Hierarchical Modeling of Psychosocial, Parental, and Environmental Factors for Susceptibility to Tobacco Product Use in 9–10-Year-Old Children

Purpose: Tobacco use during early adolescence can harm brain development and cause adverse health outcomes. Identifying susceptibility in early adolescence before initiation presents an opportunity for tobacco use prevention. Methods: Data were drawn from the Adolescent Brain and Cognitive Development study that enrolled 9–10-year-old children in 21 US cities between 2016 and 2018 at baseline. Separate nested hierarchical models were performed to incrementally examine the associations of sociodemographic factors, psychosocial influences, parental substance use, immediate social contacts, and perceived neighborhood safety with tobacco use susceptibility among never tobacco users (n = 10,449), overall and stratified by gender. Results: A total of 16.6% of youths who have never used tobacco reported susceptibility to tobacco. Females (vs. males, adjusted odds ratio [AOR] [95% confidence interval {CI}] = 0.80 [0.70–0.91]), positive parental monitoring (AOR [95% CI] = 0.76 [0.66–0.87]) and positive school environment (AOR [95% CI] = 0.95 [0.93–0.98]) were associated with reduced susceptibility to tobacco use. Parental education level (high school, AOR [95% CI] = 1.52 [1.02–2.28]; bachelor's degree, AOR [95% CI] = 1.53 [1.03–2.28]; or postgraduate degree, AOR [95% CI] = 1.54 [1.03–2.3] vs. less than high school), youth substance ever use (AOR [95% CI] = 2.24 [1.95–2.58]), internalizing problems (AOR [95% CI] = 1.03 [1–1.06]), and high scores on negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency-impulsive behavior scale were associated with increased susceptibility to tobacco use. Stratified analysis showed that parent-perceived neighborhood safety was associated with reduced susceptibility to tobacco use among males but not among females (AOR [95% CI] = 0.89 [0.81–0.99]) vs. (AOR [95% CI] = 1.01 [0.9–1.13]). A positive school environment was associated with lower susceptibility to tobacco use among females but not among males. Discussion: Parental, environmental, and psychosocial factors influence early childhood tobacco susceptibility. Family and school-based tobacco prevention programs should consider integrating these factors into primary school curricula to reduce youth tobacco susceptibility and later initiation.