Nicotine Dependence Occurs Quickly in Youth

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As they consider the new bill that would give the FDA the power to regulate cigarettes, Congress needs to take into account new information on nicotine dependence. According to a recent study published in the July edition of The Archives of Pediatrics and Adolescent Medicine, nicotine dependence can occur in young cigarette smokers long before they begin to smoke daily.

The study examined 1,246 sixth-grade students at public schools in Massachusetts over a four-year period. Of those students, 217 reported inhaling cigarette smoke, with an average age of 12.8 years at first inhalation. They became the focus of the study because inhalation is necessary to deliver the nicotine that causes dependence.

The researchers found that the loss of autonomy over smoking habits -- as measured by the Hooked on Nicotine Checklist, which includes various symptoms such as cravings -- preceded daily smoking over 70% of the time. In addition, 10% of the smokers lost autonomy in as few as two days. Cigarette dependence, as defined by the World Health Organization, preceded daily smoking nearly 39% of the time. These results counter the widely held belief that heavy cigarette use is necessary to cause addiction.

The researchers suggest that infrequent smoking can lead to addiction because the nicotine from one or two puffs of a cigarette is enough to occupy 50% of the brain's nicotinic receptors. In addition, the effects on the brain from a single dose of nicotine can last up to a month. Therefore, one cigarette can be enough to relieve craving and withdrawal symptoms for many days. These reasons help to explain the study's finding that half of those who lose autonomy over cigarette use will do so by the time they are smoking seven or eight cigarettes per month. In addition, the median cotinine salivary content at the onset of dependence was 5.35micrograms/mL, which is well below the 15micrograms/mL that defines the cutoff for distinguishing smokers from passive smokers. To put this in perspective, youth who smoked less than one cigarette per week had a mean salivary cotinine level of 13.1micrograms/mL, showing that a nicotine intake high enough to maintain blood cotinine levels throughout the day is not necessary to initiate dependence.

Although the researchers acknowledge limitations to their study such as self-reported data and inability to generalize their results to other population groups, these new findings reinforce the importance of educating children about tobacco. In addition, the results emphasize how even teens who only smoke a few cigarettes per month may need help overcoming withdrawal symptoms and should be educated on cessation methods.

In light of these new findings, more efforts should be made to deter youth from smoking. An amendment to the Family Smoking Prevention and Tobacco Control Act, the current bill being debated in the Senate HELP committee, proposes banning cloves from cigarettes. Cloves are particularly attractive to teens because of their smoother feel. Therefore, cloves should banned so that they do not lure more youth into trying cigarettes and increasing their likelihood of addiction. The supporters of this bill -- who include Senator Edward Kennedy, the Campaign for Tobacco-Free Kids, and Phillip Morris, the nation's largest cigarette maker -- do not favor this amendment, a sign that this bill is not in the best interest of our nation's youth nor public health.

Patricia Ludwig is a research intern at the American Council on Science and Health (,

See also: the teen version of ACSH's book Cigarettes: What the Warning Label Doesn't Tell You.