Burning question: Researchers chart nicotine addiction among teens

We can all imagine a heavily addicted smoker reaching for a pack of cigarettes on the bedside table and lighting up before getting out of bed in the morning, but the individual in our imagined scenario likely is not a 12-year-old child. Yet adolescents as young as 12 do smoke, and researchers have found that the sooner they do so upon waking in the morning, the more addicted they may be.

“Among adults, a shorter time to the first cigarette after waking up in the morning has become increasingly recognized as an indicator of nicotine dependence because of its association with biological measures of nicotine exposure, smoking relapse and failed cessation attempts,” said Steven Branstetter, assistant professor of biobehavioral health at Penn State. “However, until now, no one had examined the relationship between time to first cigarette and these measures among adolescents.”

Branstetter — whose research focuses on youth tobacco use, tobacco cessation and the influence of family, peers and social context in adolescent behavior — teamed up with Joshua Muscat, professor of public health sciences at Penn State, to examine data from the National Health and Nutrition Examination Survey. The team narrowed the survey participants down to 220 adolescents between the ages of 12 and 19 who were regular smokers. The researchers’ goal was to examine the relationship between time to first cigarette, the number of cigarettes smoked per day, and blood levels of continine, a metabolite of nicotine.

The team found that the time to first cigarette was significantly correlated with several smoking behaviors, including the number of cigarettes smoked per day, the time since the last cigarette and having a family member who smokes at home.

“Most importantly, we found that a shorter time between waking and having the first cigarette of the day is a strong indicator of nicotine uptake, as defined by serum continine levels, in adolescents,” said Branstetter. “In other words, adolescents who smoke sooner after waking up in the morning tend to inhale more deeply and more thoroughly, which is why they have higher levels of continine in their blood. And these kids who take in more nicotine per cigarette may be more dependent on nicotine — regardless of the number of cigarettes they smoke per day.”

The results appeared online Sept. 18 in the journal Nicotine & Tobacco Research.

According to the researchers, compared with adults, adolescent smokers tend to be lighter smokers overall, are less likely to inhale when they smoke and are less likely to smoke when they are ill. Nevertheless, even adolescent smokers who smoke less than five cigarettes a day or who are nondaily smokers experience dependence and withdrawal symptoms at very high rates.

“The time to first cigarette could be an important component in screening for high-risk smoking adolescents and could also help in designing tailored smoking cessation interventions for these youth,” said Branstetter.