Measures Of Nicotine Dependence Research Articles

Hardcore smoking among continuing smokers in Canada 2004-2012.

Decline in adult smoking prevalence in Canada seems to have slowed, suggesting that smoking rate may have plateaued. It is unclear whether this, at least in part, can be interpreted as evidence that some groups or individuals are becoming less resistant to tobacco control measures. This study examined trends in the prevalence of hardcore smoking in Canada. A nationally representative sample of adult daily smokers was drawn from the Canadian Tobacco Use Monitoring Survey 2004 to 2012 (n = 13,861). Hardcore smokers were defined in two ways: Hardcore 1 comprised those that reported no quit attempt, no quit intention, and smoke their first cigarette within 30 min after awakening and hardcore 2 comprised hardcore 1 plus those smoking 15 or more cigarettes per day. Logistic regression was used to examine associations between hardcore measures and year and socio-demographic variables. Overall, there was no significant difference in hardcore smoking over time for the periods covered in this study. Analysis examining a single hardcore component, time-to-first cigarette (TTFC) after awakening as a measure of nicotine dependence showed similar results. A clear marked socioeconomic gradient in TTFC was found, those with university education (OR 0.46, 95 % CI 0.37-0.57), college (OR 0.51, 95 % CI 0.42-0.63), secondary (OR 0.68, 95 % CI 0.57-0.82) were significantly less likely to have TTFC ≤ 30 min compared with less than secondary education. This study does not support the hardening hypothesis when interpreted as the increase in hardcore smokers over time.

Multiple tobacco use and increased nicotine dependence among people with disabilities

BackgroundPeople with disabilities (PWD) are at greatest risk for tobacco use compared to people without disabilities. However, little is known about the use of multiple types of tobacco by PWD. Objective/HypothesisThe purpose of this study was to examine nicotine dependence among a sample of PWD who use multiple types tobacco products. We hypothesized that individuals who used multiple forms of tobacco would have higher levels of nicotine dependence. MethodsA tobacco survey was administered to clients who use tobacco and receive services from an organization that provides independent living services to PWD. The self-report brief survey included measures of nicotine dependence and items indicating the types of tobacco products participants used. A total of 113 male and female participants with disabilities (mean age = 51.7, SD = 10.1) participated in the study. ResultsMultiple tobacco use was reported by 16.8% of the participants and was significantly associated with nicotine dependence. Compared to single tobacco product users, multiple tobacco users were more likely to use tobacco within the first 30 min of waking, believe tobacco the first thing in the morning would be the most difficult to give up, and find it hard to not use tobacco in prohibited locations. ConclusionsThe use of multiple types of tobacco products among PWD disability is relatively common and is associated with greater nicotine dependence. Tobacco cessation interventions targeting PWD should consider the addressing unique challenges of preventing different types of tobacco products.

Brain regions affected by impaired control modulate responses to alcohol and smoking cues.

Despite the commonly observed comorbidity of alcohol and tobacco use disorders and years of research, the mechanism underlying concurrent use of alcohol and tobacco is not yet clear. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between brain responses to alcohol and smoking cues in 45 subjects with episodic drinking and regular smoking. fMRI data were collected from two studies performing an alcohol-craving task and a smoking-craving task. First, we identified brain voxels significantly activated for both substance cues and then associated the activation of these voxels with various alcohol- and nicotine-dependence measures. Significant clusters (cluster-wise p < .05) correlated with behavioral assessments were extracted, and clusters identified from both cues were compared. The association tests with various dependence scores showed that the loss of behavioral control subcategory in the Alcohol Dependence Scale was significantly correlated with brain activation of the posterior cingulate cortex (PCC) and right posterior insula regardless of cue types. Our findings suggest that the PCC and right posterior insula, each playing a role in the salience network, are affected significantly by impaired control for alcohol and in turn influence brain responses to not only alcohol but also smoking cues, providing insight to neuronal mechanisms for concurrent use or comorbidity of alcohol and nicotine dependence.

Relationship between frequency and intensity of cigarette smoking and TTFC/C among students of the GYTS in select countries, 2007-2009.

This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS). Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers' odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD). The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD. Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents' TTFC/C status.

The effects of chronic cigarette smoking on gray matter volume: influence of sex.

