Time to First Cigarette after Waking Predicts Cotinine Levels

Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 12/2009; 18(12):3415-20. DOI: 10.1158/1055-9965.EPI-09-0737
Source: PubMed


There is wide variability in cotinine levels per cigarette smoked. We hypothesized that in addition to smoking frequency, other behavioral measures of nicotine dependence, such as the time to first cigarette after waking, are associated with cotinine levels. To test this hypothesis, we measured plasma and urinary cotinine in a community-based study of 252 black and white daily cigarette smokers. Among one pack per day smokers, plasma cotinine levels varied from 16 to 1,180 ng/mL, a 74-fold difference. Two nicotine dependence phenotypes were discerned by time after waking. Subjects in the "low" dependent phenotype smoked >30 minutes after waking and nearly all smoked < or =20 cigarettes per day. Cotinine levels increased linearly with cigarette consumption in this group. Subjects in the "high" dependent phenotype smoked < or =30 minutes after waking but had a wide range in the frequency of daily cigarettes (6-70). Compared with the low dependent phenotype, there were relatively small differences in cotinine by cigarette frequency with evidence of a plateau effect in heavy smokers ( approximately 30). After adjusting for cigarette frequency, the levels of cotinine by time to first cigarette were as follows: < or =5 minutes, 437 [95% confidence limits (CL), 380-494]; 6 to 30 minutes, 352 (95% CL, 291-413), 31 to 60 minutes, 229 (95% CL, 140-317), and >60 minutes, 215 (95% CL, 110-321). Similar findings were observed for urinary cotinine. These findings suggest that the time to first cigarette is a strong predictor of nicotine uptake and should be considered in the design of smoking interventions.

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Available from: Ralph S Caraballo
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    • "that most strongly predicts addiction to nicotine, probably because morning smoking reflects the smoker's overnight withdrawal symptoms [14]. TTFC also shows good correlation with biological measures of nicotine ingestion [15]. The FTND, TTFC, and number of CPD are all predictive of smoking continuation and significantly associated with relapse following a quit attempt [16] [17]. "
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    ABSTRACT: . The study aim was to examine the influence of education and income on multiple measures of risk of smoking continuation. Methods . Three logistic regression models were run on cigarette consumption, dependence, and intention to quit based on nationally representative samples (2007–2012) of approximately 1 200 current smokers aged 30–66 years in Norway. Results . The relative risk ratio for current versus never smokers was RRR 5.37, 95% CI [4.26–6.77] among individuals with low educational level versus high and RRR 1.53, 95% CI [1.14–2.06] in the low-income group versus high (adjusted model). Low educational level was associated with high cigarette consumption, high cigarette dependence, and no intention to quit. The difference in predicted probability for having high cigarette consumption, high cigarette dependence, and no intention to quit were in the range of 10–20 percentage points between smokers with low versus those with high educational level. A significant difference between low- and high-income levels was observed for intention to quit. The effect of education on high consumption and dependence was mainly found in smokers with high income. Conclusion . Increased effort to combat social differences in smoking behaviour is needed. Implementation of smoking cessation programmes with high reach among low socioeconomic groups is recommended.
    Full-text · Article · Aug 2015
    • "In a study comparing two versions of the Cigarette Dependence Scale (CDS;Etter, Le Houezec, &amp; Perneger, 2003) and the FTND, the time-to-first-cigarette item within the FTND was the only tobacco dependence measure that predicted smoking abstinence during tobacco dependence treatment for smokers with substance use disorders (Rohsenow, Martin, Tidey, Monti, &amp; Colby, 2013). Even after controlling for cigarettes per day, TTFC predicts cotinine levels in adolescent (Branstetter &amp; Muscat, 2013) and adult smokers (Fu, Fernandez, et al., 2011;Fu, Martinez-Sanchez, et al., 2011;Muscat, Chen, et al., 2009;Muscat, Stellman, Caraballo, &amp; Richie, 2009;Toll, Schepis, O&apos;Malley, McKee, &amp; Krishnan-Sarin, 2007;Park et al., 2004).Shorter time-to-first-cigarette has also been associated with health outcomes such as increased risk of head and neck cancer (Muscat, Ahn, Richie, &amp; Stellman , 2011a), lung cancer (Muscat,Ahn, Richie, &amp; Stellman 2011b), and supraglottis larynx (but not glottis larynx) cancer (Muscat, Liu, Livelsberger, Richie, &amp; Stellman, 2012). Longer TTFC, however, has been Time to First Cigarette, 5 associated with quitting smoking over the course of one year in a large sample of smokers in the UK (West, McEwen, Bolling, &amp; Owen, 2001). "
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    ABSTRACT: Introduction: The time a smoker waits until the first cigarette of the morning is often used as a measure of dependence with the rationale that more dependent smokers will smoke sooner upon waking than will less dependent smokers after going several hours without a cigarette overnight.Aims: We sought to examine the relationship between time-to-first-cigarette (TTFC) and household smoking restrictions in two independent samples.Methods: Two samples of smokers, one treatment-seeking community sample (N = 433) and one non-treatment seeking sample of smokers with serious mental illness (i.e., Schizophrenia, Schizoaffective Disorder, or Bipolar I Disorder) (N = 94), provided information on cigarette dependence with the Fagerström Test for Nicotine Dependence (FTND) and on household smoking restrictions.Results: Half (50%) of smokers with serious mental illness and 36.7% of smokers from the general population reported that there were no limitations to smoking in their home. Household smoking restrictions were significantly and positively related to TTFC in both samples.Conclusions: These data indicate that greater attention to TTFC may be warranted. The TTFC item is intended to measure dependence based on the premise that greater dependence should be associated with shorter TTFC. If TTFC is related to a household smoking ban, however, this item may not be assessing dependence as intended in some cases.
    No preview · Article · Feb 2015 · The Journal of Smoking Cessation
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    • "The objective of this current study was to measure smoking topography and serum nicotine levels in smokers with schizophrenia and compare these to control smokers without mental illness. We were also interested in looking at puffing patterns for the first cigarette of the day smoked since it is a predictor of daily nicotine uptake, and nicotine dependence (Muscat et al., 2009). "
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    ABSTRACT: People with schizophrenia are frequent and heavy smokers. 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. 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. 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.
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