What question did this study set out to answer?

This study aimed to examine nicotine use patterns and validate tobacco use in schizophrenia patients using urinary cotinine levels.

February 22, 2026Open Access

Nicotine use patterns and symptomatology in schizophrenia: Assessing the reliability of self-reported tobacco use using urinary cotinine levels

PSPanna SharmaAll India Institute of Medical Sciences NDNimesh DesaiInstitute of Human Behaviour and Allied Sciences DKDeepak KumarInstitute of Human Behaviour and Allied Sciences

Key Points

This study aimed to examine nicotine use patterns and validate tobacco use in schizophrenia patients using urinary cotinine levels.
Conducted a hospital-based cross-sectional study
Collected sociodemographic data and nicotine dependence severity
Evaluated symptom severity using standardized instruments
Measured urinary cotinine levels to validate self-reported tobacco use
40% of participants smoked tobacco, 35% used smokeless tobacco, and 25% used both forms
Strong positive correlation between nicotine dependence and symptom severity with mFTND scores (r = 0.53, p < 0.001)
Validation of self-reported tobacco use through urinary cotinine levels enhancing clinical assessment credibilities

Abstract

Objectives: Tobacco use among individuals with schizophrenia is a pressing concern, and the relationship between nicotine dependence and symptomatology is multifaceted. This study aimed to assess the patterns of nicotine use among patients with schizophrenia in India and validate tobacco use through urinary cotinine levels. Material and Methods: This hospital-based cross-sectional study collected sociodemographic data, nicotine dependence severity, and evaluated symptom severity using standardized instruments. Urinary cotinine levels were measured to validate self-reported tobacco use. Results: Among the 170 male schizophrenia patients studied, 75 fulfilled the inclusion criteria. A substantial proportion was unemployed (72%) and urban residents (60%). Smoking emerged as the predominant form of tobacco use (40%), followed by smokeless tobacco (35%), and 25% used both. Significant positive correlations were observed between the severity of nicotine dependence, assessed by modified Fagerstrom test for nicotine dependence (mFTND) scores, and symptomatology, as measured by positive and negative syndrome scale rating criteria, positive (r = 0.35, p < 0.007) and negative (r = 0.3, p < 0.021) scores. Urinary cotinine levels exhibited a strong positive correlation with mFTND scores (r = 0.53, p < 0.001). It validated the reliability of self-reported tobacco use through significant correlations with urinary cotinine levels, bolstering their utility in clinical assessments. Conclusion: This study highlights the prevalence of tobacco use among patients with schizophrenia in India. The positive correlation between nicotine dependence severity and symptomatology highlights the intricate relationship between tobacco use and schizophrenia. The validation of self-reported tobacco use through urinary cotinine levels enhances the credibility of such assessments in clinical practice. Addressing nicotine dependence within this population is imperative for comprehensive schizophrenia treatment.

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