Chinese Medical Journal Pulmonary and Critical Care Medicine study explores nicotine dependence among smokers in China

Nicotine dependence, also known as tobacco dependence, is a chronic condition classified as a mental disorder. It affects nearly half of daily smokers, making it difficult for them to quit smoking. Similar to other chronic diseases, such as chronic obstructive pulmonary disease and diabetes, nicotine dependence often requires continuous assessments and repeated interventions.

In China, where nicotine dependence is widespread, over 158 million people are affected by this disease. This situation results in significant health and economic burdens. Understanding the severity of nicotine dependence among different populations is crucial for developing effective smoking cessation measures.

Accordingly, a research group from China assessed nicotine dependence in smokers aged 40 and above to inform smoking cessation measures. The research group was led by Dr. Liwen Fang, Director of the Respiratory Disease Prevention and Control Department at the National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention. Their study was published online on 26 June 2024 in the journal Chinese Medical Journal Pulmonary and Critical Care Medicine.

“Nicotine dependence varies widely among different populations. A comprehensive understanding of the severity of nicotine dependence among smokers with different characteristics is essential for the development and implementation of effective tobacco control and cessation interventions,” says Dr. Fang, reflecting on the motivation behind her study.

Accordingly, the study analyzed the smoking behaviors of 20,062 and 18,975 daily smokers in China using data from two national surveys conducted during 2014–2015 and 2019–2020. The results revealed that 95.6% of the smokers were men and 40.5% of the smokers were older adults aged 60 or above. 59.4% of the smokers lived in rural areas, 49.4% worked in agriculture-related fields, and 53.4% had completed middle school or higher education. Most of the smokers had smoked for over 20 years at the time of the study. Notably, 64.1% of these smokers also had chronic diseases.

Researchers further evaluated nicotine dependence in the study subjects using the Fagerström Test for Nicotine Dependence, which involves a short questionnaire that focuses on smoking habits. The test results revealed an average score of 3.9 out of 10, with men scoring slightly higher than women. The study subjects with higher education and income showed lower scores. Smokers working in the agriculture sector showed higher scores, as did those who started smoking before age 18 and had smoked for over 20 years at the time of the study. Smokers with chronic respiratory symptoms or diseases also showed higher nicotine dependence.

The researchers also categorized nicotine dependence levels as very low, low, medium, high, or very high. Among smokers aged 40 and above, 41.0% had medium-to-high nicotine dependence, with men more affected than women. The prevalence of nicotine dependence was higher in men aged 50–59, especially in men with lower education, agricultural workers, and individuals who started smoking at a young age or have been smoking for a long time. The researchers noted regional differences in nicotine dependence, with the highest nicotine dependence in South China.

Furthermore, the study highlighted that the prevalence of high nicotine dependence has decreased over the years, especially among men, rural residents, and individuals with a smoking history of ≥20 years. However, the decrease was not significant in women or individuals with chronic diseases such as diabetes or cardiovascular conditions.

Additionally, the study highlighted that nicotine dependence was more severe in smokers with chronic respiratory symptoms or diseases. While smoking cessation efforts in China have had some positive outcomes, there is still a need for more effective interventions, especially for individuals with such chronic conditions. Current smoking cessation measures experience challenges, such as low accessibility and insufficient resources, highlighting the need for improved awareness and integration of cessation services into routine healthcare.

Highlighting the study's impact, Dr. Fang says, “Our findings can inform the implementation of smoking cessation interventions, the development of smoking cessation service systems, and the evaluation of regional smoking cessation efforts.” She adds, “The results of this study can inform scientific, feasible, and effective region- and population-tailored tobacco control measures that can help improve public health outcomes in China and beyond.”

Indeed, this study paves the way for enhancing global smoking cessation efforts, offering hope to thousands of individuals affected by this disease.

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Reference

DOI: 10.1016/j.pccm.2024.05.003