Lower Level Of Dependence Research Articles

Complicated Grief and Depression in Young Adults

Young adults experience problematic responses to loss more often than is commonly recognized. Few empirical studies have examined the contribution of intrapersonal and interpersonal characteristics to grief and depression in bereaved young adults. This study investigated the association of dependency and quality of the relationship with the deceased (i.e., depth and conflict) with complicated grief (CG) and depression. Participants were 157 young adults aged 17 to 29 years who experienced loss of a family member or close friend within the past 3 years (mean = 1.74 years). Participants completed the Inventory of Complicated Grief, Beck Depression Inventory, Depth and Conflict subscales of the Quality of Relationships Inventory, and the Dependency subscale of the Depressive Experiences Questionnaire. Relationships among dependency and interpersonal depth and conflict and CG and depression were examined through analyses of covariance. Sixteen percent of participants met criteria for CG and 34% had mild to severe depression. Dependency and depth were independently related to CG and dependency was related to depression, but the pattern of associations was somewhat different for each outcome. Greater depth was associated with CG, at both high and low levels of dependency. High levels of dependency were related to more depressive symptoms. Interpretation of the findings is limited by the relatively small sample size and cross-sectional design. CG and depression are related but distinct responses to loss. Although dependency is associated with both CG and depression after loss, relationships between the bereaved and deceased that are characterized by high levels of depth are particularly related to the development of CG symptoms.

Analysis of the Socio-Health Services Used of Family Caregivers of Alzheimer Patients

Alzheimer type dementia is one of the main health problems, due to the disability and dependence it produces. The implementation of Law 39/2006 attempts to respond to the needs by means of a catalogue of socio-health services and resources to provide support to the patients and their relatives. A study was conducted with 255 caregivers/relatives of people diagnosed with Alzheimer type dementia in order to determine the profile of the beneficiaries of these services, taking into account the caregivers' knowledge, the phase of the illness, and level of dependence. The results show that caregivers with knowledge of the disease and patients who are at a more advanced stage are the ones who use the most resources. Specifically, caregivers with knowledge used the family respite to a greater extent, and predominantly caregivers of patients at a mild phase of the disease enjoyed volunteer services and help at home, whereas caregivers at more advanced phases used the Day Center and economic aid. Lastly, we underline that volunteer service is used by subjects with a lower level of dependence, whereas more dependent people use economic aid the most.

Analysis of the Socio-Health Services Used of Family Caregivers of Alzheimer Patients

Alzheimer type dementia is one of the main health problems, due to the disability and dependence it produces. The implementation of Law 39/2006 attempts to respond to the needs by means of a catalogue of socio-health services and resources to provide support to the patients and their relatives. A study was conducted with 255 caregivers/relatives of people diagnosed with Alzheimer type dementia in order to determine the profile of the beneficiaries of these services, taking into account the caregivers' knowledge, the phase of the illness, and level of dependence. The results show that caregivers with knowledge of the disease and patients who are at a more advanced stage are the ones who use the most resources. Specifically, caregivers with knowledge used the family respite to a greater extent, and predominantly caregivers of patients at a mild phase of the disease enjoyed volunteer services and help at home, whereas caregivers at more advanced phases used the Day Center and economic aid. Lastly, we underline that volunteer service is used by subjects with a lower level of dependence, whereas more dependent people use economic aid the most.

How smokers may react to cigarette taxes and price increases in Brazil: data from a national survey.

BackgroundDespite being the third largest tobacco producer in the world, Brazil has developed a comprehensive tobacco control policy that includes a broad restriction on both advertising and smoking in indoor public places, compulsory pictorial warning labels, and a menthol cigarette ban. However, tax and pricing policies have been developed slowly and only very recently were stronger measures implemented. This study investigated the expected responses of smokers to hypothetical price increases in Brazil.MethodsWe analyzed smokers’ responses to hypothetical future price increases according to sociodemographic characteristics and smoking conditions in a multistage sample of Brazilian current cigarette smokers aged ≥14 years (n = 500). Logistic regression analysis was used to examine the relationship between possible responses and different predictors.ResultsIn most subgroups investigated, smokers most frequently said they would react to a hypothetical price increase by taking up alternatives that might have a positive impact on health, i.e., they would “try to stop smoking” (52.3%) or “smoke fewer cigarettes” (46.8%). However, a considerable percentage responded that they would use alternatives that would reduce the effect of price increases, such as the same brand with lower cost (48.1%). After controlling for sex age group (14–19, 20–39, 40–59, and ≥60 years), schooling level (≥9 versus ≤9 years), number of cigarettes per day (>20 versus ≤20), and stage of change for smoking cessation (precontemplation, contemplation, and preparation), lower levels of dependence were positively associated with the response “I would try to stop smoking” (odds ratio [OR], 2.19). Young age was associated with “I would decrease the number of cigarettes” (OR, 3.44). A low schooling level was strongly associated with all responses.ConclusionsTaxes and prices increases have great potential to stimulate cessation or reduction of cigarette consumption further among two important vulnerable populations of smokers in Brazil: young smokers and those of low educational level. The results from the present study also suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it.

What socio-demographic factors influence poverty and financial health care access among disabled people in Flanders: a cross-sectional study

BackgroundCurrent literature shows that people with a disability have a lower income than people without a disability. Disabled people often experience difficulties with health care access.The objective of this study is to assess the current financial situation and poverty rate amongst disabled people in Flanders. Furthermore we wanted to analyze factors that contribute to the risk of poverty and problems with financial health care access in adult people with a disability in Flanders.MethodsAn online and paper survey were constructed and made available through two large organizations for people with different types of disability in Flanders. Descriptive statistics and logistic regression analysis were performed.ResultsIn this convenience sample, 20.9% of the 889 respondents live under the poverty threshold. Important contributing factors to the risk of poverty are having children (OR 3.43, 95% CI 2.10-5.59) and a low level of dependence (OR 16.40, 95% CI 6.21-43.28). 25.2% of the respondents did not access health care because of financial shortcomings. A low level of dependence is one important contributing factor (OR 3.16, 95% CI 1.41-6.98) to limited financial health care access.ConclusionThis research confirms that disability is associated with a higher risk of poverty and impaired financial health care access.

ICT technologies in Europe: A study of technological diffusion and economic growth under network theory

The sector of Information and Communication Technologies (ICT) is one of the key instruments for the development of an economy. The literature emphasizes its capacity for both increasing productivity and generating new sources of income and wealth (Colecchia & Schreyer, 2002; Jorgenson & Stiroh, 1999 among others). Traditionally studies on the ICT sector have focused on the analysis of its economic impact, but not on its capacity as a “bridge” for information and knowledge flows across the economic network. Following Burt's approach (1992) on structural holes, the organization of the economic network defines where and for whom new opportunities lie. The structural hole methodology allows to analyze the capacity of the ICT sector as an enabler of technological diffusion and innovation. The results show that the European ICT sector not only is important for its intermediary role in the flow of information across the economic network, but also for its low level of dependency on other sectors.

