Tobacco Use and Its Developmental Effects in Children and Adolescents

  • Pratima MurthyEmail author
  • Aniruddha Basu
  • Prabhat Kumar Chand


Tobacco use often starts in adolescence. Early initiation of tobacco use contributes to significant health morbidity and mortality attributable to tobacco use. The Global Youth Tobacco Survey (GYTS) reports that one among five school-going boys and one in ten girls currently uses tobacco. Developmental animal studies point to the role of nicotine as a gateway drug and its priming effect on future drug use. Psychological factors associated with early use of tobacco include a vulnerable temperament, lower self-efficacy, peer influence, role modelling, and other factors. Social factors include norms and social acceptance. Interview and physical examination for tobacco use should be an integral part of the assessment of adolescents. Specific assessment scales help in determining the severity of nicotine addiction. Preventive approaches, i.e. tobacco-free laws, effective health warnings, restricting access to minors form the mainstay of intervention. Studies on the effectiveness of pharmacological interventions do not suggest significantly positive tobacco cessation outcomes for children and adolescents, except perhaps for the selective use of nicotine replacement for the heavy tobacco using adolescent.


Tobacco Children Adolescents Smoking Smokeless Intervention Prevention 

Abbreviation List


World Health Organization


South East Asia Regional Office


National Family Health Survey


Global Youth Tobacco Survey


Global Adult Tobacco Survey


Drug Abuse Monitoring System


National Commission for Protection of Child Rights


Mobilizing Youth for Tobacco-Related Initiatives


Health-Related Information Dissemination Among Youth


Development and Assessment of Nicotine Dependence in Youth


Social and Emotional Contexts of Adolescents Smoking Patterns Study


Nicotine Dependence Syndrome Scale


Hooked on Nicotine Questionnaire


Modified Fagerstrom Tolerance Questionnaire


Fagerstrom Test for Nicotine Dependence


Interventional Model for Prevention of Adolescent and Children against Tobacco


Second-Hand Smoke


Third-Hand Smoke


Not on Tobacco


Nicotine Replacement Therapy


Electronic Nicotine Delivery Systems


The Cigarettes and Other Tobacco Products Act, 2003


Nicotine Nasal Spray



Ms Sharanya Mohan for the illustrations.


