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National Cancer Institute
Behavioral Research - Cancer Control and Population Sciences

NCI Measures Guide for Youth Tobacco Research

Susceptibility to Smoking
Pierce et al. (1995; 1996)

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Brief Description: This 4-item instrument is used to predict which never smokers are likely to start smoking. Item responses are on a 4-point Likert scale (definitely yes, probably yes, probably not, definitely not) and include "refused" and "don't know" options.
Target Population: Adolescent never smokers, aged 12-18 years.
Administrative Issues: This instrument can be administered over the telephone.
Scoring Information: To classify a respondent as not susceptible to smoking, the respondent must indicate "definitely not" to all four items. Any other response to any item classifies a respondent as "susceptible."
Psychometrics: Validity: Cronbach's alpha= 0.84
Susceptibility, as indexed by items 1, 2, and 4, was evaluated in the source references. Item 3 was added recently and will be included in forthcoming publications. All items are significantly associated with smoking behavior four years later. They are also inversely related to age and perceived school performance, and positively related to exposure to other smokers. Scores on these items were greater for Hispanics, and for adolescents in the lowest parent education and family income categories.
Commitment not to smoke, defined as responding "definitely not" to items 2 and 4 among puffers (who had not smoked a whole cigarette) or "definitely not" to item 2 among those who had smoked a whole cigarette, was a significant predictor of not progressing to established smoking among 14-18 year old adolescents (Choi, Pierce, Gilpin, Farkas, & Berry, 1997).
Clinical Utility of Instrument: This instrument can be used to identify adolescents who are most at risk for smoking and may particularly benefit from preventive interventions.
Research Applicability: This instrument can be used as an outcome measure in evaluating interventions designed to reduce smoking susceptibility. It can also be used to identify a research population of interest and as a predictor variable in studies of the initiation and progression of smoking.
Copyright, Cost, and Source Issues: This measure is freely available in the public domain.
Source Reference: Pierce JP, Farkas AJ, Evans N, Gilpin EA. An improved surveillance measure for adolescent smoking. Tobacco Control 1995; 4:S47-S56.

Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. Validation of susceptibility as a predictor of which adolescents take up smoking in the U.S. Health Psychology 1996;15:355-361.

Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking. Journal of the American Medical Association 1998; 279:511-515.

Choi WS, Gilpin EA, Farkas AJ, Pierce JP. Determining the probability of future smoking among adolescents. Addiction 2001; 96:313-323.
Supporting References: Sargent JD, Dalton M, Beach M, Bernhardt A, Heatherton T & Stevens M. Effect of cigarette promotions on smoking uptake among adolescents. Preventive Medicine 2000;30:320-327.

Pierce JP, Distefan JM, Jackson C, White MM, Gilpin, EA. Does tobacco marketing undermine the influence of recommended parenting in discouraging adolescents from smoking? American Journal of Preventive Medicine 2002;23:73-81.
Author: John P. Pierce, Ph.D.
Contact Information: Cancer Prevention and Control Program
Cancer Center
University of California, San Diego
La Jolla, CA 92093-0645
Email: jppierce@ucsd.edu
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Last Updated: May 1, 2012

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