Overestimation of peer smoking prevalence predicts smoking initiation among primary school students in Hong Kong

Purpose: To investigate the relationship between perceived prevalence of smoking and smoking initiation among Hong Kong primary second- to fourth-grade-students. Methods: A cohort of 2,171 students was surveyed in 2006 and again in 2008. Students who perceived ever-smoking prevalence in peers as "none" or "some" were considered as correct (reference group), whereas those who perceived it as "half" (overestimation) or "most/all" (gross overestimation) were considered as incorrect. Results: At baseline, overestimation was found to be cross-sectionally associated with ever-smoking (p < .01). At follow-up, 7.2% of never-smoking students with incorrect estimation at baseline had started smoking, which was 79% (95% confidence interval: 3%-213%), greater than that of 3.7% for those with correct estimation. Among the never-smoking students with incorrect estimation, subsequent correct estimation was associated with 70% (95% confidence interval: 47%-83%) lower risk of smoking initiation compared with persistent incorrect estimation. Conclusion: Overestimation of the prevalence of peer smoking predicted smoking initiation among children. Interventions should be carried out to evaluate whether correcting children's overestimation of peer smoking could reduce smoking initiation.