Cognitive Susceptibility to Smoking and Initiation of Smoking during Childhood: A Longitudinal Study

doi:10.1006/pmed.1997.0255

Preventive Medicine

Volume 27, Issue 1, January 1998, Pages 129-134

https://doi.org/10.1006/pmed.1997.0255 Get rights and content

Abstract

Background.The earlier the onset of cigarette smoking the greater the risk of addictive smoking. Because smoking initiation is occurring at ever younger ages, early onset of smoking is primarily a childhood phenomenon. In this study cognitive susceptibility to smoking was examined as a risk factor for childhood onset of cigarette smoking. This was the first prospective investigation of cognitive susceptibility to smoking as a predictor of smoking initiation by children.

Methods.Three annual surveys were completed by 788 children who, at baseline, were in the third or fifth grade and had never puffed on a cigarette.

Results.At baseline, 51% of children had either single or multiple indicators of susceptibility to smoking. Over 2 years, children with single indicators of susceptibility were 80% more likely to initiate smoking, and children with multiple indicators of susceptibility were four times as likely to initiate smoking as nonsusceptible peers. Susceptibility was a stronger predictor of initiation than all other predictors examined, including exposure to family members and friends who smoke cigarettes.

Conclusion.Among abstinent children ages 8 to 10 years, cognitive susceptibility to smoking was a significant predictor of whether they initiated smoking prior to adolescence. Reducing children's susceptibility to smoking could strengthen efforts to prevent early onset of cigarette smoking.

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Cited by (143)