Cigarette smoke contains nicotine and toxic chemicals and may cause significant neurochemical and anatomical brain changes. Voxel-based morphometry studies have examined the effects of smoking on the brain by comparing gray matter volume (GMV) in nicotine dependent individuals (NDs) to nonsmoking individuals with inconsistent results. Although sex differences in neural and behavioral features of nicotine dependence are reported, sex differences in regional GMV remain unknown. The current study examined sex differences in GMV in a large sample of 80 NDs (41 males) and 80 healthy controls (41 males) using voxel-based morphometry. Within NDs, we explored whether GMV was correlated with measures of cigarette use and nicotine dependence. High-resolution T1 structural scans were obtained from all participants. Segmentation and registration were performed in SPM8 using the optimized DARTEL approach. Covariates included age and an estimate of total global GMV. Differences were considered significant at p≤0.001, with a whole brain FWE-corrected cluster probability of p<0.025. Among NDs compared to Controls less GMV was observed in the thalamus and bilateral cerebellum and greater GMV was observed in the bilateral putamen and right parahippocampus. Lower thalamic GMV was observed in both female and male NDs compared to Controls. Female NDs also had lower GMV in the left cerebellum and in the ventral medial and orbitofrontal cortices with no areas of greater GMV. Male NDs had lower GMV in bilateral cerebellum and greater GMV in bilateral parahippocampus and left putamen. Within male NDs, GMV in the left putamen was correlated with number of pack years. This study, conducted in a large cohort, contributes to our knowledge of brain morphology in nicotine addiction and provides additional evidence of sex-specific effects on GMV in NDs. Identifying brain vulnerabilities with respect to sex provides a methodological framework for personalized therapies to improve relapse rates for both sexes.

Open label smoking cessation with varenicline is associated with decreased glutamate levels and functional changes in anterior cingulate cortex: preliminary findings.

Rationale: Varenicline, the most effective single agent for smoking cessation, is a partial agonist at α4β2 nicotinic acetylcholine receptors. Increasing evidence implicates glutamate in the pathophysiology of addiction and one of the benefits of treatment for smoking cessation is the ability to regain cognitive control.Objective: To evaluate the effects of 12-week varenicline administration on glutamate levels in the dorsal anterior cingulate cortex (dACC) and functional changes within the cognitive control network.Methods: We used single-voxel proton magnetic resonance spectroscopy (1H-MRS) in the dACC and functional MRI (fMRI) during performance of a Stroop color-naming task before and after smoking cessation with varenicline in 11 healthy smokers (open label design). Using the dACC as a seed region, we evaluated functional connectivity changes using a psychophysiological interaction (PPI) analysis.Results: We observed a significant decrease in dACC glutamate + glutamine (Glx)/Cr levels as well as significant blood oxygen level-dependent signal (BOLD) decreases in the rostral ACC/medial orbitofrontal cortex and precuneus/posterior cingulate cortex. These BOLD changes are suggestive of alterations in default mode network (DMN) function and are further supported by the results of the PPI analysis that revealed changes in connectivity between the dACC and regions of the DMN. Baseline measures of nicotine dependence and craving positively correlated with baseline Glx/Cr levels.Conclusions: These results suggest possible mechanisms of action for varenicline such as reduction in Glx levels in dACC and shifts in BOLD connectivity between large scale brain networks. They also suggest a role for ACC Glx in the modulation of behavior. Due to the preliminary nature of this study (lack of control group and small sample size), future studies are needed to replicate these findings.

Nicotine dependence, “background” and cue-induced craving and smoking in the laboratory

BackgroundNicotine dependence has been associated with higher “background” craving and smoking, independent of situational cues. Due in part to conceptual and methodological differences across past studies, the relationship between dependence and cue-reactivity (CR; e.g., cue-induced craving and smoking) remains unclear. Methods207 daily smokers completed six pictorial CR sessions (smoking, negative affect, positive affect, alcohol, smoking prohibitions, and neutral). Individuals rated craving before (background craving) and after cues, and could smoke following cue exposure. Session videos were coded to assess smoking. Participants completed four nicotine dependence measures. Regression models assessed the relationship of dependence to cue-independent (i.e., pre-cue) and cue-specific (i.e., pre-post cue change for each cue, relative to neutral) craving and smoking (likelihood of smoking, latency to smoke, puff count). ResultsDependence was associated with background craving and smoking, but did not predict change in craving across the entire sample for any cue. Among alcohol drinkers, dependence was associated with greater increases in craving following the alcohol cue. Only one dependence measure (Wisconsin Inventory of Smoking Dependence Motives) was consistently associated with smoking reactivity (higher likelihood of smoking, shorter latency to smoke, greater puff count) in response to cues. ConclusionWhile related to cue-independent background craving and smoking, dependence is not strongly associated with laboratory cue-induced craving under conditions of minimal deprivation. Dependence measures that incorporate situational influences on smoking correlate with greater cue-provoked smoking. This may suggest independent roles for CR and traditional dependence as determinants of smoking, and highlights the importance of assessing behavioral CR outcomes.

