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标题：Changes in Cigarette Use and Nicotine Dependence in the United States: Evidence From the 2001–2002 Wave of the National Epidemiologic Survey of Alcoholism and Related Conditions
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作者：Renee D. Goodwin ; Katherine M. Keyes ; Deborah S. Hasin 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：8
页码：1471-1477
DOI：10.2105/AJPH.2007.127886
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the roles of gender and poverty in cigarette use and nicotine dependence among adults in the United States. Methods. Our data were drawn from the 2001–2002 National Epidemiological Survey of Alcoholism and Related Conditions, a nationally representative sample of US adults 18 years and older. Results. The overall rate of cigarette use declined between 1964 and 2002. Nicotine dependence does not appear to have declined overall, and there is evidence that nicotine dependence has increased among women in recent cohorts. The odds of nicotine dependence among cigarette users appear to have increased significantly in recent cohorts. Conclusions. Despite recent declines in cigarette use, the prevalence of nicotine dependence has increased among some groups and has remained steady overall, which may be hampering public health initiatives to reduce cigarette use. Efforts to study or curb cigarette use should therefore take nicotine dependence into account. Cigarette use is the leading preventable cause of death among adults in the United States.¹ According to the Centers for Disease Control and Prevention, cigarettes are responsible for approximately 440 000 deaths annually.² Since 1964, when the first surgeon general's report on smoking and health was released, awareness concerning the harmful effects of cigarette use has risen, and in recent years, there has been evidence of a decline in cigarette use. In 2003, the US Department of Health and Human Services reported that the frequency of smoking among adults had declined from 25% in 1990 to 23% in 2000 and 22.5% in 2002.³ Recent studies indicate that this effect may have reached a plateau between 2004 and 2006.⁴ The overall decline from 1964 levels is viewed as confirmatory evidence that public health efforts to increase awareness of the health risks of cigarettes^{4 , 5} and to decrease cigarette use (e.g., through increased taxation) have succeeded in altering cigarette use behavior.⁶ However, previous studies have mainly addressed tobacco use or cigarette smoking per se rather than examining amount of cigarette use (i.e., frequency and duration) in detail. Specifically, they have not addressed the regular, heavy cigarette use that frequently characterizes nicotine dependence, which is the pattern of use thought to be the most detrimental to health and longevity. Among studies that have examined prevalence rates of cigarette consumption across time, few have focused specifically on the prevalence of nicotine dependence, and most have not distinguished between nicotine dependence and nondependent cigarette use in prevalence estimates. However, nicotine dependence warrants study as a separate area of concern. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ), defines nicotine dependence as a mental disorder,⁷ and research has suggested that nicotine dependence is as strong an addiction and is as difficult to treat as cocaine addiction.⁸ In addition, researchers have established that trends in prevalence of cigarette use are not necessarily parallel with trends in prevalence of nicotine dependence.^{9 , 10} However, studies that have measured fluctuations in the prevalence of cigarette use have failed to measure fluctuations in nicotine dependence,¹¹ despite the fact that cigarette use and nicotine dependence are likely to have distinct risk factors, courses, treatments, prevention strategies, and outcomes.^{9 , 12 – 14} In addition, the outcomes associated with nicotine dependence are thought to be far more severe than those associated with occasional cigarette use, because negative health outcomes are thought to be fairly proportionate to the number of cigarettes smoked.^{14 – 20} Another factor that has changed dramatically in the epidemiology of tobacco consumption and dependence over the past several decades is gender. There have been substantial disparities between men and women in the prevalence of cigarette use and nicotine dependence over the past forty years, with smoking being far more common among men for most of that time.²¹ However, recent evidence suggests a relatively narrow gender gap in smoking prevalence.²² Little is known about gender differences and changes in prevalence of nicotine dependence over the past several decades. Socioeconomic status has also been shown to be associated with differences in prevalence of cigarette use. Some reports have suggested that cigarette use may be disproportionately common among those in poverty,^{23 – 28} and rates of cigarette use among adults in different socioeconomic groups are thought to have shifted over time.²⁹ Still, previous studies have not provided information on potential disparities in nicotine dependence by gender and poverty status. This information would ideally be elicited by studies that track changes in prevalence of nicotine dependence by means of repeated general population surveys that use consistent measures, carried out over many years. Unfortunately, such data are not available, but given the major public health importance of cigarette use and nicotine dependence, we sought a different way to address these questions. To that end, we decided to use data from a large, cross-sectional survey with excellent measures of cigarette use and nicotine dependence in the United States,³⁰ taking steps to minimize biases from reporting and differential mortality. In this study, we had 3 goals: (1) to examine rates of nondependent cigarette use over 4 recent birth cohorts among adults in the United States, (2) to examine the prevalence of nicotine dependence among adults over these 4 birth cohorts, and (3) to examine the results by gender and poverty status in order to elicit changes in cigarette use and nicotine dependence among groups that may be especially vulnerable, including women and those in poverty.