Although pregnant smokers are aware of the negative peri- and postnatal health consequences of smoking, the cessation rate in pregnancy is low, raising the question of why pregnant smokers have difficulty quitting. Reasons might be that pregnant smokers experience more intense craving and withdrawal symptoms than non-pregnant smokers. We compared craving and withdrawal in 306 pregnant smokers versus 93 non-pregnant women using data from two smoking cessation trials. Complete data were analyzed using pre-quit and post-quit (2weeks after quit date) craving and withdrawal measured by the 12-item French Tobacco Craving Questionnaire (FTCQ-12) and French Minnesota Nicotine Withdrawal Scale (FMNWS). Pregnant smokers started smoking and smoked regularly earlier and succeeded far less at quitting smoking by week 2 than the general population of smokers (11% versus 43%). Post-quit date FTCQ-12 general score was higher in pregnant smokers compared to comparison groups, and was driven by elevated emotionality and expectancy. FMNWS decreased significantly less among pregnant smokers than among non-pregnant smokers. Insufficient reduction of craving and withdrawal symptoms in response to a quit attempt may partially explain why pregnant smokers may have more difficulty quitting than non-pregnant smokers. Because this was a historical comparison, findings are preliminary; however, they might foster further investigation of differences in craving and withdrawal symptoms in pregnant versus non-pregnant smokers.

INTRODUCTIONValid and reliable brief measures of cigarette dependence are essential for research purposes and effective clinical care. Two widely-used brief measures of cigarette dependence are the six-item Fagerström Test for Cigarette Dependence (FTCD) and five-item Cigarette Dependence Scale (CDS-5). Their respective metric characteristics among pregnant smokers have not yet been studied.METHODSThis was a secondary analysis of data of pregnant smokers (N = 476) enrolled in a smoking cessation study. We assessed internal consistency, reliability, and examined correlations between the instruments and smoking-related behaviors for construct validity. We evaluated predictive validity by testing how well the measures predict abstinence 2 weeks after quit date.RESULTSCronbach's alpha coefficient for the CDS-5 was 0.62 and for the FTCD 0.55. Measures were strongly correlated with each other, although FTCD, but not CDS-5, was associated with saliva cotinine concentration. The FTCD, CDS-5, craving to smoke, and withdrawal symptoms failed to predict smoking status 2 weeks following the quit date.CONCLUSIONSSuboptimal reliability estimates and failure to predict short-term smoking call into question the value of including either of the brief measures in studies that aim to explain the obstacles to smoking cessation during pregnancy.

BACKGROUND:Valid and reliable brief measures of tobacco craving are necessary for research and clinical purposes. However, comparisons of the utility of single-item and brief multidimensional craving measures are scarce.METHODS:We analyzed two tobacco craving measures, the French versions of the 12-item Tobacco Craving Questionnaire (FTCQ-12) and the single craving item on the Minnesota Nicotine Withdrawal Scale, in pregnant and non-pregnant (females and males) French smokers from two independent smoking cessation trials. Using data from pregnant smokers, we estimated first a prognostic model for each measure and compared their ability to predict relapse from one visit to the next. We next used cutoff values for both measures to determine how well craving distinguished current smokers from abstainers. For cross-validation, we tested how well the same cut-off values generalized to non-pregnant smokers.RESULTS:Two FTCQ-12 factors (Expectancy and Purposefulness) predicted smoking status; scores were higher in pregnant non-abstainers than abstainers. The sum of these two factors, FTCQ-12 risk score (RS), yielded higher sensitivity both in prognostic and diagnostic models than single-item MNWS craving. FTCQ-12 RS had higher sensitivity among pregnant than non-pregnant smokers. Specificity of both tobacco craving measures was similar among pregnant smokers, but higher with MNWS craving than with FTCQ-12 RS in non-pregnant smokers.CONCLUSIONS:FTCQ-12 RS and MNWS craving can be used together in clinical practice to rapidly predict smoking status. Interventions targeting Expectancy and Purposefulness may result in higher likelihood of abstinence, especially among pregnant smokers.

