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The disease consequences of smoking such as high blood pressure, heart disease, and lung cancer, are well documented (U.S. Department of Health and Human Services, 1964, 1989, and 2010). One clear finding from epidemiological studies is that the early uptake of smoking during adolescence can lead to addiction in adulthood. A recent study by the Centers for Disease Control (CDC) found nearly 9 out of 10 adult cigarette smokers tried their first cigarette as minors and 99% tried smoking by age 26 (CDC, 2017). To mitigate smoking incidence and reduce the harm caused by smoking, a number of primary prevention programs have targeted adolescents during the early middle school and high school years. It is well established in the literature that the causes of smoking are numerous and involve the complex interplay of many factors. The Transtheoretical Model (TTM) is a model of health behavior change capable of investigating and comparing many factors of smoking acquisition. The purpose of this study was to investigate the causal effects of TTM processes of change and mediators of smoking prevention on smoking acquisition during adolescence. The secondary data comes from a longitudinal sample of nonsmoking middle school students (N=1573) followed over 4 years. We found TTM process measures (Dramatic Relief, Self-Liberation, and Stimulus Control) in the 6 grade led to small indirect effects through situational temptations in the 7 -8 grades on smoking acquisition by 9 grade. There was no evidence that gender or race moderated the indirect effects in the final models. This was the first study to determine causal relationships between TTM factors and smoking uptake. Future studies may consider investigating the applicability of the models in more diverse groups.

Investigating and Comparing the Mechanisms of Behavior Change to Prevent Smoking Acquisition in Middle School Students