Minnesota Nicotine Withdrawal Scale Research Articles

Effects of acupuncture and nicotine patch on smoking: a multicenter, randomized, controlled, double-blind clinical trial.

To evaluate the effects of acupuncture and/or nicotine patches on smoking cessation. Eighty-eight participants were randomly allocated into four groups: acupuncture combined with nicotine patch (ACNP), acupuncture combined with sham nicotine patch (ACSNP), sham acupuncture combined with nicotine patch (SACNP), and sham acupuncture combined with sham nicotine patch (SACSNP). The primary outcome was self-reported smoking abstinence verified with expiratory Carbon Monoxide (CO) after 8 weeks of treatment. The modified Fagerstrom Test for Nicotine Dependence (FTND) score, Minnesota Nicotine Withdrawal Scale (MNWS), and the Brief Questionnaire of Smoking Urge (QSU-Brief) score were used as secondary indicators. SPSS 26.0 and Prism 9 software were used for statistical analyses. Seventy-eight participants completed the study. There were no significant differences in patient characteristics at baseline across the four groups. At the end of treatment, there was a statistically significant difference (χ2 = 8.492, p = 0.037) in abstaining rates among the four groups. However, there were no significant differences in the reduction in the number of cigarettes smoked daily (p = 0.111), expiratory CO (p = 0.071), FTND score (p = 0.313), and MNWS score (p = 0.088) among the four groups. There was a statistically significant difference in QUS-Brief score changes among the four groups (p = 0.005). There was no statistically significant interaction between acupuncture and nicotine patch. Acupuncture combined with nicotine replacement patch therapy was more effective for smoking cessation than acupuncture alone or nicotine replacement patch alone. No adverse reactions were found in the acupuncture treatment process. http://www.chictr.org.cn/showproj.aspx?proj=61969, identifier ChiCTR2100042912.

An observational human laboratory assessment of nicotine delivery, vaping topography and subjective effects of usual brand electronic cigarette use among young adults.

To measure nicotine delivery, vaping topography and subjective effects of current generations of disposable, cartridge-based and other types of electronic cigarettes (e-cigarettes) among young adults. Observational, human laboratory assessment of e-cigarette use in Columbus, Ohio, USA (July 2020 to June 2021). Participants (n = 96, 60.4% female, age mean = 21.7 [standard deviation = 1.7] years, 82.4% white race) were identified via their participation in a cohort study or other convenience sampling and were 18 to 25 years old, vaped ≥4days/week for ≥4weeks and used other tobacco products for ≤5days of past 30 days. Participants completed a pre-vaping questionnaire, vaped their usual brand of e-cigarette ad libitum for 30 min and completed a post-vaping questionnaire. Outcome variables included pre- and post-vaping measures of plasma nicotine (t = 0 and t = 30, respectively) and craving and withdrawal symptoms, as well as vaping topography (e.g. flow rate and inter-puff interval), pre-vaping expectancies and post-vaping product appeal. Variables used to characterize the sample included demographics, e-cigarette and other tobacco use history, e-cigarette dependence and e-cigarette device characteristics (e.g. device type, flavor and nicotine form). Participants reported moderate nicotine dependence on average via the E-Cigarette Dependence Scale (mean = 6.9 [standard deviation = 4.0]). Following 30 min of ad libitum vaping, participants achieved substantial plasma nicotine boost (mean = 18.8 [standard deviation = 14.5] ng/mL), corresponding with statistically significant decreases in withdrawal symptoms measured via the Minnesota Nicotine Withdrawal Scale (pre-vaping mean = 9.0 [standard deviation = 5.1], post-vaping mean = 4.3 [standard deviation = 3.9]; P-value <0.0001). Pre-vaping, participants reported moderate vaping expectancies (e.g. mean = 2.5 [standard deviation = 1.0] on a scale from 0 to 4 for smell and taste expectancies); post-vaping, participants reported high satisfaction (mean = 4.6 [standard deviation = 1.2] on a scale from 1 to 7) and moderate reward (mean = 2.9 [standard deviation = 1.2]) and respiratory sensations (mean = 3.7 [standard deviation = 1.6]). Nearly half of participants (47.9%) used disposable e-cigarettes, and most used a mint/menthol or fruit flavored (99.0%) and nicotine salt (98.9%) e-liquid. Among young adults in the United States, the latest generations of e-cigarettes appear to deliver large quantities of nicotine (similar to cigarettes) and significantly relieve withdrawal symptoms, and they are appealing.

