American Association for Cancer Research

AACR Press Releases

Rise and Shine Shouldn’t Mean Cigarette Time: Increased Nicotine Levels Detected in Those Who Light-up Earlier


December 3, 2009

• Time to first cigarette after waking is a valid measure of nicotine dependence.
• Results suggest a possible association for increased risk for lung cancer.
• Cessation efforts should consider behavioral aspects of nicotine dependence.

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PHILADELPHIA - People who smoke their first cigarette within minutes after waking up have much higher levels of cotinine, a by-product of nicotine when processed by the body, than those who wait to smoke, regardless of the number of cigarettes smoked.

"Since cotinine levels appear to reflect the risk of lung cancer, our results suggest that smokers who smoke immediately after waking may be especially at risk for lung cancer," said researcher Joshua E. Muscat, Ph.D., M.P.H., professor of public health sciences at Penn State College of Medicine. "These people may require a more intensive intervention than other smokers to help them quit smoking on a sustained or permanent basis."

Results of this study are published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, as part of a special tobacco focus in the December issue.

Nicotine levels in the blood can be measured biochemically by the concentration of the metabolite cotinine. Muscat, along with John P. Richie, Jr., Ph.D., professor of public health sciences and pharmacology at Penn State College of Medicine, and colleagues conducted a community-based study in Westchester County, N.Y., to examine whether a behavioral aspect of nicotine dependence (the amount of time to the first cigarette after waking up) affects the physiological uptake of nicotine. This in turn may affect one's success in quitting smoking and have multiple health effects, such as lung cancer.

The study included 252 healthy black and white people who were daily cigarette smokers. Researchers examined a number of behavioral factors that are thought to measure the urge to smoke, and results showed a clear trend between lighting-up earlier and higher cotinine levels.

Cotinine levels varied from 16 ng/mL to 1180 ng/mL - a 74-fold difference, according to the study. Participants who waited 30 minutes or more were categorized into the "low" dependant phenotype; those who smoked within the first 30 minutes of waking were considered "high." Number of cigarettes smoked per day and its association with cotinine levels varied as well.

"Not all smokers are the same and approaches to smoking reduction may need to account for individual smoking behaviors such as the intensity and frequency of puffing, cravings and physiological symptoms," said Muscat. "It is unclear why smokers who take their first puff immediately after waking have higher cotinine levels, but this may reflect a more intense pattern of smoking. We need to find out why this is."

The researchers are currently conducting follow-up studies to investigate levels of additional nicotine metabolites that will further confirm this association and help determine the impact of time to first cigarette as a novel risk factor for lung cancer.

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The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Media Contact:
Tara Yates
(267) 646-0558
tara.yates@aacr.org