Affective motives for smoking among early stage smokers.

As most smokers initiate smoking during adolescence, assessment of smoking motives that underlie trajectories of dependence is critical for both prevention and cessation efforts. In the current study, we expected participants with higher nicotine dependence would smoke (a) less for positive reinforcement (PR) and (b) more for negative reinforcement (NR) motives. We secondarily assessed the relative contribution of PR to NR motives across levels of dependence. Data were drawn from a study on cue-elicited craving among occasional versus daily adolescent smokers aged 16-20 years (N = 111). Smoking motives were assessed in relation to 3 commonly used measures of nicotine dependence: (a) Fagerström Test for Nicotine Dependence (FTND), (b) Autonomy over Smoking Scale (AUTOS), and (c) Nicotine Dependence Syndrome Scale (NDSS). Compared to occasional smokers, daily smokers had significantly higher scores on each dependence measure and endorsed more prominent NR smoking motives. Each measure of nicotine dependence was strongly associated with NR motives for smoking, although measures differed in their association with PR motives. As expected, the FTND, AUTOS, and NDSS each significantly predicted smoking motive difference score (PR - NR), such that higher dependence was associated with more prominent NR motives for smoking. Results are consistent with our understanding of dependence and provide further support for 3 common measures of nicotine dependence among early stage smokers.

Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers

BackgroundMarijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use. MethodsParticipants were 165 adolescents (13–17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS). ResultsThe adolescent sample (mean age=16.1 years, SD=0.95) averaged 3.0 CPD (SD=3.0) for 1.98 years (SD=1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25–44% of the variance for all four measures of adolescent nicotine dependence. ConclusionsMarijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.

The relationship between the nicotine metabolite ratio and three self-report measures of nicotine dependence across sex and race.

Variability in the rate of nicotine metabolism, measured by the nicotine metabolite ratio (NMR), is associated with smoking behavior. However, data linking the NMR with nicotine dependence measured by the Fagerström test for nicotine dependence (FTND) are mixed. Few past studies have examined alternative measures of nicotine dependence and how this relationship may vary by sex and race. Using data from smokers undergoing eligibility evaluation for a smoking cessation clinical trial (n = 833), this study examined variability in the relationship between NMR and nicotine dependence across sex and race and using three measures of nicotine dependence: FTND, time-to-first-cigarette (TTFC), and the heaviness of smoking index (HSI). Controlling for sex and race, nicotine metabolism was associated with nicotine dependence only when using the HSI (p < 0.05). Male normal metabolizers of nicotine were more likely to have high nicotine dependence based on the FTND and HSI (p < 0.05), but NMR was not related to measures of nicotine dependence in women. For African Americans, the NMR was associated with nicotine dependence only for the TTFC (p < 0.05), but NMR was not associated with nicotine dependence among Caucasians. Post hoc analyses indicated that the NMR was associated with cigarettes per day, overall, and among men and Caucasians (p < 0.05). While there was some variation in the relationship between nicotine metabolism and nicotine dependence across measures and sex and race, the results indicate that this relationship may be more attributable to the association between NMR and cigarettes per day.

Associations between smoking and psychiatric comorbidity in U.S. Iraq- and Afghanistan-era veterans.

