Early tobacco use triggers nicotine dependence

Intermittent tobacco use among young adolescents promotes early development of symptoms of dependence, according to an analysis of data collected from more than 1,200 sixth-graders in a 4-year prospective study in which participants underwent up to 11 cycles of in-person interviews. The dependence symptoms-which were monitored using the 10-symptom Hooked on Nicotine Checklist-promoted an escalation in frequency of tobacco use, which in turn promoted the development of additional dependence symptoms in a mutually reinforcing vicious cycle.

The symptoms of nicotine dependence appeared in a typical sequence, investigators found. Strong desire to smoke was the most common presenting symptom, reported by 24% of participants. Withdrawal symptoms were next, reported by 5%. These 2 symptoms generally were followed by feeling addicted and difficulty controlling smoking. Within 1 month after the first cigarette, 4% of subjects reported diminished autonomy (any symptom), with a progressive increase in development of dependence symptoms over time, although monthly smoking (smoking at least once during each of 2 consecutive 30-day periods) typically preceded the first dependence symptom of any kind. Strong desire and withdrawal symptoms generally came before the onset of daily smoking. Feeling addicted and difficulty controlling tobacco use tended to appear at about the same time and after daily smoking had begun. All told, of the 370 youngsters who had inhaled from a cigarette, 62% smoked at least once a month, 53% experienced dependence symptoms, and 40% escalated their tobacco use to daily smoking (Doubeni CA, et al. Pediatrics. 2010;125[6]:1127-1133).

Commentary