Tobacco use and dependency in hospitalized patients with respiratory diseases: a survey based analysis of influencing factors_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TAO Yuhan ¹ ^* , ZHAO Lihong ² ^* , WANG Yubin ¹ , ZHANG Yuling ¹ , ZHOU Xiaojie ¹ ,  MAO Hui ¹

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Respiratory and Critical Care Medicine, Chengdu Pidu District Hospital of TCM, Chengdu, Sichuan 611730, P. R. China;

Corresponding?author：

MAO Hui, Email: merrymh@yeah.net

Keywords：

Tobacco dependence; nicotine dependence; influencing factors; nicotine metabolism; withdrawal symptoms

DOI：

10.7507/1671-6205.202506028

Video：

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Objective To investigate the smoking status and factors influencing tobacco dependence among inpatients with respiratory diseases, and analyze the relationship of salivary and plasma nicotine metabolic ratio (NMR) with tobacco dependence and withdrawal symptoms. Methods A cross-sectional study was conducted on eligible patients admitted to the Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, between October 2023 and October 2024. Basic information of enrolled patients was collected and smoking questionnaires were administered. The participants were categorized into current smokers or former smokers based on smoking status. The current smokers were classified into no dependence, mild dependence, moderate dependence, and severe dependence by ICD-10, Chinese guidelines, and FTND. Group differences were analyzed with ANOVA and chi-square test. Tobacco dependence risk factors were identified by univariate/multivariate logistic regression. The smokers were stratified into slow and normal metabolizers based on NMR to analyze its correlation with tobacco dependence and withdrawal symptoms. Results Among 602 enrolled patients, 20.4% initiated smoking before age 18 years, with a mean smoking history of 46.2 pack-years. Family members smoked in 49.3% and friends smoked in 89.5% of cases; primary smoking motivations were conformity, curiosity, and boredom relief. Tobacco dependents had significantly higher rates of family member smoking (P=0.005) and withdrawal symptoms (P<0.001). Logistic regression identified lower education level, absence of pulmonary infection, parental smoking, and higher daily cigarette consumption as significant risk factors for tobacco dependence. NMR was positively correlated with nicotine dependence severity (saliva: r_s=0.303, P=0.013; plasma: r_s=0.297, P=0.045). Normal metabolizers had a significantly higher prevalence of nicotine dependence than slow metabolizers (saliva: 56.3% vs. 33.3%, P=0.014; plasma: 58.8% vs. 25.0%, P=0.044). Withdrawal symptoms were positively correlated with NMR (r_s=0.244, P=0.048), with a higher incidence in normal metabolizers (81.3% vs. 58.8%, P=0.048). Conclusion Lower education level, absence of pulmonary infection, parental smoking, and higher daily cigarette consumption are major risk factors for tobacco dependence. Normal nicotine metabolizers are more likely to exhibit higher levels of tobacco dependence and withdrawal symptoms than slow metabolizers.

