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Nicotine Dependence in the United States
Prevalence, Trends, and Smoking Persistence
Naomi Breslau, PhD;
Eric O. Johnson, PhD;
Eva Hiripi, MS;
Ronald Kessler, PhD
Arch Gen Psychiatry. 2001;58:810-816.
Background The prevalence of smoking in the United States has been closely monitored.
However, little is known about the epidemiology of nicotine dependence. We
studied DSM-III-R nicotine dependence in the United
States, trends across cohorts, and the role of nicotine dependence in smoking
persistence.
Methods The Tobacco Supplement to the National Comorbidity Survey was administered
to a representative subset of 4414 persons aged 15 to 54 years. The World
Health Organization's Composite International Diagnostic Interview was used
to assess nicotine dependence.
Results Lifetime prevalence of nicotine dependence was 24%, nearly half of those
who had ever smoked daily for a month or more. The highest risk for nicotine
dependence occurred in the first 16 years after daily smoking began, at which
point the rate declined and continued at a slower pace for several years.
Nicotine dependence increased the risk of smoking persistence, with an odds
ratio (OR) of 2.2 (95% confidence interval [CI], 1.6-3.0). Members of the
most recent cohort, who were 15 to 24 years of age at the time of the survey,
were the least likely to smoke daily, but those who smoked had the highest
risk of dependence: OR for daily smoking in the most recent vs earliest cohort
was 0.7 (95% CI, 0.5-0.9), and for dependence among smokers, 7.2 (95% CI,
5.0-10.4).
Conclusions Despite evidence that nicotine dependence is the leading preventable
cause of death and morbidity, it remains a common psychiatric disorder. Smoking
cessation and the decline in uptake in recent years varied across subgroups
of the population.
From the Departments of Psychiatry, Henry Ford Health System, Detroit,
Mich (Drs Breslau and Johnson), Case Western Reserve University School of
Medicine, Cleveland, Ohio (Dr Breslau), and University of Michigan School
of Medicine, Ann Arbor (Dr Breslau); and the Department of Health Care Policy,
Harvard Medical School, Boston, Mass (Ms Hiripi and Dr Kessler).
Corresponding author and reprints: Naomi Breslau, PhD, Henry Ford
Health System, One Ford Place, 3A, Detroit, MI 48202-3450 (e-mail:
nbresla1{at}hfhs.org).
RELATED ARTICLE
Distinguishing Nicotine Dependence From Smoking: Why It Matters to Tobacco Control and Psychiatry
John R. Hughes
Arch Gen Psychiatry. 2001;58(9):817-818.
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