title: Predictors of persistent nicotine dependence among adults in the United States.
abstract: BACKGROUND
  Evidence suggests that nicotine dependence is the key barrier to successful smoking cessation. No previous study has documented predictors of persistent nicotine dependence among adults in the community. The goal of this study is to prospectively identify predictors of continued nicotine dependence over a 3-year period among adults.
  
  
  METHODS
  Data were drawn from Waves I and II of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults in the United States. Logistic regression analyses were used to estimate the odds of persistent nicotine dependence at Wave 2 given the presence of various sociodemographic and psychiatric predictors at Wave 1.
  
  
  RESULTS
  Mood, anxiety, personality and illicit substance use disorders were associated with significantly increased risk of persistent nicotine dependence. The strength of these relationships was attenuated slightly after adjusting for demographic differences, but remained statistically significant. Persistent nicotine dependence was more common among unmarried, younger females with lower income levels and lower educational attainment.
  
  
  CONCLUSIONS
  To our knowledge, this study is the first to prospectively identify predictors of persistent nicotine dependence among adults. Our results suggest that the incorporation of mental health treatment into alternative smoking cessation approaches may help to increase the effectiveness of these programs and that a greater focus of these services on vulnerable segments of the population is needed in order to reduce continued disparities in smoking in the general population.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, Rm 1505, New York, NY 10032, USA. rdg66@columbia.edu
authors.forename: Renee D
authors.initials: RD
authors.lastname: Goodwin
authors.forename: Jina
authors.initials: J
authors.lastname: Pagura
authors.forename: Rae
authors.initials: R
authors.lastname: Spiwak
authors.forename: Adina R
authors.initials: AR
authors.lastname: Lemeshow
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
mesh_terms: D000328:Adult; D000339:Affect; D000367:Age Factors; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000523:psychology; D010551:Personality; D010554:Personality Disorders / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology