Symptoms of Tobacco Dependence Among
Middle and High School Tobacco Users
Results from the 2012 National Youth Tobacco Survey

Benjamin J. Apelberg, PhD, MHS, Catherine G. Corey, MSPH, Allison C. Hoffman, PhD,
Megan J. Schroeder, PhD, Corinne G. Husten, MD, Ralph S. Caraballo, PhD, MPH,
Cathy L. Backinger, PhD, MPH

Background: A growing body of evidence suggests that tobacco dependence symptoms can occur
soon after smoking onset and with low levels of use. However, limited data are available nationally
and among non-cigarette tobacco users.
Purpose: To examine the prevalence and determinants of tobacco dependence symptoms among
adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative,
school-based survey of U.S. middle and high school students.
Methods: Multivariate logistic regression was used to identify independent predictors of dependence
symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco.
Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the
complex survey design.
Results: Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI¼18.6, 23.1) of
current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95%
CI¼39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most
consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and
female gender. A 2–4-fold increase in the odds of symptom reporting was found in adolescents using
tobacco products on as few as 3–5 days compared to those who only used it for 1–2 of the past
30 days.
Conclusions: A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full
implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.
(Am J Prev Med 2014;47(2S1):S4–S14) Published by Elsevier Inc. on behalf of American Journal of Preventive
Medicine