title: The changing risk profile of the American adolescent smoker: implications for prevention programs and tobacco interventions.
abstract: OBJECTIVE
  To determine how the association between cigarette smoking and other risky behaviors, such as substance use, violence, and risky sexual practices, has changed between 1991 and 2003.
  
  
  METHODS
  Youth Risk Behavior Surveys (YRBS) from 1991 to 2003 were analyzed. For each cohort, logistic regression models controlling for gender, race/ethnicity, and school grade were used to describe the associations between smoking and other risky behaviors. Changes in the odds ratios over time were confirmed with a trend analysis.
  
  
  RESULTS
  The strength of the relationship between smoking and other risky behaviors increased for lifetime number of sexual partners (1991 odds ratio [OR] 1.49; 2003 OR 1.61 (p < .001)), sexual partners in the past 3 months (1991 OR 1.77; 2001 OR 2.05 (p < .001)), and never wearing a bicycle helmet 1991 OR 1.40; 1997 OR 5.94 (p < .001). Increases were also seen for binge drinking, and physical fighting. The association between cigarette smoking and marijuana use decreased slightly.
  
  
  CONCLUSIONS
  Future prevention efforts and tobacco intervention programs should recognize that current adolescent smokers are even more likely to engage in risky sexual behavior, risky alcohol-related behaviors, and to not use a seatbelt or bicycle helmet than were adolescents in the early nineties.
authors.affiliation: Strong Children's Research Center, Department of Pediatrics, Division of Adolescent Medicine, University of Rochester School of Medicine, Rochester, New York 14642, USA.
authors.forename: Deepa R
authors.initials: DR
authors.lastname: Camenga
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Klein
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012309:Risk-Taking; D012725:Sexual Behavior; D012907:Smoking / Q000523:psychology* / Q000639:trends*; D000074606:Smoking Prevention; D019966:Substance-Related Disorders; D014754:Violence