Can Lifestyle Influence the Risk of High Nicotine Dependence?

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Zhongbo Chen, Xuechan Yu, Hongying Ma, Jie Chen, Hui Chen, Qidong Zhuang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-218419/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Nicotine dependence (ND) is a maladaptive pattern of tobacco smoking with withdrawal symptoms like other drug addictive disorders. It is very common in clinic that smokers always have different degree of nicotine dependence with same amount of tobacco consumption. Lifestyle may influence cigarettes daily consumption or smoke state. So it is critical to prove the influence of healthy or unhealthy lifestyles in high nicotine dependence smokers. This study aimed to identify behavioral correlates to high ND. Methods: 343 patients who went to clinic for smoking cessation were recruited. Participants completed a demographic questionnaire. The extent of Nicotine dependence was determined by Fagerstrom Test for Nicotine Dependence (FTND). Results: High ND patients (FTND>5) showed significant life style compared with mild and moderate ND patients (FTND<5) is significantly ( χ 2 =36.98, P value=0.002). There is no single lifestyle index can significantly distinguish high ND from mild and moderate ND. However, combined behaviors of caffeine drink and mental activities after dinner contribute to the risk of high ND (OR:1.939, 95%CI:1.154-3.258, P value=0.012). In addition, combined index of(sleep time < 8 hours, caffeine drink and mental activities after dinner) each significantly distinguished patients of high ND from patients of mild and moderate ND. with high nicotine dependence(OR:2.208, 95%CI:1.032-4.737, P value=0.042）. Conclusion: Interact effects of mental activities after dinner and caffeine drink will increase the risk of high nicotine dependence. Sleep less than 8 hours with behaviors of mental activities after dinner and caffeine drink also have the same effect. Critical Care & Emergency Medicine Lifestyle High nicotine dependence Sleep Caffeine drink Mental activities after dinner Introduction Tobacco smoking is a preventable human behavior and has been identified to play critical role in the pathogenesis of various malignant cancers( 1 ) and as well as pulmonary diseases, such as chronic obstructive pulmonary disease (COPD)( 2 ). Nicotine dependence (ND) is a maladaptive pattern of tobacco smoking with withdrawal symptoms like other drug addictive disorders and it has already been defined by the Diagnosis and Statistical Manual of Mental Disorder—edition IV (DSM-IV)( 3 ). Previous studies have shown that different lifestyle is closely related to smoke state change and cigarettes consumption( 4 ).Caffeine withdrawal increase difficulties in quitting smoking( 5 ). Alcohol and nicotine dependence are likely to co-occur in the same person, which is the reason of lower likelihood of smoking cessation( 6 , 7 ). People with healthy life habits, including exercise and enough time of sleep, may have less cigarettes daily consumption and lower nicotine dependence ( 8 – 11 ). Moreover, it is very common in clinic that smokers always have different degree of nicotine dependence with same amount of tobacco consumption. Therefore, we considered that whether some relationship between lifestyle and high nicotine dependence. However, so far there is no evidence showing unhealthy factors increased the risk of high ND, vice versa. We sought to figure out the relationship between lifestyle and ND by a designed survey which recorded healthy and unhealthy life behaviors as medical history. Methods And Procedures A survey designed by our group members recorded patients’ lifestyles from April 2010 to January 2020 in The Affiliated Hospital of Medical School of Ningbo University. Three hundred and forty three patients were recruited and complete the survey. All research subjects provide informed consent, and survey designation was approved by the Ethics Committee of the Affiliated Hospital of Medical school of Ningbo University (Ningbo, China). Informed consent contained from all patients before finish the survey. All methods were carried out in accordance with NCCN Clinical Practice Guidelines in Oncology of Smoking Cessation( 12 ). Survey design Clinical characteristics and life behaviors ( 1 )Demographic (age, gender, BMI) data were recorded as clinical characteristics. ( 2 ) Healthy lifestyles was identified as following: athletics(exercise more than 3 times a week and each time more than 30 minutes( 8 , 9 );sleep time ≥ 8 hours; take afternoon nap; often eat fruits. ( 3 ) Unhealthy lifestyles include: sleep time < 8 hours; alcohol consumption; caffeine drink; mental activities after dinner before sleep( 13 ) (including gambling, overtime work, play video games, studying or other mental thinking activities). Measurement of nicotine dependence Nicotine dependence was measured by Fagerstrom Test for Nicotine Dependence (FTND)( 14 , 15 ). FTND score > 5 was regarded as high nicotine dependence. FTND score ≤ 5 was considered as mild and moderate nicotine dependence. Statistical analysis The information and results questionnaire for 343 patients were included in the statistics. t -test and mean ± Standard deviation(SD) were used in age, BMI. Gender distribution and life behaviors distribution in two groups(FTND ≤ 5 and FTND > 5) were calculated by chi-square analysis. All independent or interaction effects of behaviors were analyzed by multiple logistic-regression. These analysis were calculated by IBM SPSS Statistics 21.0 and P value < 0.05 was considered