PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of tobcontTobacco ControlVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Tob Control. 2002 September; 11(3): 228–235.
PMCID: PMC1759001

Development of symptoms of tobacco dependence in youths: 30 month follow up data from the DANDY study

Abstract

Objective: To determine if there is a minimum duration, frequency or quantity of tobacco use required to develop symptoms of dependence.

Design and setting: A retrospective/prospective longitudinal study of the natural history of tobacco dependence employing individual interviews conducted three times annually in two urban school systems over 30 months. Detailed histories of tobacco use were obtained including dates, duration, frequency, quantity, patterns of use, types of tobacco, and symptoms of dependence.

Participants: A cohort of 679 seventh grade students (age 12–13 years).

Main outcome measures: The report of any of 11 symptoms of dependence.

Results: Among 332 subjects who had used tobacco, 40% reported symptoms, with a median latency from the onset of monthly smoking of 21 days for girls and 183 days for boys. The median frequency of use at the onset of symptoms was two cigarettes, one day per week. The report of one or more symptoms predicted continued smoking through the end of follow up (odds ratio (OR) 44, 95% confidence interval (CI) 17 to 114, p < 0.001).

Conclusions: Symptoms of tobacco dependence commonly develop rapidly after the onset of intermittent smoking, although individuals differ widely in this regard. Girls tend to develop symptoms faster. There does not appear to be a minimum nicotine dose or duration of use as a prerequisite for symptoms to appear. The development of a single symptom strongly predicted continued use, supporting the theory that the loss of autonomy over tobacco use begins with the first symptom of dependence.