  1. Arora, M., Mathur, M. R., & Singh, N. (2013). A framework to prevent and control tobacco among adolescents and children: introducing the IMPACT model. Indian Journal of Pediatrics, 80(Suppl 1), S55–S62.PubMedCrossRefGoogle Scholar
  2. Arora, M., Tewari, A., Tripathy, V., Nazar, G. P., Juneja, N. S., Ramakrishnan, L., et al. (2010). Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India. Health Promotion International, 25(2), 143–152.PubMedCrossRefGoogle Scholar
  3. Awasthi, S., Jha, S. K., Rawat, C. M. S., Pandey, S., & Swami, S. S. (2010). Correlates of tobacco use among male adolescents in schools of Haldwani, Nainital. Health and Population: Perspectives and Issues, 33(1), 42–49.Google Scholar
  4. Bailey, S. R., Crew, E. E., Riske, E. C., Ammerman, S., Robinson, T. N., & Killen, J. D. (2012). Efficacy and tolerability of pharmacotherapies to aid smoking cessation in adolescents. Paediatric Drugs, 14(2), 91–108.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Bang, S. J., & Commons, K. G. (2011). Age-dependent effects of initial exposure to nicotine on serotonin neurons. Neuroscience, 179, 1–8.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Barros, M. C. M., Mitsuhiro, S. S., Chalem, E., Laranjeira, R. R., & Guinsburg, R. (2011). Prenatal tobacco exposure is related to neurobehavioral modifications in infants of adolescent mothers. Clinics (São Paulo, Brazil), 66(9), 1597–1603.Google Scholar
  7. Black, D. W., & Grant, J. E. (2014). DSM-5 guidebook: The essential companion to the diagnostic and statistical manual of mental disorders. American Psychiatric Pub.Google Scholar
  8. Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 6(Suppl 2), S125–S140.CrossRefGoogle Scholar
  9. Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000). Measuring nicotine dependence among youth: A review of available approaches and instruments. Drug and Alcohol Dependence, 59(Suppl 1), S23–S39.PubMedCrossRefGoogle Scholar
  10. Dar, R., & Frenk, H. (2010). Can one puff really make an adolescent addicted to nicotine? A critical review of the literature. Harm Reduction Journal, 7, 28.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Dhavan, P., Stigler, M. H., Perry, C. L., Arora, M., & Reddy, K. S. (2009). Patterns of tobacco use and psychosocial risk factors among students in 6th through 10th grades in India: 2004–2006. Asian Pacific Journal of Cancer Prevention, 10(5), 807–813.PubMedGoogle Scholar
  12. Dierker, L., Hedeker, D., Rose, J., Selya, A., & Mermelstein, R. (2015). Early emerging nicotine dependence symptoms in adolescence predict daily smoking in young adulthood. Drug and Alcohol Dependence, 151, 267–271.PubMedPubMedCentralCrossRefGoogle Scholar
  13. DiFranza, J. R., Rigotti, N. A., McNeill, A. D., Ockene, J. K., Savageau, J. A., St Cyr, D., et al. (2000). Initial symptoms of nicotine dependence in adolescents. Tobacco Control, 9(3), 313–319.PubMedPubMedCentralCrossRefGoogle Scholar
  14. DiFranza, J. R., Savageau, J. A., Fletcher, K., Ockene, J. K., Rigotti, N. A., McNeill, A. D., et al. (2002). Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study. Archives of Pediatrics and Adolescent Medicine, 156(4), 397–403.PubMedCrossRefGoogle Scholar
  15. Dino, G., Horn, K., Goldcamp, J., Fernandes, A., Kalsekar, I., & Massey, C. (2001). A 2-year efficacy study of Not On Tobacco in Florida: An overview of program successes in changing teen smoking behavior. Preventive Medicine, 33(6), 600–605.PubMedCrossRefGoogle Scholar
  16. Dongre, A., Deshmukh, P., Murali, N., & Garg, B. (2008). Tobacco consumption among adolescents in rural Wardha: Where and how tobacco control should focus its attention? Indian Journal of Cancer, 45(3), 100–106.PubMedCrossRefGoogle Scholar
  17. Ferrante, G., Simoni, M., Cibella, F., Ferrara, F., Liotta, G., Malizia, V., et al. (2013). Third-hand smoke exposure and health hazards in children. Monaldi Archives for Chest Disease, 79(1), 38–43.PubMedGoogle Scholar
  18. Gajalakshmi, V., Asma, S., & Warren, C. W. (2004). Tobacco survey among youth in South India. Asian Pacific Journal of Cancer Prevention: APJCP, 5(3), 273–278.PubMedGoogle Scholar
  19. Galanter, M., Kleber, H. D., & Brady, K. (2014). The American psychiatric publishing textbook of substance abuse treatment. American Psychiatric Pub.Google Scholar
  20. Gervais, A., O’Loughlin, J., Meshefedjian, G., Bancej, C., & Tremblay, M. (2006). Milestones in the natural course of onset of cigarette use among adolescents. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 175(3), 255–261.Google Scholar
  21. Goldsmid, E. (2007). A CounterBlaste to Tobacco. By King of England James I. Dodo Press.Google Scholar
