated an increased risk of poor sleep quality (adjusted odds ratio ORadj = 4.69 with 95% CI of 2.179-10.10; p-value <0.001; and adjusted odds ratio ORadj =1.27 with 95% CI of 1.04-1.55; p-value 0.019, respectively). Conclusion Our study found a significant association between nicotine dependence and poor sleep quality among medical residents and fellows, with smokers being more susceptible to sleep disturbances. The high prevalence of IQOS smoking among medical residents and fellows in Lebanon highlights the urgent need for comprehensive research investigating the effects of heated tobacco products. Furthermore, our study reveals a critical insight into the potential additive effects of nicotine, suggesting that the concurrent use of multiple tobacco products may further elevate the risk of poor sleep quality. Recognizing the implications of our findings, it is imperative to develop targeted interventions and educational programs that promote healthier sleep habits and facilitate smoking cessation among medical residents and fellows.

More utilitarian judgment in Internet addiction? An exploration using process dissociation and the CNI model

BACKGROUND

Internet addiction (IA), which is disadvantageous for decision making, such as moral judgment, is a pernicious threat to contemporary societies. However, few studies consider social cognition abilities as an important variable in IA.

OBJECTIVES

This study explores the psychological mechanism of IA facing the moral dilemma.

METHODS

Forty participants with IA and 89 healthy participants were recruited. They finished the Internet Addiction Test and completed the moral judgment task. The process dissociation (PD) method and the consequences, norms, and generalized inaction (CNI) model were used to analyze moral judgment data.

RESULTS

Compared with the healthy control (HC) group, the traditional analysis showed that the IA group made more utilitarian judgment regarding moral dilemmas. PD analysis showed that the IA group had decreased deontological inclination, without utilitarian inclination. The CNI model further showed that the sensitivity of the IA group to moral rules was significantly lower than that of the HC group, while there was no significant difference between groups in the sensitivity to the consequences and the general preference for action.

CONCLUSIONS

Individuals with IA make more utilitarian judgment when faced with a moral dilemma, which is related to their weak sensitivity to moral norms.

Association between nicotine dependency with occupational injury in Korean men

Background

The relationship between smoking status or second-hand smoking and occupational injuries has been the subject of considerable study, but few have studied the relationship between nicotine dependence and occupational injuries. The objective of this study was to investigate the relationship between nicotine dependence and occupational injury among employees at a range of Korean companies.

Methods

Initially, the personal and occupational characteristics and nicotine dependences of workers were measured, and 12 months later a survey was used to determine whether subjects had experienced any occupational injury. This study was conducted in several workplaces on 6,893 male workers in manufacturing and service industries that received health screening at Inha University Hospital in Incheon.

Results

The adjusted odds ratios (ORs) of occupational injury in the low, moderate, and high nicotine dependence groups were 1.38 (95% confidence interval [CI]: 1.04-1.84), 1.52 (95% CI: 1.10-2.10), and 1.71 (95% CI: 0.92-3.19), respectively. For smokers only, adjusted ORs tended to increase linearly (p for trend < 0.05). When only smokers were included, analysis of continuous FTND (Fagerstrom Test of Nicotine Dependence) scores showed that adjusted OR increased by 1.10 (95% CI: 1.03-1.19) per FTND point. After stratifying the data by working type and working hours per week, the non-shift work group maintained this relationship (OR: 1.13, 95% CI: 1.04-1.24) and OR was higher in the group that works more than 60 hours per week with FTND score as a continuous variable (OR: 1.24, 95% CI: 1.07-1.44).

Conclusions

The study shows nicotine dependency might affect occupational injury. From a short-term perspective, addressing worker's nicotine dependence by giving an adequate break time or smoking area might reduce work-related injuries.

Monetary Reward Discounting, Inhibitory Control, and Trait Impulsivity in Young Adults With Internet Gaming Disorder and Nicotine Dependence

