الفهرس 
Epidemiology of nicotine dependenceOnly 14 pages are availabe for public view
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Abstract
Smoking remains the largest preventable cause of morbidities in the world. Much could be done to improve the motivation and management of smoking cessation in primary health care centers besides the specialized smoking cessation clinics using and stressing on the smokers’ psychosocial variables and not only using the medical problems caused by tobacco smoking, in order to develop a supportive organizational infra-structure to insure the delivery of high quality clinical care.
Smokers use nicotine to modulate levels of arousal and to control mood. Smoking improves concentration, reaction time, and performance of certain tasks. Relief from withdrawal symptoms is probably the primary reason for this enhanced performance and heightened mood. Cessation of smoking causes the emergence of withdrawal symptoms: irritability, depressed mood, restlessness, and anxiety. The intensity of these mood disturbances is similar to that found
in psychiatric outpatients. (Neal L. Benowitz, 2010).
Research findings have not revealed whether common factors influence the development of anxiety, depression, and
smoking, whether anxiety and depression lead to smoking, or whether the reverse is true (Morrell and Cohenm,
2006).There is a synergistic and potentially bidirectional relationship between depression and smoking. Smokers with depression are significantly less likely to quit smoking, and depressed individuals are more likely to be smokers. Smokers with depression are more likely to have increased levels of negative mood both precessation and postcessation. Also, negative mood is associated with greater relapse rates (Hall
and Prochaska,2009 )
Three types of models have been proposed to account for the association between smoking and depression .The first model, often referred to as the self-medication model, suggests that nicotine has particular reinforcing properties for depressed people who use it to enhance their mood. The second model states that the association is in fact spurious because both depression and smoking are caused by common factors. And the third model states that smoking cessation may lead to depression, particularly in vulnerable people (Borelli et al.1996).
From these data we concluded the overlapping symptoms and high co-morbidity between depression, anxiety
and smoking cessation. . Identifying the difference in diagnostic criteria in relation to smoke cessation will determine the type of treatment plan recommended and prevent
worsening of symptoms and relapse.
We designed this cross-sectional, case-control, observational study in order to determine the prevalence of depression and anxiety in a sample of adult patients attending smoke cessation clinic in the institute of psychiatry Ain shams university to quite smoking, during the period of conducting the study. Each participant 2 months after the target quit date dated for a new counseling.
Forty cases were recruited, twenty cases and twenty control according to specific inclusion and exclusion criteria.
For those cases we performed certain questionnaire in order to find out the different variables we wanted to highlight. The tools were carefully selected to serve for the purpose of the study, this included (1) Out patient smoke cessation clinic standard sheet, (2) Standardized psychiatric assessment using The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), (3)Nicotine Dependence Test (Fagerström), (4)Hamilton Depression Rating Scale (HDRS), (5) Hamilton Anxiety Rating scale (HARS).
All data gathered were recorded, tabulated and transferred on Statistical Package IBM SPSS statistics (V.
20.0, IBM Corp., USA, 2012) was used for data analysis. Data were expressed as both number and percentage for categorized data. Chi-square test to study the association between each 2 variables or comparison between 2 independent groups as regards the categorized data. The probability of error at 0.05 was considered significant, while at 0.01 and 0.001 are highly significant. Results were displayed to answer questions raised
in the hypothesis of this study Statistical methods.
Results of the study:
We found that men and women are equally likely to give up smoking, but they vary in a number of subjective elements of the smoking cessation process with no statistical significance regarding depression severity and anxiety severity post to smoking cessation.
By studying the age variable effect we found no significant impact of age difference on outcomes of smoking cessation, in comparing to the control group.
Socio-demographic variables (Gender, Age, Marital status, Occupation, residence) demonstrated that the variables
were insignificant in their outcomes.
Also, the impact of the smoking dependence Index, the statistically insignificant anxiety in the abstinent smokers may be explained by the continuous strong social network support.
No relationship was found between depression and degree of smoking dependence in who are adherent to our cessation program.
Meanwhile our results indicate that severity of depression and anxiety during smoking cessation treatment in clients with past history of substance abuse lead to depressed mood over time , with high significant difference, (P=0.055).with no significant difference regarding anxiety in history of substance abuse.
Our study also found that recent advances in pharmacotherapy added to the motivational interview offer help for patients who are attempting to quit smoking decreasing depression symptoms with a significant difference, yet with no correlation regarding the anxiety symptoms.