Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study.

CONTEXT There is no validated, theory-based tool for assessing the onset of nicotine dependence. However, the use of all addictive substances can result in a loss of autonomy. We propose that nicotine dependence begins when autonomy is lost, ie, when the sequelae of tobacco use, either physical or psychological, present a barrier to quitting. OBJECTIVES To test the autonomy theory of nicotine dependence, and to evaluate the Hooked on Nicotine Checklist (HONC) as a measure of the loss of autonomy over tobacco use. DESIGN The psychometric performance and concept validity of the HONC were evaluated in a 30-month prospective longitudinal study of the natural history of tobacco use in a cohort of 679 seventh-grade students. RESULTS As hypothesized, endorsement of a single item on the HONC was associated with a failed attempt at smoking cessation (odds ratio [OR], 29; 95% confidence interval [CI], 13-65), continued smoking until the end of follow-up (OR, 44; 95% CI, 17-114), and daily smoking (OR, 58; 95% CI, 24-142). Scores on the HONC correlated with the maximum amount smoked (r = 0.65; P<.001) and the maximum frequency of smoking (r = 0.79; P<.001). Internal reliability was 0.94. A 1-factor solution explained 66% of the total variance. CONCLUSIONS The data support the autonomy theory that dependence begins with the loss of autonomy. The autonomy theory represents a potentially useful alternative to current concepts of nicotine dependence for adolescents, and the HONC appears to measure lost autonomy in adolescents. Construct validity was demonstrated by its utility in predicting failed cessation and the progression of tobacco use. In addition, the psychometric properties were excellent.

[1]  Karl Fagerstrom,et al.  Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire , 1989, Journal of Behavioral Medicine.

[2]  R. West,et al.  Cigarette withdrawal symptoms in adolescent smokers , 2004, Psychopharmacology.

[3]  J. O'Loughlin,et al.  Reliability of selected measures of nicotine dependence among adolescents. , 2002, Annals of epidemiology.

[4]  J. O'Loughlin,et al.  The hardest thing is the habit: a qualitative investigation of adolescent smokers' experience of nicotine dependence. , 2002, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[5]  L. Rolnitzky,et al.  Smoking cessation in adolescents: the role of nicotine dependence, stress, and coping methods. , 2001, Archives of pediatrics & adolescent medicine.

[6]  N. Rigotti,et al.  Initial symptoms of nicotine dependence in adolescents , 2000, Tobacco control.

[7]  S. Shiffman,et al.  Measuring nicotine dependence among youth: a review of available approaches and instruments. , 2000, Drug and alcohol dependence.

[8]  L. Koehly,et al.  Validation of the modified Fagerström tolerance questionnaire with salivary cotinine among adolescents. , 2000, Addictive behaviors.

[9]  G F Koob,et al.  Neural mechanisms underlying nicotine addiction: acute positive reinforcement and withdrawal. , 2000, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[10]  R. Klesges,et al.  A study of the psychometric and predictive properties of the Fagerström Test for Nicotine Dependence in a population of young smokers. , 1999, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[11]  Laura M. Koehly,et al.  Adolescent Nicotine Dependence Measured by the Modified Fagerström Tolerance Questionnaire at Two Time Points , 1998 .

[12]  R. Woolard,et al.  Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. , 1998, Journal of consulting and clinical psychology.

[13]  T E Keeler,et al.  Teenage smoking, attempts to quit, and school performance. , 1998, American journal of public health.

[14]  T. Beebe,et al.  DSM-IV substance use disorder criteria for adolescents: a critical examination based on a statewide school survey. , 1998, The American journal of psychiatry.

[15]  H. Wittchen,et al.  Smoking and Nicotine Dependence , 1998, European Addiction Research.

[16]  T. Robinson,et al.  Nicotine dependence among adolescent smokers. , 1998, Archives of pediatrics & adolescent medicine.

[17]  C. Ritenbaugh,et al.  Smoking experimentation and initiation among adolescent girls: qualitative and quantitative findings. , 1997, Tobacco control.

[18]  J. Anthony,et al.  The latent dimensionality of DIS/DSM-III-R nicotine dependence: exploratory analyses. , 1996, Addiction.

[19]  R. O'donnell,et al.  A Survey of Adolescent Smoking Patterns , 1996, The Journal of the American Board of Family Medicine.

[20]  R. Niaura,et al.  Measuring nicotine dependence among high-risk adolescent smokers. , 1996, Addictive behaviors.

[21]  J. Eddy.  Attitudes and beliefs of adolescent experimental smokers: A smoking prevention perspective , 1996 .

[22]  W. Stanton,et al.  DSM-III-R tobacco dependence and quitting during late adolescence. , 1995, Addictive Behaviours.

