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Smoking is a major concern amongst youth in Switzerland. This study aims to understand the longitudinal drivers of smoking initiation among middle school students in Switzerland. Data was collected as part of an ongoing longitudinal survey study. Participants were students from middle schools in Switzerland. 1076 adolescents were surveyed in four waves from 2015 to 2019. All participants were non-smokers at the start of the study, when they were aged 10 respectively 11. Furthermore, data from adolescents' parents were collected, including their smoking behavior, perceived quality of relation with their child, as well as parental monitoring behavior. A survival analysis was carried out, describing if and when the event of smoking initiation occurs among adolescents. Our life table showed that 31% (n = 330) of participants started smoking between the first and fourth years of their schooling. The proportion of non-smoking participants decreased yearly. The proportions of non-smokers were 0.98, 0.93, 0.86, and 0.83 in 2016, 2017, 2018 and 2019 respectively. A life table was used to describe and summarize the sample distribution of smoking initiation and the percentage of risk. Second, a Discrete-Time Hazard Model was tested with parental smoking behavior, perceived quality of relation with their child and parental monitoring behavior as drivers to predict adolescents' smoking initiation. The findings show that the number of smokers and new smokers increases over time among adolescents. Parental smoking behavior and the perceived quality of relationship with their offspring are factors that influence an adolescent's smoking initiation. This suggests that there may be sharing and normative influences amongst the cohorts as students move up the school grades. Future studies should investigate personal and environmental factors that contribute to smoking initiation amongst adolescents. Key messages Findings show that the number of smokers and new smokers increases over time among adolescents. Sharing and normative influences among adolescents as they move up the school grades may influence smoking initiation.

Onset of smoking amongst middle school students in Switzerland