The risk of smoking increases with specific psychiatric diagnoses (e.g., posttraumatic stress disorder); but the risk has also been shown to increase as a function of the number of psychiatric illnesses with which a person is diagnosed. The current study examined this association and other correlates of smoking-psychiatric comorbidity in a sample of U.S. Iraq- and Afghanistan-era veterans who have served since September 11, 2001. The sample consisted of 1,691 veterans (Mage = 37.5 years, 20.2% women, 53.2% minority). Veterans completed measures of smoking history, nicotine dependence, and smoking expectancies; they also underwent a structured diagnostic interview to establish any current and/or lifetime psychiatric diagnoses. Consistent with previous studies, the number of comorbid diagnoses was significantly associated with both heavy (>20 cigarettes/day) and light-to-moderate (≤20 cigarette/day) smoking. Moreover, among current smokers, significant correlations between self-reported dependence and number of diagnoses were observed. Examination of self-reported smoking expectancies revealed that a greater number of diagnoses were associated with greater expectancies of negative affect reduction, stimulation and state enhancement, taste and sensorimotor manipulation, social facilitation, craving and addiction, and boredom reduction. The present findings confirm the association between the number of comorbid diagnoses reported in previous studies, and extends those findings by identifying smoking expectancies differences among smokers with comorbid diagnoses.

A multiple motive/multi-dimensional approach to measure smokeless tobacco dependence

BackgroundUnlike various research studies conducted to address dependence among smokers, only a few studies have examined smokeless tobacco (ST) dependence. The Fagerström Tolerance Questionnaire (FTQ) and Fagerström Test for Nicotine Dependence (FTND) based scales are the most widely used measures of nicotine dependence for both ST users and smokers. These scales were initially developed to measure physical dependence and tolerance and not to assess other salient dimensions of dependence such as craving, compulsion, or withdrawal, as defined by DSM-IV and ICD-10. The aim of this study is to develop and validate a multidimensional scale that has better content coverage, factor structure, and psychometric properties to measure dependence among ST users. Methods100 adult male smokeless tobacco users were recruited through email distribution lists and community referral. Participants completed three different nicotine dependence questionnaires and provided information related to their tobacco use and demographic characteristics. They also provided a saliva sample for cotinine measurement. In order to develop the new ST scale, subscales and items were selected based on correlation and factor analysis of the modified WISDM-68. Reliability and validity of the new scale, Oklahoma Scale for Smokeless Tobacco Dependence (OSSTD) were also assessed. ResultsThe new ST scale identified seven latent constructs including 23 items to measure ST dependence. Internal consistency as measured by Cronbach's coefficient (α=0.925) indicated better reliability of OSSTD than FTND-ST. Concurrent validity of OSSTD as evaluated by comparing it with dependence diagnosis and FTND-ST was affirmative. There was a significant correlation between the OSSTD total score and the cotinine levels and tobacco use characteristics among study participants. ConclusionOSSTD possesses better psychometric properties and provides an effective and efficient tool to measure ST dependence as a multidimensional construct.

Abstract C15: Differences in the characteristics of those receiving smoking cessation advice

Abstract Clinical practice guidelines recommend that healthcare providers assess the tobacco use status of their patients and advise those that smoke to quit. Studies show that advice to stop smoking delivered by a doctor is associated with a 2-fold increase in smoking cessation. However, not all smokers who are seen by a doctor get advised to stop smoking. This study describes the characteristics of smokers who received advice to stop smoking when they were seen by a health care provider. Based upon previous studies, we hypothesized that older smokers with poorer self-reported health, and greater nicotine addiction would be more likely to report receiving advice to stop smoking when seen by a health provider. Data for this analysis are from the International Tobacco Control (ITC) US adult smoker cohort (N=6,669) survey conducted annually from 2002-2011. Participants who reported having visited a healthcare provider within the past year of survey were eligible for inclusion. Trends in the prevalence of participants reporting cessation advice and quit assistance were assessed. Repeated measures logistic regression using generalized estimating equations (GEE) was used to model receipt of counseling. Predictors of receipt of advice to stop smoking included demographic characteristics (age, gender, race/ethnicity, education, and household income), heaviness of smoking (a measure of nicotine dependence), previous quit attempts, and self-reported health status. Over 60% of respondents reported having been seen by a healthcare provider, with over 60% receiving advice to stop smoking. Those who received advice to stop smoking were more likely to be older, report ‘fair’ or ‘poor’ health, and to have reported a quit attempt since their previous interview. Among those who received advice to quit, less than one third received a referral or quit prescription, and less than one half received a stop smoking pamphlet from their healthcare provider. Results indicate that not all smokers get advice to stop smoking when seen by their doctor and those who do appear to be older and less healthy, and more receptive to a quitting message based upon past quit attempts. These data suggest that health care providers may be profiling their patients in terms of those who are in need of cessation counseling rather than uniformly providing this advice to all patients. Among those who received advice to stop smoking the majority received no other type of assistance suggesting that delivery of cessation services to smokers is inadequate. Citation Format: Monica E. Cornelius, K Michael Cummings. Differences in the characteristics of those receiving smoking cessation advice. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C15.

