title: Smoking cessation behaviors three months following acute insular damage from stroke.
abstract: BACKGROUND
  Recent evidence suggests that the insular cortex may play an important role in cognitive and emotional processes that facilitate drug use but it is unclear whether changes to the insula would result in sustained abstinence. To better understand the role of the insula in maintaining abstinence, we examined quitting patterns in smokers with acute damage to their insula relative to other regions.
  
  
  METHODS
  Prospective cohort study with 3month follow-up, beginning June 2013 and ending May 2014.
  
  
  METHODS
  Three acute care hospitals in Rochester, NY.
  
  
  METHODS
  One-hundred-fifty-six current smokers hospitalized for acute ischemic stroke; 38 with insular infarctions and 118 with non-insular infarctions, assessed by 3 neuroradiologists.
  
  
  METHODS
  Self-reported smoking status (seven-day point prevalence and continuous abstinence), complete abstinence from any nicotine product, and disruption of smoking addiction (defined by criteria on smoking status, difficulty of quitting, and urge) were assessed at three months post-stroke. Time to relapse (in days) after discharge was also assessed.
  
  
  RESULTS
  Insular damage was associated with increased odds of three-month continuous abstinence (OR=3.71, 95% CI: 1.59, 8.65) and complete cessation from any nicotine product (OR=2.72, 95% CI: 1.19, 6.22). Average time to relapse was longer in the insular-damaged group (17.50days, SD=19.82) relative to non-insular damage (10.42days, SD=18.49). Among quitters, insular damage was also associated with higher relative odds of experiencing a disruption of addiction compared to non-insular damage (adjusted OR=5.60, 95% CI: 1.52, 20.56).
  
  
  CONCLUSIONS
  These findings support the potential role of the insular cortex in maintaining smoking and nicotine abstinence. Further research is needed to establish whether the insula may be a novel target for smoking cessation interventions.
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644, Rochester, NY 14642, United States. Electronic address: amir.abdolahi@philips.com.
authors.forename: Amir
authors.initials: A
authors.lastname: Abdolahi
authors.affiliation: Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States; Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States; Department of Clinical and Social Sciences in Psychology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Williams
authors.affiliation: Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States.
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Benesch
authors.affiliation: Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States.
authors.forename: Henry Z
authors.initials: HZ
authors.lastname: Wang
authors.affiliation: Department of Radiology, Rochester General Health System, 1425 Portland Ave., Rochester, NY 14621, United States.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Spitzer
authors.affiliation: Department of Radiology, Rochester General Health System, 1425 Portland Ave., Rochester, NY 14621, United States.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Scott
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644, Rochester, NY 14642, United States.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Block
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644, Rochester, NY 14642, United States.
authors.forename: Edwin
authors.initials: E
authors.lastname: van Wijngaarden
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000209:etiology* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D014029:Tobacco Use Disorder / Q000628:therapy*
keywords: Cessation; Insular cortex; Nicotine; Smoking; Stroke