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Addictive Behaviors Reports 8(2018)95-101 Contents lists available at ienceDirect Addictive Behaviors Reports ELSMER journal homepage: www.elsevier.com/locate/abrep - - Measurement and predictive value of susceptibility to cigarettes, e-cigarettes, cigars, and hookah among Texas adolescents pdates Felicia R. Carey, Anna V. Wilkinson, Melissa B. Harrell% Elisabeth A. Cohn, Cheryl L. Perry Michael&Susan Dell Center for Healthy Living,University of Texas Health Science Center at Houston,School of Public Health in Austin,1616 Guadalupe S4 Suite 6.300, Austin,TX 78701,United States of America ABSTRACT Susceptibility to cigarette smoking,defined as the lack of a firm commitment not to smoke in the future,begins in childhood and is a phase in the transition from never to ever use of cigarettes.While a consistent and validated predictor of cigarette use,little research has assessed whether the susceptibility construct applies equally well across other tobacco products.Baseline data were collected in 2014-2015 from a representative sample of(n=2844)middle and high school students in five counties surrounding the four largest cities in Texas,(49%female and mean age 13.13 years,with subsequent waves at 6,12,and 18 months.Confirmatory factor analysis examined the appropriateness of a three-item susceptibility measure(product-specific curiosity,intention to use,and peer influence)across product types and ethnic groups (Hispanic versus non-Hispanic). Logistic regression examined whether product specific susceptibility at baseline predicted future product in- itiation. At baseline, 11.5%, 17.0%, 17.4% and 29.4%, of adolescent never users were susceptible to cigars, cigarettes,hookah and e-cigarettes, respectively; significantly more Hispanic than non-Hispanic adolescents were susceptible to e-cigarettes (32.4%versus 26%,p < 0.01) and cigarettes (19.9%versus 13.9%, p < 0.05).Product-specific items were significantly and consistently associated with the respective underlying susceptibility product construct and across ethnic groups(p < 0.001 for all).Susceptibility to e-cigarettes(AOR=2.28-6.64)or any combustible product(cigarettes,hookah,cigars;AOR=3.38-5.20)significantly predicted subsequent ever use.This study confirms the appropriateness of the susceptibility construct across four tobacco product types and ethnic groups,and the utility of susceptibility in predicting future product use among adolescents. 1. Introduction use tobacco products in the future,is a critical construct,predictive of tobacco use and amenable to intervention. Research examining the Use of conventional tobacco products,like cigarettes and cigars,has initial susceptibility construct based on behavioral intentions,peer in- decreased in recent years among adolescents, while use of tobacco fluence, and self-efficacy(Pierce et al., 1996) demonstrated that com- products, like e-cigarettes and hookah, continues to increase (Singh prehensive community anti-smoking media programs, are effective in et al., 2016).These trends and the growing popularity of specific pro- altering and suppressing adolescents' susceptibility to smoking ducts call for identifying risk factors that predict product use initiation. (Meshack et al., 2004). A revised measure of the susceptibility con- Numerous studies have demonstrated susceptibility to cigarettes among struct, which incorporated curiosity with behavioral intentions and never smoking adolescents is associated with increased risk of experi- peer influence, demonstrated little loss in internal consistency, but a mentation with cigarettes and becoming an established smoker reduction in predictive validity and accuracy (Pierce et al., 2005). To (Jackson,1998;Jackson&Dickinson,2004;Nodora et al.,2014;Pierce, date,a few studies have assessed whether the original susceptibility to Choi,Gilpin,Farkas,&Merritt,1996;Pierce,Distefan,Kaplan,&Gilpin, cigarettes construct(Pierce et al.,1996)also can be adapted to measure 2005; Spelman et al., 2009; Strong et al., 2015; Unger, Johnson, susceptibility to other products, like e-cigarettes, hookah, and cigars Stoddard, Nezami, &Chou, 1997). Limited research suggests that sus- (e.g.,Bold et al.,2017;Lechner et al.,2018),and none have examined ceptibility to e-cigarettes or hookah independently predicts future e- the susceptibility construct that includes curiosity. Yet, recent survey cigarette (Bold, Kong, Cavallo, Camenga, & Krishnan-Sarin, 2017) or data suggest that the most common reason for adolescents to try e- hookah use(Lipkus,Reboussin,Wolfson,&Sutfin,2015),respectively, cigarettes is out of curiosity (Kong, Morean, Cavallo, Camenga, & and that susceptibility to cigarettes predicts future e-cigarette and cigar Krishnan-Sarin, 2015; Patrick et al., 2016). Thus, utilizing a suscept- use(Cole,Kennedy,Chaurasia,&Leatherdale, 2017).Still,few studies ibility construct that includes curiosity might be particularly useful to have examined product-specific susceptibility measures in predicting our understanding of susceptibility to non-cigarette tobacco products. future use of products other than cigarettes. Additionally, no studies have assessed whether the susceptibility Susceptibility,which reflects the lack of a firm commitment not to construct (Pierce et al., 2005) functions equally across ethnic groups. *Corresponding author. E-mail address:Melissa.B.Harrell@uth.tmc.edu(M.B.Harrell). https://doi.org/10.1016/j.abrep.2018.08.005 Received 17 April 2018;Received in revised form 3 August 2018;Accepted 16 August 2018 Available online 18 August 2018 2352-8532/©2018 The Authors.Published by Elsevier Ltd.This is an open access article under the CC BY-NC-ND license (http://creativeco mmo ns.orgAicenses/BY-NC-ND/4.O/).