The absence of DSM-IV nicotine dependence in moderate-to-heavy daily smokers

BACKGROUND: Current theoretical models of nicotine dependence assume a close relationship between use and dependence; however, previous data suggest that many daily smokers fail to develop nicotine dependence. OBJECTIVES: To determine what percentage of daily smokers fail to meet DSM-IV criteria for nicotine dependence within their lifetime, how non-dependence relates to duration and quantity of cigarette use, and whether other tobacco use and/or specific dependence criteria differentiate never-dependent and dependent smokers. METHODS: Cross-sectional data collected via personal interview from a nationally representative sample of 8213 past year daily smokers were analyzed. RESULTS: Approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking >or=10 cigarettes per day and began smoking daily >or=10 years prior, remained never nicotine dependent. CONCLUSIONS: The absence of nicotine dependence in heavy daily smokers may result from limitations in the measurement of dependence and/or nicotine exposure. Alternatively, some individuals may be relatively resistant to becoming nicotine dependent despite extensive use. The latter explanation would have important implications for understanding the nature of nicotine dependence.     

The hardening hypothesis: is the ability to quit decreasing due to increasing nicotine dependence? A review and commentary

The "hardening hypothesis" states tobacco control activities have mostly influenced those smokers who found it easier to quit and, thus, remaining smokers are those who are less likely to stop smoking. This paper first describes a conceptual model for hardening. Then the paper describes important methodological distinctions (quit attempts vs. ability to remain abstinent as indicators, measures of hardening per se vs. measures of causes of hardening, and dependence measures that do vs. do not include cigarettes per day (cigs/day).) After this commentary, the paper reviews data from prior reviews and new searches for studies on one type of hardening: the decreasing ability to quit due to increasing nicotine dependence. Overall, all four studies of the general population of smokers found no evidence of decreased ability to quit; however, both secondary analyses of treatment-seeking smokers found quit rates were decreasing over time. Cigs/day and time-to-first cigarette measures of dependence did not increase over time; however, two studies found that DSM-defined dependence appeared to be increasing over time. Although these data suggest hardening may be occurring in treatment seekers but not in the general population of smokers, this conclusion may be premature given the small number of data sets and indirect measures of quit success and dependence in the data sets. Future studies should include questions about quit attempts, ability to abstain, treatment use, and multi-item dependence measures.     

Individual differences in adoption of treatment for smoking cessation: demographic and smoking history characteristics

BACKGROUND: Behavioral and pharmacological treatments have been shown to improve smoking cessation rates, but treatments are under-utilized. AIMS: To examine the demographic and smoking history characteristics associated with adoption of treatment for cessation. DESIGN: Analysis of the 2003 tobacco use special cessation supplement to the current population survey. PARTICIPANTS: Representative sample of 12,027 U.S. daily smokers ages 18 and older who made a quit attempt in the past year. MEASUREMENTS: Use of behavioral, pharmacological or alternative treatments for cessation; demographic variables (age, gender, ethnicity, education and income) and measures of nicotine dependence. RESULTS: Females, Whites, older, more educated and wealthier smokers were more likely to adopt treatment in a quit attempt, as were more nicotine dependent smokers. Females were more likely than males to use behavioral treatments. Females and more educated smokers were more likely to combine behavioral and pharmacological treatment. Among those who used only one treatment, males, older and more nicotine dependent smokers were more likely to adopt pharmacological treatments. CONCLUSIONS: The majority of smokers make quit attempts without the benefit of proven behavioral or pharmacological treatments. Efforts are needed to increase use of smoking cessation treatments among all smokers, particularly combination treatment.     

Characteristics associated with smoking in a Hispanic sample

Although general smoking prevalence has declined, similar declines have not been observed in some underserved populations. For example, groups such as ethnic minorities, individuals with psychiatric diagnoses, those with a history of substance use, and weight concerned smokers have not shown comparable reductions. The goal of this study is to create a profile of Hispanic smokers in the El Paso/Juárez area and identify predictors of smoking. In this cross-sectional study, these variables were assessed in 160 English-speaking Hispanic volunteers. Participants completed measures of tobacco use, nicotine dependence, weekly alcohol consumption, acculturation, depressive symptomatology, weight concern, and drug use. Expired carbon monoxide and body composition were also assessed. Participants were light smokers with low levels of nicotine dependence and expired carbon monoxide, a significant number of past quit attempts, and limited use of cessation aids. Significant characteristics associated with smoking included male gender, use of mental health services, increasing number of drinks per week, and lifetime use of illicit drugs. These findings suggest substance use and psychiatric comorbidity are associated with smoking in this population and may be barriers to quitting. These factors should be considered in developing culturally-sensitive tobacco cessation interventions for Hispanic smokers, particularly those residing on the U.S./México border.     

