The loss of autonomy over smoking in relation to lifetime cigarette consumption

Department of Family Medicine and Community Health, University of Massachusetts Medical School, United States
Addictive behaviors (Impact Factor: 2.76). 01/2010; 35(1):14-18. DOI: 10.1016/j.addbeh.2009.08.001


New Zealand youth who had smoked only one cigarette had diminished autonomy over smoking. We sought to examine this issue in a US sample and examine the early onset of DSM-IV nicotine dependence. A self-administered survey was completed by 367 adolescent smokers in Massachusetts. Diminished autonomy was measured with the Hooked on Nicotine Checklist. Diminished autonomy was present in 5.7% of youth after one cigarette, in 9% after 2, in 26% after 3–4, in 44% after 5–9, in 43% after 10–19, in 67% after 20–99, and in 96% after 100 or more. DSM-IV nicotine dependence was absent in youth who had not smoked 10 cigarettes but was present in 9% after 10–19 cigarettes, in 17% after 20–99, and in 58% after 100 or more. Our data confirm the New Zealand study by showing diminished autonomy among subjects who had smoked only 1 or 2 cigarettes. Diminished autonomy after one or two cigarettes, and DSM-IV nicotine dependence after 10–19, support the sensitization-homeostasis theory of nicotine addiction that the addiction process is initiated by the first few cigarettes.

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    • "Infrequent smoking and smoking trajectories among adults remain open research issues. Youth data emerging over the past decade, however, have consistently concluded the trajectory of smoking begins with the loss of autonomy that occurs during infrequent use [25] [26] [27] [28] [29] [30]. Among adults who have adopted the practice of infrequent smoking, research not only suggests it can remain a stable pattern lasting long periods of time [31] [32] [33] but that it also poses substantial health risk with adverse outcomes paralleling dangers observed among daily smoking, especially for cardiovascular disease [34]. "
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    ABSTRACT: To compare prevalence estimates and assess issues related to the measurement of adult cigarette smoking in the National Health Interview Survey (NHIS) and the National Survey on Drug Use and Health (NSDUH). 2008 data on current cigarette smoking and current daily cigarette smoking among adults ≥18 years were compared. The standard NHIS current smoking definition, which screens for lifetime smoking ≥100 cigarettes, was used. For NSDUH, both the standard current smoking definition, which does not screen, and a modified definition applying the NHIS current smoking definition (i.e., with screen) were used. NSDUH consistently yielded higher current cigarette smoking estimates than NHIS and lower daily smoking estimates. However, with use of the modified NSDUH current smoking definition, a notable number of subpopulation estimates became comparable between surveys. Younger adults and racial/ethnic minorities were most impacted by the lifetime smoking screen, with Hispanics being the most sensitive to differences in smoking variable definitions among all subgroups. Differences in current cigarette smoking definitions appear to have a greater impact on smoking estimates in some sub-populations than others. Survey mode differences may also limit intersurvey comparisons and trend analyses. Investigators are cautioned to use data most appropriate for their specific research questions.
    Journal of Environmental and Public Health 05/2012; 2012(8):918368. DOI:10.1155/2012/918368
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    • "It should also be noted that the highest rate of consumption measured in our study was " ten or more cigarettes, " which does not correspond with a very high rate of consumption. However, studies have shown that adolescents report loss of autonomy over tobacco use, such that quitting is difficult or produces discomfort, after smoking as few as one or two cigarettes (e.g., Savageau et al. 2009; Scragg et al. 2008; Ursprung and DiFranza 2009). Additionally, we did not biochemically verify smoking status. "
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    ABSTRACT: Previous studies suggest that earlier cigarette smoking initiation in adolescence predicts greater cigarette consumption later in adolescence or adulthood. Results from these studies have been used to inform interventions for adolescent smoking. However, previous studies suffer from several important methodological limitations. The objective of the present study was to address these limitations by longitudinally and prospectively examining whether and how age of initiation of smoking among adolescents predicts cigarette consumption by age 16 or 17. Participants completed an in-class survey every 6 months for 2-3 school years. Participants included 395 adolescents (Mean age=14 years at baseline; 53.2% female) from two public high schools in Northern California (Schools A and B) who completed self-report measures of smoking initiation, number of friends who smoke, and number of whole cigarettes smoked by the final survey time point. Adolescents who were older when they first smoked one whole cigarette were 5.3 to 14.6 times more likely in School A and 2.9 to 4.3 times more likely in School B to have smoked a greater number of cigarettes by age 16 or 17. Results suggested that earlier smoking initiation may not lead to heavier cigarette consumption later in time, as has been previously shown. There may be a period of heightened vulnerability in mid- or late adolescence where smoking experimentation is more likely to lead to greater cigarette consumption. Targeting prevention efforts to adolescents aged 14 to 17 years may further reduce smoking initiation among youth, thus limiting subsequent smoking-related morbidity and mortality in adulthood.
    Prevention Science 03/2011; 12(3):247-54. DOI:10.1007/s11121-011-0209-6 · 2.63 Impact Factor
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