Time-Varying Effect of Risk-Perception on Cigarette Use Among High School Seniors

Time-Varying Effect of Risk-Perception on Cigarette Use among
High School Seniors

Introduction. Research suggests that the perceived risk of harm associated with negative health-related behaviors (e.g. cigarette smoking) may impact risk behavior engagement. As anti-tobacco campaigns use tactics aimed at increasing the perceived risk associated with cigarette use (e.g., picture based warnings on cigarette packaging), there is a need to understand the association between risk perception and cigarette use. Research suggests that adolescents are less likely to perceive risky behaviors, such as smoking, as being potentially harmful. As such, adolescents may be particularly vulnerable to engaging in negative health-related behaviors such as cigarette smoking despite presented risks.

Method. The current study utilizes data from years 1990-2013 of the Monitoring the Future cross-sectional survey. The analytic sample contained 32,775 high school seniors (52% female; 78% White). Perceived risk and harm exposure was assessed using one item: “How much do you think people risk harming themselves (physically or in other ways) if they smoke one or more packs of cigarettes per day?” This item was recoded into 4 binary items for each level of risk to create 4 risk groups: no risk, slight risk, moderate risk, and great risk. Time-varying effect models (TVEMs) were used to examine the time-varying prevalence of past month cigarette use across historical time, in addition to the time-varying association between risk group and actual cigarette use. 

Results. Overall prevalence of past month cigarette use varied across historical time, with highest rates occurring between 1990 and 1998 (~32%). Following 1998, data displayed a steady decline, with rates half as likely in 2013. Testing smoking rates by risk group showed that HS seniors reporting a ‘slight risk’ associated with heavy cigarette smoking displayed the highest rates of past month smoking across time (~25-30%). The ‘no-’ and ‘moderate risk’ groups reported similar rates of past month use between 1993 and 2013 (~17%), however, from 1990-1993 the ‘no risk’ group displayed even lower, but increasing rates (~7-17%). Those reporting ‘great risk’ were least likely to report past month use (~5%). ‘Great-’, ‘moderate-‘, and ‘slight risk’ groups displayed linear patterns of use which remained stable over time. However, the ‘no risk’ group demonstrated a slightly quartic pattern.

Conclusions. HS seniors vary in their perception of risk associated with heavy cigarette smoking. Perception of high risk appears be associated with low levels of actual cigarette use whereas perception of slight risk appears associated with the highest levels of cigarette use.