  22. Gray, K. M., Carpenter, M. J., Lewis, A. L., Klintworth, E. M., & Upadhyaya, H. P. (2012). Varenicline versus bupropion XL for smoking cessation in older adolescents: a randomized, double-blind pilot trial. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 14(2), 234–239.CrossRefGoogle Scholar
  23. Gunjal Sandeep, S., Borle Amod, L., Narlawar Uday, W., Ughade Suresh, N., Chaudhari Vijaya, L., & Humne Arun, Y. (2012). Tobacco and alcohol use in tribal school students from Central India.Google Scholar
  24. Gupta, P. C., & Sreevidya, S. (2004). Smokeless tobacco use, birth weight, and gestational age: Population based, prospective cohort study of 1217 women in Mumbai, India. BMJ, 328(7455), 1538.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Haug, S., Schaub, M. P., Venzin, V., Meyer, C., & John, U. (2013). Efficacy of a text message-based smoking cessation intervention for young people: A cluster randomized controlled trial. Journal of Medical Internet Research, 15(8).Google Scholar
  26. Hockenberry, J. M., Timmons, E. J., & Weg, M. W. V. (2011). Adolescent mental health as a risk factor for adolescent smoking onset. Adolescent Health, Medicine and Therapeutics, 2, 27–35.PubMedPubMedCentralCrossRefGoogle Scholar
  27. Hu, M.-C., Muthén, B., Schaffran, C., Griesler, P. C., & Kandel, D. B. (2008). Developmental trajectories of criteria of nicotine dependence in adolescence. Drug and Alcohol Dependence, 98(1–2), 94–104.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Huttenlocher, P. R. (1979). Synaptic density in human frontal cortex—developmental changes and effects of aging. Brain Research, 163(2), 195–205.PubMedCrossRefGoogle Scholar
  29. Iñiguez, S. D., Warren, B. L., Parise, E. M., Alcantara, L. F., Schuh, B., Maffeo, M. L., Bolaños-Guzmán, C. A. (2009). Nicotine exposure during adolescence induces a depression-like state in adulthood. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 34(6), 1609–1624.Google Scholar
  30. Kandel, D. B., & Kandel, E. R. (2014). A molecular basis for nicotine as a gateway drug. The New England Journal of Medicine, 371(21), 2038–2039.PubMedCrossRefGoogle Scholar
  31. Karpinski, J. P., Timpe, E. M., & Lubsch, L. (2010). Smoking cessation treatment for adolescents. The Journal of Pediatric Pharmacology and Therapeutics, 15(4), 249–263.PubMedPubMedCentralGoogle Scholar
  32. Kaur, J., & Jain, D. C. (2011). Tobacco control policies in India: implementation and challenges. Indian Journal of Public Health, 55(3), 220–227.PubMedCrossRefGoogle Scholar
  33. Kristman-Valente, A. N., Brown, E. C., & Herrenkohl, T. I. (2013). Child physical and sexual abuse and cigarette smoking in adolescence and adulthood. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 53(4), 533–538.CrossRefGoogle Scholar
  34. Kumar, V., Talwar, R., Roy, N., Raut, D., & Singh, S. (2014). Psychosocial determinants of tobacco use among school going adolescents in Delhi, India. Journal of Addiction, 2014, 170941.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Leventhal, H., & Cleary, P. D. (1980). The smoking problem: A review of the research and theory in behavioral risk modification. Psychological Bulletin, 88(2), 370–405.PubMedCrossRefGoogle Scholar
  36. Lydon, D. M., Wilson, S. J., Child, A., & Geier, C. F. (2014). Adolescent brain maturation and smoking: what we know and where we’re headed. Neuroscience and Biobehavioral Reviews, 45, 323–342.PubMedPubMedCentralCrossRefGoogle Scholar
  37. Makwana, N. R., Shah, V. R., & Yadav, S. (2007). A study on prevalence of smoking and tobacco chewing among adolescents in rural areas of Jamnagar district, Gujarat state. JMSR, 1(1), 1–13.Google Scholar
  38. Malhotra, C., Sharma, N., Saxena, R., & Ingle, G. K. (2007). Drug use among juveniles in conflict with the law. Indian Journal of Pediatrics, 74(4), 353–356.PubMedCrossRefGoogle Scholar
  39. Malhotra, S., Malhotra, A., Kakkar, N., Das, P. P., & Singh, J. (2009). The clinical and demographic profile of Nicotine users among Children and Adolescents. German Journal of Psychiatry, 54, 31-2.Google Scholar
  40. Mayhew, K. P., Flay, B. R., & Mott, J. A. (2000). Stages in the development of adolescent smoking. Drug and Alcohol Dependence, 59(Suppl 1), S61–s81.PubMedCrossRefGoogle Scholar
  41. Mohan, D., Thomas, M. G., Sethi, H. S., & Prabhu, G. G. (1979). Prevalence and patterns of drug use among high-school students: A replicated study. Bulletin on Narcotics, 31(3–4), 77–86.PubMedGoogle Scholar
  42. Moolchan, E. T., Robinson, M. L., Ernst, M., Cadet, J. L., Pickworth, W. B., Heishman, S. J., et al. (2005). Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction. Pediatrics, 115(4), e407–e414.PubMedCrossRefGoogle Scholar
