title: The association between peer, parental influence and tobacco product features and earlier age of onset of regular smoking among adults in 27 European countries.
abstract: BACKGROUND
  Factors that influence smoking initiation and age of smoking onset are important considerations in tobacco control. We evaluated European Union (EU)-wide differences in the age of onset of regular smoking, and the potential role of peer, parental and tobacco product design features on the earlier onset of regular smoking among adults <40 years old in 27 EU countries.
  
  
  METHODS
  We analysed data from 4442 current and former smokers aged 15-39 years, collected for the Eurobarometer 77.1 survey (2012). Respondents reported their age at regular smoking onset and factors that influenced their decision to start smoking, including peer influence, parental influence and features of tobacco products. Multi-variable logistic regression, adjusted for age; geographic region; education; difficulty to pay bills; and gender, was used to assess the role of the various pro-tobacco influences on early onset of regular smoking (i.e. <18 years).
  
  
  RESULTS
  Among ever smokers, the mean age of onset of regular smoking was 16.6 years, ranging from 15.8 to 18.8 years in member countries. 68.1% responded that they started smoking regularly when they were <18 years old. Ever smokers who reported they were influenced by peers (OR = 1.70; 95%CI 1.30-2.20) or parents (OR = 1.60; 95%CI 1.21-2.12) were more likely to have started smoking regularly <18 years old. No significant association between design and marketing features of tobacco products and an early initiation of regular smoking was observed (OR = 1.04; 95%CI 0.83-1.31).
  
  
  CONCLUSIONS
  We identified major differences in smoking initiation patterns among EU countries, which may warrant different approaches in the prevention of tobacco use.
authors.affiliation: 1 School of Public Health, Imperial College London, London, UK 2 Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, MA, USA f.filippidis@imperial.ac.uk.
authors.forename: Filippos T
authors.initials: FT
authors.lastname: Filippidis
authors.affiliation: 2 Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Israel T
authors.initials: IT
authors.lastname: Agaku
authors.affiliation: 2 Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, MA, USA 3 Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Constantine I
authors.initials: CI
authors.lastname: Vardavas
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents; D010379:Peer Group; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D062789:Tobacco Products; D055815:Young Adult