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Distinguishing risk factors for the onset of cravings, withdrawal symptoms and tolerance in novice adolescent smokers
  1. P Wileyto1,2,
  2. J O’Loughlin3,4,5,
  3. M Lagerlund6,
  4. G Meshefedjian7,
  5. E Dugas4,
  6. A Gervais7
  1. 1
    Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2
    Transdisciplinary Tobacco Use Research Center (TTURC), Philadelphia, Pennsylvania, USA
  3. 3
    Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
  4. 4
    Centre de Recherche CHUM, Montréal, Québec, Canada
  5. 5
    Institut National de Santé Publique du Québec, Montréal, Québec, Canada
  6. 6
    Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  7. 7
    Agence de la Santé et des Services Sociaux de Montréal, Direction de Santé Publique, Montréal, Québec, Canada
  1. Correspondence to J O’Loughlin, Department of Social and Preventive Medicine, University of Montreal, 3875 St Urbain, Montreal, Quebec H2W 1V1, Canada; jennifer.oloughlin{at}


Aim: 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 3 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: Female sex, inhalation, smoking a whole cigarette, weekly smoking, daily smoking and alcohol use each independently increased the incidence of the onset of cravings. Inhalation, weekly smoking, daily smoking and alcohol use predicted the onset of withdrawal symptoms. Withdrawal symptoms, smoking a whole cigarette, monthly smoking, 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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  • Funding This work was supported by the National Cancer Institute of Canada, with funds from the Canadian Cancer Society (grant number 010271).

  • Competing interests None.

  • Ethics approval Ethical approval was obtained from the McGill University Faculty of Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.