Patterns and characteristics of nicotine dependence among adults with cigarette use in the United States between 2016 and 2019
1. Among adults in the US who reported past-month cigarette use, the prevalence of nicotine dependence decreased significantly from 2006-2019
2. Adults over the age of 50 reported the highest degree of nicotine dependence among all age groups.
3. The prevalence of nicotine dependence was greater among those who were male, White race, low income, low educational attainment, divorced or separated, reported substance use or major depressive disorder, or living in a non-metropolitan statistical area.
Evidence Rating Level: 2 (Good)
Study Rundown: Cigarette smoking is the number one preventable cause of morbidity and mortality. Greater nicotine dependence is associated with increased difficulty achieving smoking cessation, as well as healthcare burden, disability, and poorer quality of life. This serial cross-sectional study assessed how nicotine dependence is influenced by age, sociodemographic characteristics, substance-use disorder, and major depressive disorder. Researchers collected data from individuals with reported past-month cigarette use via the 2006-2019 National Surveys on Drug Use and Health. The prevalence of nicotine dependence decreased significantly from 2006 to 2019 among all age groups, except those aged 18-26 who reported stable nicotine dependence. Adults over age 50 had the highest prevalence of nicotine dependence, especially those with co-existing substance use and major depressive disorder. Other demographic factors were additionally identified to be associated with increased risk of nicotine dependence, such as male sex, White race, low income or educational attainment, divorced or separated relation status, prior or current substance use, prior or current major depressive disorder, or living in a non-metropolitan area. Overall, study findings may be used to further corroborate preexisting data regarding the association between demographic factors and nicotine dependence, potentially assisting in health policy formation in the future.
In-Depth [serial cross-sectional study]: The study population included 152,354 adults who reported past-month cigarette use. Nicotine dependence was determined based on the Nicotine Dependence Syndrome Scale or the Fagerström Test of Nicotine Dependence. Data were collected on past-month nicotine dependence, past-year substance use disorder, and past-year major depressive episodes, as well as sociodemographic data including age, sex, race, ethnicity, education, employment, income, marital status, and metropolitan statistical area status. Among the study population, the prevalence of nicotine dependence decreased from 2006 to 2019, with an average annual percentage change (AAPC) of −0.4% (95% CI, −0.5% to −0.4%; P < .001). Over this time period, nicotine dependence decreased for all age groups, with the exception of the 18-26 group (AAPC, −0.5%; 95% CI, −1.4% to 0.4%; P = .27). Nicotine dependence varied with age, with adults over age 50 reporting the highest prevalence of nicotine dependence. Compared to the 50+ age group, nicotine dependence was 32% lower for those aged 18-25 (adjusted risk ratio [ARR], 0.68; 95% CI, 0.66-0.70), 18% lower for those aged 26-34 (ARR, 0.82; 95% CI, 0.80-0.84), and 6% lower for those aged 35 to 49 years (ARR, 0.94; 95% CI, 0.92-0.96). The prevalence of nicotine dependence was greater among those who were male, White race, lower income, low educational attainment, divorced or separated, reported substance use or major depressive disorder, and living in a non-metropolitan statistical area. The difference in the prevalence of nicotine dependence between those with co-occurring MDE and SUD and those without both conditions was significantly greater for the 50+ age group compared to the 18 to 25 age group (18.69 percentage point difference [83.32% vs 64.63%] vs 7.67 percentage point difference [48.88% vs 41.21%]; P < .001). A limitation of this study is that the data collection method did not include individuals who were institutionalized or those without a fixed address, who are known to have a high degree of nicotine dependence. As well, there was no data collected for nicotine use via e-cigarettes. Future research should continue to assess sociodemographic and age-related trends in nicotine use and dependence while expanding the study population to include institutionalized and houseless individuals, as well as those who use e-cigarettes and other forms of nicotine.
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