The Mismatch between Adult Smokers’ Abstinence Expectancies and Experiences at Outpatient Facilities: An Exploratory Study

Background:: Smokers’ expectancies about abstinence, that is the effects that smokers anticipate when they attempt to quit smoking, remain understudied. The aim of the present study was to examine the relation between smoking abstinence expectations and subjective experience over time among individuals in smoking cessation treatment. Methods:: A total of 215 adult smokers seeking treatment at two Italian third-level outpatient facilities were assessed at baseline and three-time points after the quit day (QD): 7 days, and 1 and 3 months. The following self-report instruments were administered: the Smoking Abstinence Expectancies Questionnaire (SAEQ), as a baseline measure of expectancies before quitting; the SAEQ-past, for assessing the actual occurrence of symptoms that were expected; the Minnesota Nicotine Withdrawal Scale, as a measure of withdrawal symptoms post-quitting. Results:: One and 3 months after the QD, participants reported fewer negative abstinence symptoms than expected, except for somatic symptoms, and fewer positive consequences than expected. A mismatch between smoking abstinence expectations and actual postquitting experiences was found, thus expectancies were violated. Conclusion:: The present findings confirm the need to assess both abstinence expectancies and actual post-quitting experiences. Future studies should examine tailored interventions aimed at educating smokers about expectancies and post-quitting experiences.

Acupuncture for treatment of tobacco withdrawal syndrome: systematic review and Meta-analysis

To systematically review the efficacy of acupuncture for the treatment of tobacco withdrawal syndrome. The randomized controlled trials (RCTs) regarding acupuncture for treatment of tobacco withdrawal syndrome were searched in CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane, Medline and EMbase databases. The search period was from January 1st of 2011 to December 31st of 2021. After data extraction and bias risk assessment of the included literature, the Meta-analysis was performed using RevMan5.4.1 software. Totally 23 RCTs were included, including 2 120 patients. The Meta-analysis results showed that compared with medication, acupuncture showed no significant difference at improving Fagerström test for nicotine dependence (FTND) score (MD=0.16, 95%CI: -0.08, 0.41), heaviness of smoking index (HSI) score (MD=0.11, 95%CI: -0.13, 0.36), Minnesota nicotine withdrawal scale (MNWS) score (MD=0.12, 95%CI: -0.11, 1.35), questionnaire of smoking urges (QSU) score (MD=-0.30, 95%CI: -2.78, 2.18), Hamilton depression scale (HAMD) score (MD=0.76, 95%CI: -1.54, 3.06), abstinence rate (RR=0.95, 95% CI: 0.82, 1.10) and effective rate (RR=1.01, 95%CI: 0.95, 1.07). Acupuncture was superior to sham acupuncture in reducing MNWS score (MD=-4.88, 95%CI: -5.21, -4.55, P<0.000 01). Acupuncture was superior to cognitive behavioral therapy in reducing FTND score (MD=-1.41, 95%CI: -1.74, -1.08), MNWS score (MD=-4.28, 95%CI: -5.31, -3.25) and increasing abstinence rate (RR=2.19, 95%CI: 1.39, 3.45, P<0.000 01, P<0.001). Acupuncture could effectively improve tobacco withdrawal syndrome, increase abstinence rate and effective rate. Limited by the quantity and quality of the included studies, this conclusion needs to be verified by more studies.

Insula deep rTMS and varenicline for smoking cessation: A randomized control trial study protocol.

Background: Current approved therapies for smoking cessation have modest long-term effects for abstinence. The insular cortex has been identified by preclinical and clinical studies as a critical target for addiction treatment. Insula functions can be modulated non-invasively using brain stimulation. It is unknown if deep repetitive transcranial magnetic stimulation (rTMS) of the insula can improve smoking cessation of smokers trying to quit using varenicline. Methods: This will be a randomized, double-blind, sham-controlled clinical trial with 50 nicotine dependent smokers looking to quit. They will be randomly assigned to receive either active (10 Hz) or sham insula deep rTMS. Deep rTMS will be administered for 4 weeks (5 days/week). All participants will receive open label varenicline for 12 weeks. The primary outcome measure will be the 7-day point prevalence abstinence at the end of 12 weeks. The secondary outcomes will be Fagerström Test of Nicotine Dependence, Minnesota Nicotine Withdrawal Scale, Tiffany Questionnaire of Smoking Urges, expired carbon monoxide measurements, cigarettes smoked per day, point prevalence abstinence at end of 4 weeks, prolonged and continuous abstinence at 6 months. The measures will be collected throughout the 3-month treatment period as well as at the 6-month follow up. Discussion: This trial will test for the first time the impact of deep insula rTMS on smoking cessation in smokers treated with varenicline. This trial will use an H-coil specific to the insula, while previous studies have targeted both the insula and prefrontal cortex. This trial will inform on the utility to combine insula deep rTMS with varenicline to improve smoking abstinence rates. Clinical Trial Registration: Trial registered at https://clinicaltrials.gov/ct2/show/NCT04083144 (Identifier: NCT04083144).

