Predictors of early abstinence in smokers with schizophrenia.
BACKGROUND
In patients with schizophrenia, the smoking cessation rate is low and the burden of smoking-related morbidity and mortality is high. Identification of factors associated with abstinence may allow clinicians to optimize treatment prior to a smoking cessation attempt.


METHODS
To identify factors associated with successful smoking cessation in patients with a DSM-IV diagnosis of schizophrenia, we analyzed baseline data from 114 stable outpatient smokers with schizophrenia who participated in 1 of 2 smoking cessation trials. The outcome of interest was 4 weeks' continuous abstinence at the end of a 12-week nicotine dependence treatment intervention. Baseline factors associated with abstinence were identified with univariate methods and entered into a manual, forward-selection multivariable regression model to identify independent predictors of abstinence. The study was conducted from March 1999 to February 2004.


RESULTS
Fourteen of 114 participants (12%) had biochemically verified 4 weeks' continuous abstinence at week 12. We included 10 noncorrelated variables with a univariate association with abstinence in a multivariable model, controlling for pharmacotherapy, age, and gender. Age at initiation of smoking and baseline variability in attentiveness, as measured by Continuous Performance Test-AX (CPT-AX) hit reaction time standard error, were independently associated with abstinence. For every year increase in age at initiation of smoking, the OR for abstinence was 1.36 (95% CI = 1.01 to 1.83), p = .048. For every millisecond decrease in the variability of the reaction time of CPT-AX, the OR for achieving abstinence was 1.55 (95% CI = 1.07 to 2.24), p = .021.


CONCLUSIONS
Later initiation of smoking was associated with increased and baseline attentional impairment with reduced odds of abstinence. Additional research to further our understanding of the relationship between attentional impairment and cigarette smoking in schizophrenia may lead to improved nicotine dependence treatments for this group.
Culhane
Melissa A
MA
Schizophrenia Research Program, Boston; Addiction Research Program, Boston, USA.
Schoenfeld
David A
DA
Barr
Ruth S
RS
Cather
Corinne
C
Deckersbach
Thilo
T
Freudenreich
Oliver
O
Goff
Donald C
DC
Rigotti
Nancy A
NA
Evins
A Eden
AE
D000279:Administration, Cutaneous; D000328:Adult; D001288:Attention; D002638:Chewing Gum; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009538:Nicotine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use; D011109:Polymethacrylic Acids / Q000627:therapeutic use; D011145:Polyvinyls / Q000627:therapeutic use; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D016540:Smoking Cessation / Q000523:psychology; D061485:Tobacco Use Cessation Devices; D014481:United States
D002638:Chewing Gum; D018722:Nicotinic Agonists; D011109:Polymethacrylic Acids; D011145:Polyvinyls; D009538:Nicotine