Cognitive interviews for measurement evaluation of the Fagerström Test for Nicotine Dependence (FTND) in smokers with schizophrenia spectrum disorders

Association Between Nicotine-dependent Gene Polymorphism and Smoking Cessation in Patients With Lung Cancer

BACKGROUND

Patients with lung cancer continue to smoke owing to complex factors. Failure to quit smoking (defined as nicotine dependence) is significantly associated with genetic status. This study aimed to investigate the relationship between polymorphisms in nicotine dependence genes and smoking status after the diagnosis of lung cancer.

PATIENTS AND METHODS

A total of 240 patients with lung cancer were included from July 2017 to March 2018. According to the actual smoking condition after lung cancer diagnosis, eligible patients were divided into 3 groups: the never-smoking group, the failure to quit smoking group, and the successful smoking cessation group. Fagerstrom Test for Nicotine Dependence scores were used to evaluate the smoking status of each group. Three nicotine-dependent genes with 6 loci were detected.

RESULTS

Among the 240 patients, 86 were never-smokers, 51 failed to quit smoking, and 104 successfully quit smoking. The initial age of smoking in the failure to quit smoking group was significantly younger than those in the successful smoking cessation group (P = .001). There was a significant difference in the GG and AG and AA genotype distributions of CHRNA3 (rs578776) among the 3 groups (P = .003). There was also a significant difference in the distribution of CHRNA4 (rs2229959) genotypes among the 3 groups (P = .003). However, there was no significant difference in the genotype distribution of CHRNA5 (rs588765) among the 3 groups (P = .277).

CONCLUSIONS

Gene polymorphisms of CHRNA3 (rs578776) and CHRNA4 (rs1044396 and rs2229959) were associated with the success of smoking cessation after the diagnosis of lung cancer, which should be considered in the management of smoking cessation after patients are diagnosed with lung cancer.

Risk factors for nicotine dependence in Chinese patients with lung cancer

Objective

Smoking is a poor prognostic factor for lung cancer. Nicotine dependence remains the major cause of failure of smoking cessation. We investigated the risk factors for nicotine dependence in patients with lung cancer.

Methods

Eligible patients were identified from November 2014 to February 2015. Age, marital status, educational level, annual household income, occupation, histology of lung cancer, tumor stage, smoking status, neuron-specific enolase (NSE) level, drive gene mutations, sleep quality, and patient personality were assessed. Physical nicotine dependence was assessed by the Fagerstrom Test for Nicotine Dependence (FTND).

Results

In total, 202 smokers were included in this study. Univariate analysis showed that marital status and pain were significantly correlated with nicotine dependence. Pearson’s correlation analysis showed that age at the initiation of smoking, attempts to quit, NSE level, and sleep quality were significantly correlated with FTND scores.

Conclusions

Pain, more attempts to quit, and poorer sleep quality were significantly associated with nicotine dependence. These risk factors could help to prevent smoking in Chinese patients with lung cancer.

Effect of nicotine dependence on quality of life and sleep quality in patients with lung cancer who continue to smoke after diagnosis

Background

Hundreds of millions of Chinese individuals continue to smoke and rates of lung cancer still continue to rise. However, there were few studies that examined the effects of nicotine dependence on quality of life (QOL) and sleep quality in lung cancer patients. This study aimed to investigate the effect of nicotine dependence on QOL and sleep quality in lung cancer patients who continue to smoke after diagnosis.

Methods

This cross-sectional survey study included 202 patients with lung cancer. Smokers were separated into two groups based on the Fagerstrom Test for Nicotine dependence: the low dependence (LD) (<4 score) group (n=59) and the high dependence (HD) (≥4 score) group (n=143). Both Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) and Chinese version of Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the two groups of lung cancer patients. Then we analyzed the difference of QOL and sleep quality between two distinct nicotine dependence groups.

Results

Physical functioning, role functioning, emotional functioning, cognitive functioning, global health status and social functioning items in the LD group were significantly higher than the HD group (P<0.001). Fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea and financial problems in the LD group were significantly lower than those in the HD group (P<0.001). Significantly higher scores in the HD group were found concerning the three sleep components including sleep duration, sleep efficiency and daytime function. The mean global PSQI score in the HD group was significantly higher than the LD group (P=0.014).

Conclusions

These findings suggest that lung cancer patients who continue to smoke after diagnosis should receive health education in order to improve their QOL and quality of sleep after the word education. This can be useful for clinicians and nurses who are trying to motivate smokers to quit smoking.

Nicotine dependence in Croatian male inpatients with schizophrenia

BACKGROUND

Patients with schizophrenia have the highest known rates of cigarette smoking, but less is known about their smoking behavior and the differences across geographical regions, including Croatia. The aim of this study was to compare patterns of nicotine dependence between patients with schizophrenia and healthy individuals, and to determine the relationship between clinical presentation and the severity of smoking.

METHODS

This cross-sectional study included 182 recently hospitalized male inpatients and 280 healthy males, who were daily smokers. All participants have fulfilled the Fagerstrom Test for Nicotine Dependence (FTND). Patients were also evaluated by the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Patients had higher FTND total score (p = 0.010), smoked their first cigarette earlier in the morning (p = 0.000), consumed higher number of cigarettes (p = 0.000), while healthy subjects had more difficulties to refrain from smoking in places where it is forbidden (p = 0.000) and smoked more even when they were sick (p = 0.000). While severe dependence was more prevalent in the patient group, light dependence was more frequent in control subjects (p = 0.04). Smoking behavior was not associated with either PANSS total score or any of its subscales and items.

CONCLUSIONS

Smokers with schizophrenia differ from healthy smokers in both smoking behavior and level of dependence. Longitudinal studies are needed to shed more light on the complex relationship between smoking and psychopathology in schizophrenia.

Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial

INTRODUCTION

The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime. A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing standard treatment compared to smokers with no mental illness. We sought to determine if combination extended treatment (COMB-EXT) and home visits (HV) would lead to improved outcomes in smokers with schizophrenia.

METHODS

Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV, COMB-EXT without HV, or treatment as usual (TAU) (random assignment). COMB-EXT consisted of group cognitive-behavioral therapy (CBT), bupropion, nicotine patch, and nicotine lozenge, which were initiated within 2 weeks and continued for 26 weekly visits. HV consisted of biweekly visits to the home with assessment of secondhand smoke (SHS) exposure and brief behavioral therapy with participants and others in the home environment. TAU consisted of group CBT plus serial single or combination medication trials as per standard care.

RESULTS

Smokers with schizophrenia who received COMB-EXT (with or without HV) had greater reductions in cigarettes per day than those treated with TAU (both ps < .01). In addition, 7-day point prevalence abstinence rates for the three groups were 45%, 20%, and 8%, respectively, which was significantly higher for COMB-EXT plus HV than TAU (χ²(1) = 4.8, p = .03). Groups did not differ significantly in the number of adverse events, and HV were easily scheduled.

CONCLUSION

COMB-EXT improves outcomes for smokers with schizophrenia. HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population.

IMPLICATIONS

The clear benefit found here of rapidly initiated, combination, extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia. Furthermore, HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence, indicating that this intervention may be worthy of future research.

PTSD symptomatology and readiness to quit smoking among women with serious mental illness

INTRODUCTION

Posttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking.

METHODS

376 adult women smokers aged 18-73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD(+)). In multiple regressions, we examined the associations of screening PTSD(+) with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking.

RESULTS

Nearly half the sample (43%) screened PTSD(+), which was significantly associated with the use of stimulants (OR=1.26) and opiates (OR=1.98), drug use disorders (OR=2.01), and poorer mental health (B=-2.78) but not physical health functioning. PTSD(+) status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B=2.13) and intention to stop smoking in the next month (OR=2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD(+) remained predictive of greater desire and intention to quit smoking.

