Smoking within 30 minutes of waking, smoking daily, smoking more cigarettes per day, and waking at night to smoke are associated with tobacco use disorder. Environmental cues can evoke craving and withdrawal. Serious medical conditions, such as lung and other cancers, cardiac and pulmonary disease, perinatal problems, cough, shortness of breath, and accelerated skin aging, often occur.
Cigarettes are the most commonly used tobacco product, representing over 90% of to- bacco/nicotine use. In the United States, 57% of adults have never been smokers, 22% are former smokers, and 21% are current smokers. Approximately 20% of current US. smok- ers are nondaily smokers. The prevalence of smokeless tobacco use is less than 5%, and the prevalence of tobacco use in pipes and cigars is less than 1%.
DSM-IV nicotine dependence criteria can be used to estimate the prevalence of tobacco use disorder, but since they are a subset of tobacco use disorder criteria, the prevalence of tobacco use disorder will be somewhat greater. The 12-month prevalence of DSM-IV nic- otine dependence in the United States is 13% among adults age 18 years and older. Rates among 18— to 29-year-olds to 4% among individuals age 65 years and older. The prevalence of current nicotine dependence is greater among Native American and Alaska Natives (23%) than among whites (14%) but is less among African Americans (10%), Asian Amer- icans and Pacific Islanders (6%), and Hispanics (6%). The prevalence among current daily smokers is approximately 50%.
In many developing nations, the prevalence of smoking is much greater in males than in females, but this is not the case in developed nations. However, there often is a lag in the demographic transition such that smoking increases in females at a later time.
The majority of US. adolescents experiment with tobacco use, and by age 18 years, about 20% smoke at least monthly. Most of these individuals become daily tobacco users. Initi- ation of smoking after age 21 years is rare. In general, some of the tobacco use disorder cri- teria symptoms occur soon after beginning tobacco use, and many individuals’ pattern of use meets current tobacco use disorder criteria by late adolescence. More than 80% of in- dividuals who use tobacco attempt to quit at some time, but 60% relapse within 1 week and less than 5% remain abstinent for life. However, most individuals who use tobacco make multiple attempts such that one-half of tobacco users eventually abstain. Individuals who use tobacco who do quit usually do not do so until after age 30 years. Although non- daily smoking in the United States was previously rare, it has become more prevalent in the last decade, especially among younger individuals who use tobacco.
Temperamental. Individuals with externalizing personality traits are more likely to initiate tobacco use. Children with attention-deficit/hyperactivity disorder or conduct disorder, and adults with depressive, bipolar, anxiety, personality, psychotic, or other substance use disorders, are at higher risk of starting and continuing tobacco use and of to- bacco use disorder.
Environmental. Individuals with low incomes and low educational levels are more likely to initiate tobacco use and are less likely to stop.
Genetic and physiological. Genetic factors contribute to the onset of tobacco use, the continuation of tobacco use, and the development of tobacco use disorder, with a degree of heritability equivalent to that observed with other substance use disorders (i.e., about 50%). Some of this risk is specific to tobacco, and some is common with the vulnerability to developing any substance use disorder.