Underage smoking increases nicotine dependence, making cessation more difficult
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Key takeaways:
- Japanese individuals who started smoking cigarettes at a younger age smoked more per day and had greater nicotine dependency.
- Smoking initiation below the legal age was tied to lower rates of smoking cessation.
People who started smoking before the legal age smoked more cigarettes per day and had greater nicotine dependence and lower rates of smoking cessation vs. those who initiated after the legal age, researchers reported.
In addition, in a Japanese cohort, those who started smoking at age 20 years or younger had higher levels of self-reported depression and antidepressant use, according to data presented at the European Society of Cardiology Congress.
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“Our results show that starting smoking early is linked with higher nicotine dependency, even in young adulthood,” Koji Hasegawa, MD, PhD, of the Clinical Research Institute at National Hospital Organization Kyoto Medical Center and the division of molecular medicine at University of Shizuoka School of Pharmaceutical Sciences, both in Japan, said in a press release. “The study indicates that increasing the legal age to buy tobacco to 22 years or older could lead to a reduction in the number of people addicted to nicotine and at risk of adverse health consequences.”
For this study, Hasegawa and colleagues evaluated the impact of age at smoking initiation on rate of smoking cessation, nicotine dependency and psychological status, with a cutoff point of age 20 years — the legal smoking age in Japan.
The study included 1,382 individuals (mean age, 58 years; 30% women) who visited the National Hospital Organization Kyoto Medical Center outpatient clinic for smoking cessation from 2007 to 2019. Participants were stratified by age at smoking initiation, with 556 initiating before age 20 years and 826 initiating at age 20 years or older.
Researchers used the Fagerström questionnaire score to assess nicotine dependency, with questions including, “How soon after you wake up do you smoke your first cigarette?”, “Do you find it difficult to refrain from smoking in places where it is forbidden?” and “How many cigarettes per day do you smoke?”. Lower scores were indicative of lower nicotine dependency.
Psychological status was assessed using the Zung Self-Rating Depression Scale (SDS).
Hasegawa and colleagues reported that individuals who started smoking at age 20 years or older were on average older by the time of their visit to the smoking cessation clinic (54 vs. 61 years; P < .001) and smoked fewer cigarettes per day (average, 25 vs. 22 per day; P < .001) compared with those who started smoking at age 20 years or younger.
The researchers observed that individuals who started smoking at age 20 years or older had lower self-reported levels of nicotine dependency (mean Fagerström score, 7.4 vs. 6.3) and depression (SDS score, 41 vs. 39; P for all < .001; proportion taking antidepressants, 8.8% vs. 5.6%; P = .023) and a higher rate of smoking cessation (45.5% vs. 56%; P = .001) compared with those who started smoking at age 20 years or younger.
Moreover, they observed a trend of lower nicotine dependency with increasing age at smoking initiation (P < .001).
Reference:
- Smokers who start below age 20 become more addicted and find it difficult to quit. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Smokers-who-start-below-age-20-become-more-addicted-and-find-it-difficult-to-quit. Published Aug. 25, 2023. Accessed Aug. 25, 2023.
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Komiyama M, et al. Abstract 81503. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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