Abstract B54: A candidate gene study of smoking cessation

Abstract Background: Efforts to identify genes that influence smoking cessation have been largely unsuccessful to date. However, SNPs in the chromosome 15q25 region that encodes the nicotinic receptor subunits CHRNA5, CHRNA3, and CHRNB4 have been consistently and strongly associated with nicotine dependence as measured directly through dependence surveys or indirectly with smoking quantity (cigarettes per day, cpd). These SNPs have been found to either be modestly or not at all associated with smoking cessation as defined by a variety of different phenotypes. Despite the fact that nicotine dependence influences smoking cessation, these results suggest that cessation may be influenced by a wider range of genetic variants than just those that influence measures of nicotine dependence. Methods: To identify genes important for smoking cessation, we defined a smoking cessation phenotype based on number of quit attempts; easy quitters achieved successful, long-term (&amp;gt; 1 year) abstinence after their first quit attempt and difficult quitters reported ≥10 attempts before either continuing to smoke or quitting. We identified 1,500 easy quitters and 1,500 difficult quitters who were participants in the Cancer Prevention Study-3 (CPS-3), a large prospective study of cancer incidence and mortality conducted by the American Cancer Society. The association of 83 SNPs from 25 nicotine signaling and metabolism genes that had previously been associated with some aspect of smoking behavior with difficulty quitting was determined using logistic regression. Results: Three SNPs in three separate genes were significantly associated with difficult quitting (p&amp;lt;0.05). These were SLC6A3 rs2652511 [per allele odds ratio (OR)=0.89, 95% confidence intervals (CI): 0.80-0.99, p-trend=0.040], HTR1B rs6298 (per allele OR=0.88, 95% CI: 0.80-0.99, p-trend=0.034), and CHRNA5 rs16969968 (per allele OR=1.12, 95% CI: 1.00-1.22, p-trend=0.045). A genetic risk score based on number of risk alleles from these three SNPs was also associated with difficult quitting (OR=1.62, 95% CI:1.26-2.08, p=1.9 x 10-4 for score of 5-6 versus 0-2). None of the associations remained statistically significant after correction for multiple comparisons. Conclusions: Although none of the SNPs investigated were statistically significantly associated with the number of quit attempts, these results suggest that examining this phenotype in future genome-wide association studies would be useful for the discovery of genes that could be targeted for the development of novel smoking cessation aids. Citation Format: Victoria L. Stevens, Susan M. Gapstur, Juzhong Sun, Eric J. Jacobs, Mia M. Gaudet, J. Lee Westmaas, Alpa V. Patel. A candidate gene study of smoking cessation. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B54.

The association between smoking bans and nicotine dependence: A longitudinal analysis of current smokers in Canada

BackgroundWhile a substantial body of research has examined the effects of smoking bans on smoking behavior, little is known about the relationship between smoking bans and nicotine dependence. The objective of this study was to examine whether home and workplace smoking bans are associated with reduced nicotine dependence among continuing smokers. MethodsWe used longitudinal data of 1073 adult daily smokers from the Canadian National Population Health Survey (2004–2010). Generalized estimating equations were used to examine the association between smoking bans and nicotine dependence. ResultsSmokers living in homes where smoking is restricted were less likely to be nicotine dependent (OR=0.40, 95% CI=0.32–0.50) than smokers living in homes with no such smoking restriction. Workplace smoking policies had no significant association with nicotine dependence (complete ban: OR=0.79, 95% CI=0.56–1.11; partial ban: OR=0.82, 95% CI=0.57–1.16). There was some evidence that workplace smoking bans were significantly associated with nicotine dependence when single items of the Fagerstrom test were considered. ConclusionsThis paper demonstrates that the presence of a home smoking ban was associated with lower nicotine dependence among continuing smokers. The relationship of workplace bans with nicotine dependence was less clear and was contingent on the measure of nicotine dependence employed. These findings further confirm the importance of bans on smoking in the home, workplace, and other public places on reducing tobacco-related harms.

