Article Text

Download PDFPDF
Children's loss of autonomy over smoking: the global youth tobacco survey
  1. Elpidoforos S Soteriades1,2,
  2. George Spanoudis3,
  3. Michael A Talias4,
  4. Charles W Warren5,
  5. Joseph R DiFranza6
  1. 1Cyprus Institute of Biomedical Sciences (CIBS), Department of Occupational and Environmental Medicine, Nicosia, Cyprus
  2. 2Harvard School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, Massachusetts, USA
  3. 3Department of Psychology, University of Cyprus, Nicosia, Cyprus
  4. 4Open University of Cyprus, Healthcare Management Program, Nicosia, Cyprus
  5. 5Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
  6. 6University of Massachusetts Medical School, Department of Family Medicine and Community Health, Worcester, Massachusetts, USA
  1. Correspondence to Professor Joseph R DiFranza, Department of Family Medicine and Community Health, 55 Lake Avenue, Worcester, MA 01655, USA; difranzj{at}
  • Competing interests The authors declare that they have no financial and/or other relationship that may lead to a conflict of interest.


Background Empirical data suggest that children with infrequent tobacco use have difficulty quitting smoking.

Methods Data were obtained from the nationally representative Global Youth Tobacco Survey of middle-school students in Cyprus and Greece. Regression analyses examined associations between smoking frequency (smoking days per month or cigarettes smoked per day) and loss of autonomy (difficulty refraining from smoking).

Results The prevalence of lost autonomy was 40% among subjects who smoked 1 or 2 days/month and 41% among subjects who averaged less than one cigarette/day and increased in a dose-response pattern. Regression models derived from the Cyprus data were replicated by the Greek data.

Conclusions Two national surveys confirm previous reports of difficulty with smoking cessation with infrequent smoking. Since loss of autonomy is universally recognised as a core feature of addiction, our data indicate that young adolescents experience symptoms of nicotine addiction with infrequent tobacco use.

  • Nicotine addiction
  • tobacco
  • dependence
  • children
  • GYTS
  • smoking
  • addiction theories
  • Cyprus
  • Greece
  • Addiction

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding Centers for Disease Control.

  • Ethics approval This study was conducted with the approval of the Centers for Disease Control.

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