Tobacco Use Disorder 573
bed, smoking around flammable chemicals) oc cur at an intermediate prevalence. Although
these criteria are less often endorsed by toba cco users, if endorsed, they can indicate a
more severe disorder.
Associated Features Supporting Diagnosis
Smoking within 30 minutes of waking, smoking daily, smoking more cigarettes per day,
and waking at night to smoke are associated with tobacco use di sorder. Environmental
cues can evoke craving and withdrawal. Serious medical conditions, such as lung and
other cancers, cardiac and pulmonary disease , perinatal problems, cough, shortness of
breath, and accelerated skin aging, often occur.
Prevalence
Cigarettes are the most commonly used toba cco product, representing over 90% of to-
bacco/nicotine use. In the United States, 57% of adults have never been smokers, 22% are
former smokers, and 21% are current smokers.  Approximately 20% of current U.S. smok-
ers are nondaily smokers. The prevalence of sm okeless tobacco use is less than 5%, and the
prevalence of tobacco use in pipes and cigars is less than 1%. 
DSM-IV nicotine dependence criteria can be used to estimate the prevalence of tobacco
use disorder, but since they are a subset of to bacco use disorder criteria, the prevalence of
tobacco use disorder will be somewhat greater. The 12-month prevalence of DSM-IV nic-
otine dependence in the United States is 13% among adults age 18 years and older. Rates
are similar among adult males (14%) and fe males (12%) and decline in age from 17%
among 18- to 29-year-old s to 4% among individuals age 65 years and older. The prevalence