Nicotine Dependence in US Decreased From 2006 to 2019

Nicotine dependence prevalence and cigarette use decreased between 2006 and 2019 in the general US adult population and for all subgroups aged 26 years and older, researchers reported in JAMA Network Open.

Investigators sought to determine how age, psychiatric comorbidities, sociodemographic factors, and time period affected the prevalence of nicotine dependence in the US. They therefore conducted a cross-sectional study assessing nicotine dependence patterns in US community-dwelling adults (aged ≥18 years), using data from the 2006 to 2019 National Surveys on Drug Use and Health (NSDUH). The data were analyzed from January 15 to February 15, 2023. Past-month nicotine dependence was defined according to criteria from the Nicotine Dependence Syndrome Scale or the Fagerström Test of Nicotine Dependence.

Of the 152,354 community-dwelling adults with past-month cigarette use, 54.1% were male, 18.8% were aged 18 to 25 years, 21.4% were aged 26 to 34 years, 29.0% were aged 35 to 49 years, 30.8% were aged 50 years and older, and 69.8% were non-Hispanic White.

The overall adjusted prevalence of nicotine dependence decreased from 59.52% in 2006 (95% CI, 57.93%-61.10%) to 56.00% in 2019 (95% CI, 54.38%-57.60%) (average annual percentage changes [AAPC], -0.4%; 95% CI, -0.5% to -0.4%; P <.001), for a percentage point difference of 3.52 and a percentage change of 5.91%.

The adjusted prevalence of nicotine dependence was 32% lower in individuals aged 18 to 25 years (adjusted risk ratio [ARR], 0.68; 95% CI, 0.66-0.70), 18% lower in those aged 26 to 34 years (ARR, 0.82; 95% CI, 0.80-0.84), and 6% lower in those aged 35 to 49 years (ARR, 0.94; 95% CI, 0.92-0.96) vs those aged 50 years and older who had past-month cigarette smoking.

The adjusted prevalence of nicotine dependence in adults with past-month cigarette smoking from 2006 to 2019 was statistically unchanged in those aged 18 to 25 years (AAPC, -0.5%; 95% CI, -1.4% to 0.4%; P =.27), but it was reduced in those aged 26 to 49 years (ages 26-34 years: AAPC, -0.5%; 95% CI, -0.9% to -0.2%; P =.008; ages 35-49 years: AAPC, −0.8%; 95% CI, -1.0% to -0.5; P <.001) and those aged 50 years and older (AAPC, -0.3%; 95% CI, -0.5% to 0.0%; P =.04). The adjusted nicotine dependence prevalence in 2019 was 41.27% (95% CI, 39.21%-43.37%) for individuals aged 18 to 25 years, 50.64% (95% CI, 47.99%- 53.30%) for those aged 26 to 34 years, 60.71% (95% CI, 58.27%-63.09%) in those aged 34 to 49 years, and 64.43% (95% CI, 60.98%-67.74%) in those aged 50 years and older.

Nicotine dependence was 4% greater among men aged 26 to 34 years (ARR, 1.04; 95% CI, 1.01- 1.07) and 3% higher in men aged 35 to 49 years (ARR, 1.03; 95% CI, 1.00-1.05) vs women of the same age. The prevalence was lower across age groups among individuals who were ethnic/racial minorities vs non-Hispanic White.

The effect of substance use disorder and/or major depressive episodes on nicotine prevalence was much greater in those age 50 and older. The difference in nicotine dependence prevalence in those with vs without substance use disorder and/or major depressive episodes was 18.69% (83.32% vs 64.63%, respectively) for those 50 years and older vs 7.67% (48.88% vs 41.21%, respectively) for those age 18 to 25 years and 8.28% (57.76% vs 49.48%, respectively) for those age 35 to 49 years (P <.001).

Study limitations include the cross-sectional design and potential underestimation of the prevalence of nicotine dependence. Also, e-cigarette use was not assessed from 2006 to 2019 in the NSDUH, which is also a self-report survey. Study authors further noted that the success of cessation treatments, increased cigarette prices, and smoking-free air laws helped lower cigarette consumption and increase cessation rates over time.

“These results suggest the need to implement evidence-based tobacco cessation strategies that are specific to age and psychiatric comorbidities,” the investigators concluded.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.