In this research study, Gervais and colleagues describe the sequence and timing of 12 milestones (6 related to cigarette use and 6 to symptoms of nicotine dependence) among grade 7 students. They found that symptoms of nicotine dependence can take hold long before regular smoking, even after the first puff in some cases.
This information needs to be incorporated into intervention programs aimed at young smokers.
In a related commentary, Klein discusses the challenges in helping young smokers quit and the need for stronger public health efforts to keep youth from starting in the first place.
p. 255 Milestones in the natural course of onset of cigarette use among adolescents
-- A. Gervais et al
Adolescents and smoking: The first puff may be the worst
-- J.D. Klein