Adolescent Smoking Initiation Research Articles

Preventing smoking initiation in adolescents living in vulnerable socioeconomic conditions: Study protocol of the KickAsh!-intervention.

Adolescents living in vulnerable socioeconomic conditions are confronted with tobacco-related health disparities. As school-based interventions appear to be less effective among these youngsters, other approaches are necessary. One promising avenue is youth social work settings that offer sport and recreational activities (SR-settings). SR-settings have been examined as a levering context for health promotion, but evidence regarding smoking prevention is currently lacking. This study describes the protocol of a non-randomised cluster controlled trial evaluating a smoking prevention intervention for adolescents. At least 24 SR-settings are needed for the intervention and control group. A mixed-method design will be used. Quantitative measures will be used to assess effectiveness, involving validated questionnaires on smoking initiation behaviour and influencing factors (i.e. attitude, self-efficacy, social influence and risk perception). In addition, feasibility will be assessed with regard to intervention fidelity, dose and reach. Data will be collected at baseline, three and nine months following the intervention. To gain deeper understanding on the impact and underlying processes of the intervention, we will conduct qualitative interviews with users (adolescents) and implementers (youth workers within the SR-settings) of the intervention. Conducting this trial will offer novel insights into the effectiveness of a smoking prevention intervention designed for adolescents living in vulnerable socioeconomic conditions. A mixed-method design will enable to measure impact, implementation and underlying processes of the intervention. Overall, this design will enhance our understanding on the suitability of SR-settings as contexts for smoking prevention initiatives targeting hard-to-reach youth. This trial is registered on Clinicaltrials.gov: NCT05920772.

Gene-environment transactions between peer cigarette use, parental supervision, and Chinese adolescent cigarette smoking initiation.

The initiation and continued use of tobacco products constitute an ongoing source of preventable disease that continues to pose a significant risk to global adolescent health. Scarce research has sought to explore the influences of two well-known environmental risk factors, parental supervision and peer cigarette use, on genetic and environmental contributions to adolescent cigarette use, especially in non-Western populations. Following 602 Chinese twin pairs (52% female, N = 1204) from early to middle adolescence at two-time points (Mage = 12 and 15) from 2006 to 2009 and using multivariate biometric modeling, this study examined gene-environment interplay (i.e., gene-environment correlation and interaction) between perceived parental supervision, peer cigarette use, and adolescent cigarette smoking initiation. From early to middle adolescence, genetic influences on cigarette smoking initiation became more pronounced, whereas shared environmental influences that promote similarity between family members diminished. Genetic factors primarily explained the links between parental supervision and cigarette smoking initiation in mid-adolescence. Peer cigarette use displayed stronger associations with and moderating potential in adolescent cigarette smoking initiation than parental supervision. High levels of peer cigarette use amplified genetic risk for cigarette smoking initiation in mid-adolescence. Chinese adolescent cigarette smoking initiation involves dynamic gene-environment transactions primarily with peer processes over development. Mid-adolescence constitutes a developmental period wherein underlying genetic risk for cigarette smoking initiation is particularly sensitive to peer influences. Targeted interventions aimed at reducing Chinese adolescent cigarette smoking initiation should focus on peer processes during this developmental period.

Factors associated with initiation of tobacco smoking among schooling adolescents in the age group of 13 – 15 years in the Kandy district, Sri Lanka

Adolescent smoking problem has still remained a public health concern, but factors that contribute to the initiation of adolescent smoking are not well-known in Sri Lanka. The study aimed to determine the factors associated with the initiation of tobacco smoking among schooling adolescents in government schools in the age group of 13-15 years in the Kandy district. A cross-sectional study was conducted in selected government schools of Sinhala, Tamil, and English mediums in the Kandy district. The subjects were selected using a stratified multi-stage cluster sampling method. A pretested self-administered questionnaire was used. The factors associated with the initiation of smoking were determined by a multivariable analysis using logistic regression.A total of 1395 students (Male 52.9%) were included in the study. The initiation of tobacco smoking was significantly associated with being a male student (Adjusted Odds ratio (AOR)=26.24; 95% CI=7.49-91.44), the parent being a smoker (AOR=6.04; 95% CI=2.83-12.91), education level of a father below GCE O/L (AOR=5.65; 95% CI=2.20-14.49), education level of mother below GCE O/L (AOR=2.63; 95% CI=1.18-6.25), presence of household member who smokes (AOR=7.10; 95% CI=2.76-18.29), social network use (AOR=10.73; 95% CI=3.63-31.75) and the parent being a quitter (AOR=0.29; 95% CI=0.11-0.79). Factors identified for smoking initiation give a clue to intervene in the target population focusing family related and other modifiable factors.

