UK National Smoking Cessation Conference - UKNSCC
2009 UK National Smoking Cessation Conference - London more...

Night smoking: a better measure of tobacco dependence
Jonathan Foulds, Professor, UMDNJ-School of Public Health and Director, Tobacco Dependence Program New Jersey, USA


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Jonathan Foulds

Many current measures of tobacco dependence include questions on amount used (e.g. cigarettes per day) and time to first use after waking in the morning. However, many smokers wake during the night and smoke (e.g. over 50% of patients attending our clinic), and this has not traditionally been assessed or used clinically as a marker of high dependence.

In our treatment clinic we have found that smokers who sometimes awaken at night to smoke (at baseline assessment) are significantly less likely to be abstinent at 6-month follow-up and have a shorter period of abstinence before relapsing, even after controlling for other measures of dependence (including time to first smoke of the day). Another recent study found very similar results (41% prevalence), and reported that night smokers typically awaken to smoke two nights per week. Night smokers may require specific attention to reduction in caffeine consumption and possibly treatment with a 24-hour nicotine patch rather than bupropion.

It is recommended that the following two questions be added to routine assessment of tobacco dependence:

1. Do you sometimes awaken at night to smoke or use tobacco? (yes/no)

2. If yes, how many nights per week do you typically awaken to smoke?

Bover MT, Foulds J, et al. Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome. Int J Clin Pract. 2008 Feb; 62(2): 182–90.

Scharf DM, Dunbar MS, Shiffman S. Smoking during the night: prevalence and smoker characteristics. Nicotine Tob Res. 2008 Jan; 10(1): 167–78.

Declaration of interest: Jonathan has worked as a consultant, as a promotional speaker and received honoraria from pharmaceutical companies involved in production of tobacco dependence treatment medications (e.g. Pfizer, Novartis, GSK, Celtic Pharma) as well as a variety of agencies involved in promoting health (e.g. universities and hospitals). He has also worked as an expert witness in litigation, including for plaintiffs in law suits against tobacco companies. He has not received any funding from the tobacco industry other than deposition fees from defendants attorneys in litigation against the tobacco industry (i.e. while acting as a witness for the plaintiffs). He is paid for writing a regular column on a health website:

Source of funding: Jonathan Foulds is primarily funded by a grant from New Jersey Department of Health and Senior Services. His other recent research funding (also as P.I.) is from the Cancer Institute of New Jersey, the Rutgers Community Health Foundation and the Robert Wood Johnson Foundation.


About the presenter
Jonathan Foulds PhD, is a Professor at UMDNJ-School of Public Health and the Director of its Tobacco Dependence Program ( He trained as a clinical psychologist in the United Kingdom and has spent most of his career developing and evaluating methods to help smokers beat their addiction to tobacco. He was on the Management Group of the Hungarian
Anti-Smoking Campaign (1995–6), has been a technical leader of a World Health Organization project to improve the regulation of tobacco dependence treatment in Europe (2000), and was Director of Research for the charity, Quit, which ran the largest telephone helpline for smokers in the world at that time. He was a founding member and Vice President of the Association for the Treatment of Tobacco Use and Dependence (ATTUD) 2004–6.

He has published over 70 papers on tobacco and writes a regular blog on smoking cessation.


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