Julayi 2007
UJoseph R. DiFranza, MD; Judith A. Savageau, MPH; Kenneth Fletcher, PhD; okqhubekayo UJennifer O'Loughlin, PhD; ULori Pbert, PhD; Judith K. Ockene, PhD; UAnn D. McNeill, PhD; UJennifer Hazelton, BA; UKaren Friedman, BA; Gretchen Dussault, BA; UConnie Wood, uMSW; Robert J. Wellman, PhD
UkuBambisana noMbhali Ulwazi lweCandelo
Arch Pediatr Adolesc Med. 2007;161(7):704-710. doi:10.1001/archpedi.161.7.704
Abstract
injongo Ukwandisa iziphumo zoPhuhliso lokuqala kunye noVavanyo lweNikotine yokuxhomekeka kuLutsha kuphononongo ngokusebenzisa iindlela zokuxilonga ukuxhomekeka kwecuba kunye nomlinganiselo we-biochemical wokuthathwa kwe-nicotine. Uphononongo lokuqala lwafumanisa ukuba iimpawu zokuxhomekeka zidla ngokuvela kamsinya nje emva kokuqala kokutshaya kwamathuba athile.
uyilo Isifundo esilindelekileyo seminyaka emi-4.
Icwangcisa Izikolo zikarhulumente 6 Massachusetts uluntu.
nxaxheba Iqela labafundi bebanga lesithandathu abali-1246.
Ngoncedo Udliwano-ndlebe olulishumi elinanye.
Iziphumo eziPhambili Ilahleko yokuzimela geqe kwicuba njengoko kulinganiswe ngoLuhlu lokuHlola lwe-Hooked on Nicotine, kunye nokuxhomekeka kwecuba njengoko kuchaziwe Ulwahlulo lwamazwe ngamazwe lweZifo, uHlaziyo lwe-10 (ICD-10).
iziphumo Phakathi kwe-217 ye-inhalers, i-127 yalahlekelwa ukuzimela ngokusetyenziswa kwayo icuba, i-10% ikwenzile oko kwiintsuku ezi-2 kwaye i-25% ikwenzile oko kwiintsuku ezingama-30 zokuqala zokuphefumla kwicuba; Isiqingatha sasilahlekelwe kukuzimela ngexesha babetshaya imidiza esi-7 ngenyanga. Phakathi kwee-inhalers ezingama-83 eziye zaphuhliswa ICD-10-ukuxhomekeka kuchaziweyo, isiqingatha sasikwenzile oko ngelixa babetshaya iisigarethi ezingama-46 ngenyanga. Kudliwano-ndlebe olulandela ukuqala kwe ICD-10-ukuxhomekeka kuchaziweyo, i-concentration ye-salivary cotinine ephakathi kwabantu abatshayayo ngoku yayiyi-5.35 ng / mL, inqanaba eliwela kakuhle ngaphantsi kwe-cutoff esetyenziselwa ukwahlula okusebenzayo kubantu ababhemayo.
izigqibo Olona lutsha lusesichengeni luphulukana nokuzimela geqe kwicuba kwisithuba nje sosuku okanye ezi-2 zokuphefumla okokuqala kwicuba. Ukubonakala kweempawu zokuhoxiswa kwecuba kunye nemizamo engaphumeleli yokuyeka ukutshaya kunokuqala ukutshaya imihla ngemihla; ICD-10-ukuxhomekeka okuchaziweyo kunokwandulela ukutshaya imihla ngemihla kwaye kubonakala ngokuqhelekileyo ngaphambi kokuba ukusetyenziswa kufikelele kwi-cigarettes ye-2 ngosuku.
Phakathi kwamagalelo akhe amaninzi abalulekileyo, uRussell1- 4 yachaza “umzekelo wokutshaya” kungcelele lwezincoko ezinempembelelo ezapapashwa kwiminyaka engaphezu kwama-30 eyadlulayo. Kulo mzekelo, uvavanyo lokuqala lokutshaya lukhuthazwa yimiba yengqondo kunye nokufuna ukwazi, kodwa ngokukhawuleza "imivuzo ye-pharmacological" ye-nicotine ngendlela "yokuzonwabisa," "i-sedative," okanye "ukuvuselela" ukutshaya inika inkuthazo yokusetyenziswa ngaphambi kokuxhomekeka. . Ngokutsho kukaRussell, “Emva kweminyaka emi-3 okanye emi-4 yokutshaya ngamaxesha athile, ukutshaya okuqhelekileyo kwabantu abadala kuqalisa.”3 Xa umntu esela imidiza engaphezu kwama-20 ngosuku, uye abe “likhoboka lecuba” yaye “umntu otshayayo uba neempawu zokuyeka xa etshaya imizuzu engama-20 ukusa kwengama-30.”3 Le nkcazo yeklasikhi yembali yendalo yokuxhomekeka kwe-nicotine yayingafane ibe ngumngeni5 ukuya kutsho ekupheleni kwenkulungwane yama-20.
