Recollections and repercussions of the first inhaled cigarette
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.
References (29)
- et al.
Smoking onset among teens: An empirical analysis of initial situations
Addictive Behaviors
(1985) Some variables contributing to the onset of cigarette smoking among junior high school students
Social Science and Medicine
(1970)- et al.
Adolescent nicotine exposure causes persistent upregulation of nicotinic cholinergic receptors in rat brain regions
Brain Research
(1999) - Albrecht, S. A., Braxter, B., Allison, B. A., & Reynolds, M. D. (2000, February). Predictors of smoking cessation among...
Pharmacologic aspects of cigarette smoking and nicotine addiction
New England Journal of Medicine
(1988)- et al.
Factors associated with the starting of cigarette smoking by primary school children
British Journal of Preventive & Social Medicine
(1974) - et al.
A survey of adolescent smoking patterns
Journal of the American Board of Family Practice
(1996) - et al.
Tobacco acquisition and cigarette brand selection among youth
Tobacco Control
(1994) - et al.
Initial symptoms of nicotine dependence in adolescents
Tobacco Control
(2000) - et al.
Measuring the loss of autonomy over nicotine use in adolescents: The DANDY (Development and Assessment of Nicotine Dependence in Youths) Study
Archives of Pediatrics & Adolescent Medicine
(2002)
Smoking patterns and cessation motivations during adolescence
International Journal of the Addictions
The development of smoking behavior: Conceptualization and supportive cross-sectional survey data
Journal of Applied Social Psychology
Factors influencing choice of low-tar cigarettes
Cited by (131)
Subjective effects as predictors of substance use disorders in a clinical sample: A longitudinal study
2023, Drug and Alcohol DependenceStimulus functions of nicotine
2022, Advances in PharmacologySubjective experiences at e-cigarette initiation: Implications for e-cigarette and dual/poly tobacco use among youth
2021, Addictive BehaviorsCitation Excerpt :The relationship between negative subjective experiences (e.g., nausea) at initiation and progression to sustained tobacco use is more complex. For example, negative subjective experiences at initiation reduce the probability of sustained use for cigar products (Mantey et al., 2017) and smokeless tobacco (Zabor et al., 2013) but increase the risk for progression to sustained use (Klein et al., 2013; Sanouri Ursprung et al., 2011) of combustible cigarettes and onset of nicotine dependence (DiFranza et al., 2004; Sanouri Ursprung et al., 2011). Research examining subjective experiences at e-cigarette initiation remains limited.
Subjective responses predict d-amphetamine choice in healthy volunteers
2021, Pharmacology Biochemistry and BehaviorThe motivational valence of methamphetamine relates inversely to subsequent methamphetamine self-administration in female C57BL/6J mice
2021, Behavioural Brain ResearchCitation Excerpt :MA-taking elicits a variety of drug effects in the individual user that range from those typically perceived to have positive motivational/affective valence (e.g., euphoria and high energy) to those often perceived to have negative motivational/affective valence (anxiety, dysphoria, headaches, cardiovascular hyperactivity) [3,4]. Clinical and epidemiological data point to individual differences in the perception of a drug’s effects as appetitive or aversive as having a major influence upon the risk of continued drug abuse and subsequent addiction (e.g. [5–10,79,84]). However, a large number of confounding variables (incl. other drug abuse or therapeutic drug treatment, trauma &/or frequent aversive life events, duration of drug abstinence etc.) render it difficult to disentangle cause-effect relations between subject factors, biomarkers and addiction vulnerability/resiliency in human subjects, as it is impossible to study these relations in any systematic, experimentally-controlled, fashion.