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First Puff Can Turn Kids Into Smokers: Study

Research suggests that, for some, addiction grabs hold quickly

MONDAY, Oct. 1 (HealthDay News) -- Just a single drag on a cigarette may drag a teen into smoking addiction, a new study suggests.

Researchers say almost a third of kids interviewed who tried smoking said their first cigarette brought them a feeling of relaxation -- and two-thirds of those kids went on to become smokers.

"This provides further support for the idea that dependence begins with the first cigarette," said study lead author Dr. Joseph DiFranza, a professor in the department of family medicine and community health at the University of Massachusetts Medical School in Worcester, Mass.

DiFranza's findings are reported in the October issue of Pediatrics.

Between 2002 and 2006, the study authors tracked the smoking habits of 217 sixth-graders, averaging 12 years of age, who they recruited from six schools in Massachusetts. Nearly three-quarters of the children were non-Hispanic whites, and all reported having inhaled a cigarette at least once.

A total of 11 in-person, 20-minute interviews were conducted over the four-year study period. The teens also completed psychological evaluations while recounting their history of tobacco use.

Tobacco-dependence was assessed based on such criteria as cravings, compulsion to smoke, changes in tolerance, time devoted to the pursuit of smoking, and an inability to quit.

As well, all the boys and girls were asked questions regarding basic personality traits, attitudes and beliefs, their social environment, and involvement with their family and community.

The result: Once a teen had tried cigarettes, very little they did afterward impacted on whether they became addicted or not.

Furthermore, experiencing that feeling of being "relaxed" immediately after the first puff of a cigarette was the leading predictor of becoming dependent on cigarettes and then being unable to quit, the researchers found. Almost 29 percent of youngsters interviewed said they had experienced such a feeling after their first cigarette.

Just over 38 percent of the ever-smoking youngsters went on to develop a clinical dependence on cigarettes. Almost 67 percent of the participants who recalled being relaxed following their first inhale became dependent, the researchers reported, compared to 29 percent of those who experienced no such relaxation effect.

Another factor that appeared to somewhat up the risk for dependence was having seen an ad with Joe Camel -- the Camel cigarette brand's mascot between 1987 and 1997, the study found. Psychological factors -- such as being depressed and having a novelty-seeking personality -- also boosted the likelihood of addiction.

Post-inhale relaxation was the biggest risk factor for being unable to quit smoking, the researchers added. In fact, 91 percent of teens who claimed such feelings also said they were unable to kick the habit. Overall, almost 60 percent of the entire group of kids interviewed said they had lost their "autonomy," in terms of being able to stop smoking.

The findings suggest that the physiological addiction triggered by a first cigarette may be even more of a risk factor for smoking dependence than personality-driven factors, according to the researchers.

Based on the study results, DiFranza's team advocated an all-out ban on tobacco advertising to lower teens' likelihood of experimenting with cigarettes. More might also be done to educate young people of the dangers of that first cigarette, DiFranza added.

"You've never seen a commercial on TV warning that you can get hooked from the first cigarette," he noted. "And, to my knowledge, this has not yet been taught in classrooms. This is not a message that we've ever used in our public health programs. So, probably 99 percent of kids you asked probably think it's safe to try it once. What could be the problem with that? But there is a big risk to even trying it just once. And that should be the message that we give to our kids."

One expert said the study raises a few interesting questions.

"First, I wouldn't have expected that young people -- of all groups -- would experiment with cigarettes as a way to seek relaxation," said Joel Killen, a professor in the department of medicine with the Stanford Prevention Research Center at Stanford University School of Medicine in Stanford, Calif. "I would think that as a social group, kids would tend to look for the opposite -- for stimulation," he said.

"There is also this ongoing conundrum concerning nicotine addiction that people have talked about for a long time," Killen said. "That is that a lot of smokers report that they smoke for this relaxing effect -- an easing of their anxiety -- despite the fact that nicotine is actually a stimulant."

However, recent animal studies have suggested that the first few puffs of cigarette smoke do provoke a physiological reaction akin to relaxation, but it is a transient feeling that occurs before stimulation kicks in, Killen said.

Does this mean that teens might, in fact, be attracted to cigarettes for that relaxation-stimulation effect?

"To my knowledge, this question has yet to be studied in humans," Killen responded. "So, it remains a paradox."

More information

For more on teen smoking, visit the American Lung Association.

SOURCES: Joseph DiFranza, M.D., department of family medicine and community health, University of Massachusetts Medical School, Worcester, Mass; Joel Killen, Ph.D., professor, department of medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif; October 2007 Pediatrics

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