In patients with schizophrenia, the smoking cessation rate is low and the burden of smoking-related morbidity and mortality is high. Identification of factors associated with abstinence may allow clinicians to optimize treatment prior to a smoking cessation attempt.
To identify factors associated with successful smoking cessation in schizophrenia, baseline data from 114 stable outpatient smokers with schizophrenia who participated in one of two smoking cessation trials were analyzed. The outcome of interest was 4-week, continuous abstinence at the end of a 12-week nicotine dependence treatment intervention. Baseline factors associated with abstinence were identified with univariate methods and entered into a manual, forward selection multivariable regression model to identify independent predictors of abstinence.
Fourteen of 114 participants (12.3%) had biochemically-verified, 4-week, continuous abstinence at week 12. Nine, non-correlated variables with a univariate association with abstinence were included in a multivariable model, controlling for pharmacotherapy, age and gender. Age at initiation of smoking and baseline variability in attentiveness, as measured by Continuous Performance Test (CPT) Hit Reaction Time standard error, were independently associated with abstinence. For every year increase in age at initiation of smoking, the odds ratio for abstinence was 1.36 (95% CI: 1.01–1.83), p=0.048. For every millisecond decrease in the variability of the reaction time of CPT, the odds ratio for achieving abstinence was 1.55 (95% CI: 1.07–2.24), p=0.021.
Later initiation of smoking was associated with increased and baseline attentional impairment with reduced odds of abstinence. Additional research to further our understanding of the relationship between attentional impairment and cigarette smoking in schizophrenia may lead to improved nicotine dependence treatments for this group.
Keywords: schizophrenia, smoking cessation, nicotine, bupropion, predictors, abstinence, attention, neuropsychological tests