Smoking behavior among hospital staff still influences attitudes and counseling on smoking.

Smoking among health professionals has been shown to influence smoking-related knowledge and counseling in clinical practice. The evidence regarding smoking as a risk factor has increased in the past decade. The present study was carried out in 2000 and investigated the associations between individual smoking behavior among hospital staff and (a). smoking-related knowledge, (b). attitudes toward counseling on smoking, and (c). self-reported smoking-related counseling provided by the staff. The study was based on a survey using self-administered questionnaires given to all hospital staff in a large university hospital in Denmark. Altogether, 82% of staff (2561) returned a completed questionnaire. Analyses focused on a subsample consisting of health professionals in the clinical wards (1429). Multivariate analyses were performed in which smoking-related knowledge, attitudes toward smoking-related counseling, smoking-related counseling practices, and self-rated qualifications for counseling were main outcome measures. Health professionals who were current smokers systematically underestimated the health consequences of smoking and differed significantly from nonsmokers in their assessments of smoking as a risk factor. Nonsmokers might overestimate smoking as a risk factor. Nonsmokers gave patients advice on smoking cessation significantly more often than did current smokers (ex-smokers, OR=2.5, 95% CI=1.8-3.4; never-smokers, OR=1.5, 95% CI=1.1-2.0). Ex-smokers and smokers felt significantly more qualified to counsel patients about smoking than did never-smokers (ex-smokers, OR=1.8, 95% CI=1.3-2.5; smokers, OR=1.4, 95% CI=1.0-1.9). Individual smoking behavior among hospital staff was strongly associated with smoking-related knowledge, attitudes, and counseling practices. Lack of self-rated qualifications was a major barrier to professional counseling on smoking in a hospital framework.     

Changes in psychiatric patients' thoughts about quitting smoking during a smoke-free hospitalization.

Though exempted from national bans of tobacco smoking in hospitals, some psychiatric facilities have voluntarily gone 100% smoke free with little reported difficulty in clinical management. The impact of smoking restrictions on psychiatric patients' thoughts about quitting smoking, however, is not known. This study investigates changes in thoughts about quitting smoking for patients hospitalized in a smoke-free psychiatric inpatient facility. Participants were 100 smokers recruited from a university-based adult inpatient psychiatry unit. The present study focused on participants' reported desire to quit smoking, their expectancy of success and anticipated difficulty with quitting, and their smoking abstinence goal. Assessments were conducted at hospital intake and shortly before hospital discharge. Follow-up assessments were conducted by phone at 1 week, 1 month, and 3 months post-hospitalization to measure smoking behavior. Although no cessation treatment was provided in this observational study, from admission to discharge, participants reported an increased expectancy of success with quitting and a decreased expectancy of difficulty with staying quit. They also were more likely to endorse a smoking-related goal. Psychiatric diagnosis was not related to thoughts about abstinence. Furthermore, participants' thoughts about abstinence at discharge were significantly related to their subsequent smoking behavior. Hospitalization in a smoke-free environment is associated with increases in patients' expectancies about quitting and staying smoke free.     

Anxiety sensitivity and smoking motives and outcome expectancies among adult daily smokers: replication and extension.

The present investigation examined the incremental validity of anxiety sensitivity in the context of distress intolerance in terms of predicting smoking motives and outcome expectancies. Participants were a community sample of 144 daily smokers (85 women, M (age) = 29.72 years, SD = 11.96). Results indicated that above and beyond discomfort intolerance, Axis I diagnoses, gender, volume of alcohol consumption, and average number of cigarettes smoked per day, anxiety sensitivity significantly incrementally predicted habitual, addictive, and negative affect reduction motives to smoke, as well as negative reinforcement outcome expectancies. No such incremental effects were similarly evident for distress intolerance. Findings are discussed in relation to the role of anxiety sensitivity in smoking motives and outcome expectancies.     

Anxiety sensitivity and perceived control over anxiety-related events: associations with smoking outcome expectancies and perceived cessation barriers among daily smokers.

The present investigation examined the extent to which the cognitive factors of anxiety sensitivity (AS) and perceived control over anxiety-related events are independently related to smoking outcome expectancies and perceived barriers to quitting. Participants were 125 community-recruited adult, daily smokers. Consistent with hypotheses, AS and perceived control over anxiety-related events independently and significantly predicted smokers' expectancies for negative affect reduction from smoking, whereas only AS predicted expectancies for negative personal consequences from smoking. Also as hypothesized, AS and perceived control over anxiety-related events each independently and significantly predicted level of general perceived barriers to quitting smoking. All of the observed significant effects were evident above and beyond the variance accounted for by gender, alcohol consumption, number of cigarettes smoked per day, and negative affectivity. Together, these findings further the literature on the relation between anxiety-relevant cognitive factors and psychological smoking processes.     

