title: Recalled first reactions to inhaling nicotine predict the level of physical dependence.
abstract: BACKGROUND
  The level of physical dependence is a measure of addiction that correlates highly with addiction-associated changes in brain structure. We sought to determine whether age at first inhalation and initial reactions to inhaling nicotine are related to level of physical dependence in early adulthood.
  
  
  METHODS
  Young adults (n=312; mean age=24 years; 51% female) from the Nicotine Dependence in Teens study who had smoked at least once in the preceding three months completed self-report questionnaires in 2011-12. We assessed level of physical dependence with three validated self-report items assessing 'wanting,' 'craving' and 'needing' triggered by nicotine deprivation. Survey items assessed smoking behavior, including age at first inhalation, and recalled first reactions to inhaling nicotine.
  
  
  RESULTS
  After adjusting for covariates, experiencing relaxation, heart racing/pounding, rush or "buzz" (OR=1.45; 95% CI: 1.08, 1.94) and dizziness (OR=1.58; 95% CI: 1.15, 2.18) at first nicotine inhalation were associated with an increased odds of being at a higher level of physical dependence in young adulthood; the association for experiencing relaxation (OR=1.78; 95% CI: 1.20, 2.64) and heart racing/pounding (OR=1.51; 95% CI: 1.00, 2.28) persisted after additionally controlling for all other first reactions. Neither age at first inhalation nor unpleasant first reactions predicted level of physical dependence.
  
  
  CONCLUSIONS
  In accordance with prior research, our findings suggest that smokers who are particularly sensitive to the pleasant, "buzz-related" and generally arousing effects of nicotine may be more likely to attain higher levels of physical dependence.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts, 01655, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wellman
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts, 01655, USA. Electronic address: Joseph.DiFranza@umassmemorial.org.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: DiFranza
authors.affiliation: Department of Social and Preventive Medicine, University of Montréal, 3875 St. Urbain, 1st Floor, Montreal, Quebec, H2W 1V1, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Tour St-Antoine, 850 St-Denis, Montreal, Quebec, H2X 0A9, Canada; Institut national de santé publique du Québec, 945 Wolfe Avenue, Quebec (QC) G1V 5B3, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Loughlin
mesh_terms: D000293:Adolescent; D001143:Arousal; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D009042:Motivation; D057181:Pleasure; D018570:Risk Assessment; D012907:Smoking / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000523:psychology*; D055815:Young Adult
keywords: Addiction; Dependence; Smoking; Tobacco; Young adults