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.
DOI of Published Version
Arch Pediatr Adolesc Med. 2007 Jul;161(7):704-10. Link to article on publisher's site
Archives of pediatrics & adolescent medicine
DiFranza JR, Savageau JA, Fletcher KE, O'Loughlin JL, Pbert L, Ockene JK, McNeill AD, Hazelton J, Friedman K, Dussault G, Wood C, Wellman RJ. (2007). Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study.. Family Medicine and Community Health Publications. https://doi.org/10.1001/archpedi.161.7.704. Retrieved from https://escholarship.umassmed.edu/fmch_articles/48