Tob Control 2000;9:313-319 ( Autumn )

Initial symptoms of nicotine dependence in adolescents

Joseph R DiFranza^a, Nancy A Rigotti^c, Ann D McNeill^d, Judith K Ockene^b, Judith A Savageau^a, Dorothy St Cyr^a, Mardia Coleman^a

^a Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA, ^b Department of Medicine, University of Massachusetts Medical School, ^c Harvard Medical School, Boston, Massachusetts, USA, ^d Health Education Authority, London, UK

Correspondence to: Joseph R DiFranza MD, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, Massachusetts 01655, USA; joe.difranza{at}ummhc.org

Received 24 November 1999; Revision received 14 April 2000; Accepted 14 April 2000

OBJECTIVESIt has been assumed that nicotine dependence has a slow onset and occurs only after prolonged daily use of tobacco. A cohort of young adolescents was followed to determine when the first symptoms of nicotine dependence occur with respect to the duration and frequency of tobacco use.
DESIGNA cohort of 681 seventh grade students (age 12-13 years) from seven schools in two small cities in central Massachusetts was followed over one year. Detailed information regarding tobacco use was obtained in individual confidential interviews conducted in school three times over the year. The latency time to the onset of symptoms of nicotine dependence was measured from the time a subject first smoked at a frequency of at least once per month.
RESULTS22% of the 95 subjects who had initiated occasional smoking reported a symptom of nicotine dependence within four weeks of initiating monthly smoking. One or more symptoms were reported by 60 (63%) of these 95 subjects. Of the 60 symptomatic subjects, 62% had reported experiencing their first symptom before smoking daily or began smoking daily only upon experiencing their first symptom.
DISCUSSIONThe first symptoms of nicotine dependence can appear within days to weeks of the onset of occasional use, often before the onset of daily smoking. The existence of three groups of individualsrapid onset, slower onset, and resistantdistinguishable from one another by their susceptibility to nicotine dependence, is postulated.


Keywords: adolescents; nicotine; addiction; dependence

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© 2000 by Tobacco Control
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