Background Understanding disparities in adolescent cigarette smoking is important for effective prevention. Methods We investigated disparities in adolescent smoking based on cumulative reported psychosocial/health risk among respondents ages 12-17 years in the US National Survey of Drug Use and Health from 2002 to 2019. Multivariable regression estimated associations of cumulative risk, survey years, and their interaction predicting past-month and daily smoking. Eleven psychosocial/health variables associated with youth smoking formed composite measures of cumulative risk, categorizing risk as Low (0-2), Moderate (3-4), or High (5+). The main outcomes were weighted past-month and daily smoking by cumulative risk and time, examining prevalence and proportional change across years. Results Among 244,519 adolescents, greater cumulative risk predicted higher smoking prevalence across all outcomes. Compared to the Low-risk category, past-month smoking odds (adjusted odds ratio, 95%CI) were 9.14 (8.58-9.72) and 46.15 (43.38-49.10) times greater in the Moderate- and High-risk categories. For daily smoking, odds were 14.11 (11.92-16.70) and 97.32 (83.06-114.03) times greater among the Moderate- and High-risk categories. Regarding proportional change, the Low-risk category exhibited the steepest decline in past-month smoking from 2002-2003 to 2018-2019 (-85.1%), followed by the Moderate- (-79.2%) and High-risk (-65.7%) categories. Daily smoking declined more steeply among the Low- (-96.5%) and Moderate- (-90.5%) than High-risk category (-86.4%). Conclusions Cumulative risk is a robust predictor of adolescent smoking. While record-setting reductions in adolescent smoking extend across risk categories, disparities favoring youth with fewer risks are evident throughout. Recognizing cumulative risk can inform the development of more targeted and effective prevention efforts.

中文翻译：

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2002 年至 2019 年美国青少年吸烟的累积社会心理和健康差异


背景 了解青少年吸烟的差异对于有效预防很重要。方法 我们根据 2002 年至 2019 年美国全国药物使用与健康调查中 12-17 岁受访者累积报告的社会心理/健康风险调查，调查了青少年吸烟的差异。多变量回归估计了累积风险、调查年份及其交互作用的关联，从而预测了过去一个月和每天的吸烟情况。与青少年吸烟相关的 11 个社会心理/健康变量构成了累积风险的综合衡量标准，将风险分为低 （0-2）、中 （3-4） 或高 （5+）。主要结局是按累积风险和时间加权过去一个月和每天的吸烟量，检查患病率和跨年份的比例变化。结果 在 244,519 名青少年中，更高的累积风险预示着所有结果的吸烟率更高。与低风险类别相比，中度和高风险类别的过去一个月吸烟比值 （调整比值比，95%CI） 分别是 9.14 （8.58-9.72） 和 46.15 （43.38-49.10） 倍。对于日常吸烟，中高风险类别的几率分别是 14.11 （11.92-16.70） 和 97.32 （83.06-114.03） 倍。在比例变化方面，从 2002-2003 年到 2018-2019 年，低风险类别的过去一个月吸烟率下降幅度最大 （-85.1%），其次是中度 （-79.2%） 和高风险 （-65.7%） 类别。低风险 （-96.5%） 和中度 （-90.5%） 的每日吸烟率下降幅度高于高风险 （-86.4%）。结论 累积风险是青少年吸烟的可靠预测指标。虽然青少年吸烟率创纪录的减少范围涵盖各个风险类别，但有利于风险较低的青少年的差异在整个过程中都很明显。 识别累积风险可以为制定更有针对性和更有效的预防工作提供信息。