title: Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey.
abstract: BACKGROUND
  A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users.
  
  
  OBJECTIVE
  To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students.
  
  
  METHODS
  Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design.
  
  
  RESULTS
  Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days.
  
  
  CONCLUSIONS
  A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.
authors.affiliation: Office of Science Rockville, Maryland. Electronic address: benjamin.apelberg@fda.hhs.gov.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Apelberg
authors.affiliation: Office of Science Rockville, Maryland.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Corey
authors.affiliation: Office of Science Rockville, Maryland.
authors.forename: Allison C
authors.initials: AC
authors.lastname: Hoffman
authors.affiliation: Office of Science Rockville, Maryland.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Schroeder
authors.affiliation: Office of the Center Director, Center for Tobacco Products, Food and Drug Administration, Rockville, Maryland.
authors.forename: Corinne G
authors.initials: CG
authors.lastname: Husten
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Caraballo
authors.affiliation: Office of Science Rockville, Maryland.
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Backinger
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D012574:Schools; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000706:statistics & numerical data*; D062789:Tobacco Products; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014030:Tobacco, Smokeless; D014481:United States / Q000453:epidemiology