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.     

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

IntroductionAdults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.MethodsThe sample includes male, AD smokers (N = 129) with 1–32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.ResultsOverall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82–0.90), motivation to quit (IRRs = 0.65–0.85), and intrinsic reasons for quitting (IRRs = 0.96–0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05–1.07), impulsivity (IRRs = 1.01–1.03), weight-control expectancies (IRRs = 1.10–1.15), and childhood sexual abuse (IRRs = 1.03–1.07) predicted more cigarettes/day.ConclusionsSmokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.     

Transdermal nicotine for smoking cessation in postmenopausal women

This study examined the efficacy of transdermal nicotine in postmenopausal smokers, and whether a history of depression or hormone replacement therapy (HRT) moderated smoking cessation outcomes. Postmenopausal smokers (N=152) received intensive smoking cessation counseling and were randomly assigned to use either a 21-mg nicotine patch for 3 months, with a 1-month taper, or a placebo patch. The primary outcome was biochemically validated 7-day point prevalence smoking abstinence during treatment (i.e., 1, 2, 6, and 12 weeks after the quit date) and 1 year after study medication was discontinued. Subjects who received transdermal nicotine were significantly more likely than placebo-treated subjects to remain abstinent from smoking during treatment, but not at the 1-year follow-up. The majority of subjects (>50%) in both groups accurately identified their treatment assignment. History of depression was associated with a decreased likelihood to abstain from smoking throughout the study. HRT did not moderate smoking outcomes. These data indicate that transdermal nicotine may provide short-term benefits for smoking cessation in postmenopausal women. However, efforts are needed to improve long-term abstinence rates and smoking outcomes among women with a history of depression.     

Nicotine dependence as a moderator of a quitline-based message framing intervention

High nicotine dependence is a reliable predictor of difficulty quitting smoking and remaining smoke-free. Evidence also suggests that the effectiveness of various smoking cessation treatments may vary by nicotine dependence level. Nicotine dependence, as assessed by Heaviness of Smoking Index baseline total scores, was evaluated as a potential moderator of a message-framing intervention provided through the New York State Smokers' Quitline (free telephone based service). Smokers were exposed to either gain-framed (n=810) or standard-care (n=1222) counseling and printed materials. Those smoking 10 or more cigarettes per day and medically eligible were also offered a free 2-week supply of nicotine patches, gum, or lozenge. Smokers were contacted for follow-up interviews at 3 months by an independent survey group. There was no interaction of nicotine dependence scores and message condition on the likelihood of achieving 7-day point prevalence smoking abstinence at the 3-month follow-up contact. Among continuing smokers at the 3-month follow-up, smokers who reported higher nicotine dependence scores were more likely to report smoking more cigarettes per day and this effect was greater in response to standard-care messages than gain-framed messages. Smokers with higher dependence scores who received standard-care messages also were less likely to report use of nicotine medications compared with less dependent smokers, while there was no difference in those who received gain-framed messages. These findings lend support to prior research demonstrating nicotine dependence heterogeneity in response to message framing interventions and suggest that gain-framed messages may result in less variable smoking outcomes than standard-care messages.     

Naltrexone effects on short-term and long-term smoking cessation

OBJECTIVES: This study examined the efficacy of naltrexone, a long-acting opiate antagonist, as a smoking cessation aid in a double-blind placebo-controlled randomized trial. It was hypothesized that naltrexone would result in higher quit rates at the end of treatment and six months later. METHODS: Subjects were 68 smokers aged 18 to 65 who smoked at least 20 cigarettes daily and wished to stop smoking. They took naltrexone or placebo daily for four weeks and were seen weekly for individual smoking cessation therapy. RESULTS: A statistical trend towards a higher overall cessation rate (cotinine < 15 ng/mL) at end-of-treatment was observed among subjects treated with naltrexone than placebo (46.7% vs. 26.3%, respectively, odds ratio = 2.5, p < .10); however, this difference was attenuated at six months (27% vs. 15%, respectively, odds ratio = 1.9, p = ns). Stratified analysis indicated the usefulness of naltrexone primarily for female smokers and those with a history of major depression. These effects remained six months later. CONCLUSION: These results provide, at best, mild promise for naltrexone as a smoking cessation drug and provide another instance of a differential response to nicotine dependence treatment according to gender and depression history.     

