5.0 Stages in the uptake of smoking

Introduction

Tobacco use typically begins early in life, with many people who smoke first experimenting during adolescence or early adulthood.^1-3 Earlier initiation is associated with a greater likelihood of continued smoking and higher levels of consumption later in life,¹ contributing to increased long-term health harms. Research has consistently shown that young people are more sensitive to nicotine than adults and can develop signs of dependence after relatively limited exposure.^4-6 Even low-level or intermittent smoking during adolescence has been found to increase the risk of ongoing tobacco use in adulthood.⁷ Susceptibility to smoking—defined as the absence of a firm decision not to smoke—has also been shown to be an important predictor of future experimentation.^8,9 A substantial minority of Australian adolescents who have never smoked are classified as susceptible,¹⁰ highlighting the importance of early and sustained prevention efforts. Australian data indicate that while most secondary school students have never smoked, a proportion continue to experiment with cigarettes, with prevalence increasing with age.¹⁰ These patterns underscore the need for interventions that delay or prevent uptake and reduce progression to regular smoking.

5.0 Stages in the uptake of smoking

Traditionally, the process of taking up smoking has been conceptualised as a progression through stages, including precontemplation, smoking preparation, trying cigarettes, experimentation, regular smoking, and addiction.¹¹ While these stages have served as useful guiding points in research and prevention efforts, they are a simplistic representation of smoking progression.¹

Subsequent research has highlighted the significant heterogeneity in the development of smoking behaviours, and researchers began utilising multiple developmental smoking trajectories to better understand patterns of tobacco uptake.^12-14

Different studies have identified varying numbers and patterns of trajectories, many using about four, with some up to seven, based on age of onset, steepness of acceleration, and persistence of use, perhaps reflecting the complexity of modelling cigarette use over time.¹⁵ There is some agreement across studies in terms of identifying an early-onset group that is consistently high or quickly accelerating in their smoking, a later-onset group, light-smoking groups whose tobacco use does not progress,^15,16 as well as, susceptible or non-susceptible nonsmokers, and discontinued users or quitters.^15-18

The 2012 Surgeon General’s report¹ suggested that the following four trajectories may be one of several ways of conceptualising the different pathways:

These patterns of smoking behaviours can vary by gender and ethnicity;¹ however, further research is needed to identify factors that can predict and discriminate between trajectories, in order to effectively tailor prevention and intervention programs.²⁰ Evidence differentiates some of the psychosocial variables (such as family factors and the influence of role models) influencing adolescent smoking onset compared with the frequency of smoking.²¹ Socioeconomic factors, educational attainment, peer influences are all important predictors of smoking behaviours among young people,¹ as well as whether early, subjective experiences with smoking are positive or negative.²² To design effective interventions, it is necessary to understand the multiple factors that shape smoking behaviour. Individual characteristics such as physiology and personality intersect with family influences, peer and social networks, and broader cultural and societal contexts. The influence of these determinants shifts over time as children and adolescents progress through different developmental stages.

Throughout Chapter 5, evidence to date on each of the following components of uptake and prevention will be explored:

5.1 Factors influencing uptake by young people overview

5.2 Prevention

5.3 Early biological factors

5.4 Adolescence and brain maturation

5.5 Temperament, mental health problems and self-concept

5.6 Intentions, attitudes and beliefs

5.7 Family and the home environment

5.8 The influence of peers

5.9 The educational environment

5.10 Cultural background

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Products and packaging created to appeal to new users

5.14 Smokefree policies

5.15 Tobacco advertising and promotion targeted at young people

5.16 Smoking in movies, TV and other popular culture media

5.17 Media campaigns and young people

5.18 Harnessing predictors of uptake to prevent smoking

5.19 The profound effects of the denormalisation of smoking

5.20 Factors influencing uptake of smoking later in life

5.21 Other drug use

Test your knowldge

References

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