In the JournalsPerspective

More than two-thirds of individuals who try smoking become daily smokers

Approximately 69% of individuals who ever tried a cigarette progressed — at least briefly —to daily smoking, according to a study published in Nicotine and Tobacco Research.

“The ‘conversion rate’ from initial experimentation to daily smoking is a potentially important metric of smoking behavior, but estimates of it based on current representative data are lacking,” Max Birge, MChem, MBBS, from the Barts and the London School of Medicine and Dentistry at the Queen Mary University of London, and colleagues wrote.

Birge and colleagues performed a systematic review of existing data to determine the proportion of individuals who try one cigarette and subsequently become daily smokers. Researchers examined eight surveys from the Global Health Data Exchange that were conducted after 2000 and included questions about ever trying a cigarette and ever smoking daily. The surveys used representative samples of the general adult population and included 216,314 respondents.

The surveys revealed 60.3% of respondents ever tried a cigarette. Of these respondents, 68.9% had converted to smoking daily.

“This is the first time that the remarkable hold that cigarettes can establish after a single experience has been documented from such a large set of data,” Peter Hajek, PhD, a co-author of the study who is also from the Barts and the London School of Medicine and Dentistry at the Queen Mary University of London, said in a press release.

“In the development of any addictive behavior, the move from experimentation to daily practice is an important landmark, as it implies that a recreational activity is turning into a compulsive need,” he added. “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.”

The researchers noted a margin of error between 60.9% and 76.9% because the surveys included in the analysis used different methodologies and generated different results.

“Concerns were expressed that e-cigarettes could be as addictive as conventional cigarettes, but this has not been the case,” Hajek said. “It is striking that very few non-smokers who try e-cigarettes become daily vapers, while such a large proportion on non-smokers who try conventional cigarettes become daily smokers. The presence of nicotine is clearly not the whole story.” – by Alaina Tedesco

 

Disclosures: Hajek reports providing consultancy to and receiving research funding from manufacturers of stop-smoking medications. All other authors report no relevant financial disclosures.

 

Approximately 69% of individuals who ever tried a cigarette progressed — at least briefly —to daily smoking, according to a study published in Nicotine and Tobacco Research.

“The ‘conversion rate’ from initial experimentation to daily smoking is a potentially important metric of smoking behavior, but estimates of it based on current representative data are lacking,” Max Birge, MChem, MBBS, from the Barts and the London School of Medicine and Dentistry at the Queen Mary University of London, and colleagues wrote.

Birge and colleagues performed a systematic review of existing data to determine the proportion of individuals who try one cigarette and subsequently become daily smokers. Researchers examined eight surveys from the Global Health Data Exchange that were conducted after 2000 and included questions about ever trying a cigarette and ever smoking daily. The surveys used representative samples of the general adult population and included 216,314 respondents.

The surveys revealed 60.3% of respondents ever tried a cigarette. Of these respondents, 68.9% had converted to smoking daily.

“This is the first time that the remarkable hold that cigarettes can establish after a single experience has been documented from such a large set of data,” Peter Hajek, PhD, a co-author of the study who is also from the Barts and the London School of Medicine and Dentistry at the Queen Mary University of London, said in a press release.

“In the development of any addictive behavior, the move from experimentation to daily practice is an important landmark, as it implies that a recreational activity is turning into a compulsive need,” he added. “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.”

The researchers noted a margin of error between 60.9% and 76.9% because the surveys included in the analysis used different methodologies and generated different results.

“Concerns were expressed that e-cigarettes could be as addictive as conventional cigarettes, but this has not been the case,” Hajek said. “It is striking that very few non-smokers who try e-cigarettes become daily vapers, while such a large proportion on non-smokers who try conventional cigarettes become daily smokers. The presence of nicotine is clearly not the whole story.” – by Alaina Tedesco

 

Disclosures: Hajek reports providing consultancy to and receiving research funding from manufacturers of stop-smoking medications. All other authors report no relevant financial disclosures.

 

    Perspective
    Harold Farber

    Harold Farber

    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 U.S. 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 a very 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 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

    Disclosures: Farber reports serving as Chair, Tobacco Action Committee, American Thoracic Society and Associate Medical Director, Texas Children's Health Plan.