Screening Tools for Who Will Start Smoking and the Future of Clinical Prediction.

Abstract

Is the lack of a prognostic tool to assist clinicians in identifying youth at risk of transitioning from never to ever smoking a major barrier to counseling? Sylvestre et al1 address this in a longitudinal study of 12- to 13-year-olds in Montreal. They start with 58 candidate items on youth tobacco use initiation and monitor these early adolescents closely from 1999 to 2005, finding that 12 variables (age, 4 worry or stress items, 1 depression item, 2 self-esteem items, and 4 alcohol or tobacco items) are a best fit in predicting which youth go on to be among the ∼16% who were nonsmokers at baseline and then puffed on a cigarette during the coming year. The authors’ statistical analysis and use of modeling are elegant, and they call attention to an important and often overlooked fact that a first puff of a cigarette is a sentinel event that can rapidly lead to nicotine dependence and sustained smoking. However, the assumptions made by the authors in the question they posed, and thus the tool they developed, raise concerns that … Address correspondence to Jonathan D. Klein, MD, MPH, FAAP, Department of Pediatrics, University of Illinois at Chicago, 840 S Wood St, MC 856, Chicago, IL 60612. E-mail: jonklein{at}uic.edu