as statistical difference. Results Demographics of the cohort are shown in Table 1 , there were no differences in age, gender and BMI between the two groups. However, healthy and unhealthy lifestyles were differently distributed in the two groups (Table 2 ) ( χ 2 = 36.98, P value = 0.002), indicating that each behavior of athletics, sleep, sleep time ≥ 8h, fruits consumption didn’t decrease the risk of high ND no matter independently or combined (Table 3 ). Results in Table 4 showed that caffeine drink combined with mental activities after dinner increase the risk of high nicotine dependence (OR:1.939, 95%CI:1.154,3.258, P value = 0.012). Three unhealthy interaction behaviors (sleep time < 8 hours, caffeine drink and mental activities after dinner) are associated with high nicotine dependence (OR:2.208, 95%CI:1.032,4.737, P value = 0.042). Discussion Nicotine dependence is a maladaptive pattern of tobacco smoking with withdrawal symptoms like other drug addictive disorders. Many life behaviors may change cigarettes daily consumption or smoke state ( 4 ). People with healthy behaviors has lower nicotine dependence ,such as exercising, sleep enough time( 8 , 16 ). Previous studies demonstrate that unhealthy lifestyles ,including sleep duration ( 10 , 16 ), caffeine drink consumption( 5 , 17 ), alcohol dependence( 6 , 7 ), mental activities (gambling( 18 , 19 ), play video games( 20 ), overtime working( 21 )) increase cigarettes consumption and turn ex-smokers or non-smokers into smokers. However, smokers with several different lifestyles is common in their daily life and there are few studies investigate the influence of combined lifestyles on high nicotine dependence. To our knowledge, our research is the first to study revealing the relationship between healthy or unhealthy combined lifestyles and the risk of high ND. Importantly, we revealed that interaction of mental activities after dinner, caffeine drink and sleep time less than 8 hours greatly increased the risk of high ND. During night without smoking, decrease of nicotine level can recover nicotinic-acetylcholine receptors. It may contribute to development of withdrawal symptoms in the morning when caving for cigarettes( 22 ). Sleep duration further decreases positive mood and increases negative mood( 10 ).Dopamine caused by the calming effect of nicotine relieve this bad mood( 23 ).Therefore, smokers with high nicotine dependence will considered the first few cigarettes as the most pleasurable of the day. We can also understand sleep duration may increase the risk of high nicotine dependence. Mental activities after dinner( 13 ) (including gambling, overtime work, play video games, studying or other mental thinking activities) and smoking may be related to environment factor, such as colleagues, classmates, gamblers and video game patters. Moreover, tobacco was used to make dopamine to get rid of anxious and cope with stress to focus attention in these situations( 24 – 26 ).Furthermore, coffee or caffeine drink is also the choice for dealing with tiredness in that some low-cost addictive substance are available anywhere and anytime. The prevalence of drinking caffeine beverage and smoking together will happen during mental activities after dinner or morning without enough sleep time. Caffeine withdrawal symptoms increased difficulties in smoking cessation( 17 ).So,synergistict effects of mental activities after dinner, caffeine drink, sleep duration increase the risk of high nicotine dependence. Our data proved that healthy lifestyles can’t help decrease the risk of high ND. This result is different than previous studies that smokers with exercises have lower nicotine dependence and lower tobacco consumption ( 8 , 9 ).The main reason of differences is that we chose all range of age smokers with exercise more than 3 times a week and each time more than 30 minutes. This inclusion criteria can be wildly used in all high nicotine dependent smokers. And we also proved that afternoon snap didn’t decrease the risk of high nicotine dependence. Short breaks, such as a nap, relieve stress and reduce brain fatigue during workdays. Some smokers who need nicotine for getting rid of tiredness will decrease cigarettes consumption in that enough rest help brains to focus attention. There are few studies showed the relationship between nap with nicotine dependence. Therefore, we draw a suggestion that smokers who come to clinic for cessation help with high nicotine dependence should fully consider individualized treatment no matter with healthy or unhealthy lifestyles instead of avoiding unhealthy life behaviors or developing healthy lifestyles only. In the future, standards of unhealthy life behaviors, such and cups of caffeine drink and the sort of mental activities can obviously increase nicotine dependence in smokers. Healthy life behaviors, such as nap, should be more investigated the mechanism underlying nicotine dependence. Conclusion Interact effects of mental activities after dinner and caffeine drink will increase the risk of high nicotine dependence. Sleep less than 8 hours with mental activities after dinner and caffeine drink also have the same effect. Avoiding these factors may decrease likelihood for high nicotine addiction and may help increase possibility for smoking cessation. Smokes should decrease mental activities at night, caffeine drink will be take less in the meanwhile. Enough rest also makes brain relax which decrease anxious and stress. All these factors’ correction may help decrease risk of high nicotine dependence. Individualized treatment for smokers should fully consider both healthy and unhealthy lifestyles. Declarations Competing interests The authors declare that they have no competing interests. Ethical approval Our study and survey designation approved by the Ethics Committee of the Affiliated Hospital of Medical school of Ningbo University (NBU-2020-080, Ningbo, China). Informed consent was obtained from all patients before conducted the survey. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Funding Funding for this study was provided by The Affiliated Hospital of Medical School of Ningbo University Youth Talent Cultivation Program (FYQM-LC-202003), and the Natural Science Foundation of Ningbo (2018A610271). The Affiliated Hospital of Medical School of Ningbo University Youth Talent Cultivation Program and Natural Science Foundation of Ningbo had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Data availability Statement Our data generated and analyzed during the study are available from the corresponding authors in the future research on reasonable request. Authors' contributions Zhongbo Chen conducted the research. Zhongbo Chen and Xuechan Yu analyzed and calculated data and wrote the first draft of manuscript together. All authors read and approved the final manuscript. Acknowledgements We thank all patients who finished the survey. References Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. Ca-Cancer J Clin. 2019;69(1):7-34. 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):464-76. 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):381-9. Strine TW, Okoro CA, Chapman DP, Balluz LS, Ford ES, Ajani UA, et al. Health-related quality of life and health risk behaviors among smokers. Am J Prev Med. 2005;28(2):182-7. 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):229-56. Falk DE, Yi H-y, Hiller-Sturmhofel 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 research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism. 2006;29(3):162-71. 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):985-90. Audrain-McGovern J, Rodriguez D, Moss HB. Smoking progression and physical activity. Cancer Epidemiol Biomarkers Prev. 2003;12(11 Pt 1):1121-9. Loprinzi PD, Walker JF. Nicotine Dependence, Physical Activity, and Sedentary Behavior among Adult Smokers. N Am J Med Sci. 2015;7(3):94-9. Hamidovic A, de Wit H. Sleep deprivation increases cigarette smoking. Pharmacol Biochem Be. 2009;93(3):263-9. 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):31-8. Shields PG, Herbst RS, Arenberg D, Benowitz NL, Bierut L, Luckart JB, et al. Smoking Cessation, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(11):1430-68. Yu X, Yu Y, Ma H, Chen Z, Deng Z. Mental activities after dinner increase cigarettes consumption. Sci Rep. 2021;11(1):2405. Payne TJ, Smith PO, McCracken LM, McSherry WC, Antony MM. Assessing nicotine dependence: a comparison of the Fagerstrom Tolerance Questionnaire (FTQ) with the Fagerstrom Test for Nicotine Dependence (FTND) in a clinical sample. Addict Behav. 1994;19(3):307-17. Ray R, Schnoll RA, Lerman C. Nicotine dependence: biology, behavior, and treatment. Annu Rev Med. 2009;60:247-60. Cohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkmeyer J, et al. Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence. Addict Biol. 2014;19(3):486-96. Tanda G, Goldberg SR. Alteration of the behavioral effects of nicotine by chronic caffeine exposure. Pharmacol Biochem Behav. 2000;66(1):47-64. Grant JE, Potenza MN. Tobacco use and pathological gambling. Ann Clin Psychiatry. 2005;17(4):237-41. McGrath DS, Barrett SP. The comorbidity of tobacco smoking and gambling: a review of the literature. Drug Alcohol Rev. 2009;28(6):676-81. 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):1453-7. Angrave D, Charlwood A, Wooden M. Working time and cigarette smoking: evidence from Australia and the United Kingdom. Soc Sci Med. 2014;112:72-9. Dani JA, Heinemann S. Molecular and cellular aspects of nicotine abuse. Neuron. 1996;16(5):905-8. Gilbert DG. Paradoxical tranquilizing and emotion-reducing effects of nicotine. Psychol Bull. 1979;86(4):643-61. Gray JA, Young AM, Joseph MH. Dopamine's role. Science. 1997;278(5343):1548-9. DeWitt EEJ. Neuroeconomics: A Formal Test of Dopamine's Role in Reinforcement Learning. Curr Biol. 2014;24(8):R321-R4. 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):334-43. Tables Table 1 Clinical characteristics in two groups FTND ≤ 5 (n = 151) FTND>5 (n = 192) P value Age,years Mean ± SD 42.60 ± 11.01 43.13 ± 11.06 0.664 Gender,n Male 141 176 0.682 Female 10 16 BMI,Kg/m 2 Mean ± SD 23.47 ± 2.72 23.64 ± 7.72 0.796 Table 2 Healthy and unhealthy lifestyles distribution in two groups χ 2 P value FTND ≤ 5 22.13 0.139 FTND>5 36.98 0.002 * * P< 0.05 was considered as statistical significance. Table 3 The relationship between healthy lifestyles and high nicotine dependence OR(95%CI) P value athletics 0.820 (0.521–1.291) 0.392 sleep time ≥ 8h 0.943 (0.641–1.447) 0.787 afternoon nap 1.081 (0.684–1.708) 0.74 fruits 0.683 (0.415–1.124) 0.133 athletics + sleep time ≥ 8h 0.779 (0.444–1.336) 0.384 athletics + afternoon nap 1.072 (0.596–1.928) 0.818 athletics + fruits 0.576 (0.298–1.111) 0.1 sleep time ≥ 8h + afternoon nap 1.118 (0.603–2.075) 0.723 sleep time ≥ 8h + fruits 0.927 (0.497–1.729) 0.811 afternoon nap + fruits 1.079 (0.480–2.422) 0.855 athletics + sleep time ≥ 8h + friuts 0.772 (0.337–1.771) 0.542 athletics + sleep time ≥ 8h + afternoon nap 0.924 (0.402–2.126) 0.853 athletics + fruits + afternoon nap 1.012 (0.368–2.782) 0.982 afternoon nap + fruits + sleep time ≥ 8h 1.105 (0.344–3.553) 0.867 athletics + sleep time ≥ 8h + friuts + afternoon nap 0.983 (0.259–3.724) 0.979 Table 4 The relationship between unhealthy lifestyles and high nicotine dependence OR(95%CI) P value sleep time<8h 1.061 (0.691–1.628) 0.787 alcohol consumption 0.748 (0.425–1.318) 0.315 caffeine drink 0.869 (0.566–1.336) 0.523 mental activities after dinner 1.475 (0.956–2.275) 0.079 sleep time<8h + alcohol consumption 1.236 (0.561–2.725) 0.599 sleep time<8h + coffein drink 1.011 (0.622–1.645) 0.964 sleep time<8h + mental activities after dinner 1.142 (0.671–1.945) 0.624 alcohol consumption + caffeine drink 0.675 (0.338–1.349) 0.266 alcohol consumption + mental activities after dinner 0.481 (0.202–1.144) 0.098 caffeine drink + mental activities after dinner 1.939 (1.154–3.258) 0.012 * sleep time<8h + alcohol consumption + caffeine drink 1.494 (0.581–3.843) 0.405 sleep time<8h + alcohol consumption + mental activities after dinner 0.914 (0.301–2.780) 0.875 sleep time<8h + caffeine drink + mental activities after dinner 2.208 (1.032–4.737) 0.042 * alcohol consumption + caffeine drink + mental activities after dinner 0.676 (0.240–1.909) 0.46 sleep time<8h + alcohol consumption + caffeine drink + mental activities after dinner 1.591 (0.391–6.470) 0.516 * P< 0.05 was considered as statistical significance. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-218419","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":10997693,"identity":"ed8f9f18-a38e-4639-a0d6-ec959bce1ab7","order_by":0,"name":"Zhongbo Chen","email":"","orcid":"","institution":"Affiliated Hospital of Medical School Ningbo University and Ningbo City Third Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhongbo","middleName":"","lastName":"Chen","suffix":""},{"id":10997694,"identity":"71481eb9-42d8-4c52-a479-d142eee3b0b1","order_by":1,"name":"Xuechan 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Nicotine dependence (ND) is a maladaptive pattern of tobacco smoking with withdrawal symptoms like other drug addictive disorders and it has already been defined by the Diagnosis and Statistical Manual of Mental Disorder\u0026mdash;edition IV (DSM-IV)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Previous studies have shown that different lifestyle is closely related to smoke state change and cigarettes consumption(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).Caffeine withdrawal increase difficulties in quitting smoking(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Alcohol and nicotine dependence are likely to co-occur in the same person, which is the reason of lower likelihood of smoking cessation(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). People with healthy life habits, including exercise and enough time of sleep, may have less cigarettes daily consumption and lower nicotine dependence (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Moreover, it is very common in clinic that smokers always have different degree of nicotine dependence with same amount of tobacco consumption. Therefore, we considered that whether some relationship between lifestyle and high nicotine dependence. However, so far there is no evidence showing unhealthy factors increased the risk of high ND, vice versa. We sought to figure out the relationship between lifestyle and ND by a designed survey which recorded healthy and unhealthy life behaviors as medical history.\u003c/p\u003e "},{"header":"Methods And Procedures","content":"\u003cp\u003eA survey designed by our group members recorded patients\u0026rsquo; lifestyles from April 2010 to January 2020 in The Affiliated Hospital of Medical School of Ningbo University. Three hundred and forty three patients were recruited and complete the survey. All research subjects provide informed consent, and survey designation was approved by the Ethics Committee of the Affiliated Hospital of Medical school of Ningbo University (Ningbo, China). Informed consent contained from all patients before finish the survey. All methods were carried out in accordance with NCCN Clinical Practice Guidelines in Oncology of Smoking Cessation(\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical \u003c/strong\u003e\u003cstrong\u003echaracteristics and life behaviors\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)Demographic (age, gender, BMI) data were recorded as clinical characteristics. (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) Healthy lifestyles was identified as following: athletics(exercise more than 3 times a week and each time more than 30 minutes(\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e);sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8 hours; take afternoon nap; often eat fruits. (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) Unhealthy lifestyles include: sleep time \u0026lt; 8 hours; alcohol consumption; caffeine drink; mental activities after dinner before sleep(\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e) (including gambling, overtime work, play video games, studying or other mental thinking activities).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of nicotine dependence\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eNicotine dependence was measured by Fagerstrom Test for Nicotine Dependence (FTND)(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). FTND score \u0026gt; 5 was regarded as high nicotine dependence. FTND score\u0026thinsp;\u0026le;\u0026thinsp;5 was considered as mild and moderate nicotine dependence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003cp\u003eThe information and results questionnaire for 343 patients were included in the statistics. \u003cem\u003et\u003c/em\u003e-test and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation(SD) were used in age, BMI. Gender distribution and life behaviors distribution in two groups(FTND\u0026thinsp;\u0026le;\u0026thinsp;5 and FTND \u0026gt; 5) were calculated by chi-square analysis. All independent or interaction effects of behaviors were analyzed by multiple logistic-regression. These analysis were calculated by IBM SPSS Statistics 21.0 and \u003cem\u003eP\u003c/em\u003e value \u0026lt; 0.05 was considered as statistical difference.