Kids who see cigarettes as easily accessible are more likely to end up as regular smokers, particularly if they have friends who smoke, according to a new report published in the current issue of Annals of Family Medicine. The study, funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation, could be valuable to smoking intervention efforts by allowing health professionals to identify and target high-risk children.

“We found that if you get kids to answer just two simple questions – ‘would it be easy for you to get a cigarette?’ and ‘do you have friends who smoke?’ – you can identify those who are at high risk of becoming regular smokers,” said lead author, Chyke Doubeni, PhD, with the University of Massachusetts Medical School. “Saying yes to either should raise a red flag and prompt doctors and others to talk with parents and kids about how to avoid smoking.”

The researchers interviewed 1,195 sixth-graders in Massachusetts who had never before puffed on a cigarette or who smoked less than once a week. They followed them from January 2002 to February 2006.

Over the four years of the study, 177 students tried out smoking and 109 became regular smokers. All those who picked up the habit either agreed with the statement “it would be easy for me to get a cigarette” or acknowledged having a friend who smoked – or both. The researchers also found that perceptions of accessibility and prevalence of peer smokers both intensified as the kids got older. At the start of the study, 21 percent of the participating students perceived cigarettes as easily accessible and only 9 percent had friends that smoked. By the fourth year of the study period, 50 percent perceived easy access to cigarettes and 32 percent had friends who smoked. Also, the study found that as they get older, kids appear to become more aware of which stores sell cigarettes.

“The take home message is clear: knowing that it is easy to get cigarettes is like adding fuel to the fire when it comes to youth smoking,” Doubeni said. “And having a friend who smokes naturally makes cigarettes seem readily available. Ultimately, the kids who reported both peer smokers and easy access were the ones most likely to become regular smokers, compared to those who were exposed to none of those factors.”

“Either factor—easy access or peer smokers—should be seen as a warning sign, but when they all occur together, then you are really putting kids at risk,” Doubeni said. “We found that there is a synergy between having a friend that smoked and perceiving easy access; having a friend who smokes naturally makes cigarettes seem readily available. Ultimately, the kids who reported both peer smokers and easy access were the ones most likely to become regular smokers, compared to those who were exposed to only one of those factors.”

For children in low-income families eligible for Medicaid, the Early and Periodic Screening, Diagnosis and Treatment program already is supposed to screen for smoking risk factors, such as peer influences and tobacco use. The authors recommend that in general, family physicians and pediatricians inside and outside of Medicaid should make a point of specifically discussing with their patients perceptions regarding the availability of cigarettes and whether or not their friends smoke.

“Getting this kind of information can allow health care professionals to move more aggressively to warn children and their parents that they are dangerously close to engaging in a behavior that could severely damage their bodies and, over time, even kill them,” said Doubeni. “It can serve as a wake-up call to intervene and help kids avoid succumbing to a habit that can be extremely hard to quit.”

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The Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation funds research into policies related to alcohol, tobacco and illegal drugs.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime.

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