The effects of the iPlayClean education programme on doping attitudes and susceptibility to use banned substances among high-level adolescent athletes from the UK: A cluster-randomised controlled trial
2020, International Journal of Drug Policy
Background This study examined the effects of the iPlayClean anti-doping intervention on attitudes towards doping and susceptibility, and whether delivery mode affected the results.
Methods A total of 1081 high-level UK athletes (14–18 years old, 904 males, 177 females) were cluster-randomised to the control (11 teams/organisations/schools, 314 athletes), face-to-face group presentation (8 teams/organisations/schools, 254 athletes), online (11 teams/organisations/schools, 251 athletes), or face-to-face presentation with online access (5 teams/organisations/schools, 262 athletes).
Results Compared to the control group, all modes of the iPlayClean anti-doping education programme reduced favourable attitudes towards doping immediately after the intervention, which was sustained across all intervention groups 8 weeks later. All delivery modes impacted doping susceptibility immediately after the intervention, in comparison to the control group, but the effects were only sustained for the face-to-face presentation group.
Conclusion Contrary to findings within previous anti-doping interventions, we have shown that doping attitudes can be changed and that the results can be sustained across all modes of delivery, 8 weeks later. Research is required to assess for how long these changes are sustained, and how often anti-doping education should be delivered to high-level athletes to reinforce clean play values.
Evaluating the predictive value of measures of susceptibility to tobacco and alternative tobacco products
2019, Addictive Behaviors
Citation Excerpt :
The “susceptibility to smoking index” (Choi, Gilpin, Farkas, & Pierce, 2001; Jackson, 1998; Nodora et al., 2014; Pierce, Choi, Gilpin, Farkas, & Merritt, 1996; Pierce, Distefan, Kaplan, & Gilpin, 2005; Strong et al., 2015; Unger, Johnson, Stoddard, Nezami, & Chou, 1997) has been widely accepted as a measure used to estimate elevated risk of future initiation of combustible cigarettes, and has historically been used in numerous cross-sectional studies to provide timely results on risk factors for cigarette initiation, when prospective data are not available (U.S. Department of Health and Human Services, 2014; U.S. Department of Health and Human Services, 2016).
The “cigarette susceptibility index” has been adapted for other products, yet, the validity of these adapted measures–particularly among youth who have used other tobacco products–has not been evaluated.
We used prospective data from the Southern California Children's Health Study to evaluate the association of questionnaire measures assessing susceptibility to e-cigarette, cigarette, hookah and cigar/cigarillo/little cigar use at wave 1 (W1; 11th/12th grade) with subsequent initiation between W1 and W2 (16 months later, N = 1453). We additionally examined whether each effect estimate differed by use of other tobacco products at W1.
Odds ratios, attributable risk%, and risk differences for product initiation among susceptible vs. non-susceptible youth were consistently higher among never users of any tobacco product than among youth with any tobacco use history. For example, susceptible (vs. non-susceptible) youth with no prior tobacco use had 3.64 times the odds of subsequent initiation of e-cigarettes (95%CI:2.61,5.09), while among users of another product, susceptible (vs. non-susceptible) youth had 1.95 times the odds of e-cigarette initiation (95%CI:0.98,3.89; p-interaction = 0.016). 60.4% of e-cigarette initiation among never users of any product could be attributed to susceptibility, compared to 19.8% among users of another product. The e-cigarette absolute risk difference between susceptible and non-susceptible youth was 21.9%(15.2,28.6) for never users, vs. 15.4%(0.2,30.7) for users of another product.
Tobacco product-specific susceptibility associations with initiation of use at W2 were markedly attenuated among prior users of other products, demonstrating reduced utility for these measures among subjects using other products.
Measurement and predictive value of susceptibility to cigarettes, e-cigarettes, cigars, and hookah among Texas adolescents
2018, Addictive Behaviors Reports
Susceptibility to cigarette smoking, defined as the lack of a firm commitment not to smoke in the future, begins in childhood and is a phase in the transition from never to ever use of cigarettes. While a consistent and validated predictor of cigarette use, little research has assessed whether the susceptibility construct applies equally well across other tobacco products. Baseline data were collected in 2014–2015 from a representative sample of (n = 2844) middle and high school students in five counties surrounding the four largest cities in Texas, (49% female and mean age 13.13 years, with subsequent waves at 6, 12, and 18 months. Confirmatory factor analysis examined the appropriateness of a three-item susceptibility measure (product-specific curiosity, intention to use, and peer influence) across product types and ethnic groups (Hispanic versus non-Hispanic). Logistic regression examined whether product specific susceptibility at baseline predicted future product initiation. At baseline, 11.5%, 17.0%, 17.4% and 29.4%, of adolescent never users were susceptible to cigars, cigarettes, hookah and e-cigarettes, respectively; significantly more Hispanic than non-Hispanic adolescents were susceptible to e-cigarettes (32.4% versus 26%, p < 0.01) and cigarettes (19.9% versus 13.9%, p < 0.05). Product-specific items were significantly and consistently associated with the respective underlying susceptibility product construct and across ethnic groups (p < 0.001 for all). Susceptibility to e-cigarettes (AOR = 2.28–6.64) or any combustible product (cigarettes, hookah, cigars; AOR = 3.38–5.20) significantly predicted subsequent ever use. This study confirms the appropriateness of the susceptibility construct across four tobacco product types and ethnic groups, and the utility of susceptibility in predicting future product use among adolescents.
Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth
2018, Social Science and Medicine
The United States courts have blocked the implementation of graphic warning labels on cigarette packages (GWLs). This decision was based, in part, on the premise that GWLs are unnecessarily emotional and are meant to scare rather than inform consumers about smoking's health effects. However, research in judgment and decision-making suggests these relationships are more complex.
In this article, we draw on several theoretical frameworks that lead to competing hypotheses about the relationships between negative affect, health risk beliefs, and quit intentions (among adult smokers) or susceptibility to start smoking (among non-smoking youth).
We tested these competing mediation models using data from two experiments with two populations each—adult smokers (Ns = 313 and 238) and primarily non-smoking middle-school youth (Ns = 340 and 237). Using mobile recruitment methods, we focused specifically on individuals from socioeconomically disadvantaged communities in rural and urban areas of the Northeastern United States.
The best fitting model across all four datasets was one in which label-induced negative affect (a) directly predicted intentions/susceptibility but also (b) indirectly predicted intentions/susceptibility via risk beliefs. Although mediation analyses did not demonstrate significant serial mediation effects of label exposure on intentions/susceptibility through negative affect then risk beliefs, there was some evidence that label exposure indirectly promoted adults' quit intentions through negative affect. Additionally, negative affect consistently mediated the indirect effect of label exposure on strengthened risk beliefs among adults and youth.
These results speak to the importance of negative affect in directly motivating adult smokers' quit intentions but also serving an informational function, directing adult smokers and non-smoking youth to accept the health risks of smoking.
Cognitive risk factors of electronic and combustible cigarette use in adolescents
2018, Addictive Behaviors
Cognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents.
Data were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e–cigarettes were examined.
Adolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not.
Our data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other.
This is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents.
Performance of cigarette susceptibility index among e-cigarette and hookah users
2018, Drug and Alcohol Dependence
Citation Excerpt :
Instead, the use of the susceptibility index in combination with history of alternative tobacco product use or immersion in a tobacco-friendly social environment may more accurately identify any youth at risk of smoking initiation. The susceptibility to cigarette smoking measure was first developed in the mid-1990s (Pierce et al., 1996); since then, several studies have been conducted to examine the performance of these measures, with inclusion of an item assessing curiosity, found to increase the sensitivity of the susceptibility index (Choi et al., 2001; Jackson, 1998; Nodora et al., 2014; Pierce et al., 1996; Pierce et al., 2005; Strong et al., 2014; Unger et al., 1997). Compared to the initial validation study, results from the current study examining the utility of cigarette susceptibility show generally similar sensitivity (46.4% in our study, compared to 51.5% in the initial validation study) and specificity (79.0% in our study, compared to 72.4% in the initial validation study) (Pierce et al., 1996).
Susceptibility to cigarette smoking has been used since the mid-1990s as a measure to identify youth at risk of cigarette initiation. However, it is unclear how well this measure predicts future smoking among electronic (e-)cigarette or hookah users, or among those in tobacco-friendly social environments.
We used prospective data from the Southern California Children’s Health Study to evaluate the performance (sensitivity, specificity, predictive value) of a composite index assessing susceptibility to smoking, and to evaluate whether performance of the measure differed by use of e-cigarettes or hookah, or immersion in a tobacco-friendly social environment. Susceptibility to cigarette smoking was measured in 11th/12th grade (2014) among never cigarette-smokers (N = 1266); follow-up data on smoking initiation were obtained approximately 16 months later.
Overall, 16.4% of youth initiated smoking between baseline and follow-up. The sensitivity of the susceptibility to smoking index was low (46.4%), and specificity was high (79.0%). No difference in sensitivity was observed by baseline e-cigarette use; specificity was higher among never e- cigarette users. Differences in negative predictive value (NPV) and positive predictive value (PPV) were also observed by baseline e-cigarette and hookah use. Specificity was generally lower, and sensitivity was generally higher for those in tobacco-friendly social environments.
Our findings suggest that use of the susceptibility to smoking index in cross-sectional studies of older adolescents to identify those likely to begin smoking may be inappropriate for those using alternative tobacco products (e.g., e-cigarettes or hookah).

