April 08, 2020
2 min read
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Youth cigarette smoking yields frequent, sustained smoking in middle age

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Individuals who began smoking at a younger age were more likely to be daily smokers as adults and less likely to have quit smoking by their 40s, according to findings from the International Childhood Cardiovascular Cohort published in the Journal of the American Heart Association.

In addition, participants who did not begin smoking until their 30s were less likely to continue smoking into their 40s.

For this study of cigarette smoking in Finland, Australia and the U.S., researchers assessed seven study cohorts of which 46.9% of participants reported never smoking and 53.1% smoked at some point from age 6 to 19 years.

Researchers observed that children and adolescents who smoked daily were more likely to smoke daily in their 20s (P for trend < .001), and also more likely to continue smoking into their 40s (P for trend < .001).

Of participants who reported trying cigarettes from age 6 to 12 years, 50.4% became daily smokers as adults. This association declined as the age of trying first cigarettes rose (P for trend < .001).

Moreover, participants who began smoking at age 18 or 19 years and continued to smoke through their 20s were less likely to have quit by their 40s (P for trend = .004).

The patterns were similar across the three countries, according to the researchers.

For this international study of 6,687 participants (57% women), the researchers documented smoking prevalence and volume among individuals who were aged 6 to 19 years during the 1970s and 1980s who also reported smoking status during their 20s and 40s. This analysis did not report on CV outcomes within the cohort.

“Our findings add to a considerable literature that smoking that starts in childhood and adolescence is very hard to quit. The authors speculate that this reflects development of stronger impulse control as each person ages,” David R. Jacobs Jr., PhD, Mayo professor of public health in the division of epidemiology and community health at the University of Minnesota, Minneapolis, told Healio. “The results strongly support Tobacco 21, a movement to prevent any sale of tobacco products to persons under age 21. While this concept became federal law as part of the U.S. budget law enacted in 2019, tobacco sales are still allowed in this age range in most parts of the world.

“Legislators can help children and adolescents to avoid cigarettes entirely,” Jacobs told Healio. “Medical professionals can discourage smoking in individual patients and support family and environmental circumstances that strongly discourage cigarette smoking in childhood and adolescence. This advice should extend beyond the United States.”

Rose Marie Robertson

“This is a very important study, both because it has data from multiple countries and because it has been able to follow individuals into middle age, a critical observation. It reemphasizes the importance of keeping tobacco products out of the hands of children before age 21 to prevent long-term addiction,” Rose Marie Robertson, MD, FAHA, deputy chief science and medical officer for the AHA and co-principal investigator of the AHA’s Tobacco Center for Regulatory Science, said in the release. “Vaping products had not been introduced at the time these study participants were teens, but it is plausible that the findings may relate to vaping as well, since both addiction to nicotine and the adverse effects of nicotine on the developing brain in youth are relevant to these nicotine delivery devices as well.” – by Scott Buzby

Disclosures: The authors report no relevant financial disclosures.