Predictors of nicotine dependence symptoms among never-smoking adolescents: A longitudinal analysis from the Nicotine Dependence in Teens Study

Background: Recent cross-sectional studies suggest some adolescents who have never smoked cigarettes experience nicotine dependence (ND) symptoms and that exposure to second-hand smoke, social exposure to smoking, and alcohol use are plausible correlates. The aim of this study was to replicate and extend these findings by investigating possible predictors of ND symptoms longitudinally. Method: Participants included 847 secondary school students who had never smoked cigarettes enrolled in the Nicotine Dependence in Teens Study. Adolescents completed self-report questionnaires measuring smoking status, ND symptoms, and risk factors for ND in smokers (i.e., socio-demographic indicators, social exposure to smoking, psychosocial indicators, and substance use) in 20 survey cycles from 7 to 11th grade. Generalized estimating equations, which account for repeated measures within individuals, were used to test the predictors of ND symptoms. Results: Consistent with previous research, 7.8% of never-smokers across all cycles endorsed at least one ND symptom. Younger age (p≤.001), country of birth (p≤.05), peer smoking (p≤.001), teacher smoking (p≤.05), depression (p≤.05), stress (p≤.001), lower self-esteem (p≤.05), impulsivity (p≤.05), and alcohol use (p≤.001) predicted greater ND symptoms in multivariable modeling. Conclusions: Replicating previous cross-sectional findings, peer smoking and alcohol use predicted ND symptoms among never-smoking adolescents. Extending these findings, previous predictors only observed among ever-smokers, including socio-demographic and psychosocial indicators, also predicted ND symptoms. This longitudinal investigation demonstrated the temporal relation of the predictors preceding ND symptoms. Future research should consider longer prospective studies with younger children to capture early onset of ND symptoms and with longer follow-up to detect eventual smoking uptake.