Development of pulsed intravenous nicotine infusions as a model for inhaled nicotine in humans.

Although nicotine from cigarettes is delivered in puff-sized amounts, most preclinical and human intravenous (IV) nicotine studies have used bolus or continuous infusions. To determine the feasibility of a pulsed-nicotine infusion model in smokers. Following overnight abstinence, 12 adult smokers underwent 5 laboratory sessions. Using a crossover design, in each session, participants were assigned to 1 of 5 conditions: (1) high/fast: 1.0mg nicotine delivered over 5 pulsed-infusions, then 15 saline infusions; (2) high/slow: 1.0mg nicotine delivered over 20 pulsed-infusions; (3) low/fast: 0.2mg nicotine delivered over 5 pulsed-infusions, then 15 saline infusions; (4) low/slow: 0.2mg nicotine delivered over 20 pulsed-infusions; and (5) placebo: Saline delivered over 20 pulsed-infusions. Subjective drug effects, urges to smoke, nicotine withdrawal, and cognitive performance were measured in each session. Both the high/fast and high/slow conditions were associated with greater "head rush" and "high" (p < 0.05). The high/fast condition also provided greater suppression of urges to smoke and nicotine withdrawal (p < 0.05), indexed by the Questionnaire of Urges to Smoke-Brief, and the Minnesota Nicotine Withdrawal Scale, respectively. The high/fast and high/slow conditions produced greater increases in heart rate (p < 0.01) than saline. Finally, there were no main effects of dosing conditions on cognitive performance, indexed by the continuous performance test. These findings demonstrate the feasibility of pulsed-nicotine infusions to model nicotine delivery by smoking. This model could inform future studies testing novel smoking cessation therapies and tobacco regulatory studies testing the impact of nicotine reduction approaches.

Dose-dependent effects of Varenicline on tobacco craving and withdrawal in tobacco smokers with and without schizophrenia

BackgroundPeople with schizophrenia (SCZ) have significantly higher tobacco smoking rates and lower quit rates than the general population. Varenicline, a partial agonist at α4β2 nicotinic acetylcholine receptors (nAChRs) is an effective smoking cessation pharmacotherapy, however, investigation into its effects in SCZ are less well-studied and mechanisms may differ from non-psychiatric controls due to dysregulation in nAChR neurotransmission associated with SCZ. Here, we investigate whether Varenicline attenuates acute abstinence-induced increases in craving and withdrawal in participants with and without SCZ. MethodsFollowing biochemically-verified overnight abstinence and subsequent smoking reinstatement, individuals with nicotine-dependence (n = 13 SCZ or schizoaffective; n = 12 controls) were assessed on the Minnesota Nicotine Withdrawal Scale (MNWS) and Tiffany Questionnaire for Smoking Urges (TQSU). Participants were pretreated in a double-blind, counterbalanced manner with Varenicline (0, 1 or 2 mg/day x 3 days) over three separate weeks. Data were analyzed using linear mixed-effects modelling and estimated marginal means. ResultsRobust effects of smoking abstinence were observed on TQSU and MNWS scores in SCZ and control participants. Relative to 1 mg, 2 mg/day of Varenicline attenuated abstinence-induced increases in craving (TQSU Factor 1 d=−0.47, p = .006; TQSU Factor 2 d=−0.42, p = .008) and withdrawal (MNWS d=−0.35, p = .03) in both groups. ConclusionOur preliminary findings suggest that subacute Varenicline treatment reduces abstinence-induced craving and withdrawal in participants with and without SCZ. The efficacy of Varenicline on tobacco withdrawal and craving requires further study.

