Uzależnienie od nikotyny
Epidemiologia
Uzależnienie od nikotyny jest przewlekłym stanem charakteryzującym się silnym pragnieniem używania tytoniu, trudnościami w kontroli konsumpcji oraz objawami odstawienia, co prowadzi do kontynuacji palenia mimo negatywnych skutków zdrowotnych. Globalnie około 1,1 miliarda osób pali papierosy, z 75% palaczy w krajach zachodnich klasyfikowanych jako uzależnieni, a wskaźnik uzależnienia według kryteriów DSM-5 w USA wynosi 20,0% (12-miesięczne) i 27,9% (życiowe). Młodzież jest szczególnie narażona na szybkie rozwinięcie uzależnienia, z objawami pojawiającymi się już po pierwszych zaciągnięciach, co utrudnia rzucenie palenia. Wysokie uzależnienie od nikotyny (FTND≥6) obserwuje się u 17,4% codziennych palaczy w Chinach, a wśród kierowców ciężarówek w Brazylii 68,6% palaczy wykazuje wysoki lub bardzo wysoki stopień uzależnienia. Czynniki ryzyka uzależnienia obejmują niski status społeczno-ekonomiczny, niskie wykształcenie, choroby psychiczne oraz wczesny wiek inicjacji palenia. Uzależnienie od nikotyny jest silnie powiązane z chorobami układu oddechowego, w tym POChP, gdzie palenie matki w ciąży pośredniczy w ryzyku rozwoju choroby u potomstwa, oraz z rakiem płuc, szczególnie u osób palących pierwszego papierosa w ciągu 5 minut od przebudzenia, co zwiększa ryzyko nowotworu ponad trzykrotnie.
- Epidemiologia uzależnienia od nikotyny
- Globalna prevalencja uzależnienia od nikotyny
- Uzależnienie od nikotyny w różnych populacjach
- Czynniki demograficzne i społeczne wpływające na uzależnienie od nikotyny
- Współwystępowanie z innymi zaburzeniami
- Nadzór nad uzależnieniem od nikotyny
- Genetyka uzależnienia od nikotyny
- Implikacje dla zdrowia publicznego
Epidemiologia uzależnienia od nikotyny
Uzależnienie od nikotyny stanowi poważny problem zdrowia publicznego na całym świecie. Jest to przewlekły stan napędzany uzależniającymi właściwościami nikotyny, prowadzący do kontynuacji używania wyrobów tytoniowych i związanych z tym negatywnych skutków zdrowotnych. Używanie tytoniu jest jedną z głównych przyczyn zgonów możliwych do uniknięcia, powodując ponad 8 milionów zgonów rocznie i zabijając połowę użytkowników, którzy nie rzucają palenia.12
Globalna prevalencja uzależnienia od nikotyny
Na całym świecie około 1,1 miliarda osób pali papierosy, a około 80% z 1,3 miliarda użytkowników tytoniu mieszka w krajach o niskim i średnim dochodzie.1 Jeśli spojrzymy na uzależnienie zamiast na rozpowszechnienie, nikotyna może uzależniać więcej użytkowników niż jakikolwiek inny narkotyk. Szacuje się, że uzależnienie od nikotyny w ciągu życia wynosi około 24% w Chinach i 14% w Stanach Zjednoczonych. Około 75% palaczy w świecie zachodnim można sklasyfikować jako uzależnionych.1
Według najnowszych danych, około połowa palaczy (i jedna trzecia byłych palaczy) jest uzależniona na podstawie kryteriów DSM, niezależnie od wieku, płci czy kraju pochodzenia, choć liczba ta może być wyższa, jeśli zastosuje się inne definicje uzależnienia.1 W Stanach Zjednoczonych częstość występowania 12-miesięcznego i życiowego uzależnienia od nikotyny według DSM-5 wynosi odpowiednio 20,0% i 27,9%.1
Uzależnienie od nikotyny w różnych populacjach
Młodzież i młodzi dorośli są szczególnie narażeni na rozwój uzależnienia od nikotyny. Badania wykazały, że objawy uzależnienia od nikotyny mogą pojawić się wkrótce po pierwszym zaciągnięciu się, co sprawia, że rzucenie palenia staje się trudne na długo przed osiągnięciem progu 100 wypalonych papierosów w ciągu życia. Mimo niskiego spożycia papierosów, 21-30% palaczy z 7 klasy zgłasza objawy uzależnienia od nikotyny. Odsetek ten wzrasta do 27-44% w 8 klasie i pozostaje stabilny pomimo zwiększonego spożycia papierosów.1
Badania ujawniają, że średni wiek osób palących po raz pierwszy wynosi 14,5 roku, a średni wiek codziennych palaczy to 17,7 roku. Około 20% uczniów ostatniej klasy szkoły średniej pali. Wczesne rozpoczęcie używania tytoniu przyczynia się do większego wskaźnika uzależnienia, co czyni okres dojrzewania szczególnie wrażliwym wiekiem.1
Istnieją znaczące dowody na to, że wiek inicjacji jest związany z poziomem uzależnienia od nikotyny. Badania długoterminowe śledzące uczestników od okresu dojrzewania do wczesnej dorosłości wykazały statystycznie istotny gradient, gdzie młodszy wiek inicjacji wiązał się z większym uzależnieniem od nikotyny. Wcześniejszy wiek inicjacji wiąże się z większą intensywnością i utrzymywaniem się palenia poza okres dojrzewania i przez całą dorosłość.12
Grupy zawodowe takie jak kierowcy ciężarówek stanowią populację szczególnie narażoną na uzależnienie od nikotyny. Badanie przeprowadzone w Brazylii wykazało, że rozpowszechnienie używania tytoniu wśród kierowców ciężarówek wynosiło 21,1% (n = 132; 95%CI: 18,1-24,5), co jest wyższe niż szacowane dla ogólnej populacji mężczyzn w Brazylii (18,9%, 95%CI: 18,0-19,7). Spośród palaczy, którzy odpowiedzieli na test Fagerströma (FTND) (n = 118; 89,4%), większość miała wysokie/bardzo wysokie uzależnienie nikotynowe (68,6%; 95%CI: 59,8-76,3).12
Czynniki demograficzne i społeczne wpływające na uzależnienie od nikotyny
Istnieją różne grupy osób, które są bardziej skłonne do palenia niż przeciętna populacja, takie jak osoby o niskim poziomie wykształcenia lub niskim statusie społeczno-ekonomicznym oraz osoby z chorobami psychicznymi.1 Wyniki badań wskazują również, że wśród palaczy niektóre podgrupy mogą być bardziej uzależnione niż inne grupy.2
Mężczyźni palą częściej niż kobiety i uzyskują wyższe wyniki w skalach uzależnienia. Jednak kobiety mogą mieć mniejsze szanse na pomyślne rzucenie palenia, co sugeruje, że mogą być bardziej uzależnione według tego kryterium.3
Niektóre badania sugerują, że palenie mentolowych papierosów jest nieproporcjonalnie rozpowszechnione wśród nastolatków, osób czarnoskórych/Afroamerykanów, dorosłych kobiet, osób mieszkających w północno-wschodniej części Stanów Zjednoczonych oraz osób o dochodach rodzinnych niższych niż 50 000 dolarów.1
W Chinach badanie przeprowadzone w prowincji Zhejiang ujawniło, że 17,4% codziennych palaczy było wysoko uzależnionych od nikotyny, ze średnim wynikiem w teście Fagerströma wynoszącym 3,1±2,4. Wysokie uzależnienie od nikotyny (FTND≥6) obserwowano u 17,4% codziennych palaczy. Prevalencja wysokiego uzależnienia od nikotyny różniła się w zależności od wieku, wykształcenia, zawodu i wieku rozpoczęcia codziennego palenia.12
Zauważono niższy poziom uzależnienia od nikotyny wśród osób z wyższym wykształceniem niż wśród osób z niższym wykształceniem: podstawowym lub niższym (OR=3,07) i średnim (OR=2,62). Ogólnie rzecz biorąc, palacze o niskim statusie społeczno-ekonomicznym są bardziej skłonni do wysokiego stopnia uzależnienia od nikotyny.3
Współwystępowanie z innymi zaburzeniami
Obserwuje się zwiększoną częstość występowania uzależnienia od nikotyny u osób z zaburzeniami psychicznymi, takimi jak zaburzenia lękowe i zaburzenia używania substancji.1 Osoby z współistniejącym uzależnieniem od nikotyny i co najmniej jednym zaburzeniem psychicznym stanowią 11,1% dorosłych Amerykanów, ale palą 53,6% wszystkich konsumowanych papierosów.1
Palacze z uzależnieniem nikotynowym wydają się być również bardziej narażeni na stany psychiatryczne, takie jak duża depresja i alkoholizm. Uzależnienie od nikotyny odzwierciedla przymusowe używanie tytoniu zawierającego nikotynę, fizjologiczną tolerancję (tj. potrzebę używania zwiększonych ilości nikotyny w celu osiągnięcia pożądanego efektu), odstawienie nikotyny po zaprzestaniu używania tytoniu (np. objawy takie jak głód nikotyny, drażliwość, złość, niepokój, depresja, zwiększony apetyt) i kontynuację używania pomimo znaczących problemów związanych z używaniem tytoniu (np. problemy zdrowotne).1
Różnica między używaniem tytoniu a uzależnieniem może być znacząca, biorąc pod uwagę niedawne badania wskazujące, że osoby nigdy nie palące codziennie stanowią znaczącą mniejszość palaczy, zwłaszcza wśród niektórych mniejszości etnicznych, gdzie wskaźniki przewidywalnie nieuzależnionych użytkowników (nigdy nie palących codziennie) są tak wysokie jak 16,8%.2
Nadzór nad uzależnieniem od nikotyny
Dobry monitoring śledzi zakres i charakter epidemii tytoniowej i wskazuje, jak najlepiej dostosować politykę. Prawie połowa światowej populacji jest regularnie pytana o używanie tytoniu w reprezentatywnych badaniach krajowych wśród dorosłych i młodzieży.1
Systemy nadzoru i monitorowania
WHO monitoruje środki MPOWER od 2007 roku. Szczegółowe informacje na temat postępów w kontroli tytoniu na poziomie globalnym, regionalnym i krajowym można znaleźć w serii raportów WHO na temat globalnej epidemii tytoniowej.2
W USA kilka krajowych badań dostarcza danych do szacowania zachowań związanych z paleniem wśród młodzieży i młodych dorosłych. Jednak niektóre systemy nadzoru nie monitorują objawów uzależnienia od nikotyny, a kryterium 100 papierosów wypalonych w ciągu życia jest używane w co najmniej jednym systemie nadzoru do definiowania obecnych palaczy, co może prowadzić do niedoszacowania problemu.11