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDemographics of the cohort are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, there were no differences in age, gender and BMI between the two groups. However, healthy and unhealthy lifestyles were differently distributed in the two groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) (\u003cstrong\u003e\u0026chi;\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;36.98, \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.002), indicating that each behavior of athletics, sleep, sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h, fruits consumption didn\u0026rsquo;t decrease the risk of high ND no matter independently or combined (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Results in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e showed that caffeine drink combined with mental activities after dinner increase the risk of high nicotine dependence (OR:1.939, 95%CI:1.154,3.258, \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.012). Three unhealthy interaction behaviors (sleep time \u0026lt; 8 hours, caffeine drink and mental activities after dinner) are associated with high nicotine dependence (OR:2.208, 95%CI:1.032,4.737, \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.042).\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eNicotine dependence is a maladaptive pattern of tobacco smoking with withdrawal symptoms like other drug addictive disorders. Many life behaviors may change cigarettes daily consumption or smoke state (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). People with healthy behaviors has lower nicotine dependence ,such as exercising, sleep enough time(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Previous studies demonstrate that unhealthy lifestyles ,including sleep duration (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), caffeine drink consumption(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), alcohol dependence(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), mental activities (gambling(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), play video games(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), overtime working(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)) increase cigarettes consumption and turn ex-smokers or non-smokers into smokers. However, smokers with several different lifestyles is common in their daily life and there are few studies investigate the influence of combined lifestyles on high nicotine dependence. To our knowledge, our research is the first to study revealing the relationship between healthy or unhealthy combined lifestyles and the risk of high ND. Importantly, we revealed that interaction of mental activities after dinner, caffeine drink and sleep time less than 8 hours greatly increased the risk of high ND.\u003c/p\u003e \u003cp\u003eDuring night without smoking, decrease of nicotine level can recover nicotinic-acetylcholine receptors. It may contribute to development of withdrawal symptoms in the morning when caving for cigarettes(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Sleep duration further decreases positive mood and increases negative mood(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).Dopamine caused by the calming effect of nicotine relieve this bad mood(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).Therefore, smokers with high nicotine dependence will considered the first few cigarettes as the most pleasurable of the day. We can also understand sleep duration may increase the risk of high nicotine dependence.\u003c/p\u003e \u003cp\u003eMental activities after dinner(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) (including gambling, overtime work, play video games, studying or other mental thinking activities) and smoking may be related to environment factor, such as colleagues, classmates, gamblers and video game patters. Moreover, tobacco was used to make dopamine to get rid of anxious and cope with stress to focus attention in these situations(\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).Furthermore, coffee or caffeine drink is also the choice for dealing with tiredness in that some low-cost addictive substance are available anywhere and anytime. The prevalence of drinking caffeine beverage and smoking together will happen during mental activities after dinner or morning without enough sleep time. Caffeine withdrawal symptoms increased difficulties in smoking cessation(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).So,synergistict effects of mental activities after dinner, caffeine drink, sleep duration increase the risk of high nicotine dependence.