Nicotine Dependence among Chinese City Dwellers: A Population-Based Cross-Sectional Study

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