6.7 Addiction and the adolescent smoker
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Most smokers begin using tobacco during their teens.48 Intermittent or occasional smoking during adolescence is associated with a greater likelihood of becoming addicted, and of progressing to smoking on a daily basis, compared with experimentation in adulthood. About three quarters of teenagers who smoke regularly will continue smoking as adults.49 Those who start smoking as teenagers tend to smoke for longer, and to smoke more heavily, than those who adopt smoking at a later age.40 This in turn correlates with a much higher risk of developing tobacco-related disease later in life.50
There is evidence that signs of tobacco addiction may occur rapidly in adolescent smokers at low or intermittent levels of consumption.51, 52 Research from the US applying the Hooked on Nicotine Checklist ('HONC'—see Section 6.5) has shown that the loss of autonomy over smoking occurs on average within two months after the onset of smoking. The median consumption level at which symptoms of dependency were reported was two cigarettes per day, smoked on one day per week, and two thirds of respondents who reported experiencing a HONC symptom were not smoking on a daily basis.53 Related research showed that prior to the development of any HONC symptoms, occasional smokers were able to quit smoking far more readily. The onset of one or more symptoms of dependency heralded an increase in frequency of consumption, and although personal recognition that dependency had occurred may have led to quit attempts at this stage, quitting was now more difficult.54
In other US research using the HONC system, a study of young smokers (aged 12-13 and followed up over 30 months) showed that of children who had ever tried smoking, 40% reported symptoms of dependence.41 Of children who reported inhaling tobacco smoke, 58% reported symptoms of dependence. Of those children who reported experiencing one or more symptoms of dependence, 18% reported symptoms soon after first use, 33% reported symptoms when smoking once monthly, 49% reported symptoms with weekly smoking, and 70% recorded symptoms of dependency before the onset of daily smoking.41 Girls were more likely to report experiencing symptoms of dependency than boys, and to experience them earlier in their smoking career (median latency 21 days for girls compared to 183 days for boys).41 Other research from the US shows that younger smokers (aged 10–18) are around twice as likely to report that 'it's really hard to quit' than older smokers (aged 19–22) with the same consumption level.55
It is thought the apparent increased susceptibility to the addictiveness of tobacco in young people may be due to the comparative immaturity of the adolescent brain, leading to greater neurological disruption in response to nicotine.40, 41, 56 Adolescents who experience nausea, dizziness or relaxation when they initially smoke a cigarette are much more likely to develop a HONC symptom than those who do not.54
There is a significant gap between the reality of adolescent addiction to nicotine, and young smokers' beliefs about their ability to control their use of the substance. This is discussed in Section 6.11.
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