Nicotine-dependence symptoms are associated with smoking frequency in adolescents

doi:10.1016/S0749-3797(03)00198-3

American Journal of Preventive Medicine

Volume 25, Issue 3, October 2003, Pages 219-225

https://doi.org/10.1016/S0749-3797(03)00198-3 Get rights and content

Abstract

Background

Although many sociodemographic and psychosocial factors have been identified as related to adolescent smoking, few studies have examined the role of nicotine-dependence (ND) symptoms. The objective was to study the association between ND symptoms and smoking status among adolescents in the early stages of the smoking onset process.

Methods

The McGill University Study on the Natural History of Nicotine Dependence is an ongoing 6-year prospective investigation of the natural history of ND among 1267 grade 7 students in ten Montreal high schools. The baseline response was 55.4%. Subjects for this cross-sectional analysis of baseline data, collected in 1999, included 241 past 3-month smokers (mean age [SD]=13.0±0.7 years at baseline). ND symptoms were measured in five indicators, including a measure based on the criteria for tobacco dependence in the International Classification of Diseases-10th Revision (ICD-10), the Hooked on Nicotine Checklist, and three symptom clusters (withdrawal, self-medication, and ND/cravings symptoms). The association between ND symptom indicators and each of sporadic, monthly, weekly, and daily smoking relative to less frequent smoking was investigated in multiple logistic regression analysis.

Results

Despite low cigarette exposure, 16.6% (95% confidence interval [CI], 11.9%–21.3%) of past 3-month smokers were tobacco dependent. The proportion increased from 0%, 3.1% (95% CI, 0.0%–9.2%), and 4.6% (95% CI, 0.2%–9.0%) among triers, sporadic smokers, and monthly smokers, respectively, to 19.4% (95% CI, 5.5%–33.3%) and 65.9% (95% CI, 51.9%–79.9%) among weekly and daily smokers, respectively. ND/cravings consistently distinguished each smoking category from less frequent smokers; the odds ratios (95% CI) for ND/cravings symptoms were 1.16 (0.99–1.35) in sporadic smokers; 1.17 (1.06–1.29) in monthly smokers; 1.34 (1.19–1.50) in weekly smokers; and 1.39 (1.22–1.59) in daily smokers.

Conclusions

These data challenge current smoking onset models, which suggest that ND develops only after several years of heavy or daily smoking. ND symptoms are associated, at least cross-sectionally, with increased smoking in adolescents. To increase the likelihood of being effective, tobacco-control programs for children and adolescents will need to take early ND symptoms into account.

Introduction

Progression to nicotine-dependent smoking has been conceptualized as proceeding sequentially over 2 to 3 years through five stages, including the preparatory, trying, experimentation, regular use, and addiction dependent stages. Lengthy and regular tobacco use has been considered necessary for nicotine dependence (ND) to develop.1 Recent reports,2, 3, 4 however, have raised concerns that ND symptoms can develop soon after initiation, and that these symptoms might lead to smoking intensification. DiFranza et al.2 showed that approximately 20% of adolescents reported ND symptoms within 1 month of initiating monthly smoking.

Although many sociodemographic, psychosocial, and environmental factors are related to adolescent smoking,1 few studies have examined the role of ND symptoms. This oversight relates in part to the assumption that ND cannot develop before sustained heavy tobacco use and therefore cannot contribute to the establishment of daily smoking. Also, there is no widely accepted, theoretically derived, and psychometrically sound tool to measure ND in adolescents.5 However, several measures have recently been validated2, 6, 7, 8 so that ND symptoms can now be studied in adolescent smoking.

The purpose of this article was to assess the importance of ND symptoms in early smoking. The authors hypothesized that ND symptoms would occur before heavy daily tobacco use and would differentiate subjects on the basis of how frequently they smoked.

Section snippets

Methods

The McGill University Study on the Natural History of Nicotine Dependence in Teens is a prospective investigation of 1267 students, initially aged 12–13 years, who were recruited from all grade 7 classes in a convenience sample of seven English and three French secondary schools located in Montreal. The objectives were to measure the onset of ND symptoms in relation to tobacco exposure, and to investigate the relative etiologic importance of environmental, psychosocial, and genetic factors in

Results

In the baseline sample of 1267 students, 29.2% of males and 35.1% of females were ever smokers (p=0.03); 46.4% of male and 69.3% of female ever smokers had smoked in the 3 months preceding the baseline questionnaire (p<0.000). Table 1 compares selected characteristics of never, ever, and past 3-month smokers.