Impacts of nicotine metabolite rate and acupuncture frequency on smoking cessation: a randomized controlled trial

To compare the efficacy of different acupuncture frequencies in tobacco-dependent patients and explore the impact of nicotine metabolite rate (NMR) on smoking cessation in the intervention with acupuncture. A total of 120 cases of tobacco-dependent patients were randomly divided into a high-frequency group (60 cases, 12 cases dropped off) and a low-frequency group (60 cases, 6 cases dropped off). In the two groups, smoking cessation counseling was provided prior to acupuncture. Acupuncture was applied to Baihui (GV 20), Lieque (LU 7), Zusanli (ST 36), etc. Additionally, electric stimulation was added at Lieque (LU 7) and Zusanli (ST 36), with continuous wave, 15 Hz in frequency. The duration of treatment was 8 weeks in either group. In the high-frequency group, the treatment was given 5 times weekly from week 1 to week 4, and was 3 times weekly from week 5 to week 8. In the low-frequency group, the treatment was given 3 times weekly from week 1 to week 4, and was twice a week from week 5 to week 8. The immediate withdrawal rate, persistent withdrawal rate, the score of Fagerstrőm test for nicotine dependence (FTND) before and after treatment, as well as the score of Minnesota nicotine withdrawal scale (MNWS) in 1 and 8 weeks of treatment were compared among the patients with high and low NMR between the two groups separately. The Logistic regression analysis was used to screen the influencing factors of smoking cessation in the intervention with acupuncture. After treatment, there was no statistical significance of the differences in the immediate withdrawal rate (35.4% [17/48] vs 29.6% [16/54]) and the persistent withdrawal rate (33.3% [16/48] vs 25.9% [14/54]) between the high-frequency group and the low-frequency group (P>0.05). The difference in withdrawal rate had no statistical significance between high and low NMR patients (P>0.05). FTND scores after treatment were lower than those before treatment (P<0.01) and MNWS scores were lower than those in 1 week of treatment (P<0.01) in the two groups. However, the differences had no statistical significance between the two groups and between the patients with high NMR and low NMR (P>0.05). Age, education level and NMR were the influencing factors of smoking cessation in the intervention with acupuncture (P<0.05). Acupuncture with different frequencies has no obvious impact on the efficacy in tobacco-dependent patients. The lower nicotine metabolite rate in individuals, the better efficacy of acupuncture. The smokers with high nicotine metabolite rate may obtain a better effect of cessation in the high-frequency intervention with acupuncture.

Clinical Observation of Auricular Acupressure Combined with Transcranial Direct Current Stimulation for Nicotine Dependence

<sec><title>Objective</title> To observe the clinical effect of auricular acupressure combined with transcranial direct current stimulation (tDCS) for nicotine dependence. </sec><sec><title>Methods</title> A total of 90 patients with nicotine dependence were divided into three groups (combination group, tDCS group and auricular acupressure group), using the method of random number table, with 30 cases in each group. In the auricular acupressure group, vaccaria segetalis were applied at the point representing the lung,stomach, shenmen, mouth, pizhixia and heart. The patients were asked to self-administrate auricular acupressure for two minutes per session, five times a day. When the desire to smoke was strong, patients were adviced to press and pinch it for 3 minutes. In addition, the auricular acupressure pads were changed every 2 days, three times per week, for four weeks. In the tDCS group, tDCS was applied at the dorsolateral prefrontal cortex, 1.4 mA in intensity, 20 min each time, three times per week, for four weeks. In the combination group, we applied the auricular acupressure combined with tDCS and the methods were the same as the tDCS group and the auricular acupressure group. Before treatment and 2, 4 weeks after treatment, the smoking frequency a day, Fagerström test of nicotine dependence (FTND) score, the questionnaire of smoking urges (QSU) score, Minnesota nicotine withdrawal scale (MNWS) score and the concentration of cotinine in urine were observed in all three groups. </sec><sec><title>Results</title> There was no significant difference in daily smoking frequency, FTND score, QSU score, MNWS score and cotinine concentration in urine before treatment (<italic>P</italic><0.05). Compared with before treatment, the daily smoking frequency of each group decreased after 4 weeks of treatment (<italic>P</italic><0.05); the daily smoking frequency of the combination group was (8.50±3.60), which was better than that of the tDCS group (11.16±4.29) and the auricular acupressure group (12.83±3.39) (<italic>P</italic><0.05); at 4 weeks of follow-up period, the daily smoking frequency in the combination group was (10.38±4.56), which was better than that in the tDCS group (13.76±5.87) and the auricular acupressure group (15.65±6.25) (<italic>P</italic><0.05). Compared with before treatment, FTND score, MNWS score and QSU score in each group decreased after 4 weeks of treatment (<italic>P</italic><0.05); the FTND score of the combination group was (1.46±1.41), which was better than that of the tDCS group (2.70±2.03) and the auricular acupressure group (2.83±1.23) (<italic>P</italic><0.05); the MNWS score of the combination group was (4.73±3.16), which was better than that of the tDCS group (6.33±3.38) and the auricular acupressure group (6.96±2.09) (<italic>P</italic><0.05); the QSU score of the combination group was (12.70±3.15), which was better than the tDCS group (15.86±5.34) and the auricular acupressure group (16.60±6.71) (<italic>P</italic><0.05). Compared with before treatment, the concentration of cotinine in urine of each group decreased after 4 weeks of treatment (<italic>P</italic><0.05); the concentration of cotinine in urine in the combination group was (11.42±6.33), which was better than that in the tDCS group (18.23±8.54) and the auricular acupressure group (20.74±9.04) (<italic>P</italic><0.05). </sec><sec><title>Conclusion</title> Auricular acupressure combined with tDCS could reduce daily smoking frequency, decrease tobacco dependence and smoking craving, and alleviate withdrawal symptoms. Its efficacy is better than auricular acupressure alone or tDCS treatment alone, and this treatment is of great value to promotion. </sec>

