BACKGROUND:

Although many smoking prevention programs have been implemented on a large-scale basis, the effectiveness of these programs varies greatly.

While these programs have undoubtedly prevented many young adults from starting to smoke, recent smoking initiation rates among females have consistently exceeded the rates of males and smoking initiation rates among Afro-Americans remain at high levels. More information is needed on the reasons for smoking initiation among adolescents, particularly females. Despite considerable interest in this area, virtually nothing is known regarding the reasons for adoption of smoking in Black or white females. Not a single prospective study has evaluated race-and gender-specific models for the prediction of smoking onset. For example, while it is commonly assumed that the weight-reducing qualities of smoking are associated with smoking onset among female adolescents, not a single prospective study has been conducted that documents that weight-related concerns at one age predict smoking onset at a later age.

The study was part of the Collaborative Projects on Women's Health initiative which was proposed by the NHLBI staff, given concept clearance at the February 1992 National Heart, Lung, and Blood Advisory Council, and released as a Request for Applications in April 1992.

DESIGN NARRATIVE:

The study was part of a two grant project on the Collaborative Projects on Women's Health. Dr. Robert Klesges conducted a longitudinal study to assess whether weight concerns of adolescent girls predict smoking onset at a later age. His collaborator, Dr, Linda Eck (R01HL50946), evaluated the role of smoking in dietary intake, physical activity, and metabolic rate and determined the differential effects of smoking and race on the energy balance of African American and white women.

Dr. Klesges' study was renewed in FY 1998 to continue longitudinal observation of factors relating to the onset of smoking in a biracial population of 6,967 boy and girl students first surveyed as seventh graders in 1993-94. The cohort was tracked through the end of high school and two years after high school in order to investigate the determinants of smoking onset both in high school and into the young adult years.

The study was renewed in February 2001 through January 2005 to follow-up participants for four years post-high school to assess the extent of young adult smoking onset and cessation, to determine predictors of smoking onset, and identify predictors of cessation for both early onset and late onset smokers.