Sex differences in nicotine dependence among addictions clients accessing a smoking cessation programme in Vancouver, British Columbia, Canada

ACCESSIBLE SUMMARY: ? The purpose of this study was to examine differences in substance use disorders, psychiatric disorders and nicotine dependence among 323 women and men accessing a smoking cessation programme in an addiction treatment setting in Vancouver, British Columbia, Canada. ? Individuals with substance use and psychiatric disorders have smoking prevalence rates nearly double that of the general population. Yet, there are distinct differences between men and women in their smoking behaviour and responses to smoking cessation treatment. Few studies have examined such sex differences among individuals with substance use and psychiatric disorders. ? The study found that compared with individuals with no psychiatric diagnosis, those with a mood, anxiety and psychotic disorders were significantly more likely to be female; whereas compared with those without a substance use disorder, individuals with alcohol, cocaine or marijuana disorder were more likely to be male. Moreover, among women having an anxiety disorder history and smoking a greater number of cigarettes per day were significantly associated with high nicotine dependence. Among men, smoking a greater number of cigarettes per day and having a lower confidence in quitting were significantly associated with high nicotine dependence. ? These findings suggest the need for appropriate assessment of smoking behaviour and nicotine dependence among individuals accessing addictions treatment services. Moreover, these findings further provide evidence of the need for tailored interventions for tobacco dependence among men and women with histories of substance use and psychiatric disorder. ABSTRACT: Most individuals in drug treatment programmes use tobacco and are dependent on nicotine. For 323 participants (65% men, mean age = 49.3 years) with a history of substance use disorder (SUD) and/or psychiatric disorders (PD) enrolled in a tobacco dependence clinic programme, we compared baseline characteristics among women and men and examined factors associated with nicotine dependence (ND). Individuals with mood, anxiety and psychotic disorders were more likely to be female, whereas men were more likely to be characterized by alcohol, cocaine and marijuana use, older age, older age at smoking initiation and higher confidence in quitting smoking scores. In stratified multivariate analyses, among women, history of an anxiety disorder and a greater number of cigarettes smoked per day were associated with higher ND scores; among men, a greater number of cigarettes smoked per day and higher confidence in quitting scores were associated with higher ND scores. Given the differences in smoking, SUD and PD histories between women and men accessing addiction treatment, and differential associations with ND, it is important to further explore factors that may enhance tailored treatments and inform future studies examining biological and psychosocial factors for tobacco use in SUD and PD treatment populations.