Ask an Expert: Concerns of a first-time smoker

Q: “I’m 17, and I've smoked twice in my life, both times last month. Now I’m coughing and my chest has a raw feeling to it. I’m not coughing up blood and I don't have shortness of breath, but I did hold the smoke in my mouth, and I breathed a little second-hand smoke, too. Could I have lung cancer?”

Answer from John R. Handy, Jr., M.D., co-director of Providence Thoracic Oncology Program and director of Providence Thoracic Surgery Program

You are right to be worried about the consequences of your smoking, because they can be very serious.

Each time you smoked, you exposed your body to cancer-causing chemicals. Although the exposure probably was not enough to give you lung cancer, your smoking very well may have contributed to your cough and that raw feeling in your chest.

An even more dangerous consequence, however, is that it put you at much higher risk of developing a lifelong addiction to tobacco, which could set you up for a lifetime of health problems. New studies are revealing that the first few cigarettes an adolescent ever smokes have a huge impact on whether or not he or she will become addicted. This is a health threat that you and your friends should take very seriously.

Since you have already experimented with smoking, it’s important for you to understand all of the possible consequences of your actions. Following is some more information about how smoking just two times may affect these three areas of your life:

  • Your risk of lung cancer
  • Your risk of other health problems
  • Your risk of addiction

Your risk of lung cancer
Just to set the record straight: when you smoke, it’s not only lung cancer you have to worry about. Smoking also causes cancers of the mouth, throat, voice box, esophagus, pancreas, kidney, bladder, stomach, cervix and blood (leukemia). The risk of getting lung cancer – the deadliest type of cancer – is 20 times higher in smokers than in non-smokers.

Your risk of getting these cancers increases with each additional cigarette and each additional day that you smoke. It’s all related to the amount of cancer-causing chemicals that you inhale into your body over time.

The amount of these chemicals that you exposed yourself to was comparatively small, so the chances that you got lung cancer from those two experiences are very small. (Even if you had developed lung cancer, you wouldn’t notice symptoms this soon. That’s another terrible thing about lung cancer – the symptoms, such as coughing up blood, don’t show up until the cancer is very advanced, and by then, it’s usually too late for a cure.)

However, that doesn’t mean those two smokes had no effect on you. By inhaling addictive chemicals, you put yourself at risk of tobacco dependency and all of the short-term and long-term health problems that can come along with it – including lung cancer.

Your risk of other health problems
Smoking just one or two times can cause immediate symptoms, such as the coughing and raw throat that you experienced, as well as nausea, lightheadedness, dizziness and other unpleasant feelings. That’s the instant effect of all those toxic chemicals coming out of a cigarette or cigar, which your body isn’t used to.

Other problems you could experience after just a couple of smokes include:

  • Wheezing, due to constricted airways
  • Increased phlegm production
  • Persistent coughing
  • Impaired physical performance
  • Constriction of blood vessels
  • Increased heart rate and blood pressure
  • Increased risk of blood clots
  • Elevated risk of stroke and heart attack
  • Heartburn Bad breath
  • Weakened immune system
  • Increased risk of colds, bronchitis and pneumonia (and slower recovery)

Read more about the immediate effects of smoking.

Your risk of addiction
Just about every person who is hooked on smoking today started out like you, with just a couple of smokes as a teen or preteen. Several studies have shown that the first cigarette smoked during adolescence has a serious impact on the risk of addiction. A 2000 study showed that “symptoms of dependence develop soon after the first cigarette.” Those findings have been confirmed by two more recent studies.

It’s an addiction that rivals heroin in terms of how hard it is to resist the cravings. That’s no exaggeration – that’s for real. The results of the latest study on tobacco addiction in youth (The Development and Assessment of Nicotine Dependence in Youth-2 Study, or DANDY-2, published in July 2007 in the Archives of Pediatrics and Adolescent Medicine) are so convincing that the study’s chief investigator concluded, “Prudence dictates that youth must be warned that it may take only one cigarette to initiate a lifelong dependence on tobacco.”

Don’t take another chance.
You’re at the right age to be asking these questions. If you can stave off the peer pressure to smoke in late adolescence, then you are unlikely to become a smoker.

Here are a few more motivating statistics:

  • Half of all smokers die from a disease related directly to cigarette smoking.
  • If you look at the top five reasons why people die in America, four of them are related directly to cigarette smoking.
  • People who smoke in the house or car with friends and family members subject their loved ones to increased risks of cancer, chronic respiratory infection, sudden infant death syndrome and all the other illnesses and risks faced by smokers.
  • There are no medicines you can take and very few things you can do that have a more positive effect on your overall health than not smoking cigarettes.

Don’t risk a lifetime of addiction and health problems. Take it from a doctor who spends every day with people who have lung cancer: Don’t smoke again.

I hope you will take this information to heart and share it with your friends. I’m glad you asked this question, and I wish you a long, healthy, smoke-free life.

November 2007  

Ask an Expert is a public education forum only.

Ask an Expert does not respond directly to your questions or provide personal medical advice, diagnoses, treatment recommendations or second opinions through our Web site or by e-mail. Please talk with your health care provider about any questions specific to your medical care.