Profiles Predict Teen Escalation to Daily Smoking

Researchers affiliated with the University of Illinois at Chicago have identified four distinct profiles that predict teen smokers’ escalation to regular smoking over time. Teens who showed early signs of nicotine dependency — even when they hadn’t smoked many cigarettes, frequently or for long — were more likely to be regular smokers four years later, they found.

The four profiles predict risk with a differential probability for progression to daily smoking within four years, said Robin Mermelstein, director of the Institute for Health Research and Policy, who led the research team. Each profile takes into account smoking frequency and intensity, symptoms of nicotine dependence, and alcohol and other substance use. Above all, symptoms of nicotine dependence predicted whether a teen would be a regular smoker.

“This study points out the importance of looking at signs of nicotine dependency separately from frequency or history of smoking,” said Mermelstein, a professor of psychology and clinical professor of community health sciences. “It is important to look for nicotine dependency even if teens smoke very lightly or infrequently.”

Reporting nicotine dependence at very early stages of smoking — even fewer than 100 cigarettes in their lifetimes — is a strong predictor of whether teens will become daily smokers in late adolescence, she said. In particular, the research team found that teens who felt the need to smoke first thing in the morning in their earliest stages of smoking were most likely to develop into daily smokers.

Mermelstein said this research helps identify teenagers at risk of becoming daily smokers and can lead to better interventions for this age group.

"We now have some early signals to help identify who needs early intervention,” Mermelstein said. “Even when adolescents are smoking infrequently, they are more at risk for developing more entrenched smoking patterns if they report placing a priority on smoking.”

One in five teens nationwide smoked at least one cigarette in the previous month, according the Centers for Disease Control and Prevention. Each day in the United States, about 3,800 youth try their first cigarette. About 1,000 of them will become daily smokers.

The researchers tracked 697 teens for four years who, at an initial baseline assessment, had recently smoked, but were not daily smokers. Most of the group (594) had smoked at least once over the previous three months but had not smoked more than 100 cigarettes, or five packs of cigarettes, in their lives. The rest of the group had smoked at least once in the past month and had smoked more than 100 cigarettes lifetime. This sample of teens was drawn from a larger longitudinal study of adolescent smoking patterns directed by Mermelstein, which enrolled almost 1,300 ninth- and 10th-graders from 16 Chicago-area high schools.

At the beginning of the study and at five points over four years, the teens were asked about their frequency of smoking over the previous month, the number of cigarettes they smoked, to what extent they experienced symptoms of nicotine dependence and other factors, such as alcohol use. Some of the teens who smoked socially and did not report a need to smoke in the morning showed little probability of becoming daily smokers.

Mermelstein and co-author Lisa Dierker of Wesleyan University first reported that early symptoms of nicotine dependence predicted regular smoking among teens in the Journal of Pediatrics in May 2010.

The work is supported by the National Cancer Institute of the National Institutes of Health (Grant No. P01CA098262).

Read the abstract of the article, “Adolescent nicotine dependence symptom profiles and risk for future daily smoking” and more about this longitudinal study.

This news release was written by Janet Hill, a master’s degree student in the UIC School of Public Health.