• Robert J Wellman, Erika N Dugas, Hartley Dutczak, Erin K O'Loughlin, Geetanjali D Datta, Béatrice Lauzon, and Jennifer O'Loughlin.
• Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts.
• Am J Prev Med. 2016 Nov 1; 51 (5): 767-778.

ContextThe onset of cigarette smoking typically occurs during childhood or early adolescence. Nicotine dependence symptoms can manifest soon after onset, contributing to sustained, long-term smoking. Previous reviews have not clarified the determinants of onset.Evidence AcquisitionIn 2015, a systematic review of the literature in PubMed and EMBASE was undertaken to identify peer-reviewed prospective longitudinal studies published between January 1984 and August 2015 that investigated predictors of cigarette smoking onset among youth aged <18 years who had never smoked.Evidence SynthesisNinety-eight conceptually different potential predictors were identified in 53 studies. An increased risk of smoking onset was consistently (i.e., in four or more studies) associated with increased age/grade, lower SES, poor academic performance, sensation seeking or rebelliousness, intention to smoke in the future, receptivity to tobacco promotion efforts, susceptibility to smoking, family members' smoking, having friends who smoke, and exposure to films, whereas higher self-esteem and high parental monitoring/supervision of the child appeared to protect against smoking onset. Methodologic weaknesses were identified in numerous studies, including failure to account for attrition or for clustering in samples, and misidentification of potential confounders, which may have led to biased estimates of associations.ConclusionsPredictors of smoking onset for which there is robust evidence should be considered in the design of interventions to prevent first puff in order to optimize their effectiveness. Future research should seek to define onset clearly as the transition from never use to first use (e.g., first few puffs).Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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