Objawy uzależnienia od nikotyny powinny być monitorowane w systemach nadzoru młodzieży, ponieważ przedstawiają inny „obraz” niż papierosy, a ich pojawienie się może stanowić krytyczny „punkt bez powrotu”. Interwencje dla początkujących palaczy są potrzebne we wszystkich klasach, aby zaprzestać palenia przed wystąpieniem uzależnienia od nikotyny. Bez zmiany koncentracji uwagi na początkujących, a nie na już uzależnionych palaczy, wiele dzieci, które próbują papierosów, uzależni się.1
Trendy w uzależnieniu od nikotyny
Najnowsze dane sugerują, że w Stanach Zjednoczonych wskaźniki codziennego palenia i liczba papierosów wypalanych dziennie spadają, co sugeruje zmniejszenie uzależnienia w populacji wśród obecnych palaczy.1 Palenie papierosów wśród dorosłych spadło z 12,5% w 2020 r. do 11,5% w 2021 r., co jest najniższym odnotowanym wskaźnikiem od 1965 r.1
W 2021 r. 11,5% dorosłych Amerykanów (28,3 miliona osób) paliło papierosy: 13,1% mężczyzn, 10,1% kobiet. W 2023 r. około 1 na 100 uczniów szkół średnich (1,1%) zgłosiło, że paliło papierosy w ciągu ostatnich 30 dni. W tym samym roku prawie 2 na 100 uczniów szkół średnich (1,9%) zgłosiło, że paliło papierosy w ciągu ostatnich 30 dni.2
Użycie papierosów elektronicznych wśród uczniów szkół średnich w USA wzrosło gwałtownie między 2017 a 2019 r. z 11,7% w 2017 r. do 20,8% w 2018 r. i 27,5% w 2019 r. Jednak częste używanie i oznaki uzależnienia od e-papierosów pozostały rzadkie wśród uczniów, którzy kiedykolwiek używali tylko e-papierosów i nigdy żadnego innego produktu tytoniowego.11
W 2023 r. około 1 na 22 uczniów szkół średnich (4,6%) zgłosiło, że używało papierosów elektronicznych w ciągu ostatnich 30 dni. W tym samym roku 1 na 10 uczniów szkół średnich (10,0%) zgłosiło, że używało papierosów elektronicznych w ciągu ostatnich 30 dni.1
Związek z innymi chorobami
Używanie tytoniu, głównie w postaci papierosów, jest główną przyczyną zgonów możliwych do uniknięcia w Stanach Zjednoczonych, stanowiąc prawie 20% wszystkich zgonów. Niedawne szacunki śmiertelności związanej z paleniem (SAM) z lat 1990-1994 wskazują, że palenie papierosów powodowało prawie 431 000 zgonów rocznie.1
Palenie papierosów jest odpowiedzialne za ponad 480 000 zgonów rocznie w Stanach Zjednoczonych, w tym ponad 41 000 zgonów wynikających z narażenia na bierne palenie. Jest to około jednej piątej wszystkich zgonów rocznie, czyli 1300 zgonów dziennie.11
Uzależnienie od nikotyny jest główną przyczyną zgonów na całym świecie. Ważnymi przyczynami śmiertelności związanej z paleniem są miażdżycowa choroba naczyń, nowotwory i przewlekła obturacyjna choroba płuc (POChP). Palenie może również przyczyniać się do innych chorób, takich jak histiocytoza X, zapalenie oskrzelików, bezdech senny, samoistna odma opłucnowa, niska masa urodzeniowa i śmiertelność okołoporodowa.22
Wpływ na POChP: Przewlekła obturacyjna choroba płuc (POChP) stanowi globalne wyzwanie zdrowotne, zaliczając się do głównych przyczyn zachorowalności i śmiertelności na całym świecie. Palenie, uznawane za najbardziej istotną przyczynę POChP, prowadzi do jej rozwoju u około połowy wszystkich palaczy.1
Badanie obejmujące 5943 uczestników (2991 z POChP i 2952 kontrolnych) wykazało, że uzależnienie od tytoniu (TD) było bardziej rozpowszechnione w grupie POChP (POChP: n=582, 40,40%; kontrola: n=478, 33,90%; P<.001). Po dostosowaniu do kowariancji, palenie matki podczas ciąży (MSDP) miało istotny wpływ na POChP (β=.097; P<.001). Stwierdzono związek między MSDP a TD (β=.074; P<.001), a także między TD a POChP (β=.048; P=.007). Analiza mediacji TD w związku MSDP-POChP wykazała istotne efekty bezpośrednie i pośrednie (bezpośrednie: β=.094; P<.001 i pośrednie: β=.004; P=.03).1
Badanie to wykazało bezpośredni związek między uzależnieniem od tytoniu a POChP i podkreśliło potencjalny związek między paleniem matki podczas ciąży a ryzykiem POChP u potomstwa, ujawniając pośredniczącą rolę uzależnienia od tytoniu w tym związku.21
Wpływ na raka płuc: Osoby silnie uzależnione od nikotyny – te, które palą pierwszego papierosa w ciągu pięciu minut po przebudzeniu – są bardziej narażone na rozwój raka płuc niż te, które czekają godzinę lub dłużej, aby zapalić. Badacze zaobserwowali, że osoby, które paliły pierwszego papierosa w ciągu pięciu minut od przebudzenia, miały ponad trzy razy większe ryzyko raka płuc w porównaniu z tymi, które czekały dłużej niż godzinę przed wypaleniem pierwszego papierosa w ciągu dnia, po uwzględnieniu innych cech palenia, wieku i płci.1
Ocena czasu do pierwszego papierosa może pomóc klinicystom szybko ocenić ryzyko raka płuc. Odkrycia podkreślają potrzebę rzucenia palenia nawet przez lekkich palaczy, ponieważ nawet lekcy palacze, którzy są lub stają się uzależnionymi palaczami, mogą być narażeni na znaczne ryzyko rozwoju raka płuc.2
Genetyka uzależnienia od nikotyny
Palenie papierosów jest główną przyczyną możliwej do uniknięcia zachorowalności i śmiertelności. Zmienność genetyczna przyczynia się do inicjacji, regularnego palenia, uzależnienia od nikotyny i rzucenia palenia. Badanie asocjacji genomu przeprowadzone na 58 000 palaczy pochodzenia europejskiego lub afrykańskiego z wykorzystaniem Testu Fagerströma dla Uzależnienia od Nikotyny (FTND) wykazało pięć loci istotnych dla całego genomu, w tym wcześniej niezgłaszane loci MAGI2/GNAI1 (rs2714700) i TENM2 (rs1862416), oraz rozszerzyło loci zgłaszane dla innych cech związanych z paleniem na uzależnienie od nikotyny.1
Warianty genetyczne związane z uzależnieniem od nikotyny
Uzależnienie od nikotyny (odziedziczalność oparta na SNP = 8,6%) jest genetycznie skorelowane z 18 innymi cechami związanymi z paleniem (r_g = 0,40-1,09) i chorobami współistniejącymi. W porównaniu z innymi etapami palenia, znane loci dla uzależnienia od nikotyny są ograniczone. Tylko sześć powtarzalnych, istotnych dla całego genomu loci zostało zidentyfikowanych: CHRNB3-CHRNA6 (chr8p11), DBH (chr9q34), CHRNA5-CHRNA3-CHRNB4 (chr15q25), DNMT3B i NOL4L (chr20q11) oraz CHRNA4 (chr20q13).21
Test Fagerströma dla Uzależnienia od Nikotyny (FTND) zapewnia złożony fenotyp, który obejmuje wiele behawioralnych i psychologicznych cech uzależnienia od nikotyny wśród palaczy. Jego ważność może wynikać z włączenia pytania o czas do pierwszego papierosa rano (TTFC), które wydaje się być szczególnie silnie związane z prawdopodobieństwem nawrotu i może być szczególnie pouczającą miarą dziedziczności uzależnienia od nikotyny.2
Zaproponowano, że podatność na uzależnienie od nikotyny jest moderowana przez zmiany w locus receptora μ-opioidowego (OPRM1), ale wyniki badań na ludziach różnią się, a badania prospektywne oparte na genotypie są niedostępne. Indywidualna odpowiedź na nikotynę różni się znacznie, częściowo ze względu na czynniki genetyczne. Umiarkowaną dziedziczność (~0,6) stwierdzono dla uzależnienia od nikotyny w dużych badaniach bliźniąt, a podobne wyniki uzyskano również dla inicjacji i używania.1
Nagradzające właściwości nikotyny są częściowo mediowane przez receptory μ-opioidowe (MOR) kodowane przez locus OPRM1. Pojedynczy polimorfizm nukleotydowy (SNP), rs1799971:AG (A118G), istnieje w egzonie 1 genu OPRM1 i koduje niesynonimową substytucję (Asn40Asp) w zewnątrzkomórkowej pętli N-końcowej MOR, co prowadzi do utraty miejsca glikozylacji.2
Kilka badań wskazało na związek wariantu A118G z indywidualnymi różnicami we wzmacnianiu nikotyny lub uzależnieniu, ale jego rola pozostaje niejasna i zgłaszano sprzeczne wyniki. Nadal nie jest jasne, czy OPRM1 A118G zmienia podatność na zachowania związane z paleniem.1
Wpływ genetyki na rzucenie palenia
Najbardziej znaczącym odkryciem translacyjnego badania z wykorzystaniem myszy humanizowanych OPRM1 jest uderzające podobieństwo między gatunkami w zakresie wrażliwości na wzmacnianie nikotyny jako funkcji genotypu i płci. Wykazanie większej wrażliwości na nagradzające efekty nikotyny u mężczyzn noszących allel OPRM1 118G jest ważne dla rozwoju spersonalizowanych podejść do zapobiegania i leczenia uzależnienia od palenia.23
Genetyczne warianty w CHRNA3/5 (rs8034191 i rs1051730) były istotnie związane z uzależnieniem od nikotyny. Jednak w stosunkowo małej grupie obecnych palaczy nie znaleziono związku wariantów genetycznych w CHRNA3/5 (rs8034191 i rs1051730) z nasileniem rozedmy lub zatrzymania powietrza w TK; wpływ obecnego palenia na rozedmę mierzoną TK może ograniczać wykrycie istotnych związków genetycznych.1
Papierosy są głównym środowiskowym czynnikiem ryzyka rozwoju POChP, a uzależnienie od nikotyny silnie wpływa na zachowania związane z paleniem. Badanie przeprowadzone w celu wyjaśnienia związku między uzależnieniem od nikotyny, genetyczną podatnością na uzależnienie od nikotyny a objętościowymi wynikami TK u palaczy wykazało, że wśród 842 obecnie palących osób (335 przypadków POChP i 507 kontroli), 329 osób (39,1%) wykazało wysokie uzależnienie od nikotyny. Osoby z wysokim uzależnieniem od nikotyny miały większą skumulowaną i bieżącą ilość palenia.1