Full Text

The Full Text of this article is available as a PDF (202K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Watkins SS, Koob GF, Markou A. Neural mechanisms underlying nicotine addiction: acute positive reinforcement and withdrawal. Nicotine Tob Res. 2000 Feb;2(1):19–37. [PubMed]
  • Pomerleau CS, Majchrzak MJ, Pomerleau OF. Nicotine dependence and the Fagerström Tolerance Questionnaire: a brief review. J Subst Abuse. 1989;1(4):471–477. [PubMed]
  • Colby SM, Tiffany ST, Shiffman S, Niaura RS. Measuring nicotine dependence among youth: a review of available approaches and instruments. Drug Alcohol Depend. 2000 May 1;59 (Suppl 1):S23–S39. [PubMed]
  • Edwards G, Gross MM. Alcohol dependence: provisional description of a clinical syndrome. Br Med J. 1976 May 1;1(6017):1058–1061. [PMC free article] [PubMed]
  • Rounsaville BJ, Spitzer RL, Williams JB. Proposed changes in DSM-III substance use disorders: description and rationale. Am J Psychiatry. 1986 Apr;143(4):463–468. [PubMed]
  • McNeill AD, West RJ, Jarvis M, Jackson P, Bryant A. Cigarette withdrawal symptoms in adolescent smokers. Psychopharmacology (Berl) 1986;90(4):533–536. [PubMed]
  • Hatsukami DK, Hughes JR, Pickens RW, Svikis D. Tobacco withdrawal symptoms: an experimental analysis. Psychopharmacology (Berl) 1984;84(2):231–236. [PubMed]
  • Hatsukami DK, Gust SW, Keenan RM. Physiologic and subjective changes from smokeless tobacco withdrawal. Clin Pharmacol Ther. 1987 Jan;41(1):103–107. [PubMed]
  • Hughes JR, Hatsukami D. Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry. 1986 Mar;43(3):289–294. [PubMed]
  • Robinson TE, Berridge KC. The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Brain Res Rev. 1993 Sep-Dec;18(3):247–291. [PubMed]
  • Fagerstrom KO, Heatherton TF, Kozlowski LT. Nicotine addiction and its assessment. Ear Nose Throat J. 1990 Nov;69(11):763–765. [PubMed]
  • Pomerleau CS, Carton SM, Lutzke ML, Flessland KA, Pomerleau OF. Reliability of the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence. Addict Behav. 1994 Jan-Feb;19(1):33–39. [PubMed]
  • DiFranza Joseph R, Savageau Judith A, Fletcher Kenneth, Ockene Judith K, Rigotti Nancy A, McNeill Ann D, Coleman Mardia, Wood Constance. Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study. Arch Pediatr Adolesc Med. 2002 Apr;156(4):397–403. [PubMed]
  • Leventhal H, Cleary PD. The smoking problem: a review of the research and theory in behavioral risk modification. Psychol Bull. 1980 Sep;88(2):370–405. [PubMed]
  • Jackson C. Cognitive susceptibility to smoking and initiation of smoking during childhood: a longitudinal study. Prev Med. 1998 Jan-Feb;27(1):129–134. [PubMed]
  • Lamkin LP, Houston TP. Nicotine dependency and adolescents: preventing and treating. Prim Care. 1998 Mar;25(1):123–135. [PubMed]
  • Chassin L, Presson CC, Sherman SJ, Edwards DA. The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns. Health Psychol. 1990;9(6):701–716. [PubMed]
  • Shiffman S. Refining models of dependence: variations across persons and situations. Br J Addict. 1991 May;86(5):611–615. [PubMed]
  • DiFranza JR, Rigotti NA, McNeill AD, Ockene JK, Savageau JA, St Cyr D, Coleman M. Initial symptoms of nicotine dependence in adolescents. Tob Control. 2000 Sep;9(3):313–319. [PMC free article] [PubMed]
  • Reasons for tobacco use and symptoms of nicotine withdrawal among adolescent and young adult tobacco users--United States, 1993. MMWR Morb Mortal Wkly Rep. 1994 Oct 21;43(41):745–750. [PubMed]
  • Dappen A, Schwartz RH, O'Donnell R. A survey of adolescent smoking patterns. J Am Board Fam Pract. 1996 Jan-Feb;9(1):7–13. [PubMed]
  • Henningfield JE, Clayton R, Pollin W. Involvement of tobacco in alcoholism and illicit drug use. Br J Addict. 1990 Feb;85(2):279–291. [PubMed]
  • Indicators of nicotine addiction among women--United States, 1991-1992. MMWR Morb Mortal Wkly Rep. 1995 Feb 17;44(6):102–105. [PubMed]
  • Bradburn NM, Rips LJ, Shevell SK. Answering autobiographical questions: the impact of memory and inference on surveys. Science. 1987 Apr 10;236(4798):157–161. [PubMed]
  • Ershler J, Leventhal H, Fleming R, Glynn K. The quitting experience for smokers in sixth through twelfth grades. Addict Behav. 1989;14(4):365–378. [PubMed]
  • Bayer SA, Yackel JW, Puri PS. Neurons in the rat dentate gyrus granular layer substantially increase during juvenile and adult life. Science. 1982 May 21;216(4548):890–892. [PubMed]
  • Altman J, Bayer SA. Migration and distribution of two populations of hippocampal granule cell precursors during the perinatal and postnatal periods. J Comp Neurol. 1990 Nov 15;301(3):365–381. [PubMed]
  • Bayer SA. 3H-thymidine-radiographic studies of neurogenesis in the rat olfactory bulb. Exp Brain Res. 1983;50(2-3):329–340. [PubMed]
  • McWilliams JR, Lynch G. Rate of synaptic replacement in denervated rat hippocampus declines precipitously from the juvenile period to adulthood. Science. 1983 Aug 5;221(4610):572–574. [PubMed]
  • Colby SM, Tiffany ST, Shiffman S, Niaura RS. Are adolescent smokers dependent on nicotine? A review of the evidence. Drug Alcohol Depend. 2000 May 1;59 (Suppl 1):S83–S95. [PubMed]
  • Breslau N, Fenn N, Peterson EL. Early smoking initiation and nicotine dependence in a cohort of young adults. Drug Alcohol Depend. 1993 Sep;33(2):129–137. [PubMed]