The effect of smoking initiation in adolescence on the subsequent smoking trajectories of people who smoke, and the role of adverse childhood experiences: Results from the 1958 British cohort study.

To examine the association between smoking initiation in adolescence and subsequent different smoking trajectories of people who smoke, and to examine the combined effect of adverse childhood experiences (ACEs) and smoking initiation in adolescence on smoking trajectories of people who smoke. Data are from 8757 individuals in Great Britain from the birth cohort National Child Development Study and who reported being smokers or former smokers by age 23. Smoking initiation in adolescence was measured at 16 y and smoking trajectories were derived from smoking variables from ages 23 to 55. We modelled the relationship between smoking initiation in adolescence with or without ACEs and smoking trajectories. Individuals who initiated smoking in adolescence were more likely to quit later than quitting in twenties (RRR quitting in thirties =3.43 [2.40; 4.89] p<.001; RRR quitting in forties =5.25 [3.38; 8.14] p<.001; RRR quitting in fifties =4.48 [2.95; 6.79] p<.001), to relapse (RRR Relapse =3.66 [2.82; 4.76] p<.001) and to be persistent smokers (RRR persistent =5.25 [3.81; 7.25] p<.001) compared to those who had initiated smoking in young adulthood. These effects were particularly pronounced in case of ACEs. Smoking prevention programs aimed at reducing smoking initiation should be promoted to adolescents to limit the burden of smoking, especially for people who have suffered adversity during childhood.

Association between vmPFC gray matter volume and smoking initiation in adolescents

Smoking of cigarettes among young adolescents is a pressing public health issue. However, the neural mechanisms underlying smoking initiation and sustenance during adolescence, especially the potential causal interactions between altered brain development and smoking behaviour, remain elusive. Here, using large longitudinal adolescence imaging genetic cohorts, we identify associations between left ventromedial prefrontal cortex (vmPFC) gray matter volume (GMV) and subsequent self-reported smoking initiation, and between right vmPFC GMV and the maintenance of smoking behaviour. Rule-breaking behaviour mediates the association between smaller left vmPFC GMV and smoking behaviour based on longitudinal cross-lagged analysis and Mendelian randomisation. In contrast, smoking behaviour associated longitudinal covariation of right vmPFC GMV and sensation seeking (especially hedonic experience) highlights a potential reward-based mechanism for sustaining addictive behaviour. Taken together, our findings reveal vmPFC GMV as a possible biomarker for the early stages of nicotine addiction, with implications for its prevention and treatment.

Early-life tobacco smoke exposure, genetic susceptibility and the risk of type 2 diabetes in adulthood: A large prospective cohort study

ObjectivesWe aimed to assess the relationships between early-life tobacco smoke exposures and the incident risk of type 2 diabetes (T2D) in later life as well as the joint effects and interactions between genetic susceptibility and early-life tobacco exposures. MethodsWe used data on in utero tobacco exposure and the age of smoking initiation to estimate the status of early-life tobacco exposure in the UK Biobank. Cox proportion hazard models were applied to estimate the associations between early-life tobacco exposure and T2D risk and investigate joint effects and interactions of early-life tobacco smoke exposure with genetic susceptibility. ResultsAmong 407,943 subjects from the UK Biobank, 17,115 incident cases were documented during a median follow-up of 12.80 years. Compared with subjects without prenatal tobacco exposure, those with in utero tobacco exposure had a higher risk of T2D with a hazard ratio (HR) (95 % confidence interval [CI]) of 1.11 (1.08, 1.15). Besides, the HRs (95 % CIs) of incident T2D for smoking initiation in adulthood, adolescence, and childhood (vs. never smokers) were 1.36 (1.31, 1.42), 1.44 (1.38, 1.50), and 1.78 (1.69, 1.88), respectively (P trend <0.001). No interaction between early-life tobacco exposure and genetic susceptibility was observed. In addition, participants with prenatal (HR 4.67 [95 % CI 4.31, 5.06]) or childhood (6.91 [6.18, 7.72]) tobacco exposure combined with high genetic risk showed the highest risk of T2D, compared to low genetic risk subjects without early-life smoke exposure. ConclusionEarly-life tobacco exposure was associated with an increased risk of T2D later in life regardless of genetic background. This highlights the significance of education campaigns aimed at reducing smoking among children, adolescents, and pregnant women as an effective measure to combat the T2D epidemic.