Kvalitet života osoba sa invaliditetom i njihovih porodica

A large number of studies concerned with the quality of life of healthy and sick people, and a large number of persons with disabilities, which is on the rise, mainly due to traffic accidents, raises the question of quality of their life and quality of life of their families. According to estimates by the UN, around 450 million people worldwide are disabled, and at least one out of ten inhabitants of each country is disabled to a certain extent. About 10% of the population of Serbia are people with disabilities, which makes between 700,000 and 800,000 people with disabilities. The Aim Of The Work is to highlight the quality of life of persons with disabilities and the quality of life of their families. Methods: We analyzed the data and literature in the field of physical medicine, geriatrics, internal medicine, neurology, public health, quality of life, social medicine and health statistics in the part relating to the health and quality of life of people with disabilities and their families. Results And Discussion: The attitude towards people with disabilities throughout history has varied depending on the level of economic and cultural development, and many other circumstances. Behavior is changing and starting from a completely inhuman treatment, stigma, ignorance, passive relationship to the human social relations and social integration. People with disabilities, with the support of primarily members of their families, have launched important processes of self-organization in order to achieve their rights and form their own associations. People with disabilities are mostly cared for within their own families or placed in an appropriate institution intended for them. Quality of life of persons with disabilities and their families is different and it doesn't show the unique results. There are studies that suggest that caring for a disabled member of the family strengthens their unity and cohesion. It improves the quality of life of a disabled member, and other members of his family. But also, some other studies suggest that caring for a disabled member of the family contributes to poor or rarely improved quality of life of a disabled member, and reduced quality of life of his family. Conclusion: In the analysis of the quality of life of people with disabilities and their family members, especially parents or children, or the holder of care, it's important to keep in mind what kind of disability in a family member is all about. Disability which carries a high level of dependence on family members disturbs and reduces the quality of life of the entire family. Disability which carries a low level of dependence on family members does not reduce the quality of life for the whole family. It is necessary to protect the rights of persons with disabilities and their families, and to take all measures necessary to improve their life quality.

Entitlement is about ‘others’, narcissism is not: Relations to sociotropic and autonomous interpersonal styles

Although narcissism and psychological entitlement are correlated, they may predict different patterns of interpersonal relationships. We hypothesized that narcissism is primarily about the self, while entitlement is about the self in relation to others. Therefore interpersonal relationships should play a minimal role in narcissism but should occupy a larger role in entitlement. To test this, we had 621 undergraduate students complete the Personal Style Inventory II which measures sociotropic (dependence) and autonomous (independence) interpersonal styles as well as the Psychological Entitlement Scale and the Narcissistic Personality Inventory. We analyzed the variance explained by entitlement and by narcissism for each interpersonal style and their subscales. Narcissism negatively predicted sociotropy and was unrelated to autonomy, indicating low levels of dependence without being overly-independent. Conversely, entitlement positively predicted both sociotropy and autonomy, revealing an inconsistent mix of dependence on others and a need for independence from them. Therefore, although psychological entitlement and narcissism share a self-centric orientation, the two constructs differ in terms of orientation to others.

Care needs and workload required by institutionalised psychiatric patients

This descriptive study used a quantitative approach to assess the nursing care needs of patients with mental disorders, the mean number of care hours these patients were provided and the workload these patients require nursing team. The research was conducted in a public neuropsychiatric hospital located in south eastern Brazil in 2010 and included 105 patients as subjects. A patient classification tool was applied to characterise care profiles. Statistical analysis was performed using principal component analysis and analysis of variance. Patients were predominantly in the low care category (73.3%). The mean care hours ranged from 0.57 to 0.88 for nurses and 1.97 to 3.16 for nursing assistants, and the workload ranged from 119.6 to 183 hours . The present study showed that the care needs of most patients were at a low level of dependency and that most patients did not need to be institutionalised. Furthermore, it was found that the care hours provided by the nursing staff were not sufficient to meet the care needs of the patients.

Evaluating tumor heterogeneity in immunohistochemistry-stained breast cancer tissue