Jednakże, wbrew początkowej hipotezie, nasilenie rozedmy było ujemnie skorelowane z wynikiem FTND zarówno u osób kontrolnych (= -0,19, p 0,0001), jak i u przypadków POChP (= -0,18, p = 0,0008). Niższy wynik FTND, płeć męska, niższy wskaźnik masy ciała i niższy FEV1 były niezależnymi czynnikami ryzyka nasilenia rozedmy w przypadkach POChP. Oba SNP CHRNA3/5 były związane z FTND u obecnych palaczy. Związek wariantów genetycznych w CHRNA3/5 z nasileniem rozedmy stwierdzono tylko u byłych palaczy, ale nie u obecnych palaczy.21
Implikacje dla zdrowia publicznego
Uzależnienie od nikotyny ma wiele implikacji dla zdrowia publicznego. Po pierwsze, uzależnienie od nikotyny jest główną siłą napędzającą chęć palenia, co sprawia, że bardzo trudno jest rzucić palenie. Po drugie, uzależnienie od nikotyny ma wysoki stopień współchorobowości z pewnymi stanami psychiatrycznymi, takimi jak nadużywanie substancji i zaburzenia nastroju. Po trzecie, palenie jest najczęstszym czynnikiem ryzyka dla złego stanu zdrowia, który bezpośrednio wpływa na układ oddechowy i sercowo-naczyniowy oraz powoduje przedwczesne zgony.1
Wyzwania w rzucaniu palenia
Uzależnienie od tytoniu jest przewlekłym stanem napędzanym uzależnieniem od nikotyny. Pomyślne rzucenie palenia może być zwiększone przez interwencję dostawców opieki zdrowotnej i leczenie oparte na dowodach. Według danych National Health Interview Survey z 2022 r., około dwie trzecie (67,7%) z 28,8 miliona dorosłych Amerykanów, którzy palili, chciało rzucić palenie, a około połowa (53,3%) podjęła próbę rzucenia, ale tylko 8,8% rzuciło palenie. Połowa dorosłych, którzy palili i odwiedzili pracownika służby zdrowia w ciągu ostatniego roku, otrzymała porady (50,5%) lub pomoc (49,2%) w rzuceniu palenia. Wśród tych, którzy próbowali rzucić palenie, 38,3% korzystało z leczenia (tj. poradnictwa lub leków).1
W 2022 r. większość dorosłych, którzy palili, chciała rzucić palenie, a około połowa próbowała rzucić w ciągu ostatniego roku, ale mniej niż 10% udało się rzucić palenie. Zgodnie z wcześniejszymi badaniami, ta analiza wykazała niską częstość występowania klinicznej interwencji w zakresie rzucania palenia (tj. porad i pomocy) oraz wykorzystania leczenia. W tym ustaleniu mogą odgrywać rolę różne bariery w dostępie do leczenia.1
Odstawienie nikotyny jest głównym czynnikiem utrudniającym rzucenie palenia. Raport Światowej Organizacji Zdrowia z 2010 r. stwierdza: „Wykazano, że większe uzależnienie od nikotyny wiąże się z niższą motywacją do rzucenia palenia, trudnościami w próbie rzucenia i niepowodzeniem w rzuceniu, a także z wcześniejszym paleniem pierwszego papierosa w ciągu dnia i paleniem większej liczby papierosów dziennie”.1
Więcej niż 90 procent tych palaczy, którzy próbują rzucić palenie bez szukania leczenia, nie udaje się, przy czym większość nawraca w ciągu tygodnia. Żądza, czyli chęć nikotyny, została opisana jako główna przeszkoda w pomyślnym powstrzymaniu się od palenia.1
Strategie interwencji i leczenia
Istnieją możliwości dla sektorów zdrowia publicznego i opieki zdrowotnej, aby zwiększyć rzucanie palenia, w tym rozszerzenie dostępu i wykorzystania usług i wsparcia w zakresie rzucania palenia. Włączenie sprawiedliwych strategii rzucania palenia do wszystkich wysiłków w zakresie zapobiegania i kontroli tytoniu handlowego może pomóc w postępie i wsparciu rzucania palenia dla wszystkich grup populacyjnych.2
Departament Zdrowia i Usług Społecznych USA zidentyfikował możliwości postępu i wsparcia w rzucaniu palenia, w tym wśród grup populacyjnych doświadczających dysproporcji związanych z paleniem i rzucaniem palenia. Kompleksowe strategie zapobiegania i kontroli tytoniu handlowego, takie jak strategie detaliczne i polityka wolna od dymu tytoniowego, mogą wspierać i zwiększać rzucanie palenia na poziomie populacji.2
Leki i behawioralne poradnictwo są dwoma głównymi rodzajami leczenia zaprzestania palenia tytoniu. Leki zaprzestające palenie zmniejszają objawy odstawienia i głód nikotynowy. Istnieją dwa rodzaje leków stosowanych w leczeniu uzależnienia od nikotyny: produkty dostępne bez recepty, które zawierają nikotynę, oraz leki na receptę, które nie zawierają nikotyny. Poradnictwo behawioralne uczy osoby umiejętności radzenia sobie i rozwiązywania problemów, których mogą używać, aby unikać tytoniu i zapobiegać nawrotom.12
Ocena czasu do pierwszego papierosa może pomóc klinicystom szybko ocenić ryzyko raka płuc. Odkrycia podkreślają potrzebę rzucenia palenia nawet przez lekkich palaczy, ponieważ nawet lekcy palacze, którzy są lub stają się uzależnionymi palaczami, mogą być narażeni na znaczne ryzyko rozwoju raka płuc.2
Niektórzy dostawcy leczenia uważają, że nierealistyczne jest oczekiwanie od ludzi, że będą próbować rzucić tytoń w tym samym czasie, gdy radzą sobie z innym problemem używania substancji. Większość osób używających tytoniu nie rozwija innych problemów z używaniem substancji, ale dla niektórych osób tytoń wydaje się być narkotykiem bramkowym. Historia palenia, szczególnie codziennego, zwiększa prawdopodobieństwo, że młodzi dorośli będą używać alkoholu, konopi i nielegalnych narkotyków. Ponad 80 procent młodzieży, która ma zaburzenia używania substancji, używa tytoniu, rozwija uzależnienie od nikotyny i kontynuuje używanie tytoniu jako dorośli.34
Wnioski i rekomendacje
Uzależnienie od nikotyny/tytoniu to zespół zjawisk behawioralnych, poznawczych i fizjologicznych, które rozwijają się po wielokrotnym użyciu tytoniu i które zazwyczaj obejmują silne pragnienie używania tytoniu, trudności w kontrolowaniu jego używania, uporczywość w używaniu tytoniu pomimo szkodliwych konsekwencji, wyższy priorytet nadany używaniu tytoniu niż innym czynnościom i obowiązkom, zwiększoną tolerancję i czasami fizyczny stan odstawienia.1
Wyniki badań wskazują na wysoką częstość występowania wysokiego/bardzo wysokiego uzależnienia od nikotyny wśród populacji badanych, co podkreśla poważny problem zdrowia publicznego w krajach o niskim i średnim dochodzie, takich jak Nepal. Programy zaprzestania palenia powinny być projektowane i wdrażane z uwzględnieniem poziomu uzależnienia od nikotyny i etapu zmiany palaczy.21
Posiadanie podstawowych informacji na temat poziomu uzależnienia od nikotyny i czynników wpływających na codziennych palaczy może pomóc w opracowaniu bardziej ukierunkowanych i stopniowych strategii interwencji w zakresie rzucania palenia, a także wczesnych interwencji, które koncentrują się na czynnikach związanych z nikotyną w odpowiednim czasie.3
Zmniejszenie obciążenia zdrowotnego związanego z produktami tytoniowymi wymaga wielodyscyplinarnego podejścia w zakresie badań, leczenia, szkoleń, usług i zmian polityki.1 Wczesna interwencja wobec palacza jest kluczowa, aby zaprzestać palenia, zanim uzależnienie od nikotyny się rozwinie. Bez koncentracji interwencji na palaczach rozpoczynających zamiast na palaczach już uzależnionych, wiele dzieci, które próbują papierosów, stanie się uzależnionych.1
Ciągły nadzór nad populacjami używającymi różnych rodzajów produktów tytoniowych dodatkowo pomoże w identyfikacji grup, które mogą skorzystać z dodatkowych strategii zapobiegania i rzucania palenia, oraz rozszerzony dostęp i dostępność leczenia i poradnictwa w zakresie uzależnienia od tytoniu.1
Kolejne rozdziały
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Materiały źródłowe
- #1 Nicotine dependence – Wikipediahttps://en.wikipedia.org/wiki/Nicotine_dependence
Nicotine dependence is a serious public health problem because it leads to continued tobacco use and the associated negative health effects. Tobacco use is one of the leading preventable causes of death worldwide, causing more than 8 million deaths per year and killing half of its users who do not quit. […] According to the World Health Organization, „Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day.” […] There is an increased incidence of nicotine dependence in individuals with psychiatric disorders, such as anxiety disorders and substance use disorders. […] First-time nicotine users develop a dependence about 32% of the time.
- #1 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/917297-overview
Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1300 deaths every day. […] Nicotine addiction is a leading cause of death worldwide. The important causes of smoking-related mortality are atherosclerotic vascular disease, cancer, and chronic obstructive pulmonary disease (COPD). Smoking also can contribute to other diseases, such as histiocytosis X, respiratory bronchiolitis, obstructive sleep apnea, idiopathic pneumothorax, low birth weight, and perinatal mortality. […] Worldwide, approximately 1.1 billion people smoke. Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. […] Also worldwide, tobacco use causes nearly 8 million deaths per year. More than 7 million of those deaths are the result of direct tobacco use, while around 1.3 million are the result of non-smokers being exposed to second-hand smoke.