Near majority of adults favor R ratings for films with smoking

Near majority of adults favor R ratings for films with smoking

In Utero and Childhood/Adolescence Exposure to Tobacco Smoke, Genetic Risk, and Lung Cancer Incidence and Mortality in Adulthood.

Rationale: The individual effects of early-life tobacco smoke exposure and its interactions with genetic factors on lung cancer in adulthood remain unclear. Objectives: To investigate the associations of early-life tobacco exposures as well as their interactions with polygenic risk scores (PRSs) with lung cancer incidence and mortality. Methods: A total of 432,831 participants from the UK Biobank study were included. We estimated the associations of in utero exposure to tobacco smoke, the age of smoking initiation and their interactions with PRSs with lung cancer incidence and mortality in adulthood using Cox proportional hazard models. Measurements and Main Results: Lung cancer incidence (hazard ratio [HR]: 1.59, 95% confidence interval [CI], 1.44-1.76) increased among participants with in utero tobacco exposure. Multivariable-adjusted HRs (with 95% CIs) of lung cancer incidence for smoking initiation in adulthood, adolescence, and childhood (versus never-smokers) were 6.10 (5.25-7.09), 9.56 (8.31-11.00), and 15.15 (12.90-17.79) (Ptrend < 0.001). Similar findings were observed in lung cancer mortality. Participants with high PRSs and in utero tobacco exposure (versus low PRSs participants without in utero exposure) had an HR of 2.35 for lung cancer incidence (95% CI, 1.97-2.80, Pinteraction = 0.089) and 2.43 for mortality (95% CI, 2.05-2.88, Pinteraction = 0.032). High PRSs with smoking initiation in childhood (versus never-smokers with low PRSs) had HRs of 18.71 for incidence (95% CI, 14.21-24.63, Pinteraction = 0.004) and 19.74 for mortality (95% CI, 14.98-26.01, Pinteraction = 0.033). Conclusions: In utero and childhood/adolescence exposure to tobacco smoke and its interaction with genetic factors may substantially increase the risks of lung cancer incidence and mortality in adulthood.

Associations of adverse childhood experiences with smoking initiation in adolescence and persistence in adulthood, and the role of the childhood environment: Findings from the 1958 British birth cohort

Adverse childhood experiences (ACEs) have been identified as a strong determinant of smoking. We aimed to examine the association between ACEs and early smoking initiation and subsequent persistence and the contribution of five pathways including family factors, parental involvement, material living conditions, social activities and conscientiousness.Data are from 7414 individuals born in 1958 in Great Britain included in the National Child Development Study. ACEs were measured at ages 7, 11, and 16. Smoking initiation was derived from smoking variables from ages 16 to 42 and persistent smoking was derived from smoking variables from ages 23 to 42. We modelled the relationship between ACEs and smoking, and further assessed the contribution of each pathway using multinomial logistic regressions.During childhood, 20.9% of respondents experienced one ACE and 6.4% two or more. Those who experienced ACEs had a higher risk of initiating smoking by age 16 and of persistent smoking (RRR initiation by 16y = 1.89 [1.62; 2.20] for one ACE; RRR initiation by 16y = 2.36 [1.81; 3.08] for two or more ACEs, and RRR persistent smoking = 2.07 [1.73; 2.47] for one ACE, RRR persistent smoking = 2.59 [1.92; 3.49] for two or more ACEs). The factors that contributed most to explaining these associations were parental smoking, sibling order and conscientiousness. ACEs remained associated with persistent smoking after further adjusting for young adulthood variables.Smoking prevention measures may need to be tailored when considering adolescents from communities where ACEs are more prevalent to curtail initiation, intensity and persistence. FundingThis work was supported by the Institut National du Cancer & the Institut de recherche en santé publique (grant agreement: No. [2019–204]).