Withdrawal Symptoms among Cigarette and Waterpipe Smokers: A Study in Natural Setting.

Background:The rates of tobacco use, including cigarette and waterpipe smoking, are surging in the Eastern Mediterranean region. The use of these products causes nicotine dependence that makes even short-term tobacco abstinence difficult due to aversive symptoms. During the daytime fasting of the month of “Ramadan”, people accept significant disruption in regular activities, including tobacco smoking. Thus, daytime during Ramadan (before sunset) is likely associated with abstinence symptoms emerging among tobacco smokers. We assessed this hypothesis by measuring tobacco/nicotine abstinence symptoms and craving among smokers of cigarettes or waterpipes during Ramadan.Methods:A cross-sectional survey-based study was conducted on a convenience sample of adults. Participants were assessed for general information about tobacco smoking, dependence, and nicotine desire or craving, and withdrawal symptoms using the Minnesota Nicotine Withdrawal Scale (MNWS) and the Tiffany-Drobes Questionnaire on Smoking Urges.Results:The study sample included 632 exclusive cigarette smokers and 161 exclusive waterpipe tobacco smokers. After fasting and abstaining from tobacco during the day, approximately 75% of cigarette smokers and 20% of waterpipe smokers reported smoking within the first 30 minutes. In addition, 10% of cigarette smokers and 30% of waterpipe smokers reported smoking within the first 60 minutes. Regarding smoking urge, no significant difference was found between cigarette and waterpipe smokers. For nicotine craving and withdrawal, significant differences between cigarette and waterpipe smokers were found when comparing mean scores for each of the following items: (i) urge to smoke, (ii) craving nicotine, (iii) hunger, (iv) desire for sweets, and (v) depression/feeling blue (P-values < 0.05).Conclusion:This study provided evidence from the month of Ramadan that waterpipe smoking is associated with abstinence-induced smoking urge and withdrawal symptoms that are comparable to cigarette smoking. More interdisciplinary research must be focused on developing interventions to reduce tobacco smoking, including waterpipe.

N-acetylcysteine as an adjunctive treatment for smoking cessation: a randomized clinical trial.

Objective:This randomized controlled trial examined the efficacy and safety of N-acetylcysteine as an adjunctive treatment for smoking cessation.Methods:Heavy smokers were recruited from smoking cessation treatment for this 12- week randomized controlled trial. Eligible tobacco use disorder outpatients (n=34) were randomized to N-acetylcysteine or placebo plus first-line treatment. Abstinence was verified by exhaled carbon monoxide (COexh). The assessment scales included the Fagerström Test for Nicotine Dependence, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Minnesota Nicotine Withdrawal Scale, and the Medication Adherence Rating Scale. We also assessed anthropometrics, blood pressure, lipid profile, and soluble tumor necrosis factor receptor (sTNF-R) levels 1 and 2.Results:First-line treatment for smoking cessation plus adjunctive N-acetylcysteine or placebo significantly reduced COexh (p < 0.01). In the N-acetylcysteine group, no significant changes were found in nicotine withdrawal symptoms, depressive and anxiety symptoms, anthropometric measures, blood pressure, or glucose compared to placebo. However, there was a significant reduction in sTNF-R2 levels between baseline and week 12 in the N-acetylcysteine group.Conclusions:These findings highlight the need to associate N-acetylcysteine with first-line treatment for smoking cessation, since combined treatment may affect inflammation and metabolism components.Clinical trial registration:NCT02420418

Electrophysiological Evidence of Event-Related Potential Changes Induced by 12 h Abstinence in Young Smokers Based on the Flanker Study.