\u003c/p\u003e \u003cp\u003eOur data proved that healthy lifestyles can\u0026rsquo;t help decrease the risk of high ND. This result is different than previous studies that smokers with exercises have lower nicotine dependence and lower tobacco consumption (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).The main reason of differences is that we chose all range of age smokers with exercise more than 3 times a week and each time more than 30 minutes. This inclusion criteria can be wildly used in all high nicotine dependent smokers. And we also proved that afternoon snap didn\u0026rsquo;t decrease the risk of high nicotine dependence. Short breaks, such as a nap, relieve stress and reduce brain fatigue during workdays. Some smokers who need nicotine for getting rid of tiredness will decrease cigarettes consumption in that enough rest help brains to focus attention. There are few studies showed the relationship between nap with nicotine dependence. Therefore, we draw a suggestion that smokers who come to clinic for cessation help with high nicotine dependence should fully consider individualized treatment no matter with healthy or unhealthy lifestyles instead of avoiding unhealthy life behaviors or developing healthy lifestyles only.\u003c/p\u003e \u003cp\u003eIn the future, standards of unhealthy life behaviors, such and cups of caffeine drink and the sort of mental activities can obviously increase nicotine dependence in smokers. Healthy life behaviors, such as nap, should be more investigated the mechanism underlying nicotine dependence.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eInteract effects of mental activities after dinner and caffeine drink will increase the risk of high nicotine dependence. Sleep less than 8 hours with mental activities after dinner and caffeine drink also have the same effect. Avoiding these factors may decrease likelihood for high nicotine addiction and may help increase possibility for smoking cessation. Smokes should decrease mental activities at night, caffeine drink will be take less in the meanwhile. Enough rest also makes brain relax which decrease anxious and stress. All these factors\u0026rsquo; correction may help decrease risk of high nicotine dependence. Individualized treatment for smokers should fully consider both healthy and unhealthy lifestyles.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study and survey designation approved by the Ethics Committee of the Affiliated Hospital of Medical school of Ningbo University (NBU-2020-080, Ningbo, China). Informed consent was obtained from all patients before conducted the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this study was provided by The Affiliated Hospital of Medical School of Ningbo University Youth Talent Cultivation Program (FYQM-LC-202003), and the Natural Science Foundation of Ningbo (2018A610271). The Affiliated Hospital of Medical School of Ningbo University Youth Talent Cultivation Program and Natural Science Foundation of Ningbo had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability Statement \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur data generated and analyzed during the study are available from the corresponding authors in the future research on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhongbo Chen conducted the research. Zhongbo Chen and Xuechan Yu analyzed and calculated data and wrote the first draft of manuscript together. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all patients who finished the survey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSiegel RL, Miller KD, Jemal A. Cancer statistics, 2019. Ca-Cancer J Clin. 2019;69(1):7-34.\u003c/li\u003e\n\u003cli\u003eWillemse 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):464-76.\u003c/li\u003e\n\u003cli\u003eRobins 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):381-9.\u003c/li\u003e\n\u003cli\u003eStrine TW, Okoro CA, Chapman DP, Balluz LS, Ford ES, Ajani UA, et al. 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Cancer Epidemiol Biomarkers Prev. 2003;12(11 Pt 1):1121-9.\u003c/li\u003e\n\u003cli\u003eLoprinzi PD, Walker JF. Nicotine Dependence, Physical Activity, and Sedentary Behavior among Adult Smokers. N Am J Med Sci. 2015;7(3):94-9.\u003c/li\u003e\n\u003cli\u003eHamidovic A, de Wit H. Sleep deprivation increases cigarette smoking. Pharmacol Biochem Be. 2009;93(3):263-9.\u003c/li\u003e\n\u003cli\u003eFucito 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):31-8.\u003c/li\u003e\n\u003cli\u003eShields PG, Herbst RS, Arenberg D, Benowitz NL, Bierut L, Luckart JB, et al. Smoking Cessation, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14(11):1430-68.\u003c/li\u003e\n\u003cli\u003eYu X, Yu Y, Ma H, Chen Z, Deng Z. Mental activities after dinner increase cigarettes consumption. Sci Rep. 2021;11(1):2405.\u003c/li\u003e\n\u003cli\u003ePayne TJ, Smith PO, McCracken LM, McSherry WC, Antony MM. Assessing nicotine dependence: a comparison of the Fagerstrom Tolerance Questionnaire (FTQ) with the Fagerstrom Test for Nicotine Dependence (FTND) in a clinical sample. Addict Behav. 1994;19(3):307-17.\u003c/li\u003e\n\u003cli\u003eRay R, Schnoll RA, Lerman C. Nicotine dependence: biology, behavior, and treatment. Annu Rev Med. 2009;60:247-60.\u003c/li\u003e\n\u003cli\u003eCohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkmeyer J, et al. Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence. Addict Biol. 2014;19(3):486-96.\u003c/li\u003e\n\u003cli\u003eTanda G, Goldberg SR. Alteration of the behavioral effects of nicotine by chronic caffeine exposure. Pharmacol Biochem Behav. 2000;66(1):47-64.\u003c/li\u003e\n\u003cli\u003eGrant JE, Potenza MN. Tobacco use and pathological gambling. 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Science. 1997;278(5343):1548-9.\u003c/li\u003e\n\u003cli\u003eDeWitt EEJ. Neuroeconomics: A Formal Test of Dopamine's Role in Reinforcement Learning. Curr Biol. 2014;24(8):R321-R4.