Past 3-month smokers reported a wide range of smoking experiences, from tried only once or twice to smoking 121 cigarettes per week (Table 2). Forty-seven subjects (19.5%) were triers,

Discussion

Although ND symptoms are recognized as barriers to cessation in youth,21, 22, 23 few studies examine their influence early in the smoking onset process. In this study, even adolescents who had smoked only once or twice reported ND symptoms. Both the range and prevalence of specific symptoms increased markedly with increased frequency of smoking. It is striking that despite low cigarette exposure, high proportions of weekly and daily smokers were ICD-10 tobacco dependent. ND/cravings emerged as

Acknowledgements

This research was funded by the National Cancer Institute of Canada, with funds from the Canadian Cancer Society. J. O'Loughlin is an Investigator of the Canadian Institutes of Health Research. P.B.S. Clarke is a Chercheur National of the Fonds de la recherche en santé du Québec. R. F. Tyndale acknowledges the support of a Canadian Research Chair in Pharmacogenetics. The authors are grateful to the school administrators, teachers, and students who participated.

References (27)

J. O'Loughlin et al.
Reliability of selected measures of nicotine dependence among adolescents
Ann Epidemiol
(2002)
W.S. Choi et al.
Which adolescent experimenters progress to established smoking in the United States?
Am J Prev Med
(1997)
S. Zhu et al.
Predictors of smoking cessation in U.S. adolescents
Am J Prev Med
(1999)
Preventing tobacco use among young people. A report of the Surgeon General, 1994
(1994)
J.R. DiFranza et al.
Measuring the loss of autonomy over nicotine use in adolescentsthe DANDY (Development and Assessment of Nicotine Dependence in Youths) study
Arch Pediatr Adolesc Med
(2002)
J.R. DiFranza et al.
Initial symptoms of nicotine dependence in adolescents
Tob Control
(2000)
J.R. DiFranza et al.
Development of symptoms of tobacco dependence in youths30 month follow up data from the DANDY study
Tob Control
(2002)
S.M. Colby et al.
Measuring nicotine dependence among youtha review of available approaches and instruments
Drug Alcohol Depend
(2000)
J. O'Loughlin et al.
The hardest thing is the habita qualitative investigation of adolescent smokers' experience of nicotine dependence
Nicotine Tob Res
(2002)
J. O'Loughlin et al.
Assessment of nicotine dependence symptoms in adolescentsa comparison of five indicators
Tob Control
(2002)

S.E. Evers et al.

Dietary intake and anthropometric status of 7 to 9 year old children in economically disadvantaged communities in Ontario

J Am Coll Nutr

(1995)

M.K. Park et al.

Accuracy of blood pressure measurement by the Dinamap monitor in infants and children

Pediatrics

(1998)

R.V. Luepker et al.

Outcomes of a field trial to improve children's dietary patterns and physical activity

JAMA

(1996)

Cited by (231)

