Smoking Trajectories of Adolescent Novice Smokers in a Longitudinal Study of Tobacco Use
Introduction
Adolescent smoking is an important public health problem because of its relation to adult tobacco consumption and because its prevalence has not declined in recent years to the same extent as that of adults. In fact, smoking prevalence in adolescents increased during most of the 1990s, raising concerns about future increases in adult smoking frequency, with concomitant rises in tobacco-related morbidity and mortality.
Although most adolescents try smoking, only about 25% will become regular smokers (1). It is largely unknown how smoking intensity and frequency evolve from the earliest smoking experience of youth to adult smoking levels. Understanding the early smoking patterns of novice adolescent smokers is important for identifying youth at risk of continued smoking and for developing more intensive and effective cessation interventions tailored to the needs of specific subgroups of smokers.
Several previous studies have investigated cigarette smoking trajectories in adolescents. Chassin et al. (2) identified six classes of trajectories in subjects aged 11 to 31 years using both an a priori classification method and empirical latent class growth modeling, including stable abstainers, erratic smokers, early stable and late stable smokers, quitters, and experimenters. Colder et al. (3) identified five classes of smoking patterns in subjects aged 11 to 16 years: early rapid escalators, late moderate escalators, late slow escalators, stable light smokers, and stable puffers. However, in both studies, the follow-up was anchored at an arbitrary time zero on the scale of age, and not at the time of smoking onset. In addition, the time intervals between follow-up measurements were wide, which might not have allowed for the necessary discriminatory power of the analytical techniques utilized.
The objective of this study was to identify longitudinal trajectories of smoking intensity in adolescent novice smokers, as well as personal characteristics related to specific trajectory patterns.
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Study Population
The McGill University Study on the Natural History of Nicotine Dependence (NDIT Study) is a 6-year (1999–2005) longitudinal study of 1293 students recruited from all grade 7 classes in a convenience sample of 10 Montreal secondary schools. The schools included a mix of French and English schools; urban, suburban, and rural schools; and schools located in high- and low-income neighborhoods. Over half (55.4%) of eligible students participated at baseline; the relatively low response rate was
Results
Table 1 describes selected characteristics of the 369 subjects retained for analysis. The average age at smoking onset was 13.1 years (range, 12.0–17.0). Two-thirds (64.8%) of the subjects were girls.
Discussion
The goals of our study were to identify longitudinal trajectories of smoking intensity in adolescent novice smokers, to identify predictors of trajectory pattern, and to explore the development of nicotine dependence and tolerance in relation to trajectory pattern. The overall trajectory pattern in novice smokers can be described by a curve based on a quadratic polynomial function. Traditional growth modeling, based on the presumption of a single underlying growth process, was supplemented by
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This research was funded by the National Cancer Institute of Canada, with funds from the Canadian Cancer Society. Igor Karp was supported by a Canadian Institutes for Health Research (CIHR) Fellowship. Jennifer O'Loughlin was a CIHR Investigator at the time this study was conducted and is currently the Canada Research Chair in the Childhood Determinants of Adult Chronic Disease.