Steven Stellman - Time to first cigarette after waking predicts cotinine levels

Document created by Steven Stellman on Dec 1, 2016
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  IMuscat, J. E., Stellman, S. D., Caraballo, R. S., Richie, J. P.,   Jr. 18 (12) 3415-20-

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

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