Internet Gaming Disorder (IGD) has been considered a potential behavioral or non-substance addiction that requires further investigation. Recognition of the commonalities between IGD and Substance Use disorders (SUD) would be of great help to better understand the basic mechanisms of addictive behaviors and excessive Internet gaming. However, little research has targeted a straightforward contrast between IGD and SUD on neuropsychological aspects. The present study thus aimed to explore the associations of reward processing and inhibitory control with IGD and nicotine dependence (ND) in young adults. Fifty-eight IGD and 53 ND individuals, as well as 57 age- and gender-matched healthy controls, were assessed with a series of measurements including the Delay-discounting Test (DDT), Probability Discounting Test (PDT), the Stroop Color-Word Task, a revised Go/No Go Task, and the Barratt Impulsiveness Scale (BIS-11). Multivariate analysis of variance (mANOVA) models revealed that both IGD and ND groups scored higher than healthy controls on the BIS-11 attentional, motor, and non-planning impulsiveness (Cohen's d = 0.41-1.75). Higher degrees of delay discounting on the DDT were also found in IGD and ND groups compared to healthy controls (Cohen's d = 0.53-0.69). Although IGD group did not differ from healthy controls on the PDT, ND group had a lower degree of probability discounting than healthy controls (Cohen's d = 0.55), suggesting a reduction in risk aversion. Furthermore, ND subjects showed a lower correct accuracy in the incongruent trials of the Stroop task than healthy controls (Cohen's d = 0.61). On the Go/No Go task, both IGD and ND groups had a lower correct accuracy in the No-Go trials than healthy controls (Cohen's d = 1.35-1.50), indicating compromised response inhibition. These findings suggested that IGD was linked to both anomalous reward discounting and dysfunctional inhibitory control, which was comparable with one typical SUD category (i.e., ND). This study might promote a better understanding of the pathogenesis of IGD as a potential addictive disorder similar to SUD.

Remission of Food Addiction Does Not Induce Cross-Addiction after Sleeve Gastrectomy and Gastric Bypass: A Prospective Cohort Study

BACKGROUND

The hypothesis of "cross-addiction" has never been validated, and numerous aspects speak against it.

OBJECTIVES

To compare the differences between sleeve gastrectomy (SG) and gastric bypass (GB) procedures concerning cross-addiction.

SETTING

Center for maximum care in Germany.

METHODS

We performed a prospective analysis of patients undergoing SG or GB as the first surgical treatment for severe obesity. All patients completed validated questionnaires to evaluate food intake (Yale Food Addiction Scale, YFAS), alcohol intake (Alcohol Use Disorders Identification Test), nicotine use (Fagerstrom Test for Nicotine Dependence), exercise (Exercise Addiction Inventory), drug addiction (20-item Drug Abuse Screening Test), and Internet use disorder (Internet Addiction Test) before the operation (T0) and 6 (T6) and 24 (T24) months postoperatively (ClinicalTrials.gov identifier: NCT02757716).

RESULTS

One hundred thirteen patients underwent SG (n = 68) or GB (n = 45). At the follow-up, 61% completed the questionnaires at T6 and 44% at T24. In the YFAS, the percentage of patients diagnosed with food addiction decreased from 69 to 10%, and the mean symptom count decreased from 3.52 ± 1.95 to 1.26 ± 0.99 at T24 (p < 0.0001); these values did not differ between the surgical groups (p = 0.784). No significant evidence of cross-addiction was observed for use of alcohol, nicotine, drugs, the Internet, or exercise in either surgical group. The percentage of patients with moderate nicotine dependence increased in the SG group (+8.9%) at T24, but this was not significant.

CONCLUSION

In this single-center cohort study, surgery for obesity caused significant addiction remission regarding food but without inducing cross-addiction after 2 years. Importantly, no significant differences were seen between the SG and GB procedures.

Association Between Nicotine-dependent Gene Polymorphism and Smoking Cessation in Patients With Lung Cancer

BACKGROUND

Patients with lung cancer continue to smoke owing to complex factors. Failure to quit smoking (defined as nicotine dependence) is significantly associated with genetic status. This study aimed to investigate the relationship between polymorphisms in nicotine dependence genes and smoking status after the diagnosis of lung cancer.

PATIENTS AND METHODS

A total of 240 patients with lung cancer were included from July 2017 to March 2018. According to the actual smoking condition after lung cancer diagnosis, eligible patients were divided into 3 groups: the never-smoking group, the failure to quit smoking group, and the successful smoking cessation group. Fagerstrom Test for Nicotine Dependence scores were used to evaluate the smoking status of each group. Three nicotine-dependent genes with 6 loci were detected.

RESULTS

Among the 240 patients, 86 were never-smokers, 51 failed to quit smoking, and 104 successfully quit smoking. The initial age of smoking in the failure to quit smoking group was significantly younger than those in the successful smoking cessation group (P = .001). There was a significant difference in the GG and AG and AA genotype distributions of CHRNA3 (rs578776) among the 3 groups (P = .003). There was also a significant difference in the distribution of CHRNA4 (rs2229959) genotypes among the 3 groups (P = .003). However, there was no significant difference in the genotype distribution of CHRNA5 (rs588765) among the 3 groups (P = .277).

CONCLUSIONS

Gene polymorphisms of CHRNA3 (rs578776) and CHRNA4 (rs1044396 and rs2229959) were associated with the success of smoking cessation after the diagnosis of lung cancer, which should be considered in the management of smoking cessation after patients are diagnosed with lung cancer.

Profiles of Impulsivity in Problematic Internet Users and Cigarette Smokers

Problematic Internet use (PIU) has been gradually recognized as a mental health issue among adolescents and young students. PIU shows many similarities with substance use disorders, but the shared and distinct mechanisms underlying them are unclear. The purpose of the current study was to explore the relationships between impulsive traits and PIU as well as cigarette smoking behaviors among young adults. Two independent samples of university students (N 1 = 1281, N 2 = 1034, respectively) over 3 years were assessed with multiple measurements of impulsivity, including the Barratt Impulsiveness Scale-11 (BIS-11), the UPPSP Impulsive Behaviors Scale (UPPSP), and the Delay-discounting Test (DDT). Logistic regression models revealed that across the two independent samples, BIS-11 Attentional Impulsiveness was the common trait positively predicting both PIU and cigarette smoking. While BIS-11 Motor Impulsiveness as well as UPPSP Lack of Perseverance, Lack of Premeditation, and Negative Urgency were the typical traits linked to PIU as positive predictors, UPPSP Sensation Seeking was the unique trait linked to cigarette smoking as a positive predictor. These results suggested that specific dimensions of impulsivity might be concurrently implicated in PIU and cigarette smoking among young adults, putatively representing important trait marks for addictive behaviors.

Effectiveness of a new multi-component smoking cessation service package for patients with hypertension and diabetes in northern Thailand: a randomized controlled trial (ESCAPE study)

Background

Smoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand.

Methods

This randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of:

regular patient motivation by the same nurse over a 3-month period;

a monthly piCO+ Smokerlyzer test for 3 months;

continual assistance from a trained family member, using a smoking-cessation- diary; and

optional nicotine replacement chewing gum therapy.

The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up.

The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117.

Results

The median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55–5.61.

Conclusion

In relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries.

Trial registration

Current controlled trials ISRCTN89315117.

WHO international clinical trial identifier number: U1111–1145-6916; 3/2013.

Use of the Fagerström test to assess differences in the degree of nicotine dependence in smokers from five ethnic groups: The HELIUS study

BACKGROUND

The prevalence of smoking varies across ethnic groups in developed countries, but little is known about ethnic variations in specific aspects of nicotine dependence (ND). We conducted item-response analyses in current smokers to compare ND factors across five ethnic groups.

METHODS

Data were obtained from a population-based, multi-ethnic cohort study conducted in the Netherlands. The Fagerström Test for Nicotine Dependence (FTND) was assessed in 1147 Dutch, 991 South-Asian Surinamese, 1408 African Surinamese, 1396 Turkish, and 584 Moroccan smokers (N = 5526). We tested whether the factorial structure of the FTND was invariant across ethnic groups using a multi-group confirmatory factor analysis. FTND item and total scores and factor means were compared across groups.

RESULTS

The two-factor model representing "morning smoking" and "smoking patterns" provided an adequate fit. The items "Cigarettes smoked daily" and "Time until first cigarette" showed differential item functioning (DIF) as a function of ethnicity. Three out of four ethnic minority groups scored significantly higher on both factors compared to the Dutch origin group (all p < 0.001) before and after taking DIF into account, while the African Surinamese scored higher only on "morning smoking" when DIF was accounted for.

DISCUSSION

The factor structure of the FTND is not measurement invariant across ethnic groups in this population-based sample. Accounting for DIF affecting the nicotine dependence factor scores, although South-Asian Surinamese, Turkish, and Moroccan groups showed higher levels of dependence than the Dutch origin group, genetic as well as environmental factors may account for the observed differences.

Risk factors for nicotine dependence in Chinese patients with lung cancer

Objective

Smoking is a poor prognostic factor for lung cancer. Nicotine dependence remains the major cause of failure of smoking cessation. We investigated the risk factors for nicotine dependence in patients with lung cancer.

Methods

Eligible patients were identified from November 2014 to February 2015. Age, marital status, educational level, annual household income, occupation, histology of lung cancer, tumor stage, smoking status, neuron-specific enolase (NSE) level, drive gene mutations, sleep quality, and patient personality were assessed. Physical nicotine dependence was assessed by the Fagerstrom Test for Nicotine Dependence (FTND).

Results

In total, 202 smokers were included in this study. Univariate analysis showed that marital status and pain were significantly correlated with nicotine dependence. Pearson’s correlation analysis showed that age at the initiation of smoking, attempts to quit, NSE level, and sleep quality were significantly correlated with FTND scores.

Conclusions

Pain, more attempts to quit, and poorer sleep quality were significantly associated with nicotine dependence. These risk factors could help to prevent smoking in Chinese patients with lung cancer.

Relationship Between Nicotine Dependency and Occupational Injury in a Japanese Large-Scale Manufacturing Enterprise: A Single-Center Study

OBJECTIVES

Although several studies have shown the association between smoking and occupational injury, the exact mechanism by which smoking contributes to occupational injury remains unclear. We conducted a 5-year case-control study in a population of Japanese large-scale enterprise workers aimed to verify the hypothesis that nicotine dependency is positively associated with occupational injury.

