Factors associated with smoking initiation among middle and high school students in Puerto Rico, 2002-2004

Background: Smoking among children and adolescents starts at an earlier age each year. It is a serious public health issue a national and international level. Purpose and Objectives: To identify the socio-demographic factors associated with smoking initiation among middle and high school students of private and public schools in Puerto Rico. Methods: A cross-sectional survey (Consulta Juvenil surveillance system) representative of all middle and high school population was conducted (N = 301,483). The principal variable of this study was smoking initiation, measured as the difference between the age of the student at the moment of the survey and the age in which they began to smoking. Descriptive statistics and lineal multiple regression were performed. Results: The prevalence of smoking behavior was 20.7%. Overall, 33% of the students in middle school and 67% of the students in high school reported having initiated the use of cigarettes. In addition, more than half (64%) of the students reported to have initiated the use of cigarrettes at age of 13 or less. The data suggest that age, sex, academic level, parents educative level, familiar composition, birthplace and health status were significantly associated with smoking initiation (p-value <0.001). Conclusion: The study findings suggest that smoking initiation is occurring at early ages and is associated with several socio-demographic characteristics. The development and implementation of school smoking prevention programs is recommended, especially among the middle school population.