Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study

Joseph R. DiFranza, University of Massachusetts Medical School
Judith A. Savageau, University of Massachusetts Medical School
Kenneth E. Fletcher, University of Massachusetts Medical School
Jennifer L. O'Loughlin, McGill University
Lori Pbert, University of Massachusetts Medical School
Judith K. Ockene, University of Massachusetts Medical School
Ann D. McNeill, University of London
Jennifer Hazelton, University of Massachusetts Medical School
Karen Friedman, University of Massachusetts Medical School
Gretchen Dussault, University of Massachusetts Medical School
Constance Wood, University of Massachusetts Medical School
Robert J. Wellman, University of Massachusetts Medical School

Document Type Article

Abstract

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.