- #1 The epidemiology of nicotine dependence | SpringerLinkhttps://link.springer.com/chapter/10.1007/978-1-4471-0769-9_89
Tobacco: The Growing Epidemic […] If one looks at dependence instead of prevalence, nicotine may addict more users than any other drug. The lifetime dependency on nicotine is approximately 24% in China and 14% in the United States. Approximately 75% of the smokers in the western world can be classified as dependent.
- #1 Nicotine dependence – Wikipediahttps://en.wikipedia.org/wiki/Nicotine_dependence
Estimates are that half of smokers (and one-third of former smokers) are dependent based on DSM criteria, regardless of age, gender or country of origin, but this could be higher if different definitions of dependence were used. […] Recent data suggest that, in the United States, the rates of daily smoking and the number of cigarettes smoked per day are declining, suggesting a reduction in population-wide dependence among current smokers. […] However, there are different groups of people who are more likely to smoke than the average population, such as those with low education or low socio-economic status and those with mental illness. […] There is also evidence that among smokers, some subgroups may be more dependent than other groups. […] Men smoke at higher rates than do women and score higher on dependence indices; however, women may be less likely to be successful in quitting, suggesting that women may be more dependent by that criterion.
- #1https://pmc.ncbi.nlm.nih.gov/articles/PMC8154113/
Prevalences of 12-month and lifetime DSM-5 NUD were 20.0% and 27.9%. […] Individuals with current NUD with at least one psychiatric disorder comprised 11.1% of U.S. adults but smoked 53.6% of total cigarettes consumed. […] Findings underscore the need to address nicotine use in clinical settings. […] The burden of U.S. cigarette consumption among psychiatrically comorbid individuals with NUD appears even greater than that among individuals with ND in our previous study. […] Rates of help seeking were low (20.3% and 18.8%) for both 12-month and lifetime DSM-5 NUD. […] Integration of NUD services into primary care, mental health and substance abuse treatment settings is warranted.
- #1 Measures of nicotine dependence enhance interpretation of number of cigarettes smoked in youth smoking surveillance – PubMedhttps://pubmed.ncbi.nlm.nih.gov/31493751/
Measures of nicotine dependence enhance interpretation of number of cigarettes smoked in youth smoking surveillance. […] Nicotine dependence (ND) symptoms can occur soon after first puff, so that stopping smoking becomes difficult well before 100 cigarettes lifetime is attained. Yet some surveillance systems do not monitor ND symptoms and 100-cigarettes lifetime is used in at least one surveillance system to define current smokers. […] Despite low cigarette consumption, 21-30% of grade 7 smokers reported ND symptoms. This increased to 27-44% in grade 8 and remained stable thereafter despite increased cigarette consumption. In grade 7, 10% of all smokers had not attained the 100-cigarette milestone but were already dependent. In grade 8, 9, 10 and 11, these proportions were 12%, 8%, 6% and 6%, respectively.
- #1 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/917297-overview
Cigarette smoking declined from 12.5% in 2020 to 11.5% in 2021, the lowest prevalence recorded since 1965. […] In 2021, 11.5% of US adults (28.3 million people) currently smoked cigarettes: 13.1% of men, 10.1% of women. […] In 2023, about 1 of every 100 middle school students (1.1%) reported that they had smoked cigarettes in the past 30 days. In the same year, nearly 2 of every 100 high school students (1.9%) reported that they had smoked cigarettes in the past 30 days. […] Studies reveal that the average age of first-time smokers is 14.5 years and the average age of daily smokers is 17.7 years. Approximately 20% of high school seniors smoke. […] Early onset of tobacco use contributes to greater rates of addiction, making adolescence a particularly vulnerable age. […] The 2020 US Surgeon Generals report concluded that prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by age 18 years (88%), with 99% of first use occurring by age 26 years.
- #1 2 Patterns of Tobacco Use by Adolescents and Young Adults | Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products | The National Academies Presshttps://nap.nationalacademies.org/read/18997/chapter/4
There is considerable evidence that age of initiation is associated with levels of nicotine dependence. […] Longitudinal studies following participants from adolescence to young adulthood also showed a statistically significant gradient, with younger ages of initiation associated with greater nicotine dependence. […] An earlier age of initiation is associated with greater levels of nicotine dependence. […] An earlier age of initiation is associated with greater intensity and persistence of smoking beyond adolescence and through adulthood.
- #1 SciELO Brazil – Epidemiology of tobacco use and nicotine dependence in truck drivers Epidemiology of tobacco use and nicotine dependence in truck drivershttps://www.scielo.br/j/rsp/a/btTMXy5y5w73yLnxPzwhWhz/?lang=en
The prevalence of tobacco use among truck drivers was 21.1% (n = 132; 95%CI: 18.1-24.5). […] Of the total number of smokers who responded to the FTND (n = 118; 89.4%), most had high/very high nicotinic dependence (68.6%; 95%CI: 59.8-76.3). […] The results showed a high prevalence of tobacco use and high/very high nicotine dependence among the truck drivers. […] This investigation estimated the prevalence and factors associated with tobacco use and nicotine dependence in truck drivers in Brazil. […] The findings show a high prevalence of tobacco use and reveal its association with occupational aspects (employment contract and daily working hours). […] The prevalence of tobacco use in the sample was 21.1% (95%CI: 18.1-24.5), which is higher than that estimated for the general male population in Brazil (18.9%, 95%CI: 18.0-19.7), verifying the vulnerability of truck drivers to the use of this substance.
- #1https://www.tobaccoinduceddiseases.org/Epidemiology-of-menthol-cigarette-use-in-the-United-States,66040,0,2.html
Approximately one-fourth of all cigarettes sold in the United States have the descriptor menthol on the cigarette pack. It is important to determine what socio-demographic factors are associated with smoking menthol cigarettes if indeed these types of cigarettes are related to smoking initiation, higher exposure to smoke constituents, nicotine dependence, or reduced smoking cessation. […] Menthol cigarettes are disproportionately smoked by adolescents, blacks/African Americans, adult females, those living in the Northeast of the United States and those with family incomes lower than $50,000. […] Menthol cigarettes are disproportionately smoked by groups of U.S. cigarette smokers. It is likely that other disparities in menthol cigarette use exist that we have not covered or have not been studied yet.
- #1 Analysis of nicotine dependence among daily smokers in China: evidence from a cross-sectional study in Zhejiang Province | BMJ Openhttps://bmjopen.bmj.com/content/12/10/e062799
Objective The current study aimed to assess the level of nicotine dependence and its influencing factors among daily smokers in Zhejiang, China. […] Results The findings revealed that 17.4% of daily smokers were highly dependent on nicotine, and the mean Fagerström Test for Nicotine Dependence score of daily smokers was (3.1±2.4). […] Conclusions This study elucidated that nearly one-fifth of daily smokers in Zhejiang, China, have high nicotine dependence levels. Improved health information on tobacco smoking is needed to encourage daily smokers to quit smoking, particularly among young males, unemployed persons and those with lower education levels. […] Nicotine dependence contributes to the maintenance of tobacco use and difficulty with cessation. […] The average FTND score of daily smokers was 3.1, and more than one-sixth of respondents were highly dependent on nicotine. Age, educational level, occupation and age of starting daily smoking were strongly associated with high nicotine dependence.
- #1 THE EPIDEMIOLOGY OF TOBACCO USE, DEPENDENCE, AND CESSATION IN THE UNITED STATES – EM consultehttps://www.em-consulte.com/article/590420/the-epidemiology-of-tobacco-use-dependence-and-ces
This article reviews the epidemiology of tobacco use, nicotine dependence, and smoking cessation in the United States, drawing on the latest epidemiologic data and augmenting prior epidemiologic reviews. […] Nicotine dependence reflects compulsive use of nicotine-containing tobacco, physiologic tolerance (i.e., needing to use increased amounts of nicotine to achieve the desired effect), nicotine withdrawal upon discontinuation of tobacco use (e.g., symptoms such as craving for nicotine, irritability, anger, anxiety, depression, increased appetite), and continued use despite significant problems related to tobacco use (e.g., health problems). […] The distinction between tobacco use and dependence may be significant given recent studies indicating that never-daily smokers make up a significant minority of smokers, especially among certain ethnic minorities, where prevalence rates of probable nondependent users (never-daily) smokers are as high as 16.8%. […] Nicotine-dependent tobacco users also appear to be at increased risk for psychiatric conditions such as major depression and alcoholism.
- #1https://www.who.int/news-room/fact-sheets/detail/tobacco
Good monitoring tracks the extent and character of the tobacco epidemic and indicates how best to tailor policies. Almost half of the world’s population are regularly asked about their tobacco use in nationally representative surveys among adults and adolescents. […] The WHO FCTC is a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance. Since its entry into force in 2005, the WHO FCTC has 182 Parties covering more than 90% of the worlds population. […] WHO has been monitoring MPOWER measures since 2007. For more details on progress made for tobacco control at global, regional and country level, please refer to the series of WHO reports on the global tobacco epidemic.
- #1 2 Patterns of Tobacco Use by Adolescents and Young Adults | Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products | The National Academies Presshttps://nap.nationalacademies.org/read/18997/chapter/4
Several national surveys provide data for estimation of smoking behavior among adolescents and young adults in the United States. […] This chapter then continues with evidence about the effect of age of initiation on patterns of nicotine dependence and cessation. […] The relationship between socioeconomic status and smoking also differs by racial/ethnic category (HHS, 2012). […] The often irregular pattern of tobacco use behavior presents a challenge for clearly identifying exactly when nicotine dependence develops in the progression of tobacco use. […] Nicotine dependence is characterized by physiological adaptations (e.g., tolerance, withdrawal) and other accommodating behaviors (e.g., time spent in activities necessary to obtain and use nicotine and to recover from its effects and the forfeiting or reduction of important social, occupational, or recreational activities) resulting from chronic smoking.
- #1 Measures of nicotine dependence enhance interpretation of number of cigarettes smoked in youth smoking surveillance – PubMedhttps://pubmed.ncbi.nlm.nih.gov/31493751/
ND symptoms should be monitored in youth surveillance systems since they tell a different „story” than cigarettes and their appearance may represent a critical „point-of-no-return.” Interventions for incident smokers are needed across grades to stop smoking before ND manifests. Without a shift in focus toward incident rather than established smokers, many children who try cigarettes will become addicted.
