Extent of smoking and nicotine dependence in the United States: 1991-1993.

Rates of nicotine dependence vary in different sociodemographic groups in the population. These group differences remain to be understood. The objective of this study is to specify the relationship between cigarette consumption and nicotine dependence and whether group differences are explained by quantity smoked or differential sensitivity to nicotine. The data used derived from National Household Surveys on Drug Abuse (1991-1993), multistage area probability samples of the US population 12 years old and over, and anonymous structured household interviews, considering subjects who were last-month smokers (12,550 White, 4903 Black, 4839 Hispanic). The main outcome measure was last-year nicotine dependence based on symptoms of dependence and drug-related problems approximating DSM-IV dependence criteria. Rates are higher among females than males, Whites than minorities and the lowest among older adults. Dependence rates increase sharply up to half a pack of cigarettes smoked per day. At higher quantities, the increased risk for dependence is minimal. The higher rate of dependence among females than males results from a greater number of symptoms at the same quantity smoked. The similarity of adolescent and middle-adult rates results from the fact that adolescents smoke significantly fewer cigarettes than adults, but experience higher rates of dependence at the same levels of use. Although adults 50 and over are the heaviest smokers, they experience the lowest rates of dependence because of hypothesized lower sensitivity to increased quantity of nicotine intake. The higher rates among Whites than Blacks appear to result from heavier smoking and greater sensitivity to nicotine effects. It was concluded that adolescents, women and Whites are particularly vulnerable to becoming dependent on nicotine. Group-specific thresholds may be more appropriate criteria than an absolute threshold to define the risk for nicotine dependence.