Risk and protective factors for tobacco onset among young people

Tobacco smoking is the leading cause of morbidity and mortality worldwide. Snus use has also a negative impact on health. The majority of all people who smoke starts at an early age. Therefore, it is important to understand the contributing factors for tobacco onset to prevent tobacco use in children and young adults.

We conducted a scoping review to identify different factors related to tobacco onset among children and young adults in the Nordic countries.

The results show that factors at different levels and areas were examined. The potential risk factors identified in the studies include:

  • individual factors such as hyperactivity or impulsivity, antisocial behaviour, conduct problems, depression symptoms, exposure to smoking in films, lack of a firm intention to abstain from tobacco and poor school performance
  • social factors such as attitude toward smoking, pressure to smoke from friends, friends who smoke and bullying
  • living conditions such as family members who use tobacco, family background, socioeconomic status and some school and class-related factors.

Few protective factors have been investigated.

The quality assessment showed that two studies had low risk of bias, four studies had medium risk, and four studies had high risk. The most common type of systematic bias related to the lack of adjustments for potential confounders and attrition bias in some studies.

Factors associated with tobacco onset have also been investigated in other settings, outside the Nordic countries, and the results are in line with this review.

The scoping review contributes to more knowledge

This scoping review contributes to more knowledge on:

  • factors examined in the Nordic countries related to tobacco onset among children and adolescents
  • the type of bias existing in the published research
  • potential knowledge gaps.

More research is needed to identify and better understand different factors for tobacco onset in children and young adults that can contribute to more effective interventions.

About the scoping review

A literature search was conducted in PubMed and PsycInfo for prospective longitudinal studies published between January 2000 and February 2020 in the Nordic countries that examined tobacco use in children and young adults up to 25 years.

The literature search identified 2,670 studies, and after exclusion based on title, abstract, and full text review 10 studies were included. Four studies were conducted in Sweden, two in Finland, two in Iceland, and one study each in Norway and Denmark.

All studies examined children and adolescents who were 18 years or younger at follow-up. The number of participants in the studies ranged between 700 and 3,000, with a mean follow-up of 4 years (range 0.5–10 years). All studies examined smoking as outcome and two studies also examined snus use.

Read more about the scoping review (folkhalsomyndigheten.se) (in Swedish with summary in English)