Background and Objectives: Research in the United States has shown that craving tobacco is associated with smoking, yet no investigation has been done into the relationship between craving and the use of tobacco in Saudi Arabian smokers. The aim of this cross-sectional study was to examine the craving of tobacco by Saudi males and its influence on daily smoking. Subjects were recruited under the auspices of the Tobacco Control Program in Jeddah City and Riyadh. Methods: The American English version of the tobacco craving questionnaire (TCQ-12) is a valid measure of four distinct aspects (factors) of tobacco craving. The TCQ-12 was translated into Arabic tobacco craving questionnaire (ATCQ-12) and administered to a sample of 322 male smokers. Predictive validity was determined by examining the relationship between the factors and the number of cigarettes smoked per day (CPD). Results: In a general linear multivariate analysis of variance model, CPD increased significantly as either ATCQ-12 Factor 1 (emotionality) or Factor 3 (compulsiveness) increased. A significant Factor 1 by Factor 3 interaction indicated that Factor 1 was a better predictor of heavy smoking, but only when Factor 3 was low. Factor 3 was a better predictor of heavy smoking, but only when Factor 1 was low. Conclusions: The ATCQ-12 is a rapid measure of craving and valid predictor of CPD and heavy smoking. Craving in anticipation of smoking as relief from a negative mood (emotionality) is an indicator of psychological withdrawal symptoms, while craving in anticipation of the inability to control tobacco use (compulsiveness) is an indicator of physical dependence.

Background: Research suggests that craving is a predictor of smoking relapse. Craving can be assessed by multiple item or multifactorial scales or by single items. However, no systematic comparisons of their prognostic validity or accuracy have been published.Methods: The French versions of the 12-item Tobacco Craving Questionnaire (FTCQ-12) and the single craving item on the Minnesota Nicotine Withdrawal Scale (MNWS) are brief, valid, and reliable self-report measures of tobacco craving. In this secondary study, we analyzed data from French smokers with health-related problems enrolled in the Adjustment of DOses of Nicotine in Smoking (ADONIS) cessation trial. We estimated prediction models for each measure and compared their ability to distinguish correctly participants who relapsed from those who did not at 1-8 weeks after their quit date.Results: Adjusted for all potential confounders FTCQ-12 risk score (RS; Factor 2, Expectancy plus Factor 4, Purposefulness) and MNWS craving were valid predictors of smoking relapse at endpoints measured 1-7 weeks apart. Prognostic accuracy of FTCQ-12 RS was greatest at 1-2 weeks follow-up compared to only 1 week for MNWS craving. Sensitivity for FTCQ-12 RS and MNWS craving was 85% and 53%, respectively.Conclusions: FTCQ-12 RS suggests a relapse process involving urges and desires in anticipation of the positive benefits of smoking linked with intent and planning to smoke. Findings also suggest that FTCQ-12 RS may be a better predictor instrument for smoking relapse than MNWS craving. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Introduction: Oral fluid collection is noninvasive and easily observed making it an attractive matrix for objectively determining smoking status. Despite large intersubject variability, cotinine oral fluid concentrations correlate with cigarettes smoked per day (CPD). Few studies, however, assessed nicotine markers in oral fluid other than cotinine; other markers might improve smoking status assessment and/or time of last cigarette. Materials and Methods: Smoking histories and oral fluid specimens were collected from nontreatment-seeking light (1-10 CPD) and heavy smokers (greater than 10 CPD) and from environmentally exposed and nonexposed nonsmokers who provided written informed consent for this Institutional Review Board-approved study. Nicotine, cotinine, hydroxycotinine (OH-cotinine), and norcotinine oral fluid concentrations were quantified by liquid chromatography tandem mass spectrometry. Results: Comparison of 1, 3, and 10 ng/mL oral fluid liquid chromatography tandem mass spectrometry cutoffs demonstrated that 10-ng/mL cutoffs performed optimally for cotinine, OH-cotinine, nicotine, and norcotinine identifying 98%, 97%, 88%, and 15% of self-reported smokers; 1% nonsmokers had greater than 10 ng/mL cotinine. No self-reported nonsmoker had greater than 10 ng/mL OH-cotinine, nicotine, or norcotinine. Norcotinine was only identified in smokers' oral fluid. Oral fluid nicotine, cotinine, and nicotine/cotinine ratios were correlated with time of last smoking (r = -0.53, -0.23, and -0.51; P < 0.05) and CPD (r = 0.35, 0.26, and 0.33; P < 0.01), respectively. Discussion and Conclusion: OH-cotinine performed slightly better than cotinine for distinguishing smokers from nonsmokers and should be considered as an additional oral fluid smoking indicator. Further research is required to determine if oral fluid norcotinine is a marker for distinguishing light and heavy smokers. Moderate correlations suggest nicotine, cotinine, and nicotine/cotinine ratios may be useful for determining smoking recency in “spot samples” collected during nicotine cessation treatment.