URussell waba nguvulindlela ekuqondeni impembelelo yomdiza wokuqala otshayayo ebudeni beminyaka yokufikisa: “Kufuneka icuba elingekho ngaphezu kwesithathu okanye elinesine kweli xesha libuthathaka ukuqinisekisa ngendaleko ekutshayeni ngokuthe rhoqo kwiminyaka embalwa.”3,6 Ngexesha apho ukutshaya kwakuyinto eqhelekileyo entlalweni, uRussell wathi “li-15 kuphela ekhulwini labo banemidiza engaphezulu kwesinye abakuphephayo ukutshaya rhoqo.”3 Ngenxa yokuthetha kwakhe ukuba abantu abadala abatshayayo ngamaxesha athile kunye naphakathi babengaxhomekekanga ngokwenene,7 ayizange icace into yokuba ukutshaya imidiza embalwa kunempembelelo enzulu ngolo hlobo, awayifanisa “nesigwebo seminyaka engama-40.”7
Imodeli echaza ukuxhomekeka njenge-sequela kade yokutshaya kakhulu rhoqo kwaye yacelwa umngeni ngo-2000 ngokupapashwa kophando lokuqala olulindelekileyo lwembali yendalo yokuxhomekeka kwenikotini.8 Uphuhliso kunye noVavanyo lweNikotine yokuxhomekeka kuLutsha (i-DANDY) luchaze ukuba iimpawu zokuxhomekeka zikhula ngokukhawuleza emva kwecuba lokuqala, kungekho mfuneko encinci yenani lemidiza etshayayo okanye ukuphindaphinda okanye ubude bexesha lokusetyenziswa.8,9 Nganye kwiimpawu zokuxhomekeka kwe-11 ezihlolwe zichazwe ubuncinane be-1 ulutsha kwiiveki ze-2 zokuqalisa ukutshaya kwenyanga. I-median frequency yokusetyenziswa ekuqalekeni kwempawu yayiziintsuku ezi-4 ngenyanga, kwaye ubuninzi be-median yayiyi-cigarettes ye-8 ngenyanga. Idatha yenze ijiko lePoisson elineempawu eziqhelekileyo ezibonisa ngokukhawuleza emva kokuqaliswa kokutshaya okwethutyana.
Uphononongo lwe-DANDY lunike ingxelo enye into ebingalindelekanga: iimpawu zokuyeka phakathi kwabantu abatshayayo. Ubulumko obuqhelekileyo bubambe ukuba iimpawu zokuyeka zibonakala kuphela ngamanqanaba aphakathi okutshaya imihla ngemihla,3 kwaye ubukho babo bufuna ukuba umntu agcine ubukho be-nicotine rhoqo emzimbeni, othatha ubuncinane iisigarethi ezi-5 ngosuku.10- 12
I-Nicotine Dependence in Teens (NDIT) isifundo eQuebec, eCanada, iphindaphinda kwaye yandisa uphononongo lwe-DANDY ngokubonisa ukuba iimpawu zokuyeka zingavela ngaphambi kokuqala kokutshaya imihla ngemihla.13 kwaye oko Ulwahlulo lwaMazwe ngaMazwe lweZifo, uHlaziyo lwe-10 (ICD-10), iindlela zokuxilonga ukuxhomekeka kwecuba zibonakala ngexesha lokusetyenziswa kwecuba ngezikhathi ezithile.13,14 Ukusebenzisa uhlalutyo lokusinda kunye nokulinganisa ukusuka kwi-puff yokuqala, uphando lwe-NDIT luchaze ukuba i-25% yabo bonke abantu abakhukhumele baye baqhubela phambili ekuphefumlweni ngeenyanga ze-1.5, banqwenela ngeenyanga ze-4.5, ukutshaya inyanga nenyanga nge-8.8, kwezinye iimpawu zokurhoxisa kwiinyanga ze-11, ukuya ukutshaya ngeveki nge 19.4 iinyanga, kwaye ukuze ICD-10-ukuxhomekeka kuchazwe (ubukho bemilinganiselo ye-3) ngeenyanga ze-40.6.15 Olu qikelelo lubaxa izinto ezibambekayo zokwenyani, njengoko zisekwe kumhla wovavanyo olulandela isiganeko ngasinye. Ngethuba leenyanga ze-3 phakathi kwe-inhalation yokuqala (i-latency yeenyanga ze-1.5) kunye nokukhanga kokuqala (iinyanga ze-4.5), ulutsha olwalungekatshaya inyanga nenyanga lutshaya ngaphantsi kwe-cigarettes ye-3 (i-latency ukuya kwinyanga yokutshaya yayiyi-8.8 iinyanga). Idatha ye-NDIT ibonisa ukuba, kulutsha, ukuphefumula umsi kwi-cigarettes ye-1 okanye i-2 kuphela yanele ukubangela umnqweno, uphawu oluqhelekileyo. ICD-10-ukuxhomekeka okuchaziweyo.
