Understanding factors that influence smoking uptake.

OBJECTIVE To explore relationships between patterns of smoking uptake and social context and attitudinal variables. DESIGN Cross sectional survey. SETTING Public schools in Tucson, Arizona and Albuquerque, New Mexico. PARTICIPANTS 982 children in grades 6-9 (ages 11-15 years). MAIN OUTCOME MEASURES Items measuring smoking history, nicotine dependence and quit attempts, susceptibility to smoking in the future, smoking norms, use of other tobacco products, attitudes toward smoking, and demographic characteristics. RESULTS Overall, 43% of children had smoked a cigarette and 57% had never used them. Ever smokers lived in social contexts with more smoking and where smoking was normative. Among never users, 25% are susceptible to smoking; these children have positive attitudes toward smoking, do not feel social pressure to stay off cigarettes, and had more friends who smoked. Among ever users, 36% were currently smoking in the past 30 days. Current users also lived in social context with more smoking and had positive attitudes toward smoking. Most users had tried to stop smoking. Only 9% of current users smoked daily; 29% had not smoked a whole cigarette. Greater cigarette consumption was associated with more favourable attitudes toward smoking. Most of past users were in early uptake: 95% had smoked less than 100 cigarettes but 49% were susceptible to smoking again. CONCLUSIONS There is promise in differentiating subgroups among the never, past and current use of cigarettes. Susceptibility within each of these groups was associated with similar patterns of attitudes and social context. These patterns in smoking uptake need to be confirmed prospectively.