One-year predictors of smoking initiation and of continued smoking among elementary schoolchildren in multiethnic, low-income, inner-city neighbourhoods

OBJECTIVE: To identify one-year predictors of smoking initiation among never-smokers, and of continued smoking among ever-smokers. DESIGN: Two sequential cohorts of grade 4 and 5 children. Data were collected as part of Coeur en sante St Louis du Parc, a non-randomised controlled trial to evaluate the impact of a school-based heart health promotion programme. SETTING: 24 inner-city elementary schools located in multiethnic, low-income neighbourhoods in Montreal. SUBJECT: 1824 schoolchildren aged 9-12 years with baseline and one-year follow-up data. MAIN OUTCOME MEASURES: Changes in smoking behaviour over a year; the ability of baseline data to predict smoking initiation and continued smoking a year later was investigated in logistic regression analyses. RESULTS: The prevalence of ever-smoking was 21.1% at baseline and 30.2% at one-year follow up. One in six never-smokers initiated smoking; one in three ever-smokers continued smoking. Predictors of initiation included age (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3 to 2.0), male gender (OR = 1.5 (95% CI = 1.1 to 2.0)), friends who smoke (OR = 2.3 (95% CI = 1.7 to 3.3)), sibling(s) who smoke (OR = 1.9 (95% CI = 1.2 to 3.1)), father/mother who smokes (OR = 2.2 (95% CI = 1.6 to 3.0)), and frequent high fat/"junk food" consumption (OR = 1.6 (95% CI = 1.1 to 2.1)). Age and friends who smoke were also independent predictors of continued smoking in both genders. In addition, in boys, current smokers at baseline were 2.6 times (95% CI = 1.4 to 5.0) more likely to continue smoking than past smokers. In girls, being overweight was associated with continued smoking (OR = 3.5 (95% CI = 1.6 to 7.6)). CONCLUSIONS: Smoking prevention programmes should address parental and sibling influences on smoking, in addition to refusal skills training. Among girls, weight-related issues may also be important.