The Impact of the First Smoked Cigarette—Coughing, Nausea or Addiction?

What is the percentage of those who initiate cigarette smoking and become regular smokers? Surprisingly, this question has never been rigorously studied—-until now.

Smoking Research

This interesting research by Birge, Hajek and colleagues (2018) published in the journal Nicotine & Tobacco Research analyzed findings from over 215,000 survey respondents. The study provides good evidence for supporting efforts to reduce and delay the first smoked cigarette among adolescents. Data was culled from the Global Health Data Exchange which includes surveys meeting the standard for “Best Practices” from the U.K., U.S., Australia and New Zealand, all of which included questions regarding the first smoked cigarette and subsequent daily smoking.

What did these data tell us?

The conversion rate from the first smoked cigarette to daily smoking was calculated and analyzed. Predictably, the results varied somewhat by study design and methodology, nonetheless 60.3 percent of respondents reported they had ever tried a cigarette. Among those, over two-thirds (68.9 %) reported progressing to daily smoking.

Commenting the findings, researcher, Professor Peter Hajek from Queen Mary College in the U.K. stated:

“In the development of any addictive behaviour, the move from experimentation to daily practice is an important landmark, as it implies that a recreational activity is turning into a compulsive need. We’ve found that the conversion rate from ‘first time smoker’ to ‘daily smoker’ is surprisingly high, which helps confirm the importance of preventing cigarette experimentation in the first place.

In the U.K., the most recent prevalence data reveals that 19 percent of 11-15 year olds have ever tried a cigarette, which is lower than previous years. Given the high conversion rate established by the current study, researchers suggest that part of the reduction in smoking prevalence observed over the past 20 years can be attributed to less experimentation with cigarettes among adolescents.

Why Does This Matter?

  • Worldwide, tobacco use causes nearly 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030.
  • Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.
  • On average, smokers die 10 years earlier than nonsmokers.
  • If smoking continues at the current rate among U.S. youth, 5.6 million are expected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger who are alive today.

Source: CDC 2017

The relationship between the first cigarette and persistent smoking is not well-understood or established. And although overall prevalenceAsk the Expert continues to decline in the west, smoking remains a major modifiable health risk for far too many people, especially those who have their first cigarette as a child or teenager.

My early research established that smoking like other addictive behaviors are commonly initiated during adolescence, a time when the frontal cortical area in the human brain has yet to maturate. The brain’s dopaminergic reward path originates in the primitive midbrain, travels through the left ventral striatum, where the nucleus accumbens is located, to releases dopamine when humans (and all mammals) engage in basic survival behavior, (feeding, hydration, sex). The pathway terminates in the highly evolved prefrontal cortex (PFC) in humans. In healthy people, the PFC attains its full size and neuronal maturity by age 19 for females and 25 for males. When fully developed, the PFC has the capacity to mediate and prioritize the salience, context and importance of the DA signal, whereby predicting the potential risk and reward prior to behavioral engagement. In other words, this inhibitory function of the PFC mediates hedonically driven urges originating from the primitive midbrain. Thus, it makes humans less susceptible to risk taking and social pressures. Yet, psychoactive substances usurp the reward system, providing pleasure for health risk behaviors, and inhibiting the function of the PFC. As you can imagine, this is doubly dangerous during adolescence, before the brain’s PFC is fully developed.

Given the mortality associated with smoking and all addiction, preventing or delaying the first exposure to any psychoactive substance until the brain’s PFC is fully developed is a viable target for prevention efforts. Educating the public regarding the mechanisms for addiction and the heightened risks during adolescence should be a public health priority.

Max Birge MChem, MBBS, Stephen Duffy PhD, Joanna Astrid Miler PhD, Peter Hajek PhD. What Proportion of People Who Try One Cigarette Become Daily Smokers? A Meta-Analysis of Representative Surveys Nicotine & Tobacco Research, 2017, 1–7 doi:10.1093/ntr/ntx243