\u003c/li\u003e\n\u003cli\u003eGrant 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):334-43.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eClinical characteristics in two groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFTND\u0026thinsp;\u0026le;\u0026thinsp;5 (n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eFTND\u0026gt;5 (n\u0026thinsp;=\u0026thinsp;192)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge,years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e42.60\u0026thinsp;\u0026plusmn;\u0026thinsp;11.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e43.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.664\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender,n\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e176\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.682\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI,Kg/m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e23.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e23.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.796\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eHealthy and unhealthy lifestyles distribution in two groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFTND\u0026thinsp;\u0026le;\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.139\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFTND\u0026gt;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e* \u003cem\u003eP\u0026lt;\u003c/em\u003e0.05 was considered as statistical significance.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe relationship between healthy lifestyles and high nicotine dependence\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR(95%CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.820 (0.521\u0026ndash;1.291)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.392\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.943 (0.641\u0026ndash;1.447)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eafternoon nap\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.081 (0.684\u0026ndash;1.708)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efruits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.683 (0.415\u0026ndash;1.124)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.133\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.779 (0.444\u0026ndash;1.336)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.384\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;afternoon nap\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.072 (0.596\u0026ndash;1.928)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.818\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;fruits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.576 (0.298\u0026ndash;1.111)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u0026thinsp;+\u0026thinsp;afternoon nap\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.118 (0.603\u0026ndash;2.075)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.723\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u0026thinsp;+\u0026thinsp;fruits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.927 (0.497\u0026ndash;1.729)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.811\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eafternoon nap\u0026thinsp;+\u0026thinsp;fruits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.079 (0.480\u0026ndash;2.422)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.855\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u0026thinsp;+\u0026thinsp;friuts\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.772 (0.337\u0026ndash;1.771)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.542\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u0026thinsp;+\u0026thinsp;afternoon nap\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.924 (0.402\u0026ndash;2.126)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.853\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;fruits\u0026thinsp;+\u0026thinsp;afternoon nap\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.012 (0.368\u0026ndash;2.782)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.982\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eafternoon nap\u0026thinsp;+\u0026thinsp;fruits\u0026thinsp;+\u0026thinsp;sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.105 (0.344\u0026ndash;3.553)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.867\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eathletics\u0026thinsp;+\u0026thinsp;sleep time\u0026thinsp;\u0026ge;\u0026thinsp;8h\u0026thinsp;+\u0026thinsp;friuts\u0026thinsp;+\u0026thinsp;afternoon nap\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.983 (0.259\u0026ndash;3.724)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.979\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe relationship between unhealthy lifestyles and high nicotine dependence\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR(95%CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.061 (0.691\u0026ndash;1.628)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ealcohol consumption\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.748 (0.425\u0026ndash;1.318)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.315\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecaffeine drink\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.869 (0.566\u0026ndash;1.336)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.523\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.475 (0.956\u0026ndash;2.275)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.079\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;alcohol