Association between tobacco industry denormalization beliefs,tobacco control community discontent and smokers' level of nicotine dependence

Introduction

Tobacco industry denormalization (TID) informs the public about the tobacco industry's role in the tobacco epidemic and is an important component of a comprehensive tobacco control strategy. Although TID beliefs have been noted in adult smokers and associated with intent to quit, research has not evaluated whether they are affected by smokers' level of nicotine dependence. The present article sought to concurrently examine how attitudes towards the tobacco industry and tobacco control groups may differ among smokers of varying levels of nicotine dependence. In addition, it evaluated how these attitudes and beliefs may be associated with smokers' intentions to reduce or quit smoking.

Methods

A random digit dialing telephone survey was conducted of 889 Canadian current daily smokers, 18 years and older.

Results

Attitudes towards the tobacco industry were mixed among the entire cohort and differences in beliefs towards the tobacco industry were not found among smokers of varying levels of nicotine dependence. However, smokers that held strong TID beliefs were 5 times more intent to quit smoking than those without such beliefs. Compared to smokers with low level of nicotine dependence, heavy smokers were more likely to report strong overall displeasure with the tobacco control community (OR = 1.98, 95% CI = 1.23–3.19, p = 0.005), however there were no differences with regards to future intent to quit.

Conclusions

The absence of strong negative sentiment toward the tobacco industry among smokers as a whole suggests that more targeted anti-industry messages are needed, raising greater awareness of tobacco industry practices within smokers and non-smokers alike. As heavier smokers' discontent with the tobacco control community highlights increasing social disapproval and pressure to quit smoking, future educational and media strategies used for smoking cessation purposes may benefit from emphasizing more of the positive attributes associated with quitting smoking, as opposed to the negative features of smoking itself.     

Development of a screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV.

A 10-item questionnaire (the Tobacco Dependence Screener; TDS) for screening of tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV was newly developed. The reliability and validity were assessed in three samples of smokers in Japan. A total of 58 male smokers completed the TDS and the Fagerstrom Tolerance Questionnaire (FTQ), and they were interviewed using the World Health Organization's Composite International Diagnostic Interview (Sample 1). A total of 118 male and 36 female smoking outpatients completed the TDS and the FTQ and provided a breath sample for carbon monoxide measurement (Sample 2). A total of 194 male smokers joined a health education program using a health risk appraisal (HRA) and reported their smoking status and completed the TDS 6 months after receiving the HRA results (Sample 3). The Cronbach's alpha coefficients for the TDS ranged from .74 to .81 among the samples, whereas those for the FTQ ranged from .41 to .64. Receiver operator characteristic analyses indicated that the TDS had a better screening performance for ICD-10, DSM-III-R, and DSM-IV diagnoses than did the FFQ. The TDS score significantly and positively correlated with the severity of the diagnoses, the carbon monoxide levels, number of cigarettes smoked per day, and years of smoking. The TDS score was significantly lower in those who quit smoking than in those who did not quit smoking after the HRA. It is suggested that the TDS is a reliable and useful screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV.     

Usage of an Internet smoking cessation resource: The Australian QuitCoach

Introduction and Aims. The QuitCoach ( http://www.quitcoach.org.au ) is a tailored, Internet‐delivered smoking cessation advice program. This paper compares QuitCoach users both with smokers in general, and with callers to a telephone‐based smoking cessation service (the Victorian Quitline). It also explores patterns of QuitCoach usage by time of year and day of the week. Design and Methods. Data are from responses to the QuitCoach online assessment collected between 2003 and 2007 (n = 28 247). Comparison data are from the Victorian Quitline service, from the first five waves of the International Tobacco Control Four Country Survey, the 2004–05 National Health Survey, and from anti‐smoking Target Audience Rating Points for Australia. Results. QuitCoach users were more likely to be female and younger than both smokers in general and Quitline users. They were intermediate in nicotine dependence. QuitCoach users are less likely to have just quit than Quitline callers. Half of QuitCoach users first use after setting a quit date. Usage is related to anti‐smoking advertising and to day of week, being highest earlier in the week. Discussion and Conclusions. The QuitCoach successfully targets the moderately addicted. Use is sensitive to anti‐smoking campaigns. There is a need for greater promotion of the QuitCoach as a resource with the capacity to meet the needs of those already quit and those still uncertain as to whether to try.[Balmford J, Borland R, Li L, Ferretter I. Usage of an Internet smoking cessation resource: The Australian QuitCoach. Drug Alcohol Rev 2009;28:66–72]     