Perceived health risks associated with the use of tobacco and nicotine products during the COVID-19 pandemic.

INTRODUCTIONThe perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. This study aimed to examine the perceived risks of tobacco use on COVID-19 infection and severity, and possible COVID-related changes in perceptions of tobacco use and overall health.METHODSWe conducted an online survey of adults in the United States in June 2020 (n=2097). The survey covered cigarettes, cigars, e-cigarettes, and hookah. We also assessed changes in the use of any of the four tobacco products. Multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product, with the adjustment of demographic and COVID-19 related variables.RESULTSFor all four tobacco products, the perceived risks to general health were slightly higher during the pandemic than before the pandemic (77% vs 79.5% for cigarettes) and the perceived risk of COVID-19 severity was larger than the perceived risk of COVID-19 infection (73.3% vs 56.2% for cigarettes). All risk measures varied with tobacco products consistently, with the risks highest for cigarettes, then cigars, followed by e-cigarettes and hookah. Females and people with higher income or education were more likely to endorse the risks of tobacco use than their counterparts. People who perceived higher risks of using cigarettes (OR=1.65; 95% CI: 1.20–2.27) and cigars (OR=1.63; 95% CI: 1.17–2.27) to COVID-19 severity were more likely to have decreased or quit their use.CONCLUSIONSTobacco/nicotine use was perceived to increase the risk of COVID-19 severity and the perceived risk of tobacco/nicotine use to general health was high during the pandemic, particularly for cigarettes. The change of perceived risks appeared to be prompting harm-reducing changes in tobacco product use.

Association between electronic cigarette use and tobacco cigarette smoking initiation in adolescents: a systematic review and meta-analysis

BackgroundThis systematic review of prospective longitudinal primary studies sought to determine whether electronic cigarette (e-cigarette) use by teenagers who had never smoked conventional tobacco cigarettes (tobacco cigarettes) at baseline was associated with subsequently commencing tobacco cigarette smoking.MethodsThe review followed the principles of a systematic review and meta-analysis. A key word search identified peer-reviewed articles published between 1 January 2005 and 2 October 2019 from seven bibliographic databases and one search engine. Using pre-prepared inclusion/exclusion criteria two researchers independently screened abstracts, and subsequently, full text papers. Selected articles were quality assessed in duplicate. Data on study participants characteristics, exposure and outcome measures were recorded in an adapted Cochrane Data Extraction Form. Feasibility assessment was done to detect clinical heterogeneity and choose an approach to meta-analysis. Analysis comprised pairwise random effects meta-analyses, and sensitivity and subgroup analyses.ResultsFrom the 6619 studies identified, 14 one-off primary studies in 21 articles were suitable for inclusion. The participants ages ranged from 13 to 19 years and comprised teenagers based in Europe and North America. Nine of the 14 one-off studies, with follow-up periods between 4 and 24 months, met the criteria for inclusion in a meta-analysis of the association between ever use of e-cigarettes and subsequent initiation of tobacco cigarette use. Based on primary study adjusted odds ratios, our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00–5.48, I2 68%, 9 primary studies) times higher odds of commencing tobacco cigarette smoking for teenagers who had ever used e-cigarettes at baseline, though the odds ratio were marginally lower (to 3.71 times odds, 95%CI: 2.83–4. 86, I2 35%, 4 primary studies) when only the four high-quality studies were analysed.ConclusionThe systematic review found that e-cigarette use was associated with commencement of tobacco cigarette smoking among teenagers in Europe and North America, identifying an important health-related harm. Given the availability and usage of e-cigarettes, this study provides added support for urgent response by policymakers to stop their use by teenagers to decrease direct harms in this susceptible population group, as well as to conserve achievements in diminishing tobacco cigarette initiation.