e-Cigarettes Used by Adolescents to Try to Quit Smoking Are Associated With Less Quitting: A Cross-Sectional Analysis of the National Youth Tobacco Survey
2023, Journal of Adolescent Health
This paper determines the association between youth e-cigarette use “to try to quit using other tobacco products, such as cigarettes” and having stopped smoking cigarettes (defined as an ever cigarette smoker who did not smoke in the past 30 days).
This study uses data from the NYTS from 2015 through 2021, focusing on youth who started smoking cigarettes before they started using e-cigarettes. Associations between using e-cigarettes to quit and having stopped smoking were computed using logistic regression accounting for the complex survey design and adjusting for level of nicotine dependence, year, age, gender, and race/ethnicity. Sensitivity analyses allowed for having started cigarettes and e-cigarettes in the same year and without regard for starting sequence.
The primary analytic subsample included 6435 United States middle and high school students (mean age 15.9 years, 55.4% male). Using e-cigarettes to quit was associated with significantly lower odds of having stopped smoking cigarettes (odds ratio, 0.62; 95% confidence interval, 0.45–0.85), controlling for nicotine dependence and demographics. Youth with higher levels of nicotine dependence also had lower odds of having stopped smoking. The results were stable over time. Sensitivity analyses produced similar results.
Ever-smoking youth who used e-cigarettes “to try to quit using other tobacco products, such as cigarettes” had lower odds of having stopped smoking cigarettes than those who did not use e-cigarettes as to try to quit. Physicians, regulators, and educators should discourage youth from attempting to use e-cigarettes as a way to stop smoking cigarettes.
Momentary associations between affect and craving as a function of perceived smoking opportunity in young adults smoking 1–5 cigarettes per day: An ecological momentary assessment study
2023, Drug and Alcohol Dependence
Very light daily smoking (1–5 cigarettes/day) is associated with adverse consequences and is prevalent among young adults. Evidence suggests that perceived smoking opportunity modulates links between affect and craving in adults with heavier smoking patterns (e.g., > 10 cigarettes per day), but there is a lack of similar data in young adults with very light daily smoking patterns. This study addresses this gap by investigating the associations between affect and craving as a function of perceived smoking opportunity under naturalistic conditions.
Forty-one young adults aged 18–25 (M=21.03, SD=1.75) who reported smoking 1–5 cigarettes per day (M=3.2, SD=1.2) completed intermittent ratings of momentary affective valence and arousal, smoking craving, and perceived smoking opportunity on smartphones five times per day for seven days.
Multilevel analyses suggested that when participants felt more pleasant or unpleasant, they were likely to report more intense craving. When smoking opportunity was perceived as high, affective arousal was positively associated with craving; this association was not observed when opportunity to smoke was perceived as low.
These findings indicate that higher momentary intensity of affective valence (both negative and positive) is linked to stronger momentary craving in young adults who report very light daily smoking. Anticipating an opportunity to satisfy craving by smoking may strengthen the association between reported affective arousal and craving in this population. These results highlight the potential benefits of coping with craving (e.g., by regulating affect) for those who engage in light tobacco use, especially in environments with high cigarette availability.
Symptoms of tobacco dependence among middle and high school tobacco users – Data from the 2019–2020 National Youth Tobacco Survey
2023, Addictive Behaviors
Previous studies have indicated that youth who use tobacco products, including cigarettes, cigars, and smokeless tobacco, demonstrate dependence symptoms. However, the tobacco marketplace has expanded dramatically in recent years, and few studies have examined dependence symptoms among youth who use novel products. This study combined 2019–2020 National Youth Tobacco Survey data to report the prevalence and determinants of tobacco dependence symptoms among U.S. middle and high school current (past 30-day) tobacco users.
Prevalence estimates were calculated to examine dependence outcomes and other covariates by user groups (single product users and multiple product users). Multivariable logistic regression analyses were used to identify independent predictors of tobacco dependence among current users of cigarettes, cigars (regular cigars, cigarillos, and little cigars), e-cigarettes, heated tobacco products, hookah, pipe tobacco, bidis, and smokeless tobacco products (chew, snuff, dip, snus, and dissolvables).
Among current tobacco users, 15.7 % (95 % CI: 14.2–17.3) reported wanting to use tobacco within 30 min of waking and 28.3 % (95 % CI: 26.3–30.5) reported strong cravings for tobacco in the past 30 days. Nearly-two-thirds of current users were single product users, of which 80.5 % reported using e-cigarettes. Reporting of dependence symptoms was generally associated with multiple product use, higher frequency of use, earlier initiation age, and use of flavored products.
Among U.S. adolescents, a considerable amount of current tobacco product users, even infrequent users, reported symptoms of dependence. These findings highlight the continued importance of prevention strategies for youth tobacco experimentation and progression to regular use.
Behavioral predictors of individual differences in opioid addiction vulnerability as measured using i.v. self-administration in rats
2021, Drug and Alcohol Dependence
Like other forms of psychopathology, vulnerability to opioid addiction is subject to wide individual differences. Animal behavioral models are valuable in advancing our understanding of mechanisms underlying vulnerability to the disorder’s development and amenability to treatment.
This review provides an overview of preclinical work on behavioral predictors of opioid addiction vulnerability as measured using the intravenous (i.v.) self-administration (SA) model in rats. We also highlight several new approaches to studying individual differences in opioid addiction vulnerability in preclinical models that could have greater sensitivity and lead to more clinically relevant findings.
Evidence for the relationship between various behavioral traits and opioid SA in the preclinical literature is limited. With the possible exceptions of sensitivity to opioid agonist/withdrawal effects and stress reactivity, predictors of individual differences in SA of other drugs of abuse (e.g. sensation-seeking, impulsivity) do not predict vulnerability to opioid SA in rats. Refinement of SA measures and the use of multivariate designs and statistics could help identify predictors of opioid SA and lead to more clinically relevant studies on opioid addiction vulnerability.
Molecular and neuronal mechanisms underlying the effects of adolescent nicotine exposure on anxiety and mood disorders
2021, Neuropharmacology
Tobacco addiction is highly co-morbid with a variety of mental health conditions, including schizophrenia, mood and anxiety disorders. Nicotine, the primary psychoactive compound in tobacco-related products is known to functionally modulate brain circuits that are disturbed in these disorders. Nicotine can potently regulate the transmission of various neurochemicals, including dopamine (DA), γ-amino-butyric acid (GABA) and glutamate, within various mesocorticolimbic structures, such as the ventral tegmental area (VTA), nucleus accumbens (NAc) and prefrontal cortex (PFC), all of which show pathologies in these disorders. Many neuropsychiatric diseases have etiological origins during neurodevelopment, typically occurring during vulnerable periods of adolescent or pre-natal brain development. During these neurodevelopmental periods, exposure to extrinsic drug insults can induce enduring and long-term pathophysiological sequelae that ultimately increase the risk of developing chronic mental health disorders in later life. These vulnerability factors are of growing concern given rising rates of adolescent nicotine exposure via traditional tobacco use and the increasing use of alternative nicotine delivery formats such as vaping and e-cigarettes. A large body of clinical and pre-clinical evidence points to an important role for adolescent exposure to nicotine and increased vulnerability to developing mood and anxiety disorders in later life. This review will examine current clinical and pre-clinical evidence that pinpoints specific mechanisms within the mesocorticolimbic circuitry and molecular biomarkers linked to the association between adolescent nicotine exposure and increased risk of developing mood and anxiety-related disorders.
This article is part of the special issue on ‘Vulnerabilities to Substance Abuse’.
The reinforcement threshold and elasticity of demand for nicotine in an adolescent rat model of depression
2021, Drug and Alcohol Dependence
The Food and Drug Administration (FDA) is considering setting a nicotine standard for tobacco products to reduce their addictiveness. Such a standard should account for the apparent greater vulnerability to nicotine addiction in some subpopulations, such as adolescents with depression. The present study examined whether the reinforcement threshold and elasticity of demand (i.e., reinforcing efficacy) for nicotine in a genetic inbred rat model of depression (Flinders Sensitive Line [FSL]) differs from an outbred control strain.
Acquisition of nicotine self-administration (NSA) across a wide range of nicotine doses was measured in both FSL and Sprague-Dawley (SD) control adolescent rats. At the highest dose, elasticity of demand was also measured. Nicotine pharmacokinetics was examined to determine whether it might modulate NSA, as it does smoking in humans.
FSL rats acquired self-administration quicker and showed more inelastic demand (greater reinforcing efficacy) than SDs at the highest unit dose. However, there was no strain difference in the reinforcement threshold of nicotine. FSL rats exhibited faster nicotine clearance, larger volume of distribution, and lower plasma and brain nicotine concentrations. However, these differences were not consistently related to strain differences in NSA measures.
These findings are consistent with studies showing greater dependence and reinforcing efficacy of cigarettes in smokers with depression and those with relatively fast nicotine metabolism. However, these findings also suggest that a nicotine standard to reduce initiation of tobacco use should be similarly effective in both the general adolescent population and those with depression.