consumption\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.236 (0.561\u0026ndash;2.725)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.599\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;coffein drink\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.011 (0.622\u0026ndash;1.645)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.964\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.142 (0.671\u0026ndash;1.945)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.624\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ealcohol consumption\u0026thinsp;+\u0026thinsp;caffeine drink\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.675 (0.338\u0026ndash;1.349)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.266\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ealcohol consumption\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.481 (0.202\u0026ndash;1.144)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.098\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecaffeine drink\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.939 (1.154\u0026ndash;3.258)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.012\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;alcohol consumption\u0026thinsp;+\u0026thinsp;caffeine drink\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.494 (0.581\u0026ndash;3.843)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.405\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;alcohol consumption\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.914 (0.301\u0026ndash;2.780)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.875\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;caffeine drink\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.208 (1.032\u0026ndash;4.737)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.042\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ealcohol consumption\u0026thinsp;+\u0026thinsp;caffeine drink\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.676 (0.240\u0026ndash;1.909)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esleep time\u0026lt;8h\u0026thinsp;+\u0026thinsp;alcohol consumption\u0026thinsp;+\u0026thinsp;caffeine drink\u0026thinsp;+\u0026thinsp;mental activities after dinner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.591 (0.391\u0026ndash;6.470)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.516\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e* \u003cem\u003eP\u0026lt;\u003c/em\u003e0.05 was considered as statistical significance.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lifestyle, High nicotine dependence, Sleep, Caffeine drink, Mental activities after dinner","lastPublishedDoi":"10.21203/rs.3.rs-218419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-218419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Nicotine dependence (ND) is a maladaptive pattern of tobacco smoking with withdrawal symptoms like other drug addictive disorders. It is very common in clinic that smokers always have different degree of nicotine dependence with same amount of tobacco consumption. Lifestyle may influence cigarettes daily consumption or smoke state. So it is critical to prove the influence of healthy or unhealthy lifestyles in high nicotine dependence smokers. This study aimed to identify behavioral correlates to high ND.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e343 patients who went to clinic for smoking cessation were recruited. Participants completed a demographic questionnaire. The extent of Nicotine dependence was determined by Fagerstrom Test for Nicotine Dependence (FTND).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e High ND patients (FTND\u0026gt;5) showed significant life style compared with mild and moderate ND patients (FTND\u0026lt;5) is significantly\u0026nbsp;\u0026nbsp;(\u003cstrong\u003eχ\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e=36.98, \u003cem\u003eP\u003c/em\u003e value=0.002). There is no single lifestyle index can significantly distinguish high ND from mild and moderate ND. However, combined behaviors of caffeine drink and mental activities after dinner contribute to the risk of high ND (OR:1.939, 95%CI:1.154-3.258, \u003cem\u003eP \u003c/em\u003evalue=0.012). In addition, combined index of(sleep time \u0026lt; 8 hours, caffeine drink and mental activities after dinner) each significantly distinguished patients of high ND from patients of mild and moderate ND.\u0026nbsp;with high nicotine dependence(OR:2.208, 95%CI:1.032-4.737, \u003cem\u003eP \u003c/em\u003evalue=0.042）.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eInteract effects of mental activities after dinner and caffeine drink will increase the risk of high nicotine dependence. Sleep less than 8 hours with behaviors of mental activities after dinner and caffeine drink also have the same effect.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Can Lifestyle Influence the Risk of High Nicotine Dependence?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-19 20:38:17","doi":"10.21203/rs.3.rs-218419/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d104be92-e4fa-4f2b-93dc-e711b9955d42","owner":[],"postedDate":"February 19th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":2516785,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2021-02-19T20:38:18+00:00","versionOfRecord":[],"versionCreatedAt":"2021-02-19 20:38:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-218419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-218419","identity":"rs-218419","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}