Idatha yobungqina evela kwizifundo ze-DANDY kunye ne-NDIT zenze imfuneko yokuhlolwa kwakhona kwemodeli kaRussell. Ethathwe kule datha, ithiyori ye-sensitization-homeostasis iqinisekisa ukuba iinkqubo ze-neurophysiological eziphantsi kokuxhomekeka kwe-nicotine zisekwe kwi-cigarette yokuqala.16 Ukuthomalalisa inkanuko eqhutywa ngokwasemzimbeni kunye nokurhoxa iba yeyona nto ikhuthazayo kwabo batshaya kuphela iisigarethi ezimbalwa ngenyanga nganye. Ekuqaleni, iimpawu zokunqwenela kunye nokuyeka zingagcinwa ngokutshaya i-cigarette i-1 ngeveki okanye kunjalo, kodwa njengoko ukunyamezela kukhula, ixesha lokukhululeka elinikezelwa ngumdiza ngamnye liyancipha ngokuqhubekayo. Ukuba umntu otshayayo akakuthinteli ukusela, usenokuba “neempawu zokuyeka xa etshaya ngalo lonke ixesha [eye] engatshayanga imizuzu engama-20 ukusa kwengama-30,” njengoko uRussell watshoyo.3
Ngaloo ndlela, uncwadi lonwabisa imizekelo emi-2 yophuhliso lokuxhomekeka. Injongo yoPhuhliso kunye noVavanyo lokuXhomekeka kweNicotine kuLutsha-2 (DANDY-2) kuphononongo yayikukuvavanya ithiyori ye-sensitization-homeostasis ngokumisela ukuba umnqweno, ukurhoxa, kunye nezinye iimpawu zokuxhomekeka kwenikotini zivela ngexesha lokutshaya okuqhelekileyo. kwandulela ukutshaya yonke imihla. Uphononongo lwe-DANDY-2 luphuculwe kwi-predecessor yalo ngokusebenzisa umlinganiselo we-biochemical wokuthatha inikotini, ukuvavanya ICD-10-kuchazwa ukuxhomekeka kwecuba, ukusebenzisa uhlalutyo lokusinda, ukulinganisa i-latency ukusuka kwi-inhalation yokuqala ye-nicotine, kunye nokuqwalasela impembelelo ye-45 enokuthi ibe yingozi yokutshaya.
Olu yayiluphando lweminyaka emi-4 lweqela labafundi bebanga lesithandathu. Zonke iinkqubo zavunywa yiYunivesithi yaseMassachusetts Medical School ibhodi yokuphonononga iziko kunye nabalawuli bezikolo zendawo.
Izifundo ziye zagaywa kwizikolo ezi-6 zasedolophini nakwidolophu yaseMassachusetts ezikhethiweyo ukuba zibonelele ngesampulu eyohlukeneyo ngokobuhlanga nangobuhlanga. Uphononongo lwapapashwa ngezikolo. Imvume enolwazi ifunyenwe kwisifundo kunye nomnye wabazali bakhe. Ekuphela kwenqobo yokukhetha yaba kukungakwazi komfundi ukunxibelelana ngesiNgesi. (Imeko yokutshaya ayikhange ibonise ukufaneleka.) Izifundo ezatshintsha isikolo zagcinwa ukuba isikolo esitsha sasihamba ngeyure e-1 ngemoto saza isikolo esitsha savuma.
Nyaka ngamnye ukususela ngoJanuwari 2002 ukuya kutsho kuJanuwari 2006, kwaqhutywa udliwano-ndlebe olu-3 lwabucala, oluyimfihlo, lokujongana ubuso ngobuso nesifundo ngasinye ezikolweni kulungiselelwa amaza ali-11 ewonke okuqokelelwa kwedatha. Udliwano-ndlebe luqeqeshelwe ukuququzelela ukukhunjulwa ngokuchanekileyo kwemihla kunye neziganeko.17,18 Ikhalenda yeziganeko zobuqu yenzelwe umsebenzisi ngamnye wecuba ukuseka ixesha kunye nokulandelelana kweempawu kunye neziganeko ezibalulekileyo zokusetyenziswa kwecuba. Amanqaku aphambili aquka ukufunxa kokuqala; ukuphefumla okokuqala; ukuqala kwenyanga, iveki, kunye nokutshaya imihla ngemihla; ulwamkelo lwezinto ezikuLuhlu lwe-Hooked on Nicotine Checklist (HONC); kunye nokuzaliseka kwe ICD-10 indlela yokuxhomekeka kwicuba. Imihla ethile yeziganeko ezibalulekileyo zarekhodwa xa zikhona. Ngaphandle koko, ukuba isiganeko esibalulekileyo senzeke ekuqaleni kwenyanga, kwabhalwa njengenzeke ngomhla wesi-7; embindini, njengowe-15; kwaye ekupheleni kwenyanga, njenge-25. Awona maxesha mafutshane axeliweyo okubambezeleka ayengaphantsi kokukhunjuzwa komkhethe. Ukuba iziganeko zazibekwe ngokubanzi, isifundo kwakufuneka sikhumbule ngokuzimeleyo imihla emi-2. Noko ke, ukuba iziganeko zenzeke kwangolo suku okanye ngeentsuku ezilandelelanayo, umhla wesiganeko sesibini wawubalwa ngokongezwa inani leentsuku ezifanelekileyo kulowo wesiganeko sokuqala.
Iimpendulo kwixesha lokuqala lokuphefumla zarekhodwa kudliwano-ndlebe ngokukhawuleza emva kweso siganeko. Idatha yedemografi yaqokelelwa kudliwano-ndlebe lokuqala. Kudliwano-ndlebe ngalunye, irekhodi yesifundo yahlaziywa malunga neentlobo zecuba elisetyenzisiweyo; ubude bexesha, ukuphindaphindwa, kunye nobungakanani bokusetyenziswa; kunye namaxesha okuzila.
