Average age at start of regular tobacco use in adult smokers was 14 years. Initiation Try the first few cigarettes Peer influences more important than family influences Adolescent motivated to improve self-image Experimental Gradual increase in frequency of smoking and increase in variety of situations in which cigarettes are used See positive aspects and few negative aspects of smoking Minimal pleasure from smoking Still deciding if smoking is for them May develop self image as a smoker Physiological reactions may have greatest effect on whether or not smoking continues or progresses. Adolescent learns how to handle a cigarette and how to inhale correctly. Smoking regulates emotional responses elicited by environmentally induced stress. Smoking regulates cravings conditioned to external cues.
Smoking regulates cravings due to internal cues caused by decreasing nicotine levels.
Frequent unsuccessful attempts to quit smoking Development of tolerance to nicotine effects manifested by decrease of characteristic symptoms despite continued use or the need to increase amounts of nicotine used to get the same effects Large amounts of time spent in obtaining or using tobacco Important events given up because of restrictions of tobacco use Continued tobacco use despite negative consequences Cravings of tobacco experienced by tobacco user Discontinuation of tobacco use produces a syndrome of withdrawal. NIMH Computerized Diagnostic Interview Schedule for children, a structured diagnostic interview, can diagnose psychopathology in patients aged 7-17 years. Nicotine Dependence Syndrome Scale measures smoking drive, behavioral priority, tolerance, continuity, and stereotypy. The PARS is a useful clinical tool, well suited to a busy adolescent practice. Make treatment available.