METHODS

A total of 3179 to 3574 male workers annually participated in this study conducted from 2008 to 2012. Employees who had an occupational injury as detailed in the company records were included in the case group, while employees who did not have any occupational injury were included in the control group. Information on smoking status, nicotine dependency [assessed according to time to first cigarette (TTF) and cigarette per day (CPD)], and potential confounders were obtained via questionnaires administered during periodic health checkups. Odds ratios (ORs) were estimated via multiple logistic regression analysis and integrated using the general variance-based fixed effects model.

RESULTS

The overall adjusted OR of occupational injury in smokers was 1.71 [95% confidence interval (95% CI): 1.10 to 2.66]. The OR for low and high nicotine dependency according to TTF was 1.52 (95% CI: 0.92 to 2.51) and 1.98 (95% CI: 1.15 to 3.41), respectively.

CONCLUSION

Nicotine dependency was related to an increased risk of occupational injury. These findings support the hypothesis that smoking is associated with occupational injury.

Psychoactive substance use and perception of mental health status in inmates of two Portuguese prisons

Aim

To describe patterns of and associations between psychoactive substance use and perception of mental health status amongst male prisoners.

Method

Participants consisted of 60 male prisoners, with a mean age of 38.5 (SD = 11.0). A standardised interview with three sections was carried out: 1) socio-demographic variables, 2) perception of mental health status by CORE-OM, 3) evaluation of psychoactive substance use and dependence (tobacco, alcohol, and illegal drugs).

Results

The majority of the participants reported using a named psychoactive substance during the current detention period. Substance use and addiction tended to be higher amongst the younger men and those who had achieved a higher education. A minority perceived their mental health as good. Self-reported low and mild impairment of mental health is higher in participants who achieved a higher education level and, moderate and severe impairment is higher in lower educated participants. The perceived impairment appeared to be less severe in smokers and alcohol users.

Conclusion

This study highlights the need for a better understanding of the underlying causes and subsequent consequences of the high prevalence of inmate’s psychoactive substances use, as well as the better perception of mental health status in those who consume psychoactive substances.

Effect of nicotine dependence on quality of life and sleep quality in patients with lung cancer who continue to smoke after diagnosis

Background

Hundreds of millions of Chinese individuals continue to smoke and rates of lung cancer still continue to rise. However, there were few studies that examined the effects of nicotine dependence on quality of life (QOL) and sleep quality in lung cancer patients. This study aimed to investigate the effect of nicotine dependence on QOL and sleep quality in lung cancer patients who continue to smoke after diagnosis.

Methods

This cross-sectional survey study included 202 patients with lung cancer. Smokers were separated into two groups based on the Fagerstrom Test for Nicotine dependence: the low dependence (LD) (<4 score) group (n=59) and the high dependence (HD) (≥4 score) group (n=143). Both Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) and Chinese version of Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the two groups of lung cancer patients. Then we analyzed the difference of QOL and sleep quality between two distinct nicotine dependence groups.

Results

Physical functioning, role functioning, emotional functioning, cognitive functioning, global health status and social functioning items in the LD group were significantly higher than the HD group (P<0.001). Fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea and financial problems in the LD group were significantly lower than those in the HD group (P<0.001). Significantly higher scores in the HD group were found concerning the three sleep components including sleep duration, sleep efficiency and daytime function. The mean global PSQI score in the HD group was significantly higher than the LD group (P=0.014).

Conclusions

These findings suggest that lung cancer patients who continue to smoke after diagnosis should receive health education in order to improve their QOL and quality of sleep after the word education. This can be useful for clinicians and nurses who are trying to motivate smokers to quit smoking.

The association of dopamine pathway gene score, nicotine dependence and smoking cessation in a rural male population of Shandong, China

BACKGROUND AND OBJECTIVES

Smoking and smoking cessation are both psychological and physiological traits. We aimed to investigate the interaction between dopamine pathway gene scores and nicotine dependence on smoking cessation in a rural Chinese male population.

METHODS

Participants were recruited from 17 villages in Shandong, China. DNA was extracted from blood sample of 819 participants. 25 single nucleotide polymorphisms (SNPs) in 8 dopamine (DA) pathway genes were genotyped. Weighted gene score of each gene is used to analyze the whole gene effect. Logistic regression was used to calculate odds ratios (OR) and multivariate-adjusted OR of each gene score for smoking cessation. Multiplicative model interaction was assessed through a cross-product interaction term of gene score by nicotine dependence in a multivariate logistic regression model.

