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The incidence of experimental smoking in school children: an 8-year follow-up of the child and adolescent behaviors in long-term evolution (CABLE) study

Hsing-Yi Chang1*, Wen-Chi Wu2, Chi-Chen Wu1, Jennifer Y Cheng1, Baai-Shyun Hurng3 and Lee-Lan Yen14

Author Affiliations

1 Division of Preventive Medicine and Health Service Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan, ROC

2 School of Health Care Management, Department of Nutrition and Health Sciences, Kainan University, Taiwan, ROC

3 Center for Population and Health Survey Research, Bureau of Health Promotion, Department of Health, Taichung, Taiwan, ROC

4 Institute of Health Policy and Management, College of Public Health, National Taiwan University. Rm. 623, No. 17, Xu-Zhou Road, Taipei 100, Taiwan, ROC

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BMC Public Health 2011, 11:844  doi:10.1186/1471-2458-11-844

Published: 3 November 2011



Studies have established that most regular adult smokers become addicted in their adolescent years. We investigated the incidence of and risk factors associated with initial experimental smoking among a group of school children who were followed for 8 years.


We used cohort data collected as part of the Child and Adolescent Behaviors in Long-term Evolution (CABLE) study, which selected nine elementary schools each from an urban area (Taipei City) and a rural area (Hsingchu county) in northern Taiwan. From 2002 to 2008, children were asked annually whether they had smoked in the previous year. An accelerated lifetime model with Weibull distribution was used to examine the factors associated with experimental smoking.


In 2001, 2686 4th-graders participated in the study. For each year from 2002 to 2008, their incidences of trial smoking were 3.1%, 4.0%, 2.8%, 6.0%, 5.3%, 5.0% and 6.0%, respectively. There was an increase from 7th to 8th grade (6.0%). Children who were males, lived in rural areas, came from single-parent families, had parents who smoked, and had peers who smoked were more likely to try smoking earlier. The influence of parents and peers on experimental smoking demonstrated gradient effects.


This study used a cohort to examine incidence and multiple influences, including individual factors, familial factors, and community factors, on experimental smoking in adolescents. The findings fit the social ecological model, highlighting the influences of family and friends. School and community attachment were associated with experimental smoking in teenagers.

cigarette smoking; adolescent behavior; epidemiological factors; socioeconomic factors