Most adult smokers do not smoke out of choice but in order to satisfy a nicotine addiction that developed in adolescence.¹ Smoking usually starts between 11 and 15 years of age, so most adult smokers are simply adolescent smokers who have failed to quit.

Startling new evidence from the US suggests that addiction to tobacco develops very rapidly in adolescence and can even affect those who have only recently tried their first cigarette.

The four-year prospective study, published in the Archives of Pediatrics and Adolescent Medicine, consisted of 1,246 students aged 11 to 14 years from schools in Massachusetts. It used the International Classification of Diseases definition of tobacco dependence and the Hooked on Nicotine Checklist for measuring loss of autonomy over tobacco. Data were collected through a series of scripted interviews with each child annually from 2002 to 2006, supplemented by measurement of salivary cotinine (a breakdown product of nicotine).

The study found that 25% of the adolescents who became dependent on cigarettes had evidence of addiction within a month of trying their first cigarette, 10% within two days.

Some participants experienced symptoms of tobacco dependence within a day of first inhaling. Half the smokers had lost autonomy over tobacco by the time they were smoking seven cigarettes per month. Even intermittent smokers exhibited cravings and withdrawal symptoms.

The cotinine testing confirmed that dependence can occur at very low levels of smoking (at a cotinine level below that used to distinguish between active and passive smoking).

Given the enormous health risks attached to smoking, it is important for parents and doctors to understand how susceptible young people are. This study suggests that even one cigarette may be enough to initiate a life-long dependence on tobacco. It builds on the findings of two earlier studies of nicotine dependence in youth, which also suggested that the processes in the brain underlying nicotine addiction may be set in motion by the first inhaled cigarette.

DiFranza JR, Savageau JA, Fletcher K et al. Symptoms of tobacco dependence after brief intermittent use. Arch Pediatr Med 2007;161:704-710