摘要：Objectives. The predictive value of perceptions of smoking-related risks and benefits with regard to adolescent smoking initiation has not been adequately established. We used prospective, longitudinal data to directly test whether smoking-related perceptions predict smoking initiation among adolescents. Methods. We administered surveys assessing perceptions of smoking-related risks and benefits to 395 high school students, beginning at the start of their ninth-grade year. We conducted follow-up assessments every 6 months until the end of 10th grade, obtaining 4 waves of data. Results. Adolescents who held the lowest perceptions of long-term smoking-related risks were 3.64 times more likely to start smoking than were adolescents who held the highest perceptions of risk. Adolescents who held the lowest perceptions of short-term smoking-related risks were 2.68 times more likely to initiate. Adolescents who held the highest perceptions of smoking-related benefits were 3.31 times more likely to initiate. Conclusions. Findings from this study provide one of the first sets of empirical evidence to show that smoking initiation is directly related to smoking-related perceptions of risks and benefits. Thus, efforts to reduce adolescent smoking should continue to communicate the health risks of smoking and counteract perceptions of benefits associated with smoking. Tobacco use is the leading cause of preventable deaths in the United States. Tobacco use causes approximately 440 000 deaths annually, which is twice the number of deaths attributed to alcohol, homicide, illicit drug use, and suicide combined. 1 There are more than 60 million daily smokers in the United States. 2 Each year, approximately 1 million additional people become daily cigarette users, 44.2% of whom are younger than 18 years. 2 Every day, more than 4000 adolescents aged 12 to 17 years try their first cigarette, and 1300 of them go on to become daily smokers. 2 Given these statistics, it is clear that preventing initiation of tobacco use among adolescents is crucial to reducing adult-onset disease and mortality. A prominent explanation for adolescent smoking is that adolescents have poor decisionmaking and risk-judging skills, leading them to believe they are invulnerable to harm. 3 , 4 This explanation is consistent with major theories of health behavior, including decisional balance theory, the health belief model, and the theory of planned behavior. 5 – 9 These theories serve as the basis for many tobacco-use intervention programs that aim to decrease initiation and increase cessation by giving adolescents information about tobacco risks. 10 However, it is unclear whether the practice of communicating tobacco-related risk information to adolescents is evidence-based, because most of the research providing evidence to support this strategy is based on cross-sectional data. Cross-sectional research has shown that adolescents who smoke perceive tobacco-related risks to be lower than do adolescents who have not smoked, 11 – 13 adolescents' perceptions of tobacco-related benefits play a role in smoking, 14 – 16 and adolescents who have smoked perceive more tobacco-related benefits than do adolescents who have never smoked. 16 , 17 Only 2 studies have used longitudinal data to examine whether perceptions of risks actually predict future tobacco use. One of these studies found that the belief that smoking is generally risky to one's health predicted levels of 30-day smoking 1 year after high school. 18 The other study used data collected over 3 years to demonstrate that the belief that cigarettes cause cancer or heart disease deters smoking onset. 19 No studies have been conducted to determine whether beliefs about different types of harm—namely, short-term risks like smelling bad, developing a cough, or having shortness of breath—influence adolescent smoking. Moreover, no longitudinal research has included perceptions of tobacco-related risks and perceptions of tobacco-related benefits in a single analysis examining their impact on smoking. We conducted a prospective, longitudinal study to test whether adolescents' perceptions of smoking-related risks or benefits predicted smoking initiation. We also tested whether there was a difference in predictive value between perceived short-term risks and perceived long-term risks, and whether there was a difference in predictive value between perceived risks and perceived benefits. We gathered data by administering surveys to 395 adolescents, beginning in the fall semester of ninth grade and continuing with follow-up surveys every 6 months until the spring semester of 10th grade, obtaining 4 waves of data.
