Children who pick up smoking may not recognize the symptoms of nicotine dependence early on in the habit, say researchers writing in Pediatrics.

Their study found that sixth-graders who started smoking in the 4-year period 2002–2006 were unable to recognize that symptoms such as irritability and desire to smoke are harbingers of addiction.

Researchers surveyed 1246 adolescent smokers every three to four months, over the four-year period.  Study participants were monitored for 10 symptoms of dependence with the Hooked on Nicotine Checklist. The association between number of symptoms and smoking frequency was examined using cross-lagged analyses.

Of the 370 subjects who had inhaled from a cigarette during the study period, 62% smoked at least once per month, 52% experienced dependence symptoms, and 40% went on to become daily smokers.

The study concluded that nondaily use of tobacco can trigger these early signs of dependence. Early dependence promotes increased smoking. That in turn accelerates additional signs of dependence, which leads to even higher frequencies of smoking. Eventually, it leads to addiction.

Educating young people so they can detect these early signs of addiction may be a good way to encourage earlier and successful tobacco cessation efforts, the researchers say.

: Chyke A. Doubeni, George Reed, Joseph R. Difranza. Early Course of Nicotine Dependence in Adolescent Smokers. Pediatrics, May 2010; doi: 10.1542/peds.2009-0238