Eighty per cent of adult smokers start smoking before 18 years of age, at an average age of 15 years. (1) Young people assume that they will stop before they experience any serious health problems.
However, nicotine dependence can develop very quickly and most regular teenage smokers are soon unable to quit, often before they are smoking daily. (2)
Many different factors determine the risk of taking up smoking and many of these are beyond the child’s control. Young people may find it very hard to balance the possible short term gain of smoking against the long-term effects, until it is too late.
Genetics plays a major role
Genetic research over the last decade has found that inheritance is a major determinant of smoking. (4) About 50% of the chance that a child will even try a cigarette is due to their genetic makeup. Inherited personality traits such as risk-taking, poor self-control and rebelliousness are associated with having that first cigarette.
After initial experimentation, some children will become addicted to nicotine and some will not. It is estimated that about 50-60% of the risk of becoming nicotine-dependent is determined by one’s genetic makeup.
Peers and family
Smoking during adolescence is primarily a social activity and peer smoking is one of the strongest influences on smoking uptake, even more influential than parental smoking. Teenagers want to be perceived as ‘cool’ and be included in the peer group. They see smoking as something to share with friends. (5)
Parental smoking is also an important influence. This is due to a number of factors, including children modelling the behaviour, beliefs, expectations and attitudes of their parents, perceived parental approval of smoking and ready access to tobacco. Smoking rates are greater if both parents smoke and if an older sibling smokes. (6)
However, even with smoking parents, adolescents have a lower risk of smoking if parents express disapproval of smoking or ban smoking in the home. (7)
Like adults, young people may smoke to relieve anxiety and tension, to help them feel at ease in social situations and to help them cope with everyday stress. (8) Adolescence is a difficult time socially and emotionally for many young people and nicotine can provide temporary relief. For the same reasons, smoking is even more common in adolescents with mental illness such as ADHD, depression, social phobia and conduct disorder. (9)
Concerns about body weight also influence the uptake of smoking, especially for girls. Smoking suppresses the appetite and speeds up the metabolism, assisting with weight control. Gaining weight after quitting can also make giving up smoking harder and can lead to relapse. (10)
The socioeconomic status of the family is also a factor. (11) Children from lower socioeconomic groups with less parental education and income have higher smoking rates, perhaps because their parents are more likely to smoke or because they may be more likely to experience stress and difficult life events.
Smoking is also associated with lesser academic achievement. (12) Students who smoke are more likely to feel more negatively towards school, to miss school more often, to perform less well academically, to engage in early school misbehaviour and to drop out of school at an earlier age than non-smokers.
References available on request
Adolescent smoking is one of the key themes of the inaugural Australian Smoking Cessation Conference, being held at the University of Sydney from 6-8 November 2013. Professor Joseph DiFranza (http://profiles.umassmed.edu/profiles/ProfileDetails.aspx?From=SE&Person=49), the world’s foremost expert and researcher on adolescent smoking will be conducting a 4-hour workshop and giving presentations, along with other experts in the field. For more information go towww.sydney.edu.au/bmri/ascc2013.
Dr Colin Mendelsohn is a Tobacco Treatment Specialist and Vice-President of the Australian Association of Smoking Cessation Professionals. www.colinmendelsohn.com.au