Iisampuli ze-saliva zaqokelelwa kudliwano-ndlebe ngalunye kwizifundo eziye zabika naluphi na ukusetyenziswa kwecuba ngexesha leentsuku ze-30 ezandulelayo, kwaye inani lemidiza etshayayo ngexesha leentsuku ze-3 zangaphambili zabhalwa. I-Cotinine, i-metabolite ye-nicotine, inesiqingatha sobomi beeyure ze-17 kwaye inokubonwa ematheni iintsuku eziliqela emva kwecuba lokugqibela.19,20 Izifundo ezala ukubonelela ngesampulu yamathe zahlala kuphononongo. Iisampulu ze-saliva zafakwa kwi-centrifuged, zafakwa emkhenkceni ku--20 ° C, zaza zathunyelwa kumkhenkce owomileyo ukuya kwilebhu ezimeleyo yokulinganisa icotinine eyimfama kusetyenziswa i-gas-liquid chromatography.21
Amanyathelo esiphumo abandakanya ukuzimela okuncitshisiweyo ngaphezu kwenikotini kunye ne- ICD-10-ukuxilongwa okuchaziweyo kokuxhomekeka kwenikotini. Ukuzimela ngokupheleleyo kulahleka xa i-sequelae yokusetyenziswa kwecuba, nokuba ngokomzimba okanye ngokwasengqondweni, kubonisa umqobo wokuyeka.22 Izinto ezilishumi elinanye zisetyenziselwe ukuvavanya ukuzimela kwisifundo sokuqala se-DANDY; I-10 kwaba iqulunqa i-HONC (1 Table).22 I-HONC ibonise ukunyaniseka okufanayo kunye nokuqikelelwa kwangaphambili, ukuthembeka kokuvavanya kwakhona, isiseko esizinzileyo sento enye, kunye nokuthembeka kwangaphakathi okugqwesileyo, kunye neCronbach α ye-0.90 kwi-0.94 kwizifundo ze-4 zabaselula.22- 29 Ngoku isetyenziswa kwiilwimi ezili-12, i-HONC iye yavavanywa ngokucokisekileyo kunye nolutsha kunawo nawuphi na umlinganiselo wokuxhomekeka kwinikotini.23
Ngokubonakala kwesibonakaliso sokuqala se-HONC, umntu otshayayo ulahlekelwe ukuzimela ngokupheleleyo. Umhla wokuqalisa kweempawu ze-HONC nganye, kunye nokuphindaphinda (iintsuku kwinyanga ye-28-day) kunye nesixa sokusetyenziswa kwecuba (ugwayi ngenyanga) ngexesha lophawu lokuqala lwe-HONC lwarekhodwa. Ubuzaza bokuncipha kokuzimela geqe babalwa ngokushwankathela inani elongezelekayo lezinto zeHONC eziqinisekisiweyo (0-10). Ukufumanisa ukuba ukulahlekelwa kokuzimela kuhambelana nokuqhubela phambili kokutshaya, sisebenzise i-χ2 uvavanyo lokuthelekisa ukutshaya imihla ngemihla phakathi kwezifundo ezingenazo iimpawu ze-HONC kunye nabo babeneempawu ze-1 okanye ngaphezulu. Abemi bolu hlalutyo yayingabo bonke abantu ababekhafule icuba kwaye, ngokwahlukeneyo, abo baphefumleyo.
Sisebenzise udliwano-ndlebe lwezinto ezingama-22 ukuseka i ICD-10-ukuxilongwa okuchaziweyo kokuxhomekeka kwecuba; Iimpawu ezi-3 okanye ngaphezulu ziyafuneka ukuxilongwa (1 Table).14 Sabhala umhla xa i ICD-10 iikhrayitheriya zafunyanwa kuqala kunye nenqanaba lokusetyenziswa kwecuba ngelo xesha.
Ulutsha olungaphantsi kwesiqingatha lusezela icuba lokuqala.30 Njengoko iimpawu zokuxhomekeka bezingayi kulindeleka ukuba akukho sesichengeni sechiza, siye sanciphisa uhlalutyo lwethu kwizifundo eziye zaxela ukuphefumla nokubala umva (inani leentsuku phakathi kweziganeko ezi-2) ngokususa umhla wokuphefumla ukusuka kumhla wemiba elandelayo.
Kwizifundo ezi-6 eziye zachaza ukusetyenziswa kwenyanga ngaphambi kokuphefumla, ukubalwa kwe-latency ukutshaya inyanga kwavelisa inani elibi. Kwezi zifundo ze-6, umhla we-inhalation yokuqala wawusetyenziswe njengomhla wokuqala wokutshaya inyanga. Izifundo ezimbini zichaze iimpawu ze-HONC emva kokukhukhuma kodwa ngaphambi komhla oxeliweyo wokuphefumla; oku kukwavelise ixabiso le-latency kunye neeyunithi zexesha elibi. Kwingcinga yokuba ukuchaswa kwe-nicotine kwenzeka ngaphambi kokuba kuxelwe, umhla wokuphefumla ubhalwe njengolahlekileyo, ngaloo ndlela ungabandakanyi ezi zifundo ze-2 kuhlalutyo lwe-latency. Ekuphela kwesifundo esasisebenzise icuba lokuhlafuna rhoqo ngaphambi kokuphefumla saye sawiswa kuhlalutyo lwe-latency, njengoko ukuvezwa kwe-nicotine kwandulela ukuphefumla kokuqala.
Ngenxa yeyantlukwano yobudala, ubuhlanga, isini, i-metabolism, kunye nendlela icuba etshaywa ngayo (umzekelo, inani le-puffs kunye ne-puff volume), akunakwenzeka ukuguqulela inqanaba le-cotinine kwi-cigarettes etshaywayo kwinqanaba lomntu.31 Kubantu abadala, amanqanaba e-cotinine abonisa ukudibanisa okungahambisani nokusetyenziswa kwecuba kulo lonke uluhlu ukusuka ekukhanyeni ukuya ekutshayeni kakhulu (r = 0.44) kodwa ubonise umbutho womgca xa ukusetyenziswa kwecuba lilingana neecuba ezingaphantsi kwe-10 kwiiyure ze-17 zangaphambili (r = 0.53).31 McNeill et al32 kuxelwe inqanaba eliqhelekileyo le-cotinine ye-salivary ye-201 ng/mL phakathi kwabafikisayo abatshaya umyinge we-210 yecuba ngenyanga. Ngokusekwe kolu mbalelwano lurhabaxa, sifumanise ukuba kulula ukusebenzisa amaxesha alinganayo e-x-axis ukubonisa ukusetyenziswa okuzixelayo (icuba ngenyanga) kunye namanqanaba e-cotinine kumanani ukuze iimilo zeegophe zithelekiswe, kodwa oku akufanelekanga itolikwe ngendlela engeyiyo njengebonisa ukuba amanqanaba e-cotinine alingana nemidiza etshayayo ngenyanga.