Tobacco use among those with serious psychological distress: results from the national survey of drug use and health, 2002

There have been relatively few population-based studies that have documented the extent of tobacco use among those with mental health disorders. Recently, the K6 scale, designed to assess serious psychological distress (SPD) at the population level, has been incorporated into a number of population-based health behavior surveys. The present study documented the prevalence of tobacco use products, dependence, and quit behavior among those with and without SPD utilizing the 2002 National Survey of Drug Use and Health. Results from the current study indicated that adults with SPD had greater odds of lifetime, past month, and daily use of cigarettes, cigars and pipes than adults without SPD. Common measures of nicotine dependence (e.g., Nicotine Dependence Syndrome Scale) indicated that a greater percentage of those with SPD were nicotine dependent compared to those without SPD. Lastly, quit ratios differed notably by SPD status. Among those with SPD, 29% quit or were former smokers compared to 49% of those without SPD. Findings highlight the importance of continuing to enhance public health efforts towards smoking cessation among those with mental health disorders, extensive tobacco surveillance and monitoring of tobacco trends among this group, and evaluating the extent to which this group of smokers may contribute to a hardening of the population.     

Prevalence of DSM/ICD-defined nicotine dependence

This review compares nicotine dependence and the ability to stop smoking in smokers with no alcohol problems to smokers with current, past or lifetime (i.e., either current or past) alcohol problems. We searched computerized databases, meeting abstracts and made requests to listserves and grantees for comparisons of the above categories. We could not use meta-analyses and, thus, used consistency across studies to make conclusions. We located 17 articles on nicotine dependence, 12 on the ability to quit on a given attempt, 7 on lifetime quitting and 2 on quit attempts. Smokers with current and past alcohol problems were more nicotine dependent than smokers with no alcohol problems. Surprisingly, smokers with past problems were as able to quit on a given attempt as smokers with no problems. We hypothesize this may be because such smokers learned skills in resolving their alcohol problems that neutralized their increased nicotine dependence. Smokers with current or past alcohol problems appear to be less likely to quit in their lifetime. Given their equal ability to quit on a given attempt, this could be due to fewer quit attempts; however, whether this is actually so is unclear. Our results that smokers with past alcohol problems can quit as easily as those without alcohol problems suggest that smokers with past alcohol problems may respond to minimal treatments for smoking cessation.     

Correlates of smoking cessation in a nationally representative sample of U.S. adults

Persistent cigarette smoking is associated with significant morbidity and mortality. Correlates of difficulty quitting smoking include psychopathology, such as major depressive disorder, and problems with other substances, such as alcoholism. In addition, socio-demographic risk (e.g. poverty) and protective (e.g. living in a region with stringent tobacco laws) influences can modify risk for persistent cigarette smoking. Using data on 17,919 individuals with a lifetime history of smoking 100 or more cigarettes, from a nationally representative U.S. sample, we examine the constellation of risk and protective factors that correlate with smoking cessation (defined as remaining smoke-free in the past 12 months) across four cohorts: young (18-31 years), intermediate-aged (32-43 years), middle-aged (44-60 years) and older (61-99 years) adults. Using survival analyses, we demonstrate that in addition to a history of DSM-IV nicotine dependence, which is negatively associated with smoking cessation, living below the poverty line is also associated with persistent smoking across all age cohorts. Residents over the age of 31 years living on the U.S. West Coast are less likely to be persistent smokers as well. Major depressive disorder is associated with persistent smoking, but interestingly, only in middle-aged and older adults. Alcoholism and a family history of substance use problems are both correlated with persistent smoking but only in older adults. Here, we find evidence for psychopathology that may hinder successful quit attempts during the developmental period when a majority of quit attempts are made (early to mid-40's). However, our analyses also highlight the important benefits of effective tobacco legislation on the U.S. West Coast and urge policy makers to actively consider addressing issues surrounding tobacco taxation and the impact of poverty on tobacco use, in addition to the risks posed by co-occurring psychiatric problems and other substance use disorders.     

