Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e974-e983 (doi:10.1542/peds.2007-0027)
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ARTICLE

Susceptibility to Nicotine Dependence: The Development and Assessment of Nicotine Dependence in Youth 2 Study

Joseph R. DiFranza, MDa, Judith A. Savageau, MPHa, Kenneth Fletcher, PhDa, Lori Pbert, PhDb, Jennifer O'Loughlin, PhDc, Ann D. McNeill, PhD, PGCEd, Judith K. Ockene, PhDb, Karen Friedman, BAa, Jennifer Hazelton, BAa, Connie Wood, MSWa, Gretchen Dussault, BSa and Robert J. Wellman, PhDa,e

a Departments of Family Medicine and Community Health
b General Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
c Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
d University College London, London, United Kingdom
e Department of Psychology, Fitchburg State College, Fitchburg, Massachusetts

OBJECTIVES. The purpose of this work was to identify characteristics that predict progression from the first inhalation of a cigarette to dependence. We studied a cohort of 1246 public school 6th-graders in 6 Massachusetts communities (mean age at baseline: 12.2 years).

METHODS. We conducted a 4-year prospective study using 11 interviews. We assessed 45 risk factors and measured diminished autonomy over tobacco with the Hooked on Nicotine Checklist and evaluated tobacco dependence according to the International Classification of Diseases, 10th Revision. Cox proportional-hazards models were used.

RESULTS. Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette and depressed mood. Tobacco dependence was predicted by feeling relaxed, familiarity with Joe Camel, novelty seeking, and depressed mood.

CONCLUSIONS. Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence or loss of autonomy. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or any of the other measured psychosocial factors. These results are discussed in relation to the theory that the process of dependence is initiated by the first dose of nicotine.

Key Words: nicotine • tobacco • adolescents • addiction • dependence

Abbreviations: DANDY—Development and Assessment of Nicotine Dependence in Youth • HONC—Hooked on Nicotine Checklist • ICD-10—International Classification of Diseases, Tenth Revision • HR—hazard ratio • ADHD—attention-deficit/hyperactivity disorder • CI—confidence interval

Accepted Mar 16, 2007.




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Hypoism causes cigarette addiction, not cigarettes
Dan F Umanoff, M.D.
Pediatrics Online, 1 Oct 2007 [Full text]