Objective: To examine the development of smoking behaviour among adolescents who, at age 11, had tried cigarettes just once.
Design: A five-year prospective study.
Setting: 36 schools in South London, England.
Subjects: A socioeconomically and ethnically diverse sample of students completed questionnaires annually from age 11–16. A total of 5863 students took part, with an annual response rate ranging from 74–85%. 2041 (35%) provided smoking status data every year.
Main outcome measures: Current smoking (smoking sometimes or more often) for the first time. Cotinine assays provided biochemical verification of smoking status.
Results: Students who at age 11 reported having tried smoking cigarettes just once (n = 260), but were not smoking at the time, were more likely to take-up smoking at a later age than those that had not tried smoking (n = 1719), even after a gap of up to three years of not smoking. The odds of starting to smoke at age 14 were 2.1 times greater (95% confidence interval 1.2 to 3.5) in the age 11 “one time triers” than the “non-triers”, even once sex, ethnicity, deprivation, parental smoking and conduct disorder were adjusted for.
Conclusions: This is the first clear demonstration of a “sleeper effect” or period of dormant vulnerability. Our findings have implications for understanding the development of cigarette use and for policies to reduce smoking in young people. Preventing children from trying even one cigarette may be important, and the design of interventions should recognise adolescents who have smoked just once, several years previously, as potentially vulnerable to later smoking uptake.
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Funding: This study was funded by Cancer Research UK and the Department of Health for England who had no involvement in any aspect of the design, collection, analysis and interpretation of data, the writing of the report or the decision to submit the paper for publication.
Conflict of interest: Robert West undertakes research and consultancy for developers and manufacturers of smoking cessation treatments such as nicotine replacement products. No other authors have any conflicts of interest.
Ethics approval: This study was approved by the University College London/University College London Hospital Ethics Committee
Contribution of authors: JAF, JW, NHB, MJJ and RW participated in the conception, analysis and interpretation of the above paper. JAF and RW wrote the manuscript and JW, MJJ and NHB were involved in revisions of the original manuscript.
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