title: Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting.
abstract: OBJECTIVE
  To identify predictors of nicotine withdrawal symptoms among smokers who participated in a randomized cessation trial in a low-income country.
  
  
  METHODS
  We analyzed data from 269 smokers who participated in a randomized, placebo-controlled smoking cessation trial conducted in primary healthcare in Aleppo, Syria. All participants received behavioral counseling and were randomized to receive either 6 weeks of nicotine or placebo patch and were followed for one year.
  
  
  RESULTS
  Throughout the study, lower total withdrawal score was associated with greater education (p = 0.044), older age of smoking initiation (p = 0.017), lower nicotine dependence (p = 0.024), higher confidence in ability to quit (p = 0.020), lower reported depression (p < 0.001), higher adherence to patch (p = 0.026), belief of receiving nicotine patches rather than placebo (p = 0.011), and waterpipe use (p = 0.047).
  
  
  CONCLUSIONS
  Lower nicotine dependence, greater educational attainment, higher confidence in ability to quit and waterpipe use predict lower withdrawal severity. Waterpipe smoking may serve as a barrier to smoking cessation efforts in countries where its use is highly prevalent. Further, expectancies about the effects of pharmacotherapy appear to mediate the experience of nicotine withdrawal.
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA. zbent002@fiu.edu.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Ben Taleb
authors.affiliation: Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA.|Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria.|Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Taghrid
authors.initials: T
authors.lastname: Asfar
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Jaber
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA.
authors.forename: Rehab
authors.initials: R
authors.lastname: Auf
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA.|Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods / Q000706:statistics & numerical data; D003376:Counseling / Q000379:methods; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine; D011203:Poverty; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology* / Q000523:psychology; D013593:Syria; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data; D014029:Tobacco Use Disorder / Q000517:prevention & control
chemical_list: D009538:Nicotine
keywords: Cessation; Low-income countries; Nicotine; Smoking; Withdrawal