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Multicenter Study
. 2020 Nov;158(5):2184-2191.
doi: 10.1016/j.chest.2020.05.608. Epub 2020 Jun 27.

Association of Cigarette Type and Nicotine Dependence in Patients Presenting for Lung Cancer Screening

Nichole T Tanner  1 , Nina A Thomas  2 , Ralph Ward  3 , Alana Rojewski  4 , Mulugeta Gebregziabher  5 , Benjamin A Toll  6 , Gerard A Silvestri  7
Affiliations
Multicenter Study

Association of Cigarette Type and Nicotine Dependence in Patients Presenting for Lung Cancer Screening

Nichole T Tanner et al. Chest. 2020 Nov.

Abstract

Background: Over decades, there have been several alterations to cigarettes, including the addition of filters and flavoring. However, lung cancer remains the leading cause of cancer-related death in the United States.

Research question: The aim of this study was to examine the association of type of cigarette on nicotine dependence in the setting of lung cancer screening.

Study design and methods: This study is a secondary analysis of the American College of Radiology Imaging Network arm of the National Lung Screening Trial. Tobacco dependence was evaluated by using the Fagerstrӧm Test for Nicotine Dependence, the Heaviness of Smoking Index, and time to first cigarette. Clinical outcomes, including nicotine dependence and tobacco abstinence, were assessed with descriptive statistics and χ2 tests, stratified according to cigarette tar level, flavor, and filter. Logistic regression was used to study the influence of variables on smoking abstinence.

Results: More than one-third of individuals presenting for lung cancer screening are highly addicted to nicotine and smoke within 5 min of waking up. Smokers of unfiltered cigarettes were more nicotine dependent compared with filtered cigarette smokers (OR, 1.32; P < .01). Although smokers of light/ultralight cigarettes had lower dependence (OR, 0.76, P < .0001), there was no difference in smoking abstinence compared with regular cigarette smokers. There was no difference in outcomes when comparing smokers of menthol vs unflavored cigarettes.

Interpretation: In a screening population, the type of cigarette smoked is associated with different levels of dependence. Eliciting type of cigarette and time to first cigarette has the potential to allow for tailored tobacco treatment interventions within this context.

Keywords: cigarette type; lung cancer screening; nicotine dependence; tobacco cessation.

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Figures

Figure 1
Figure 1
A-C, Anatomy of a cigarette depicting different methods to reduce tar yield. A, Reduced density of tobacco with reconstituted or expanded tobacco, additives and flavorings, tobacco blending (with barley, Oriental, or burley tobaccos), or use of lower nicotine yield tobacco and reduced circumference of cigarette rod allows for less tobacco per cigarette. B, Increased porosity and additives to paper allow for increased burn rate and air dilution. C, Filter ventilation allows air dilution of smoke delivered to user.
Figure 2
Figure 2
Forest plot illustrating nicotine dependence scores comparing types of cigarette. Smokers of unfiltered cigarettes score higher in nicotine dependence, whereas smokers of light cigarettes score lower. There is no difference in dependence for smokers of menthol cigarettes vs smokers of regular cigarettes. FTND = Fagerstrӧm Test for Nicotine Dependence; HSI = Heaviness of Smoking Index; TTFC = time to first cigarette.
See this image and copyright information in PMC

Comment in

  • Smoking Cessation Is Not About Assessing Dependency But Practicing Empathy.
    Braillon A. Braillon A. Chest. 2021 May;159(5):2121-2122. doi: 10.1016/j.chest.2020.12.059. Chest. 2021. PMID: 33965148 No abstract available.
  • Response.
    Tanner NT, Thomas NA, Ward R, Rojewski A, Gebregziabher M, Toll BA, Silvestri GA. Tanner NT, et al. Chest. 2021 May;159(5):2122. doi: 10.1016/j.chest.2021.01.027. Chest. 2021. PMID: 33965149 No abstract available.

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