Reciprocal associations between cigarette consumption and DSM-IV nicotine dependence criteria in adolescent smokers.

aimsTo examine the inter-relationships between cigarette consumption and DSM-IV nicotine dependence (ND) criteria from smoking onset in adolescence up to 7 years later, adjusting for alcohol consumption and DSM-IV alcohol dependence (AD) criteria.

designA cohort drawn from grades 6-10 in an urban school system was interviewed five times at 6-month intervals (waves 1-5) and 4.5 years later (wave 6). A parent was interviewed three times.

settingChicago, Illinois.

participantsRecent smokers (n = 409). MEASUREMENTS: Structured household interviews ascertained number of cigarettes smoked, DSM-IV ND symptoms, drinks consumed, DSM-IV AD symptoms, and selected covariates. Reciprocal prospective associations between number of cigarettes smoked and ND criteria, controlling for time-varying alcohol consumption and dependence criteria, were examined with cross-lagged models.

findingsReciprocal associations between number of cigarettes smoked and ND criteria were both significant. Cigarette consumption had stronger associations with later ND [β = 0.25, 95% confidence interval (CI) = 0.17-0.32] than dependence had with later cigarette consumption (β = 0.09, 95% CI = 0.01-0.16). Alcohol and cigarette consumption influenced each other; AD scores were associated with later ND scores but not the reverse. Reports of pleasant initial experiences from smoking were associated positively with cigarette consumption and ND the first year after smoking onset; later smoking onset was negatively associated with cigarette consumption the seventh year after onset; parental ND predicted cigarette consumption and ND throughout.

conclusionsIn adolescent smokers, higher cigarette consumption predicts later severity of DSM-IV nicotine dependence more than the reverse. Smoking and drinking also influence each other mutually over time.