Identifying and selecting effective graphic health warnings to prevent perceptual wearout on tobacco packaging and in advertising

AbstractGraphic visual health warnings (GHWs) on cigarette packaging are used in more than 120 countries globally. Because there are concerns about the effectiveness of using the same visual warnings over many years due to wearout, a primary issue is how to identify the most effective visual stimuli. Adolescent smokers and nonsmokers provided more than 2000 ratings of different visual warnings. Cluster analysis and follow‐up analyses are used to identify a high‐performing visual stimuli group from the larger group of GHWs. Subsequent analyses also show that compared to other pictorial stimuli, the high‐performing group is perceived as effective in preventing adolescent smoking initiation and adolescent smokers' motivation to quit. These findings addressing the selection and evaluation of high‐performing visual warnings have implications for global health and public policy communities through identification of pictorial warnings that can be most effective in impacting smoking‐related outcomes for adolescents.

Tobacco-Free Home Rules and Association with Adolescent Smoking Initiation

Tobacco-Free Home Rules and Association with Adolescent Smoking Initiation

Early smoking initiation and changes in body weight, blood pressure and lipid profile in males: results of a 26-year prospective study

Aim. To study the relationship of early smoking initiation (adolescence) with changes in body weight, blood pressure (BP), and lipid profile in males within a prospective study. Material and methods. This paper presents the results of a 26-year follow-up of two groups: group 1 — males who began to smoke up to 17 years; group 2 — males who have not smoked until 17 years of age. The examination included a standard questionnaire, anthropometry, blood pressure measurement, determination of lipids and apolipoproteins (apo). Results. In males with an early smoking initiation, its prevalence by the age of 22 was 64,8%, and by the age of 43 it decreased to 41,7%. At 43, 60% of the original number of smokers continued to smoke. The relative risk for adolescents who started smoking before 17 years of age to be every day smoker at the age of 22, 33 and 43, respectively, was 2,2, 1,7 and 2,1 times higher than their peers who did not smoke before 17 years. With age, the prevalence of smoking decreased and its intensity increased (number of cigarettes smoked per day). At 33-43, in the group of early smoking initiation, compared with nonsmokers, there were higher values of body mass index, waist circumference, waist-to-hip ratio, systolic and diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, apo B, and apo B/apo AI ratio. Conclusion. Smoking initiation in adolescence is associated with an early adherence to smoking, higher prevalence in young adulthood and a high probability of continuation in adulthood. It also contributes to the general and abdominal obesity in adulthood and increases the atherogenicity of lipoprotein profile.

The Cigarette Smoking Initiation and Continuation in Adolescents Undergoing a Long-Term Behavioral Intervention.

Targeting adolescents' smoking reduces its burden on health systems. We investigated the effects of the first multidisciplinary community-based lifestyle intervention in the Eastern Mediterranean region, on smoking initiation, continuation, and risk of current smoking in Iranian adolescents. The current analyses were conducted on 945 nonsmoker adolescents (12-18 years) who participated in Phase II of Tehran Lipid and Glucose Study (TLGS) and were examined four times in 12 years. The lifestyle intervention including school-based and public programs was implemented, focusing on all components of healthy lifestyle. Using a two-step cluster analysis, families were classified as high and low risk, based on parental risk factors of adolescents' smoking. Participants who failed to complete all the follow-ups (n = 99) and those with missing smoking data were excluded. Subsequently, 872 adolescents (538 control, 334 intervention) were included in the Cox model on smoking initiation, and 674 adolescents (414 control, 260 intervention) were included in the logistic regression on smoking status. Mean age of adolescents was 15.08 ± 1.94 years at baseline. The hazard of the smoking initiation was significantly lower in the intervention (hazard ratio = 0.71, 95% confidence interval: 0.51-0.99; p = .044) compared with control group. At the end of the fourth follow-up, intervention reduced the odds of current cigarette smoking by 29%. Within the intervention group, the high-risk cluster was at a 35% lower risk of initiating smoking and had 37% lower odds of becoming a current smoker. However, the intervention could not make a difference in preventing those who initiated smoking from maintaining it during the follow-ups. Our results demonstrate that lifestyle modification programs targeting at-risk populations could reduce risk of smoking initiation and current smoking in adolescents in long term. Experiencing cigarette smoking at the critical period of adolescence could result in adulthood habitual smoking. Therefore, identifying adolescents who are more at risk of smoking initiation and implementing targeted interventions are of great importance in public health. Our findings highlight the long-term effectiveness of a multidisciplinary community-based behavioral intervention on forming smoking behaviors in adolescents. The current intervention was successful in reducing smoking uptake in adolescents living in high-risk families.

Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018

Success in reducing the prevalence of adolescent smoking could reflect complete prevention of smoking initiation or a shift in the age of cigarette smoking initiation from adolescence into early adulthood. To assess trends in early adult (ages 18-23 years) vs adolescent (age <18 years) cigarette smoking initiation and transition to daily cigarette smoking from 2002 to 2018. Ages at initiation of smoking and the transition to daily smoking were ascertained from the National Survey on Drug Use and Health (2002-2018), an annual, population-based, repeated cross-sectional study representative of the US population. This cross-sectional analysis was restricted to young adults who completed the survey at ages 22 to 23 years during survey years 2002 to 2018 to limit potential age-related recall bias. Retrospectively collected age of cigarette smoking initiation was assessed among ever cigarette smokers; age of transition to daily smoking was assessed among ever daily cigarette smokers. Data analysis was performed from June 2019 to July 2020. Calendar year of survey (2002 to 2018). The main outcomes were population-weighted cigarette smoking prevalence and cigarette smoking initiation and transition to daily smoking in adolescence (age <18 years) vs early adulthood (ages 18-23 years). Among 71 756 young adults aged 22 to 23 years (38 226 women [50.5%]), ever cigarette smoking prevalence decreased from a population-weighted estimate of 74.6% (95% CI, 73.1%-75.9%) in 2002 to 51.4% (95% CI, 49.3%-53.5%) in 2018 (P < .001). Daily smoking prevalence rates similarly decreased from 41.1% (95% CI, 39.1%-43.1%) in 2002 to 20.2% (95% CI, 18.6%-21.8%) in 2018 (P < .001). However, among 48 015 ever smokers, the proportion initiating smoking in early adulthood (ages 18-23 years) increased over this time, from 20.6% (95% CI, 18.5%-22.8%) in 2002 to 42.6% (95% CI, 39.6%-45.7%) in 2018 (P < .001). Similarly, among 24 490 daily cigarette smokers, the proportion who transitioned to daily smoking in early adulthood increased from 38.7% (95% CI, 35.9%-41.6%) in 2002 to 55.9% (95% CI, 52.0%-59.8%) in 2018 (P < .001). A substantial proportion of beginning smokers and most new daily smokers are now young adults, reflecting a shift from adolescence to early adulthood, a population segment once considered beyond the critical risk period for cigarette smoking onset. Expanding the long-standing emphasis on adolescent surveillance and prevention in adolescence to include the young adult population is warranted.

Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation.

Studies have consistently found a longitudinal association between e-cigarette use (vaping) and cigarette smoking. Many have interpreted such association as causal. This systematic review and meta-analysis evaluated the plausibility of a causal interpretation by (1) estimating the effect of adolescent vaping on smoking initiation, adjusted for study quality characteristics, (2) evaluating the sufficiency of adjustment for confounding based on the social development model (SDM) and the social ecological model (SEM) and E-value analyses and (3) investigating sample attrition and publication bias. Systematic review and meta-analysis of longitudinal studies that examined the association between e-cigarette use at baseline and smoking at follow-up. Participants were non-smokers aged <18 at baseline. Meta-analysis of 11 studies showed a significant longitudinal association between vaping and smoking [adjusted odds ratio (aOR)=2.93, 95% confidence interval (CI)=2.22, 3.87]. Studies with sample sizes <1000 had a significantly higher odds ratio (OR=6.68, 95% CI=3.63, 12.31) than studies with sample sizes>1000 (OR=2.49, 95% CI=1.97, 3.15). Overall, the attrition rate was very high (median=30%). All but one study reported results from complete sample analysis, despite those dropping out having higher risk profiles. Only two studies comprehensively adjusted for confounding. The median E-value was 2.90, indicating that the estimates were not robust against unmeasured confounding. There is a longitudinal association between adolescent vaping and smoking initiation; however, the evidence is limited by publication bias, high sample attrition and inadequate adjustment for potential confounders.

