Inter-relationships linking probability of becoming a case of nicotine dependence with frequency of tobacco cigarette smoking

Introduction: Once smoking starts, some tobacco cigarette smokers (TCS) can make very rapid transitions into tobacco dependence syndromes (TCD). With adjustment for smoking frequency, we posit female excess risk for this rapid-onset TCD. In a novel application of functional analysis for tobacco research, we estimate four Hill function parameters and plot TCD risk against a gradient of smoking frequency, as observed quite soon after smoking onset. Methods: In aggregate, the National Surveys of Drug Use and Health, 2004-2013, identified 1546 newly incident TCS in cross-sectional research, each with standardized TCD assessment. Results: Hill function estimates contradict our apparently over-simplistic hypothesis. Among newly incident TCS males with only 1-3 recent smoking days, an estimated 1%-3% had become rapidonset TCD cases; non-overlapping confidence intervals show lower TCD risk for females. In contrast, among daily smokers, closer to 50% of female TCS showed rapid-onset TCD, versus under 20% of male TCS, but a larger sample will be needed to confirm the apparent female excess risk at the daily smoking frequency level. Conclusions: Smoking frequency and TCD onset become inter-dependent quite soon after TCS onset. Feedback loops are expected, and might explain a potential reversal of male-female differences across smoking frequency gradients. These novel epidemiological estimates prompt new thinking and questions about interventions. Implications: In this large sample epidemiological study, with a nationally representative sample of newly incident TCS assessed cross-sectionally, we see a quite rapid onset of tobacco dependence, with an early male excess that fades out at higher levels of smoking frequency. Next steps include development of outreach and intervention for this very rapid-onset tobacco dependence.