Sex specific trajectories in cigarette smoking behaviors among students participating in the Unplugged school-based randomized control trial for substance use prevention

ObjectivesUnderstanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic.MethodsGrowth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N = 1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention.ResultsA two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR = 1.17, p = 0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR = 1.22, p < 0.01 slow escalators; OR = 1.54, p = 0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR = 1.02, p = 0.98).ConclusionsThis study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.

► GMM was used to analyze data from the school-based RCT for substance use prevention.
► We examined trajectories in cigarette smoking behaviors among males and females.
► A 2-class model characterized tobacco use as a sex and intervention status function.
► More rapid cigarette use increases were observed in females as compared to males.
► There was no difference in sex distribution, comparing the two classes.