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Distinguishing risk factors for the onset of cravings, withdrawal symptoms and tolerance in novice adolescent smokers
  1. Paul Wileyto1,
  2. Jennifer O'Loughlin2,
  3. Magdalena Lagerlund3,
  4. Garbis Meshefedjian4,
  5. Erika Dugas5,
  6. André Gervais4
  1. 1 University of Pennsylvania, Transdisciplinary Tobacco Use Research Center (TTURC), United States;
  2. 2 University of Montreal, Centre de recherche CHUM, Canada;
  3. 3 Schulich School of Medicine and Dentistry, University of Western Ontario, Canada;
  4. 4 Agence de la santé et des services sociaux de Montréal, Direction de santé publique de Montréal, Canada;
  5. 5 Centre de recherche CHUM, Canada
  1. * Corresponding author; email: jennifer.oloughlin{at}


Purpose: While many studies report determinants of adolescent cigarette smoking, few identify risk factors for nicotine dependence (ND). This study distinguished between risk factors for three hallmarks of ND including cravings, withdrawal symptoms and tolerance.

Methods: A total of 319 novice smokers were followed every three months from first puff on a cigarette until the end of secondary school. Outcomes included time to first report of cravings, withdrawal symptoms, and tolerance.

Results: Each of female sex, inhalation, smoking a whole cigarette, weekly smoking, daily smoking, and alcohol use independently increased the incidence of the onset of cravings. Inhalation, weekly and daily smoking, and alcohol use predicted the onset of withdrawal symptoms. Withdrawal symptoms, smoking a whole cigarette, monthly and daily smoking, and friends and siblings smoking increased the incidence of the onset of tolerance. None of parental education, impulsivity, novelty-seeking, self-esteem, depression, stress, parental smoking, physical activity, or participation in sports teams was associated with the outcomes.

Conclusion: The hallmarks of early ND are related to intensity and frequency of cigarette use. Avoidance of daily smoking may be particularly important in preventing the onset of ND symptoms and sustained smoking.

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