Nicotine dependence in the United States - Prevalence, trends, and smokingpersistence

Background: The prevalence of smoking in the United States has been closely monitored. However, little is known about the epidemiology of nicotine dep endence. We studied DSM-III-R nicotine dependence in the United States, tre nds across cohorts, and the role of nicotine dependence in smoking persiste nce. Methods: The Tobacco Supplement to the National Comorbidity Survey was admi nistered to a representative subset of 4414 persons aged 15 to 54 years. Th e 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 bega n, at which point the rate declined and continued at a slower pace for seve ral years. Nicotine dependence increased the risk of smoking persistence, w ith an odds ratio (OR) of 2.2 (95% confidence interval [CI], 1.6-3.0). Memb ers of the most recent cohort, who were 15 to 24 years of age at the time o f the survey, were the least likely to smoke daily, but those who smoked ha d the highest risk of dependence: OR for daily smoking in the most recent v s earliest cohort was 0.7 (95% CI, 0.5-0.9), and for dependence among smoke rs, 7.2 (95% CI, 5.0-10.4). Conclusions: Despite evidence that nicotine dependence is the leading preve ntable cause of death and morbidity, it remains a common psychiatric disord er. Smoking cessation and the decline in uptake in recent years varied acro ss subgroups of the population.