Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study

Arch Pediatr Adolesc Med. 2007 Jul;161(7):704-10. doi: 10.1001/archpedi.161.7.704.


Objective: To extend the findings of the first Development and Assessment of Nicotine Dependence in Youth study by using diagnostic criteria for tobacco dependence and a biochemical measure of nicotine intake. The first study found that symptoms of dependence commonly appeared soon after the onset of intermittent smoking.

Design: A 4-year prospective study.

Setting: Public schools in 6 Massachusetts communities.

Participants: A cohort of 1246 sixth-grade students.

Interventions: Eleven interviews.

Main outcome measures: Loss of autonomy over tobacco as measured by the Hooked on Nicotine Checklist, and tobacco dependence as defined in International Classification of Diseases, 10th Revision (ICD-10).

Results: Among the 217 inhalers, 127 lost autonomy over their tobacco use, 10% having done so within 2 days and 25% having done so within 30 days of first inhaling from a cigarette; half had lost autonomy by the time they were smoking 7 cigarettes per month. Among the 83 inhalers who developed ICD-10-defined dependence, half had done so by the time they were smoking 46 cigarettes per month. At the interview following the onset of ICD-10-defined dependence, the median salivary cotinine concentration of current smokers was 5.35 ng/mL, a level that falls well below the cutoff used to distinguish active from passive smokers.

Conclusions: The most susceptible youths lose autonomy over tobacco within a day or 2 of first inhaling from a cigarette. The appearance of tobacco withdrawal symptoms and failed attempts at cessation can precede daily smoking; ICD-10-defined dependence can precede daily smoking and typically appears before consumption reaches 2 cigarettes per day.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Behavior, Addictive / chemically induced*
  • Behavior, Addictive / diagnosis
  • Child
  • Cotinine / analysis
  • Female
  • Humans
  • Incidence
  • International Classification of Diseases
  • Interviews as Topic
  • Male
  • Massachusetts / epidemiology
  • Personal Autonomy*
  • Prospective Studies
  • Psychological Tests
  • Risk Assessment
  • Risk Factors
  • Saliva
  • Schools
  • Smoking / epidemiology*
  • Smoking / physiopathology*
  • Smoking Cessation
  • Students / psychology*
  • Time Factors
  • Tobacco Use Disorder / diagnosis
  • Tobacco Use Disorder / epidemiology*
  • Tobacco Use Disorder / physiopathology
  • Tobacco Use Disorder / psychology


  • Cotinine