Can one puff really make an adolescent addicted to nicotine? A critical review of the literature

Abstract

RationaleIn the past decade, there have been various attempts to understand the initiation and progression of tobacco smoking among adolescents. One line of research on these issues has made strong claims regarding the speed in which adolescents can become physically and mentally addicted to smoking. According to these claims, and in contrast to other models of smoking progression, adolescents can lose autonomy over their smoking behavior after having smoked one puff in their lifetime and never having smoked again, and can become mentally and physically "hooked on nicotine" even if they have never smoked a puff.ObjectivesTo critically examine the conceptual and empirical basis for the claims made by the "hooked on nicotine" thesis.MethodWe reviewed the major studies on which the claims of the "hooked on nicotine" research program are based.ResultsThe studies we reviewed contained substantive conceptual and methodological flaws. These include an untenable and idiosyncratic definition of addiction, use of single items or of very lenient criteria for diagnosing nicotine dependence, reliance on responders' causal attributions in determining physical and mental addiction to nicotine and biased coding and interpretation of the data.DiscussionThe conceptual and methodological problems detailed in this review invalidate many of the claims made by the "hooked on nicotine" research program and undermine its contribution to the understanding of the nature and development of tobacco smoking in adolescents.

Thwarting science by protecting the received wisdom on tobacco addiction from the scientific method

“…"[1] Consistent with all the arguments in their essay, the authors present no data to support this speculation. Why would youth expect to become addicted after smoking a few cigarettes when, in the world according to Dar, prolonged daily use is a prerequisite to addiction?…”

“…"[1] The fact that the data contradict their preconceived notions does not represent a methodological flaw in the study.…”

Psychometric Properties of the Autonomy over Tobacco Scale in German

“…As with the English version, the German AUTOS scores were higher with greater lifetime tobacco consumption and current frequency of tobacco use, representing two important tests of concurrent validity [14] . Many people remain skeptical that early emerging symptoms of the loss of autonomy have any clinical relevance [23,24] . In a longitudinal study, endorsement of any symptom of diminished autonomy on the HONC predicted a failed attempt at cessation, continued smoking until the end of follow-up and progression to daily smoking [4] .…”

Assessing demographic differences in decisional balance for smoking prevention and temptations to try smoking among adolescent subgroups

“…Donovan's 16 review of studies on substance initiation among adolescents noted the abovementioned problem as well as the lack of reporting on the psychometric properties of measures used in these studies. Another review conducted by Dar and Frenk 24 on studies on the initiation and progression of smoking among adolescents, noted similar concerns and recommended that researchers use empirically supported constructs of smoking initiation and report evidence of the validity and reliability of their instruments.…”