A case of Sj?gren's syndrome associated with advanced hemolytic anemia caused by worsening autoimmune cholangiopathy

AIMS: Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine than those who do not take up smoking. DESIGN AND SETTING: The present study was designed to investigate this hypothesis by querying initial experiences with cigarette smoking in smokers, ex-smokers and never-smokers recruited from the local community. PARTICIPANTS: Subjects were 80 women (23 highly-dependent smokers (Fagerstrom Tolerance Questionnaire score > or = 7), 30 less-dependent smokers (FTQ < or = 6), 12 ex-smokers and 15 never-smokers). MEASUREMENTS: Subjects were asked to rate pleasurable sensations and displeasurable sensations on a scale of 1 = none to 4 = intense, and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea and cough; social context was also queried. Pleasurable rush or buzz, relaxation, dizziness, nausea and cough were related to ratings of pleasurable and unpleasant sensations to establish their affective valence. FINDINGS: Pleasurable sensations, pleasurable rush or buzz and relaxation (pleasant effects) were significantly more likely to occur in the smoker categories than in never-smokers. The ratio of pleasurable to unpleasant sensations, computed as an index of overall hedonic impact of initial exposure, also significantly favored the smoker categories. By contrast, unpleasant sensations, nausea and cough (unpleasant effects) did not differ significantly among groups. Dizziness, which did not definitely emerge as either pleasurable or unpleasant, was significantly more likely to be reported among the smoker groups than among never-smokers. CONCLUSIONS: People who become highly dependent cigarette smokers appear to have more pleasurable sensations at their initial exposure to tobacco; unpleasant reactions to the first cigarette do not seem to protect against subsequent smoking.