Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Addiction. 2009 Aug;104(8):1393-402. doi: 10.1111/j.1360-0443.2009.02603.x. Epub 2009 May 29.
To determine whether there is a sequence in which adolescents experience symptoms of nicotine dependence (ND) as per the DSM-IV.
A two-stage design was implemented to select a multi-ethnic target sample of adolescents from a school survey of 6th-10th graders from the Chicago Public Schools. The cohort was interviewed at home five times with structured computerized interviews at 6-month intervals over a 2-year period.
Subsample of new tobacco users (n = 353) who had started to use tobacco within 12 months prior to wave 1 or between waves 1 and 5. MEASUREMENTS AND STATISTICAL METHODS: Monthly histories of DSM-IV symptoms of ND were obtained. Log-linear quasi-independence models were estimated to identify the fit of different cumulative models of progression among the four most prevalent dependence criteria (tolerance, impaired control, withdrawal, unsuccessful attempts to quit), indexed by specific symptoms, by gender and race/ethnicity.
Pathways varied slightly across groups. The proportions who could be classified in a progression pathway not by chance ranged from 50.7% to 68.8%. Overall, tolerance and impaired control appeared first and preceded withdrawal; impaired control preceded attempts to quit. For males, tolerance was experienced first, with withdrawal a minor path of entry; for females withdrawal was experienced last, tolerance and impaired control were experienced first. For African Americans, tolerance by itself was experienced first; for other groups an alternative path began with impaired control.
The prevalence and sequence of criteria of ND fit our understanding of the neuropharmacology of ND. The order among symptoms early in the process of dependence may differ from the severity order of symptoms among those who persist in smoking.
根据 DSM-IV 确定青少年出现尼古丁依赖（ND）症状的顺序。
采用两阶段设计，从芝加哥公立学校 6 至 10 年级学生的学校调查中选择一个多民族青少年目标样本。该队列在两年期间，每隔 6 个月通过结构化计算机访谈在家中进行 5 次访谈。
在第 1 波或第 1 波和第 5 波之间的 12 个月内开始使用烟草的新烟草使用者（n = 353）的子样本。
获得 DSM-IV ND 症状的每月病史。对数线性拟独立模型用于估计不同累积进展模型在四个最常见依赖标准（耐受性、控制受损、戒断、戒烟失败）中的拟合情况，这些标准通过特定症状、性别和种族/民族来索引。
途径在不同群体中略有不同。可以通过机会分类的进展途径的比例范围从 50.7%到 68.8%。总体而言，耐受性和控制受损首先出现，并先于戒断；控制受损先于戒烟尝试。对于男性，首先出现耐受性，戒断是次要的进入途径；对于女性，最后出现戒断，首先出现耐受性和控制受损。对于非裔美国人，首先出现的是耐受性；对于其他群体，一个替代途径从控制受损开始。
ND 标准的流行率和顺序符合我们对 ND 神经药理学的理解。依赖过程早期症状之间的顺序可能与持续吸烟人群中症状的严重程度顺序不同。