  • Taioli E, Wynder EL. Effect of the age at which smoking begins on frequency of smoking in adulthood. N Engl J Med. 1991 Sep 26;325(13):968–969. [PubMed]
  • Chen J, Millar WJ. Age of smoking initiation: implications for quitting. Health Rep. 1998 Spring;9(4):39–48(Fre). [PubMed]
  • Escobedo LG, Marcus SE, Holtzman D, Giovino GA. Sports participation, age at smoking initiation, and the risk of smoking among US high school students. JAMA. 1993 Mar 17;269(11):1391–1395. [PubMed]
  • Everett SA, Warren CW, Sharp D, Kann L, Husten CG, Crossett LS. Initiation of cigarette smoking and subsequent smoking behavior among U.S. high school students. Prev Med. 1999 Nov;29(5):327–333. [PubMed]
  • Smith TA, House RF, Jr, Croghan IT, Gauvin TR, Colligan RC, Offord KP, Gomez-Dahl LC, Hurt RD. Nicotine patch therapy in adolescent smokers. Pediatrics. 1996 Oct;98(4 Pt 1):659–667. [PubMed]
  • Hurt RD, Croghan GA, Beede SD, Wolter TD, Croghan IT, Patten CA. Nicotine patch therapy in 101 adolescent smokers: efficacy, withdrawal symptom relief, and carbon monoxide and plasma cotinine levels. Arch Pediatr Adolesc Med. 2000 Jan;154(1):31–37. [PubMed]
  • Trauth JA, Seidler FJ, McCook EC, Slotkin TA. Adolescent nicotine exposure causes persistent upregulation of nicotinic cholinergic receptors in rat brain regions. Brain Res. 1999 Dec 18;851(1-2):9–19. [PubMed]
  • Trauth JA, McCook EC, Seidler FJ, Slotkin TA. Modeling adolescent nicotine exposure: effects on cholinergic systems in rat brain regions. Brain Res. 2000 Aug 4;873(1):18–25. [PubMed]
  • Trauth JA, Seidler FJ, Slotkin TA. An animal model of adolescent nicotine exposure: effects on gene expression and macromolecular constituents in rat brain regions. Brain Res. 2000 Jun 9;867(1-2):29–39. [PubMed]
  • Kelley BM, Middaugh LD. Periadolescent nicotine exposure reduces cocaine reward in adult mice. J Addict Dis. 1999;18(3):27–39. [PubMed]
  • Trauth JA, Seidler FJ, Slotkin TA. Persistent and delayed behavioral changes after nicotine treatment in adolescent rats. Brain Res. 2000 Oct 13;880(1-2):167–172. [PubMed]
  • Dozois DN, Farrow JA, Miser A. Smoking patterns and cessation motivations during adolescence. Int J Addict. 1995 Sep;30(11):1485–1498. [PubMed]
  • Parrott AC. Stress modulation over the day in cigarette smokers. Addiction. 1995 Feb;90(2):233–244. [PubMed]
  • Gilbert DG, Robinson JH, Chamberlin CL, Spielberger CD. Effects of smoking/nicotine on anxiety, heart rate, and lateralization of EEG during a stressful movie. Psychophysiology. 1989 May;26(3):311–320. [PubMed]
  • Mansvelder HD, McGehee DS. Long-term potentiation of excitatory inputs to brain reward areas by nicotine. Neuron. 2000 Aug;27(2):349–357. [PubMed]
  • Benwell ME, Balfour DJ, Anderson JM. Evidence that tobacco smoking increases the density of (-)-[3H]nicotine binding sites in human brain. J Neurochem. 1988 Apr;50(4):1243–1247. [PubMed]
  • Ksir C, Hakan R, Hall DP, Jr, Kellar KJ. Exposure to nicotine enhances the behavioral stimulant effect of nicotine and increases binding of [3H]acetylcholine to nicotinic receptors. Neuropharmacology. 1985 Jun;24(6):527–531. [PubMed]
  • Marks MJ, Stitzel JA, Collins AC. Time course study of the effects of chronic nicotine infusion on drug response and brain receptors. J Pharmacol Exp Ther. 1985 Dec;235(3):619–628. [PubMed]
  • Schwartz RD, Kellar KJ. In vivo regulation of [3H]acetylcholine recognition sites in brain by nicotinic cholinergic drugs. J Neurochem. 1985 Aug;45(2):427–433. [PubMed]
  • Wonnacott S. The paradox of nicotinic acetylcholine receptor upregulation by nicotine. Trends Pharmacol Sci. 1990 Jun;11(6):216–219. [PubMed]
  • Lapchak PA, Araujo DM, Quirion R, Collier B. Effect of chronic nicotine treatment on nicotinic autoreceptor function and N-[3H]methylcarbamylcholine binding sites in the rat brain. J Neurochem. 1989 Feb;52(2):483–491. [PubMed]
  • Perkins KA, Donny E, Caggiula AR. Sex differences in nicotine effects and self-administration: review of human and animal evidence. Nicotine Tob Res. 1999 Dec;1(4):301–315. [PubMed]
  • Donny EC, Caggiula AR, Rowell PP, Gharib MA, Maldovan V, Booth S, Mielke MM, Hoffman A, McCallum S. Nicotine self-administration in rats: estrous cycle effects, sex differences and nicotinic receptor binding. Psychopharmacology (Berl) 2000 Sep;151(4):392–405. [PubMed]
  • Rojas NL, Killen JD, Haydel KF, Robinson TN. Nicotine dependence among adolescent smokers. Arch Pediatr Adolesc Med. 1998 Feb;152(2):151–156. [PubMed]
  • Stanton WR. DSM-III-R tobacco dependence and quitting during late adolescence. Addict Behav. 1995 Sep-Oct;20(5):595–603. [PubMed]
  • Hatsukami DK, Hughes JR, Pickens RW. Blood nicotine, smoke exposure and tobacco withdrawal symptoms. Addict Behav. 1985;10(4):413–417. [PubMed]
  • Breslau N, Peterson EL. Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences. Am J Public Health. 1996 Feb;86(2):214–220. [PubMed]
  • Prokhorov AV, Pallonen UE, Fava JL, Ding L, Niaura R. Measuring nicotine dependence among high-risk adolescent smokers. Addict Behav. 1996 Jan-Feb;21(1):117–127. [PubMed]
  • Projected smoking-related deaths among youth--United States. MMWR Morb Mortal Wkly Rep. 1996 Nov 8;45(44):971–974. [PubMed]

Articles from Tobacco Control are provided here courtesy of BMJ Publishing Group