Early smoking onset and risk for subsequent nicotine dependence: a monozygotic co-twin control study
Open accessAbstract
OBJECTIVE: Early onset of regular smoking is associated with an elevated risk for later nicotine dependence. Whether or not this association is causal is unknown and has substantial public policy implications. METHOD: The authors used a monozygotic co-twin control study design. Pairs were selected from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders for discordance in age at onset of regular smoking. Nicotine dependence was measured by the Fagerström test for nicotine dependence and level of craving. RESULTS: The authors identified 175 male-male and 69 female-female monozygotic twin pairs who differed by at least 2 years in age at onset of regular smoking. During their period of heaviest smoking, the twin who began smoking earlier had significantly higher Fagerström test scores in both the male-male (Cohen's d=0.20) and female-female twin pairs (d=0.26). Craving for cigarettes when unable to smoke was also higher in the early-onset member in both groups (male pairs, d=0.38; female pairs, d=0.25). The early-onset smoking twin did not differ from the later-onset twin in symptoms of alcohol or cannabis abuse or dependence, current alcohol use, or maximal level of cannabis, sedative, stimulant, or cocaine use. CONCLUSIONS: Controlling for genetic and familial-environmental effects, age at onset of regular smoking predicted level of nicotine dependence. Consistent with the animal literature, these findings suggest that in humans, early nicotine exposure directly increases level of later nicotine dependence. These results should be interpreted in the context of the methodological strengths and limitations of the monozygotic co-twin design.
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This also provides a biological basis for the clinical observation that the age of first cigarette use is a critical determinant of tobacco dependence, with those who begin in their early teens having the greatest difficulty quitting.
“This also provides a biological basis for the clinical observation that the age of first cigarette use is a critical determinant of tobacco dependence, with those who begin in their early teens having the greatest difficulty quitting [157,158].”
From Nicotine on the developing brain. (2023) · cites this paper as [158]
The Results report that twins who began regular smoking earlier had higher later nicotine-dependence scores, and the Discussion says the findings suggest—but do not prove—a causal link. The study measured onset of regular smoking, not age at first cigarette use, and the cited passages do not establish that early-teen starters have the greatest difficulty quitting. (LLM, conf=0.87)
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Self-citation
- Authors
- Kendler, K. S., Myers, J., Damaj, M. I., & Chen, X.
- Affiliations
- Virginia Commonwealth University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2013-04
- Volume
- 170
- Issue
- 4
- Pages
- 408-413
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3615117
- OpenAlex
- W2117546511
- Cited by
- 177
- References
- 41
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 12 · 2023: 9 · 2022: 17 · 2021: 11 · 2020: 15 · 2019: 18 · 2018: 14 · 2017: 20 · 2016: 13 · 2015: 14 · 2014: 14 · 2013: 1 · 2012: 1
- FWCI
- 9.73
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH040828, MH 40828, R01MH049492)
- National Institute on Drug Abuse (/DA-49492, R01DA011287, K01DA019498, DA-019498, DA011287)
- National Center for Research Resources (UL1RR031990)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Keywords
- early smoking onset, nicotine dependence, monozygotic twin discordance, nicotine craving, Fagerström Test for Nicotine Dependence, tobacco use, alcohol and cannabis use
- MeSH terms
- Adult, Female, Humans, Male, Risk Factors, Sex Characteristics, Smoking, Tobacco Use Disorder, Twins, Monozygotic, Virginia, Behavior, Addictive, Age of Onset, Substance-Related Disorders
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