Original articleAdolescence and Later Life Disease Burden: Quantifying the Contribution of Adolescent Tobacco Initiation From Longitudinal Cohorts
Section snippets
Methods
Three sets of analysis were undertaken. We first used data from four national or regional longitudinal cohorts which provided data on age of initiation of smoking from adolescent waves and data on adult smoking beyond age 25 years.
The British National Childhood Development Study (NCDS) [11] is a nationally representative birth cohort which followed all UK children born in 1 week in 1958 (n = 17,638) and followed them up frequently till age 50 years (2008).
The U.S. National Longitudinal Study of
Results
Data on smoking adulthood by smoking status in adolescence (10–19 years) are shown for each cohort (the NCDS at 50 years and persistent adult smoking, Add Health, VACHS, and Pelotas cohorts) in Table 1. For each cohort, the table shows the proportion of adult smokers who initiated regular smoking in adolescence <20 years together with the associated risk ratio (RR) for being an adult smoker related to adolescent smoking, the AAF for adult smoking, and the adjusted AAF (adjusted for
Discussion
The contribution of adolescence to adult smoking burden is high, with 50%–72% of adult smoking related to adolescent initiation in the longitudinal cohorts studied here. Initiation in young people ≤ 16 years was more strongly associated with adult smoking burden than initiation later in adolescence. We found effects to be similar across older and more contemporary cohorts in high- and middle-income countries. Our findings in these cohorts took into account recent secular trends toward fewer
Acknowledgments
The first draft of this article was written by R.V. Authors’ contributions: R.V. and D.H. had the idea for the study. R.V. led the writing of the study and undertook the analyses of all cohorts except the Add Health cohort. D.H. undertook the analyses in the Add Health cohort and contributed to writing the article. J.M. and B.H. provided the Pelotas data, assisted in analyses of the Pelotas data and contributed to writing the article. A.M. and G.P. contributed to the ideas underlying the
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Conflicts of Interest: The authors have no conflicts of interest to disclose.
Ethical review: No new ethical review permissions were required for these secondary data analyses of existing historical cohorts.