title: Can smoking initiation contexts predict how adult Aboriginal smokers assess their smoking risks? A cross-sectional study using the 'Smoking Risk Assessment Target'.
abstract: Smoking prevalence is slow to reduce among Indigenous Australians of reproductive age. We analysed the relationships between age of smoking initiation, recalled initiation influences and self-assessment of smoking risks in Aboriginal smokers.
  
  
  
  A community-based cross-sectional survey of Aboriginal smokers aged 18-45 years (N=121; 58 men) was undertaken, using single-item measures. The Smoking Risk Assessment Target (SRAT) as the primary outcome measure enabled self-assessment of smoking risks from 12 options, recategorised into 3 groups. Participants recalled influences on their smoking initiation. Multinomial logistic regression modelling included age, gender, strength of urges to smoke, age at initiation (regular uptake) and statistically significant initiation influences on χ(2) tests ('to be cool', alcohol and cannabis).
  
  
  
  Frequent initiation influences included friends (74%; SD 0.44), family (57%; SD 0.5) and alcohol (40%; SD 0.49). 54% (n=65) of smokers had the highest risk perception on the SRAT, selected by those who cared about the smoking risks and intended to quit soon. On multivariate analyses, compared with the highest level of SRAT, male gender, lower age of uptake and strong urges to smoke were significantly associated with the lowest level of SRAT, selected by those who refuted risks or thought they could not quit. Lower age of uptake and alcohol were associated with mid-level of SRAT, selected by those who cared about smoking risks, but did not consider quitting as a priority.
  
  
  
  Characteristics of smoking initiation in youth may have far-reaching associations with how smoking risks are assessed by adults of reproductive age, and their intentions to quit smoking. Becoming a regular smoker at under the age of 16 years, and influences of alcohol on smoking uptake, were inversely associated with high-level assessment of smoking risks and intention to quit in regional Aboriginal smokers. The SRAT may help tailor approaches to Indigenous smoking cessation.
authors.affiliation: School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia.
authors.forename: Gillian Sandra
authors.initials: GS
authors.lastname: Gould
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
authors.forename: Kerrianne
authors.initials: K
authors.lastname: Watt
authors.affiliation: Health Behaviour Research Centre, Epidemiology and Public Health, University College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: Australian Aboriginal and Torres Strait Islander Centre, James Cook University, Townsville, Queensland, Australia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cadet-James
authors.affiliation: Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D033062:Friends; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D012737:Sex Factors; D000074285:Smokers; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D000073869:Tobacco Smoking; D055815:Young Adult
keywords: Indigenous populations; alcohol; risk assessment; smoking cessation; smoking initiation; tobacco smoking