Nicotine Dependence among Current Tobacco Users – A Comparison between Rural and Urban Areas of Puducherry

Objectives: This study aimed to assess the level of nicotine dependence and its associated factors among current tobacco users residing in areas attached to rural and urban health training centers of a medical college in Puducherry. Subjects and Methods: A cross-sectional study was conducted among consenting current tobacco users, aged ≥18 years. Seriously ill study subjects not comprehensive for data collection were excluded. Nicotine dependence was assessed using the validated tool Fagerstrom Test for Nicotine Dependence (FTND) for smoking tobacco users and FTND – smokeless tobacco (FTND-ST) for smokeless tobacco users. Subjects with scores below 4, 4–6, or above 6 were classified to be having a low, moderate, or high level of nicotine dependence, respectively. Results: Of the 712 current tobacco users, 82.3%, 22.2%, and 4.5% were smokers, smokeless tobacco users, and dual users, respectively. Assessment by the FTND questionnaire revealed that 60.8% had a low level of nicotine dependency whereas 60.1% had moderate-to-high level of nicotine dependency. The median FTND scores were significantly higher among illiterates, increasing age, in urban areas, those smoking a greater number of cigarettes/bidis per day, and longer duration of smoking. The median FTND-ST scores were significantly higher among illiterates, unemployed, and those consuming higher number of packs per day. Conclusion: Most of the current smoking tobacco users had a low-to-moderate level of nicotine dependence, while a high level was observed among the majority of the current smokeless tobacco users. Nicotine dependency estimates provide baseline information that influences policy decisions on the development and implementation of tobacco cessation strategies.