More research is needed on seriously mentally ill smokers, who, to date, have been under-studied and suffer disproportionate tobacco use and disease. This proposal responds to an NIMH Program Announcement (PA-05-019) and is consistent with a recent NIMH workgroup on Tobacco Use and Cessation in Psychiatric Disorders which concluded that significant advances in treating smokers with schizophrenia might not occur until there is better understanding of the role of nicotine in the context of the mental disorder. Individuals with schizophrenia are heavy smokers with only half the success in making a quit attempt as other smokers. Preliminary evidence, including our own, indicates that smokers with schizophrenia have higher nicotine levels than control smokers who smoke the same number of cigarettes per day. This is presumed to be an increase in nicotine intake which is due to differences in cigarette puffing behavior although studies have not confirmed this. The emphasis of this proposal is to conduct two studies of cigarette puffing behavior and nicotine intake in smokers with schizophrenia and compare these results to 2 control groups: smokers without mental illness and smokers with bipolar disorder. We expect that smokers with schizophrenia will have a higher nicotine intake per cigarette, also termed """"""""nicotine boost"""""""", compared to controls. We also expect that smokers with schizophrenia will differ in smoking topography measures with decreases in inter-puff interval (IPI, the time between puffs) compared to controls. In Study #1 we will recruit 300 smokers (100 with schizophrenia, 100 with bipolar disorder and 100 controls without mental illness) in order to measure nicotine intake and smoking topography on a usual smoking day. Subjects will participate in three blood draws and a smoking topography session during ad lib smoking from 6am to 3pm. In Study #2 we will measure nicotine boost from a single cigarette in a laboratory based design using repeated blood measures in a subgroup of 30 smokers from Study #1. This study allows us to precisely measure the nicotine peak and also characterize nicotine blood levels in the first hour after smoking to measure the total nicotine dose from a single cigarette. Understanding differences in nicotine boost has important implications for the type of nicotine replacement medications which may prove be most effective for this group and is an important step in the development of better pharmacological treatments.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
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Adult Psychopathology and Disorders of Aging Study Section (APDA)
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Muehrer, Peter R
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University of Medicine & Dentistry of NJ
Schools of Medicine
United States
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Williams, Jill M; Gandhi, Kunal K; Lu, Shou-En et al. (2013) Rapid smoking may not be aversive in schizophrenia. Nicotine Tob Res 15:262-6
Williams, Jill M; Gandhi, Kunal K; Lu, Shou-En et al. (2012) Nicotine intake and smoking topography in smokers with bipolar disorder. Bipolar Disord 14:618-27
Williams, Jill M; Gandhi, Kunal K; Lu, Shou-En et al. (2011) Shorter interpuff interval is associated with higher nicotine intake in smokers with schizophrenia. Drug Alcohol Depend 118:313-9
Williams, Jill M; Zimmermann, Mia Hanos; Steinberg, Marc L et al. (2011) A comprehensive model for mental health tobacco recovery in new jersey. Adm Policy Ment Health 38:368-83
Williams, Jill M; Steinberg, Michael B; Steinberg, Marc L et al. (2011) Varenicline for tobacco dependence: panacea or plight? Expert Opin Pharmacother 12:1799-812
Williams, Jill M; Gandhi, Kunal K; Lu, Shou-En et al. (2010) Higher nicotine levels in schizophrenia compared with controls after smoking a single cigarette. Nicotine Tob Res 12:855-9
Gandhi, Kunal K; Williams, Jill M; Menza, Matthew et al. (2010) Higher serum caffeine in smokers with schizophrenia compared to smoking controls. Drug Alcohol Depend 110:151-5
Williams, Jill M; Gandhi, Kunal K; Benowitz, Neal L (2010) Carbamazepine but not valproate induces CYP2A6 activity in smokers with mental illness. Cancer Epidemiol Biomarkers Prev 19:2582-9
Williams, Jill M; Steinberg, Marc L; Zimmermann, Mia Hanos et al. (2010) Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. J Subst Abuse Treat 38:384-93
Gandhi, K K; Foulds, J; Steinberg, M B et al. (2009) Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic. Int J Clin Pract 63:360-7

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