Tobacco dependence and associated factors among smokers aged 15 years and older in Wuxi, China: a cross-sectional study

BACKGROUND: Tobacco dependence remains a critical public health challenge in China. However, population-level data on its prevalence and determinants, particularly at the local level, remain scarce. This study aimed to estimate the prevalence of tobacco dependence and analyze its sociodemographic and behavioral correlates among current smokers in Wuxi City. METHODS: A population-based cross-sectional survey was conducted from June to October 2024 among residents aged ≥ 15 years in Wuxi, using a four-stage complex sampling design. Data were collected via face-to-face interviews. Tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence, with a score of ≥ 4 indicating dependence. Complex sampling weighting was applied. Rao-Scott χ² tests and survey-weighted multivariable logistic regression were used to identify factors associated with tobacco dependence. RESULTS: A total of 6,646 participants were included in the survey. Among adults aged ≥ 15 years, the prevalence of current smoking was 19.62% (male: 37.73%, female: 0.44%). Among individuals who currently smoke (n = 1,309), 30.66% exhibited tobacco dependence (male: 30.78%, female: 19.50%). Dependence prevalence increased significantly with age and was higher among those with lower education level (both P < 0.001). In multivariable analyses, older age and lower education level remained significant factors. Compared with smokers aged 15-34 years, those aged 55-64 (aOR = 2.69, 95% CI: 1.35-5.37) and ≥ 65 years (aOR = 3.43, 95% CI: 1.66-7.09) had significantly higher odds of dependence. Smokers with middle/high school (aOR = 2.16) or primary education level or less (aOR = 2.61) were more likely to be dependent than those with college or higher education level. Compared with those reporting "Good" health, smokers reporting "Average" self- reported health had significantly higher odds of tobacco dependence (aOR = 1.54, 95% CI: 1.11-2.14). CONCLUSION: Tobacco dependence among current smokers in Wuxi is significantly associated with older age, lower education level, and self-reported average health status. These findings highlight the need for targeted tobacco control interventions focused on older individuals with lower education level to reduce tobacco dependence and promote public health. CLINICAL TRIAL NUMBER: Not applicable.