Onset of smoking amongst middle school students in Switzerland

Abstract Smoking is a major concern amongst youth in Switzerland. This study aims to understand the longitudinal drivers of smoking initiation among middle school students in Switzerland. Data was collected as part of an ongoing longitudinal survey study. Participants were students from middle schools in Switzerland. 1076 adolescents were surveyed in four waves from 2015 to 2019. All participants were non-smokers at the start of the study, when they were aged 10 respectively 11. Furthermore, data from adolescents' parents were collected, including their smoking behavior, perceived quality of relation with their child, as well as parental monitoring behavior. A survival analysis was carried out, describing if and when the event of smoking initiation occurs among adolescents. Our life table showed that 31% (n = 330) of participants started smoking between the first and fourth years of their schooling. The proportion of non-smoking participants decreased yearly. The proportions of non-smokers were 0.98, 0.93, 0.86, and 0.83 in 2016, 2017, 2018 and 2019 respectively. A life table was used to describe and summarize the sample distribution of smoking initiation and the percentage of risk. Second, a Discrete-Time Hazard Model was tested with parental smoking behavior, perceived quality of relation with their child and parental monitoring behavior as drivers to predict adolescents' smoking initiation. The findings show that the number of smokers and new smokers increases over time among adolescents. Parental smoking behavior and the perceived quality of relationship with their offspring are factors that influence an adolescent's smoking initiation. This suggests that there may be sharing and normative influences amongst the cohorts as students move up the school grades. Future studies should investigate personal and environmental factors that contribute to smoking initiation amongst adolescents. Key messages Findings show that the number of smokers and new smokers increases over time among adolescents. Sharing and normative influences among adolescents as they move up the school grades may influence smoking initiation.

Refinement of cg05575921 demethylation response in nascent smoking

The initiation of adolescent smoking is difficult to detect using carbon monoxide or cotinine assays. Previously, we and others have shown that the methylation of cg05575921 is an accurate predictor of adult smoking status. But the dose and time dependency of the demethylation response to smoking initiation in adolescents is not yet well understood. To this end, we conducted three consecutive annual in-person interviews and biological samplings of 448 high school students (wave 1 (W1)-wave 3 (W3)). At W1 (n = 448), 62 subjects reported using tobacco and 72 subjects reported using cannabis at least once in their life-time with 38 and 20 subjects having a positive cotinine and cannabinoid levels, respectively, at W1 intake. At W3 (n = 383), 67 subjects reported using tobacco and 60 subjects reported using cannabis at least once with 75 and 60 subjects having positive cotinine and cannabinoid levels, respectively, at W3. Subjects with undetectable cotinine levels at all three-time waves had stable levels of cg05575921 methylation throughout the study (88.7% at W1 and 88.8% at W3, n = 149), while subjects with positive cotinine levels at all 3 time points manifested a steady decrease in cg05575921 methylation (81.8% at W1 and 71.3% at the W3, n = 12). In those subjects with an affirmative smoking self-report at W3 (n = 17), the amount of demethylation at cg05575921 was correlated with time and intensity of smoking. We conclude that cg05575921 methylation is a sensitive, dose-dependent indicator of early stages of smoking, and may help to identify smokers in the early stages of smoking.

Smoking to cope: Addictive behavior as a response to mental distress

Individuals with mental health problems smoke at far higher rates than their peers, and have done for decades. This paper explores a potential explanation: smoking as a means to cope with distress. The proposed “coping response” framework is assessed by analyzing how adolescents respond to two events known to trigger acute mental distress: violent crime victimization and death of a non-family member the respondent felt close to. Consistent with a coping response, these shocks yield statistically significant increases in first cigarette use, recent smoking, and daily smoking, with greater initiation responses among those who are depressed at baseline, and dampened responsiveness among those facing higher cigarette taxes. Back-of-the-envelope estimates suggest that differential responsiveness to adverse events by baseline depression explains 5% of first cigarette use in this sample, and almost a third of the gap in adolescent smoking initiation between those in the highest and lowest terciles of depression scores.