Elsevier

Addictive Behaviors

Volume 29, Issue 2, February 2004, Pages 261-272
Addictive Behaviors

Recollections and repercussions of the first inhaled cigarette

https://doi.org/10.1016/j.addbeh.2003.08.002Get rights and content

Abstract

Context: It has not been determined if a youth's reaction to the first smoking experience is predictive of future nicotine dependence, or whether the impact of the first cigarette can be altered by manipulating levels of tar, nicotine and menthol. Objective: To determine if the recalled response to the first cigarette is predictive of the development of symptoms of nicotine dependence and whether it is influenced by the type of cigarette smoked. Design and Setting: A retrospective/prospective longitudinal study of the natural history of nicotine dependence employing individual interviews conducted three times annually in two urban school systems over 3 years. Subjects were asked to recall their first smoking experience. Participants: A cohort of 237 subjects who had inhaled on a cigarette. Main Outcome Measures: Symptoms associated with smoking; the Hooked on Nicotine Checklist of 10 symptoms of dependence. Results: Reactions to the initial smoking experience were unrelated to gender or cigarette brand, strength or mentholation. Relaxation in response to the first inhalation was the strongest predictor of symptoms of nicotine dependence. Dizziness and nausea were also independent predictors of dependence symptoms. Conclusions: The data suggest that increased sensitivity to nicotine as manifested by relaxation, dizziness, or nausea in response to the first exposure to nicotine represents a risk factor for the development of nicotine dependence.

Introduction

Individuals react to their first cigarette in different ways (Pomerleau, Collins, Shiffman, & Pomerleau, 1993). Nausea, burning throat, bad taste, and coughing are aversive symptoms, while lightheadedness, a ‘rush,’ a ‘buzz,’ dizziness, and relaxation can be pleasurable Hirschman et al., 1984, Pomerleau et al., 1998. Common sense might suggest that a pleasant experience would predict continued experimentation, while an unpleasant initial smoking experience would discourage further use (Kozlowski & Harford, 1976). The sensitivity model predicts, paradoxically, that individuals who first experience adverse effects will be at higher risk for subsequent dependence (Pomerleau et al., 1993). Drug naive individuals with high innate sensitivity to nicotine are predicted to be more likely to experience both symptoms of nicotine toxicity (nausea, dizziness) and the reinforcing pharmacological effects of nicotine (relaxation). It is proposed that nicotine is a stronger reinforcer for nicotine-sensitive individuals, hence sensitivity (toxicity) would predict subsequent dependence (Pomerleau et al., 1993).

While the literature is consistent in indicating that pleasant reactions predict continued use, Bewley et al., 1974, Friedman et al., 1985, Hirschman et al., 1984, Pomerleau et al., 1998, Pomerleau et al., 1999, the predictive value of adverse reactions has been decidedly mixed. The common sense model is supported by a report that adverse reactions were far more common among college students who had not taken up smoking than among those who had (Kozlowski & Harford, 1976). Also, genetic studies have revealed that impaired metabolism of nicotine is protective against continued tobacco use (Tyndale & Sellers, 2001). Consistent with the common sense model, unpleasant reactions did not predict the subsequent course of smoking in several studies Bewley et al., 1974, Friedman et al., 1985, Hirschman et al., 1984, Palmer, 1970, Pomerleau et al., 1998.

Consistent with the sensitivity model, Pomerleau et al. (1993) and Shiffman (1989) reported that chippers (adult smokers with minimal signs of dependence) had fewer aversive reactions than regular smokers, and that subjects who felt “sick or dizzy on first smoking” were more likely to progress to regular smoking. Although dizziness can be a symptom of toxicity, it can also be a behaviorally rewarding sensation, clouding the interpretation of this finding.

Two studies have reported no gender effects in the number of unpleasant initial reactions Friedman et al., 1985, Hirschman et al., 1984, but Silverstein, Feld, and Kozlowski (1980) reported that girls were significantly more likely to report feeling sick as a result of smoking their first cigarette than were boys.

Methodological challenges add to the difficulty of work in this area. Friedman et al. (1985) report that half of young smokers do not inhale their first cigarette. It is possible that the first cigarette did not represent an actual exposure to nicotine in many subjects in previous studies. The doses received by those who do inhale must vary. Memories of early smoking experiences may be selective or altered by long recall periods. It is not known whether adults paid to smoke in controlled experimental conditions react in the same way to the initial dose of nicotine as children do when sneaking their first puff.

The impact of cigarette characteristics such as nicotine delivery and mentholation on the initial smoking experience has not been reported. Silverstein et al. (1980) speculated that the availability of low nicotine cigarettes might make it easier for girls to smoke their initial cigarette without becoming sick, thereby contributing to rising smoking rates among teenage girls. This theory was not supported by a survey of British adolescent smokers, of whom, only 10% regularly smoked low-tar brands (Jarvis, Marsh, & Matheson, 1989).

The purposes of our study were to determine if the properties of the cigarette affect the initial smoking experience, and if youths' initial reactions to cigarette smoke are predictive of nicotine dependence, that is, the subsequent loss of autonomy over the use of nicotine.

Section snippets

Methods

A more detailed description of the methods for the main outcomes of the DANDY (Development and Assessment of Nicotine Dependence in Youths) study have been published (DiFranza et al., 2000). This was a longitudinal study of a single cohort of seventh grade youths followed over a period of 30 months. The data were collected through eight rounds of individual interviews conducted in the schools approximately every 4 months between January 1998 and June 2000 using a structured protocol.

Results

Of the 679 subjects, almost half (49%, n=332) had used tobacco. Among the 332 tobacco users, 132 reported at least one HONC symptom (40%). HONC symptoms were more common among the 237 subjects who reported inhaling tobacco (53%) than among the 95 subjects who had tried tobacco but who denied inhaling (6%, OR=16.8, 95% CI=7–40). Monthly smoking was reported by 145 subjects (21% of all subjects, 44% of tobacco users), and 91 subjects progressed to daily use (13% of all subjects, 27% of tobacco

Discussion

Our results provide support for the sensitivity model: subjects who experienced relaxation, dizziness and nausea in response to their first inhaled cigarette were more likely to develop symptoms of nicotine dependence.

The calming effect of nicotine is consistently given by adolescents as the primary reason for smoking Albrecht et al., 2000, Benowitz, 1988, Dappen et al., 1996, Dozios et al., 1995, Lotecka & Lassleben, 1981, Parrott, 1995, Wang et al., 1996. Consistent with previous studies, we

Acknowledgments

This study was funded by grant number CA77067-03 from the National Cancer Institute and by the Massachusetts Department of Public Health Tobacco Control Program. The opinions expressed in this paper are those of the authors and do not necessarily represent the official views of the National Cancer Institute or the Massachusetts Department of Public Health.

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