title: Nicotine dependence among adolescent smokers.
abstract: OBJECTIVE
  To assess nicotine dependence among adolescents to determine whether quitting smoking is associated with the emergence of nicotine withdrawal symptoms and craving, and to identify the factors associated with these symptoms.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  We studied 2197 10th-grade students in 6 San Jose, Calif, high schools.
  
  
  METHODS
  Smoking status; history of quitting smoking; Modified Fagerstrom Tolerance Questionnaire (mFTQ) scores; subjective nicotine withdrawal symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; Center for Epidemiologic Studies Depression Scale (CES-D); and saliva cotinine levels.
  
  
  RESULTS
  Of the 485 participants who reported having smoked during the past 30 days, 249 reported previous attempts to quit smoking. Among the participants who had attempted to quit, the self-reported frequencies of subjective 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 correlated with the mFTQ score (Spearman r = 0.51; P < .001). In a stepwise linear regression analysis, the mFTQ score and the CES-D score accounted for approximately 35% of the variance in total number of withdrawal symptoms (R2 = 0.35; P < .001). Males smoked significantly more and had significantly higher mFTQ scores than did females, while female smokers had significantly higher CES-D scores than did their male counterparts.
  
  
  CONCLUSIONS
  Considerable levels of nicotine dependence were present among adolescent smokers. Use of mFTQ scores; withdrawal symptoms including nicotine craving; CES-D scores; and saliva cotinine levels may be helpful in designing cessation programs targeted to nicotine-dependent adolescents.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Rojas
authors.forename: J D
authors.initials: JD
authors.lastname: Killen
authors.forename: K F
authors.initials: KF
authors.lastname: Haydel
authors.forename: T N
authors.initials: TN
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D003367:Cotinine / Q000032:analysis; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009538:Nicotine / Q000009:adverse effects; D015995:Prevalence; D011581:Psychological Tests; D012463:Saliva / Q000737:chemistry; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D016540:Smoking Cessation; D013375:Substance Withdrawal Syndrome; D014029:Tobacco Use Disorder / Q000209:etiology* / Q000523:psychology
chemical_list: D009538:Nicotine; D003367:Cotinine