An article published recently in The Lancet Global Health (June 1, 2020) and the University of Oxford – News looked at the risk of smoking in a large study conducted in Cuba. Evidence has shown that smoking causes about 100,000 deaths per week worldwide, more than coronavirus is now causing.

UK and US researchers from the Nuffield Department of Population Health at Oxford University, together with Cuban researchers from the National Institute of Cardiology in Havana, investigated the association between smoking habits, focusing on the age when smokers started, and cause-specific premature mortality in a large cohort of adults in Cuba that included 120,000 men and women aged 30-70 in five Cuban provinces.

smoking before age 15 Added-value of this study. Smoking before age

The main new finding of the study was the lethal effect of starting to smoke in childhood. The authors say that “The large excess mortality caused by starting to smoke in early adulthood is well recognized, but the effects of starting before age 15 years (and particularly before age 10 years) have not been adequately investigated (our emphasis) until now. Therefore, our findings from Cuba led us to re-examine US data relating adult mortality to participants starting to smoke regularly before age 15 years, which revealed similar effects of starting to smoke at younger than at older ages.” (our emphasis). These results are of great relevance for the US, also a great tobacco producer with similar smoking habits to those of Cuba. In this respect, according to the Global Adult Tobacco Surveys, at least 50 million adult smokers worldwide started before age 15 years.

The habit of smoke in childhood is more frequent that is thought, including 10 years old smokers

Results in figures

  • A third of current cigarette smokers started smoking before age 15 years.
  • All-cause mortality (i.e. all deaths that occur in a population, regardless of the cause) was highest in participants who had started at ages 5-9 years,
  • followed by ages 10-14 years,
  • and ages 20 or older. Smoking accounted for a quarter of all premature deaths in this population,
  • But quitting before about 40 years avoided almost all of the excess mortality due to smoking. Quitting is more common in the US and developed countries than in Cuba.


“Starting in childhood approximately doubled the rate of premature death […]. About half of participants who start smoking before age 15 years and do not stop will eventually die of complications from their habit. The greatest risks were found among adults who began smoking before age 10 years.

Reexamine anti-smoking campaigns giving special priority to the group most at risk appears to be an urgent issue. An apparently cultural issue that is difficult to combat with legal prohibitions.


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