[23]  M. Schuckit,et al.  The DSM-IV field trial for substance use disorders: major results. , 1995, Drug and alcohol dependence.

[24]  A. Parrott,et al.  Stress modulation over the day in cigarette smokers. , 1995, Addiction.

[25]  M. Schuckit,et al.  Alcohol Dependence: Provisional Description of a Clinical Syndrome , 1995, Alcohol Health and Research World.

[26]  Indicators of nicotine addiction among women--United States, 1991-1992. , 1995, MMWR. Morbidity and mortality weekly report.

[27]  J. Farrow,et al.  Smoking patterns and cessation motivations during adolescence. , 1995, The International journal of the addictions.

[28]  L. Kozlowski,et al.  Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI. , 1994, Drug and alcohol dependence.

[29]  Reasons for tobacco use and symptoms of nicotine withdrawal among adolescent and young adult tobacco users--United States, 1993. , 1994, MMWR. Morbidity and mortality weekly report.

[30]  C. Pomerleau,et al.  Reliability of the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence. , 1994, Addictive behaviors.

[31]  Terry E. Robinson,et al.  Incentive-sensitization As The Basis Of Drug Craving , 1993 .

[32]  H. Kraemer,et al.  Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation. , 1992, Journal of consulting and clinical psychology.

[33]  M. Benwell,et al.  The effects of acute and repeated nicotine treatment on nucleus accumbens dopamine and locomotor activity , 1992, British journal of pharmacology.

[34]  E. Goddard.  Why children start smoking. , 1990, British journal of addiction.

[35]  T. Nakashima,et al.  Nicotine-induced sensitization to ambulatory stimulant effect produced by daily administration into the ventral tegmental area and the nucleus accumbens in rats. , 1992, Life sciences.

[36]  L. Kozlowski,et al.  The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. , 1991, British journal of addiction.

[37]  A. McNeill.  The development of dependence on smoking in children. , 1991, British journal of addiction.

[38]  J. Henningfield,et al.  Involvement of tobacco in alcoholism and illicit drug use. , 1990, British journal of addiction.

[39]  C. Pomerleau,et al.  Relationship between nicotine tolerance questionnaire scores and plasma cotinine. , 1990, Addictive behaviors.

[40]  W. Corrigall,et al.  Evidence for a behavioral deficit during withdrawal from chronic nicotine treatment , 1989, Pharmacology Biochemistry and Behavior.

[41]  C. Spielberger,et al.  Effects of smoking/nicotine on anxiety, heart rate, and lateralization of EEG during a stressful movie. , 1989, Psychophysiology.

[42]  Y. K. Fung.  Effects of chronic nicotine pretreatment on (+)‐amphetamine and nicotine‐induced synthesis and release of [3H]dopamine from [3H]tyrosine in rat nucleus accumbens , 1989, The Journal of pharmacy and pharmacology.

[43]  H. Leventhal,et al.  The quitting experience for smokers in sixth through twelfth grades. , 1989, Addictive behaviors.

[44]  C. Pomerleau,et al.  Nicotine dependence and the Fagerström Tolerance Questionnaire: a brief review. , 1989, Journal of substance abuse.

[45]  E. O. O. Smoking.  "The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General" (Title Page through Table of Contents) , 1988 .

[46]  R. Spitzer,et al.  Proposed changes in DSM-III substance use disorders: description and rationale. , 1986, The American journal of psychiatry.

[47]  G. Edwards.  The alcohol dependence syndrome: a concept as stimulus to enquiry. , 1986, British journal of addiction.

[48]  R. Mermelstein,et al.  Some methodological cautions in the use of the Tolerance Questionnaire. , 1986, Addictive behaviors.

[49]  E. Khantzian,et al.  The Self-Medication Hypothesis of Addictive Disorders: Focus on Heroin and Cocaine Dependence , 1985 .

[50]  L. Kozlowski,et al.  The Interaction of Psychosocial and Biological Determinants of Tobacco Use: More on the Boundary Model1 , 1984 .

[51]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.

[52]  W. B. Hansen.  Behavioral predictors of abstinence: early indicators of a dependence on tobacco among adolescents. , 1983, The International journal of the addictions.

[53]  L. Lotecka,et al.  The High School "Smoker": A Field Study of Cigarette-Related Cognitions and Social Perceptions. , 1981 .

[54]  S. Perdrizet,et al.  Smoking in teenagers: some psychological aspects. , 1980, Adolescence.

[55]  K. Fagerström,et al.  Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. , 1978, Addictive behaviors.

[56]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[57]  G. Schwartz,et al.  Smoking on cue: a behavioral approach to smoking reduction. , 1971, Journal of health and social behavior.