RESULTS

After adjusting for age, occupation, education, marital status, self-rating anxiety score, and disease status, we observed significant negative associations of catechol-O-methyltransferase (COMT), dopamine receptor D2 (DRD2) gene score and smoking cessation, as well as significant positive associations between ankyrin repeat and kinase domain containing 1 (ANKK1), dopamine transporter (SLC6A3), dopamine receptor D4 (DRD4) gene score and smoking cessation. A significant multiplicative model interaction between nicotine dependence and the SLC6A3 gene score on smoking cessation was also observed (p = .03).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

There is a significant multiplicative model interaction of SLC6A3 gene score and nicotine dependence on smoking cessation. This finding could help to identify smokers who may be at high risk of relapse, and thus to develop more professional and personalized smoking cessation treatment. (Am J Addict 2016;25:493-498).

Smoking-related correlates of psychomotor restlessness and agitation in a community sample of daily cigarette smokers

BACKGROUND AND OBJECTIVES

Psychomotor restlessness and agitation (PMA) is a putatively important, yet understudied, psychopathologic correlate of smoking. The scant smoking research on PMA previously conducted has been narrow in scope and conducted among psychiatric patients. To examine the generalizability and relevance of PMA to smoking, this cross-sectional study investigated associations between PMA and a variety of smoking processes in a community sample.

METHODS

Participants in this study were non-treatment-seeking smokers (N = 254, ≥10 cig/day, M age = 44 years) from the community without an active mood disorder. At baseline, they completed a PMA symptom checklist, a composite depressive symptom index, and a battery of smoking questionnaires.

RESULTS

Linear regression models adjusting for depressive symptoms and demographics indicated that PMA level was positively associated with severity of nicotine withdrawal symptoms during prior quit attempts (β = .18, p < .05), anticipated likelihood of withdrawal in a future quit attempt (β = .19, p < .05), motivation to smoke for negative reinforcement (β = .14, p < .05), and smoking expectancies for negative reinforcement (β = .17, p < .05), negative consequences (β = .22, p < .01), and positive reinforcement (β = .14, p < .05). PMA was not significantly associated with smoking chronicity, frequency, or dependence severity.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Smokers with elevated PMA appear to experience greater smoking-induced affect modulation and nicotine withdrawal than the average smoker, regardless of other depressive symptoms. Given that PMA differentiates a qualitatively unique profile of smoking characteristics, PMA warrants consideration in tobacco addiction research and practice.

Withdrawal: Expanding a Key Addiction Construct

Withdrawal is an essential component of classical addiction theory; it is a vital manifestation of dependence and motivates relapse. However, the traditional conceptualization of withdrawal as a cohesive collection of symptoms that emerge during drug deprivation and decline with either the passage of time or reinstatement of drug use, may be inadequate to explain scientific findings or fit with modern theories of addiction. This article expands the current understanding of tobacco withdrawal by examining: (1) withdrawal variability; (2) underlying causes of withdrawal variability, including biological and person factors, environmental influences, and the influence of highly routinized behavioral patterns; (3) new withdrawal symptoms that allow for enhanced characterization of the withdrawal experience; and (4) withdrawal-related cognitive processes. These topics provide guidance regarding the optimal assessment of withdrawal and illustrate the potential impact modern withdrawal conceptualization and assessment could have on identifying treatment targets.

Relationships between trait urgency, smoking reinforcement expectancies, and nicotine dependence

Urgency (i.e., the tendency to act rashly during negative/positive affect) may increase vulnerability to a variety of risky behaviors. This cross-sectional study of nontreatment-seeking smokers examined the relationship between urgency, level of nicotine dependence, and smoking reinforcement expectancies. Both positive and negative urgency were associated with nicotine dependence. Mediational analyses illustrated that smoking reinforcement expectancies significantly accounted for urgency-dependence relations, with negative reinforcement expectancies displaying incremental mediational effects. If replicated and extended, these findings may support the use of treatments that modify beliefs regarding smoking reinforcement outcomes as a means of buffering the risk of nicotine dependence carried by urgency.

Evidence-based new service package vs. routine service package for smoking cessation to prevent high risk patients from cardiovascular diseases (CVD): study protocol for randomized controlled trial

BACKGROUND

Smoking cessation is a high-priority intervention to prevent CVD events and deaths in developing countries. While several interventions to stop smoking have been proved successful, the question of how to increase their effectiveness and practicality in developing countries remains. In this study, a newly devised evidence-based smoking cessation service package will be compared with the existing service in a randomized controlled trial within the community setting of Thailand.

