Hispanic Middle School Youth Have Highest Susceptibility to Smoking

Summary and Comment |
October 17, 2016

Hispanic Middle School Youth Have Highest Susceptibility to Smoking

  1. John D. Cowden, MD, MPH

Among youth nonsmokers, racial and ethnic disparities in smoking susceptibility persisted over a 15-year period, with Hispanic youth showing the highest susceptibility.

  1. John D. Cowden, MD, MPH

Susceptibility to smoking, defined as a lack of firm commitment to not smoke, raises the risk of smoking experimentation among youth. Racial and ethnic disparities in susceptibility have been identified, but how such disparities change over time has not been described.

Using the National Youth Tobacco Survey from 1999 to 2014, researchers stratified roughly 144,000 nonsmoking youth (ages 9 to 21 years) by race and ethnicity to evaluate trends in susceptibility disparities. Susceptibility was defined by a positive answer to at least one of three questions: (1) “Do you think you will try a cigarette soon?” (2) “Do you think you will smoke a cigarette in the next year?” (3) “If one of your friends were to offer you a cigarette, would you smoke it?” Analyses were adjusted for demographics, living with smokers, and exposure to tobacco advertising.

From 1999 to 2014, susceptibility for all races and ethnicities combined ranged from 21% to 23%. Compared to non-Hispanic whites, Hispanic nonsmokers were consistently more susceptible throughout the study period (highest adjusted odds ratio, 1.67), while non-Hispanic blacks were less susceptible (lowest aOR, 0.80). Overall, youth were most susceptible at age 13 to 15 years, though racial and ethnic disparities existed starting at 11 years of age.


Given that almost 90% of adult smokers start smoking during their youth, understanding the epidemiology of smoking susceptibility offers clinicians an opportunity to tailor prevention discussions. Clinicians should recognize that while Hispanic youth are at highest risk, all children starting at age 11 would benefit from counseling on smoking prevention. Using the questions from this study in the clinical setting may be an effective way to assess a patient's susceptibility.

Editor Disclosures at Time of Publication

  • Disclosures for John D. Cowden, MD, MPH at time of publication Leadership positions in professional societies Co-Chair, Culture, Ethnicity, and Health Care Special Interest Group, Academic Pediatric Association


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