Uhlalutyo lwe-Kaplan-Meier lusetyenziselwe ukufumanisa amathuba akhulayo okufikelela kwinqanaba ngalinye, kuthathelwa ingqalelo iyantlukwano nganye ngobude bokuvezwa (ukusetyenziswa kwecuba).15 Izifundo zicingelwa ukuba zisengozini yokuqalisa ukuxhomekeka ukusuka ekuphefumleleni kokuqala. Izifundo eziye zaqhubeka zitshaya de udliwano-ndlebe lwabo lokugqibela zaqwalaselwa ukuba zihlolwe ngaloo mhla wodliwano-ndlebe ukuba bebengekasifumani isiphumo somdla. Izifundo eziyekile ukutshaya kwaye abazange baqalise kwakhona ngaphambi kokuba udliwano-ndlebe lwabo lokugqibela bacingelwa ukuba bahlolwe iintsuku ezingama-30 emva kokutshaya kwabo kokugqibela (ukuvumela ixesha lokuvela kweempawu zokuyeka).
Bebonke bali-1246 kubafundi abangama-1808 (68.9%) ababhalise kwibanga lesithandathu abathe bavolontiya kolu phando. Kwezi, ama-77.8% (970) agcinwe ngamaza ali-11 okuqokelelwa kwedatha; Izifundo ezingama-208 zisusiwe. Isampuli yayiyi-51.9% yabasetyhini, kunye nobudala beminyaka eyi-12.2 (uluhlu, iminyaka eyi-11-14) kwi-interview yokuqala. Abemi bebengama-70.2% abamhlophe, 18.4% amaHispanic, 5.0% abamnyama, 3.7% amaAsia, kunye ne-2.7% yamaIndiya aseMelika. Ukusetyenziswa kwecuba ubomi bonke kuyanikezelwa 2 Table; kuphela yi-1.1% yezifundo ezisebenzise icuba kwiintsuku ezingama-30 zangaphambili kwisiseko. Izifundo ze-370 ezikhukhumele kwi-cigarette zine-avareji yeminyaka eyi-11.7 kwiminyaka yokuqala yokukhupha (uluhlu, i-2.5-16.7; i-SD, iminyaka eyi-3.0), kunye ne-217 inhalers yayineminyaka eyi-avareji kwi-inhalation yokuqala ye-12.8 iminyaka (uluhlu, i-2.5-17.1 ; SD, 2.6 iminyaka). Kwi-217 inhalers ekugxilwe kuyo kolu hlalutyo, i-127 (58.5%) ilahlekelwe ukuzimela kunye ne-83 (38.2%) yaphuhliswa. ICD-10-ukuxhomekeka okuchaziweyo.
Iipesenti kunye ne-medians zixelwe xa idatha inokuhanjiswa kwePoisson. Ipesenti ye-25 ye-frequency yokutshaya xa ukuzimela kulahlekile yayiyi-1 imini ngenyanga (n = 106; i-median, iintsuku ze-5.5 ngenyanga; uluhlu, iintsuku ze-0-28); ngobungakanani becuba elisetyenzisiweyo, yayiyi-cigarette enye ngenyanga (i-median, i-cigarettes e-1; uluhlu, i-7-0 ye-cigarettes). Inqanaba le-560 yepesenti ye-salivary cotinine kudliwano-ndlebe olulandela uphawu lokuqala lwe-HONC lwaluyi-25 ng / mL (n = 0.4; i-median, 61 ng / mL; uluhlu, 1.9-0 ng / mL).
Umzobo 1 uthelekisa ukusetyenziswa kwecuba okuxeliweyo kunye namanqanaba e-cotinine ngexesha apho ukuzimela kwakulahlekile. I-saliva ayizange iqokelelwe kwizifundo ezingavumiyo okanye ezingatshayanga kwiintsuku ezingama-30 zangaphambili. Ngaloo ndlela, idatha ye-cotinine isekelwe kwi-subset yezifundo apho idatha yokusetyenziswa kwecuba irekhodwe. Zombini iijika zibonisa ukuba ukulahlekelwa kokuzimela kwenzeka ngokukodwa kwinqanaba eliphantsi le-nicotine intake.
Ipesenti yokusabalalisa amaxabiso e-cotinine kunye nokusetyenziswa kwecuba ngokuzixelayo ekulahlekelweni kokuzimela. Kudliwano-ndlebe emva kokuqalisa kweempawu, izifundo zabonelela ngesampulu ye-saliva yokuzimisela kwe-cotinine kwaye baxela ukuba bekusetyenziswe ntoni na xa beqala ukufumana uphawu. Kwinqanaba le-cotinine ye-salivary, i-x-axis imele i-cotinine concentration kwi-nanograms nge-milliliter (n = 62); ukusetyenziswa kwecuba, imele i-cigarettes ngenyanga ye-28-day (n = 106). Ubungakanani besampulu yokumisela i-cotinine buncinci kunokusebenzisa icuba kuba amathe awaqokelelwanga ukuba umbandela uyekile ukutshaya okanye walile isicelo sethu sesampulu.
