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

Abstract

Rationale: In 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.

Objectives: To critically examine the conceptual and empirical basis for the claims made by the "hooked on nicotine" thesis.

Method: We reviewed the major studies on which the claims of the "hooked on nicotine" research program are based.

Results: The 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.

Discussion: The 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.

Figure 1

The relationships of smoking status to self-reported physical addiction and mental addiction (Adapted from Figure 2 in Okoli et al. [56]).