The prospects for tobacco harm reduction

Tobacco harm reduction (THR) policies aim to reduce the prevalence of tobacco-related harm by encouraging smokers who are unable or unwilling to quit to adopt less harmful ways of obtaining nicotine, such as pharmaceutical nicotine and oral tobacco snuff. Proponents of THR argue that the effects of tobacco control policies have reduced smoking as much as they reasonably can and that we can best reduce tobacco-related harm by encouraging smokers to use these methods, which substantially reduce the health risks of smoking. Critics argue that THR policies will undermine the two traditional tobacco control goals of preventing the uptake of smoking by young people and encouraging smokers to quit. I assess the main arguments and evidence advanced for and against THR.     

Socioeconomic disparities in quitting smoking and in steps on the smoking cessation pathway among smokers in Italy: findings from the SIDRIAT cohort study

Objectives: The aim of this research was to examine socioeconomic disparities in quitting smoking and the association between socioeconomic status (SES) and steps in the smoking cessation pathway.

Methods: We conducted an 11-year longitudinal cohort study examining the association between SES and quitting smoking among 721 current smokers at baseline. At the follow-up survey there were 466 smokers composed by those who continued smoking since baseline and those who began ore relapsed smoking. Among these we then studied the association between SES and steps on the pathway of quitting: nicotine dependence, motivational factors (expectancy of gains in quality of life after quitting; worries about health; favourable attitudes about smoking), beliefs about quitting (intention to quit smoking within the next 6?months; self-efficacy), and past quitting history.

Results: Smokers with fewer years of education were less likely to quit. Higher nicotine dependence was associated with lower education and with workers classified as managers and professionals, who were also more likely to record favourable smoking attitudes, and to have made ≥1 quit attempts. Manual workers reported lower self-efficacy in quitting, and were less likely to report 6?months of abstinence.

Conclusions: Higher education levels may predict quitting smoking over a long period. Interventions are needed to reduce dependence and to enhance self-efficacy in lower educated smokers, as well as to reduce favourable smoking attitudes among higher occupational classes.     

Association of Current and Lifetime DSM-IV Drug use Disorder Diagnoses to 6-Month Changes in Smoking Behavior in Risky Drinking Smokers: A Pilot Study

Background: Alcohol and other drug use disorders co-occur with cigarette smoking and negatively impact cessation outcomes. Objectives: This study examined the differential effects of current and lifetime DSM-IV drug diagnoses on the 6-month smoking outcomes of 84 untreated heavy drinking smokers who were motivated to quit smoking in the next 6-months. Methods: Generalized estimating equations (GEE) assessed changes in nicotine dependence, readiness to quit smoking, and prevalence of heavy smoking from baseline to 6-months as a function of time, baseline drinking severity, and drug diagnosis. Results: GEE models showed that nicotine dependence and prevalence of heavy smoking decreased over 6-months, irrespective of drug diagnosis and baseline alcohol consumption. Several 3-way interactions were found, showing differences in the rate of change over time in readiness to quit smoking and prevalence of heavy smoking as a function of current versus lifetime drug diagnosis and higher versus lower of baseline alcohol consumption. Conclusions/Importance: Drug diagnoses are common in risky drinking smokers, and significantly impede changes in smoking behavior and motivation to quit. Treatment planning for smoking cessation should include a thorough assessment of current and past drug use behavior to determine the impact on readiness to quit and quit success. Mechanisms of change in smokers with multiple substance use diagnoses should be examined.     

Mechanisms of adolescent smoking cessation: roles of readiness to quit, nicotine dependence, and smoking of parents and peers

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.     