- #1https://discovery.ucl.ac.uk/id/eprint/10109770/
Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey 2017-2019 reveal about high school e-cigarette use in the USA? […] Between 2018 and 2020, the US Food and Drug Administration announced various restrictions on e-cigarette manufacturers in response to a perceived epidemic of e-cigarette use and nicotine dependence among high school students. […] Past-30-day e-cigarette use increased from 11.7% in 2017 to 20.8% in 2018, and 27.5% in 2019. […] While use of e-cigarettes in US high-school students increased sharply between 2017 and 2019, frequent use and signs of e-cigarette dependence remained rare in students who had only ever used e-cigarettes and never any other tobacco product.
- #1https://discovery.ucl.ac.uk/id/eprint/10109770
Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey 2017-2019 reveal about high school e-cigarette use in the USA? […] Between 2018 and 2020, the US Food and Drug Administration announced various restrictions on e-cigarette manufacturers in response to a perceived epidemic of e-cigarette use and nicotine dependence among high school students. […] We analysed e-cigarette use and dependence in the NYTS in relation to lifetime history of use of tobacco products. […] Past-30-day e-cigarette use increased from 11.7% in 2017 to 20.8% in 2018, and 27.5% in 2019. […] Conclusions: While use of e-cigarettes in US high-school students increased sharply between 2017 and 2019, frequent use and signs of e-cigarette dependence remained rare in students who had only ever used e-cigarettes and never any other tobacco product.
- #1 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/287555-overview
Studies reveal that the average age of first-time smokers is 14.5 years and the average age of daily smokers is 17.7 years. Approximately 20% of high school seniors smoke. […] The 2020 US Surgeon Generals report concluded that prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by age 18 years (88%), with 99% of first use occurring by age 26 years. […] The Surgeon Generals report also states that tobacco use among adolescents and young adults has decreased substantially, especially since 1998. However, this decrease has begun to level off, particularly since 2007. Some groups have demonstrated increases in the prevalence of tobacco use (eg, the growth of smokeless tobacco use among White males). […] In 2023, about 1 out of every 22 middle school students (4.6%) reported that they had used electronic cigarettes in the past 30 days. In the same year, 1 of every 10 high school students (10.0%) reported that they had used electronic cigarettes in the past 30 days.
- #1 THE EPIDEMIOLOGY OF TOBACCO USE, DEPENDENCE, AND CESSATION IN THE UNITED STATES – EM consultehttps://www.em-consulte.com/article/590420/the-epidemiology-of-tobacco-use-dependence-and-ces
Tobacco use, primarily in the form of cigarettes, is the leading preventable cause of death in the United States, accounting for almost 20% of all deaths. […] Recent estimates of smoking-attributable mortality (SAM) from 1990 to 1994 indicate that cigarette smoking caused nearly 431,000 deaths per year. […] In 1996, the US Food and Drug Administration (FDA) determined that nicotine in tobacco is addictive and that most cigarette smokers and users of smokeless tobacco continue to use tobacco in order to satisfy their addiction to nicotine. […] In addition, the American Psychiatric Association has included nicotine dependence in its Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in recognition of the addictiveness of nicotine. […] Tobacco use and dependence, therefore, represent a significant public health issue in both the United States and globally.
- #1 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/287555-overview
Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1300 deaths every day. […] Nicotine addiction is a leading cause of death worldwide. The important causes of smoking-related mortality are atherosclerotic vascular disease, cancer, and chronic obstructive pulmonary disease (COPD). Smoking also can contribute to other diseases, such as histiocytosis X, respiratory bronchiolitis, obstructive sleep apnea, idiopathic pneumothorax, low birth weight, and perinatal mortality. […] Worldwide, approximately 1.1 billion people smoke. Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. […] Also worldwide, tobacco use causes nearly 8 million deaths per year. More than 7 million of those deaths are the result of direct tobacco use, while around 1.3 million are the result of non-smokers being exposed to second-hand smoke.
- #1 JMIR Public Health and Surveillance – Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Studyhttps://publichealth.jmir.org/2024/1/e53170/
This study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. […] Chronic obstructive pulmonary disease (COPD) is a global health challenge, ranking among the leading causes of both morbidity and mortality worldwide. […] Smoking, recognized as the most significant cause of COPD, leads to its development in approximately half of all smokers. […] A systematic review suggested that maternal smoking during pregnancy (MSDP) is associated with an increased risk of COPD. […] Despite widespread recognition of the adverse effects of MSDP on offspring COPD, the underlying mechanisms remain incompletely elucidated. […] Tobacco dependence (TD) is a complex condition influenced by genetic and environmental factors, classified as a mental disorder according to the International Classification of Diseases, and TD should be recognized as a lethal noncommunicable disease.
- #1 JMIR Public Health and Surveillance – Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Studyhttps://publichealth.jmir.org/2024/1/e53170/
Maternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD), but the underlying mechanism remains unclear. […] This study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD). […] The study included 5943 participants (2991 with COPD and 2952 controls). […] TD was more prevalent in the COPD group (COPD: n=582, 40.40%; controls: n=478, 33.90%; P<.001). [...] After adjusting for covariates, MSDP had a significant effect on COPD (β=.097; P<.001). [...] There was an association between MSDP and TD (β=.074; P<.001) as well as between TD and COPD (β=.048; P=.007). [...] Mediation analysis of TD in the MSDP-COPD association showed significant direct and indirect effects (direct: β=.094; P<.001 and indirect: β=.004; P=.03).
- #1 JMIR Public Health and Surveillance – Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Studyhttps://publichealth.jmir.org/2024/1/e53170/
Previous studies have established that individuals with a history of MSDP face an elevated risk of TD in adolescence and adulthood. […] This study revealed a direct association between TD and COPD. […] This study bears significant implications as it substantiates the partial mediating role of TD in the link between MSDP and COPD, underlining the importance of developing interventions targeting TD to mitigate the incidence of COPD in offspring.
- #1 Study finds stronger nicotine dependency associated with higher risk of lung cancer – NCIhttps://www.cancer.gov/news-events/press-releases/2014/smokinglungcancer
People who are highly addicted to nicotine — those who smoke their first cigarette within five minutes after awakening — are at higher risk of developing lung cancer than those who wait for an hour or more to smoke. […] The researchers observed that people who had smoked their first cigarette within five minutes of waking up had more than three times the risk of lung cancer compared with those who waited longer than an hour before smoking their first cigarette of the day, after taking into account other smoking characteristics, age and gender. […] Assessing time to a first cigarette may help clinicians quickly assess lung cancer risk. […] The findings underscore the need for even light smokers to quit, because even light smokers who are, or who become dependent smokers, can be at substantial risk for developing lung cancer.
- #1 Expanding the genetic architecture of nicotine dependence and its shared genetics with multiple traits | Nature CommunicationsClose bannerClose bannerhttps://www.nature.com/articles/s41467-020-19265-z
Cigarette smoking is the leading cause of preventable morbidity and mortality. Genetic variation contributes to initiation, regular smoking, nicotine dependence, and cessation. We present a Fagerström Test for Nicotine Dependence (FTND)-based genome-wide association study in 58,000 European or African ancestry smokers. We observe five genome-wide significant loci, including previously unreported loci MAGI2/GNAI1 (rs2714700) and TENM2 (rs1862416), and extend loci reported for other smoking traits to nicotine dependence. Nicotine dependence (SNP-based heritability = 8.6%) is genetically correlated with 18 other smoking traits (r_g = 0.40â1.09) and co-morbidities. Our results highlight nicotine dependence-specific loci, emphasizing the FTND as a composite phenotype that expands genetic knowledge of smoking.
- #1 Expanding the genetic architecture of nicotine dependence and its shared genetics with multiple traits | Nature CommunicationsClose bannerClose bannerhttps://www.nature.com/articles/s41467-020-19265-z
In comparison to other stages of smoking, known loci for ND are limited. Only six reproducible, genome-wide significant loci have been identified: CHRNB3-CHRNA6 (chr8p11), DBH (chr9q34), CHRNA5-CHRNA3-CHRNB4 (chr15q25), DNMT3B and NOL4L (chr20q11), and CHRNA4 (chr20q13). A more complete understanding of the genetics underlying ND is needed, as it could help to predict the likelihood of quitting smoking, withdrawal severity, response to treatment, and health-related consequences. […] The FTND provides a composite phenotype that captures multiple behavioral and psychological features of ND among smokers. Its validity may be due to the inclusion of the time-to-first-cigarette in the morning (TTFC) item, which appears to be especially strongly associated with relapse likelihood and may be an especially informative measure of heritability of ND. […] Our findings highlight two genetic loci with previously unreported associations with cigarette smoking, genetic correlations between ND and 18 other phenotypes, and enrichment of ND heritability with genes expressed in cerebellum.
- #1 A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology | Translational Psychiatryhttps://www.nature.com/articles/tp2016132
It has been proposed that vulnerability to nicotine addiction is moderated by variation at the -opioid receptor locus (OPRM1), but results from human studies vary and prospective studies based on genotype are lacking. […] The individual response to nicotine varies widely, partly due to genetic factors. Moderate heritability (~0.6) has been found for nicotine addiction in large twin studies, and similar findings have also been obtained for initiation and use. […] Understanding the role of genetic factors may allow for the development of personalized approaches to the prevention and treatment of nicotine addiction. […] The rewarding properties of nicotine are mediated in part by -opioid receptors (MOR) encoded by the OPRM1 locus. […] A single nucleotide polymorphism (SNP), rs1799971:AG (A118G), exists within exon 1 of the OPRM1 gene and encodes a non-synonomous substitution (Asn40Asp) in the extracellular N-terminal loop of MOR, resulting in loss of a glycosylation site.
- #1 A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology | Translational Psychiatryhttps://www.nature.com/articles/tp2016132
Several studies have implicated the A118G variation with individual differences in nicotine reinforcement or addiction, but its role remains unclear and conflicting findings have been reported. […] It thus remains unclear whether OPRM1 A118G alters the susceptibility to smoking behaviors. […] Human genetic studies aimed at identifying risk variants suffer from two important potential confounds: linkage disequilibrium with other variants and stratification bias. […] Here we used this humanized OPRM1 mouse model in a translational approach to clarify some of the reported genotype and sex discrepancies associated with the A118G variation as related to nicotine reinforcement. […] The most salient finding of the present translational study is a striking similarity between species in the sensitivity to nicotine reinforcement as a function of genotype and sex. […] Our demonstration of greater sensitivity to the rewarding effects of nicotine in males carrying the OPRM1 118G allele is important for the development of personalized approaches to the prevention and treatment of smoking addiction.