Ipesenti ye-25 yokuphindaphinda ukusetyenziswa ekuqaleni kwe ICD-10Ukuxhomekeka okuchaziweyo kwakuyientsuku ze-8 ngenyanga yeentsuku ezingama-28 (n = 81; i-median, iintsuku ze-28; uluhlu, iintsuku ze-0-28); ngobungakanani becuba ezitshayayo, yayizisi-8 zecuba ngenyanga (umdiza, 46 wecuba; uluhlu, 0-560 imidiza). Inqanaba lama-25 lepesenti ye-salivary cotinine kudliwano-ndlebe olulandelayo ICD-10-ukuxhomekeka okuchazwe ngu-0.4 ng / mL (n = 54; i-median, 5.35 ng / mL; uluhlu, 0.0-211.4 ng / mL). Umzobo 2 ibonisa ukusetyenziswa okuzixelayo kunye namanqanaba e-cotinine ekuqaleni kwe ICD-10-ukuxhomekeka okuchaziweyo. Idatha ye-cotinine ibonisa ukuxinwa okuphezulu kwezifundo kwiqondo eliphantsi lokusetyenziswa ekuqaleni ICD-10-ukuxhomekeka okuchaziweyo.
Ipesenti yokusasazwa kwamaxabiso e-cotinine kunye nokusetyenziswa komdiza ozixelayo ekuqaleni kwe Ulwahlulo lwaMazwe ngaMazwe lweZifo, uHlaziyo lwe-10 (ICD-10)-ukuxhomekeka okuchaziweyo. Kudliwano-ndlebe emva kokuqalisa kweempawu, izifundo zabonelela ngesampulu ye-saliva yokuzimisela kwe-cotinine kwaye baxela ukuba bekuyintoni ukusetyenziswa kwecuba xa beqala ukuhlangabezana neenqobo zokuziphatha. ICD-10-ukuxhomekeka okuchaziweyo. Kwinqanaba le-cotinine ye-salivary, i-x-axis imele i-cotinine concentrations kwi-nanograms nge-milliliter (n = 54); ukusetyenziswa kwecuba, imele icuba ngenyanga yeentsuku ezingama-28 (n = 82). Ubungakanani besampulu yokumisela i-cotinine buncinci kunokusebenzisa icuba kuba amathe awaqokelelwanga ukuba umbandela uyekile ukutshaya okanye walile isicelo sethu sesampulu.
3 Table uthelekisa iziganeko zeempawu ze-10 ze-HONC kunye nokuba zivela rhoqo kangakanani ngaphambi kokuqala kokutshaya imihla ngemihla. Njengoko kubonisiwe kwikholamu yesibini yedatha, yonke inqanaba lenzeka kwezinye izifundo ngaphambi kokuba baqhubele phambili nokutshaya imihla ngemihla. Ukulahleka kokuzimela kwangaphambi kokutshaya imihla ngemihla kwi-70.1% yezifundo ezilahlekelwe ukuzimela; ICD-10-ukuxhomekeka okuchaziweyo kwandulela ukutshaya kwansuku zonke i-38.6% yexesha. I-10th kunye ne-25th yeepesenti ze-latency ukusuka ekuphefumleleni ukuya ekulahlekeni kokuzimela yayiyi-2 kunye neentsuku ze-30, ngokulandelanayo (n = 111; uluhlu, iintsuku ze-0-3898), kwaye ukusuka ekuphefumleleni ukuya ekuqaleni ICD-10-ukuxhomekeka kuchazwe, babeyi-61 kunye neentsuku ze-139 (n = 81; uluhlu, iintsuku ze-13-3712), ngokulandelanayo. Kwakungekho mahluko ubalulekileyo wesini kwi-latency ukuya kuxhomekeke, ukulahleka kokuzimela, okanye nayiphi na i-10 yeempawu ze-HONC.
Phakathi kwezifundo eziye zakhukhumalisa i-cigarette, ukulahlekelwa kokuzimela kwakudibene nokutshaya imihla ngemihla kunye ne-odds ratio ye-195.8 (i-95% yexesha lokuzithemba, i-62-614; ixabiso eliqikelelwayo elichanekileyo = 0.71; ixabiso elibi lokuxela kwangaphambili = 0.99). Phakathi kwabo baye baphefumla, i-odds ratio yayiyi-83.4 (i-95% yexesha lokuzithemba, i-26-265; ixabiso eliqikelelwayo eliqinisekileyo = 0.74; ixabiso elibi lokuxela kwangaphambili = 0.97).