Gender differences in the comorbidity of smoking behavior and major depression

OBJECTIVE: The present investigation sought to determine whether smoking behavior was associated with current or lifetime major depression and whether this association was greater in women. METHODS: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2002, n=42,565). Relationships between smoking status (daily, occasional, prior) and DSM-IV major depression (current or lifetime) by gender were assessed in terms of odds ratios using logistic regressions. RESULTS: Current (daily, occasional) and prior smoking significantly increased odds of having current or prior major depression. These associations varied as a function of gender. Women with prior smoking were at significantly higher risk of current and past depression than men (OR: 1.53 vs 1.36; 1.72 vs 1.36), as was true for current occasional (OR: 1.92 vs 1.39; 1.90 vs 1.30) and daily smoking (OR: 2.52 vs 1.95; 1.84 vs 1.48). CONCLUSIONS: The association between smoking and current or past depression is not necessarily limited to smoking that meets criteria for nicotine dependence, and is more potent in women. Smoking cessation interventions for this population should consider the role that depression may play in failure to quit and smoking relapse, particularly in women.     

Associations between nicotine dependence,anhedonia, urgency and smoking motives

Models of nicotine dependence have suggested that the association between urgency, a subconstruct of impulsivity, and smoking behaviors may be mediated by motivations. Motives that are driven by expectations that smoking will relieve negative affect or increase positive affect may be especially salient in persons who have depression symptoms such as anhedonia. Support for associations between symptoms of depression, urgency, and addiction has been found for alcohol dependence, but empirical analysis is lacking for an interactive effect of urgency and depression symptoms on nicotine dependence. The current study investigated relationships among the urgency facet of impulsivity, anhedonia, smoking motives, and nicotine dependence with secondary analyses of a sample of 1084 daily smokers using simultaneous moderation and multiple mediation analyses. The moderation analysis revealed that although urgency was significantly associated with smoking at average or higher levels of anhedonia, it was unrelated to smoking when few anhedonia symptoms were endorsed. Further, multiple mediation analyses revealed that the smoking motives of craving, cue exposure, positive reinforcement, and tolerance significantly mediated the relationship between urgency and nicotine dependence. Results suggest that models of alcohol addiction that include an interactive effect of urgency and certain symptoms of depression may be applied to nicotine dependence. Examination of the multiple mediational pathways between urgency and nicotine dependence suggests directions for intervention efforts.     

Risk factors for adolescent smoking: parental smoking and the mediating role of nicotine dependence

Background

Parental smoking and early-emerging nicotine dependence symptoms are well-documented risk factors for adolescent smoking. However, very little is known about the mediating pathways through which these risk factors may act, or whether parental smoking may cause or signal early-emerging nicotine dependence symptoms.

Methods

Data were drawn from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study. Adolescents who had smoked under 100 cigarettes in their lifetime (n = 594; low-exposure group) and adolescents who had smoked over 100 cigarettes, but fewer than 5 cigarettes per day (n = 152) were included in the analyses. Path analysis was performed on longitudinal data to investigate the association between parental smoking and smoking frequency at the 48 months follow-up, both directly and through mediating variables of smoking frequency, smoking quantity, and nicotine dependence.

Results

Father's smoking was associated with higher adolescent nicotine dependence scores at the baseline assessment wave. Structural equation modeling revealed that mother's smoking at baseline was associated with adolescent's smoking frequency at the 48-month follow-up, and its effect was partially mediated by both smoking frequency and nicotine dependence among low-exposure adolescent smokers.

Conclusions

Parental smoking is a risk factor for future smoking in low-exposure adolescent smokers, above and beyond the risks posed by smoking behavior and nicotine dependence. Moreover, parental smoking is associated with early-onset nicotine dependence in low-exposure adolescent smokers. As an easily measureable risk factor, parent smoking status can be used to identify and intervene with novice adolescent smokers who are at high risk for chronic smoking behavior.     

吸烟的危害与尼古丁替代疗法

吸烟是引起死亡的主要原因之一,全球每年有500余万人死于吸烟。它已成为严重的公共卫生问题。研究显示,烟雾中含有4000余种化合物,其中至少有43种为致癌物。长期吸烟可致多种疾病如癌症、肺气肿、心脏病及脏器损害,并可引起依赖性（成瘾）。依赖性主要由烟草含有的尼古丁所致。经常吸烟者大多对尼古丁成瘾。因此,经常吸烟者停止吸烟可出现尼古丁戒断症状,表现为烦躁、焦虑、头晕、头昏、头痛、失眠及注意力不集中。大多数吸烟者戒烟失败主要与尼古丁成瘾有关。鉴此,推出了尼古丁替代疗法（nicotine replacement therapy,NRT）。NRT是一种不经吸烟而使尼古丁缓慢进入体内的方法。该法不仅能消除或减轻尼古丁戒断症状,并且能避免吸烟的危害。研究结果表明,NRT能明显提高戒烟的成功率,而且其成瘾风险低。NRT常用制剂有咀嚼胶、贴剂、吸入剂、鼻喷剂等。这些制剂均能引起一些不良反应,反应的程度均较轻,但反应类型各制剂有所不同。NRT制剂可安全地用于心血管病患者。NRT不宜用于孕妇、乳母及未成年人。总之,NRT对吸烟者而言是一种安全有效的戒烟方法,NRT制剂在很多国家已作为OTC使用多年,值得推荐。     