View all citing articles on Scopus

View full text

Research articleNicotine-dependence symptoms are associated with smoking frequency in adolescents

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Ann Epidemiol

Am J Prev Med

Am J Prev Med

Preventing tobacco use among young people. A report of the Surgeon General, 1994

Measuring the loss of autonomy over nicotine use in adolescentsthe DANDY (Development and Assessment of Nicotine Dependence in Youths) study

Arch Pediatr Adolesc Med

Initial symptoms of nicotine dependence in adolescents

Tob Control

Development of symptoms of tobacco dependence in youths30 month follow up data from the DANDY study

Tob Control

Measuring nicotine dependence among youtha review of available approaches and instruments

Drug Alcohol Depend

The hardest thing is the habita qualitative investigation of adolescent smokers' experience of nicotine dependence

Nicotine Tob Res

Assessment of nicotine dependence symptoms in adolescentsa comparison of five indicators

Tob Control

Dietary intake and anthropometric status of 7 to 9 year old children in economically disadvantaged communities in Ontario

J Am Coll Nutr

Accuracy of blood pressure measurement by the Dinamap monitor in infants and children

Pediatrics

Outcomes of a field trial to improve children's dietary patterns and physical activity

JAMA

Research article
Nicotine-dependence symptoms are associated with smoking frequency in adolescents