1. In a large and diverse cohort study, multiple susceptibility factors accurately predicted smoking outcomes 4 years later.
2. Exposure to tobacco marketing and electronic cigarette use were also strongly associated with smoking outcomes.
Evidence Rating Level: 2 (Good)
Study Rundown: Previous research has shown that the majority of adult smokers experimented with tobacco during adolescence. In this study, researchers aimed to better understand how smoking susceptibility and tobacco industry advertising affect initiation of smoking behaviors amongst youth. A 4-item susceptibility test was administered to adolescent never-smokers aged 12-17, including questions related to their curiosity about smoking, prognostication about their smoking status, and peer pressure. Enrolled subjects were also asked about whether they had viewed tobacco-product related marketing on social media or used an app that was tobacco-related. After adjusting for age and demographics, a dose-response relationship was seen between number of susceptibility measures and likelihood to experiment or actively engage in cigarette smoking, as well as specific tobacco related media exposures. A major limitation of the study is that it did not consider mental health symptoms or use of other tobacco products as possible predictors of cigarette use. Overall, findings indicate that using smoking susceptibility questionnaires and inquiring about tobacco media exposure may enable primary care physicians to identify adolescents at risk for future smoking.
In-Depth [prospective cohort]: 8,899 participants were enrolled as part of wave 1, with the majority (67.2%) classified as non-susceptible. By Wave 4, 16.4% of these never smokers had become experimental smokers, 7.6% were current smokers, and 1.8% were established smokers (67.2% remained never smokers). Compared with non-susceptible adolescents, subjects with one susceptibility item at wave 1 were more likely to be experimental (aOR = 2.0; 95% CI = 1.7–2.3) and current (aOR =1.7; 95% CI = 1.3–2.1) smokers at wave 4. Adolescents with level 2 susceptibility at wave 1 were more likely to be experimental smokers (aOR = 3.8; 95% CI = 3.1–4.7). Adjusted for tobacco-related marketing and media exposure, youth who endorsed 3 or 4 susceptibility items at wave 1 were more likely to be experimental (aOR = 6.0; confidence interval [CI] = 4.8–7.4), current (aOR = 4.2; CI = 3.2–5.4), or established (aOR = 4.4; CI = 2.4–7.9) smokers at wave 4. Use of electronic cigarettes at any wave was associated with an increased risk of experimental cigarette use (aOR = 7.7; 95% CI = 6.6–9.1) among youth.
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