AIMS:Many cities have banned indoor smoking in public places. Thus, an updated recommendation for a breath carbon monoxide (CO) cut-off is needed that optimally determines smoking status. We evaluated and compared the performance of breath CO and semiquantitative cotinine immunoassay test strips (urine and saliva NicAlert®) alone and in combination.DESIGN:Cross-sectional study.SETTING:Urban drug addiction research and treatment facility.PARTICIPANTS:Ninety non-treatment-seeking smokers and 82 non-smokers.MEASUREMENTS:Participants completed smoking histories and provided breath CO, urine and saliva specimens. Urine and saliva specimens were assayed for cotinine by NicAlert® and liquid chromatography-tandem mass spectrometry (LCMSMS).FINDINGS:An optimal breath CO cut-off was established using self-report and LCMSMS analysis of cotinine, an objective indicator, as reference measures. Performance of smoking indicators and combinations were compared to the reference measures. Breath CO ≥5 parts per million (p.p.m.) optimally discriminated smokers from non-smokers. Saliva NicAlert® performance was less effective than the other indicators.CONCLUSIONS:In surveys of smokers and non-smokers in areas with strong smoke-free laws, the breath carbon monoxide cut-off that discriminates most effectively appears to be ≥5 p.p.m. rather than the ≥10 p.p.m. cut-off often used. These findings may not generalize to clinical trials, regions with different carbon monoxide pollution levels or areas with less stringent smoke-free laws.

Increases in self-reported craving and changes in autonomic functioning are reliably elicited when smokers are exposed to tobacco-related stimuli compared with neutral stimuli. However, few studies have reported the time course of cue-elicited craving or have directly compared the effectiveness of smoking cues versus imagery to evoke a craving response. In addition to these two issues, we investigated the influence of tobacco deprivation and sex on craving, mood, and autonomic responses. Sixty cigarette smokers (30 men, 30 women) were tested in two counterbalanced sessions, one after overnight tobacco deprivation and one during ad libitum smoking. At each session, participants were exposed to four randomized experimental trials: smoking imagery, neutral imagery, smoking cues, and neutral cues. Tobacco craving and mood were assessed repeatedly and physiological measures were recorded continuously for 30 min after imagery or cue exposure. Compared with neutral trials, smoking cues and smoking imagery reliably increased tobacco craving, negative mood, heart rate, and blood pressure and decreased positive mood ratings. Changes were observed immediately after cue and imagery presentation and remained unchanged for 30 min. Responding was greater in the nondeprived condition, and cues elicited more robust responding than imagery for most measures. Women responded more robustly to smoking cues only in the nondeprived condition, whereas imagery evoked greater responses in men during both conditions. These findings provide new data on the time course, magnitude, and tobacco deprivation effects on elicited craving. Sex differences were dependent on stimulus type and deprivation condition.

INTRODUCTIONThe French version of the Tobacco Craving Questionnaire (FTCQ) is a valid and reliable 47-item self-report instrument that assesses tobacco craving in four factors: emotionality, expectancy, compulsivity, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the FTCQ (FTCQ-12).METHODThe FTCQ-12 was administered to treatment-seeking French smokers (n = 310) enrolled in the Adjustment of DOses of NIcotine in Smoking Cessation (ADONIS) trial. We conducted confirmatory factor analysis (CFA) and examined congruence in factor loadings between the FTCQ and FTCQ-12 to determine the validity and reliability of the FTCQ-12. Measures of tobacco craving, withdrawal, smoking patterns, and smoking history were included to explore the concurrent validity of the FTCQ-12. We used craving scores to distinguish participants who were highly dependent on nicotine from those less dependent on nicotine.RESULTSCFA indicated excellent fit for a four-factor model, with congruence coefficients indicating moderate similarity in factor patterns and loadings between the FTCQ and FTCQ-12. Individual factors of the FTCQ-12 correlated positively with smoking history and withdrawal variables. Participants who were highly dependent on nicotine were nearly six times more likely to score >5 on the General Craving Score (maximum: 7) than those less dependent on nicotine.DISCUSSIONFindings suggest that the FTCQ-12 measures the same four factors as the FTCQ and TCQ, and these four constructs have unique properties. The FTCQ-12 yields valid and reliable indices of tobacco craving and has potential clinical utility for rapid assessment of tobacco craving in smokers seeking treatment.