The prevalence, predictors and associated health outcomes of high nicotine dependence using three measures among US smokers

Using the Fagerström Test of Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI) and the time-to-first-cigarette (TTFC), this study estimated prevalence, evaluated optimal scale cut-offs, identified predictors and assessed potential impact on health, productivity and health-care use of high nicotine dependence among US smokers. This cross-sectional study used 2011 National Health and Wellness Survey data (n = 50 000). Nicotine dependence, demographic data, measures of health, productivity and health-care use and health attitudes were assessed. The prevalence of high nicotine dependence ranged from 23% (TTFC < 5 minutes) to 63.6% (TTFC < 30 minutes). Based on diagnostic accuracy, the cut-offs for high nicotine dependence using HSI and TTFC varied according to FTND cut-off: if FTND > 4, then HSI > 3 and TTFC < 30 minutes represented optimal cut-offs; if FTND > 5, HSI > 4 and TTFC < 5 minutes represented optimal cut-offs. Across all measures, high nicotine dependence was related significantly to being male, single, age 45-64 years and Caucasian; lower education; lack of health insurance; under/unemployment; comorbid respiratory or cardiovascular disease, diabetes or psychiatric illness; and lower rates of exercise and concern for weight control. Controlling for demographic variables and comorbid physical and psychiatric illness, high nicotine dependence, measured by FTND, HSI or TTFC, was associated significantly with reduced mental and physical quality of life, reduced work-place productivity and more health-care use. High nicotine dependence is associated with lower quality of life, lower work productivity and higher health-care use. The Heaviness of Smoking Index and the time-to-first-cigarette can provide useful screening measures of nicotine dependence in clinical and research settings.

Nicotine Dependence and Biochemical Exposure Measures in the Second Trimester of Pregnancy

Introduction:The Heaviness of Smoking Index (HSI) is validated to measure nicotine dependence in nonpregnant smokers, and in these smokers, mean salivary and serum cotinine levels are related by a ratio of 1.25. However, as nicotine metabolism increases during gestation, these findings may differ in pregnancy. We investigated the validity of HSI in pregnancy by comparing this with 3 biochemical measures; in a search for a less-invasive cotinine measure in pregnancy, we also explored the relationship between mean blood and salivary cotinine levels.Methods:Cross-sectional analyses using baseline data from the Smoking, Nicotine, and Pregnancy Trial. Participants were 16–46 years old, 12–24 weeks gestation, smoked more than 5 cigarettes per day, and had exhaled carbon monoxide (CO) readings of at least 8 ppm. Linear regression was used to examine correlations between HSI and blood cotinine and salivary cotinine and exhaled CO. Correlation between blood and salivary cotinine was investigated using linear regression through the origin.Results:HSI scores were associated with blood cotinine (R 2 = 0.20, n = 662, p < .001), salivary cotinine (R 2 = 0.11, n = 967, p < .001), and exhaled CO (R 2 = 0.13, n = 1,050, p < .001). Salivary and blood cotinine levels, taken simultaneously, were highly correlated (R 2 = 0.91, n = 628, p < .001) and the saliva:blood level ratio was 1.01 (95% CI 0.99–1.04).Conclusions:Correlations between HSI and biochemical measures in pregnancy were comparable with those obtained outside pregnancy, suggesting that HSI has similar validity in pregnant smokers. Salivary and blood cotinine levels are roughly equivalent in pregnant smokers.

Relationship between nicotine dependence and the endophenotype‐related trait of cognitive function but not acoustic startle reponses in Japanese patients with schizophrenia

