Nearly all smokers start before the age of 18 years.1,2 Smoking prevalence escalates rapidly during adolescence,3 and early onset of smoking is associated with a greater likelihood of being an adult smoker and with higher levels of consumption.4 Young smokers can become addicted to smoking very rapidly, even at low levels of consumption,2,5 and at significantly lower nicotine levels than adults.6 A review of international research has concluded that over two-thirds of people who try one cigarette become, at least temporarily, daily smokers.7 Early and sustained interventions for young people are therefore critical, in order to reduce both the duration and intensity of total tobacco use, with subsequent positive impacts on long-term health consequences.4
The preceding sections provide a framework for understanding the many and varied factors that influence an individual's behaviour in relation to smoking. Individual variables such as personal physiology and personality traits interact with the family environment, social milieu and broader societal expectations and contexts. The strength of influence of each determinant can be expected to fluctuate in importance, depending on individual trajectory of age and life experience. It is within the context of this complex cultural mix that children make decisions. With this in mind, further research is warranted, focusing on the interactions of factors influencing smoking initiation. Better understanding of the factors that underlie uptake as well as being able to identify those that may be amenable to change are both essential in the development of effective youth smoking interventions.
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1. Action on Smoking and Health. Beyond smoking kills: protecting children, reducing inequalities. London: ASH, 2008. Available from: http://www.ash.org.uk/files/documents/ASH_691.pdf.
2. US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm
3. Guerin N and White V. Australian secondary school students alcohol and drug (ASSAD) survey 2017 second edition. Melbourne: Cancer Council Victoria, 2020. Available from: https://www.health.gov.au/resources/collections/australian-secondary-school-students-alcohol-and-drug-assad-survey-2017
4. US Department of Health and Human Services. Preventing tobacco use among young people: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2012/
5. DiFranza J, Rigotti N, McNeill A, Ockene J, Savageau J, Cyr D, et al. Initial symptoms of nicotine dependence in adolescents. Tobacco Control 2000;9(3):313–9. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/9/3/313
6. Rubinstein M, Luks T, Moscicki A, Dryden W, Rait M and Simpson G. Smoking-related cue-induced brain activation in adolescent light smokers. Journal of Adolescent Health 2011;48(1):7–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21185518
7. Birge M, Duffy S, Miler JA, and Hajek P. What proportion of people who try one cigarette become daily smokers? A meta analysis of representative surveys. Nicotine and Tobacco Research, 2017. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29126298