NICOTINE DEPENDENCE AMONG ADOLESCENT SMOKERS

Objectives: To assess nicotine dependence among adolescents to determi ne whether quitting smoking is associated with the emergence of nicoti ne withdrawal symptoms and craving, and to identify the factors associ ated with these symptoms. Design: Cross-sectional survey. Participants : We studied 2197 10th-grade students in 6 San Jose, Calif, high schoo ls. Main Outcome Measures: Smoking status; history of quitting smoking ; Modified Fagerstrom Tolerance Questionnaire (mFTQ) scores; subjectiv e nicotine withdrawal symptoms from the Diagnostic and Statistical Man ual of Mental Disorders, Fourth Edition; Center for Epidemiologic Stud ies Depression Scale (CES-D); and saliva cotinine levels. Results: Of the 485 participants who reported having smoked during the past 30 day s, 249 reported previous attempts to quit smoking. Among the participa nts who had attempted to quit, the self-reported frequencies of subjec tive withdrawal symptoms were a strong need to smoke (45.4%), nervous and tense (31.8%), restless (29.4%), irritable (28.7%), hungry (25.3%) ,unable to concentrate (21.7%), miserable and sad (15.3%), and trouble sleeping (12.8%). The total number of withdrawal symptoms was correla ted with the mFTQ score (Spearman r=0.51; P<.001). In a stepwise linea r regression analysis, the mFTQ score and the CES-D score accounted fo r approximately 35% of the variance in total number of withdrawal symp toms (R-2=0.35; P<.001). Males smoked significantly more and had signi ficantly higher mFTQ scores than did females, while female smokers had significantly higher CES-D scores than did their male counterparts. C onclusions: Considerable levels of nicotine dependence were present am ong adolescent smokers. Use of mFTQ scores; withdrawal symptoms includ ing nicotine craving; CES-D scores; and saliva cotinine levels may be helpful in designing cessation programs targeted to nicotine-dependent adolescents.