METHOD/DESIGN

This randomized control trial will recruit 440 current smokers at CVD risk because of being diabetic and/or hypertensive. Informed, consented participants will be randomly allocated into the new service-package arm and the routine service arm. The study will take place in the non-communicable disease clinics of the Maetha District Hospital, Lampang, northern Thailand. The new smoking-cessation service-package comprises (1) regular patient motivation and coaching from the same primary care nurse over a 3-month period; (2) monthly application of piCO + smokerlyzer to sustain motivation of smoker's quitting attempt and provide positive feedback over a 3-month period; (3) assistance by an assigned family member; (4) nicotine replacement chewing gum to relieve withdrawal symptoms. This new service will be compared with the traditional routine service comprising the 5A approach in a 1-year follow-up. Participants who consent to participate in the study but refuse to attempt quitting smoking will be allocated to the non-randomized arm, where they will be just followed up and monitored. Primary outcome of the study is smoking cessation rate at 1-year follow-up proven by breath analysis measuring carbomonoxide in parts per million in expired air. Secondary outcomes are smoking cessation rate at the 6-month follow-up, blood pressure and heart rate, CVD risk according to the Framingham general cardiovascular risk score, CVD events and deaths at the 12-month follow-up, and the cost-effectiveness of the health service packages. Intention-to-treat analysis will be followed. Factors influencing smoking cessation will be analyzed by the structure equation model.

DISCUSSION

This multicomponent intervention, accessible at primary healthcare clinics, and focusing on the individual as well as the family and social environment, is unique and expected to work effectively.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN89315117.

Abstinence-related expectancies predict smoking withdrawal effects: implications for possible causal mechanisms

RATIONALE

Despite the decades-long emphasis on withdrawal in leading models of addiction, the causal mechanisms driving smoking withdrawal effects are not well known. This gap in the knowledge base has stalled theory and treatment development for smoking dependence.

OBJECTIVES

As cognitive factors have been largely neglected as predictors of withdrawal, the current study sought to examine how smokers' abstinence-related expectancies relate to withdrawal symptomatology.

METHODS

Adult smokers (N = 180; ≥10 cigarettes/day) participated in two counterbalanced experimental sessions involving either 16 h of abstinence or smoking as usual. At baseline, participants completed three withdrawal-related scales of the Smoking Abstinence Questionnaire (Withdrawal, Optimistic Outcomes, and Weight Gain scales), a self-report measure of smokers' abstinence-related expectancies. During experimental sessions, participants completed a number of instruments that covered the range of smoking withdrawal effects (i.e., negative affect, urge/craving to smoke, diminished positive affect, concentration difficulty, hunger, and physiological symptoms).

RESULTS

Even after controlling for the influence of demographic characteristics and cigarette dependence, smokers' abstinence-related expectancies were meaningful predictors of abstinence-induced changes in various withdrawal symptoms (mean adjusted standardized β = 0.22). Stronger expectancies for withdrawal and weight gain predicted more severe withdrawal effects, whereas stronger expectancies for optimistic outcomes predicted less severe withdrawal effects.

CONCLUSIONS

These findings are consistent with the notion that expectancies actively shape future experience and are the first to support the suggestion that smokers' abstinence-related expectancies may be causal agents of withdrawal symptomatology. Future research is required to more conclusively determine whether abstinence-related expectancies mold withdrawal effects.

Smoking topography and outcome expectancies among individuals with schizotypy

Compared to smokers in the general population, smokers with schizophrenia smoke more cigarettes per day and have higher nicotine dependence and biochemical indicators of nicotine intake. They also have more intense smoking topography and greater positive smoking expectancies. Little is known about the relationship between smoking and schizotypy, defined as the personality organization reflecting a vulnerability to schizophrenia-spectrum pathology. This study assessed schizotypy symptoms, smoking characteristics and behaviors, and smoking expectancies in young adults with psychometrically defined schizotypy and demographically matched controls without schizotypy. Smokers with schizotypy had higher nicotine dependence and smoked more cigarettes per week compared to control smokers. They were also more likely to endorse greater positive consequences (i.e., improved state enhancement, stimulation, social facilitation, taste/sensorimotor manipulation, reduced negative affect and boredom) and fewer negative consequences of smoking. Smokers with schizotypy and control smokers did not differ on smoking topography or carbon monoxide levels. This is the first known study to investigate relationships between these smoking-related variables in smokers with schizotypy. Individuals with schizotypy possessed certain smoking-related characteristics and smoking expectancies similar to those with schizophrenia. This offers preliminary insight into unique smoking-related factors among individuals with schizotypy and highlights the importance of continued research in this area.

Are tobacco dependence and withdrawal related amongst heavy smokers? Relevance to conceptualizations of dependence

Measured tobacco dependence is typically only modestly related to tobacco withdrawal severity among regular smokers making a quit attempt. The weak association between dependence and withdrawal is notable because it conflicts with core theories of dependence and because both measures predict cessation outcomes, suggesting they both index a common dependence construct. This study used data from a smoking cessation comparative effectiveness trial (N = 1504) to characterize relations of tobacco dependence with craving and negative affect withdrawal symptoms using multiple dependence measures and analytic methods to detect both additive and interactive effects and to determine whether withdrawal meaningfully mediates the influence of dependence on smoking cessation. We conclude: (a) Although univariate analyses suggest dependence and withdrawal measures are only modestly interrelated, more powerful analytic techniques show they are, in fact, meaningfully related and their shared variance is associated with cessation likelihood; (b) there are clear differences between craving and negative affective withdrawal symptoms, with the former more related to smoking heaviness and the latter related to trait measures of negative affect; moreover, craving more strongly mediates dependence effects on cessation; and (c) both craving and negative affect withdrawal symptoms are strongly related to a pattern of regular smoking that is sensitive to the passage of time and powerfully affected by smoking cues. These findings support models that accord an important role for associative processes and withdrawal symptoms, especially craving, in drug dependence. The findings also support the use of withdrawal variables as criteria for the evaluation of dependence measures.

