Time to First Cigarette, a Proxy of Nicotine Dependence, Increases the Risk of Pulmonary Impairment, Independently of Current and Lifetime Smoking Behavior

Abstract

This study shows that smoking sooner after waking, a reliable indicator of ND, substantially increases the risk of spirometry-defined pulmonary impairment and self-reported symptoms, independently of lifetime and current smoking behavior. This study adds to a small body of literature examining health outcomes associated with higher ND, including outcomes of COPD. The current study overcomes important shortcomings of these existing studies in at least two ways: controlling for other known risk factors for COPD, and using empirical, spirometry-defined outcomes pulmonary function rather than self-reported COPD outcomes.

New chemosensory component in the U.S. National Health and Nutrition Examination Survey (NHANES): first-year results for measured olfactory dysfunction

“…Differences in findings across these population-based studies could have result from how smoking was defined. The current analysis did not consider additional information on the level of exposure to cigarette smoking, including amount smoked per day and number of years smoking, the recency of quitting, consideration of biomarkers of smoking (e.g., cotinine), and level of nicotine dependence, which may be better measures to capture associations between smoking behaviors and negative health outcomes [96]. Preliminary data from our laboratory suggests that chronic smokers have higher rates of olfactory dysfunction (assessed by odor identification) than reported in this NHANES analysis [97] and that heavy drinking and chronic smoking interact to explain risk of self-reported olfactory dysfunction [98].…”

Time to first cigarette and serum cholesterol levels

“…Previous research has documented that earlier TTFC is associated with a higher risk for chronic obstructive pulmonary disease (Goodwin et al, 2012; Selya et al, 2016) and smoking-related cancers (Gu et al, 2014; Ito et al, 2013; Kunze et al, 2007; Muscat et al, 2011a, 2012a, 2011b), independently of smoking behavior. The current study, to the authors’ knowledge, is the first to show that TTFC, a validated measure of ND (Fagerstrom, 2003), is associated with less favorable cholesterol profiles (especially low HDL).…”

“…Three models of varying complexity were run for each outcome: 1) an unadjusted model; 2) a model adjusted for current and lifetime smoking behavior; and 3) a model adjusted for current and lifetime smoking behavior, demographics, and other CVD risk factors. An interaction term between TTFC and pack-years was tentatively included based on previous literature (Selya et al, 2016) for preliminary analysis of models 2) and 3), and was included in the final analyses only if at least trending ( p < 0.10).…”

“…That is, more nicotine-dependent smokers are at higher risk for chronic obstructive pulmonary disease (Goodwin et al, 2012; Selya et al, 2016), lung cancer (Gu et al, 2014; Ito et al, 2013; Kunze et al, 2007; Muscat et al, 2011a), and head, neck, and larynx cancers (Muscat et al, 2011b; Muscat et al, 2012). Importantly, these risks associated with higher ND remain even after accounting for previous smoking behavior; this underscores the necessity of examining the contribution of ND when evaluating the risk of smoking-related death and disease.…”

Earlier smoking after waking and the risk of asthma: a cross-sectional study using NHANES data

“…For example, adolescent smokers often develop ND at low, even non-daily levels of smoking [ 2 – 4 ], and this predicts future smoking behavior even after accounting for prior smoking behavior [ 3 , 5 , 6 ], while other demographic groups show very low ND despite heavy smoking behavior [ 2 ]. Moreover, ND poses a higher risk than does smoking behavior alone for several other smoking-related health outcomes, including lung cancer [ 7 , 8 ], larynx cancer [ 9 ], head and neck cancer [ 10 ], and chronic obstructive pulmonary disease (COPD) [ 11 , 12 ]. A limited number of studies reported that asthma significantly increases the risk of both smoking behavior and ND [ 13 , 14 ]; however, the association between asthma and ND was not assessed independently of smoking behavior.…”