A study just published in Nicotine and Tobacco Research shows that two thirds to four fifths of people who ever tried a cigarette go on to become daily smokers.
As a society we have accepted adolescent experimentation with tobacco products as normal. Close to 90% of current smokers started before their 18th birthday. Experimentation is encouraged by tobacco industry promotion, such that the US Surgeon General (2014) concluded, "The evidence is sufficient to conclude that advertising and promotional activities by the tobacco companies cause the onset and continuation of smoking among adolescents and young adults". That two-thirds to four-fifths of individuals who experiment with cigarettes go on to become daily smokers is very concerning. Cigarettes and other tobacco products kill people when used exactly as intended. Tobacco promotion is not benign.
Although shocking, these findings are not surprising. Nicotine is very a highly addictive substance. The adolescent brain is especially susceptible to the development of nicotine dependence. Signs of nicotine dependence can develop very quickly after first use, and that nicotine withdrawal symptoms drive progression from intermittent to daily smoking.
These findings call for actions on tobacco control to protect our youth. A simple, proven action would be to raise the age for sale of tobacco products to 21 years – and enforce those restrictions. Another would be to raise taxes on tobacco products – and dedicate those funds to tobacco control efforts. And yet another would be to ban flavors – including menthol – from all tobacco products.
The highly addictive nature of nicotine combined with the severe harms of tobacco use calls out for action. The very high rate of progression from experimentation to daily use documented in this study should tell us just how very important that action is.
Harold Farber, MD, MSPH
Associate Professor of Pediatrics, Pulmonary Section
Baylor College of Medicine and Texas Children's Hospital
Chair, Tobacco Action Committee, American Thoracic Society