The relationship between cigarette use, nicotine dependence, and craving in laboratory volunteers.

Data from epidemiological studies suggest that individual differences in cigarettes per day (CPD) and duration of smoking account for only a small portion of the variance in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) nicotine dependence. However, DSM-IV may be an insensitive measure of nicotine dependence; other measures might better reflect the true nature of the relationship between use and dependence. This paper describes the relationship between cigarettes per day (CPD) and years smoking and the severity of nicotine dependence as measured by the Nicotine Dependence Syndrome Scale (NDSS). Furthermore, we assessed the validity of individual differences in nicotine dependence by determining whether they related to cue-evoked craving during abstinence. Data were pooled from five laboratory studies of 489 regular (i.e., 15+ CPD) smokers. In contrast to previously reported data demonstrating a relatively strong relationship between CPD and dependence in chippers (Shiffman & Sayette, 2005), CPD and years smoking accounted for a statistically significant, but small (<6%), portion of the variance in nicotine dependence in daily smokers. Individual differences in both CPD and years smoking had little or no relationship with craving. However, the magnitude of craving was significantly related to the degree of nicotine dependence even after controlling for use variables and excluding craving-related items on the NDSS. These data suggest that among moderate to heavy daily smokers, meaningful individual differences in nicotine dependence are observed independent of differences in current daily cigarette consumption and duration of smoking. Further research into the sources of this variance is critical to understanding the process of and risk for nicotine dependence.     

Correlates of home smoking restrictions among rural smokers.

The prevalence of smoking is greater and smoking restrictions are less common in rural areas in comparison to urban areas. Consequently, rural smokers and their families are at increased risk for adverse health consequences from smoking. The presence of home smoking restrictions (i.e., limiting or banning cigarette smoking in the home) can be a mediator for smoking cessation and can reduce health risks for those who live with smokers. The purpose of the present study was to identify correlates of home smoking restrictions among rural smokers. We surveyed 472 smokers from 40 rural Kansas primary care practices who were enrolled in a smoking cessation intervention study. We assessed the prevalence of home smoking restrictions and examined the relationship between such restrictions, demographic variables, comorbid diagnoses, and psychosocial measures of smoking abstinence self-efficacy and motivation to quit. Complete home smoking restrictions were found among 25.4% of rural smokers with an additional 28.3% reporting some restrictions. Restrictions were associated with younger age, higher controlled motivation to quit (i.e., motivation from external pressure), the presence of children under age 6 years living in the home, fewer friends who smoke, and a partner who does not smoke. Smokers with a comorbid diagnosis of high cholesterol, chronic lung disease, or heart disease were less likely to have restrictions. Most smokers in rural primary care practices do not have home smoking restrictions, particularly those without children or a nonsmoking partner and those with significant risk factors for smoking-related illnesses. These patients may be critical targets for broaching issues of home smoking restrictions.     

Subjective and physiological responses to smoking cues in smokers with schizophrenia.

The prevalence of smoking is high among people with schizophrenia. Although several research groups are developing smoking treatments for these smokers, abstinence rates to date have been modest. Methodological tools such as cue exposure are useful in clinical research with smokers in general, but the value of these paradigms with smokers with schizophrenia has yet to be established. The aim of the present study was to determine the subjective and physiological effects of exposure to in vivo smoking cues in smokers with schizophrenia. A total of 25 heavy smokers with schizophrenia or schizoaffective disorder were assessed while nonabstinent and after 2-hr smoking abstinence. Urge to smoke, mood, nicotine withdrawal symptoms, heart rate, and blood pressure were measured during a precue relaxation period, after exposure to neutral cues, and after exposure to smoking cues. Results indicate that both exposure to smoking cues and brief abstinence increased urge levels, nicotine withdrawal symptom levels, and negative affect. Abstinence did not amplify the effects of cues on urges or other cue reactivity measures. These results indicate that smoking cue reactivity laboratory models may be useful for investigating potential smoking treatments for, or neurobiological contributions to, smoking behavior in smokers with schizophrenia.     

Tobacco craving predicts lapse to smoking among adolescent smokers in cessation treatment.

Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean age = 14.9 years [SD = 1.3]; mean cigarettes/day = 18.0 [SD = 7.6]; mean Fagerstr?m Test for Nicotine Dependence score = 6.8 [SD = 1.34]; 65% female), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p = .013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p<.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.     

The influence of gender, race, and menthol content on tobacco exposure measures.

Research has suggested that race, gender, and menthol cigarette use influence tobacco-smoke exposure measures and smoking-related disease risk. For example, a high proportion of Black smokers prefer menthol cigarettes and, despite smoking fewer cigarettes per day (CPD) than do Whites, tend to have higher cotinine levels. Additionally, Black males are more at risk for smoking-related lung cancer. High cotinine levels and smoking menthol cigarettes may lead to higher toxin intake, which contributes to increased disease risk. We explored the relationship between tobacco exposure variables (i.e., cotinine, CPD, carbon monoxide [CO], nicotine content, and nicotine dependence) with respect to race, gender, and menthol content in a sample of 307 smokers recruited from the greater Boston area to participate in a smoking cessation treatment trial. The pattern of correlations between tobacco exposure measures and cotinine showed a consistently positive correlation between cotinine and CO in all smokers and a correlation between cotinine and CPD in those who smoked nonmenthol cigarettes. Cotinine and CPD correlations varied by gender and race among menthol cigarette smokers. Consistently, we found a significant gender x race x menthol interaction on salivary cotinine level as well as cotinine/CPD ratio. These findings suggest that the relationship between number of cigarettes consumed and salivary cotinine is more complex than previously believed. It is not sufficient to look at race alone; researchers and clinicians need to look at race and gender concurrently, as well as type of cigarette consumed.     

Long-term changes in sleep and depressive symptoms of smokers in abstinence.

Few studies have evaluated the impact of smoking cessation on objective measures of sleep. The present study assessed the long-term effects of tobacco smoking abstinence on sleep and depression. A total of 15 chronic smokers with Hamilton Rating Scale for Depression (HAM-D) scores of less than 9 were evaluated. Subjects were screened for baseline data when they were smoking chronically. They underwent a 5-week psychological treatment for tobacco smoking, after which their depressive symptoms and sleep architecture were evaluated at 1, 2, 4, 6, 9, and 12 months of abstinence. We report the results of the seven patients who completed 1 year of evaluations and of those patients who achieved only partial abstinence. Polysomnographic recordings were taken, level of depression was measured with the HAM-D, and urinary cotinine levels also were evaluated. HAM-D scores were analyzed with and without sleep items. Nicotine abstinence reduced latency to rapid eye movement (REM) sleep and increased HAM-D scores, suggesting that chronic smokers have depressive symptoms that may be controlled by nicotine administration.     

Achieving high rates of consent for genetic testing among African American smokers.

Genetic factors play an important role in smoking behavior. Although African Americans are at disproportionately increased risk for tobacco-related morbidity and mortality, limited attention has been given to genetic investigation of tobacco use in this population. The present study examined consent for genetic testing among African American smokers enrolled in a smoking cessation clinical trial. African American light smokers (相似文献   

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia

OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.




     

Menthol cigarettes and smoking cessation during an aided quit attempt.

Menthol may make cigarettes more addictive and rates of menthol cigarette smoking are disproportionately higher among Black. However, few studies have examined the association between menthol cigarette smoking and cessation, and the studies to date have produced conflicting findings. The present study examines the effect of menthol cigarette smoking on cessation among a multi-ethnic sample of smokers making a pharmacotherapy-aided quit attempt. We hypothesized that menthol cigarette smoking would be associated with lower smoking abstinence rates and conducted a secondary analysis of data from a multi-site randomized controlled trial of an intervention designed to facilitate repeat tobacco cessation treatment (N = 1,343). The intervention consisted of a patient phone call and a computerized provider prompt. The primary outcome for this analysis was 7-day point prevalence smoking abstinence. The average age of the sample was 56 years old. Overall, 25% of the sample smoked menthol cigarettes: 19% of Whites, 62% of Blacks, and 25% of other ethnicity (p<.001). We observed no significant effects for menthol cigarette smoking or ethnicity on smoking abstinence rates. In conclusion, combined with findings from previous research, this study suggests that smoking menthol cigarettes does not decrease smoking cessation among older smokers during a quit attempt aided with pharmacotherapy.     

Reconsidering stress and smoking: a qualitative study among college students

Background

Although it is widely acknowledged among adult smokers that increases in smoking are often precipitated by stressful events, far less attention has been given to smoking during times of stress among youth.

Aims

To address this gap by drawing attention to the social utility of smoking in contexts associated with stress among college students.

