Nicotine dependence versus smoking prevalence: Comparisons among countries and categories of smokers

Objectives - To collect available international data on nicotine dependence as defined by the Fagerström Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. Data sources - Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. Study selection - Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. Data synthesis - Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). Conclusions - Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.