Symptoms of tobacco dependence after brief intermittent use - The development and assessment of nicotine dependence in youth-2 study
Symptoms of tobacco dependence after brief intermittent use - The development and assessment of nicotine dependence in youth-2 study
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DOI：
10.1001/archpedi.161.7.704
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发表时间：
2007-07-01
影响因子：
--
通讯作者：
Wellman, Robert J.
中科院分区：
文献类型：
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作者：
DiFranza, Joseph R.;Savageau, Judith A.;Wellman, Robert J.
目的：利用烟草依赖诊断标准和尼古丁摄入生化指标，扩展青少年尼古丁依赖发展与评估研究的研究成果。第一项研究发现，间歇性吸烟后不久就会出现依赖症状。设计：为期4年的前瞻性研究。环境：马萨诸塞州6个社区的公立学校。参与者：1246名六年级学生。干预：11个访谈。主要结局指标：通过尼古丁上瘾检查表测量的烟草自主性丧失，以及国际疾病分类第十次修订（ICD-10）中定义的烟草依赖。结果：在217名吸入者中，127人失去了烟草使用自主权，10%的人在第一次吸烟后2天内失去了烟草使用自主权，25%的人在第一次吸烟后30天内失去了烟草使用自主权；一半的人在每月吸7支烟的时候已经失去了自主性。在83名出现icd -10定义的依赖的吸入者中，有一半人在每月吸46支烟时就出现了依赖。在icd -10定义的依赖性开始后的访谈中，当前吸烟者的唾液可替宁浓度中位数为5.35 ng/mL，远低于用于区分主动吸烟者和被动吸烟者的临界值。结论：最易受影响的青少年在第一次吸入香烟的一两天内失去对烟草的自主性。烟草戒断症状的出现和戒烟失败的尝试可能发生在每天吸烟之前；icd -10定义的依赖可以发生在每天吸烟之前，通常出现在每天吸烟达到2支之前。
Objective: To extend the findings of the first Development and Assessment of Nicotine Dependence in Youth study by using diagnostic criteria for tobacco dependence and a biochemical measure of nicotine intake. The first study found that symptoms of dependence commonly appeared soon after the onset of intermittent smoking.Design: A 4-year prospective study.Setting: Public schools in 6 Massachusetts communities.Participants: A cohort of 1246 sixth-grade students.Interventions: Eleven interviews.Main Outcome Measures: Loss of autonomy over tobacco as measured by the Hooked on Nicotine Checklist, and tobacco dependence as defined in International Classification of Diseases, 10th Revision (ICD-10).Results: Among the 217 inhalers, 127 lost autonomy over their tobacco use, 10% having done so within 2 days and 25% having done so within 30 days of first inhaling from a cigarette; half had lost autonomy by the time they were smoking 7 cigarettes per month. Among the 83 inhalers who developed ICD-10-defined dependence, half had done so by the time they were smoking 46 cigarettes per month. At the interview following the onset of ICD-10-defined dependence, the median salivary cotinine concentration of current smokers was 5.35 ng/mL, a level that falls well below the cutoff used to distinguish active from passive smokers.Conclusions: The most susceptible youths lose autonomy over tobacco within a day or 2 of first inhaling from a cigarette. The appearance of tobacco withdrawal symptoms and failed attempts at cessation can precede daily smoking; ICD-10-defined dependence can precede daily smoking and typically appears before consumption reaches 2 cigarettes per day.