Design

Face‐to‐face semistructured interviews with college freshmen at a large midwestern university in the US.

Participants

Male and female low‐level smokers (n = 24), defined as those who reported regular weekday smoking (typically 3–4 cigarettes a day) and smoking at parties on weekends, were interviewed once in person. In addition, 40 brief interviews with smokers were conducted during final examination.

Measurements

Interviews focused on a range of issues including current smoking behaviour and reasons for smoking. As part of the interview, students were given a deck of cards that listed a range of reasons for smoking. Participants were asked to select cards that described their smoking experience in the past 2 weeks. Those who selected cards that indicated smoking when stressed were asked to explain the reasons why they did so.

Results

A review of qualitative responses reveals that smoking served multiple functions during times of stress for college students. Cigarettes are a consumption event that facilitates a brief social interaction during study times when students feel isolated from their friends. Cigarettes also serve as an idiom of distress, signalling non‐verbally to others that they were stressed. Students described smoking to manage their own stress and also to help manage “second‐hand stress” from their friends and classmates.

Conclusions

Moving away from an individual‐focused analysis of stress to a broader assessment of the social contexts of smoking provides a more nuanced account of the multifunctionalilty of cigarettes in students'' lives. Qualitative research draws attention to issues including the need for smoking and socialising during examination time, smoking as a way to take a break and refocus, notions of second‐hand stress and smoking to manage social relationships.In the past decade, several US‐based studies have reported significant levels of smoking among college students, with approximately 30% of college students reporting having smoked in the past 30 days, and 40% reporting having smoked in the past year.^1,2 Studies have found that a majority of college students who smoke are social smokers, meaning that they smoke more often with others than when alone, particularly when drinking, and that they smoke at low levels.^3,4 To understand better the patterns of low‐level tobacco use, qualitative research was conducted to examine closely the contexts in which students smoked. It has been suggested that a better understanding of the social context of smoking may help enhance tobacco control research and practice.⁵ Two broad contexts that begged consideration were positive social contexts in which tobacco use occurred (such as parties where alcohol was consumed), and contexts associated with stress, be this stressful life events (such as the taking of exams) or stressful events related to the management of social relationships and shifts in identity at this time of transition in life.This article highlights major findings of qualitative research on smoking in contexts associated with stress among college students. It is well established in the general population that increases in smoking are often precipitated by stressful events.^6,7 We draw attention to the social utility of smoking in contexts associated with stress, acknowledging that tobacco use also has psychological and physiological effects when used as a form of stress management and self‐medication.Three major issues guided the research: (1) to explore the extent to which students use smoking as a multifunctional tool for stress management; (2) to determine whether students use smoking as an idiom of distress and a means of showing empathy when a friend is under stress; and (3) to provide details on the complex of motivations that lead students to smoke during examination time.     

Adolescents' smoking expectancies: psychometric properties and prediction of behavior change.

Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered.     

Acute effects of cigarette smoking on global cerebral blood flow in overnight abstinent tobacco smokers.

We examined whether cerebral vascular reactivity to 5% CO2/95% O2 would be a useful, independent measure of effects of tobacco smoking on global cerebral blood flow (gCBF). The acute effects during smoking one's favorite brand of cigarettes were determined after overnight tobacco abstinence. Positron emission tomography was used to quantitatively measure gCBF using H(2)15O in 10 right-handed young-adult male volunteer tobacco smokers. After a 12-hr abstinence, gCBF measurements were repeated six times at 15-min intervals: First baseline, 5% CO2/95% O2 inhalation, first cigarette smoking, second baseline, 5% CO2/95% O2 inhalation, and second cigarette smoking. Surprisingly, no significant change was seen in mean gCBF during smoking compared with baseline. However, the increase in arterial plasma concentration of nicotine correlated inversely with gCBF. Out of 19 smoking sessions, gCBF increased in 7, decreased in 7, and was unchanged in 5 sessions. The gCBF increased during smoking when baseline gCBF was relatively low, whereas gCBF decreased when baseline gCBF was relatively high. Both vascular reactivity and estimated gCBF plus arterial nicotine concentrations were useful measures to predict the changes in measured gCBF. These individual differences result in important bimodal effects of smoking on the brains of different young adult tobacco smokers.     

Incremental validity of anxiety sensitivity in terms of motivation to quit, reasons for quitting, and barriers to quitting among community-recruited daily smokers.