Ishumi leepesenti labafundi abaphulukene nokuzimela ngenxa yecuba bakwenzile oko kwiintsuku ezi-2 zokuphefumla kwicuba okokuqala. Isiqingatha sasisele sikwenzile oko ngethuba babetshaya imidiza esi-7 ngenyanga. Oku kuvumelana ngokugqwesileyo nophononongo lokuqala lwe-DANDY, apho isiqingatha sabo baphulukene nokuzimela bakwenzile oko ngexesha bebetshaya iisigarethi ezisi-8 ngenyanga. Isiqingatha sabo bathe bafikelela kwiikhrayitheriya zoku ICD-10-defined dependence baye benza oko ngexesha betshaya i-1 ukuya kwi-2 icuba ngosuku. Uvavanyo lwe-biochemical luqinisekisile izinga eliphantsi kakhulu lokusetyenziswa kwecuba ekuqaleni ICD-10-ukuxhomekeka okuchaziweyo; inqanaba eliphakathi lamathe e-cotinine (5.35 ng/mL) liwele phakathi koluhlu oluphunyezwe kukusenziwa kokutshaya33 kwaye ingaphantsi kakhulu kwindawo ekucetyiswa ukuba uyinqumle (i-15 ng/mL) yokwahlula abantu abatshayayo kwiintshayi ezingenzi nto.20 Ukubeka idatha ye-cotinine ngokwembono, uMcNeill et al32 yanikela ingxelo yokuba ulutsha olutshaya ngaphantsi komdiza omnye ngeveki lunomlinganiselo we-cotinine we-salivary we-1 ng/mL, yaye abo batshaya i-cigarette esi-13.1 ukuya kwezi-1 ngeveki banomlinganiselo we-6 ng/mL. Idatha yethu iyayiphikisa ingcamango yokuba i-nicotine intake eyaneleyo ukugcina amanqanaba egazi yonke imini iyafuneka ukuqalisa ukuxhomekeka.
Ukuxhomekeka kwecuba njengoko kuchazwa yi ICD-10 kwafunyaniswa ukuba kwangexesha leentsuku ezili-13 emva kokuphefumla okokuqala, kwaye izifundo ezininzi zaphulukana nokuzimela kusuku emva kokuphefumla okokuqala. Ukubonakala kweempawu zokuxhomekeka phakathi kweentsuku zokuqaliswa kokutshaya kwabikwa okokuqala kwi-DANDY kwaye ngoku iqinisekisiwe ngophando lwe-NDIT (usebenzisa ICD-10 indlela yokuxilonga), ngophononongo lwangoku, nangophononongo oluqhubekayo olusetyenziswayo I-Diagnostic and Statistical Manual of Disabilities Iikhrayitheriya (uHlelo lwesine).13,15,34
Russell1- 4 yayichanekile ekuqondeni indima ebalulekileyo yecuba lokuqala. Sikholelwa ukuba ukuphefumla okokuqala ngqa lelona nyathelo libalulekileyo lokusetyenziswa kwecuba, njengoko idatha yethu ibonisa ukuba olunye ulutsha lufumana iimpawu zokuxhomekeka kwicuba kusuku lokuqala lokuphefumla. Iimpawu zokukhanukela kunye nokuyeka ukutshaya zidla ngokuvela ngokunqaphazekayo kwaye, njengoko besitshilo ngaphambili, kunokukhululeka kangangeentsuku ezininzi ngokutshaya icuba elinye.35 Isiqingatha sabo baya kuphulukana nokuzimela geqe kwicuba baye bakwenza oko ngexesha betshaya imidiza esi-7 okanye esi-8 ngenyanga. Idatha evela kwizifundo zombini ze-DANDY kunye ne-NDIT ihambelana ngokupheleleyo nenkcazo yembali yendalo yokuxhomekeka kwe-nicotine, njengoko kuchazwe kwi-sensitization-homeostasis theory.15,16
Ukulinganisa isantya sokuqala ngokwemiqathango yexesha ukusuka kwi-inhalation yokuqala ukuya kwi-symptom yokuqala kunokunika ingcamango yobuxoki yokuba ukuxhomekeka kukhula kancinci. Abancinci ababini banokuphulukana nokuzimela ngosuku emva kokuphefumla kwicuba labo lesibini, omnye ube ne-latency yeentsuku ze-3 kunye nomnye iminyaka emi-3. Ukwahlukahlukana okugqithisileyo kwizithuba zecuba zokuqala kunegalelo kuluhlu olukhulu kwi-latencies ephawulweyo (iintsuku ezi-0-3898 zokulahleka kokuzimela). Asazi ukuba ukuxhomekeka kunokuphenjelelwa ngokukhawuleza kangakanani kulutsha olungakhethwanga phantsi kweshedyuli yedosi efanelekileyo. Xa kuchazwa ukuqala kokuxhomekeka, imilinganiselo yokusetyenziswa kwecuba ayinakukwazi ukuchazwa ngendlela engafanelekanga kunobude bokusetyenziswa.
Nganye yeempawu zokuhoxiswa kwe-nicotine zavela kwezinye izifundo ngaphambi kokutshaya imihla ngemihla. Isenokubonakala ingenakwenzeka into yokuba ukutshaya icuba eli-1 kunika abantu abatshayayo isiqabu ekuziyekeni nasekunqweneleni ixesha elithatha iiyure ezi-2 zesiqingatha sobomi benikotini ngokomyalelo wobungakanani.35,36 Nangona kunjalo, i-nicotine efunyenwe kwi-1 ukuya kwi-2 i-puffs kwi-cigarette iya kuthatha i-50% yengqondo ye-nicotinic receptors,37 kunye nedosi enye ye-nicotine yonyusa zombini i-noradrenaline synthesis kwi-hippocampus kunye ne-potentiation ehlala ixesha elide ye-neurons (evumela ukuba bakhuphe isenzo esinokwenzeka kwinqanaba eliphantsi lokuvuselela) ubuncinane kwinyanga.38,39 Kubandakanya uphononongo lwangoku, i-4 longitudinal8,13,28 kunye nezifundo ezininzi ezinqamlezileyo5,35,40- 43 baye bachaza iimpawu zokuyeka kwabo batshayayo.