The cognitive control processes may be disrupted by abstinence in smokers, which may be helpful in the development and maintenance of addictive behavior. The purpose of this study was to measure the performance of cognitive task after 12 h of smoking abstinence by using event-related potentials (ERPs), including the error-related negativity (ERN) and the error positivity (Pe). In Eriksen flanker task, electroencephalography (EEG) signals of 24 smokers were recorded in two conditions: satiety and 12 h abstinence. In the behavioral data, both conditions exhibited more errors and more time on the incongruent trials than congruence. Meantime, the Minnesota Nicotine Withdrawal Scale (MNWS) score was increased during abstinence. Smokers showed reduced ERN and Pe after 12 h of abstinence, compared with satiety condition. The results indicate that the diminished error processing in young smokers after 12 h of abstinence. It may be related to increased withdrawal symptoms. In conclusion, the disrupted neurophysiological indexes in the general behavior monitoring system may be caused by abstinence. The results of this study may provide us with new ideas about the effects of short-term abstinence on brain cognitive neuroscience and be helpful for the solution of relapse.

Validity and reliability of the Korean version of the Wisconsin Smoking Withdrawal Scale.

Background/AimsThis study evaluated the validity and reliability of the Korean version of the Wisconsin Smoking Withdrawal Scale (WSWS-K) for use in clinical practice and research on Korean smokers.MethodsThe Wisconsin Smoking Withdrawal Scale was translated into Korean and then back-translated into English. The authors reviewed the translation and back-translation and approved the final questionnaire draft. The validity and reliability of the WSWS-K were evaluated based on data collected from 300 participants. Construct validity was evaluated with a confirmatory factor analysis. Criterion-related validity was assessed by examining the relationships between the subscales of the WSWS-K and the matched items of the Korean version of the Minnesota Nicotine Withdrawal Scale (MNWS-K).ResultsThe participants were predominantly male (93.6%) and the mean age was 59.23 ± 15.19 years. The confirmatory factor analysis revealed that fit indices (namely, the goodness-of-fit index, adjusted goodness-of-fit index, comparative fit index, and the normed fit index) exceeded or approached 0.9. Cronbach’s alpha for the entire scale was 0.87. The total score of the WSWS-K had a statistically significant positive correlation with that of the MNWS-K (Pearson’s correlation coefficient, 0.768; p < 0.01). Additionally, we performed linear regression between the WSWS-K and MNWS-K scores after adjusting for age, gender, comorbidity, and smoking history. After this adjustment, the p value of the WSWS- K was < 0.001.ConclusionsThe WSWS-K had satisfactory validity and reliability. The WSWS- K can be used with acceptable validity and reliability in research and clinical evaluation of Korean smokers.

Measurement properties of the translations of instruments evaluating the subjective effects of tobacco- and nicotine-containing products: a systematic review of the literature

Background: Several instruments are widely used for assessing dependence, craving, withdrawal symptoms, and reinforcing effects in users of tobacco- and nicotine-containing products (TNP), including the Fagerström Test for Nicotine Dependence (FTND), Questionnaire of Smoking Urges, original (QSU) and brief (QSU-b) versions; Minnesota Nicotine Withdrawal Scale, original (MNWS) and revised (MNWS-R) versions; and Cigarette Evaluation Questionnaire, original (CEQ) and modified (mCEQ) versions. Although these instruments have been translated extensively, their translations and corresponding measurement properties have not been systematically assessed. This study aimed to (1) identify the translations of these instruments for which psychometric properties have been published, (2) describe the methods used for translation, and (3) describe the measurement properties and the context in which these translations were evaluated (e.g., target population and TNP used). Methods: Embase and MEDLINE databases were systematically searched. Results: While no information could be found for the CEQ/mCEQ, several translations were available for the remaining instruments: FTND, 25; QSU and QSU-b, 4 each; QSU (12-item version), 1; MNWS, 4; and MNWS-R, 1. Cigarette smokers represented the main target population in which the validation studies were conducted. Information about the translation process was reported for 25 translations. In most cases, the properties of the translations mirrored those of the originals. Differential item functioning was explored in only one case. Conclusions: There are few publications describing the measurement properties of the translations of the FTND, QSU/QSU-b, and MNWS/MNWS-R. None of these translations have been validated for TNPs other than cigarettes, which suggests the need for greater development and validation of instruments in this area.