- #1 Epidemiology, radiology, and genetics of nicotine dependence in COPD | Respiratory Research | Full Texthttps://respiratory-research.biomedcentral.com/articles/10.1186/1465-9921-12-9
Genetic variants in CHRNA3/5 (rs8034191 and rs1051730) were significantly associated with nicotine dependence. However, in a relatively small group of current smokers, an association of genetic variants in CHRNA3/5 (rs8034191 and rs1051730) with severity of emphysema or air trapping on CT was not found; the impact of current smoking on CT-measured emphysema may limit detection of significant genetic associations.
- #1 Epidemiology, radiology, and genetics of nicotine dependence in COPD | Applied Chest Imaging Laboratoryhttps://acil.bwh.harvard.edu/epidemiology-radiology-and-genetics-nicotine-dependence-copd-0.html
BACKGROUND: Cigarette smoking is the principal environmental risk factor for developing COPD, and nicotine dependence strongly influences smoking behavior. […] This study was performed to elucidate the relationship between nicotine dependence, genetic susceptibility to nicotine dependence, and volumetric CT findings in smokers. […] Nicotine dependence was determined by the Fagerstrom test for nicotine dependence (FTND). […] Among 842 currently smoking subjects (335 COPD cases and 507 controls), 329 subjects (39.1%) showed high nicotine dependence. […] Subjects with high nicotine dependence had greater cumulative and current amounts of smoking. […] However, emphysema severity was negatively correlated with the FTND score in controls ( = -0.19, p .0001) as well as in COPD cases ( = -0.18, p = 0.0008).
- #1 Epidemiology, radiology, and genetics of nicotine dependence in COPD | Applied Chest Imaging Laboratoryhttps://acil.bwh.harvard.edu/epidemiology-radiology-and-genetics-nicotine-dependence-copd-0.html
Lower FTND score, male gender, lower body mass index, and lower FEV1 were independent risk factors for emphysema severity in COPD cases. […] Both CHRNA3/5 SNPs were associated with FTND in current smokers. […] An association of genetic variants in CHRNA3/5 with severity of emphysema was only found in former smokers, but not in current smokers. […] CONCLUSIONS: Nicotine dependence was a negative predictor for emphysema on CT in COPD and control smokers.
- #1 Nicotine dependence and quitting stages of smokers in Nepal: A community based cross-sectional study | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266661
Nicotine dependence is an addiction to tobacco products caused by the chemical nicotine present in tobacco. 80% of premature deaths due to nicotine dependence come from low-and middle-income countries. […] Our study showed that high level of nicotine dependence is a major public health problem in low-and middle-income countries like Nepal. It also highlights that effective smoking cessation programs should be developed considering the level of nicotine dependence with more focus on early interventions of its associated factors. […] Nicotine dependence has multiple public health implications. First, nicotine dependence is a major force driving the urge to smoke, making it very difficult to quit. Second, nicotine dependence has a high degree of co-morbidity with certain psychiatric conditions such as substance abuse and mood disorders. Third, smoking is the most common risk factor for ill health, which directly affects the respiratory and cardiovascular systems and causes premature death.
- #1 Adult Smoking Cessation â United States, 2022 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7329a1.htm
Tobacco dependence is a chronic condition driven by nicotine addiction. Successful quitting can be increased by health care provider intervention and evidence-based treatment. CDC assessed national estimates of cigarette smoking cessation indicators among U.S. adults using 2022 National Health Interview Survey data. In 2022, approximately two thirds (67.7%) of the 28.8 million U.S. adults who smoked wanted to quit, and approximately one half (53.3%) made a quit attempt, but only 8.8% quit smoking. One half of adults who smoked and saw a health professional during the past year received health professional advice (50.5%) or assistance (49.2%) to quit smoking. Among those who tried to quit, 38.3% used treatment (i.e., counseling or medication). Opportunities exist for both public health and health care sectors to increase smoking cessation, including expanding access to and utilization of cessation services and supports. Incorporating equitable cessation strategies into all commercial tobacco prevention and control efforts can help advance and support smoking cessation for all population groups.
- #1 Adult Smoking Cessation â United States, 2022 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7329a1.htm
In 2022, most adults who smoked wanted to quit, and approximately one half tried to quit in the past year, but fewer than 10% quit successfully. Consistent with previous studies, this analysis identified a low prevalence of clinical cessation intervention (i.e., advice and assistance) and treatment use. Several barriers to treatment access might play a part in this finding. […] The U.S. Department of Health and Human Services has identified opportunities to advance and support smoking cessation, including among population groups experiencing smoking- and cessation-related disparities. Comprehensive commercial tobacco prevention and control strategies, such as retail strategies and smoke-free policies, can support and increase cessation at the population level.
- #1 Nicotine dependence – Wikipediahttps://en.wikipedia.org/wiki/Nicotine_dependence
There is an increased frequency of nicotine dependence in people with anxiety disorders. […] Nicotine withdrawal is the main factor hindering smoking cessation. […] A 2010 World Health Organization report states, „Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day.” […] E-cigarettes may result in starting nicotine dependence again. […] Greater nicotine dependence may result from dual use of traditional cigarettes and e-cigarettes. […] Like tobacco companies did in the last century, there is a possibility that e-cigarettes could result in a new form of dependency on nicotine across the world.
- #1 HEALTH – Research Report Series: Nicotine Addictionhttps://www.ehd.org/health_tobacco_11.php
Chronic exposure to nicotine results in addiction. […] Greater than 90 percent of those smokers who try to quit without seeking treatment fail, with most relapsing within a week. […] An important but poorly understood component of the nicotine withdrawal syndrome is craving, an urge for nicotine that has been described as a major obstacle to successful abstinence. […] The medical consequences of nicotine exposure result from effects of both the nicotine itself and how it is taken. […] Cigarette smoking is the most important preventable cause of cancer in the United States. […] In pregnant women, carbon monoxide (a lethal gas) and the high doses of nicotine obtained when they inhale tobacco smoke interferes with oxygen supply to the fetus. […] Yes, extensive research has shown that behavioral and pharmacological treatments for nicotine addiction do work. […] More than 90 percent of the people who try to quit smoking relapse or return to smoking within 1 year, with the majority relapsing within a week.
- #1 Nicotine dependence | CAMHhttps://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence
Medications and behavioural counselling are the two main types of tobacco cessation treatment. […] Stop-smoking medications reduce withdrawal symptoms and nicotine cravings. […] Two types of medications exist for treating nicotine dependence: over-the-counter products that contain nicotine and prescription medications that do not contain nicotine. […] Behavioural counselling teaches the person coping and problem-solving skills they can use to avoid tobacco and prevent relapse. […] Some treatment providers think it is unrealistic to expect people to try quitting tobacco at the same time that they are dealing with another substance use problem. […] Most people who use tobacco do not go on to develop other substance use problems, but for some people, tobacco does seem to be a gateway drug. […] A history of smoking, particularly daily, increases the likelihood that young adults will use alcohol, cannabis and illegal drugs. […] More than 80 per cent of youth who have substance use disorders use tobacco, develop nicotine dependence and continue using tobacco as adults.
- #1 Smoking Cessation and Nicotine Addiction – Market Insight, Epidemiology And Market Forecast – 2032https://www.researchandmarkets.com/reports/5523746/smoking-cessation-and-nicotine-addiction?srsltid=AfmBOorsyy0al816f5iivtIb61B5njoTsipxdCJ-Tyv9wf_SgHuWq3E6
Nicotine/tobacco dependence is a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated tobacco use and that typically include a strong desire to use tobacco, difficulties in controlling its use, persistence in tobacco use despite harmful consequences, a higher priority given to tobacco use than other activities and obligations, increased tolerance and sometimes a physical withdrawal state. […] The smoking cessation and nicotine addiction epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by, Prevalent Cases of Tobacco Use, Gender-specific Prevalent Cases of Tobacco Use, Prevalent Cases of Tobacco Use by Product Type, Age-specific Prevalent Cases of Tobacco Use, Prevalent Nicotine Dependent Cases Among Cigarette Smokers, and Prevalent Cases of Smoking Cessation in the 7MM covering the United States, EU4 countries (Germany, France, Italy, and Spain), and the UK, and Japan from 2019 to 2032.
- #1 Nicotine dependence and quitting stages of smokers in Nepal: A community based cross-sectional study | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266661
This study revealed that nicotine dependence was highly substantial with low level of attempts to quit smoking among Nepalese population. Next, smoking cessation programs should be designed and implemented taking into account the level of nicotine dependence and the stage of change of the smokers. The high nicotine dependence identified throughout this study highlights a major public health problem.
- #1 About – Institute for Nicotine & Tobacco Studieshttps://ints.rutgers.edu/about/
The Institute for Nicotine Tobacco Studies has been in existence for nearly two decades, though it has operated under different names. […] The Institute quickly capitalized on tobacco regulatory science research needs and secured FDA funding. […] Since its inception, the Institute has generated over $50 million in grants, cooperative agreements, and contracts from the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the Robert Wood Johnson Foundation (RWJF), and the New Jersey Department of Health (NJDOH). […] Globally, tobacco caused diseases kill 1 in 10 adults and such deaths are projected to exceed 8 million annually by 2030. Tobacco use disproportionately impacts vulnerable populations. […] Reducing the health burden from tobacco products requires a multi-disciplinary approach in research, treatment, training, service, and policy change.
- #1 Current Cigarette Smoking Among Adults in the United States | Smoking and Tobacco Use | CDChttps://www.cdc.gov/tobacco/php/data-statistics/adult-data-cigarettes/index.html
Cigarette smoking among adults has declined over the past decades. […] Tobacco product use remains the leading cause of preventable disease and death in the United States. […] Continued surveillance of populations using different tobacco product types will further aid in identifying groups that may benefit from additional prevention and cessation strategies. […] Expanded access and availability of treatment and counseling for tobacco dependence.
- #2 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/917297-overview
Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1300 deaths every day. […] Nicotine addiction is a leading cause of death worldwide. The important causes of smoking-related mortality are atherosclerotic vascular disease, cancer, and chronic obstructive pulmonary disease (COPD). Smoking also can contribute to other diseases, such as histiocytosis X, respiratory bronchiolitis, obstructive sleep apnea, idiopathic pneumothorax, low birth weight, and perinatal mortality. […] Worldwide, approximately 1.1 billion people smoke. Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. […] Also worldwide, tobacco use causes nearly 8 million deaths per year. More than 7 million of those deaths are the result of direct tobacco use, while around 1.3 million are the result of non-smokers being exposed to second-hand smoke.
