The genetic predisposition to become addicted to nicotine is likely to be important in explaining why some young people shift from being experimental smokers to being lifelong smokers, and why many smokers find it difficult to give up smoking. However, it is clearly not the only explanation, and so we must not become complacent about dealing with the environmental factors that contribute to long-term smoking. For example, it has been shown in adolescents that having friends who smoke markedly increases the chances that an individual will smoke.8
Other factors that are likely to have a role include promotional activities by tobacco companies, access to cigarettes, parental smoking habits, and a society’s attitudes toward smoking. If a young person with a strong genetic predisposition to become a nicotine addict never tries a cigarette, then the genetic predisposition of that person is not so important. Thus, it is most important that programs, such as those supported and run by the ACCP, that are designed to encourage young people not to take up smoking, are maintained. Pressures must be placed on governments, not only in the United States, but also around the world, to limit the promotion of cigarettes to young people and to reduce adolescents’ access to them. Also, initiatives to make smoking an antisocial, unacceptable activity must be pursued to reduce the likelihood that smoking will be adopted by those predisposed to nicotine addiction, as well as those not so predisposed.