We investigated whether nicotine dependence affects these endophenotypes in Japanese schizophrenia patients and whether alpha4 and beta2 subunits of neuronal nicotinic acetylcholine receptor genes (alpha4 subunit of the nAChR gene (CHRNA4)/beta2 subunit of the nAChR gene (CHRNB2)) were associated with nicotine dependence in patients (n = 100) and healthy controls (n = 107). First, in patients, we evaluated cognitive function, using the Brief Assessment of Cognition in Schizophrenia, and acoustic startle responses. Second, we evaluated the severity of nicotine dependence, using the Tobacco Dependence Screener, the Fagerström Test for Nicotine Dependence, and the Brinkman index in current smokers in both groups. Third, we evaluated the relationship between acoustic startle responses, cognitive function, and severity of nicotine dependence. Finally, using 12 tagging single-nucleotide polymorphisms in each the CHRNA4/CHRNB2, we used multiple linear regression analysis to examine the association between nicotine dependence measures and each selected single-nucleotide polymorphism. The presence and severity of nicotine dependence were associated with verbal memory and executive function in schizophrenia patients. However, nicotine dependence was not correlated with any acoustic startle response. In addition, rs755203 and rs1044397 in CHRNA4 were associated with nicotine dependence in healthy controls. Nicotine dependence might influence the level of verbal memory and executive function in schizophrenia patients. In addition, rs755203 and rs1044397 in CHRNA4 might play a role in the pathophysiology of nicotine dependence in healthy controls in the Japanese population.

Validity and reliability of the nicotine and marijuana interaction expectancy (NAMIE) questionnaire

BackgroundThe co-occurring use of tobacco and marijuana among young people is a concern, yet little research has examined processes of co-use. Understanding expectancies around use of the two substances will help identify intervention targets. This study examined psychometric properties of the Nicotine and Marijuana Interaction Expectancy (NAMIE) questionnaire based on three modified scales of the Nicotine and Other Substance Interaction Expectancy (NOSIE) questionnaire. MethodAn anonymous online survey recruited participants (N=1152) age 18–25 (mean age 20 years, 67% male, 72% Caucasian) who reported use of cigarettes and marijuana in the past 30 days. Analyses examined reliability and validity of the NAMIE. ResultsA confirmatory factor analysis indicated good model fit for a 3-factor model. Scales were marijuana increases tobacco use and urges, tobacco increases marijuana use and urges, and smoking to cope with marijuana urges. Subscales correlated significantly with measures of cigarette smoking (r=.08 to .27, p<.01) and nicotine dependence (r=−.07 to −.20, p<.01), marijuana use (r=.08 to .29, p<.01) and dependence (r=.27 to .42, p<.01), percent of days using both cigarettes and marijuana in the past 30 days (r=.15 to .30, p<.01), thoughts about tobacco and marijuana abstinence (r=−.09 to .44, p<.01), and motivation to quit using marijuana (F=9.43, p<.001). When entered into a regression model, variables of use and thoughts about use remained significant. ConclusionsThe NAMIE was well-adapted for use with a marijuana-using community sample of young adult smokers.

Extending Application of the 'Hardcore' Definition to Smokeless Tobacco Use: Estimates from a Nationally Representative Population in India and its Implications

The term 'hardcore' has been applied to use of smoking tobacco and generally referred to as the inability or unwillingness of regular smokers to quit. The component constructs of hardcore except nicotine dependence are product neutral. With the use of 'time to first chew' as a measure of nicotine dependence, hardcore definition can be extended to characterize smokeless tobacco users. Hardcore users respond less to tobacco cessation interventions, and are prone to tobacco induced diseases including cancer. Thus identifying hardcore users would help in estimate the burden of high risk population for tobacco induced diseases. Smokeless tobacco use is predominant and accounts for more than 50% of oral cancer in India. Hence, hardcore chewing information could be used for planning of tobacco and cancer control interventions. The objective of this study was to assess the prevalence and associated factors of hardcore smokeless tobacco use in India. Global Adult Tobacco Survey (GATS)-India 2010 data were analyzed to quantify hardcore smokeless tobacco use in India with following five criteria: (1) current daily smokeless tobacco use; (2) no quit attempt in the past 12 months of survey or last quit attempt of less than 24 hours duration; (3) no intention to quit in next 12 months or not interested in quitting; (4) time to first use of smokeless tobacco product within 30 minutes of waking up; and (5) knowledge of smokeless tobacco hazards. The number of hardcore smokeless tobacco users among adult Indians is estimated to be 5% (39.5 million). This group comprises 23.2% of daily smokeless tobacco users. The population prevalence varied from 1.4-9.1% across different national regions of India. Logistic regression modeling indicated age, education and employment status to be the major predictors of hardcore smokeless tobacco use in India. The presence of a huge number (39.5 million) of hardcore smokeless tobacco users is a challenge to tobacco control and cancer prevention in India. There is an unmet need for a universal tobacco cessation programme and intensification of anti-tobacco education in communities.