The 13th World Conference on Tobacco OR Health

Objective: To describe the sequence and timing of milestones in the natural course of cigarette use onset.

Methods: Grade 7 students in ten secondary schools in Montreal (N=1293) were followed prospectively every 3-4 months for five years. The cumulative probability of attaining 12 smoking onset milestones according to time (in months) after first puff was computed using Kaplan-Meier analysis, among 311 participants who initiated cigarette smoking during follow-up.

Results: Inhalation occurred rapidly after first puff, followed sequentially by smoking a whole cigarette, self-reported mental addiction, cravings, self-reported physical addiction, monthly smoking, withdrawal symptoms and tolerance. These milestones typically occurred prior to a lifetime total of 100 cigarettes, weekly and daily smoking, and conversion to tobacco dependence. Once cravings were reported, the probability of daily smoking and conversion to tobacco dependence increased markedly. Symptoms of nicotine dependence develop soon after first puff and can precede monthly, weekly and daily smoking. Cessation interventions that manage symptoms of nicotine dependence may be needed soon after first puff.