title: Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome.
abstract: OBJECTIVE
  This study aimed to describe the characteristics of treatment-seeking patients who wake at night to smoke (night-smoking), identify factors that may be associated with night-smoking, and assess the association between night-smoking and treatment outcome.
  
  
  METHODS
  A total of 2312 consecutive eligible cigarette smokers who sought treatment at a specialist tobacco-dependence clinic declared a Target Quit Date, provided baseline information at assessment, and were then followed-up 4 and 26 weeks after their target quit date.
  
  
  RESULTS
  Of the total sample, 51.1% were identified as night-smokers and 25.1% reported smoking abstinence at 26-week follow-up. Night-smoking was associated with a number of other patient characteristics, including African-American race or Hispanic ethnicity, having smoking-related medical symptoms, having been treated for a behavioural health problem, smoking mentholated cigarettes, smoking within 30 min of waking in the morning, increased cigarettes smoked per day, and not having private health insurance. In multivariate analyses, night-smoking at assessment remained a significant predictor of smoking at 26-week follow-up when controlling for other factors associated with treatment outcome (adjusted odds ratio: 0.77, 95% confidence interval: 0.62-0.96). Night-smokers also experienced a shorter average time to relapse (38.5 vs. 56 days, p<0.0001).
  
  
  CONCLUSIONS
  Several socioeconomic and tobacco use characteristics are shared among patients who wake at night to smoke. This behaviour can be assessed by a simple question and used as a marker for tobacco dependence and as an indicator that more intensive and sustained treatment may be required.
authors.affiliation: Tobacco Dependence Program, University of Medicine & Dentistry of New Jersey-School of Public Health, New Brunswick, NJ 08901, USA. bovermi@umndnj.edu
authors.forename: M T
authors.initials: MT
authors.lastname: Bover
authors.forename: J
authors.initials: J
authors.lastname: Foulds
authors.forename: M B
authors.initials: MB
authors.lastname: Steinberg
authors.forename: D
authors.initials: D
authors.lastname: Richardson
authors.forename: S W
authors.initials: SW
authors.lastname: Marcella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020919:Sleep Disorders, Intrinsic / Q000209:etiology*; D016540:Smoking Cessation; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome