Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014-2016.
Level 4 - case-series / case-control
Cross-sectional survey analysis of pooled national data
PubMed 30498008 · doi:10.1136/tobaccocontrol-2018-054593
What was done
Combined 2014-2016 National Youth Tobacco Survey data, a nationally representative cross-sectional survey of US students in grades 6-12, were analyzed. The sample included 19,580 respondents who reported ever using any of five tobacco products: electronic cigarettes, cigarettes, cigars, smokeless tobacco, or hookah. The study assessed reported age of first use for each product and evaluated associations between early initiation (age 13 years or younger vs older than 13) and current daily use, past 30-day use, tobacco cravings, and time to first tobacco use after waking.
What was found
Among ever-users, weighted median ages of first use were 12.6 years for cigarettes, 13.4 years for smokeless tobacco, 13.8 years for cigars, 14.1 years for hookah, and 14.1 years for e-cigarettes. Initiating use at 13 years or younger was associated with greater current use of the respective product and greater nicotine dependence compared with initiating use after age 13. Specific effect estimates and confidence intervals were not reported in the abstract.
Why it matters
Early initiation across non-cigarette tobacco products shows the same associations with sustained use and nicotine dependence previously established for conventional cigarettes. Tobacco prevention strategies must reach early adolescents before age 14.
Limits
The cross-sectional design prevents causal conclusions. Data rely on retrospective self-reports from youth, which are prone to recall and social desirability biases. Numerical effect sizes and specific confounding adjustments are not reported in the abstract.
Cited by
- partial Starting cigarette smoking at age 13 almost certainly results in addiction, whereas starting at an older age rarely leads to addiction.