Nicotine dependence among Chinese city dwellers: a population-based cross-sectional study

Although nicotine addiction is thought to be the primary driver of tobacco smoking, few studies have examined nicotine dependence among Chinese mainland smokers.

A population-based cross-sectional study was designed. Subjects (4735) aged 15 years and older residents were drawn from six cities in China through a multistage systematic sampling procedure. Nicotine dependence of respondents was assessed in a face-to-face interview using the 6-item Mandarin Chinese version of the Fagerström Test for Nicotine Dependence (FTND). A multilevel regression model, accounting for cluster sampling, was used to identify correlates of dependence.

Among females, only 4.2% (n = 115) were smokers (2.5% daily, 1.7% occasional). Subsequent analysis focused on males, of whom 50.8% (n = 1477) were smokers (38.9% daily, 11.9% occasional). The average FTND score was 2.89 (95% CI: 2.77-3.01) among all current smokers. Daily smokers had a significantly higher FTND score (3.49, 95% CI: 3.35-3.63) than occasional smokers (1.12, 95% CI: 0.98-1.26) (p < .01). Of all smokers, 27.1% were considered dependent based on FTND ≥ 4. Among daily smokers, FTND scores were negatively associated with age at smoking initiation, education, and self-efficacy for quitting smoking. FTND was associated (negatively) with income among occasional smokers only. There were regional differences in FTND scores among daily smokers.

Cigarette smoking is highly prevalent among Chinese males but rare among Chinese females. Occasional smoking is also common among males. Only 3.3% of occasional male smokers appear dependent by FTND criteria. Dependence varies by smoking history and demographics. These findings have implications for design and implementation of smoking cessation interventions.