  43. Moylan, S., Jacka, F. N., Pasco, J. A., & Berk, M. (2013). How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain and Behavior, 3(3), 302–326.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Muramoto, M. L., Leischow, S. J., Sherrill, D., Matthews, E., & Strayer, L. J. (2007). Randomized, double-blind, placebo-controlled trial of 2 dosages of sustained-release bupropion for adolescent smoking cessation. Archives of Pediatrics and Adolescent Medicine, 161(11), 1068–1074.PubMedCrossRefGoogle Scholar
  45. Muttappallymyalil, J., Divakaran, B., Thomas, T., Sreedharan, J., Haran, J. C., & Thanzeel, M. (2012). Prevalence of tobacco use among adolescents in north Kerala, India. Asian Pacific Journal of Cancer Prevention: APJCP, 13(11), 5371–5374.PubMedCrossRefGoogle Scholar
  46. Narain, R., Sardana, S., Gupta, S., & Sehgal, A. (2011). Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey. The Indian Journal of Medical Research, 133, 300–307.PubMedPubMedCentralGoogle Scholar
  47. National Family Health Survey 2015-16 (NFHS4): States fact sheets. Retrieved August 27, 2016 from
  48. Nichter, M., Padmajam, S., Nichter, M., Sairu, P., Aswathy, S., Mini, G. K., et al. (2015). Developing a smoke free homes initiative in Kerala, India. BMC Public Health, 15, 480.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Nonnemaker, J., McNeely, C. A., & Blum, R. W. (2006). Public and private domains of religiosity and adolescent smoking transitions. Social Science & Medicine (1982), 62(12), 3084–3095.Google Scholar
  50. O’Loughlin, J., DiFranza, J., Tyndale, R. F., Meshefedjian, G., McMillan-Davey, E., Clarke, P. B., et al. (2003). Nicotine-dependence symptoms are associated with smoking frequency in adolescents. American Journal of Preventive Medicine, 25(3), 219–225.PubMedCrossRefGoogle Scholar
  51. Peto, R. (1994). Smoking and death: the past 40 years and the next 40. British Medical Journal, 309(6959), 937–939.PubMedPubMedCentralCrossRefGoogle Scholar
  52. Piper, M. E., Federman, E. B., Piasecki, T. M., Bolt, D. M., Fiore, M. C., & Baker, T. B. (2002, February). The Wisconsin dependence motives questionnaire: A new measure of tobacco dependence. Paper presented at the 8th annual meeting of the Society for Research on Nicotine and Tobacco, Savannah, GAGoogle Scholar
  53. Price, J. H., Jordan, T. R., & Dake, J. A. (2007). Pediatricians’ use of the 5 A’s and nicotine replacement therapy with adolescent smokers. Journal of Community Health, 32(2), 85–101.PubMedCrossRefGoogle Scholar
  54. Prokhorov, A. V., Koehly, L. M., Pallonen, U. E., & Hudmon, K. S. (1998). Adolescent nicotine dependence measured by the modified Fagerström Tolerance Questionnaire at two time points. Journal of Child & Adolescent Substance Abuse, 7(4), 35–47.CrossRefGoogle Scholar
  55. Ram, F., Lahiri, S., et al. (2010). Global adult tobacco survey 2009–2010, New Delhi.Google Scholar
  56. Ravishankar, T. L., & Nagarajappa, R. (2009). Factors attributing to initiation of tobacco use in adolescent students of Moradabad, (UP) India. Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research, 20(3), 346–349.CrossRefGoogle Scholar
  57. Reddy, S. (2007) Advancing cessation of tobacco in vulnerable Indian tobacco consuming Youth. Grantome. Retrieved from
  58. Rubinstein, M. L., Benowitz, N. L., Auerback, G. M., & Moscicki, A.-B. (2008). A randomized trial of nicotine nasal spray in adolescent smokers. Pediatrics, 122(3), e595–e600.PubMedPubMedCentralCrossRefGoogle Scholar
  59. Sagarkar, A. R., Sagarkar, R. M., Arabbi, K. C., & Shivamallappa, S. M. (2013). A substantive review on tobacco use among school-going adolescents in India. Journal of International Society of Preventive & Community Dentistry, 3(1), 7–11.CrossRefGoogle Scholar
  60. SAMHSA [Substance Abuse and Mental Health Services Administration]. (2002). Results from the 2001 National Household Survey on Drug Abuse: Volume I. Summary of national findings (Office of Applied Studies, NHSDA Series H-17, DHHS Publication No. SMA 02–3748). Rockville, MD: Author.Google Scholar
  61. Sarangi, L., Acharya, H. P., & Panigrahi, O. P. (2008). Substance abuse among adolescents in urban slums of sambalpur. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 33(4), 265–267.CrossRefGoogle Scholar
  62. Schepis, T. S., Adinoff, B., & Rao, U. (2008). Neurobiological processes in adolescent addictive disorders. The American Journal on Addictions/American Academy of Psychiatrists in Alcoholism and Addictions, 17(1), 6–23.PubMedCentralGoogle Scholar