Nangona ukutshaya okwethutyana kunye nokungenzi nto kunokuvelisa amanqanaba afanayo e-salivary cotinine, ngokwethiyori, ukutshaya okusebenzayo kufuneka kuvelise i-spikes ephezulu kumanqanaba enicotine yobuchopho. Ukuba ukuchaneka komsi okwenziwayo kwandisa umngcipheko wokuxhomekeka, sisenokuba sikubonile oku phakathi kwabo babhentsiswe kubazali abatshayayo, abantakwenu, okanye abalingane, kodwa asizange sikubone oko.44
Amandla esi sifundo kukusetyenziswa kwemilinganiselo yeziphumo ze-2 (ukulahleka kokuzimela kunye ICD-10-ukuxhomekeka okuchaziweyo), imilinganiselo ye-2 yokutshaya (ixesha lokutshaya kunye nobude bexesha), imilinganiselo ye-2 yokuvezwa (i-self-report kunye ne-biochemical assay), udliwano-ndlebe lwamaza angama-11 okuqokelela ngokusondeleyo idatha yokuqokelela; ukulandelwa kwayo kweminyaka emi-4; ukuqokelelwa kwayo kweyona mihla yokusetyenziswa kwecuba kunye nemilinganiselo yeziphumo kunomhla wokuqokelelwa kwedatha; ukusetyenziswa kwayo kuhlalutya ukusinda kunye nokuhlolwa emva kokuyeka; kunye nokungqinelana kwayo neengxelo zangaphambili.
Imida yophononongo kukuba ukuqokelelwa kwedatha bekungalindelwanga ngokupheleleyo; idatha ixhomekeke ekukhunjweni kokukhumbula; onke amanyathelo okuxhomekeka ayazixela ngokwawo; neendima zokufikisa, utywala, okanye ezinye iziyobisi azizange ziqwalaselwe. I ICD-10 ayiboneleli ngesixhobo esiqinisekisiweyo sokuvavanya iikhrayitheriya zayo. Ngenxa yokuba i-HONC ineempawu ezifanelekileyo zengqondo, sisebenzise izinto zayo ukuvavanya ICD-10 iikhrayitheriya, njengoko kufanelekile. Isampulu yethu ayinakumela abanye abantu okanye amaqela eminyaka. Nangona kunjalo, iziphumo eziphantse zifane kwizifundo zokuqala nezesibini ze-DANDY, ngokwemali ephakathi (i-8 vs 7 i-cigarettes ngenyanga, ngokulandelanayo) kunye nokuphindaphinda ukutshaya (4.0 vs 5.5 iintsuku ngenyanga, ngokulandelanayo) ekuqaleni kokuzimela okulahlekileyo. , cebisa ukuba la maxabiso anokuzinza kubo bonke abantu.
Ubulumko buyalela ukuba ulutsha lulunyukiswe ukuba kunokuthabatha umdiza omnye kuphela ukuqalisa ukuxhomekeka ubomi babo bonke ecubeni. KuPhando lweZimo zengqondo kunye neZenzo zoLutsha,45 olunye ulutsha olutshaye imidiza engaphantsi kwama-20 ebomini balo lwanikela ingxelo yokuba kunzima ukuyeka. Kwanolutsha olutshaya iicuba ezimbalwa kuphela ngenyanga lusenokufuna uncedo ukuze luqonde luze loyise ukunqwenela nokuyeka. Olu luntu kufuneka lube lugqaliselo lophando lokupheliswa kwexesha elizayo.
Imbalelwano: UJoseph R. DiFranza, MD, iSebe leMithi yeNtsapho kunye neMpilo yoLuntu, iYunivesithi yaseMassachusetts Medical School, 55 Lake Ave, Worcester, MA 01655 ([imeyile ikhuselwe]).
Yamkelwe Upapasho: NgoJanuwari 3, 2007.
Umbhali Wemivuzo: UDkt DiFranza wayenokufikelela ngokupheleleyo kuzo zonke iinkcukacha kwisifundo kwaye uthatha uxanduva lokuthembeka kwedatha kunye nokuchaneka kohlalutyo lwedatha. Umxholo wokufunda kunye noyilo: DiFranza, Ockene, kunye noMcNeill. Ukufunyanwa kwedatha: DiFranza, Hazelton, Friedman, Dussault, and Wood. Uhlalutyo nokutolika idatha: DiFranza, Savageau, Fletcher, O'Loughlin, Pbert, McNeill, kunye noWellman. Ukuyilwa kombhalo obhaliweyo: DiFranza, Savageau, Fletcher, O'Loughlin, Pbert, kunye noWellman. Uhlaziyo olubalulekileyo lwemibhalo ebhaliweyo yomxholo obalulekileyo wokuqonda: DiFranza, Savageau, Fletcher, O'Loughlin, Pbert, Ockene, McNeill, Hazelton, Friedman, Dussault, Wood, and Wellman. Uhlalutyo lwesatisatisti: Savageau, Fletcher, kunye ne-O'Loughlin. Ifunyenwe inkxaso-mali: DiFranza noOckene. Ulawulo, ubugcisa kunye nenkxaso kwizinto: DiFranza kunye neSavageau. Ukongamela isifundo: DiFranza kunye neDussault.
Ukuvezwa kweMali: Akukho zichazwe.
Imali / Inkxaso: Olu phononongo luxhaswe ngenkxaso-mali ye-RO1 DA14666 ("Utshintsho oluya kuXhomekeko lweNicotine") kwiZiko leSizwe lokuSetyenziswa gwenxa kweZiyobisi.
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