Sex differences in smoking initiation among children and adolescents

Objective: To understand differences in the context of, and reasons for, smoking initiation among boys and girls. Study design: Sex- and gender-based analysis of published literature. Methods: A comprehensive search of the PUBMED database was conducted for studies (published in the English language) between January 1980 and October 2010 that assessed smoking initiation among children and adolescents (aged 8-19 years). Information on demographics and study design were extracted by two authors from each eligible article. A sex- and gender-based analysis was employed. Results: Of 40 publications initially obtained, studies in adult or college-age populations (n = 9) and studies that did not examine the specific context of smoking initiation (n = 19) were excluded. Thus, this review is based on 12 eligible studies. Eligible studies represented data from 10,831 children and adolescents in nine countries. In most studies, boys had a lower age of smoking initiation than girls, with the exception of two studies from Yemen and China. In some countries, girls reported obtaining and smoking their first cigarette from family members at home. In most studies, the school was the main setting for initiation for boys, whereas the home setting was the main setting for girls. Conclusions: This study highlights gender and cultural differences in smoking initiation among children and adolescents. Smoking prevention programmes should thus include gender- and culture-specific content related to smoking initiation. Future studies may further examine gender- and culture-specific messaging to inform policies and enhance tailored programmes aimed at preventing smoking initiation.