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Young smokers may become addicted after one puff

Smoking cessation

Smoking cessation

Little progress has been made over the past decade in reducing levels of teenage smoking. In response, the Government has increased the legal age of tobacco sales to 18 years (from 1 October 2007). Recent research has shown that youths who experiment with cigarettes can become addicted very rapidly.1 Now a further study, from the US, suggests that the process of addiction starts with the very first puff.

In the journal Pediatrics, researchers from the University of Massachusetts Medical School present findings from a prospective study of 1,246 students, with an average age at baseline of 12 years.

The students were interviewed 11 times during a four-year study period to identify which teenagers experimented with cigarettes and which factors determined whether or not experimentation led to regular smoking.

Overall, 217 participants tried cigarettes, and 83 went on to become regular smokers.

By far the strongest factor associated with regular smoking was whether or not a young person experienced a sense of relaxation when smoking their first cigarette. Nearly one-third of those who tried cigarettes experienced this, and two-thirds of these participants went on to become addicted, regular smokers. This, say the authors, adds weight to the theory that tobacco dependence is triggered by the brain changes that occur in response to the very first dose of nicotine.

There are many factors that can influence whether a young person experiments with smoking, such as personality factors, parental smoking habits, marketing by tobacco companies and pressure from peers. However, it seems that once a cigarette is tried it is largely the physiological response that determines who will become addicted.

It is alarming that the process of dependence can be set up by the very first puff of a cigarette and underscores the need to do all we can to discourage experimentation. Failing that, there is a need to intervene early in those young people whose first response to nicotine sets them up for a dangerous and costly long-term addiction.

DiFranza JR, Savageau JA, Fletcher K et al. Susceptibility to Nicotine Dependence: The Development and Assessment of Nicotine Dependence in Youth 2 study. Pediatrics 2007;120:e974-83


Dr Kevin Lewis
Former GP, Clinical Director of Smoking Cessation, Shropshire County Primary Care Trust

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