Tobacco and Nicotine

Page last updated June 11, 2020 by Doug McVay, Editor/Senior Policy Analyst.

11. Initiation of Tobacco Use in the US, 2012

"• The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was approximately 2.3 million in 2012, which was similar to the estimates from 2004 through 2011 (ranging from 2.1 million to 2.5 million), but was higher than the estimates for 2002 and 2003 (1.9 million and 2.0 million, respectively) (Figure 5.7). The 2012 estimate averages to about 6,400 new cigarette smokers every day. About half of new cigarette smokers in 2012 (51.4 percent) initiated prior to age 18.
"• In 2002 and 2012, the numbers of cigarette initiates who were younger than age 18 when they first used were similar (1.3 million and 1.2 million, respectively). However, the number of cigarette initiates who began smoking at age 18 or older increased from 623,000 in 2002 to 1.1 million in 2012.
"• In 2012, among recent initiates aged 12 to 49, the average age of first cigarette use was 17.8 years, which was higher than the corresponding average age in 2011 (17.2 years).
"• Of those aged 12 or older who had not smoked cigarettes prior to the past year (i.e., those at risk for initiation), the past year initiation rate for cigarettes was 2.3 percent in 2012, which was similar to the rate in 2011 (2.4 percent).
"• Among youths aged 12 to 17 who had not smoked cigarettes prior to the past year (i.e., youths at risk for initiation), the incidence rate in 2012 was 4.8 percent, which was lower than the 2011 rate (5.5 percent). However, past year initiation rates in 2012 of 4.7 percent for males aged 12 to 17 and 4.8 percent for females in this age group who had never smoked prior to the past year were not significantly different from corresponding rates in 2011 (5.4 percent for males and 5.5 percent for females) (Figure 5.8). Past year initiation rates in 2012 among males and females aged 12 to 17 who were at risk for initiation of cigarette use were lower than the rates in 2002 to 2010."

Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, pp. 60-61.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...
12. Efficacy of E-Cigarettes in Tobacco Cessation and Dual Use of ENDS and Cigarettes

"Among adults, reductions in cigarettes per day were observed in several of the clinical studies83,84,86 and in 1 population-based study4 among those who did not quit. Reduction in cigarettes smoked per day could have benefit if it promotes subsequent cessation, as has been found with NRT,90 but this pattern has not yet been seen with e-cigarettes. In the cigarette reduction analyses presented in some of the studies, many participants were still smoking about half a pack cigarettes per day at the end of the study.
"Both duration (years of cigarette use) and intensity (cigarettes per day) determine the negative health effects of smoking.91 People who stop smoking at younger ages have lower age-adjusted mortality compared with those who continued to smoke later into adulthood.92 Findings for decreased smoking intensity have been less consistent, with some studies showing lower mortality with reduced daily cigarette consumption93 and others not finding a significant overall survival benefit.94 The 2014 report of the US Surgeon General concluded that 'reducing the number of cigarettes smoked per day is much less effective than quitting entirely for avoiding the risks of premature death from all smoking-related causes of death.'95 Use of electronic cigarettes by cigarette smokers to cut down on the number of cigarettes smoked per day is likely to have much smaller beneficial effects on overall survival compared with quitting smoking completely."

Rachel Grana, Neal Benowitz and Stanton A. Glantz, "Contemporary Reviews in Cardiovascular Medicine: E-Cigarettes: A Scientific Review," Circulation (Dallas, TX: American Heart Association, May 13, 2014). 2014;129:1972-1986. doi: 10.1161/CIRCULATIONAHA.114.007667, p. 1981.
http://circ.ahajournals.org/co...
http://circ.ahajournals.org/co...
13. Tobacco and Nicotine Addiction

"In summary, nicotine is the most potent constituent associated with the reinforcing effects of tobacco. However, researchers have identified other constituents in tobacco and tobacco smoke that may be reinforcing or facilitate reinforcing effects of tobacco. Nicotine metabolites have also been identified as potential reinforcers or enhancers of the reinforcing effects of nicotine. Researchers have observed that in addition to nicotine and other constituents of tobacco and tobacco smoke, sensory aspects of nicotine and environmental stimuli also have a significant role in maintaining smoking behavior (Rose et al. 1993; Shahan et al. 1999; Caggiula et al. 2001, 2002b; Perkins et al. 2001d) (for details, see “Learning and Conditioning” later in this chapter)."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 113.
http://www.cdc.gov/tobacco/dat...
14. Medicinal Nicotine Products and Addiction Potential

"Nonetheless, although the pharmacokinetics of some smokeless tobacco products may overlap with those of medicinal nicotine products, medicinal products tend to have a slower rate and a lower amount of nicotine absorption than do the most popular brands of conventional smokeless tobacco products (Kotlyar et al. 2007). Among the medicinal nicotine products, nicotine nasal spray has the fastest rate of nicotine absorption, followed by nicotine gum, the nicotine lozenge, and the nicotine patch.
"Together, these results demonstrate that the nicotine pharmacokinetics associated with cigarette smoking is likely to lead to high potential for addiction, whereas medicinal nicotine products have relatively minimal potential for addiction. For example, the extent of liking, and therefore the addiction potential for these products, are related to the speed of nicotine delivery (Henningfield and Keenan 1993). Nicotine delivered through cigarette smoking and intravenously shows the greatest dose-related liking for the drug, and nicotine delivered transdermally is associated with the least liking (Henningfield and Keenan 1993; Stratton et al. 2001)."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 114.
http://www.cdc.gov/tobacco/dat...
15. Tobacco and Nicotine Addiction

"Long-term exposure to nicotine produces biologic adaptations leading to reduced sensitivity to some of the effects of nicotine (tolerance) and symptoms of distress soon after cessation of drug use (withdrawal). Tolerance of nicotine in adolescent smokers may be related to onset of drug dependence, even though tolerance in adult smokers does not appear to be related to different indices of nicotine addiction. Withdrawal symptoms, especially self-reported cravings and negative affect, are related to some indices of addiction. A narrower focus on the individual withdrawal symptoms most strongly related to relapse, such as negative affect (e.g., depressed mood), may increase understanding of the underlying mechanisms associated with the maintenance of nicotine addiction and requires further study.
"Positive reinforcement from nicotine may play a more significant role in the initiation of smoking, and negative reinforcement, particularly relief from withdrawal, is an important contributor to the persistence of smoking and relapse. Measures of nicotine’s reinforcing effects, especially the most common measure—self-reported number of cigarettes smoked per day—are consistently related to other indices of addiction, including the risk of relapse. However, other objective measures of nicotine’s reinforcing effects, especially those reflecting persistence in smoking behavior, may provide even stronger markers of addiction for predicting clinical outcomes and for testing the efficacy of new treatments or tobacco products. Such measures may also be useful as endophenotypes of dependence for future research into the etiology of addiction, including the influence of a person’s genetic composition. Therefore, the development of these validated markers and measures for nicotine and smoking reinforcement is critical for future research examining the etiology and treatments for nicotine addiction and for tobacco product testing."

US Department of Health and Human Services. "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General." Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010, p. 124.
http://www.cdc.gov/tobacco/dat...

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