Stages of adolescent cigarette smoking acquisition: Measurement and sample profiles

doi:10.1016/0306-4603(87)90046-3

Addictive Behaviors

Volume 12, Issue 4, 1987, Pages 319-329

https://doi.org/10.1016/0306-4603(87)90046-3 Get rights and content

Abstract

A stage model of adolescent cigarette smoking acquisition was developed and an instrument to measure the stages was created. Internal validity was obtained based on principal component analysis, item analysis, and coefficient alpha. Three distinct components were labeled precontemplation, decision-making, and maintenance. The scales had reliability coefficients ranging from .86 to .94. External validity was obtained by relating the scale scores to measures of smoking behavior and intent to smoke. A cluster analysis resulted in nine distinct clusters, including profiles representing precontemplation, contemplation, decision-making, action, and maintenance stages. Further validity was obtained for the clusters by comparing groups on the perceived positive and negative consequences of smoking, and the derived pleasure from smoking.

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There is a growing concern that the historic reductions in tobacco consumption witnessed in the past decades may be undermined by the rapid increase in e-cigarette use. This study examined the association between e-cigarette use and future intention to smoke cigarettes among middle and high school students who had never smoked cigarettes. Data were drawn from the 2014–2015 Canadian Student Tobacco, Alcohol and Drugs Survey (n = 25,637). A multivariable logistic regression model was used to examine the association between e-cigarette use and susceptibility to cigarette smoking. In addition, an inverse probability of treatment weighted regression adjustment method (doubly robust estimator), which models both the susceptibility to smoking and the probability of e-cigarette use, was conducted. About 10% of the students had ever tried an e-cigarette. There were higher rates of ever e-cigarette use among students in grades 10–12 (12.5%) than those in grades 7–9 (7.3%). Students who had ever tried an e-cigarette had higher odds of susceptibility to cigarette smoking (adjusted odds ratio = 2.16, 95% confidence interval = 1.80–2.58) compared to those that had never tried an e-cigarette. Current use of an e-cigarette was associated with higher odds of smoking susceptibility (adjusted odds ratio = 2.02, 95% confidence interval = 1.43–2.84). Similar results were obtained from the doubly robust estimation. Among students who had never smoked cigarettes, e-cigarette use was associated with a higher susceptibility to cigarette smoking.
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One possible explanation for the differences in the findings in both studies may be due to the different outcome variables analyzed, with the current study focusing on vulnerability to future smoking. As discussed, the decision to initiate or start smoking is not as easy as a binary choice (yes versus no), it is more likely to involve a process or sequence of stages (Mayhew et al., 2000; Stern et al., 1987). Therefore, identifying the characteristics of those with a higher propensity to initiate smoking is beneficial for prevention targeting and public health.
Bullying involvement has been linked with substance use; however, less is known about its relationship with pre-initiation stages of adolescent cigarette smoking behavior. This study examined the association between bullying involvement and smoking susceptibility among never tried or experimented with cigarette smoking students. Susceptibility to cigarette smoking in adolescence is a strong predictor of subsequent smoking initiation.
A cross-sectional data on Canadian adolescent and youth were drawn from the 2012/2013 Youth Smoking Survey (n = 28,843). Logistic regression analysis was used to examine the association between bullying and smoking susceptibility among never-smoking students.
About 21% self-reported involvement in bullying (as a bully, victim or both). Middle school students (grades 6–8) reported more involvement in bullying (24%) than those in grades 9–12 (16%). The multivariable analyses showed that the association between bullying and smoking susceptibility was significantly different by grade level. Middle school students involved in bullying had higher odds of smoking susceptibility compared to uninvolved students (bully, adjusted odds ratio [AOR] = 2.54, 95% CI = 1.73–3.74; victim, AOR = 1.29, 95% CI = 1.11–1.48; bully–victim, AOR = 2.19, 95% CI = 1.75–2.74). There were no significant associations between all subgroups of bullying and smoking susceptibility for grades 9–12 students.
Students involved in bullying were more susceptible to smoking, although patterns of association varied by grade level. In particular, the findings highlight that non-smoking middle school students involved in bullying were susceptible to future smoking.
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Although many individuals begin smoking in adolescence, a sizable proportion of individuals begin smoking or show increases in smoking behavior after age 18 (e.g., Chassin, Presson, Pitts, & Sherman, 2000; Chassin, Presson, Sherman, & Edwards, 1991). Although several studies have found that many college students explicitly report negative attitudes towards smoking regardless of their own smoking behavior (Elders, Perry, Eriksen, & Giovino, 1994; Goddard, 1992; Johnston, O'Malley, & Bachman, 1996; Stern, Prochaska, Velicer, & Elder, 1987), social desirability may diminish the reporting of positive emotions in self-reports of attitudes towards smoking (e.g., Swanson, Rudman, & Greenwald, 2001). Because of the limitations of explicit measures, researchers use implicit measures to examine smokers' affective reactions to smoking by focusing on their responses to smoking-related cues, such as pictures of cigarettes or other smoking-related objects, using a range of paradigms such as the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998).
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^☆: This work was partially supported by Grant CA 27821 from the National Cancer Institute. The authors gratefully acknowledge the assistance of Joseph Rossi of the University of Rhode Island for his assistance in data analysis, and the staff of the Pawtucket Heart Health Program for their assistance in data collection.

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Stages of adolescent cigarette smoking acquisition: Measurement and sample profiles☆

Abstract

Addictive Behaviors

Preventive Medicine

Factors associated with the starting of cigarette smoking by primary school children

British Journal of Preventive Social Medicine

Developmental changes in attitude toward cigarette smokers during early adolescence

Psychological Reports

Personal and social skills training: Cognitive-behavioral approaches to substance abuse prevention

The Scree test for the number of factors

Multivariate Behavioral Research

The measurement of personality traits by scales and inventories

Increasing the validity of self-reports of behaviors in a smoking in children investigation

Journal of Applied Psychology

Cluster analysis