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Trends in cigarette consumption and time to first cigarette on awakening from 2002 to 2015 in the USA: new insights into the ongoing tobacco epidemic


Objective The current study estimates trends in the number of cigarettes smoked per day (CPD) and percentage of smokers having their first CPD within 30 min of waking (time to first cigarette (TTFC)<30 min) among smokers from 2002 to 2015 in the USA overall, and adjusting for demographics. Trends in TTFC<30 min were also estimated by varying levels of cigarette consumption.

Methods Data were drawn from the National Household Survey on Drug Use, an annual nationally representative cross-sectional study of the US population aged 12 and older (n=54 079–58 397 per year). Linear time trend analyses of CPD and TTFC<30 min were conducted adjusting for age, gender and income; linear time trend analyses of TTFC among those at varying levels of CPD were then performed.

Results Estimates suggest that CPD declined overall from 2002 to 2015, and that the prevalence of TTFC<30 min declined overall among smokers (p<0.0001). The proportion of smokers consuming fewer (ie, 1–5, 6–15) CPD has increased while the number consuming 16+ CPD has decreased overall. Among those smoking 1–5 (p=0.0006) and 6–15 (p<0.0001) CPD, TTFC<30 min has increased significantly, but TTFC<30 min has remained unchanged among those smoking 16 or more CPD (p=0.5838).

Conclusions Findings suggest that smokers today are consuming fewer CPD, yet are increasingly likely to have their first cigarette earlier on awakening than they were a decade ago. Intervention and outreach efforts aimed at moving the prevalence lower may benefit from evaluating and addressing nicotine dependence even among lighter smokers.

  • nicotine
  • smoking caused disease
  • addiction

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  • Contributors All authors made substantial contributions to the conception or design of the study, as well as the analysis and interpretation of the work. All authors contributed to drafting the manuscript and/or revising it for important intellectual content. All authors give final approval of the manuscript. All authors agree that they are accountable for all aspects of the work. RDG conceived of the original and wrote the manuscript; DSH, SG, AHW and MJZ provided critical feedback in the study design, interpretation of results and writing of the manuscript; MMW designed the analytic plan and oversaw data analysis; MCH and MG conducted the statistical analyses; EH contributed to literature review and drafting and revising key content of the manuscript.

  • Funding This work was supported by grant #2R01 DA20892 (Goodwin) from NIDA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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