Abstract :
Purpose
Because recent tobacco control efforts have focused almost entirely on adolescent prevention programs, we examined the hypothesis that prevention of adolescent smoking initiation may not prevent the onset of smoking in adults. Factors associated with age of smoking initiation are examined among those who initiated smoking as adults, adolescents, and those who never smoked.
Methods
Subjects were participant in the 2002 National Health Information Survey (NHIS) aged 18–28 who gave an answer to the question about ever having smoked ≥100 cigarettes. Age of initiation was dichotomized at <18 and ≥18 years. Smoking initiation was defined as lifetime use ≥100 cigarettes. Logistic regression models were constructed with sex, race, alcohol use, income, educational level, exercise frequency, number of cigarettes smoked per day, and geographic region of residence. Analyses were weighted to take into account the complex sampling design of the NHIS.
Results
Among the 33.2% (1820 of 5480) who reported smoking, 34.2% (622 of 1820) initiated smoking after the age of 18 years. Compared to nonsmokers, adult initiators were more likely to consume moderate-to-large amounts of alcohol (OR 3.88; CI: 3.05, 4.93; p < 0.001), and reside in the Midwestern United States (OR 1.74; CI: 1.23, 2.48; p = 0.002). Compared to adolescent smokers, adult initiators were more likely to be Black (OR 2.53; CI: 1.68, 3.82; p < 0.001) or other ethnic minorities (OR 1.63; CI: 1.08, 2.48; p = 0.021), have a college education (OR 4.42; CI: 2.96, 6.60; p < 0.001), and reside in the Western United States (OR 1.76; CI: 1.15, 2.71; p = 0.010).
Conclusion
Prevention of adolescent smoking initiation does not necessarily prevent the initiation of smoking in adulthood. Antismoking campaigns aimed at adolescents may merely delay smoking initiation into adulthood. If antismoking campaigns targeted at adolescents are to have lasting impact, then perhaps targeted interventions are needed to prevent delayed smoking initiation in adulthood.