Distress intolerance and withdrawal severity among daily smokers: The role of smoking abstinence expectancies

BackgroundDistress intolerance (DI), the perceived inability to withstand distress, is implicated in cigarette smoking maintenance. Greater DI may contribute to anticipation of negative outcomes from smoking abstinence, which in turn could contribute to withdrawal symptom severity. The current study aimed to evaluate (1) the association between DI and acute abstinence expectancies and (2) the potential mediating role of abstinence expectancies in the relationship between DI and withdrawal symptom severity. MethodParticipants (n = 444) were daily smokers who reported at least one prior quit attempt, participating in a larger online study on distress and smoking. DI, subjective nicotine withdrawal, and smoking abstinence expectancies were assessed using the Distress Tolerance Scale (DTS), Minnesota Nicotine Withdrawal Scale (MNWS), and Smoking Abstinence Expectancies Questionnaire (SAEQ). ResultsDTS was significantly negatively associated with SAEQ, specifically Negative Mood (r = −0.37, p < .001), Somatic Symptoms (r = −0.47, p < .001), and Harmful Consequences (r = −0.59, p < .001) subscales, but was not associated with Positive Expectancies subscale (r = 0.05, p = .31). Results indicated a significant effect of DTS on withdrawal symptom severity via SAEQ. Follow-up analyses indicated that the indirect effects were driven specifically by SAEQ Negative Mood and Harmful Consequences subscales. DiscussionDI is related to more negative abstinence expectancies, particularly affective aspects of abstinence, which may contribute to the severity of nicotine withdrawal symptoms. This study provides initial evidence of a specific cognitive process that may explain why DI contributes to heightened subjective experience of nicotine withdrawal symptoms.

Effects of acupuncture on craving after tobacco cessation: a resting-state fMRI study based on the fractional amplitude of low-frequency fluctuation.

To explore the immediate effects and mechanism of acupuncture on craving after tobacco cessation based on the fractional amplitude of low-frequency fluctuation (fALFF). This was a functional magnetic resonance imaging (fMRI) study. Forty participants were recruited and divided into a smoking group and a non-smoking group, 20 cases in each one. The smoking participants were requested to quit smoking 24 hours before the fMRI scan. The scan process was scan - acupuncture - scan. Between the two scans, acupuncture was applied at Lieque (LU 7), Hegu (LI 4), Baihui (GV 20), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) in two groups. After acupuncture, self-made craving for smoking, Minnesota Nicotine Withdrawal Scale (MNWS) and Questionnaire of Smoking Urges (QSU) were all reduced (P<0.05). The fMRI results indicated the immediate effects of acupuncture on smoking craving were significant, and identified salience network (SN) consisted of anterior cingulate cortex and insula, prefrontal cortex, visual cortex and cerebellum as key brains area. Correlation analysis indicated that NWNS scores were positively correlated with the mean fALFF in the ACC (P<0.05) and negatively correlated with the mean fALFF in the insula (P<0.05) in the smoking group. This was the first study in China to explore the neural mechanisms of acupuncture for smoking craving. The results indicated that the effects of acupuncture on smoking craving were significant, and the SN played a critical role in the process.

Withdrawal Symptom, Treatment Mechanism, and/or Side Effect? Developing an Explicit Measurement Model for Smoking Cessation Research.

Assessment of withdrawal symptoms, treatment mechanisms, and side effects is central to understanding and improving smoking cessation interventions. Though each domain is typically assessed separately with widely used questionnaires to separately assess each domain (eg, Minnesota Nicotine Withdrawal Scale = withdrawal; Questionnaire of Smoking Urges-Brief = craving; Positive and Negative Affect Schedule = affect; symptom checklist = side effects), there are substantial problems with this implicit "one questionnaire equals one construct" measurement model, including item overlap across questionnaires. This study sought to clarify the number and nature of constructs assessed during smoking cessation by developing an explicit measurement model. Two subsamples were randomly created from 1246 smokers in a clinical trial. Exploratory and confirmatory factor analyses were conducted to identify and select a model that best represented the data. Measurement invariance was assessed to determine if the factors and their content were consistent prior to and during the quit. Improvement in construct overlap within this model was compared against the implicit measurement model using correlational analyses. A 5-factor measurement model composed of negative affect, somatic symptoms, sleep problems, positive affect, and craving fits the data well prior to and during quitting. All factor content except somatic symptoms was consistent over time. Correlational analyses indicated that the 5-factor model attenuated construct overlap compared to the implicit model. The models generated from data-driven approaches (eg, the 5-factor model) reduced overlap and better represented the constructs underlying these measures. This approach created distinct, stable constructs that span over measures of side effects and potential treatment mechanisms. This study demonstrated that measures assessing treatment mechanisms, withdrawal symptoms, and side effects contain problematic overlap that reduces the clarity of these key constructs. The use of data-driven approaches showed that these measures do not map on to their posited latent constructs (eg, the Minnesota Nicotine Withdrawal Scale does not yield a withdrawal factor). Rather, these measures form distinct, basic processes that may represent more meaningful constructs for future research on cessation and treatment. Assessments designed to individually examine these processes may improve the study of treatment mechanisms.

