+Co-first authors *Contributed equally
Nicotine dependence (ND) is a maladaptive pattern of tobacco smoking with withdrawal symptoms similar to other drug addictive disorders. It is very common in clinical practice that smokers always have different degrees of nicotine dependence with the same amount of tobacco consumption. Behaviors may influence daily cigarette consumption or smoking status. Hence it is critical to ascertain the association between concurrent behaviors and high nicotine dependence among smokers.

A total of 343 patients who attended a clinic for smoking cessation were recruited, and the information on concurrent behaviors were recorded. Factors associated and not associated with nicotine dependence were recorded. Nicotine dependence was determined by Fagerström test for nicotine dependence (FTND).

High ND patients (FTND >5) showed significant behaviors distribution compared with mild and moderate ND patients (FTND ≤5). There is no single behavior that was significantly different between high ND and mild and moderate ND smokers. However, the combined effects of nicotine dependence influencing behaviors of caffeine drinking and mental activities after dinner have an association with high ND (OR=1.939; 95% CI: 1.154–3.258, p=0.012). In addition, the combined effects of inadequate sleep time (<8 hours), caffeine drinking and mental activities after dinner significantly distinguished patients of high ND from those of low ND (OR=2.208; 95% CI: 1.032–4.737, p=0.042).

Interaction effects of mental activities after dinner and caffeine drinking have an association with high nicotine dependence. Sleep of less than 8 hours with behaviors of mental activities after dinner and caffeine drinking have the same effect.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
Funding for this study was provided by The Affiliated Hospital of Medical School of Ningbo University Youth Talent Cultivation Program (Grant number: FYQM-LC-202003), Ningbo Social and Scientific Development Fund (Grant number: 2015C50012), Ningbo Health Youth Technical Key Talents Training Special Project(2020SWSQNGG-05)and the Natural Science Foundation of Ningbo (Grant numbers: 2018A610271 and 2017A610250).
All research subjects provided informed consent, and the research study was approved by the Ethics Committee of the Affiliated Hospital of Medical school of Ningbo University (Ningbo, China) with approval numbers NBU-2020-080, February 2020, and KY20210102, January 2021. All methods were carried out following NCCN Clinical Practice Guidelines in Oncology of Smoking Cessation.
The data supporting this research are available from the authors on reasonable request.
Not commissioned; externally peer reviewed.
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2019. CA Cancer J Clin. 2019;69:7-34. doi:10.3322/caac.21654.
Willemse BW, Postma DS, Timens W, ten Hacken NH. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J. 2004;23(3):464-476. doi:10.1183/09031936.04.00012704
Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38(4):381-389. doi:10.1001/archpsyc.1981.01780290015001
Zhang M, Wang LM, Li YC, et al. Cross-sectional survey on smoking and smoking cessation behaviors among Chinese adults in 2010. Article in Chinese. Zhonghua Yu Fang Yi Xue Za Zhi. 2012;46(5):404-408. Accessed May 29, 2021.
Strine TW, Okoro CA, Chapman DP, et al. Health-related quality of life and health risk behaviors among smokers. Am J Prev Med. 2005;28(2):182-187. doi:10.1016/j.amepre.2004.10.002
Swanson JA, Lee JW, Hopp JW. Caffeine and nicotine: a review of their joint use and possible interactive effects in tobacco withdrawal. Addict Behav. 1994;19(3):229-256. doi:10.1016/0306-4603(94)90027-2
Falk DE, Yi HY, Hiller-Sturmhöfel S. An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Res Health. 2006;29(3):162-171. Accessed May 29, 2021.
