Smoking susceptibility among students followed from grade six to eight

Background: Smoking is a leading risk factor for heart disease and cancer. By identifying factors associated with smoking onset, more effective prevention programs can be developed. Research questions are 1) does smoking susceptibility status change from grade six to eight, 2) are indicators of risk (perceived harm, smoking susceptibility status, positive peers, and resilience) measured in sixth grade associated with smoking susceptibility status in eighth grade and, 3) are there differences by gender in either research question? Methods: The current study is a secondary analysis of data collected during the evaluation of a Safe Schools Healthy Students Project. Students were followed from grade six to grade eight, with survey data collected in each grade from August 2006 to December 2008. Participants (n = 577) were in grade six at baseline, 52% were girls and 57% identified as White, non-Hispanic. Results: From grade six to grade eight the number of students in the high smoking susceptibility status doubled (5% to 17%). More boys than girls moved into the high susceptibility group over time. By eighth grade, boys were twice as likely to belong to the high smoking susceptibility group compared to girls (p = 0.01). Multiple logistic regression models showed that the positive peers' variable in grade six was protective for girls in their reported smoking susceptibility in grade eight. In contrast, higher resilience scores in grade six were protective for boys' reported smoking susceptibility in grade eight. Conclusions: Smoking susceptibility rose over time for all adolescents, but boys had notably sharper increases. Positive peers and having resources important to resilience may be beneficial in preventing the attitudes that support smoking initiation. Based on these results, we recommend gender-tailored, school-based smoking prevention programs that begin in grade six.