Craving for addictive drugs may predict relapse in abstinent addicts. To assess relationships between craving and use, we examined changes in craving for methamphetamine (MA) in a sample of 865 outpatients in a multisite 16-week MA-treatment study. Craving was assessed on a 0-100 scale, and MA use was assessed by self-report and confirmed by urinalysis. We hypothesized that the magnitude of craving would decline (decay) with increased time of abstinence, and that decay would be greater for more frequent MA users, and greater for intravenous (IV) users and smokers as compared to those who used MA intranasally. Craving declined significantly as the number of weeks of consecutive abstinence increased. Rate of decay was greater for IV users and smokers as compared to both intranasal users and oral users, but not for more frequent users of MA. Rate of decay was independent of age, gender, and race/ethnicity. The trajectory to 0 (no) craving was 1 week shorter for females than males because females had significantly lower pretreatment craving scores compared to males. This study confirms that the sooner MA-dependent people are able to quit using and the longer that they are able to stay abstinent, the more likely it is that their craving for MA will decrease over time.

Objective As a biomarker of smoking, semiquantitative analysis of cotinine (NicAlert(R)) offers several advantages over breath carbon monoxide (CO) and quantitative analysis of cotinine. Recent studies have used urine NicAlert(R) and breath CO in combination to verify abstinence. However, no studies have evaluated the performance of saliva NicAlert(R) against or in combination with breath CO.Method Breath CO, saliva NicAlert(R), and smoking history were compared in an urban population of daily smokers (n = 24) and nonsmokers (n = 25).Results Saliva NicAlert(R) predicted self-reported smoking with 100% sensitivity and 96% specificity. At a cutoff of > 5 ppm, breath CO had 100% sensitivity and 100% specificity in predicting self-reported smoking. Breath CO was positively correlated with saliva NicAlert(R) and negatively correlated with minutes since last cigarette.Conclusion Saliva NicAlert(R) had high sensitivity and specificity in identifying daily smokers. Compared to saliva NicAlert(R), breath CO level was more indicative of recent smoking. Future treatment studies should evaluate the performance of saliva NicAlert(R) as an alternative to the urine test. Published in 2009 by John Wiley & Sons, Ltd.

Empirical studies indicate that nicotine enhances some aspects of attention and cognition, suggesting a role in the maintenance of tobacco dependence. The purpose of this review was to update the literature since our previous review (Heishman et al. Exp Clin Psychopharmacol 2:345–395, 1994) and to determine which aspects of human performance were most sensitive to the effects of nicotine and smoking.

The Tobacco Craving Questionnaire (TCQ) is a valid and reliable 47-item self-report instrument that assesses tobacco craving in four dimensions: emotionality, expectancy, compulsivity, and purposefulness. For use in research and clinical settings, we constructed a 12-item version of the TCQ by selecting three items from each of the four factors that exhibited optimal within-factor reliability (Cronbach's alpha coefficient) and inter-item correlation. Smokers (N = 196) completed the TCQ-Short Form (TCQ-SF) after overnight tobacco deprivation and on a separate day during ad libitum smoking. Confirmatory factor analyses indicated acceptable model fit for a 4-factor model, with congruence coefficients suggesting high to very high similarity in factor patterns and magnitude of factor loadings between the TCQ and TCQ-SF in both conditions. Scores on each factor were significantly greater after tobacco deprivation than ad libitum smoking, were associated with measures of tobacco withdrawal, and varied with degree of nicotine dependence. Cronbach's alpha coefficients and average inter-item correlations were similar in both conditions and were consistent with reliability values obtained in the initial validation of the TCQ. Test-retest correlation coefficients were also similar to those found in a previous study. These findings suggest that the TCQ-SF is as valid and reliable as the 47-item TCQ in measuring tobacco craving.

