Cognitive susceptibility to smoking and initiation of smoking during childhood: a longitudinal study.
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.