Which adolescent experimenters progress to established smoking in the United States

Introduction: This study examined the adolescent smoking uptake process, specifically, the progression from experimentation to established smoking. Although adolescent smoking uptake has been described as consisting of five stages (preparation, initial trying, experimentation, regular smoking, and addiction), there is no accepted method of identifying which experimenters will proceed to become addicted. Methods: Using a nationally representative sample of adolescents between the ages of 12 and 18 at baseline, we examined their transition from experimentation (had at least a puff but has not smoked 100 cigarettes) to established smoking (smoked at least 100 cigarettes in lifetime) four years later. Results: At follow-up, 31% of the experimenters at baseline had progressed to established smoking. Baseline level of smoking experience was the strongest independent predictor of established smoking, with current experimenters (smoked in the past 30 days but less than 100 cigarettes in lifetime) having the greatest risk of progressing to established smoking compared to puffers (puffed but have not smoked a whole cigarette). Furthermore, this effect was modified by age; older current experimenters at baseline had more than double the risk of younger current experimenters of progressing to established smoking at follow-up. Absence of a firm commitment not to smoke was a significant predictor among older experimenters but not in younger experimenters. Other important predictors of the transition from experimentation to established smoking were exposure to other smokers and perceived school performance. Conclusions: We found that, even among experimenters, there is an identifiable group of adolescents who are at higher risk of progressing to established smoking that can be targeted for intervention.