The study of nicotine addiction abstinence in patients with insular infarction

Objective To investigate the effect of insular on the addiction of nicotine after insular infarction. Methods Totally 35 patients with lesions involving insular infarction were enrolled in insular damage group. The patients matched with the demographic data of the study subjects who did not involve insular infarction were the control group(n=114). All patients were given the internationally popular questionnaire of smoking urges (QSU) and fagerstrom test for nicotine dependence(FTND)during hospitalization, and they were followed up 3 months after stroke.The QSU and the minnesota nicotine withdrawal scale(MNWS) were assessment for patients who did not smoke again and did not relapse, and the QSU and FTND scale were used for the patients who still smoke. Results After 3 months follow-up, the rate of withdrawal from insular damage was 77.14%, and that in non-insular damage was 52.63%(χ2=6.62, P=0.01), and the MNWS in two groups(insular damage patients (0.59±0.97) and non-insular damage patients(1.15±1.29)), the difference was statistically significant (t=-2.00, P=0.04). All subjects were evaluated by questionnaire of smoking urges (QSU), among which QSU score was (19.40±9.63) in insular damage group and (24.47±10.39) in non-insular group, the difference was statistically significant (t=-2.57, P=0.01) . Conclusion Patients with insular lesion are more likely to cause withdrawal of nicotine addiction, suggesting that insular may be involved in cognitive processing of addiction. Key words: Insular infarction; Nicotine; Addiction; Abstinence

Effectiveness of auricular acupuncture combined with nicotine replacement therapy for smoking cessation.

INTRODUCTIONThe aim of this study was to establish if the auricular acupuncture treatment can play a complementary role in enhancing the smoking cessation rate of the smokers receiving conventional therapy, such as NRT and behavioral counseling.METHODSThis was a retrospective cohort study. Republic of Korea Air Force soldiers who visited the clinic with the intention to quit smoking from September 2016 to March 2017 were reviewed. The smoking cessation program consisted of a 6-weeks treatment period with follow-up at 3 and 6 months from the baseline. Smokers who chose to receive nicotine replacement therapy (NRT) were compared with those who chose to receive auricular acupuncture combined with NRT. Both groups received behavioral counseling.RESULTSA total of 148 subjects were reviewed in the study. Of the 86 smokers who received combination therapy, 41 achieved continuous abstinence (47.7%), while 19 out of the 62 smokers stayed abstinent from the NRT group (30.6%). There was a significant difference between the two groups (p=0.037). Minnesota Nicotine Withdrawal Scale scores significantly decreased after the treatment in both groups, but there was no significant difference between the two groups (p=0.681). No serious adverse events were reported from both groups.CONCLUSIONSThe results of this study indicate that conventional treatments, such as NRT and behavioral counseling, when combined with auricular acupuncture could be a safer and more effective smoking cessation treatment than conventional treatments alone.

A retrospective analysis of the association between providing nicotine replacement therapy at admission and motivation to quit and nicotine withdrawal symptoms during an inpatient psychiatric hospitalization

BackgroundPsychiatric patients have high tobacco use prevalence, dependence, and withdrawal severity. A tobacco-free psychiatric hospitalization necessitates the management of nicotine withdrawal (NW) for tobacco using patients. NW management often requires the provision of approved nicotine replacement therapy (NRT) to patients, which may also motivate tobacco users towards cessation. However, few studies have examined the associations between providing NRT, motivation to quit, and NW among psychiatric patients. Objective(s)To examine the associations between providing NRT at admission and motivation to quit smoking and severity of NW symptoms. DesignA retrospective review of the medical records of 255 tobacco using patients on whom NW was assessed during their hospital stay. The time when NRT was provided (i.e., at admission vs. not provided vs. on the unit), motivation to quit smoking, and 8-item Minnesota Nicotine Withdrawal Scale were assessed. ResultsThe primary NW symptom was ‘craving’ (65.1%); reporting of ‘anxiety’ varied by psychiatric diagnosis. Providing NRT at admission was not associated with motivation to quit. Patients receiving NRT on the unit (i.e., delayed receipt) had significantly higher NW than those who received NRT at admission. In multivariate analyses, receiving NRT on the unit was significantly associated with greater NW severity (β = .19, p = .002). ConclusionsAmong psychiatric patients, providing NRT at admission is associated with greater severity of NW. The provision of NRT for NW management may be considered as standard practice during tobacco-free psychiatric stays. Future studies may consider the effect of other tobacco treatment medications (such as varenicline, bupropion) on managing NW.