Quantitative clinical measurement of heterogeneity in immunohistochemistry staining would be useful in evaluating patient therapeutic response and in identifying underlying issues in histopathology laboratory quality control. A heterogeneity scoring approach (HetMap) was designed to visualize a individual patient's immunohistochemistry heterogeneity in the context of a patient population. HER2 semiquantitative analysis was combined with ecology diversity statistics to evaluate cell-level heterogeneity (consistency of protein expression within neighboring cells in a tumor nest) and tumor-level heterogeneity (differences of protein expression across a tumor as represented by a tissue section). This approach was evaluated on HER2 immunohistochemistry-stained breast cancer samples using 200 specimens across two different laboratories with three pathologists per laboratory, each outlining regions of tumor for scoring by automatic cell-based image analysis. HetMap was evaluated using three different scoring schemes: HER2 scoring according to American Society of Clinical Oncology and College of American Pathologists (ASCO/CAP) guidelines, H-score, and a new continuous HER2 score (HER2cont). Two definitions of heterogeneity, cell-level and tumor-level, provided useful independent measures of heterogeneity. Cases where pathologists had disagreement over reads in the area of clinical importance (+1 and +2) had statistically significantly higher levels of tumor-level heterogeneity. Cell-level heterogeneity, reported either as an average or the maximum area of heterogeneity across a slide, had low levels of dependency on the pathologist choice of region, while tumor-level heterogeneity measurements had more dependence on the pathologist choice of regions. HetMap is a measure of heterogeneity, by which pathologists, oncologists, and drug development organizations can view cell-level and tumor-level heterogeneity for a patient for a given marker in the context of an entire patient cohort. Heterogeneity analysis can be used to identify tumors with differing degrees of heterogeneity, or to highlight slides that should be rechecked for QC issues. Tumor heterogeneity plays a significant role in disconcordant reads between pathologists.

Abstract 5543: Hetmap: Evaluating tumor heterogeneity in immunohistochemistry-stained breast cancer tissue

Abstract Immunohistochemisty assays examining the HER2 receptor in breast cancer is the most widely adopted example of a companion diagnostic approach, which seeks to dictate therapeutic strategy based on a molecular description of a patient's disease. There are well-established guidelines for selecting patients for anti HER2 adjuvant therapies in breast cancer treatment, yet the current HER2 companion diagnostic approach is qualitative, does not sufficiently account for intratumor heterogeneity, and does not utilize any additional information about tumor cells that score beyond a specific threshold level. A major contributing factor for the failure of both treatment and diagnostic paradigm is thought to be intratumor heterogeneity. This lack of information in the scoring paradigm may contribute to inappropriate patient selection and explain why the disease in many trastuzumab treated patients progresses or becomes recurrent. Thus, a quantitative clinical measurement of heterogeneity in immunohistochemistry staining would be useful in better predicting patient therapeutic response. To answer this, we created a heterogeneity scoring approach (HetMap) that allows the visualization of an individual patient's IHC heterogeneity in the context of a cell population. We combined HER2 semi-quantitative analysis with the use of ecology diversity statistics to evaluate cell-level heterogeneity (consistency of protein expression within neighboring cells in a tumor nest) and tumor-level heterogeneity (differences of protein expression across a tumor as represented by a tissue section). We evaluated the approach on HER2 immunohistochemistry stained breast cancer samples, using 200 specimens across two different CLIA laboratories, with three pathologists at each laboratory each outlining regions of tumor for scoring by automatic cell-based image analysis. HetMap was evaluated using three different scoring schemes: HER2 scoring according to ASCO/CAP guidelines, H-Score and a new continuous HER2 score (HER2cont). Cell-level heterogeneity, reported either as an average or the maximum area of heterogeneity across a slide, had low levels of dependency on the pathologist choice of region. Tumor-level heterogeneity measurements had more dependence on the pathologist choice of regions. Significantly, discordant pathologist assessments of IHC scores in the +2, or equivocal score, range occurred most in tumors with high heterogeneity, leading to potentially major clinical impact. Thus, HetMap is a measure of heterogeneity, by which pathologists, oncologists, and drug development organizations can view cell-level and tumor-level heterogeneity for a patient for a given marker in the context of an entire patient cohort. Including such measures of heterogeneity in diagnostic approaches can help establish better thresholds for patient selection, thereby improving patient response. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5543. doi:1538-7445.AM2012-5543

