Cigarette smoking and other forms of tobacco use are responsible for over 440,000 deaths per year in the U.S. Health consequences associated with cigarette smoking include cardiovascular disease, respiratory disease, and cancer. Despite awareness of the health risks, approximately 21% of the U.S. adult population smokes. Efforts to-date to reduce smoking-related disease and illness have focused on prevention and intervention strategies that encourage cessation. Adolescence is a critical period for both intervention and prevention. Because more than three-fourths (80%) of adult smokers reported starting to smoke prior to the age of 18, prevention and brief intervention is likely to be most effective during this early period of time. In addition, earlier age of onset for smoking is associated with greater subsequent dependence severity, more substantive health sequelae, and less successful outcomes following subsequent quit attempts. Several studies have explored potential demographic and psychosocial variables that may help predict the likelihood adolescents may initiate smoking. Interestingly, many of these studies have focused predominately on Caucasian populations. Thus, is it unclear whether such findings hold true with population subgroups such as African American youth. In research to-date, AA and Caucasian groups differ in rates of smoking initiation, subsequent levels of nicotine dependence, and tobacco cessation efforts. Additionally, as adults, AA bear a disproportionate weight of smoking-related adverse health effects. Previous studies posit that certain variables (demographics, social/peer influences) may differentially influence smoking in AA adolescents. Clearly, more research is needed comparing predictors of AA adolescent smoking to those published with predominantly Caucasian adolescent samples. The present study (N=150) employed a computer-directed assessment to examine smoking in an urban sample of AA adolescents recruited through their primary care provider. The assessment included demographic and psychosocial variables previously found to predict the likelihood of an adolescent trying a cigarette in Caucasian adolescent samples (e.g., peer smoking, adult smoking in the home, self-esteem, and self-efficacy). Findings indicated that AA adolescent smokers (ever smokers) were more likely to have friends who have tried smoking, were more likely to have adult smokers in the home, and scored lower in self-efficacy skills germane to avoiding situations where smoking was present, as compared to nonsmokers. Additionally, computerized assessment for tobacco use was found to be useful in clinic settings. Study findings can aid in the development of specialized prevention and cessation campaigns for minority populations.

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Smoking rates among senior students have been related to smoking initiation in younger students. Opportunities to select smoking friends may be one explanation, however our understanding of this process has been limited by cross-sectional designs. <br ><br /> The purpose of this longitudinal study was to determine whether senior student smoking rates a) predict smoking initiation in younger elementary school students, controlling for individual exposure to family and friends who smoke and b) are related to the selection of smoking friends, increasing risk of smoking initiation as a result. <br ><br /> This study involved secondary data analysis of 2798 students from 84 Ontario elementary schools involved with the Third Waterloo Smoking Prevention Project (WSPP3). Grade 8 students completed a questionnaire at baseline to obtain the percentage of senior students who smoke in each school. Students in grade 6 completed a similar questionnaire at baseline, and were surveyed again in grades 7 and 8. Multilevel regression analyses were used to examine school and individual characteristics simultaneously. <br ><br /> Each 5% increase in the senior student smoking rate at a school increased the risk that a non-smoking grade 6 student would try smoking more than once by grade 8 (OR 1. 05) and that a non-smoking grade 6 student with no smoking friends would gain a smoking friend by grade 7 (OR 1. 10). Students who remained non-smokers in grade 7 but gained a smoking friend were more likely to try smoking more than once by grade 8 (OR 4. 31). <br ><br /> In schools where a high proportion of senior students smoked, younger students were more likely to initiate smoking, and gain a smoking friend. Anti-smoking policies and interventions may be more urgently required in these schools to lower senior student smoking rates and reduce initiation among younger students. Tailoring the intensity and content of programs to match the needs of schools is one way to potentially maximize effectiveness.

Smoking rates among senior students have been related to smoking initiation in younger students. Opportunities to select smoking friends may be one explanation, however our understanding of this process has been limited by cross-sectional designs. <br ><br /> The purpose of this longitudinal study was to determine whether senior student smoking rates a) predict smoking initiation in younger elementary school students, controlling for individual exposure to family and friends who smoke and b) are related to the selection of smoking friends, increasing risk of smoking initiation as a result. <br ><br /> This study involved secondary data analysis of 2798 students from 84 Ontario elementary schools involved with the Third Waterloo Smoking Prevention Project (WSPP3). Grade 8 students completed a questionnaire at baseline to obtain the percentage of senior students who smoke in each school. Students in grade 6 completed a similar questionnaire at baseline, and were surveyed again in grades 7 and 8. Multilevel regression analyses were used to examine school and individual characteristics simultaneously. <br ><br /> Each 5% increase in the senior student smoking rate at a school increased the risk that a non-smoking grade 6 student would try smoking more than once by grade 8 (OR 1. 05) and that a non-smoking grade 6 student with no smoking friends would gain a smoking friend by grade 7 (OR 1. 10). Students who remained non-smokers in grade 7 but gained a smoking friend were more likely to try smoking more than once by grade 8 (OR 4. 31). <br ><br /> In schools where a high proportion of senior students smoked, younger students were more likely to initiate smoking, and gain a smoking friend. Anti-smoking policies and interventions may be more urgently required in these schools to lower senior student smoking rates and reduce initiation among younger students. Tailoring the intensity and content of programs to match the needs of schools is one way to potentially maximize effectiveness.

Objectives: To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. Methods: Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents’ age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents’ age of smoking initiation. Results: Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d’Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. Conclusions: West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.