Perceived accessibility as a predictor of youth smoking

PURPOSE: Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths. METHODS: This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002-2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the baseline interview in 2002 were eligible for inclusion in this report. The outcomes for this study were the onset of smoking initiation and regular tobacco use. RESULTS: At baseline 1,027 students had never smoked cigarettes, and 168 had previously initiated smoking. During the 4 years of the study, 177 students newly initiated smoking, and 109 became regular smokers. In unadjusted city-stratified Cox proportional hazard models, perceived accessibility increased the risk for smoking initiation among nonsmokers and regular smoking among all participants in a dose-response fashion. Perceived accessibility also increased the risk for smoking progression among initiators in a dose-response fashion. The associations between perceived accessibility and smoking were robust to adjustment for peer and parental smoking. Youths with both perceived accessibility and peer-smokers had a higher risk of regular smoking and progression after initiation than either factor alone. These associations were stable to adjustment for potential confounders other than peer smoking. CONCLUSIONS: Perceived accessibility increases the risk for smoking among youths and has a stronger effect among those with peer smokers. There may be a role for identifying this group of youths for targeted interventions in child health care settings. Perceived accessibility should be carefully considered and measured in smoking intervention programs for teens