Article Text

Download PDFPDF
Initial symptoms of nicotine dependence in adolescents
  1. Joseph R DiFranzaa,
  2. Nancy A Rigottic,
  3. Ann D McNeilld,
  4. Judith K Ockeneb,
  5. Judith A Savageaua,
  6. Dorothy St Cyra,
  7. Mardia Colemana
  1. aDepartment of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA, bDepartment of Medicine, University of Massachusetts Medical School, cHarvard Medical School, Boston, Massachusetts, USA, dHealth Education Authority, London, UK
  1. 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}


OBJECTIVES It 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.

DESIGN A 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.

RESULTS 22% 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.

DISCUSSION The 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 individuals—rapid onset, slower onset, and resistant—distinguishable from one another by their susceptibility to nicotine dependence, is postulated.

  • adolescents
  • nicotine
  • addiction
  • dependence

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.