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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
  1. Renee D Goodwin1,2,3,
  2. Melanie M Wall4,5,6,
  3. Misato Gbedemah1,
  4. Mei-Chen Hu7,
  5. Andrea H Weinberger8,9,
  6. Sandro Galea10,
  7. Michael J Zvolensky11,12,
  8. Elizabeth Hangley13,
  9. Deborah S Hasin3,4,5
  1. 1Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, USA
  2. 2Institute for Implementation Science in Population Health, City University of New York, New York, USA
  3. 3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
  4. 4Department of Psychiatry, College of Physicians and Surgeons Columbia University, New York, New York, USA
  5. 5New York State Psychiatric Institute, New York, New York, USA
  6. 6Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
  7. 7Department of Sociomedical Science, Mailman School of Public Health, Columbia University, New York, New York, USA
  8. 8Ferkauf Graduate School of Psycholog, Yeshiva University, Bronx, New York, USA
  9. 9Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  10. 10Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  11. 11Department of Psychology, University of Houston, Houston, Texas, USA
  12. 12Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  13. 13Department of Psychology, Queens College, City University of New York (CUNY), Flushing, New York, USA
  1. Correspondence to Dr Renee D Goodwin, Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, New York 10027, USA; renee.goodwin{at}


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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