Nicotine addiction is the most common preventable cause of premature death presenting during adolescence. No prior study has described the onset of this condition based on case histories. We used trained personnel to conduct individual semi‐structured interviews to obtain case histories from 50 adolescent and young adult current and former smokers.Smokers experience a compulsion to use tobacco that spans a spectrum of severity from wanting, to craving, to needing. The compulsion is commonly experienced as originating foreign to the will of the smoker and recurs with a predictable periodicity that determines the latency from smoking one cigarette to wanting, craving or needing another. Novice smokers could experience latencies as lengthy as a few weeks, and more experienced smokers attributed their escalation in smoking frequency to the shortening of their latencies. Wanting, craving or needing tobacco, as described in this study, are pathognomonic for a compulsion to use tobacco.

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BackgroundThe tobacco withdrawal syndrome indicates the development of neurophysiologic dependence. Clinical evidence indicates that neurophysiologic dependence develops through a set sequence of symptom presentation that can be assessed with a new 3-item survey measure of wanting, craving, and needing tobacco, the Level of Physical Dependence (PD). This study sought to determine if advancing neurophysiologic dependence as measured by the Level of PD correlates with characteristics of white matter structure measured by Fractional Anisotropy (FA).MethodsDiffusion-MRI based FA and diffusion tensor imaging probabilistic tractography were used to evaluate 11 smokers and 10 nonsmokers. FA was also examined in relation to two additional measures of dependence severity, the Hooked on Nicotine Checklist (HONC), and the Fagerström Test for Nicotine Dependence (FTND).ResultsAmong smokers, FA in the left anterior cingulate bundle (ACb) correlated negatively with the Level of PD (r = −0.68, p = 0.02) and HONC scores (r = −0.65, p = 0.03), but the correlation for the FTND did not reach statistical significance (r = −49, p = 0.12). With advancing Levels of PD, the density of streamlines between the ACb and precuneus increased (r = −0.67, p<0.05) and those between the ACb and white matter projecting to the superior-frontal cortex (r = −0.86, p = 0.0006) decreased significantly.ConclusionsThe correlations between neural structure and both the clinical Level of PD survey measure and the HONC suggest that the Level of PD and the HONC may reflect the microstructural integrity of white matter, as influenced by tobacco abuse. Given that the Level of PD is measuring a sequence of symptoms of neurophysiologic dependence that develops over time, the correlation between the Level of PD and neural structure suggests that these features might represent neuroplastic changes that develop over time to support the development of neurophysiologic dependence.

Our goal was to create an instrument that can be used to study how smokers lose autonomy over smoking and regain it after quitting. The Autonomy Over Smoking Scale was produced through a process involving item generation, focus-group evaluation, testing in adults to winnow items, field testing with adults and adolescents, and head-to-head comparisons with other measures. The final 12-item scale shows excellent reliability (alphas = .91-.97), with a one-factor solution explaining 59% of the variance in adults and 61%-74% of the variance in adolescents. Concurrent validity was supported by associations with age of smoking initiation, lifetime use, smoking frequency, daily cigarette consumption, history of failed cessation, Hooked on Nicotine Checklist scores, and Diagnostic and Statistical Manual of Mental Disorder (4th ed., text rev.; American Psychiatric Association, 2000) nicotine dependence criteria. Potentially useful features of this new instrument include (a) it assesses tobacco withdrawal, cue-induced craving, and psychological dependence on cigarettes; (b) it measures symptom intensity; and (c) it asks about current symptoms only, so it could be administered to quitting smokers to track the resolution of symptoms.

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ObjectiveThis study aimed to evaluate the effectiveness of flavoured tobacco product restriction policies in reducing availability of flavoured products in Massachusetts communities.MethodsData were obtained from surveys of tobacco retailers conducted from July 2015 to March 2017. On a community level, flavoured product availability was defined as the per cent of retailers during a given 3-month quarter that sold flavoured cigars/cigarillos, electronic cigarettes and/or e-liquids. Communities that implemented the policy during the study period were grouped into wave 1 (n=18; 1481 retail surveys) and wave 2 (n=20; 483 retail surveys) by date of policy implementation; communities without a flavoured product restriction served as the control group (n=234; 4932 retail surveys). A difference-in-difference analysis was used to compare the change in flavoured product availability in wave 1 and wave 2 communities 3 months pre-policy and post-policy implementation to the change over the same time periods in the control group.ResultsFrom pre-policy to post-policy implementation period, communities in both waves experienced significant reductions in flavoured product availability (ranging from 27.2% to 50.9%), even after adjusting for community-level characteristics. In both waves 1 and 2, reductions in flavoured product availability were significantly greater compared with comparison communities during the same time frame, adjusting for community-level characteristics.ConclusionsCompliance with flavoured product restriction policies is high among tobacco retailers throughout Massachusetts, regardless of community demographic and retail characteristics. Reduced availability of flavoured tobacco in the retail environment has the potential to reduce youth exposure, access and use of these products.