Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study.
Department of Family Medicine and Community Health; Department of Psychiatry; Department of Medicine, Division of Preventive and Behavioral Medicine
Adolescent; Behavior, Addictive; Child; Cotinine; Female; Humans; Incidence; International Classification of Diseases; Interviews as Topic; Male; Massachusetts; Personal Autonomy; Prospective Studies; Psychological Tests; Risk Assessment; Risk Factors; Saliva; Schools; Smoking; Smoking Cessation; Students; Time Factors; Tobacco Use Disorder
Community Health | Other Medical Specialties | Preventive Medicine
OBJECTIVE: To extend the findings of the first Development and Assessment of Nicotine Dependence in Youth study by using diagnostic criteria for tobacco dependence and a biochemical measure of nicotine intake. The first study found that symptoms of dependence commonly appeared soon after the onset of intermittent smoking.
DESIGN: A 4-year prospective study.
SETTING: Public schools in 6 Massachusetts communities.
PARTICIPANTS: A cohort of 1246 sixth-grade students.
INTERVENTIONS: Eleven interviews.
MAIN OUTCOME MEASURES: Loss of autonomy over tobacco as measured by the Hooked on Nicotine Checklist, and tobacco dependence as defined in International Classification of Diseases, 10th Revision (ICD-10).
RESULTS: Among the 217 inhalers, 127 lost autonomy over their tobacco use, 10% having done so within 2 days and 25% having done so within 30 days of first inhaling from a cigarette; half had lost autonomy by the time they were smoking 7 cigarettes per month. Among the 83 inhalers who developed ICD-10-defined dependence, half had done so by the time they were smoking 46 cigarettes per month. At the interview following the onset of ICD-10-defined dependence, the median salivary cotinine concentration of current smokers was 5.35 ng/mL, a level that falls well below the cutoff used to distinguish active from passive smokers.
CONCLUSIONS: The most susceptible youths lose autonomy over tobacco within a day or 2 of first inhaling from a cigarette. The appearance of tobacco withdrawal symptoms and failed attempts at cessation can precede daily smoking; ICD-10-defined dependence can precede daily smoking and typically appears before consumption reaches 2 cigarettes per day.
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Citation: Arch Pediatr Adolesc Med. 2007 Jul;161(7):704-10. Link to article on publisher's site
DiFranza, Joseph R.; Savageau, Judith A.; Fletcher, Kenneth E.; O'Loughlin, Jennifer L.; Pbert, Lori; Ockene, Judith K.; McNeill, Ann D.; Hazelton, Jennifer; Friedman, Karen; Dussault, Gretchen; Wood, Constance; and Wellman, Robert J., "Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study." (2007). Family Medicine and Community Health Publications and Presentations. 48.