Nicotine replacement therapy use among a cohort of smokers

BACKGROUND: Nicotine replacement therapy (NRT) has been shown to assist smokers to stop smoking in randomized trials, but little is known about its use in the general population. METHODS: As part of ongoing follow-up of a cohort established in 1989 in Washington County, Maryland, a questionnaire mailed in 1998 included a question about ever use of the two NRT products then available over-the-counter: nicotine gum and nicotine patch. This study reports on ever use of NRT among the 1,954 respondents who were current smokers in 1989 and subsequently provided data on NRT use and smoking habits in 1998. RESULTS: Overall, 36% of the smokers in 1989 had ever used NRT in some form by 1998; 10% used gum only, 16% used patch only, and 10% used both gum and patch. Number of cigarettes smoked per day at baseline was the strongest predictor of ever use of NRT (ptrend < 0.001). Compared to nonusers, ever users of NRT were more likely to have more than 12 years of education (p < 0.01) and be 25-54 years old at baseline (p < 0.001). When NRT use was assessed in relation to smoking status in 1998, 30% of NRT ever users compared to 39% of nonusers had quit smoking (p < 0.01). Among persistent smokers, the likelihood of reducing the number of cigarettes smoked per day was similar between NRT ever users (40%) and nonusers (41%). CONCLUSIONS: Ever use of NRT was common among this cohort of smokers, particularly among heavy smokers. Compared to nonusers, ever users of NRT were less likely to have stopped smoking and equally likely to cut down the frequency of smoking. This may reflect a tendency to turn to NRT for help after failing to quit by other means.     

Smoking, nicotine dependence and psychiatric comorbidity--a population-based study including smoking cessation after three years

BACKGROUND: Evidence suggests that nicotine-dependent smokers are at increased risk for psychiatric comorbidity but general population data that included the number of nicotine dependence and withdrawal symptoms according to DSM-IV, the Fagerstrom Test for Nicotine Dependence (FTND), somatoform disorders and the number of psychiatric diagnoses are rare. The goal of the present study was to analyse relationships of smoking and nicotine dependence with psychiatric disease and whether psychiatric disease predicts the sustaining of smoking after three years. METHODS: Cohort study with a random adult population sample in a northern German region (N = 4075) including a baseline measurement of ever daily smokers aged 18-64 (n = 2458), a first follow-up of the current smokers at baseline (n = 1552) after 30 months and a second follow-up after 36 months. Measures included DSM-IV diagnoses by the Composite International Diagnostic Interview, FTND, smoking cessation by interview. RESULTS: Current daily smokers showed higher odds of a substance use disorder other than nicotine dependence compared with never smokers (odds ratio, OR, 4.6; confidence interval, CI, 2.9-7.2), affective (OR 1.8; CI 1.4-2.5), anxiety (OR 1.6; CI 1.2-2.0) or somatoform disorder (OR 1.4; CI 1.0-1.8). DSM-IV nicotine dependence and the FTND were positively related with the number of psychiatric diagnoses. Psychiatric comorbidity did not predict the maintenance of smoking or quitting. CONCLUSIONS: Findings of increased rates of mental disorders among smokers and nicotine-dependent smokers in the adult general population are supported by this study. The number of nicotine dependence and withdrawal symptoms are related to mental disorders. In addition, somatoform disorders show relationships with smoking similar to relationships with depressive or anxiety disorders. The intention to stop smoking should be proactively supported among these comorbid patients.     

Smoking cessation among Chinese young smokers: Does gender and age difference matters and what are the predictors?

This study assessed the gender and age differences in smoking cessation among the Chinese youth and identified factors associated with quitting smoking. This was a clinic based cross-sectional study with longitudinal components among 129 Chinese young smokers. All services in the clinic including one week's supply of nicotine replacement therapy (NRT) were free. We used structured questionnaires at baseline and at 1, 3 and 12 months. The analysis was by intention-to-treat basis. At 12 month follow up, the 7 day point prevalence quit rate (abstinence from tobacco smoking during the 7 days preceding the follow up) was 19% (25/129) and 36% (25/69) among all the attendees and among those who were successfully followed up, respectively. There was no significant gender or age differences in the quitting outcome but females and the older youth reported more withdrawal symptoms. Not reporting any withdrawal symptoms at 3 months follow up and adherence to use NRT for at least 4 weeks were significant predictors of quitting. A clinic-based smoking cessation service among Chinese young smokers produced an acceptable quit rate with no gender and age difference, indicating that a more general quit smoking approach could be taken for the youth.     

