Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status

Addict Behav. 2014 Jul;39(7):1145-51. doi: 10.1016/j.addbeh.2014.03.005. Epub 2014 Mar 13.


Introduction: Low socio-economic status (SES) is strongly related to smoking, but studies examining the association of SES with nicotine dependence (ND) are scarce. The aim of this study was to examine the associations of SES and marital status with smoking, multiple measures of ND, and cotinine as a nicotine intake biomarker.

Methods: The sample comprised 1746 ever smokers, sampled from the National FINRISK 2007 Study, who had completed a tobacco specific questionnaire in addition to the standard clinical examination. The Fagerström Test for Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI), the Nicotine Dependence Syndrome Scale (NDSS), and the Hooked On Nicotine Checklist (HONC) were assessed, while plasma cotinine was measured as a biomarker of nicotine exposure in daily smokers. Univariate and multivariate associations were assessed by linear regression and multinomial logistic regression.

Results: In multivariate models, lower education was associated with higher FTND and HSI, income with HSI, and occupation with HSI (men only), FTND, HONC and NDSS scores. Lower education was related to higher cotinine levels among daily smokers, although the association diminished slightly after adjusting for daily smoking amount. Living without a spouse was associated with daily smoking and higher ND.

Conclusion: In this cross-sectional study low SES was linked with higher ND among current smokers, while low SES was associated with higher cotinine levels among daily smokers. Living alone was linked with higher ND. Longitudinal studies are warranted to further explore these associations. As lower SES smokers are more addicted they may need more targeted cessation services to succeed in quitting smoking.

Keywords: Addiction; Cessation; Cotinine; Nicotine; Smoking; Socio-economic status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cotinine / blood*
  • Cross-Sectional Studies
  • Female
  • Finland / epidemiology
  • Humans
  • Male
  • Marital Status
  • Middle Aged
  • Nicotine*
  • Risk Factors
  • Smoking / epidemiology*
  • Social Class
  • Surveys and Questionnaires
  • Tobacco Use Disorder / epidemiology*


  • Nicotine
  • Cotinine