For many smokers, that first cigarette of the day is all part of the morning routine. But, new research suggests that smokers who light up first thing in the morning may have a disproportionate risk for developing lung cancer. According to a small study published in the December issue of the journal Cancer Epidemiology, Biomarkers & Prevention, people who smoke right after waking up show higher levels of cotinine, a metabolite of nicotine, compared with those who don’t take their first drag until later in the day—regardless of the total number of cigarettes they smoke throughout the day.
The study, led by researchers at Penn State College of Medicine, included 252 smokers, who smoked roughly 20 cigarettes per day. Across the group, researchers found, cotinine levels varied dramatically depending on how early subjects first lit up. Cotinine concentrations (measured in nanograms per milliliter) ranged from 16ng/mL to 1180ng/mL—a nearly 74-fold increase—, and the highest concentrations were found in people who began smoking first thing. Even if they smoked the same number of cigarettes throughout the day, smokers who lit up within the first 30 minutes of waking had dramatically higher levels of cotinine, compared with those who waited at least half an hour to have a smoke.
In the study, researchers categorized smokers who felt the need to have a cigarette first thing in the morning as being highly dependent, and those who could hold off for 30 minutes of lower dependency. The distinctions—and corresponding levels of risk—suggest the need to consider individual smokers’ levels of dependency and related behavior to more efficiently tailor methods to help them quit. As Joshua Muscat, a professor of public health at Penn State and one of the study’s authors, told the BBC:
“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.”
Of course, these are preliminary findings from a small study population, and further research is needed to determine whether these findings will spark overhaul of quitting methods in the future. But, in the meantime, if you’re a smoker struggling to kick the habit, skipping that early morning cigarette might be a good place to start.