Dependence symptoms and cessation intentions among US adult daily cigarette, cigar, and e-cigarette users, 2012-2013

BMC Public Health. 2016 Aug 18;16(1):814. doi: 10.1186/s12889-016-3510-2.


Background: Cigar and e-cigarette use is becoming increasingly common among US tobacco users and the Food and Drug Administration recently asserted regulatory jurisdiction over these products, among others, in May 2016. Research on tobacco dependence among users of these products is limited, however. We therefore examined several symptoms of dependence and cessation intentions among adult cigarette, cigar, and/or e-cigarette users in a nationally representative sample.

Methods: We used nationally representative data from more than 60,000 participants in the US National Adult Tobacco Survey (NATS) from 2012 to 2013 to analyze dependence symptoms and cessation intentions for users of cigarettes, cigars, and/or e-cigarettes but not other tobacco products.

Results: Among daily tobacco users, dual cigarette and cigar users on average smoked more cigarettes per day (17.3, 95 % CI = 16.1, 18.6 vs. 15.8, 95 % CI = 15.4, 16.2), had shorter times to first tobacco use after waking (21.4 min, 95 % CI = 16.6, 24.9 vs. 25.9 min, 95 % CI = 25.3, 26.5), and were more likely to report withdrawal and craving symptoms than exclusive cigarette smokers. Dual cigarette and e-cigarette users were more likely than exclusive cigarette smokers to report withdrawal and craving symptoms and cessation intentions. Exclusive cigar and e-cigarette users were less likely to report withdrawal and craving symptoms than users of other products, but even so, more than a third of exclusive cigar (38.8 %, 95 % CI = 27.4 %, 51.6 %) and e-cigarette (46.1 %, 95 % CI = 35.1 %, 57.4 %) users reported experiencing a strong craving for a tobacco product in the past 30 days.

Conclusions: Dual cigarette and cigar users show evidence of greater dependence symptoms and dual cigarette and e-cigarette users show evidence of greater dependence symptoms and cessation intentions compared with exclusive cigarette smokers. A sizeable number of users of all of the tobacco products report dependence symptoms such as craving for tobacco.

Keywords: Cessation; Cigarettes; Cigars; Dependence; E-cigarettes; Tobacco.

MeSH terms

  • Adolescent
  • Adult
  • Craving
  • Electronic Nicotine Delivery Systems / psychology*
  • Female
  • Humans
  • Intention*
  • Male
  • Middle Aged
  • Smoking / psychology*
  • Substance Withdrawal Syndrome / etiology
  • Substance Withdrawal Syndrome / psychology
  • Surveys and Questionnaires
  • Time Factors
  • Tobacco Products / statistics & numerical data
  • Tobacco Use / psychology*
  • Tobacco Use Disorder / psychology*
  • United States
  • United States Food and Drug Administration
  • Young Adult