1. Using nationally representative data, this study found that racial and ethnic disparities in smoking susceptibility among nonsmoking children, was persistent over the 15 year study period.
2. Compared to non-Hispanic whites, Hispanics were more susceptible to smoking, while non-Hispanic blacks and non-Hispanic Asian Americans were less susceptible to smoking.
Evidence Rating Level: 2 (Good)
Study Rundown: The vast majority of daily cigarette smokers initiate smoking prior to the age of 18. Little is known about trends in smoking susceptibility, a risk that precedes and strongly predicts smoking initiation. Using a nationally representative sample, this study is one of few that explore trends in racial and ethnic disparities in smoking susceptibility over recent years. Participants included never-smokers who answered 3 smoking susceptibility survey questions. Overall, youths were most susceptible to smoking from ages 13 to 15 years, with almost a third of nonsmokers susceptible at 14 years old. Smoking susceptibility averaged approximately 1 in 5 over the 15-year study period. Compared to non-Hispanic whites (NHWs), Hispanics were more susceptible to smoking for the entire study period. Non-Hispanic blacks (NHBs) and non-Hispanic Asian Americans (NHAs) were less susceptible to smoking compared to NHWs from 2000 to 2009. Smoking susceptibility among Hispanics peaked at ages 12 and 16.5 years, while NHBs were more susceptible at ages 11 to 13, compared to NHWs. This data can be used to strategically target high-risk racial/ethnic and groups before onset of cigarette smoking, thus implementing an efficient, directed prevention effort. While this study highlights important trends, the data is generalizable to in-school students only.
Study Author, Dr. Sherine El-Toukhy, PhD, MA, talks to 2 Minute Medicine: Division of Intramural Research, National Institute on Minority Health and Health Disparities, National institutes of Health, Bethesda, Maryland.
“Susceptibility means that youth are open to the idea of smoking. This article pinpoints specific ages at which youth are more likely to be susceptible to smoking and highlights differences in smoking susceptibility by race and ethnicity. Susceptibility to smoking can be used as a screening tool during clinic visits that helps physicians with prevention efforts directed toward at-risk youth to prevent them from initiating cigarette smoking in the first place.”
In-Depth [retrospective cohort]: Participants of this study included a nationally representative sample of non-smoking youths ages 9-21 years participating in the National Youth Tobacco Survey from 1999 to 2014 (n= 143, 917). Smoking susceptibility was assessed using youths’ responses to 3 specific survey questions. Overall, the proportion of susceptible youths was 21% from 1999 to 2008, and 23% from 2008 through 2014. Overall proportion of smoking susceptibility peaked from ages 13 to 15 years, with 27% of all non-smokers considered susceptible at age 14. Hispanics were more susceptible to smoking over the entire study period, compared to NHWs (highest aOR 1.67 in 2012). Among Hispanic youth, smoking susceptibility peaked at age 12 (aOR 1.60) and 16.5 (aOR 1.46). NHBs and NHAs were less susceptible than NHWs to smoking from 2000 to 2009 (lowest aOR 0.80 and 0.83, respectively). NHBs were more susceptible to smoking from ages 11 to 13 (highest aOR 1.22) while other non-Hispanics were more susceptible during ages 12 to 14 (highest aOR 1.27), compared to NHWs.
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