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Drug Alcohol Depend. 2019 Aug 30;204:107534. doi: 10.1016/j.drugalcdep.2019.06.036. [Epub ahead of print]

Measures of nicotine dependence enhance interpretation of number of cigarettes smoked in youth smoking surveillance.

Author information

1
Centre de recherche du centre hopspitalier de l`Université de Montréal (CRCHUM), Montreal, QC, Canada. Electronic address: erika.dugas@crchum.qc.ca.
2
Centre de recherche du centre hopspitalier de l`Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada. Electronic address: marie-pierre.sylvestre@umontreal.ca.
3
University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: wellmanhealth@verizon.net.
4
Harvard Medical School, Boston, MA, USA. Electronic address: JWINICKOFF@mgh.harvard.edu.
5
Institut national de sante publique du Quebec, Montreal, Quebec, Canada. Electronic address: Annie.Montreuil@inspq.qc.ca.
6
Centre de recherche du centre hopspitalier de l`Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada. Electronic address: jennifer.oloughlin@umontreal.ca.

Abstract

BACKGROUND:

Nicotine dependence (ND) symptoms can occur soon after first puff, so that stopping smoking becomes difficult well before 100 cigarettes lifetime is attained. Yet some surveillance systems do not monitor ND symptoms and 100-cigarettes lifetime is used in at least one surveillance system to define current smokers. To assess whether these features limit interpretation of grade-specific data in surveillance, we described smoking and ND symptoms across grade in incident vs. prevalent smokers, and in smokers according to 100-cigarettes lifetime.

METHODS:

Data were available in an investigation of 1294 grade 7 students from 10 Montreal-area high schools followed every 3 months from grade 7 to 11. Analyses described cigarette consumption, 100-cigarette lifetime consumption, cravings, withdrawal symptoms, mFTQ nicotine dependence and ICD-10 tobacco dependence by grade among past 3-month smokers.

RESULTS:

Despite low cigarette consumption, 21-30% of grade 7 smokers reported ND symptoms. This increased to 27-44% in grade 8 and remained stable thereafter despite increased cigarette consumption. In grade 7, 10% of all smokers had not attained the 100-cigarette milestone but were already dependent. In grade 8, 9, 10 and 11, these proportions were 12%, 8%, 6% and 6%, respectively.

CONCLUSIONS:

ND symptoms should be monitored in youth surveillance systems since they tell a different "story" than cigarettes and their appearance may represent a critical "point-of-no-return." Interventions for incident smokers are needed across grades to stop smoking before ND manifests. Without a shift in focus toward incident rather than established smokers, many children who try cigarettes will become addicted.

KEYWORDS:

Adolescents; Cigarette smoking; Nicotine dependence; Smoking frequency

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