ReviewCurrent models of nicotine dependence: what is known and what is needed to advance understanding of tobacco etiology among youth
Section snippets
Introductory remarks: the problem of youth smoking
The majority of youth experiment with tobacco and nicotine-containing products and over 25% of these individuals proceed to regular tobacco usage as adults (Escobedo et al., 1997, Giovino, 1997). After years of decline, it is now apparent that smoking initiation is rising dramatically among adolescents in the United States (CDC, 1994, CDC, 1998) and throughout the world (Winder et al., 1994, Villalbi, 1995, WHO, 1999). Recent projections suggest that of the adolescents who become regular
Conceptual framework and organizational structure
The desired use of a concept will ultimately determine the manner in which it is defined (Garfinkel, 1981). By necessity, then, our first task in exploring the theoretical concept of dependence is to ask what we would like the concept to do for us. At the most basic levels, we are interested in answering the following questions:
- 1.
What constitutes nicotine dependence?
- 2.
How does nicotine dependence develop?
- 3.
Who becomes nicotine dependent? and
- 4.
Where does nicotine dependence lead?
In order to address the
Features of substance dependence
This section reviews the prototypic features of substance dependence and relates these factors to conceptions of nicotine dependence. Several concerns need to be kept in mind. First, the review is meant to describe independently each feature as much as possible; we reserve theoretical analyses of the dynamic relationship between the features for a later section of this essay. Second, our review of the literature here, and throughout, is necessarily selective, for the purposes of illustration.
Models of dependence
Independently listing and describing the features that comprise dependence is somewhat of an atheoretical enterprise; it does not comprise a theory of dependence. The features represent the phenomenon to be explained by theory, and theory ties together these seemingly disparate features. Models of dependence do not typically differ in their acceptance of the existence of the features. Rather, theories or models of dependence differ in the emphasis or role they give each feature. In one theory,
Concluding remarks: a proposed research agenda
This essay has provided a picture of substance dependence as it is manifest among adults. It is apparent, however, that these models do little to address the etiology of tobacco use and dependence among youth. The data which support the various models of dependence are based primarily on research with adult populations and with adult animal samples. Very little comprehensive theoretical information is available on nicotine dependence as a concept among youth. A developmental analysis of these
Acknowledgements
The authors wish to thank the members of the Tobacco Etiology Research Network (Richard R. Clayton, Robert L. Balster, Linda M. Collins, Brian R. Flay, Gary Giovino, Jack E. Henningfield, Mary Jeanne Kreek, Robert J. McMahon, Kathleen R. Merikangas, Stephen Tiffany) and The Robert Wood Johnson Foundation (Marjorie A. Gutman, Nancy J. Kaufman, Denis Prager) for their suggestions and comments on versions of this manuscript. The manuscript also benefited greatly from the suggestions of John Hughes
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