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Title "Validating Measures of Stages of Smoking Initiation among Underage Adolescents" to be presented as a poster presentation at the Society of Behavioral Medicine's 28th Annual Meeting and Scientific Sessions, March 21-24, 2007, at the Marriott Wardman Park Hotel in Washington, DC.

Measuring the process of smoking initiation is critical for prevention. Two samples were used to evaluate an algorithm for measuring the stages of smoking initiation: Precontemplation (PC), Contemplation (C), Preparation (P), Action (A) and Maintenance (M), that can be used with national surveys. First, we designed an algorithm for use with the NSDUH data and compared it with a more extensive algorithm used in a local statewide survey collected from underage youth (N = 55,749) who completed the Maryland Youth Tobacco Survey (MYTS). Next, we applied this algorithm to data collected from underage youth (N = 17,709) derived from the NSDUH public use file to assess the generalizability of the staging classification. Results revealed the algorithm created for use in the NSDUH classified never and current smokers as well as the more comprehensive staging algorithm (MYTS) despite differences in questions and response options. Both staging classifications revealed similar relations with a risk factor of smoking (# of friends who smoke). Findings suggest that despite having different response options and different numbers of questions, the NSDUH algorithm appears to categorize vulnerable youth in a similar fashion compared to the more comprehensive algorithm. The caveat for using a less complete series of questions is that youth who were former smokers became ineligible for staging, limiting the generalizability of this classification. Without knowing a youth’s future intentions of smoking, it is difficult to speculate about the youth who have experimented with smoking in the past year (but not in the past month). Thus, it appears that it is to the more ‘experimental’ smokers that these results may not generalize, unless you use a more extensive series of questions. Ultimately, the problems with misclassification and attrition may limit generalizability but do not detract from the validity of the staging classification systems developed to be used with the NSDUH data. Recommendations about how best to use surveillance data to improve our understanding of initiation and direct prevention will be discussed