Russell was a pioneer in recognizing the impact of the first cigarette smoked dur- ing adolescence: It takes no more than three or four casual cigarettes in this sen- sitive period virtually to ensure evolu- tion to regular dependent smoking within a few years. 3,6 In an era when smoking was the social norm, Russell stated that only about 15 per cent of those who have more than one cigarette avoid becoming regu- lar smokers. 3 Given his assertion that oc- casional and intermittent adult smokers were truly nondependent, 7 it was never clear why smoking a few cigarettes had such a profound influence, which he equated to a 40-year sentence. 7 The model describing dependence as a late sequela of regular heavy smoking was challenged in 2000 with the publication Author Affiliations: University of Massachusetts Medical School, Worcester (Drs DiFranza, Fletcher, Pbert, Ockene, and Wellman, and Mss Hazelton, Savageau, Friedman, Dussault, and Wood)
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