Academic journal article Journal of School Health

A Period of Increased Susceptibility to Cigarette Smoking among High School Students

Academic journal article Journal of School Health

A Period of Increased Susceptibility to Cigarette Smoking among High School Students

Article excerpt

Most tobacco use begins in adolescence. (1) Adolescents who smoke typically go through five stages of initiation, beginning with the preparatory stage before they try a cigarette. (1,2) In the preparatory stage, adolescents who form permissive attitudes and beliefs about smoking are more likely to progress to the later stages--trying, experimental, regular use, and addiction/dependent smoker. (2) Susceptibility to future use can be estimated by asking adolescents who never smoked whether they made a firm commitment to not smoke. Adolescents lacking such a commitment are termed susceptible. Susceptible youth are two to four times more likely to smoke later in adolescence. (3-10) Several personal or social environmental risk factors are associated with both cigarette smoking and with susceptibility? Susceptibility, often used as a surrogate outcome variable to study the impact of risk factors on the risk of smoking, has the advantage of being measured in youth well before they begin to smoke. (9,11-15)

While susceptible youth are more likely than nonsusceptible youth to become regular smokers, researchers know little about short-term periods of increased or decreased susceptibility during adolescence. Short-term periods of increased susceptibility might represent important opportunities for prevention. In this study, susceptibility to cigarette smoking was measured in October 1999 and May 2000 among high school students who never smoked. One purpose was to study susceptibility, relationships between susceptibility and sociodemographic characteristics, and to describe potentially fruitful opportunities for prevention.



In a project to develop a youth-led tobacco prevention program, students in two St. Paul, Minn., public high schools were invited to participate in voluntary extracurricular youth-led, youth-run, adult-guided anti-tobacco activities during the 1999-2000 school year. In October 1999 and May 2000, at the beginning and end of the school year, surveys were conducted to measure awareness of these activities among samples representing all students in these schools. A secondary purpose was to learn about tobacco-related knowledge, attitudes, and behaviors, including susceptibility to future tobacco use.

Study Design

In October 1999 and May 2000, written questionnaires were given to independent, cross-sectional, randomly selected samples of students attending each school. A list of random numbers was generated for each school and used to order classes that were mandatory for all students (language arts in School A and home room in School B). Teachers for classes taken from the list in blocks of 10 were asked if they would participate. District policy allows teachers to decline participation if a survey would interfere with planned educational activities. Recruitment was stopped after teachers in eight to 11 classes from each school agreed. This method ensured that, within each school, each enrolled student had an equal chance of being surveyed. Letters were sent to families of all students in the selected classes. The letters informed parents and students of the study and offered them the opportunity to ask questions or to decline to participate.

Within each school, all classes included in the study were surveyed on the same day in the fall and the same day in the spring. Research staff explained the survey to students present that day and asked them to participate by completing an anonymous written questionnaire. Teachers were present, but research staff led the process. Students were given the option to decline or to stop completing the questionnaire at any time. Students unfamiliar with English were offered translation in their own language, but none requested it. Teachers asked students absent that day to complete the survey in class during the next two weeks, then place their questionnaires in sealed envelopes provided with the questionnaires. …

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