Mindfulness Ameliorates the Relationship between Weight Concerns and Smoking Behavior in Female Smokers: A Cross-Sectional Investigation

Weight concerns are common among female smokers and may interfere with smoking cessation. It is imperative to identify protective factors to lessen the likelihood that smoking-related weight concerns prompt smoking and hinder cessation efforts. Mindfulness is one potential protective factor that might prevent weight concerns from triggering smoking. In the current study, relationships among facets of trait mindfulness, smoking-related weight concerns, and smoking behavior were examined among 112 young adult female smokers (70.5% daily smokers; 83% Caucasian; mean age 20 [SD = 1.69]). After controlling for demographic variables, the Describing facet of trait mindfulness predicted lower smoking-related weight concerns. The mindfulness characteristics of Acting with Awareness, Nonreactivity, and Describing moderated the relationship between smoking-related weight concerns and smoking frequency, such that smoking-related weight concerns predicted greater smoking frequency in female smokers with low and medium levels of these mindfulness characteristics but did not in those with higher levels of mindfulness. These results suggest that mindfulness-based interventions may be effective for weight-concerned smokers.

Nicotine dependence among clients receiving publicly funded substance abuse treatment

BACKGROUND

Smoking and nicotine dependence (ND) are prevalent among substance abusers but little is known about characteristics of ND in this population. This information would help identify those most in need of smoking cessation programs. This study evaluated the associations of socio-demographic, tobacco- and substance use-related, and health/mental health factors to ND in adults receiving publicly funded substance abuse treatment in Tennessee.

METHODS

All Tennessee residents who received federal block grant-funded substance abuse treatment during July-December, 2004 were invited to participate in a 6 month post-intake telephone follow-up interview. Socio-demographic characteristics, perceived health and mental health, tobacco use history and patterns, and ND, assessed by the Fagerstrom Test of Nicotine Dependence (FTND), were obtained at follow-up. Alcohol and illicit drug use and smoking status prior to treatment were assessed at intake. This paper analyzes data for 855 clients who were current cigarette smokers at both intake and follow-up.

RESULTS

Sixty three percent of smokers were ND (FTND score ≥ 4). Correlates of ND included older age, poorer self-rated overall health, earlier age of onset of cigarette smoking and substance abuse, fewer smoking quit attempts in past year, single substance use (alcohol or illicit drug, vs. multiple substances) at intake, use of opiates/narcotics and sedatives, and past month self-reported depression.

CONCLUSION

ND was highly prevalent and correlated with specific types and patterns of substance abuse and depression. These results suggest that intensive smoking cessation interventions, involving behavioral support, pharmacotherapy, and mood management, are needed to effectively assist this population.

Association study of 45 candidate genes in nicotine dependence in Han Chinese

Numerous genetic linkages, association studies have been performed in different ethnic groups and revealed many susceptibility loci and genes for nicotine dependence. However, limited similar researches were performed in Han Chinese. This study was designed to investigate the association of candidate genes with nicotine dependence in Han Chinese. We genotyped 384 SNPs within 45 candidate genes with nicotine dependence in a Han Chinese population consisting 223 high nicotine dependent subjects and 257 low nicotine dependent subjects by employing GoldenGate genotyping assay (Illumina). Following association analysis was performed using PLINK software. Individual SNP-based association analysis revealed that nine SNPs located in DRD3 (rs2630351), DRD5 (rs1967550), MAP3K4 (rs2314378), DDC (rs11575461), CHRNB3 (rs4954), GABBR2 (rs2779562), DRD2 (rs11214613 and rs6589377) and CHRNA4 (rs2236196) were significantly associated with FTND after correction for multiple testing with the p values from 2.59×10(-7) to 9.99×10(-5). Haplotype-based association analysis revealed haplotype G-A-A formed by rs2630351, rs167771 and rs324032 and haplotype G-G-G-A formed by rs3773678, rs2630349, rs2630351 and rs167771 in DRD3; haplotype of G-A formed by rs2779562 and rs2808566 in GABBR2 and haplotype of T-T-A-G-A formed by rs6832644, rs4057797, rs9764, rs4552421 and rs10033119 in NPY1R are associated with FTND (p=3.61×10(-7)-8.78×10(-6)). Our results provided confirmation of the previous findings that DRD2, DRD3, DDC, CHRNB3, GABBR2 and CHRNA4 are associated with nicotine dependence. Furthermore, we for the first time report a significant association between nicotine dependence and DRD5, MAP3K4 and NPY1R. These findings need independent replication in the future studies.

