Performance of Cigarette Per Day (CPD) and Time to First Smoke (TTFS) Indicators in Explaining Dependence Outcome in Multiple Tobacco Products Use Settings

INTRODUCTION: Time to first smoke (TTFS) has been preferred over cigarette smoked per day (CPD) as a more reliable measure of nicotine dependence in western countries. Lower consumption of cigarette in South East Asia countries due to various socio-economic-cultural influences, and simultaneous usage of multiple forms of tobacco products remains a threat to validity and reliability of CPD and TTFS indicators in assessing nicotine dependence. This study is aimed at assessing the performance of these indicators in explaining dependence outcome measures.   

METHODS:  GATS-India data were analyzed considering daily consumption of manufactured cigarette when ‘cigarette-only’ used as well as when multiple i.e ‘cigarette-plus other’ tobacco products were used. Cigarette per day and TTFS were compared with dependence outcome indicators like past quit attempt in the past year and future quit intention. As a non-random sub-sample was issued to analyze dependence outcomes within individuals, GATS weight was not used.

RESULTS: In cigarette-only use setting low CPD (≤ 10 sticks) explained 90.4% of quit attempt and 89.3% of no-attempt(p=.537); as well as 92.7% of positive quit intention and  86.5% of no-intention(p=.004). While TTFS ≥ 30 minutes explained 56.4% of quit attempt and 45.8% of no-attempt(p<.001); as well as 51.3% of positive quit intention and  44.9% of no-intention(p=.029). Similar trend for CPD observed in multiple use settings. But TTFS ≥ 30 minutes explained only 45.4% of quit attempt and 41.1% of no-attempt(p=0.001), as  well as  55.2% of quit intention and 61.3% of no intention(p<.001).

CONCLUSIONS: Thus TTFS not CPD performed well to explain dependence outcomes in cigarette-only use settings but failed in the multiple use settings. Mixed consumption of multiple tobacco product affects nicotine intake and hence cigarette consumption as well as TTFS. Therefore, in multiple use settings time to first tobacco (TTFT) to assess nicotine dependence need to be explored.