  63. Shiffman, S., Waters, A., & Hickcox, M. (2004). The nicotine dependence syndrome scale: a multidimensional measure of nicotine dependence. Nicotine & Tobacco Research, 6(2), 327–348.CrossRefGoogle Scholar
  64. Sinha, D. N., Gupta, P. C., & Pednekar, M. S. (2003). Tobacco use among students in the eight North-eastern states of India. Indian Journal of Cancer, 40(2), 43–59.PubMedGoogle Scholar
  65. Shrivastav, R., Nazar, G. P., Stigler, M. H., & Arora, M. (2012). Health promotion for primordial prevention of tobacco use. Global Heart, 7(2), 143–150.PubMedCrossRefGoogle Scholar
  66. Simon, P., Kong, G., Cavallo, D. A., & Krishnan-Sarin, S. (2015). Update of adolescent smoking cessation interventions: 2009–2014. Current Addiction Reports, 2(1), 15–23.PubMedPubMedCentralCrossRefGoogle Scholar
  67. Slotkin, T. A. (2008). If nicotine is a developmental neurotoxicant in animal studies, dare we recommend nicotine replacement therapy in pregnant women and adolescents? Neurotoxicology and Teratology, 30(1), 1–19.PubMedCrossRefGoogle Scholar
  68. Stanton, A., & Grimshaw, G. (2013). Tobacco cessation interventions for young people. The Cochrane Database of Systematic Reviews, 8, CD003289.Google Scholar
  69. Tikoo, V. K., Dhawan, A., Pattanayak, R. D., Chopra, A. (2013). Assessment and pattern, profiles and correlates of substance use among children in India. National Commission on Protection of Child Rights (NCPCR), New DelhiGoogle Scholar
  70. Torres, O. V., Tejeda, H. A., Natividad, L. A., & O’Dell, L. E. (2008). Enhanced vulnerability to the rewarding effects of nicotine during the adolescent period of development. Pharmacology, Biochemistry and Behavior, 90(4), 658–663.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Tsering, D., Pal, R., & Dasgupta, A. (2008). Tobacco use among high school students of West Bengal, India. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 33(3), 207–208.CrossRefGoogle Scholar
  72. Tsering, D., Pal, R., & Dasgupta, A. (2010). Licit and illicit substance use by adolescent students in Eastern India: Prevalence and associated risk factors. Journal of Neurosciences in Rural Practice, 1(2), 76–81.PubMedPubMedCentralCrossRefGoogle Scholar
  73. Verma, A., Muddaiah, P., Krishna Murthy, A., & Sanga, R. (2015). Exploring an effective tobacco prevention programme for Indian adolescents. Public Health, 129, 23–28.PubMedCrossRefGoogle Scholar
  74. Vidhubala, E., Sahaya, G., Vijayalakshmi, S., Bharathi, P., & Quarishy, Z. B. (2014). Prevalence of tobacco use among school children, exposure to passive smoking and their knowledge level about tobacco control in Chennai city, Tamil Nadu-A School Based Survey. Journal of Indian Association for Child & Adolescent Mental Health, 10(2).Google Scholar
  75. Wasowicz, A., Feleszko, W., & Goniewicz, M. L. (2015). E-Cigarette use among children and young people: the need for regulation. Expert Review of Respiratory Medicine, 1–3.Google Scholar
  76. World Health Organization. (2009). Tobacco use among students and teachers. Findings from the Global Youth Tobacco Survey (GYTS) and the Global School Personnel Survey (GSPS) 2003–2009. World Health Organization, Centre for Diseases Control, Ministry of Health and Family Welfare, Government of India.Google Scholar
  77. World Health Organization. (2015b). Electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems. Statement March 2015. Retrieved August 31, 2015 from
  78. World Health Organization Tobacco. (2015a). Tobacco Fact Sheet July. Retrieved August 27, 2015 from
  79. Woodruff, S. I., Conway, T. L., Edwards, C. C., Elliott, S. P., & Crittenden, J. (2007). Evaluation of an Internet virtual world chat room for adolescent smoking cessation. Addictive Behaviors, 32(9), 1769–1786.PubMedCrossRefGoogle Scholar
  80. Yolton, K., Dietrich, K., Auinger, P., Lanphear, B. P., & Hornung, R. (2005). Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents. Environmental Health Perspectives, 113(1), 98–103.PubMedCrossRefGoogle Scholar
  81. Yuan, M., Cross, S. J., Loughlin, S. E., & Leslie, F. M. (2015). Nicotine and the adolescent brain. The Journal of Physiology, 593(16), 3397–3412.PubMedPubMedCentralCrossRefGoogle Scholar
  82. Zin, V., Meyer, C., John, U. (2013) Efficacy of a text message-based smoking cessation intervention for young people: A cluster randomized controlled trial. Journal of Medical Internet Research, 2, 15(8), e171.Google Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  • Pratima Murthy
    • 1
    Email author
  • Aniruddha Basu
    • 1
  • Prabhat Kumar Chand
    • 1
  1. 1.Department of Psychiatry, Centre for Addiction MedicineNIMHANSBangaloreIndia

Personalised recommendations