The Smoking-Related Weight and Eating Episodes Test (SWEET): development and preliminary validation

INTRODUCTION

Many smokers believe that smoking helps them to control their weight, and concerns about weight gain can interfere with smoking cessation. As researchers typically assess general weight concerns, a measure specific to smoking-related weight concerns is needed.

METHODS

The Smoking-related Weight and Eating Episodes Test (SWEET) was created by generating items from 4 content domains: Hunger, Craving, Overeating, and Body Image. Female undergraduate smokers (N = 280) rated their postcessation weight gain concern and completed the SWEET, Fagerström Test for Nicotine Dependence, Brief Smoking Consequences Questionnaire-Adult, Eating Attitudes Test (EAT)-26, Bulimia Test-Revised (BULIT-R), and Body Shape Questionnaire.

RESULTS

Factor analysis of the initial items suggested a 4-factor solution, suggesting 4 subscales: Smoking to suppress appetite, smoking to prevent overeating, smoking to cope with body dissatisfaction, and withdrawal-related appetite increases. Based on these results, the SWEET subscales were revised and shortened. The resulting 10-item SWEET showed excellent internal consistency (total α = .94; mean α = .86) and evidence of validity by predicting smoking frequency, eating pathology, and body image concerns (ps < .05). Smoking frequency, eating pathology, and body image concerns were significantly predicted by the SWEET while controlling for existing measures of postcessation weight gain concern.

CONCLUSIONS

The SWEET appears to be a reliable and valid measure of tendencies to smoke in response to body image concern and nicotine withdrawal and as a way to control appetite and overeating.

Nicotine withdrawal-induced negative affect is a function of nicotine dependence and not liability to depression or anxiety

INTRODUCTION

Individuals who quit smoking frequently experience symptoms of anxiety and/or depression. It is not clear whether these symptoms index liability to negative affect generally or whether such symptoms are a function of nicotine withdrawal and are thus indexed by nicotine dependence (ND).

METHODS

A population-based sample of twins (N = 4,777 individuals) reported their lifetime history of psychopathology, ND, and symptoms of anxiety and depression experienced after attempts to quit smoking. Co-twin phenotype was used to predict withdrawal-induced symptoms of negative affect and to test whether genetic factors influence liability to these symptoms.

RESULTS

Co-twin's ND was significantly associated with nicotine withdrawal-induced symptoms of anxiety and depression. Furthermore, monozygotic co-twins more strongly predicted outcome than did dizygotic co-twins, indicating that genetic factors contribute to risk. Co-twins' history of psychopathology did not predict outcome, suggesting that liability to withdrawal-induced negative affect is independent of a liability to negative affect outside the context of nicotine withdrawal.

CONCLUSIONS

These findings indicate that symptoms of anxiety or depression experienced in the context of nicotine withdrawal are best conceptualized as a component of the withdrawal syndrome, with the severity of symptoms indexed by level of ND. Genetic influences underlying ND contribute to the liability to these symptoms. Though psychopathology might be indirectly related to withdrawal-induced symptoms through its correlation with ND, it is not directly predictive of withdrawal symptoms.

Nicotine withdrawal and reward responsivity in a card-sorting task

RATIONALE

Animal studies have demonstrated decreased reward responsivity during nicotine withdrawal (e.g., Epping-Jordan et al., Nature 393:76-79, 1998) and the Card Arranging Reward Responsivity Objective Test (CARROT) has recently been used to study the effect of nicotine withdrawal on reward responsivity in humans (e.g., Al-Adawi and Powell, Addiction 92:1773-1782, 1997; Powell et al., Biol Psychiatry 51:151-163, 2002). We investigated a suggestion that nicotine withdrawal may have additional reward-related effects apart from the reward responsivity effects already observed.

OBJECTIVE

The objective of this study was to determine whether or not nicotine withdrawal results in slower improvements in performance on a card-sorting task over a series of trials.

METHOD

We carried out two experiments using a modified version of the CARROT, the mCARROT, to compare the performance of human participants in nicotine withdrawal with those who were satiated.

RESULTS

Although withdrawal produced no direct effect on the mCARROT measure of reward responsivity, the overall sorting rate was lower, and the increase in sorting rate across successive trials was slower during nicotine withdrawal than during satiation.

CONCLUSIONS

These data indicate that nicotine withdrawal impacted on task performance independently of the introduction of a performance contingent reward, suggesting a novel reward-related effect of nicotine withdrawal.