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^☆: This research was supported by the National Institute on Drug Abuse, Grant DA07919.

^☆☆: P, McGrathP, Firestone, editors

²: Address correspondence and reprint requests to the Department of Health Behavior and Health Education, CB# 7400, Rosenau Hall, Room 300D, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400. Fax: 919.966.2921. E-mail: [email protected].

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Regular ArticleCognitive Susceptibility to Smoking and Initiation of Smoking during Childhood: A Longitudinal Study☆,☆☆

Abstract

Addict Behav

The smoking problem: a review of the research and theory in behavioral risk modification

Psychol Bull

Cigarette smoking: why young people do it and ways of preventing it

Pediatric and adolescent behavioral medicine

Validation of susceptibility as a predictor of which adolescents take up smoking in the United States

Health Psychol

An improved surveillance measure for adolescent smoking?

Tobacco Control

Tobacco promotion and susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample

Am J Public Health

Preventing adolescent drug use: long-term results of a junior high program

Am J Public Health

Six-year follow-up of the first Waterloo school smoking prevention trial

Am J Public Health

Five- and six-year follow-up results from four seventh-grade smoking prevention strategies

J Behav Med

Regular Article
Cognitive Susceptibility to Smoking and Initiation of Smoking during Childhood: A Longitudinal Study☆,☆☆