Nicotine, cotinine, withdrawal, and craving patterns during smoking and nicotine nasal spray use: results from a pilot study with African American men.
Nicotine intake via smoking is highly variable. Individualized dosing of nicotine replacement therapy (NRT) may improve product efficacy, but a better understanding of the within-day and within-subject relationships between smoking, NRT use, nicotine and cotinine concentrations in blood, and cravings and withdrawal symptoms is needed to inform dosing algorithms. A pilot study was undertaken to collect data on these relationships and to assess the feasibility of the methods needed for this type of research, including a sophisticated statistical modeling technique (a two-part mixed-effects model with correlated random effects that accounts for clumping at zero). Because nicotine metabolism varies by gender and race, the sample was homogeneous with respect to these characteristics. In a within-subjects study, 27 African American adult male smokers carried a computerized cigarette dispenser for 1 week, capturing the time each cigarette was smoked. Subjects then entered an inpatient setting for 1 day of scheduled smoking (matched to data from the cigarette dispenser to create an ecologically valid schedule) and 4 days of ad libitum nicotine nasal spray use, while tobacco abstinent. Eight times per day, at 2-hour intervals, blood was drawn and ratings of cigarette cravings and withdrawal symptoms were obtained. On average, subjects used less than half of the manufacturer's recommended minimum daily dose of nicotine nasal spray. Large differences in nicotine and cotinine levels were observed between individuals. When predicting nicotine, cotinine, withdrawal, and cravings, we observed significant interactions between route of nicotine intake and a variety of independent variables.
Mabry
Patricia L
PL
SAIC-Frederick, Inc., support to Tobacco Control Research Branch (TCRB), Behavioral Research Program (BRP), Division of Cancer Control and Population Sciences (DCCPS), National Cancer Institute. Bethesda, MD. mabryp@od.nih.gov
Tooze
Janet A
JA
Moser
Richard P
RP
Augustson
Erik M
EM
Malcolm
Robert J
RJ
Benowitz
Neal L
NL
D000281:Administration, Intranasal; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000465:Algorithms; D003367:Cotinine / Q000097:blood*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology*; D004334:Drug Administration Schedule; D005731:Ganglionic Stimulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D010865:Pilot Projects; D012907:Smoking / Q000208:ethnology*; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology* / Q000209:etiology*; D014029:Tobacco Use Disorder / Q000097:blood / Q000208:ethnology / Q000517:prevention & control
D005731:Ganglionic Stimulants; D009538:Nicotine; D003367:Cotinine