Nicotine dependence, PTSD symptoms, and depression proneness among male and female smokers

Several studies have linked posttraumatic stress disorder with heavy smoking. It is not known to what extent this association is specific, as opposed to being a function of a joint association of PTSD and heavy smoking with a third variable such as depression proneness. In a cross-sectional study of 157 current regular smokers, severity of nicotine dependence (but not cigarettes smoked per day) was positively correlated with total PTSD symptoms, hyperarousal symptoms, and avoidance symptoms. These correlations were not eliminated by controlling statistically for depression vulnerability, whether it was measured on a continuous self-rating scale or on the basis of interview-diagnosed history of major depression. The association between PTSD and nicotine dependence was stronger among men than among women.     

Consistency or change in nicotine dependence according to the Fagerström Test for Nicotine Dependence over three years in a population sample

The goal was to determine whether nicotine dependence levels remain consistent or change over three years. From a population- based sample of 4075 residents aged 18-64, drawn at random, data of 696 individuals was used, who had smoked cigarettes for 21 years on average. Nicotine dependence was assessed by the Fagerstr?m Test for Nicotine Dependence (FTND) at baseline, and 30 and 36 months later. In addition, nicotine dependence and alcohol dependence were diagnosed according to the American Psychiatric Association (DSM-IV). We found an increase in the FTND over 36 months. Subgroups were revealed with sustained high, increasing, decreasing, and sustained low rates of the FTND sum score. Male gender, age at onset of smoking 15 years or younger, DSM-IV nicotine dependence, and DSM-IV alcohol dependence at baseline predicted a sustained high FTND. We conclude that nicotine dependence is increasing even after many years of smoking in an adult population sample.     

Comparison of smoking relapse curves among African-American smokers

We examined the smoking relapse curves for African-American smokers by level of smoking to characterize nicotine dependence in this population of smokers. This analysis was conducted from data originally collected to study differences in level of smoking among African-Americans at an inner-city health center in Midwest. Relatively little research has been conducted to clarify smoking and quitting patterns among African-American smokers. The median number of cigarettes smoked currently was 7 cigarettes per day (cpd) for light smokers and 20 cpd for the moderate to heavy smokers. The heavier smokers reported smoking at this rate longer than light smokers, 11 and 5 years, respectively. The major finding in this study is that African-American light smokers have abstinence rates very similar to heavier smokers and the median length of their most recent quit attempts were also similar. Therefore, stable light smokers may also need smoking cessation interventions similar to those used for heavier smokers in order to successfully stop smoking.     

Association of parental smoking history with nicotine dependence, smoking rate, and psychological cofactors in adult smokers

Family history is a powerful predictor of variation in risk of common diseases and conditions because it can represent the influence of both shared genes and shared environments. To investigate the relationship of parental smoking history with nicotine dependence and smoking rate, as well as with known psychological cofactors for smoking (depression, anxiety, alcoholism, disordered eating), we studied smoking adults who provided smoking history for both parents. We found that having two ever-smoking parents, in comparison to zero or one, was associated with higher nicotine dependence scores, cigarettes per day, and levels of anxiety in participant, with a trend for depression. Participants whose mothers smoked during pregnancy had significantly higher scores on nicotine dependence, smoking rate, and disordered eating than participants with either ever-smoking mothers who did not smoke during pregnancy or never-smoking mothers. These findings suggest that family history of smoking may be a key determinant of interindividual variation in smoking behavior, nicotine dependence, and psychological cofactors among smokers.     

Association between psychiatric disorders and smoking stages among Latino adolescents

OBJECTIVE: We examined the prevalence of smoking behaviors and their association with psychiatric disorders within a representative sample of youth from Puerto Rico. METHOD: A complex sampling design was used and analyses were conducted to account for the unequal selection probability, stratification and clustering. All analyses were weighted back to the population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0 (DISC-IV). RESULTS: After controlling for other comorbidity, major depression and oppositional defiant disorder were significantly associated with nicotine dependence, rather than with lower levels of use. In contrast, conduct disorder was generally associated with lower levels of use rather than with nicotine dependence. As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. CONCLUSIONS: By examining psychiatric correlates of smoking stages within an island-wide sample of adolescents, the present study highlights those disorders that may play a role in the development and/or persistence of smoking behavior in Puerto Rico and further clarifies the appropriate targets for smoking intervention conducted in community settings.     

Naltrexone Effects on Short-Term and Long-Term Smoking Cessation

Abstract

Objectives: This study examined the efficacy of naltrex-one, a long-acting opiate antagonist, as a smoking cessation aid in a double-blind placebo-controlled randomized trial. It was hypothesized that naltrexone would result in higher quit rates at the end of treatment and six months later.