Avaliação cognitiva de idosos institucionalizados

In Brazil, the institutionalization of the elderly occurs when they present low dependence level due to the cognitive commitment. Thus this study assessed the cognitive state of the elderly living in homes for the aged, Londrina (Parana State), detecting possible cognitive impairment, confirming previous diagnosis of dementia and subsidizing the development of recreational-educational activities. The tool applied in the cognitive evaluation was comprised by questions social and economic, demographic and psychological. The elderly cognitive state was verified through the Mini-Mental State Examination (MMSE) and Activities of Daily Living (ADL) from Katz. The cut-off points used in the MMSE were differentiated based on the schooling degree. Of the total population of 44 elderly, it was possible to accomplish the cognitive state test to 28 of them; from this 39.3% presented cognitive commitment, and this value increased for 71.4% when we applied standard cut-off points. All the people with dementia submitted to cognitive tests presented low scores. Therefore, exercises that involve the attention, concentration, logical thinking and memory, are required to preserve the individual functional capacity that ages, valuing his autonomy.

Level of dependence in patients on haemodialysis in Catalonia and evolution of mortality rates.

Age and the comorbidities associated with ESRD impair the functional autonomy of patients on haemodialysis (HD). Our objectives were to assess the level of dependence in patients on HD and their mortality rates after three years of treatment. To do so, we followed the criteria established by the "Ley de Promoción de la Autonomía Personal y Atención a las Personas en situación de dependencia", the Spanish Law of Dependence (LD). We carried out a cross-sectional descriptive study between October 2007 and January 2008. From 3702 patients in 40 dialysis units in Catalonia, 806 were selected as potential dependent individuals according to the criteria of their healthcare providers. Variables studied included: level of dependence according to the LD criteria, age, time on HD, associated pathology, treatment characteristics, family circumstances, and survival from 2009 to 2011. According to the LD, 137 were not dependent, 350 had a grade 1 dependence level, 237 grade 2, and 82 grade 3. In addition, 121 were living in an institution. The mean age was 74.9 ± 18.2 years and the median time on HD was 36 months. The prevalence of common pathologies was: diabetes (35.7%) and cardiovascular disease (29.1%). Musculoskeletal alterations (87%) and neurological disorders (38%) were the main causes of dependence. 64.2% of patients had a catheter as a vascular access. 34.9% of patients survived after three years, and these had a lower level of dependence when compared to those patients who had died, with no statistically significant differences within those three years. According to the LD, the prevalence of dependent patients in Catalonia is substantial (18.07%). These patients have a high mortality rate after three years.

P5-11-17: Evaluating Tumor Heterogeneity in Immunohistochemistry Stained Breast Cancer Tissue.

Abstract Context: Quantitative clinical measurement of heterogeneity in immunohistochemistry staining would be useful in both evaluating patient therapeutic response and identifying underlying issues in histopathology laboratory quality control. Objective: To create a heterogeneity scoring approach (HetMap) that allows the visualization of an individual patient's IHC heterogeneity in the context of a population. Design: We combined HER2 semi-quantitative analysis with the use of ecology diversity statistics to evaluate cell-level heterogeneity (consistency of protein expression within neighboring cells in a tumor nest) and tumor-level heterogeneity (differences of protein expression across a tumor as represented by a tissue section). We evaluated the approach on HER2 immunohistochemistry stained breast cancer samples, using 200 specimens across two different CLIA laboratories, with three pathologists at each laboratory each outlining regions of tumor for scoring by automatic cell-based image analysis. HetMap was evaluated using three different scoring schemes: HER2 scoring according to ASCO/CAP guidelines, H-Score and a new continuous HER2 score (HER2cont). Results: Two definitions of heterogeneity, cell-level and tumor-level, provided useful independent measures of heterogeneity. Cell-level heterogeneity, reported either as an average or the maximum area of heterogeneity across a slide, had low levels of dependency on the pathologist choice of region (coefficient of variation of 15%). Tumor-level heterogeneity measurements had more dependence on the pathologist choice of regions (coefficient of variation of 25%). Results were highly similar between the two laboratories, which is encouraging for HER2 standardization, as the labs involved different pathologists, different specimens, and different standardization procedures, although both complied with CLIA/CAP guidelines for HER2 testing. Conclusions: HetMap is a measure of heterogeneity, by which pathologists, oncologists, and drug development organizations can view cell-level and tumor-level heterogeneity for a patient for a given marker in the context of an entire patient cohort. Heterogeneity analysis can be a useful means to identify tumors with higher degrees of heterogeneity, or to highlight slides that should be rechecked for QC issues. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-17.

