Nicotine Dependence Subtypes Among Adolescent Smokers: Examining the Occurrence, Development and Validity of Distinct Symptom Profiles Marloes Kleinjan Behavioural Science Institute, Radboud University Nijmegen Brigitte Wanner and Frank Vitaro Research Unit on Children’s Psychosocial Maladjustment (G.R.I.P), University of Montre ´al Regina J. J. M. Van den Eijnden Faculty of Social Sciences, Utrecht University Johannes Brug EMGO Institute VU, University Medical Centre Rutger C. M. E. Engels Behavioural Science Institute, Radboud University Nijmegen To increase understanding of the etiology and epidemiology of nicotine dependence among adolescent smokers, the present study examined the occurrence and development of distinct nicotine dependence symptom profiles in a sample of adolescent smokers. A total of 25 secondary schools throughout the Netherlands participated in a 1-year longitudinal study. Multiple dimensions of nicotine dependence were assessed, at two time points, among 641 adolescents (aged 14 –17 years) who were classified as smokers. Results showed 4 distinct, yet stable, nicotine dependence subtypes that could be characterized by quantitative as well as qualitative differences. The symptom profiles were similar for males and females but differentially associated with previously identified correlates of nicotine dependence, namely parental smoking, peer smoking, and depressive mood. Finally, differential links of the 4 subtypes were found with regard to smoking uptake and cessation. The finding of qualitative different subgroups of adolescent smokers may have important implications for intervention efforts regarding nicotine dependence and smoking cessation. Such efforts may need to be tailored to the specific subgroups’ needs. Keywords: adolescents, smoking, nicotine dependence, subtypes, symptom profiles Adolescent smokers are known to experience symptoms of nicotine dependence, even if their exposure to cigarette smoking has been relatively short and intermittent (DiFranza et al., 2000; Kandel, Hu, Griesler, & Schaffran, 2007). Tobacco is a highly addictive substance, and the occurrence of dependence symptoms has been found to interfere with adolescents’ readiness and ability to quit smoking (Kleinjan et al., 2008; Prokhorov et al., 2001). Because of the detrimental health effects of smoking and the alleged significance of dependence in adolescent smoking persis- tence, a better understanding of nicotine dependence in adolescents is important. Nicotine dependence is perceived to be a complex disorder, and although progress has been made in identifying the nature and development of adolescent nicotine dependence, there is a need for additional progress. Among adolescent smokers, there is evidence indicative of individual variation in the occurrence and intensity of nicotine dependence symptoms, with some adolescent smokers appearing to be more susceptible to the development of specific symptoms than others (DiFranza et al., 2000). Not everybody who is exposed to nicotine becomes dependent. Also, daily smoking does not appear to be a prerequisite for the occurrence of craving and withdrawal symptoms in adolescent smokers. DiFranza and colleagues (2000) found that almost two thirds of all adolescent daily smokers and half of all adolescent occasional smokers ex- perienced craving and withdrawal symptoms. The sensitization- homeostasis model (SHM; DiFranza & Wellman, 2005) offers a theoretical framework to explain individual variations in regard to the occurrence and development of nicotine dependence symp- toms. The SHM argues that the individual susceptibility to develop specific nicotine dependence symptoms can, in addition to smok- ing habits, be explained by genetic and biological vulnerability. Therefore, we might expect to find distinctive groups of adolescent smokers that differ with regard to the occurrence of craving and withdrawal symptoms, partly independent of their smoking habits. A refinement of the features of adolescent nicotine dependence by identifying whether there are subgroups that show distinct quali- Marloes Kleinjan and Rutger C. M. E. Engels, Behavioural Science Insti- tute, Radboud University Nijmegen, Nijmegen, the Netherlands; Brigitte Wan- ner and Frank Vitaro, Research Unit on Children’s Psychosocial Maladjust- ment (G.R.I.P), University of Montre ´al, Montre ´al, Canada; Regina J. J. M. Van den Eijnden, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands; Johannes Brug, EMGO Institute VU, University Medical Centre, Amsterdam, the Netherlands. This study was partly financed by the Dutch Asthma Foundation and STIVORO For a Smoke Free Future. Correspondence concerning this article should be addressed to Marloes Kleinjan, Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, the Netherlands. E-mail: m.kleinjan@pwo.ru.nl Psychology of Addictive Behaviors © 2010 American Psychological Association 2010, Vol. 24, No. 1, 61–74 0893-164X/10/$12.00 DOI: 10.1037/a0018543 61