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This could be assessed based on four factors:[5] Using nicotine upon waking Using nicotine despite being restricted from its use (e.g., banned in certain locations, activities, events) Using nicotine to avoid withdrawal symptoms Waking up in the middle of the night to use nicotine The study concluded that a significant correlation exists between individuals with a nicotine dependence and certain Axis I (e.g., alcohol and drug use disorders, major depression, dysthymia, mania, hypomania, panic disorder with and without agoraphobia, social phobia, specific phobia, and generalized anxiety disorder) and Axis II disorders (e.g., avoidant, dependent, obsessive-compulsive, histrionic, paranoid, schizoid, and antisocial PDs).[6] There was an especially strong association to disorders involving alcohol and other drug use, as well as mood disorders such as major depression, specific phobia, antisocial, and paranoid personality disorders.[7] Nicotine smoking has also been found that put individuals at an increased risk for suicide, biopolar disorder, and a dose-response relationship has been found between smoking and schizophrenia

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In 2014, one quarter of all high school students and about eight percent of middle schoolers used some kind of tobacco product