Impact of E-cigarettes on Smoking and Related Outcomes in Veteran Smokers With Psychiatric Comorbidity

Objective: Compared to the general U.S. population, smokers with comorbid psychiatric and/or substance use disorders have lower quit rates after evidence-based treatments and disproportionately high smoking-related deaths. Improved modalities for reducing tobacco-related harm in this subpopulation are needed. Because electronic cigarettes (e-cigarettes) can now deliver physiologically relevant levels of nicotine to consumers, they represent an additional nicotine delivery system that could be used in cessation interventions. While current data suggest that the use of e-cigarettes by smokers promotes a reduction in combustible cigarette use, smoking quit rates through use of e-cigarettes appears to be low. The goal of this study was to examine impact of e-cigarette use on combustible tobacco use as well as on the readiness to quit smoking and changes in nicotine dependence in a multimorbid population. Methods: We conducted a 4-week, open-label study in 43 military veteran smokers who had no immediate intention to stop smoking and were currently receiving psychiatric services from the Department of Veterans Affairs health care system. Participants were provided with a study e-cigarette they could use ad libitum along with other tobacco products and were encouraged to attend weekly laboratory visits and a one-month follow-up visit. Main outcome measures were number of cigarettes smoked per day (CPD), the frequency of e-cigarette use, the amount of money spent on combustible cigarettes (U.S. dollars/week), alveolar carbon monoxide (CO) levels, and urine cotinine levels. Results: Mean e-cigarette use was 5.7 days per week and only 9% of participants used the e-cigarette for fewer than 4 days per week. Significant reductions in breath CO (9.3 ppm to 7.3 ppm, p < .02) and CPD (from 16.6 to 5.7, p < .001) were observed across study weeks, and no serious adverse events were reported. Three participants (10% of completers) reported smoking cessation that was corroborated biochemically. At one-month follow-up, motivation to quit smoking remained significantly higher and the level of nicotine dependence was significantly lower than at baseline. Conclusions: E-cigarettes are acceptable to smokers with psychiatric comorbidities, as indicated by sustained and frequent e-cigarette use by 90% of participants, and may promote reduction and/or cessation of combustible cigarette use. E-cigarettes appear to be a viable harm reduction modality in smokers with psychiatric comorbidities.     

Smoking among female arrestees: prevalence of daily smoking and smoking cessation efforts

Prior research on smoking in the criminal justice system has focused on men. This study examines smoking behavior among female arrestees in New York City (NYC). The sample includes 836 women interviewed as part of the Drug Use Forecasting (DUF) Program. Questionnaire items analyzed here include the use of licit and illicit substances, current pregnancy, childbearing history, demographics, age at smoking initiation, daily smoking, dependency on tobacco, and quit attempts. Bivariate techniques and logistic regression analyses were used. Fully 71% of all women and 64% of pregnant women were daily smokers. Recent cocaine or heroin users were the most likely to be daily smokers (84% and 92%). Among daily smokers, nearly a third had ever tried to cut down or quit. In the regressions, Latinas were more likely to have tried to quit; recent heroin users and women who had ever felt dependent on tobacco were the least likely to have tried. The authors strongly recommend that female inmates are prime candidates for smoking cessation counseling.     

Lack of utility of cigarettes per day cutoffs for clinical and laboratory smoking research

BackgroundMost clinical and laboratory smoking research studies require that participants smoke at a certain level to be eligible for enrollment. However, there is limited evidence that use of these cutoffs differentiates groups of smokers along clinically meaningful criteria.MethodsUsing receiver operating characteristic curves, we analyzed data from daily smokers in the National Epidemiologic Study of Alcohol Use and Related Conditions - III (NESARC-III) to examine the utility of smoking rates for determining whether participants met DSM-5 criteria for tobacco use disorder, experienced nicotine withdrawal or had a history of failed quit attempts. We also examined whether relationships between these variables differed as a function of key sample characteristics.ResultsSmoking rate exhibited a weak relationship with the presence of tobacco use disorder (AUC = 0.664), whether individuals experience nicotine withdrawal (AUC = 0.672) and whether individuals had a history of failed quit attempts (AUC = 0.578). The relationship between smoking rate and a history of failed quit attempts was weaker for women than men (p < .05). Otherwise, utility did not differ as a function of sex, race/ethnicity, education, income, or use of multiple tobacco products. Optimal cutoffs varied somewhat across indices, but the largest number of correct classifications occurred at very low smoking rates.ConclusionsResearchers should consider abandoning the use of smoking rate cutoffs to determine study eligibility. If smoking rate cutoffs are used, a rationale should be presented along with justification for the specific cutoff chosen.