Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

6. Tobacco 115Substance use, in general, increases between adolescence and young adulthood,then declines in the mid-20s. Individuals may discontinue substance usein adulthood, because the responsibilities and demands of marital, occupational,and parental roles are incompatible with substance use (Yamaguchi &Kandel, 1985). Chassin, Presson, Rose, and Sherman (1996) reported that agerelatedtrends for cigarette smoking paralleled those for other drugs in showinga significant increase between adolescence and young adulthood. However,unlike other forms of drug use, there was no significant decline in cigarettesmoking in the late 20s. The persistence of cigarette smoking into the late 20s(and beyond) may be due to three factors: (1) Nicotine dependence may contributeto low cessation rates; (2) the negative health impact of cigarette smokingmay not be encountered until later ages; and (3) because smoking is a legalbehavior whose pharmacological effects are not incompatible with the day-todaydemands of adult roles, role socialization pressure for cessation may be lessintense (Chassin et al., 1996).Although psychosocial factors play a major role in smoking onset and progressionto established smoking in adolescence, addiction to nicotine also is ofparamount importance. Recent studies (DiFranza et al., 2002) suggest that childrenshow signs of nicotine dependence within a matter of months of exposure,far quicker than heretofore imagined. Like adults, young people have difficultystopping smoking (Burt & Peterson, 1998; Green, 1980). The reasons for thisdifficulty—social pressure, urges, and withdrawal symptoms—implicate behavioralfactors and dependence on tobacco (Biglan & Lichtenstein, 1984).Hansen (1983) studied abstinence and relapse in high-school-age smokers (16–18 years old) who smoked an average of 15–20 cigarettes per day. Most studentswho quit smoking relapsed within 3 months. Variables that predicted relapsewere the number of cigarettes smoked per day and the regularity of a teenager’ssmoking pattern—findings indicative of tobacco dependence.The early initiation of smoking is of considerable concern to the publichealth community. The pathogenesis of diseases such as chronic obstructivelung disease and atherosclerotic heart disease begins early in life, and durationof exposure to tobacco contributes to the likelihood of suffering adverse consequencesas an adult (U.S. Department of Health, Education, and Welfare,1979). However, it is not necessary to wait until adulthood to see signs ofimpaired health. Seely, Zuskin, and Bouhuys (1971) reported that cough,phlegm, and shortness of breath were more common among high school studentswho smoked than among nonsmokers, with no significant differencesbetween sexes. Pulmonary function testing showed that maximum ventilation(V max) at both 50% and 25% vital capacity (midmaximal flow rates, respectively)were significantly below expected levels in boys who smoked more than15 cigarettes per day and in girls who smoked more than 10 cigarettes per day(Seely et al., 1971). The authors concluded that regular smoking for 1–5 years