An estimated 22 million US women were current smokers in 1993;
of these, 73% wanted to quit smoking . However, attempts to
quit smoking and to remain abstinent are hindered by nicotine
addiction and by the subsequent effects of nicotine withdrawal
. To assess the prevalence of selected indicators of nicotine
addiction among U.S. women, Centers for Disease Control (CDC)
analyzed data from the National Household Survey on Drug Abuse
(NHSDA) in 1991 and 1992 . This report presents the findings
of the analysis.
The NHSDA is a household survey of a nationally representative
sample of the civilian, noninstitutionalized U.S. population.
Combined data from the 1991 and 1992 surveys (n = 7,137) were
used to estimate the prevalences of four indicators of nicotine
addiction among women who smoke. Information about these indicators
was based on responses to four questions; current smokers (defined
as persons who had ever smoked 100 cigarettes and had smoked during
the 30 days preceding the survey) were asked whether, during the
12 months preceding the survey, they:
1. Felt they needed or were dependent on cigarettes
2. Needed larger amounts (more cigarettes) to get the same effect
3. Felt unable to cut down on their use even though they tried
4. Had withdrawal symptoms, that is, felt sick because they stopped
or cut down on cigarette use.
The analysis of "unable to cut down" (n = 4,422) and
"felt sick" (n = 4,646) was restricted to persons who
reported trying to reduce their use of cigarettes during the preceding
12 months. In addition, for the indicator "unable to cut
down," because of the question design, respondents who reported
not trying to reduce any drug use during the preceding 12 months
(n = 224) also were excluded. Because the likelihood of daily
smoking and the intensity of smoking (ie, number of cigarettes
smoked per day) varies directly with age, respondents were classified
into two age groups: 12- to 24-year-olds and 25-year-olds and
Among female smokers in both age groups, 75% reported feeling
dependent on cigarettes. The prevalence of feeling dependent varied
directly with intensity of smoking; among those who smoked 6 to
15 cigarettes per day, 80.6% of those aged 12 to 24 years, and
76.1% of those aged 25 years and older reported feeling dependent
on cigarettes. Female smokers aged 12 to 24 years were more likely
to report needing more cigarettes to attain the same effect than
were those aged 25 years and older (18.0% vs 13.2%). Among those
who had tried to reduce smoking during the preceding 12 months,
81.5% of 12- to 24-year-olds, and 77.8% of 25-year-olds and older
reported being unable to do so. Even among those who smoked 6
to 15 cigarettes per day, inability to reduce smoking was reported
by 82.6% of 12- to 24-year-olds, and 73.8% of the 25-year-olds
and older. Of all female smokers aged 12 years and older, 35.4%
reported withdrawal symptoms (ie, feeling sick) when they tried
to reduce their smoking.
Females in both the younger and older age groups were equally
likely to report at least one of the four indicators of nicotine
addiction (81.2% and 79.4%, respectively). Even among females
who smoked five or fewer cigarettes per day, 63.1% of those aged
12 to 24 years, and 53% of those aged 25 years and older reported
one or more of these indicators.
Editorial Note from the CDC: In 1990, an estimated 61,000
U.S. women aged 35 years and older died from cardiovascular diseases
attributable to cigarette smoking . Because the risk for myocardial
infarction can be reduced by 50% after 1 year of abstaining from
smoking,  interventions to encourage smoking cessation are
an important strategy to reduce cardiovascular mortality. Although
most women smokers want to quit smoking, only 2.5% of all smokers
successfully quit each year . The finding in this report that
approximately 80% of female smokers reported symptoms of nicotine
addiction underscores the importance of measures to increase women's
access to cessation interventions, including adjunctive nicotine-replacement
The findings in this report are subject to at least two limitations:
First, the NHSDA indicators are not comprehensive measures of
nicotine addiction, and do not include all symptoms of nicotine
withdrawal (eg, anxiety, irritability, anger, difficulty concentrating,
hunger, or cravings for cigarettes)2; as a result, the NHSDA data
may underestimate the proportion of smokers who report at least
one indicator of nicotine addiction.
Second, these findings are based on self-reported data, and perceptions
of nicotine addiction were not validated. However, in previous
studies, self-reported symptoms of nicotine addiction have been
confirmed by observer rating .
Although manifestations of cardiovascular disease occur primarily
during adulthood, related high-risk behaviors, such as tobacco
use, often are initiated during adolescence; an estimated 87%
of female daily smokers began smoking at 18 years or younger of
age (CDC, unpublished data, 1991). Young persons often try using
tobacco with a belief that they can quit. However, of adolescent
smokers who have intended to not be smoking in 5 to 6 years, 73%
still smoked 5 years later . The 1991 and 1992 NHSDA data suggest
that an important reason for young smokers' failure to quit smoking
is a prevalence of addiction similar to that among older smokers.
Because of the difficulty in achieving abstinence, and the strength
and early onset of nicotine addiction, interventions to prevent
smoking initiation are important.
School-based programs, combined with community interventions,
have been effective in preventing smoking initiation . Other
measures that can prevent smoking initiation, onset of nicotine
addiction, and subsequent morbidity and mortality associated with
cardiovascular diseases include enforcement of laws that prohibit
sales to minors, counteradvertising campaigns that "deglamorize"
smoking to youth, and increases in the real price of cigarettes.
1. CDC: Cigarette smoking among adults-United States, 1993. MMWR
2. CDC: The health consequences of smoking: Nicotine addiction-A
report of the Surgeon General. Rockville, Maryland, US Department
of Health and Human Services, Public Health Service, CDC, DHHS
publ (CDC)88-8406, 1988.
3. Substance Abuse and Mental Health Services Administration:
National household survey on drug abuse: Population estimates,
1992. Rockville, Maryland, US Department of Health and Human Services,
Public Health Service, Substance Abuse and Mental Health Services
Administration, DHHS publ (SMA)93-2053, 1993.
4. CDC: Cigarette smoking-Attributable mortality and years of
potential life lost-United States, 1990. MMWR 42:645-649, 1993.
5. CDC: The health benefits of smoking cessation: A report of
the Surgeon General, 1990. Rockville, Maryland, US Department
of Health and Human Services, Public Health Service, DHHS publ
6. CDC: Smoking cessation during previous year among adults-United
States, 1990 and 1991. MMWR 42:504-507, 1993.
7. US Department of Health and Human Services: Preventing tobacco
use among young people: A report of the Surgeon General. Atlanta,
US Department of Health and Human Services, Public Health Service,
CDC, National Center for Chronic Disease Prevention and Health