CONFERENCE PROCEEDING
Mental health and gender as determinants of smoking cessation in cytisine-treated smokers in clinical practice
1
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa - Pisa, Italy
2
Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital - Pisa, Italy
3
Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital;Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
Tob. Prev. Cessation 2026;12(Supplement 1):A106
ABSTRACT
BACKGROUND-AIM:
Cytisine is a drug of proven efficacy for smoking cessation, however mental disorders such as anxiety and depression are highly prevalent among smokers and may affect treatment efficacy. In addition, sex-related differences in quitting rates have been reported, suggesting that women may respond differently to pharmacological support. This study aimed to evaluate whether baseline anxiety, depression or gender can predict smoking cessation at 3 and 6 months in smokers treated with cytisine according to the best-practice regimen used in Italian smoking cessation centers.
METHODS:
This real-life retrospective cohort study included 59 adult smokers treated at the Smoking Cessation Center of Pisa University Hospital, Italy, from November 2022 to August 2025. All participants received cytisine according to a dosing scheme of up to six 1.5 mg tablets/day in the first week of treatment and a subsequent progressive reduction over 40 days. Baseline anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), which includes two separate subscales for anxiety (HADS-A) and depression (HADS-D). Smoking abstinence rate, confirmed by measurement of exhaled CO, was assessed at 3 and 6 months. Multivariable logistic regression models were used to determine whether baseline HADS scores independently predicted abstinence, adjusting for age, sex, psychiatric comorbidity, score of Fagerström test for nicotine dependence and exhaled CO at baseline.
RESULTS:
The median age of subjects was 59±9.8 years (range 38-81); 55.9% were female. Baseline median scores were 8±4.4 for HADS-A (range 0-19) and 5±3.2 ford HADS-D (range 1-15). Abstinence rates were 49.2% at 3 months and 35.6% at 6 months. At 3 months, female sex was independently associated with higher abstinence rates (OR=5.21; p=0.027). Conversely, higher depressive symptoms significantly reduced the likelihood of quitting (OR=0.69; p=0.022). At 6 months, none of the assessed variables reached statistical significance, although a trend towards higher abstinence rates was observed for female sex (OR=3.52; p=0.076). Furthermore, psychiatric comorbidity (OR=0.24; p=0.055) and HADS-D (OR=0.74; p=0.054) showed borderline associations with lower abstinence rates.
CONCLUSIONS:
In cytisine-treated smokers, preliminary clinical practice findings suggest that female sex is an independent predictor of early abstinence, while baseline depressive symptoms (HADS-D) significantly reduce quitting success and exert a borderline negative effect until 6 months. Psychiatric comorbidities show a borderline association with poorer abstinence, whereas anxiety (HADS-A) does not affect quitting outcomes. Routine depression screening could help identify higher-risk smokers and guide psycho-pharmacological support to improve cytisine treatment effectiveness.
Cytisine is a drug of proven efficacy for smoking cessation, however mental disorders such as anxiety and depression are highly prevalent among smokers and may affect treatment efficacy. In addition, sex-related differences in quitting rates have been reported, suggesting that women may respond differently to pharmacological support. This study aimed to evaluate whether baseline anxiety, depression or gender can predict smoking cessation at 3 and 6 months in smokers treated with cytisine according to the best-practice regimen used in Italian smoking cessation centers.
METHODS:
This real-life retrospective cohort study included 59 adult smokers treated at the Smoking Cessation Center of Pisa University Hospital, Italy, from November 2022 to August 2025. All participants received cytisine according to a dosing scheme of up to six 1.5 mg tablets/day in the first week of treatment and a subsequent progressive reduction over 40 days. Baseline anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), which includes two separate subscales for anxiety (HADS-A) and depression (HADS-D). Smoking abstinence rate, confirmed by measurement of exhaled CO, was assessed at 3 and 6 months. Multivariable logistic regression models were used to determine whether baseline HADS scores independently predicted abstinence, adjusting for age, sex, psychiatric comorbidity, score of Fagerström test for nicotine dependence and exhaled CO at baseline.
RESULTS:
The median age of subjects was 59±9.8 years (range 38-81); 55.9% were female. Baseline median scores were 8±4.4 for HADS-A (range 0-19) and 5±3.2 ford HADS-D (range 1-15). Abstinence rates were 49.2% at 3 months and 35.6% at 6 months. At 3 months, female sex was independently associated with higher abstinence rates (OR=5.21; p=0.027). Conversely, higher depressive symptoms significantly reduced the likelihood of quitting (OR=0.69; p=0.022). At 6 months, none of the assessed variables reached statistical significance, although a trend towards higher abstinence rates was observed for female sex (OR=3.52; p=0.076). Furthermore, psychiatric comorbidity (OR=0.24; p=0.055) and HADS-D (OR=0.74; p=0.054) showed borderline associations with lower abstinence rates.
CONCLUSIONS:
In cytisine-treated smokers, preliminary clinical practice findings suggest that female sex is an independent predictor of early abstinence, while baseline depressive symptoms (HADS-D) significantly reduce quitting success and exert a borderline negative effect until 6 months. Psychiatric comorbidities show a borderline association with poorer abstinence, whereas anxiety (HADS-A) does not affect quitting outcomes. Routine depression screening could help identify higher-risk smokers and guide psycho-pharmacological support to improve cytisine treatment effectiveness.
| eISSN: | 2459-3087 |
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