Certain sociodemographic groups at higher risk for nicotine use, dependence
Certain sociodemographic characteristics were associated with nicotine use and dependence, according to study results published in American Journal of Psychiatry.
“Prevalence of cigarette use in the U.S. general population has decreased markedly since the 1960s, but several trend studies have shown smaller declines in more recent decades, suggesting that large population improvements in cigarette use have lessened,” Bridget F. Grant, PhD, of FedPoint Systems in Virginia, and colleagues wrote. “Although tracking changes in cigarette use is common, less is known about changes in overall tobacco product (i.e., nicotine) use or nicotine dependence or other proxy measures used to characterize severely dependent users. The ‘hardening hypothesis’ posits that as tobacco use declines, less dependent users will quit, leaving a growing proportion of severely dependent users who may be less likely to quit, resulting in a leveling off of declines in smoking.”
Prior studies on the hardening hypothesis focused largely on proxy measures of nicotine dependence, including successful abstention, increased quit attempts, number of cigarettes per day, decreased ability to abstain and time to first cigarette within 30 minutes of awakening. Results were mixed, with some supporting and others rejecting the hypothesis. Currently, no published U.S. population survey has used alternative dependence measures to assess changes over time.
Grant and colleagues sought to address this information gap by analyzing data of 43,093 U.S. adults who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and 36,309 who participated in the 2012- 2013 NESARC-III. They compared weighted estimates of nicotine use, DSM-IV nicotine dependence and an approximation of the Fagerström Test for Nicotine Dependence with results of NESARC and NESARC-III among the overall population and among nicotine users. Further, they used a predicted marginal approach to conduct logistic regression analyses and obtain adjusted risk differences.
Results showed a slight decline from 27.7% to 26.9% in rates of 12-month nicotine use between the two surveys; however, rates increased slightly but significantly after adjusting for sociodemographic characteristics, with an adjusted risk difference of 1.4%. The researchers observed larger significant increases in 12-month nicotine dependence, with an adjusted risk difference of 2.6%, and nicotine dependence among users, with an adjusted risk difference of 6.4%. Increases in nicotine dependence, nicotine use and nicotine dependence among users appeared statistically significant for most sociodemographic subgroups. Moreover, Grant and colleagues reported significant increases among men, middle and older age groups, whites, Blacks, Hispanics and the socioeconomically disadvantaged.
“The results of this study support the hardening hypothesis,” the researchers wrote. “Because of this hardening, the remaining nicotine users may be less likely to quit because of dependence, and the allocation of nicotine intervention services may need to be reconsidered. Some individuals appear to be unlikely to quit with public health efforts (e.g., increased price, elimination of advertising, protections against secondhand smoke), so evidence-based treatment interventions should supplement these public health activities."