OBJECTIVES: Understanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic. METHODS: Growth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N=1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention. RESULTS: A two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR=1.17, p=0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR=1.22, p<0.01 slow escalators; OR=1.54, p=0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR=1.02, p=0.98). CONCLUSIONS: This study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.

Department of Addictology 1st Faculty of Medicine Charles University Prague Apolinarska 4 120 00 Praha 2 Czech Republic

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