Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America.
Michael & Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, United States of America.
PLoS One. 2021 May 5;16(5):e0251246. doi: 10.1371/journal.pone.0251246. eCollection 2021.
To prospectively estimate the age of cigarette initiation among young adults (18-24 years old) who were never cigarette users at their first wave of adult study participation overall, by sex, and by race/ethnicity given recent increases in cigarette initiation occurring in young adulthood.
Secondary analyses were conducted using the PATH restricted-use adult datasets among young adult never users of cigarettes in waves 1-3 (2013-2016) with outcomes followed-up in waves 2-4 (2014-2017). Interval censoring survival methods were used to estimate the age of initiation of (i) ever, (ii) past 30-day, and (iii) fairly regular cigarette use. Among never cigarette users when they first entered the adult study, interval censoring Cox proportional hazard models were used to explore differences in the estimated age of initiation of the three cigarette use outcomes by sex and by race/ethnicity, controlling for the effect of previous e-cigarette use and the total number of other tobacco products ever used (0-5 products) before cigarette initiation outcomes.
Among the young adults who were never cigarette users at their first wave of adult participation, the highest increase in cigarette initiation occurred between 18 and 19 years old. By age 21, 10.6% (95% CI: 9.5-11.7) initiated ever cigarette use, 7.7% (95% CI: 6.1-8.1) initiated past 30-day of cigarette use, and 1.9% (95% CI: 1.4-2.5) initiated fairly regular cigarette use. After controlling for other tobacco products: (a) males were 83% more likely to initiate past 30-day cigarette use at earlier ages than females; (b) Hispanic and Non-Hispanic Black young adults had increased risk to initiate past 30-day cigarette use at earlier ages than Non-Hispanic White young adults (62% and 34%, respectively).
The substantial amount of cigarette initiation among young adults reinforces the need for prevention strategies among this population. Although, interventions are needed for all young adult populations, strategies should target 18-21-year-olds, with potentially differential prevention targets by sex and by race/ethnicity.
鉴于最近年轻人开始吸烟的比例不断上升，本研究旨在前瞻性地估计首次参加成人研究时从未吸烟的年轻人（18-24 岁）的吸烟起始年龄，按性别和种族/族裔进行分层。
利用 PATH 限制使用的成人数据集，对首次参加成人研究时从未吸烟的年轻成年人（1 波-3 波，2013-2016 年）进行二次分析，随访结果在 2 波-4 波（2014-2017 年）中获得。采用区间 censoring 生存方法估计（i）曾经、（ii）过去 30 天和（iii）相当规律地使用香烟的起始年龄。在首次进入成人研究时从未吸烟的人群中，采用区间 censoring Cox 比例风险模型，在控制电子烟使用史和开始吸烟前使用的其他烟草制品数量（0-5 种）的影响后，按性别和种族/族裔比较三种吸烟结局的起始年龄。
在首次参加成人研究时从未吸烟的年轻人中，吸烟起始年龄的最高增长发生在 18-19 岁之间。到 21 岁时，10.6%（95%CI：9.5-11.7）开始吸烟，7.7%（95%CI：6.1-8.1）开始过去 30 天吸烟，1.9%（95%CI：1.4-2.5）开始规律吸烟。在控制其他烟草制品后：（a）男性开始过去 30 天吸烟的可能性比女性高 83%；（b）西班牙裔和非西班牙裔黑人青年开始过去 30 天吸烟的风险比非西班牙裔白人青年高 62%和 34%。
大量年轻人开始吸烟，这一现象凸显了针对这一人群实施预防策略的必要性。尽管所有年轻成年人都需要干预，但策略应该针对 18-21 岁的人群，并且可能需要根据性别和种族/族裔制定不同的预防目标。