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16.	Pleasants RA, Rivera MP, Tilley SL, et al. Both duration and pack-years of tobacco smoking should be used for clinical practice and research. Ann Am Thorac Soc, 2020, 17(7): 804-806.
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1. Dai X, Gil GF, Reitsma MB, et al. Health effects associated with smoking: a burden of proof study. Nat Med, 2022, 28(10): 2045-2055.
2. Smoking - Our World in Data. [2025-03-10]. https://ourworldindata.org/smoking.
3. Panagiotou OA, Schuit E, Munafò MR, et al. Smoking cessation pharmacotherapy based on genetically-informed biomarkers: what is the evidence?. Nicotine Tob Res, 2019, 21(9): 1289-1293.
4. Dempsey D, Tutka P, Jacob P, et al. Nicotine metabolite ratio as an index of cytochrome P450 2A6 metabolic activity. Clin Pharmacol Ther, 2004, 76(1): 64-72.
5. Lerman C, Schnoll RA, Hawk LW, et al. Use of the nicotine metabolite ratio as a genetically informed biomarker of response to nicotine patch or varenicline for smoking cessation: a randomised, double-blind placebo-controlled trial. Lancet Respir Med, 2015, 3(2): 131-138.
6. Wells QS, Freiberg MS, Greevy RA, et al. nicotine metabolism-informed care for smoking cessation: a pilot precision RCT. Nicotine Tob Res, 2018, 20(12): 1489-1496.
7. Qin R, Liu Z, Cheng AQ, et al. Efficacy of varenicline or bupropion and its association with nicotine metabolite ratio among smokers with COPD. Respirology, 2024, 29(6): 479-488.
8. Xiao D, Wang C. Tobacco dependence should be recognised as a lethal non-communicable disease. BMJ (Clinical research ed. ), 2019, 365: l2204.
9. Kalkhoran S, Benowitz NL, Rigotti NA. Reprint of: prevention and treatment of tobaccouse: JACC Health Promotion Series. J Am Coll Cardiol, 2018, 72(23 Pt B): 2964-2979.
10. Barr PB, Driver MN, Kuo SIC, et al. Clinical, environmental, and genetic risk factors for substance use disorders: characterizing combined effects across multiple cohorts. Mol Psychiatry, 2022, 27(11): 4633-4641.
11. Bourbon A, Boyer L, Auquier P, et al. Anxiolytic consumption is associated with tobacco smoking and severe nicotine dependence. Results from the national French medical students (BOURBON) study. Prog Neuropsychopharmacol Biol Psychiatry, 2019, 94: 109645.
12. Hu MC, Davies M, Kandel DB. Epidemiology and correlates of daily smoking and nicotine dependence among young adults in the United States. Am J Public Health, 2006, 96(2): 299-308.
13. Elliott JC, Stohl M, Wall MM, et al. The risk for persistent adult alcohol and nicotine dependence: the role of childhood maltreatment. Addiction (Abingdon, England), 2014, 109(5): 842-850.
14. 我省發布2018年全省人群健康白皮書人均期望壽命77.1歲- 四川省人民政府網站. [2024-12-22].
15. 馬麗娜, 黃希驥, 羅彥, 等. 湖北省青少年煙草使用及影響因素分析. 實用預防醫學, 2025, 32(6): 710-714.
16. Pleasants RA, Rivera MP, Tilley SL, et al. Both duration and pack-years of tobacco smoking should be used for clinical practice and research. Ann Am Thorac Soc, 2020, 17(7): 804-806.
17. Jayes L, Haslam PL, Gratziou CG, et al. SmokeHaz: systematic reviews and meta-analyses of the effects of smoking on respiratory health. Chest, 2016, 150(1): 164-179.
18. Latkin CA, Tseng TY, Davey-Rothwell M, et al. The relationship between neighborhood disorder, social networks, and indoor cigarette smoking among impoverished inner-city residents. J Urban Health, 2017, 94(4): 534-541.
19. 劉振宇, 陳淑敏, 暢金, 等. 2010—2021年香港地區戒煙人群特征及控煙策略探討. 中國呼吸與危重監護雜志, 2023, 22(10): 722-726.
20. Phan PT, Vu GV, Ngo CQ, et al. Tobacco smoking and nicotine dependence among patients with respiratory diseases in Vietnam: Status and correlated factors. J Subst Abuse Treat, 2022, 135: 108562.
21. Kamga A, Rochefort-morel C, Guen Y L, et al. Asthma and smoking: a review. Respir Med Res, 2022, 82: 100916.
22. Paik SH, Yeo CD, Jeong JE, et al. Prevalence and analysis of tobacco use disorder in patients diagnosed with lung cancer. PloS One, 2019, 14(9): e0220127.
23. Mcgeoch LJ, Ross S, Massa MS, et al. Cigarette smoking and risk of severe infectious respiratory diseases in UK adults: 12-year follow-up of UK biobank. J Public Health (Oxf), 2023, 45(4): e621-e629.
24. Schnoll RA, George T P, Hawk L, et al. The relationship between the nicotine metabolite ratio and three self-report measures of nicotine dependence across sex and race. Psychopharmacology, 2014, 231(12): 2515-2523.
25. Liu M, Wang H, Fu Y, et al. The role of nicotine metabolic rate on nicotine dependence and rewarding: nicotine metabolism in chinese male smokers and male mice. Mol. Neurobiol, 2024, 61(10): 7692-7706.
26. Benowitz NL, Pomerleau OF, Pomerleau CS, et al. Nicotine metabolite ratio as a predictor of cigarette consumption. Nicotine Tob Res, 2003, 5(5): 621-624.

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