Socioeconomic status is associated with the prevalence and co-occurrence of risk factors for cigarette smoking initiation during adolescence.

Objectives: To investigate whether the prevalence or co-occurrence of risk factors for cigarette smoking initiation differ by socioeconomic status (SES) and whether SES interacts with risk factors to increase initiation.

Methods: In 2005, 1451 5th grade never smokers (mean age 10.7 years) in Montréal, Canada, provided baseline data, with follow-up in 6th and/or 7th grade (2005-2007). Poisson regression analyses estimated the association between 13 risk factors and initiation. Excess risk of each risk factor in low vs. moderate-high SES participants was assessed.

Results: Cigarette smoking was initiated by 9.4% of participants (n = 137). Low SES was associated with a higher prevalence and co-occurrence of risk factors. The estimated association of most risk factors with initiation was similar across SES, although participants from low SES neighborhoods whose mothers had no university education had three times the risk of initiation [ARR = 3.10 (1.19, 8.08)] compared to more affluent peers.

Conclusions: Tobacco control efforts must address the higher prevalence and co-occurrence of risk factors in lower SES contexts since these may render initiation highly probable in many lower SES youth.