Studies have shown that adult smokers with the presence of certain genetic markers associated with slower
nicotine metabolism smoke fewer cigarettes and are more likely to quit. Although it seems likely that
nicotine metabolism affects the degree of nicotine dependence in smokers, the impact on the development
of nicotine dependence is less clear. Since addiction most frequently occurs during adolescence,
prospective studies that focus on smoking during this time period are essential to give us information on the
effects of nicotine metabolism on the progression to addiction. Objective: To ascertain whether the rate of
nicotine metabolism affects adolescents' susceptibility to nicotine addiction. Specific aims: We will
examine the association between the rate of nicotine metabolism and cigarette consumption over time in a
prospective cohort of adolescent early/experimental smokers (Aim 1). We will also examine the association
between the rate of nicotine metabolism and the development of addiction in adolescent early/experimental
smokers (Aim 2). Study design: Using a prospective cohort design, we will examine the influence of the
rate of nicotine metabolism (measured by the 3'-hydroxycotinine/cotinine ratio) on the development of
nicotine addiction in adolescent early/experimental smokers (13-16 years-old who smoke 1-14 cigarettes
per week). At baseline, smoking behavior and addiction questionnaires will be administered and saliva
samples will be obtained for determination of nicotine metabolic rate. All subjects will then be seen at 6
month intervals up to 36 months. Addiction will be measured by increasing salivary cotinine levels reflecting
increased intake and the development of nicotine addiction signs and symptoms using standardized scales.
Significance: The proposed research is critical to understanding why and how some adolescent smokers
make the transition from experimentation to addicted smoker. Although only a small percentage of teens
smoke cigarettes, we know that those who continue smoking into adulthood are more likely to smoke
heavily, less likely to quit and given the cumulative effect of smoking related toxins, are at increased risk for
developing negative outcomes from smoking. Therefore, intervening early among adolescent smokers is
essential to halt the devastating effects from smoking. Moreover, as studies of adult smokers have
suggested that response to pharmacotherapy for smoking cessation may be influenced by a smoker's
individual rate of nicotine metabolism, the metabolic rate may prove equally useful when choosing specific
forms of nicotine replacement for adolescents. Therefore, research into the effect of nicotine metabolism on
adolescent smokers may provide new and important insights into which teens may benefit from nicotine
replacement and which may be more likely to benefit from non-nicotine pharmacotherapy or non-
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