Studies in youth present conflicting results regarding the effect of nicotine metabolism on the development of nicotine dependence and other smoking behaviors (Audrain-McGovern et al., 2007; Cannon et al., 2016; Chenoweth et al., 2016; Huang et al., 2005; Moolchan et al., 2009; O'Loughlin et al., 2004; Rubinstein et al., 2008; Rubinstein et al., 2013). Some studies suggest that slow nicotine metabolism is associated with an increased risk of nicotine dependence (Chenoweth et al., 2016; O'Loughlin et al., 2004; Rubinstein et al., 2013), possibly reflecting an increased sensitivity to initial nicotine exposure among youth who metabolize nicotine more slowly. In contrast, other studies suggest that slower metabolizers have a decreased risk for dependence and related symptoms (Audrain-McGovern et al., 2007; Rubinstein et al., 2008), paralleling findings in adults regarding reduced heaviness of smoking among slow metabolizers.
