A systematic review of cigarette smoking trajectories in adolescents

Trajectory analyses differentiate subgroups of smokers based on early patterns of cigarette use, but no study has summarized this literature. We systematically reviewed the literature on adolescent cigarette smoking trajectories to document the number and shapes of trajectories identified, assess if certain study characteristics influence the number or shapes of trajectories identified, summarize factors associated with and outcomes of trajectory group membership, and assess whether the results of trajectory analyses help identify windows of opportunity for intervention. We searched PubMed and EMBASE (1/1/1980 to 1/11/2018) and identified 1695 articles. Forty-three articles with data from 37 unique datasets were retained. Each trajectory was categorized into one of three groups (i.e., low-stable, increasing, other). Number of trajectories ranged from 2 to 6 (mode = 4); 44-76% of participants were low-stable cigarette consumers, 11-21% increased consumption, and 3-11% were categorized as other. Number of data points, smoking indicator used, and time axis influenced the number of trajectories identified. Only two articles depicted the natural course of smoking since onset. Factors associated with trajectory membership included age, sex/gender, race/ethnicity, parental education, behavior problems, depression, academic performance, baseline cigarette use, parental and friends smoking, alcohol use, and cannabis use. Outcomes included illicit drug and alcohol use. Beyond parsimoniously describing cigarette smoking patterns, it is not clear whether trajectory analyses offer increased insight into the natural course, determinants or outcomes of cigarette smoking in ways that inform the development of intervention.