Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey

Am J Prev Med. 2014 Aug;47(2 Suppl 1):S4-14. doi: 10.1016/j.amepre.2014.04.013.


Background: A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users.

Purpose: To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students.

Methods: Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design.

Results: Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days.

Conclusions: A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.

MeSH terms

  • Adolescent
  • Age Factors
  • Age of Onset
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Population Surveillance
  • Prevalence
  • Schools
  • Sex Factors
  • Smoking / epidemiology*
  • Students / statistics & numerical data*
  • Tobacco Products*
  • Tobacco Use Disorder / epidemiology*
  • Tobacco, Smokeless
  • United States / epidemiology