First puff: A multi-attribute utility model for predicting smoking initiation among adolescents

Understanding why adolescents initiate smoking is important in order to contribute to smoking prevention efforts. This longitudinal study was conducted to determine the predictors of smoking initiation in adolescents using a three-parameter multi-attribute utility (MAU) decision-making model.

The multi-ethnic sample consisted of 1983 8th graders (52.8% female, 47.2% male) in Orange County, CA, who had been in 7th grade at baseline. Perceived consequences of cigarette smoking, smoking behavior, and demographic information were assessed across the study sample. Chi-square was used to examine ethnic and gender differences in risk perception and tobacco use. Logistic regression analyses were used to determine the predictability of the MAU model on smoking initiation.

The prevalence of lifetime smoking was 10% at baseline; which increased to 15% (p<0.001) at follow-up. There was a difference in risk perception and tobacco use for both sex and ethnicity/race (p <0.01). Finally, the MAU model, risk perception, and sex, were significant predictors of smoking initiation, such that for every unit increase in the baseline Total Utility score, the odds of smoking increased by 28.1% [95% CI, 1.067-1.541] at follow-up. The odds of smoking for females fell 29% [95% CI, 0.511-0.996]. An increase in risk perception increased the odds of smoking by 31.9% [95% CI, 1.199-1.452].

This study may provide guidance for future studies in understanding the driving forces for smoking initiation in adolescents. By using the MAU model, efforts can be directed towards prevention and intervention planning to help adolescents counteract risk factors for cigarette smoking.