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    Early course of nicotine dependence in adolescent smokers

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    Authors
    Doubeni, Chyke A.
    Reed, George W.
    DiFranza, Joseph R.
    UMass Chan Affiliations
    Department of Medicine, Division of Preventive and Behavorial Medicine
    Meyers Primary Care Institute
    Department of Family Medicine and Community Health
    Document Type
    Journal Article
    Publication Date
    2010-06-05
    Keywords
    Adolescent
    Adolescent Behavior
    Child
    Female
    Humans
    Male
    Prevalence
    Proportional Hazards Models
    Smoking
    Tobacco Use Disorder
    Community Health and Preventive Medicine
    Health Services Research
    Pediatrics
    Primary Care
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079339/pdf/nihms-259139.pdf
    Abstract
    OBJECTIVE: The goal was to characterize the early course of nicotine dependence. METHODS: Data were collected from 1246 sixth-graders in a 4-year (2002-2006) prospective study using 11 individual interviews. Subjects were monitored for 10 symptoms of dependence by using the Hooked on Nicotine Checklist. The bidirectional prospective relationship between the intensity of dependence (number of symptoms) and smoking frequency was examined by using cross-lagged analyses. RESULTS: Of the 370 subjects who had inhaled from a cigarette, 62% smoked at least once per month, 53% experienced dependence symptoms, and 40% experienced escalation to daily smoking. Smoking frequency predicted the number of dependence symptoms at the next interview, and the number of symptoms predicted reciprocally the observed escalation in smoking frequency. Monthly smoking was a strong risk factor for the development of symptoms (adjusted hazard ratio: 9.9 [95% confidence interval: 6.6-14.8]). A strong desire to smoke was the most common presenting symptom, typically followed by the appearance of symptoms of nicotine withdrawal, escalation to daily smoking, and then reports of feeling addicted or difficulty controlling smoking. The appearance of any dependence symptom increased the risk for daily smoking (hazard ratio: 6.81 [95% confidence interval: 4.4-10.5]). CONCLUSIONS: Nondaily tobacco use triggers the emergence of nicotine dependence. Early dependence symptoms promote escalation in smoking frequency and, reciprocally, more-frequent smoking accelerates the appearance of additional symptoms of dependence. As this positive feedback progresses, the symptoms of nicotine dependence present in a typical sequence, with some individual variation.
    Source
    Pediatrics. 2010 Jun;125(6):1127-33. Epub 2010 May 3. Link to article on publisher's site
    DOI
    10.1542/peds.2009-0238
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37083
    PubMed ID
    20439592
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1542/peds.2009-0238
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