Breslau N, Peterson E, Schultz L, Andreski P, Chilcoat H. Are smokers with alcohol disorders less likely to quit?. Am J Public Health. 1996;86(7):985-990. doi:10.2105/ajph.86.7.985
Audrain-McGovern J, Rodriguez D, Moss HB. Smoking progression and physical activity. Cancer Epidemiol Biomarkers Prev. 2003;12(11 Pt 1):1121-1129. Accessed May 29, 2021.
Loprinzi PD, Walker JF. Nicotine Dependence, Physical Activity, and Sedentary Behavior among Adult Smokers. N Am J Med Sci. 2015;7(3):94-99. doi:10.4103/1947-2714.153920
Hamidovic A, de Wit H. Sleep deprivation increases cigarette smoking. Pharmacol Biochem Behav. 2009;93(3):263-269. doi:10.1016/j.pbb.2008.12.005.
Fucito LM, Redeker NS, Ball SA, Toll BA, Ikomi JT, Carroll KM. Integrating a Behavioural Sleep Intervention into Smoking Cessation Treatment for Smokers with Insomnia: A Randomised Pilot Study. J Smok Cessat. 2014;9(1):31-38. doi:10.1017/jsc.2013.19
Shields P, Herbst R, Arenberg D, et al. Smoking Cessation, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(11):1430-1468. doi:10.6004/jnccn.2016.0152.
Yu X, Yu Y, Ma H, Chen Z, Deng Z. Mental activities after dinner increase cigarettes consumption. Sci Rep. 2021;11(1):2405. doi:10.1038/s41598-021-81978-y.
Payne TJ, Smith PO, McCracken LM, McSherry WC, Antony MM. Assessing nicotine dependence: a comparison of the Fagerström Tolerance Questionnaire (FTQ) with the Fagerström Test for Nicotine Dependence (FTND) in a clinical sample. Addict Behav. 1994;19(3):307-317. doi:10.1016/0306-4603(94)90032-9
Ray R, Schnoll RA, Lerman C. Nicotine dependence: biology, behavior, and treatment. Annu Rev Med. 2009;60:247-260. doi:10.1146/
Cao F, Cai L, Cui WL, Sun CH, He JQ. Socioeconomic difference in prevalence of nicotine dependence among Naxi ethnic minority in Yulong County of Yunnan Province. Article in Chinese. Chinese Journal of Disease Control and Prevention. 2016;20(05):452-255. doi:10.16462/j.cnki.zhjbkz.2016.05.006
Cohrs S, Rodenbeck A, Riemann D, et al. Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence. Addict Biol. 2014;19(3):486-496. doi:10.1111/j.1369-1600.2012.00487.x
Tanda G, Goldberg SR. Alteration of the behavioral effects of nicotine by chronic caffeine exposure. Pharmacol Biochem Behav. 2000;66(1):47-64. doi:10.1016/s0091-3057(00)00234-3
Grant JE, Potenza MN. Tobacco use and pathological gambling. Ann Clin Psychiatry. 2005;17(4):237-241. doi:10.1080/10401230500295370
McGrath DS, Barrett SP. The comorbidity of tobacco smoking and gambling: a review of the literature. Drug Alcohol Rev. 2009;28(6):676-681. doi:10.1111/j.1465-3362.2009.00097.x
Raiff BR, Jarvis BP, Rapoza D. Prevalence of video game use, cigarette smoking, and acceptability of a video game-based smoking cessation intervention among online adults. Nicotine Tob Res. 2012;14(12):1453-1457. doi:10.1093/ntr/nts079
Angrave D, Charlwood A, Wooden M. Working time and cigarette smoking: evidence from Australia and the United Kingdom. Soc Sci Med. 2014;112:72-79. doi:10.1016/j.socscimed.2014.04.031
Dani JA, Heinemann S. Molecular and cellular aspects of nicotine abuse. Neuron. 1996;16(5):905-908. doi:10.1016/s0896-6273(00)80112-9
Gilbert DG. Paradoxical tranquilizing and emotion-reducing effects of nicotine. Psychol Bull. 1979;86(4):643-661. doi:10.1037/0033-2909.86.4.643
Gray JA, Young AM, Joseph MH. Dopamine's role. Science. 1997;278:1548-1549. doi:10.1126/science.278.5343.1547b.
DeWitt EE. Neuroeconomics: a formal test of dopamine's role in reinforcement learning. Curr Biol. 2014;24(8):R321-R324. doi:10.1016/j.cub.2014.02.055
Grant JE, Desai RA, Potenza MN. Relationship of nicotine dependence, subsyndromal and pathological gambling, and other psychiatric disorders: data from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2009;70(3):334-343. doi:10.4088/jcp.08m04211