- #2 2 Patterns of Tobacco Use by Adolescents and Young Adults | Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products | The National Academies Presshttps://nap.nationalacademies.org/read/18997/chapter/4
There is considerable evidence that age of initiation is associated with levels of nicotine dependence. […] Longitudinal studies following participants from adolescence to young adulthood also showed a statistically significant gradient, with younger ages of initiation associated with greater nicotine dependence. […] An earlier age of initiation is associated with greater levels of nicotine dependence. […] An earlier age of initiation is associated with greater intensity and persistence of smoking beyond adolescence and through adulthood.
- #2 SciELO – Public Health – Epidemiology of tobacco use and nicotine dependence in truck drivers Epidemiology of tobacco use and nicotine dependence in truck drivershttps://www.scielosp.org/article/rsp/2022.v56/108/
To investigate the epidemiology of tobacco use and nicotine dependence in a sample of truck drivers in Brazil. […] The prevalence of tobacco use among truck drivers was 21.1% (n = 132; 95%CI: 18.1-24.5). Of the total number of smokers who responded to the FTND (n = 118; 89.4%), most had high/very high nicotinic dependence (68.6%; 95%CI: 59.8-76.3). […] The results showed a high prevalence of tobacco use and high/very high nicotine dependence among the truck drivers. […] Tobacco use and nicotine dependence represent serious public health problems. […] Truck drivers constitute a group highly vulnerable to tobacco use and nicotine dependence. […] The findings show a high prevalence of tobacco use and reveal its association with occupational aspects (employment contract and daily working hours). […] This study verified a high prevalence of high/very high nicotine dependence among the study population. […] The results of this study show a high prevalence of regular tobacco use in truck drivers who travel the BR-050 in Brazil.
- #2 Nicotine dependence – Wikipediahttps://en.wikipedia.org/wiki/Nicotine_dependence
Estimates are that half of smokers (and one-third of former smokers) are dependent based on DSM criteria, regardless of age, gender or country of origin, but this could be higher if different definitions of dependence were used. […] Recent data suggest that, in the United States, the rates of daily smoking and the number of cigarettes smoked per day are declining, suggesting a reduction in population-wide dependence among current smokers. […] However, there are different groups of people who are more likely to smoke than the average population, such as those with low education or low socio-economic status and those with mental illness. […] There is also evidence that among smokers, some subgroups may be more dependent than other groups. […] Men smoke at higher rates than do women and score higher on dependence indices; however, women may be less likely to be successful in quitting, suggesting that women may be more dependent by that criterion.
- #2 Analysis of nicotine dependence among daily smokers in China: evidence from a cross-sectional study in Zhejiang Province | BMJ Openhttps://bmjopen.bmj.com/content/12/10/e062799
High nicotine dependence (FTNDâ¥6) was observed in 17.4% of daily smokers. The prevalence of high nicotine dependence varied with age, education, occupation and age of starting daily smoking. […] A lower nicotine dependence level was observed among people with a higher education level than among those with less education: primary or less (OR=3.07) and secondary (OR=2.62). […] In general, smokers of low socioeconomic status are prone to a higher degree of nicotine dependence. […] Having baseline information on the level of nicotine dependence and influencing factors in daily smokers can help to develop more targeted and graded cessation intervention strategies, as well as early interventions that focus on nicotine-related factors in a timely manner.
- #2 THE EPIDEMIOLOGY OF TOBACCO USE, DEPENDENCE, AND CESSATION IN THE UNITED STATES – EM consultehttps://www.em-consulte.com/article/590420/the-epidemiology-of-tobacco-use-dependence-and-ces
This article reviews the epidemiology of tobacco use, nicotine dependence, and smoking cessation in the United States, drawing on the latest epidemiologic data and augmenting prior epidemiologic reviews. […] Nicotine dependence reflects compulsive use of nicotine-containing tobacco, physiologic tolerance (i.e., needing to use increased amounts of nicotine to achieve the desired effect), nicotine withdrawal upon discontinuation of tobacco use (e.g., symptoms such as craving for nicotine, irritability, anger, anxiety, depression, increased appetite), and continued use despite significant problems related to tobacco use (e.g., health problems). […] The distinction between tobacco use and dependence may be significant given recent studies indicating that never-daily smokers make up a significant minority of smokers, especially among certain ethnic minorities, where prevalence rates of probable nondependent users (never-daily) smokers are as high as 16.8%. […] Nicotine-dependent tobacco users also appear to be at increased risk for psychiatric conditions such as major depression and alcoholism.
- #2https://www.who.int/news-room/fact-sheets/detail/tobacco
Good monitoring tracks the extent and character of the tobacco epidemic and indicates how best to tailor policies. Almost half of the world’s population are regularly asked about their tobacco use in nationally representative surveys among adults and adolescents. […] The WHO FCTC is a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance. Since its entry into force in 2005, the WHO FCTC has 182 Parties covering more than 90% of the worlds population. […] WHO has been monitoring MPOWER measures since 2007. For more details on progress made for tobacco control at global, regional and country level, please refer to the series of WHO reports on the global tobacco epidemic.
- #2 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/917297-overview
Cigarette smoking declined from 12.5% in 2020 to 11.5% in 2021, the lowest prevalence recorded since 1965. […] In 2021, 11.5% of US adults (28.3 million people) currently smoked cigarettes: 13.1% of men, 10.1% of women. […] In 2023, about 1 of every 100 middle school students (1.1%) reported that they had smoked cigarettes in the past 30 days. In the same year, nearly 2 of every 100 high school students (1.9%) reported that they had smoked cigarettes in the past 30 days. […] Studies reveal that the average age of first-time smokers is 14.5 years and the average age of daily smokers is 17.7 years. Approximately 20% of high school seniors smoke. […] Early onset of tobacco use contributes to greater rates of addiction, making adolescence a particularly vulnerable age. […] The 2020 US Surgeon Generals report concluded that prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by age 18 years (88%), with 99% of first use occurring by age 26 years.
- #2 Nicotine Addiction: Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/287555-overview
Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1300 deaths every day. […] Nicotine addiction is a leading cause of death worldwide. The important causes of smoking-related mortality are atherosclerotic vascular disease, cancer, and chronic obstructive pulmonary disease (COPD). Smoking also can contribute to other diseases, such as histiocytosis X, respiratory bronchiolitis, obstructive sleep apnea, idiopathic pneumothorax, low birth weight, and perinatal mortality. […] Worldwide, approximately 1.1 billion people smoke. Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. […] Also worldwide, tobacco use causes nearly 8 million deaths per year. More than 7 million of those deaths are the result of direct tobacco use, while around 1.3 million are the result of non-smokers being exposed to second-hand smoke.
- #2 JMIR Public Health and Surveillance – Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Studyhttps://publichealth.jmir.org/2024/1/e53170/
This study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. […] Chronic obstructive pulmonary disease (COPD) is a global health challenge, ranking among the leading causes of both morbidity and mortality worldwide. […] Smoking, recognized as the most significant cause of COPD, leads to its development in approximately half of all smokers. […] A systematic review suggested that maternal smoking during pregnancy (MSDP) is associated with an increased risk of COPD. […] Despite widespread recognition of the adverse effects of MSDP on offspring COPD, the underlying mechanisms remain incompletely elucidated. […] Tobacco dependence (TD) is a complex condition influenced by genetic and environmental factors, classified as a mental disorder according to the International Classification of Diseases, and TD should be recognized as a lethal noncommunicable disease.
- #2 Study finds stronger nicotine dependency associated with higher risk of lung cancer – NCIhttps://www.cancer.gov/news-events/press-releases/2014/smokinglungcancer
People who are highly addicted to nicotine — those who smoke their first cigarette within five minutes after awakening — are at higher risk of developing lung cancer than those who wait for an hour or more to smoke. […] The researchers observed that people who had smoked their first cigarette within five minutes of waking up had more than three times the risk of lung cancer compared with those who waited longer than an hour before smoking their first cigarette of the day, after taking into account other smoking characteristics, age and gender. […] Assessing time to a first cigarette may help clinicians quickly assess lung cancer risk. […] The findings underscore the need for even light smokers to quit, because even light smokers who are, or who become dependent smokers, can be at substantial risk for developing lung cancer.
- #2 Expanding the genetic architecture of nicotine dependence and its shared genetics with multiple traits | Nature CommunicationsClose bannerClose bannerhttps://www.nature.com/articles/s41467-020-19265-z
Cigarette smoking is the leading cause of preventable morbidity and mortality. Genetic variation contributes to initiation, regular smoking, nicotine dependence, and cessation. We present a Fagerström Test for Nicotine Dependence (FTND)-based genome-wide association study in 58,000 European or African ancestry smokers. We observe five genome-wide significant loci, including previously unreported loci MAGI2/GNAI1 (rs2714700) and TENM2 (rs1862416), and extend loci reported for other smoking traits to nicotine dependence. Nicotine dependence (SNP-based heritability = 8.6%) is genetically correlated with 18 other smoking traits (r_g = 0.40â1.09) and co-morbidities. Our results highlight nicotine dependence-specific loci, emphasizing the FTND as a composite phenotype that expands genetic knowledge of smoking.
- #2 Expanding the genetic architecture of nicotine dependence and its shared genetics with multiple traits | Nature CommunicationsClose bannerClose bannerhttps://www.nature.com/articles/s41467-020-19265-z
In comparison to other stages of smoking, known loci for ND are limited. Only six reproducible, genome-wide significant loci have been identified: CHRNB3-CHRNA6 (chr8p11), DBH (chr9q34), CHRNA5-CHRNA3-CHRNB4 (chr15q25), DNMT3B and NOL4L (chr20q11), and CHRNA4 (chr20q13). A more complete understanding of the genetics underlying ND is needed, as it could help to predict the likelihood of quitting smoking, withdrawal severity, response to treatment, and health-related consequences. […] The FTND provides a composite phenotype that captures multiple behavioral and psychological features of ND among smokers. Its validity may be due to the inclusion of the time-to-first-cigarette in the morning (TTFC) item, which appears to be especially strongly associated with relapse likelihood and may be an especially informative measure of heritability of ND. […] Our findings highlight two genetic loci with previously unreported associations with cigarette smoking, genetic correlations between ND and 18 other phenotypes, and enrichment of ND heritability with genes expressed in cerebellum.
