Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool (England, UK), and to identify the predictors of experimentation with cigarettes during preadolescence. A cohort of children (n=270) completed questionnaires between 1999 and 2001 that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socioeconomic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender (P=0.041), paternal smoking (P=0.001), fraternal smoking (P=0.017), a best friend who smoked (P=0.026), and knowing someone with a smoking-related disease (P=0.006). Intentions to smoke at age 9 did not predict smoking at age 11 (P>0.05). In univariate analyses, child smoking was also associated with maternal smoking (P=0.002 at age 11), living in a low-income household (P<0.001 at age 10) and living in a deprived area (P=0.025 at age 11). Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood