Epidemiology and etiology of adolescent smoking

PURPOSE OF REVIEW: Despite the socioeconomic and personal health costs directly attributed to smoking, over one-half of high school seniors have used cigarettes, and over 15% of seniors are daily smokers. This review summarizes the recent research concerning the psychosocial and physiologic risk and protective factors associated with adolescent smoking. RECENT FINDINGS: Studies of the psychosocial risk factors have added to the evidence that stress, peers and family influences, ethnicity, and depression all serve as risk factors for the development and maintenance of smoking in adolescents. Protective factors include parental expectations and monitoring, religious activity, and sociopolitical factors, such as tobacco-related marketing bans and higher cigarette taxes. Adolescent smoking trajectories have been further defined and can be used to classify smokers in terms of dependence symptoms. Finally, neurobiological research has focused to a large extent on the concept of disinhibition as a risk factor for smoking in adolescents. SUMMARY: While rates of smoking in adolescents have declined since 1997, millions of adolescents initiate or continue smoking each year, with deleterious health and psychosocial consequences. Research into the risk and protective factors for adolescent smoking, particularly that which ties psychosocial and neurobiological factors together, is necessary to inform the development of tailored and maximally efficacious treatments for this population.