Methods: Subjects were 68 smokers aged 18 to 65 who smoked at least 20 cigarettes daily and wished to stop smoking. They took naltrex-one or placebo daily for four weeks and were seen weekly for individual smoking cessation therapy.

Results: A statistical trend towards a higher overall cessation rate (cotinine < 15 ng/mL) at end-of-treatment was observed among subjects treated with naltrexone than placebo (46.7% vs. 26.3%, respectively, odds ratio = 2.5, p < .10); however, this difference was attenuated at six months (27% vs. 15%, respectively, odds ratio = 1.9, p = ns). Stratified analysis indicated the usefulness of naltrexone primarily for female smokers and those with a history of major depression. These effects remained six months later.

Conclusion: These results provide, at best, mild promise for naltrex-one as a smoking cessation drug and provide another instance of a differential response to nicotine dependence treatment according to gender and depression history.     

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.     

Past alcohol problems do not predict worse smoking cessation outcomes

Whether smokers with a past history of alcohol problems are less able to stop smoking and have a greater need for nicotine replacement therapy than smokers without this history is unclear. We conducted a secondary analysis of a prior study of 1039 smokers randomized to 0, 21, 35 or 42 mg/day nicotine patch for smoking cessation. Because higher dose patches were being tested, only smokers of > or =30 cigs/day were included. Although smokers with current alcohol abuse or dependence were excluded, 15% of the smokers had a past (>1 year ago) Short Alcohol Dependence Data (SADD) score of > or =9 suggesting past alcohol problems. Heavy smokers with a past history of alcohol problems did not relapse sooner, were not less likely to be abstinent and did not benefit more from nicotine treatment or from higher doses than heavy smokers without this history. We conclude that a past history of alcohol problems per se does not predict inability to stop smoking.     

Predictive validity of four nicotine dependence measures in a college sample

BACKGROUND: The present study compared the predictive and incremental validity of four commonly used dependence measures (Diagnostic and Statistical Manual-IV [DSM-IV] nicotine dependence criteria, Fagerstrom Test for Nicotine Dependence [FTND], Hooked On Nicotine Checklist [HONC], Nicotine Dependence Syndrome Scale [NDSS]) in a first year college sample reporting light smoking patterns. METHODS: Nicotine dependence measures were administered at the end of the first semester and follow-up smoking behavior (i.e. continued smoking, quantity, frequency, and length of abstinence) was assessed at the end of the first and second academic years. RESULTS: Higher levels of dependence as measured by the HONC and DSM-IV predicted smoking behavior at both follow-up assessments. While higher scores on some of the NDSS factors predicted heavier smoking behavior during follow-up assessments, higher scores on other NDSS factors predicted lighter smoking behavior. The DSM-IV, NDSS-priority, and HONC measures provided some evidence for incremental validity. Higher dependence scores on all four measures were related to shorter lengths of smoking abstinence. CONCLUSIONS: The four dependence measures were differentially related to smoking behavior outcomes in a light smoking sample. These findings suggest that nicotine dependence can predict a variety of smoking behaviors in light smokers.     

Intolerance for smoking abstinence among nicotine-deprived,treatment-seeking smokers

IntroductionThe Intolerance for Smoking Abstinence Discomfort Questionnaire (IDQ-S) assesses distress tolerance specific to nicotine withdrawal. Though developed to assess withdrawal-related distress, the IDQ-S has not been validated among nicotine-deprived, treatment-seeking smokers. The present study extended previous research by examining the predictive utility of the IDQ-S among abstinent, motivated-to-quit smokers.MethodsAbstinent, treatment-seeking smokers completed the IDQ-S Withdrawal Intolerance and Lack of Cognitive Coping scales, assessments of nicotine dependence and reinforcement, and smoking history at baseline. At baseline and at 24-h, 2-week, and 1-month follow-up, participants completed a smoking cue-reactivity task (collection of cue-elicited craving and negative affect), and assessments of cigarettes per day (CPD; daily diaries at follow-up), carbon monoxide (CO), and cotinine.ResultsGreater IDQ-S Withdrawal Intolerance was associated with younger age, higher nicotine dependence and reinforcement, and less smoking years (ps < .03). Greater IDQ-S Lack of Cognitive Coping was associated with less education, lower nicotine dependence and reinforcement, higher baseline CPD, and no prior quit attempts (ps < .04). IDQ-S scales did not significantly predict cue-elicited craving or negative affect, CPD, CO, or cotinine levels at follow-up (ps > .10).ConclusionsWithdrawal intolerance and lack of cognitive coping did not predict smoking outcomes among nicotine-deprived, treatment-seeking smokers, but were associated with smoking characteristics, including nicotine dependence and reinforcement. Withdrawal intolerance and lack of cognitive coping may not be especially useful in predicting craving and smoking behavior, but future studies should replicate the present study's findings and assess the stability of the IDQ-S before forming firm conclusions about its predictive utility.