CONCLUSION

PTSD symptomatology was common in our sample of women smokers with SMI and associated with not only worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.

Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change

OBJECTIVE

Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs.

METHOD

Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization.

RESULTS

Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence.

CONCLUSION

Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.

Shorter interpuff interval is associated with higher nicotine intake in smokers with schizophrenia

BACKGROUND

People with schizophrenia are frequent and heavy smokers.

METHODS

The objective of this study was to measure serum nicotine levels and ad libitum smoking behavior for 24+2h using the CReSS micro topography device in 75 smokers with schizophrenia (SCZ) and compare these to 86 control smokers (CON) without mental illness. Mean values of repeatedly measured topography variables were compared using three-level nested linear models to adjust for between subject differences and the double nested data.

RESULTS

Smokers with SCZ smoked more cigarettes in the 24h period and took an average of 2.8 more puffs per cigarette than CON (p<0.001). The time between puffs, or interpuff interval (IPI), was shorter in SCZ by an average of 6.5s (p<0.001). The peak flow rate was higher in SCZ by an average of 4.9 ml/s (p<0.05). Smokers with SCZ spent an average of 1.0 min less time smoking a single cigarette vs. CON (p<0.001). Smokers with SCZ also had shorter IPI and more puffs per cigarette in an analysis of first cigarette of the day. For all subjects, a decrease in IPI by 1s was associated with an increase in serum nicotine of 0.19 ng/ml and in cotinine of 5.01 ng/ml (both p<0.05). After controlling for diagnosis group, higher craving scores on QSU Factor 2 (urgent desire to smoke) were associated with shorter IPI.

DISCUSSION

Smokers with schizophrenia demonstrate more intense cigarette puffing that is associated with greater nicotine intake. This pattern may provide insight into other heavily dependent smokers.

Comparison of mental health nurses' attitudes towards smoking and smoking behaviour

Smoking is widely recognized as an important public health issue for the general population and in the mental health field where the rates are particularly high. Mental health nurses are well positioned to take an active role in encouraging and supporting people diagnosed with mental illness to cease smoking. Information about smoking behaviour and the attitudes of mental health nurses is necessary to develop strategies to prepare nurses for this important role. A cross-sectional study was conducted to examine the smoking behaviour and attitudes of mental health nurses in Queensland, Australia, through a random selection of mental health nurses (n = 289). Smoking rates (16%) in this study were lower than those for the Australian population. Smokers were significantly (P < 0.001) less likely to agree that health-care facilities should promote a healthy environment. All participants, but predominantly those who smoked (P < 0.001), supported the individual's right to smoke. Participants believed they possessed appropriate skills to deliver the antismoking message effectively, although stronger beliefs were characteristic of non-smokers. Participants who smoked perceived that their smoking status assisted in facilitating interactions with consumers (P < 0.001). The findings have implications for the health promotion activities of mental health nurses.

Nicotine use and its correlates in patients with psychosis

OBJECTIVE

To examine nicotine use and its correlates among psychotic patients.

METHOD

Longitudinal naturalistic study of 176 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders, and treated with risperidone at study entry. Levels of nicotine use (smoking, snuffing) were measured along with other relevant ratings and measurements (symptoms, drug treatment, side effects, weight, cognitive functions and outcome) at baseline and once yearly for 5 years.

RESULTS

Nicotine use was twice as common as in the general population. Only few nicotine users had started after onset of psychoses. We could not find any differences among nicotine users and non-users in diagnosis, symptoms, side effects, weight, cognitive functions, personality and outcome, cross-sectionally and longitudinally, ruling against the 'self-medication' hypothesis.

CONCLUSION

A parsimonious interpretation of the findings is that patients suffering from psychosis fail to desist from nicotine rather than experience significant positive effects of the usage.