Cigarette smoking transition in females of low socioeconomic status: impact of state, school, and individual factors.

STUDY OBJECTIVE To examine whether young, especially low socioeconomic status (SES), females are influenced by tobacco control policies in terms of smoking initiation and transition to more adverse stages of smoking behaviour from adolescence to young adulthood. DESIGN AND SETTING Data from 2697 young female respondents to the national longitudinal study of adolescent health wave 1 (1994-1995) and wave 3 (2001-2002). MEASUREMENTS The following factors were used to predict the likelihood of smoking initiation and transition to heavier tobacco use between adolescence and young adulthood among females of low, middle, and high SES groups: state level tobacco control policy scores, developed by the US National Cancer Institute, state cigarette excise tax, smoking rate at school, cigarette availability at home, and number of best friends smoking. MAIN RESULTS Stronger state level tobacco policies were associated with lower likelihood of smoking initiation and adverse transition among low SES women, although the effect sizes were small. Adolescents who attended schools with higher student smoking rates; adolescents who had easier access to cigarettes at home; and adolescents who had more friends smoking were all more likely to be adverse transitioners by young adulthood. CONCLUSIONS State level tobacco control policies and individual level factors during adolescence are independently associated with smoking initiation and adverse transition by the onset of young adulthood, especially for low SES females. While states may have very little direct influence on individual level behaviours, through their policies they do have the potential to exert considerable influence on smoking behaviour that persists through adolescence into young adulthood.