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Abrams K, Skolnik N, Diamond JJ. 
“Patterns and correlates of tobacco use among suburban Philadelphia 6th- through 12th-grade students”. 
Fam Med. 1999 Feb 11;31(2):128-32.

BACKGROUND AND OBJECTIVES: Tobacco use among teenagers is increasing, even in the face of an understanding of its harmful effects. Data suggest that tobacco use often begins before entrance to eighth grade. This study examined the prevalence of tobacco use among students in 6th grade and compared it to the prevalence of tobacco use among 8th, 10th, and 12th graders in a northeastern suburban community and to national data.

METHODS: We used a survey that measured selected tobacco and smokeless tobacco use, demographic variables, school-related factors, and social influences on the use of tobacco products.

RESULTS: Sixth-grade tobacco use existed but was minimal compared to the rates seen in 8th, 10th, and 12th graders. Only 1% of 6th graders reported they were current smokers, compared with 41% of 12th graders. Risk factors for becoming a smoker were smoking habits of parents, siblings, and friends. CONCLUSIONS: Cigarette experimentation and use begins as early as sixth grade and increases substantially by eighth grade. Our data suggest that efforts toward primary prevention of smoking should be pursued between sixth and eighth grade.
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