Purpose: To directly test whether perceptions of second-hand smoke risks deter adolescent smoking initiation.
Methods: A longitudinal survey design was utilized in this study. Baseline surveys measuring perceptions of tobacco-related risks and smoking behaviors were administered to 395 high school students, with three follow-up assessments every 6 months.
Results: Perceptions of personal second-hand smoke risks and parental second-hand smoke risks significantly deterred adolescent smoking initiation. Perceptions of personal second-hand smoke risks reduced the odds of smoking by a factor of 0.63 (95% confidence interval [CI]=0.42-0.94) for each quartile increase in perceptions of personal second-hand smoke risks. Adolescents who provided the highest estimates of risks for personal second-hand smoke were 0.25 as likely to smoke as adolescents who provided the lowest estimates of risk. Perceptions of parental second-hand smoke risks reduced the odds of smoking by a factor of 0.64 (95% CI=0.43-0.93) for each quartile increase. Adolescents who perceived the highest estimates of risks associated with parental second-hand smoke were 0.26 as likely to smoke in the future compared to adolescents who provided the lowest estimates of risk. These effects are over three times as large as a smoking peer's influence on a nonsmoking adolescents' risk for smoking initiation, odds ratio [OR]=1.18 (95% CI=1.02-1.35).
Conclusions: Adolescent perceptions of risks of second-hand smoke are strongly associated with smoking initiation. Encouraging adolescents to express their objections to second-hand smoke, as well as encouraging parents to create smoke-free homes, may be powerful tobacco control strategies against adolescent smoking.