Nicotine Dependence and Loss of Autonomy among Greek Adolescent Smokers: A Countrywide Cross-Sectional Study.

Soteris Soteriades,Athanasios Basagiannis,George Rachiotis,Christos Hadjichristodoulou,Anastasia Barbouni,Varvara Mouchtouri,Elpidoforos S Soteriades

doi:10.3390/ijerph17218191

Abstract

Nicotine dependence is one of the main reasons for the continuation of smoking among adolescents. Loss of autonomy (LOA) is a measure of dependence. This study is the first to investigate LOA and its determinants among Greek adolescents. In 2013, 13-to-15-year-old middle-school students were selected by multi-stage clustered sampling. LOA was evaluated with the Hooked-on-Nicotine Checklist (HONC). Multiple univariate analysis was used to assess the association between adolescent demographics, smoking habits, and loss of autonomy. Three-hundred thirty-nine current smokers responded to the questionnaire (response rate: 82.3%). Of these respondents, 51.2% were male and 88.8% reported at least one LOA symptom. The mean HONC score was 4.13/10 (95% CI: 3.82–4.45). Higher scores were negatively associated with lower smoking frequency (cumulative odds ratio (cOR): 0.240, 95% CI: 0.144–0.400) and positively associated with lower age at first cigarette (cOR: 2.29, 95% CI: 1.38–3.82). Female gender was significantly associated with the prevalence but not the degree of LOA. Overall, the prevalence and the degree of nicotine dependence among adolescent smokers in Greece is similar to other countries. Frequent smoking and initiation of smoking at a younger age are linked to nicotine dependence, although it was not possible to make causal inferences. The relationship between nicotine dependence and gender remains unclear.

Highlights

Smoking constitutes the single most preventable cause of disability and death [1]
The cumulative odds ratio of scoring a higher Hooked-on-Nicotine Checklist (HONC) score for those who smoked less compared to those who smoked more frequently was 0.240, which suggests a positive association between higher smoking frequency and higher Loss of autonomy (LOA)
A high prevalence of nicotine dependence was found among adolescent Greek smokers

Summary

Introduction

Smoking constitutes the single most preventable cause of disability and death [1] It is the single most significant cause of cancer, and lung cancer in particular, in the general population [2]. Smoking is one of the most significant causes of pulmonary problems including asthma and chronic obstructive pulmonary disease [3]. It is strongly associated with the development of cardiovascular diseases [4] and has been reported as an associated cause of several other health problems in both genders and for all ages [5,6,7]. Public Health 2020, 17, 8191; doi:10.3390/ijerph17218191 www.mdpi.com/journal/ijerph

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