Smoking prevalance and the degree of nicotine dependence among healthcare workers at the ataturk university medical facility.

In this study, we aimed to investigate smoking prevalence and the degree of nicotine dependence in our hospital healthcare workers. This study was conducted between January 2008 and June 2008 in our hospital (Medical Facility of Atatürk University). A total of 691 (370 females, 321 males) subjects were included in this study. A questionnaire, including demographic findings, tobacco consumption information and the Fagerström nicotine dependence test, was distributed to healthcare workers and collected. The questionnaire was answered by 691 health workers, 46.5% of whom were male, and 53.5% of whom were female. Overall, the rate of smoking was 36.9%; 48% of males and 27.6% of females were current smokers. When classified according to clinic, the greatest rate of smoking was in the psychiatry clinic (60.0%), and the lowest rate of smoking was in the ear, nose and throat (ENT) Clinic (0.0%). Thirty-four percent of nurses, 18.7% of doctors, 45.5% of officers, and 50.4% of ancillary staff were smokers. According to education level, 50% of the cases (smokers) graduated from primary school, 45% of the cases graduated from high school and 26.9% of the cases graduated from university. The major reason for the initiation of smoking was attention-seeking behavior. The age at smoking initiation was 7 to 20 years in 83.9% of cases and 21 to 35 years in the remaining 16.1%. Thirty-five percent of smokers had very low levels of dependence, while 11.9% had very high levels dependence. Ninety-two percent of cases indicated they would prefer to work at a smoke-free hospital. Ninety-five percent of cases would support making this facility a smoke-free hospital. The smoking rate was 36.9% amongst our hospital health workers. Smoking prevalence was higher in males (48%) than females (27.6%). The greatest smoking rate was amongst ancillary staff. Ninety-five percent of healthcare workers were supportive of a law requiring hospitals to be smoke-free.

Precessation treatment with nicotine patch significantly increases abstinence rates relative to conventional treatment

Previous studies have reported that smoking abstinence rates are increased when nicotine skin patch treatment is initiated prior to the target quit smoking date, as compared with conventional treatment beginning on the quit date. We hypothesized that smoking in the presence of continuous levels of nicotine would attenuate the reinforcing effects of cigarette smoking and lead to a decline in dependence on inhaled nicotine, thus facilitating cessation. This study involved four groups of smokers (n = 100 per group) who received either nicotine patch (21 mg/24 hr) or placebo patch treatment for 2 weeks before the quit smoking date, and during this period, smoked their usual brands of cigarettes or switched to low-tar and nicotine cigarettes: a 2 (nicotine patch) x 2 (cigarette type) factorial design. From the quit date on, all groups received standard nicotine patch treatment, consisting of 6 weeks of 21 mg/24 hr, 2 weeks of 14 mg/24 hr, and 2 weeks of 7 mg/24 hr. Abstinence was defined as self-report of no smoking from the quit date on, confirmed by expired-air carbon monoxide. Continuous abstinence rates were approximately doubled by precessation nicotine patch treatment. The treatment mainly benefited smokers with lower levels of dependence, based on Fagerström Test for Nicotine Dependence score. All treatments were well tolerated. In view of these findings and similar results from previous studies, current labeling of the nicotine patch, which recommends using nicotine replacement therapy only after the quit date, should be reexamined.