- #2 A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology | Translational Psychiatryhttps://www.nature.com/articles/tp2016132
It has been proposed that vulnerability to nicotine addiction is moderated by variation at the -opioid receptor locus (OPRM1), but results from human studies vary and prospective studies based on genotype are lacking. […] The individual response to nicotine varies widely, partly due to genetic factors. Moderate heritability (~0.6) has been found for nicotine addiction in large twin studies, and similar findings have also been obtained for initiation and use. […] Understanding the role of genetic factors may allow for the development of personalized approaches to the prevention and treatment of nicotine addiction. […] The rewarding properties of nicotine are mediated in part by -opioid receptors (MOR) encoded by the OPRM1 locus. […] A single nucleotide polymorphism (SNP), rs1799971:AG (A118G), exists within exon 1 of the OPRM1 gene and encodes a non-synonomous substitution (Asn40Asp) in the extracellular N-terminal loop of MOR, resulting in loss of a glycosylation site.
- #2 A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology | Translational Psychiatryhttps://www.nature.com/articles/tp2016132
Several studies have implicated the A118G variation with individual differences in nicotine reinforcement or addiction, but its role remains unclear and conflicting findings have been reported. […] It thus remains unclear whether OPRM1 A118G alters the susceptibility to smoking behaviors. […] Human genetic studies aimed at identifying risk variants suffer from two important potential confounds: linkage disequilibrium with other variants and stratification bias. […] Here we used this humanized OPRM1 mouse model in a translational approach to clarify some of the reported genotype and sex discrepancies associated with the A118G variation as related to nicotine reinforcement. […] The most salient finding of the present translational study is a striking similarity between species in the sensitivity to nicotine reinforcement as a function of genotype and sex. […] Our demonstration of greater sensitivity to the rewarding effects of nicotine in males carrying the OPRM1 118G allele is important for the development of personalized approaches to the prevention and treatment of smoking addiction.
- #2 Epidemiology, radiology, and genetics of nicotine dependence in COPD | Applied Chest Imaging Laboratoryhttps://acil.bwh.harvard.edu/epidemiology-radiology-and-genetics-nicotine-dependence-copd-0.html
BACKGROUND: Cigarette smoking is the principal environmental risk factor for developing COPD, and nicotine dependence strongly influences smoking behavior. […] This study was performed to elucidate the relationship between nicotine dependence, genetic susceptibility to nicotine dependence, and volumetric CT findings in smokers. […] Nicotine dependence was determined by the Fagerstrom test for nicotine dependence (FTND). […] Among 842 currently smoking subjects (335 COPD cases and 507 controls), 329 subjects (39.1%) showed high nicotine dependence. […] Subjects with high nicotine dependence had greater cumulative and current amounts of smoking. […] However, emphysema severity was negatively correlated with the FTND score in controls ( = -0.19, p .0001) as well as in COPD cases ( = -0.18, p = 0.0008).
- #2 Adult Smoking Cessation â United States, 2022 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7329a1.htm
Tobacco dependence is a chronic condition driven by nicotine addiction. Successful quitting can be increased by health care provider intervention and evidence-based treatment. CDC assessed national estimates of cigarette smoking cessation indicators among U.S. adults using 2022 National Health Interview Survey data. In 2022, approximately two thirds (67.7%) of the 28.8 million U.S. adults who smoked wanted to quit, and approximately one half (53.3%) made a quit attempt, but only 8.8% quit smoking. One half of adults who smoked and saw a health professional during the past year received health professional advice (50.5%) or assistance (49.2%) to quit smoking. Among those who tried to quit, 38.3% used treatment (i.e., counseling or medication). Opportunities exist for both public health and health care sectors to increase smoking cessation, including expanding access to and utilization of cessation services and supports. Incorporating equitable cessation strategies into all commercial tobacco prevention and control efforts can help advance and support smoking cessation for all population groups.
- #2 Adult Smoking Cessation â United States, 2022 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7329a1.htm
In 2022, most adults who smoked wanted to quit, and approximately one half tried to quit in the past year, but fewer than 10% quit successfully. Consistent with previous studies, this analysis identified a low prevalence of clinical cessation intervention (i.e., advice and assistance) and treatment use. Several barriers to treatment access might play a part in this finding. […] The U.S. Department of Health and Human Services has identified opportunities to advance and support smoking cessation, including among population groups experiencing smoking- and cessation-related disparities. Comprehensive commercial tobacco prevention and control strategies, such as retail strategies and smoke-free policies, can support and increase cessation at the population level.
- #2 Nicotine dependence | CAMHhttps://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence
Medications and behavioural counselling are the two main types of tobacco cessation treatment. […] Stop-smoking medications reduce withdrawal symptoms and nicotine cravings. […] Two types of medications exist for treating nicotine dependence: over-the-counter products that contain nicotine and prescription medications that do not contain nicotine. […] Behavioural counselling teaches the person coping and problem-solving skills they can use to avoid tobacco and prevent relapse. […] Some treatment providers think it is unrealistic to expect people to try quitting tobacco at the same time that they are dealing with another substance use problem. […] Most people who use tobacco do not go on to develop other substance use problems, but for some people, tobacco does seem to be a gateway drug. […] A history of smoking, particularly daily, increases the likelihood that young adults will use alcohol, cannabis and illegal drugs. […] More than 80 per cent of youth who have substance use disorders use tobacco, develop nicotine dependence and continue using tobacco as adults.
- #2 Nicotine dependence and quitting stages of smokers in Nepal: A community based cross-sectional study | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266661
Nicotine dependence is an addiction to tobacco products caused by the chemical nicotine present in tobacco. 80% of premature deaths due to nicotine dependence come from low-and middle-income countries. […] Our study showed that high level of nicotine dependence is a major public health problem in low-and middle-income countries like Nepal. It also highlights that effective smoking cessation programs should be developed considering the level of nicotine dependence with more focus on early interventions of its associated factors. […] Nicotine dependence has multiple public health implications. First, nicotine dependence is a major force driving the urge to smoke, making it very difficult to quit. Second, nicotine dependence has a high degree of co-morbidity with certain psychiatric conditions such as substance abuse and mood disorders. Third, smoking is the most common risk factor for ill health, which directly affects the respiratory and cardiovascular systems and causes premature death.
- #3 Nicotine dependence – Wikipediahttps://en.wikipedia.org/wiki/Nicotine_dependence
Estimates are that half of smokers (and one-third of former smokers) are dependent based on DSM criteria, regardless of age, gender or country of origin, but this could be higher if different definitions of dependence were used. […] Recent data suggest that, in the United States, the rates of daily smoking and the number of cigarettes smoked per day are declining, suggesting a reduction in population-wide dependence among current smokers. […] However, there are different groups of people who are more likely to smoke than the average population, such as those with low education or low socio-economic status and those with mental illness. […] There is also evidence that among smokers, some subgroups may be more dependent than other groups. […] Men smoke at higher rates than do women and score higher on dependence indices; however, women may be less likely to be successful in quitting, suggesting that women may be more dependent by that criterion.
- #3 Analysis of nicotine dependence among daily smokers in China: evidence from a cross-sectional study in Zhejiang Province | BMJ Openhttps://bmjopen.bmj.com/content/12/10/e062799
High nicotine dependence (FTNDâ¥6) was observed in 17.4% of daily smokers. The prevalence of high nicotine dependence varied with age, education, occupation and age of starting daily smoking. […] A lower nicotine dependence level was observed among people with a higher education level than among those with less education: primary or less (OR=3.07) and secondary (OR=2.62). […] In general, smokers of low socioeconomic status are prone to a higher degree of nicotine dependence. […] Having baseline information on the level of nicotine dependence and influencing factors in daily smokers can help to develop more targeted and graded cessation intervention strategies, as well as early interventions that focus on nicotine-related factors in a timely manner.
- #3 A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology | Translational Psychiatryhttps://www.nature.com/articles/tp2016132
Several studies have implicated the A118G variation with individual differences in nicotine reinforcement or addiction, but its role remains unclear and conflicting findings have been reported. […] It thus remains unclear whether OPRM1 A118G alters the susceptibility to smoking behaviors. […] Human genetic studies aimed at identifying risk variants suffer from two important potential confounds: linkage disequilibrium with other variants and stratification bias. […] Here we used this humanized OPRM1 mouse model in a translational approach to clarify some of the reported genotype and sex discrepancies associated with the A118G variation as related to nicotine reinforcement. […] The most salient finding of the present translational study is a striking similarity between species in the sensitivity to nicotine reinforcement as a function of genotype and sex. […] Our demonstration of greater sensitivity to the rewarding effects of nicotine in males carrying the OPRM1 118G allele is important for the development of personalized approaches to the prevention and treatment of smoking addiction.
- #3 Nicotine dependence | CAMHhttps://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence
Medications and behavioural counselling are the two main types of tobacco cessation treatment. […] Stop-smoking medications reduce withdrawal symptoms and nicotine cravings. […] Two types of medications exist for treating nicotine dependence: over-the-counter products that contain nicotine and prescription medications that do not contain nicotine. […] Behavioural counselling teaches the person coping and problem-solving skills they can use to avoid tobacco and prevent relapse. […] Some treatment providers think it is unrealistic to expect people to try quitting tobacco at the same time that they are dealing with another substance use problem. […] Most people who use tobacco do not go on to develop other substance use problems, but for some people, tobacco does seem to be a gateway drug. […] A history of smoking, particularly daily, increases the likelihood that young adults will use alcohol, cannabis and illegal drugs. […] More than 80 per cent of youth who have substance use disorders use tobacco, develop nicotine dependence and continue using tobacco as adults.
- #4 Nicotine dependence | CAMHhttps://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence
Medications and behavioural counselling are the two main types of tobacco cessation treatment. […] Stop-smoking medications reduce withdrawal symptoms and nicotine cravings. […] Two types of medications exist for treating nicotine dependence: over-the-counter products that contain nicotine and prescription medications that do not contain nicotine. […] Behavioural counselling teaches the person coping and problem-solving skills they can use to avoid tobacco and prevent relapse. […] Some treatment providers think it is unrealistic to expect people to try quitting tobacco at the same time that they are dealing with another substance use problem. […] Most people who use tobacco do not go on to develop other substance use problems, but for some people, tobacco does seem to be a gateway drug. […] A history of smoking, particularly daily, increases the likelihood that young adults will use alcohol, cannabis and illegal drugs. […] More than 80 per cent of youth who have substance use disorders use tobacco, develop nicotine dependence and continue using tobacco as adults.