The present investigation examined the relationships between anxiety sensitivity and motivation to quit smoking, barriers to smoking cessation, and reasons for quitting smoking among 329 adult daily smokers (160 females; M (age) = 26.08 years, SD = 10.92). As expected, after covarying for the theoretically relevant variables of negative affectivity, gender, Axis I psychopathology, nonclinical panic attack history, number of cigarettes smoked per day, and current levels of alcohol consumption, we found that anxiety sensitivity was significantly incrementally related to level of motivation to quit smoking as well as current barriers to quitting smoking. Partially consistent with the hypotheses, after accounting for the variance explained by other theoretically relevant variables, we found that anxiety sensitivity was significantly associated with self-control reasons for quitting smoking (intrinsic factors) as well as immediate reinforcement and social influence reasons for quitting (extrinsic factors). Results are discussed in relation to better understanding the role of anxiety sensitivity in psychological processes associated with smoking cessation.     

Development and validation of an adolescent smoking consequences questionnaire.

Several researchers have investigated the role of outcome expectancies in the initiation and maintenance of smoking behavior. Empirical studies with adults, using a validated self-report instrument, have shown that smokers identify higher levels of positive smoking expectancies and lower levels of negative smoking expectancies compared with nonsmokers and ex-smokers. Studies examining smoking outcome expectancies among adolescents have yielded similar findings, but many of these studies did not use a self-report expectancy measure validated with teens. Therefore, the present study sought to modify a well-known adult smoking expectancy instrument, the Smoking Consequences Questionnaire (SCQ), and to validate its factor structure with a community sample of adolescent nonsmokers and current smokers (aged 11-19 years). Results of a confirmatory factor analysis provided support for a seven-latent-factor structure modeled after the SCQ-Adult. As expected, smoking behavior and the intent to smoke in the future were associated with the endorsement of positive and negative smoking outcome expectancies. The psychometric data provide early support for the validity and reliability of this modified SCQ, renamed the Adolescent Smoking Consequences Questionnaire, for the assessment of smoking expectancies among smoking inexperienced and experienced teens.     

Smoking and mental health problems in treatment-seeking university students.

Smoking prevalence and daily cigarette consumption are significantly higher among individuals with mental health problems. Studies performed in the general population report greater levels of functional disability, more psychiatric symptoms, and poorer quality of life in heavy smokers. Less is known about the burden of tobacco in individuals seeking mental health care. A total of 503 treatment-seeking university students were evaluated with a standardized and validated computer assessment tool (PsyberCare-MH, Polaris Health Directions) that assessed subjective well-being; severity of psychiatric symptoms; and vocational, social, and personal functioning. These patients also were categorized as nonsmokers/occasional smokers (n = 384), light smokers (at least weekly use; n = 68), and heavy smokers (daily smoking >10 cigarette/day; n = 51). Compared with nonsmokers, heavy smokers, but not light smokers, reported substantially poorer well-being, greater symptom burden, and more functional disability (all scales p < .008). Smoking status should be assessed in all individuals seeking mental health treatment and appropriate cessation assistance should be provided.     

"Withdrawal symptoms" in adolescents: a comparison of former smokers and never-smokers.

Since the early 1980s, investigators have been reporting that adolescent smokers felt "dependent" on cigarettes and that adolescents trying to quit smoking experienced the same withdrawal symptoms observed in adult quitters, including restlessness, insomnia, increased appetite and weight gain, irritability or anger, depression, craving for cigarettes, and trouble concentrating. We hypothesized that most of these symptoms might be attributed to adolescence itself. To investigate this hypothesis, we examined the prevalence of these seven "adult" withdrawal symptoms in a population of adolescent former smokers and never-smokers. Participants were high school students in Houston, Texas, participating in a nested, group-randomized control group study designed to estimate the impact of a CD-ROM intervention for smoking prevention and cessation. We measured differences in symptoms frequency between never-smokers and former smokers, matched in a 2:1 ratio on sex and race/ethnicity, and differences in symptoms among former smokers as a function of time since final quit attempt and prior level of smoking. Only former heavy smokers have shown significantly higher prevalence of withdrawal symptoms compared with never-smokers. Of the seven symptoms assessed, only craving incrementally increased with the intensity of smoking. Overall the individual withdrawal symptoms did not effectively differentiate between 112 never-smokers and 34 former lighter smokers (persons who used to smoke less than "a few cigarettes on most days"). Withdrawal symptoms can reliably differentiate former heavy smokers from light smokers and never-smokers, among adolescents. Because most adolescents tend to be lighter smokers, future tobacco use and cessation studies should interpret adult withdrawal symptoms among adolescents with caution.