Nondaily tobacco use among Black and White college undergraduates: A comparison of nondaily versus daily tobacco users

Little is known about how the characteristics of college undergraduate nondaily tobacco users compare to daily tobacco users. We conducted a survey to compare the sociodemographic, tobacco use, psychological, and alcohol-related factors between nondaily versus daily tobacco users in a sample of Black and White college undergraduates aged 18–24 years (N = 1623). Of this sample, 301 (18.5%) participants reported using tobacco in the previous 30 days. Of the participants reporting tobacco use in the past 30 days, 50 (16.6%) participants reported nondaily use and 21 (7.0%) participants reported daily use. Findings revealed that nondaily tobacco users were more likely than daily tobacco users to deny that use of tobacco has had a detrimental impact on their health (p < 0.001). Additionally, nondaily cigarette smokers reported a lower level of dependence than daily smokers (p < 0.001). White racial status and daily tobacco use was associated with cigarette smoking (p < 0.05), while Black racial status and nondaily tobacco use was associated with cigar smoking (p < 0.05). Use of more than one type of tobacco product was associated with White racial status (p < 0.05) and male gender (p < 0.001). Our findings expand what is known about undergraduate nondaily tobacco users and provides valuable data for designing interventions for these individuals.

Cigarette Smoking Among Adults in the United States

Cigarette Smoking Among Adults in the United States

Dependence on the nicotine gum in former smokers

We conducted an Internet survey in 2004–2007 in 526 daily users of the nicotine gum, to assess use of, and dependence on the nicotine gum in former smokers. We used modified versions of the Nicotine Dependence Syndrome Scale (NDSS-G), the Cigarette Dependence Scale (CDS-G) and the Fagerström Test (FTND-G). After 30 days, 155 participants (29%) indicated their gum use. Higher dependence on the gum predicted a lower chance of stopping using it at follow-up (odds ratio = 0.36 for each standard deviation unit on CDS-G, p = 0.001). More long-term (> 3 months) than short-term (< = 3 months) users of the gum agreed with: “I use the nicotine gum because I am addicted to it” (83% vs. 7%, p < .001), and fewer long-term users reported that they used the gum to avoid relapsing to smoking (42% vs. 92%, p < .001). Long-term users had higher ratings of dependence on the gum than short-term users, as assessed with NDSS-Gum, CDS-Gum and FTND-Gum (all p < .001). Most long-term users reported symptoms of dependence on the nicotine gum. Lower levels of dependence on the gum predicted cessation of gum use. However, long term use of the nicotine gum has no known serious adverse consequence, and may be beneficial if it prevents late relapse.

Clinical Pharmacology of Nicotine: Implications for Understanding, Preventing, and Treating Tobacco Addiction

Understanding the basic and clinical pharmacology of nicotine provides a basis for improved prevention and treatment of tobacco addiction. Nicotine acts on nicotinic cholinergic receptors in the brain to release dopamine and other neurotransmitters that sustain addiction. Neuroadaptation and tolerance involve changes in both nicotinic receptors and neural plasticity. Nicotine addiction can occur in the context of physical dependence characterized by self-medication to modulate negative affect and/or to relieve withdrawal symptoms, as well as, in light or occasional smokers, primarily for positive reinforcement in specific situations. Nicotine is metabolized primarily by CYP2A6. Its clearance exhibits considerable individual variability that is determined by genetic, racial, and hormonal (sex) factors. Genetically slow metabolism of nicotine appears to be associated with a lower level of dependence. Nicotine dependence is highly heritable and appears to be influenced by genes coding for some nicotine receptor subtypes, some neurotransmitter genes, and genes involved in neural connectivity. Novel pharmacotherapies for nicotine dependence include partial agonists for nicotinic receptors and nicotine vaccines. Pharmacogenetic studies suggest various candidate genes and a nicotine metabolism phenotype that influence outcome. Human pharmacology studies of nicotine and smoking behavior also provide a basis for assessing the benefits and risks of long-term nicotine use for harm reduction and for a potential cigarette regulatory strategy that includes reducing nicotine content of cigarettes to nonaddictive levels.