Aims This study lays the foundation for a clinical prediction model based on methamphetamine craving intensity and its ability to predict the presence or absence of within-treatment methamphetamine use. Design We used a random effects logistic approach for estimating repeated-measures, generalized linear mixed models (GLMM) using craving as the sole predictor of methamphetamine. A multivariate GLMM included craving, length of treatment, treatment assignment, and methamphetamine use the previous week as covariates to control for potential confounds. We performed receiver operating characteristic (ROC) analyses to evaluate predictive accuracy. We investigated further whether methamphetamine craving predicted subsequent use more accurately at intervals more proximal to versus those more distal to assessment, examining one-week periods ending one to seven weeks after assessment of craving. Setting The study was part of the Center for Substance Abuse Treatment (CSAT) Methamphetamine Treatment Project (MTP). Subjects Analyses were based on data from 691 methamphetamine dependent outpatients enrolled in the MTP. Measurements Craving was assessed by self-report on a 0–100 scale. Self-reported methamphetamine use was toxicologically verified. Craving and drug use were assessed weekly for 8 weeks. Findings In the univariate analysis craving predicted methamphetamine use in the week immediately following the craving report (p < 0.0001), with subject-specific use increasing 0.38% for each one-point increase in craving on a 0–100 scale. In the multivariate analysis the probability of use decreased by 2.45% for each week in treatment increased by 33.11% for previous methamphetamine use, and the probability of methamphetamine use still increased with craving, rising 0.28% for each one-point increase in craving score (all p < 0.0001). Predictive accuracy was strongest at the one-week time-lag and declined in magnitude the more distal the assessment period. Conclusions Craving is a predictor of within-treatment methamphetamine use. Intensity of craving is appropriate for use as a surrogate marker in methamphetamine dependence.

Objective. To assess the predictive value of nicotine dependence or urge to smoke for negative health symptoms one year later.Methods. Subjects were smokers (N=1519) from the US, Canada, UK, France and Spain participating in the internet based ATTEMPT study between 2004 and 2006, a multi-national prospective cohort study. Nicotine dependence was assessed by the Fagerstrom Test for Nicotine Dependence (FTND) and urge to smoke by the 10-item version of the Questionnaire of Smoking Urges (QSU-10). Specific questions were used to assess presence of chest pain specified as angina pectoris, shortness of breath, depressive mood, feeling of anxiety and visit at a primary care physician, an index of global health and health care, one year after assessment of FTND and QSU-10.Results. Smokers who reported angina pectoris, shortness of breath, low mood, anxiety or visit at a primary care physician 9 to 12 months after assessment have significantly higher FTND and QSU-10 scores than those who did not report these negative health symptoms or who did not visit a primary care physician.Conclusion. Smokers with high level of nicotine dependence or urge to smoke are at higher risk of negative health symptoms than those who have low levels of nicotine dependence or urge to smoke. (C) 2008 Elsevier Inc. All rights reserved.

Cannabis is the most widely used illicit drug in the United States, with 14.6 million current users. Cannabis-dependent individuals presenting for treatment typically report cannabis craving; however, the phenomenon has received little research attention. In the absence of a valid, multidimensional questionnaire to assess cannabis craving, we developed the Marijuana Craving Questionnaire (MCQ). The MCQ consists of four constructs or factors that characterize cannabis craving: compulsivity, emotionality, expectancy, and purposefulness. A separate score is calculated for each factor. The MCQ can be used to measure cue-elicited craving in a research setting or natural craving in cannabis-dependent individuals presenting for treatment. Either the 47-item or 12-item version can be used, and standardized instructions for completion of the MCQ should be given. The MCQ can be administered using a paper and pencil form or a computerized version. In a research setting, the MCQ should be administered immediately after cue presentation and repeated frequently to capture the full time course. In a treatment setting, the MCQ should be administered at intake and during and at the end of treatment.