Smoking initiation among Israeli adolescents: A 24-year time-to-event analysis
Menée en Israël entre 1986 et 2009 auprès de 50 254 jeunes recrues militaires, cette étude identifie les facteurs associés à l'initiation tabagique
Introduction : Preventing smoking initiation will protect future generations from smoking-attributable death and disease. This study examines correlates and patterns of initiation among Israeli youth using time-to-event analysis and other methods. Methods : Twenty-four consecutive representative samples (1986-2009) of new military recruits (N = 50,254) were analyzed. Cox regression and Kaplan-Meier analysis were used to identify factors associated with smoking initiation, and logistic regression was used to identify factors associated with smoking status. Results : The most hazardous age for smoking initiation was seventeen, subsequent to the mean age of smoking initiation (Males:15.7, Females:16.0). Age of initiation and age of greatest hazard for initiation declined among recruits between the years 1986-2009. Earlier smoking initiation among boys and girls was significantly associated with low education levels (< 12 years) (males: HR = 2.98,CI:[2.79,3.18] ;females:HR = 3.35,CI:[2.96,3.80]), low paternal education levels, Russian birthplace, and religion. Earlier initiation in boys was associated with high fitness levels and low/medium socio-economic status. Earlier initiation in girls was associated with being Western-born and ever-use of contraception. Conclusions : Smoking initiation among Israeli youth recruited to the armed forces is associated with individual and family characteristics, particularly low education levels. Time-to-event analysis complements traditional means of understanding smoking initiation by identifying ages at which initiation hazard is high.