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The Development and Assessment of Nicotine Dependence in Youth–2 Study

Joseph R. DiFranza, MD; Judith A. Savageau, MPH; Kenneth Fletcher, PhD; Jennifer O’Loughlin, PhD; Lori Pbert, PhD; Judith K. Ockene, PhD; Ann D. McNeill, PhD; Jennifer Hazelton, BA; Karen Friedman, BA; Gretchen Dussault, BA; Connie Wood, MSW; Robert J. Wellman, PhD

Arch Pediatr Adolesc Med. 2007;161(7):704-710.

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.

Author Affiliations: University of Massachusetts Medical School, Worcester (Drs DiFranza, Fletcher, Pbert, Ockene, and Wellman, and Mss Hazelton, Savageau, Friedman, Dussault, and Wood); McGill University, Montreal, Montreal, Canada (Dr O’Loughlin); St George's Hospital Medical School, University of London, London, England (Dr McNeill); and Fitchburg State College, Fitchburg, Massachusetts (Dr Wellman).

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