Trajectories in cigarette dependence as a function of anxiety: a multilevel analysis.
BACKGROUND
We assessed the association of anxiety with cigarette dependence over time, depending on smoking status (daily, occasional or ex-smoker); and the association of anxiety with (a) smoking cessation, (b) reduction, and (c) relapse.


METHODS
A prospective Internet survey of 1967 ever smokers was assessed three times at 2 weeks interval, in 2007-2010. Cigarette dependence was assessed using the cigarette dependence scale. Predictors included time, smoking status (daily, occasional or ex-smoker) and anxiety. All measures were assessed at each time point.


RESULTS
Dependence decreased over time (slope=-0.21, p<0.001), as did feeling prisoner of cigarettes (slope=-0.25, p<0.001). Both decreased faster between week 0 and week 2 then between week 2 and week 4 (slopes=0.25, and 0.13; p<0.01). Differences in anxiety across individuals were associated with dependence (slope=0.28, p=0.001), feeling prisoner of cigarettes (slope=0.38, p<0.001), cessation (OR=0.42, p<0.001), relapse (OR=1.81, p<0.01), but not with smoking reduction (OR=0.85, p=0.35). Change over time in anxiety (within individuals) was associated with dependence (slope=-0.11, p=0.04), nor feeling prisoner of cigarettes (slope=-0.21, p=0.02), predicted smoking cessation (OR=0.51, p<0.001), smoking reduction (OR=0.67, p=0.047), and relapse (OR=1.52, p=0.03).


CONCLUSIONS
Cross-sectionally, cigarette dependence, feeling prisoner of cigarettes, and smoking cessation were associated with anxiety; whereas prospectively, smoking cessation, reduction, and relapse were predicted by state anxiety. Thus, anxiety is an important factor that is associated with smoking behavior. Implications for treatment are discussed.
Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA; Harvard Medical School, Boston, MA 02115, USA; Division of Public Psychiatry, Massachusetts Mental Health Center, 75 Fenwood Road, Boston, MA 02115, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: cshaller@bidmc.harvard.edu.
Chiara S
CS
Haller
Faculty of Medicine, University of Geneva, IMSP-CMU, 1 rue Michel-Servet, CH-1211 Geneva 4, Switzerland.
Jean-François
JF
Etter
Division of Clinical Epidemiology, University of Geneva and Geneva University Hospitals, 4 rue Perret-Gentil, 1205 Geneva, Switzerland.
Delphine Sophie
DS
Courvoisier
D000328:Adult; D001007:Anxiety / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012008:Recurrence; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
Anxiety; Cigarette; Dependence; Prospective