Quitting smoking is more difficult for those who start early

People who begin smoking by the age of 16, and have experienced a challenging childhood, are more likely to find it harder to give up than those who started smoking later and had not experienced the same problems, new research has found.

Using data from the 1958 National Child Development Study (NCDS), researchers at the University of Toulouse found that the age at which people start smoking can have an impact on when they manage to quit, and how likely they are to relapse. The effects can be worse for those who also faced more adversity in childhood.

Long-term impact

NCDS follows the lives of thousands of people, born in England, Scotland and Wales in a single week in 1958.

The research used NCDS data to examine the long-term impact of taking up smoking in adolescence and early adulthood. The researchers analysed data from 8,757 individuals in Great Britain who reported being smokers or former smokers at age 23. Information on smoking initiation was assessed by whether individuals had started smoking by the age of 16. This data was then compared to information on smoking habits during adulthood, collected between the ages of 23 and 55.

Among those who reported being smokers or former smokers by age 23, half had started in adolescence by age 16.

The researchers also examined the combined effect of starting smoking at 16 with experiencing difficult circumstances in childhood. By analysing information collected at ages seven, 11 and 16 from questions to the child’s parents, teacher or health visitor, the researchers were able to define these challenges into six categories, including a childhood in care, physical neglect or family experience of alcohol abuse.

Finding it harder to quit

The research showed that among those who reported being smokers or former smokers by age 23, half had started by age 16. It also showed that those who started smoking by age 16 were five times more likely to take longer to quit compared to those who had started smoking in early adulthood (between age 16 and 23). Those who started early were also three times more likely to relapse, and five times more likely to be persistent smokers.

Of those who had reported being smokers or former smokers by age 23, a third had suffered challenges in childhood. Almost a fifth (18%) had experienced both a challenging childhood and had started smoking by the age of 16. The impact of smoking was also worse for this group. They were more likely to take longer to quit, mostly in their 40s and 50s, compared to those who did not experience adversities and who did not start smoking until later. They also had more of a chance of relapsing.

Of all those reporting being a smoker or former smoker by age 23, three quarters had a parent who smoked.

A population at risk

The health implications of this are considerable. According to the World Health Organisation, tobacco use is responsible for the world’s leading causes of death: cancer, cardiovascular disease, chronic lung disease, and diabetes.

This new NCDS research also builds on earlier studies which have shown that the physiological effects of nicotine can be worse during adolescence, when the brain is still developing.

The authors said: “Nicotine intake can lead to structural changes in the brain that are strongly implicated in addiction mechanisms… Furthermore, nicotine consumption can increase the onset of anxiety disorders, also related with withdrawal symptoms that increase cravings. This in turn reinforces the need for nicotine to reduce cravings, while worsening these anxiety disorders over time in a vicious circle of interdependence.”

As well as highlighting the need to foster positive childhood environments, the study recommends that smoking prevention programmes should be targeted at adolescents – especially those who have had a harder upbringing – when trying to prevent young people taking up the habit in the first place.

“People who have suffered adversities during childhood can also be considered as a population at risk by nurses and other medical and non-medical professionals responsible for prevention programs in schools, social services and other structures aimed at adolescents, in order to reduce initiation during adolescence and limit the burden of smoking,” the study recommended.

The authors called for further research to understand the influence of taking up smoking with e-cigarettes at a young age, and how that combines with a difficult start in life.

Further information

‘The effect of smoking initiation in adolescence on the subsequent smoking trajectories of people who smoke, and the role of adverse childhood experiences: Results from the 1958 British cohort study’ by Camille Joannès, Michelle Kelly-Irving, Sébastien Couarraze, and Raphaële Castagné was published in November 2023 on the Public Health Nursing website.