Characteristics associated with smoking initiation during young adulthood: Findings from a national cohort

Background: About 30% of ever smokers tried their first cigarette after age 17. However, characteristics of those who started smoking after high school are seldom examined. We examined factors that promote or delay smoking initiation to after high school.

Methods: A national sample of 10^th graders was surveyed annually between 2010 and 2014 (n=2275). Never smoker was defined as never reported smoking in the past 30 days. Early starter was defined as reported smoking in the past 30 days at least once between 10^th and 12^th grades. Late starter was defined as never reported smoking in the past 30 days between 10^th and 12^th grades but reported smoking in the past 30 days the first year after high school. Factors associated with being a late starter (vs. never smoker and vs. early starter) were assessed using multivariate logistic regression models.

Results: Overall, 65% of participants were never smokers, 29% were early starters, and 6% were late starters. Compared to never smokers, late starters were more likely to be male, question their sexual attraction or be attracted to the same/both genders, have friends who smoke after high school, and believed that whether or not to smoke is their own decision and depends on easy access to cigarettes as an young adult (p<0.05). Compared to early starters, late starters were more likely to have educated parents, be African American, reside in urban areas, not have friends who smoke, report not smoking is important to their parents, and believed that whether or not to smoke is an important to them and depends on easy access to cigarettes measured at 10^th grade (p<0.05).

Conclusions: Interventions to prevent smoking initiation among young adults and interventions to delay smoking initiation among high risk teenagers may need to focus on different factors to maximize efficacy.