Our study has shown that adolescent smoking is a growing problem in Ukraine. While earlier reports found that young adults have higher smoking prevalence than people in older age groups, this study has additionally shown that younger girls and women in Ukraine now have a higher risk of smoking their first cigarette earlier than had those born earlier: the mean age of smoking initiation in women decreases by 3 years per every 5 year time span. Both men and women have now greater risk of proceeding towards daily smoking than those from several years ago. This makes the need of tobacco control measures more urgent.
Different correlates of smoking initiation and transition to daily smoking in men and women give evidence that a smoking epidemic in men and women in Ukraine are in different stages of development. In men the risk of smoking initiation is higher in those having lower income, less educated, and less informed about dangers of smoking. In Ukrainian men smoking has the same correlates as in developed countries with a long history of tobacco control measures. This result is in agreement with other observations showing that smoking prevalence is lower among men with a university education than among those with primary or secondary education .
Conversely, the risk of smoking initiation is higher in those women in Ukraine who live in large cities and have smaller families. Thus, the smoking epidemic among women is developing in parallel with an urbanization and emancipation process.
Those women more likely initiate smoking who report seeing outdoor tobacco advertising, and report receiving tobacco-related information from magazines. Additionally, women receiving information on tobacco smoking from colleagues and friends are more likely to develop a daily smoking habit. Which comes first and whether the association is causal is not possible to define in a cross-sectional study.
The findings of this study are subject to several limitations. The most important limitation is typical for all cross-sectional studies, which mainly allow to generate hypotheses but not to test them. Causal inferences are beyond this study design, and we only can hypothesize whether women start smoking because they see outdoor advertising and direct or hidden ads in the magazines, or they notice these ads because they are already experimenting with smoking.
Another limitation is that some respondents mentioned only the age of daily smoking initiation and not the age of their first cigarette. We tried to overcome this by utilizing only those who mentioned at least one age in the second analysis. However, the group analysed for the correlates of establishing daily smoking was not precisely the subgroup of those who reported the age of their first cigarette. Several distortions could be possible due to recall bias though it is difficult to fully estimate its extent.
Associations found in this study can be further explored through the prospective study design. Further elaborations may include the analysis of smoking initiation processes in narrower age groups through surveys of larger groups of young people. More specific developments of the present findings related to the correlates of female smoking initiation can be expressed in qualitative studies among young women aimed at revealing peculiarities of tobacco marketing which are more likely to hook this age group, with elaboration of counter-marketing strategies.
Impact of household smoke-free regulation
Those correlates which are common for both men and women and for both smoking initiation and daily smoking establishment are related to smoking restrictions and SHS exposure. Those reporting their homes as being smoke-free and themselves as being less exposed to SHS were less likely to initiate smoking. In this study, we found correlates only with household smoking regulations, while our earlier attempts  to explore correlates of smoking status in young people have shown associations with workplace smoking regulations.
A factor in this research may be that young adults are just entering the workforce and thus policies in these institutions could not influence smoking behaviour within the previous several years. Household conditions can be, generally speaking, more stable. This may be why only household correlates, not workplace smoking regulations were found to influence tobacco initiation and use amongst this age group.
Earlier research has shown that parental and other household factors can predict adolescent smoking initiation. Farkas et al. have shown that adolescents who lived in smoke-free households were 74% (95% confidence interval [CI], 62%–88%) as likely to be smokers as adolescents who lived in households with no smoking restrictions . The mechanisms by which smoke-free homes can influence the smoking behaviour of their family members are explored by Gilpin et al. Both direct and indirect mechanisms can be involved, for example: among adolescents, a household smoking ban was associated with a lower perceived prevalence of adult smoking in their communities and more negative attitudes regarding the social acceptability of smoking. These two factors would therefore affect the likelihood of smoking initiation.
Our results show that smoking initiation is associated with household smoking regulations to a larger extent among young women than men. Male smoking is more socially accepted in Ukraine and is therefore more influenced by social environments, and in particular, job conditions. Comparatively concealed female smoking is more affected by home conditions.
Impact of tobacco advertising
Our findings show that reported exposure to tobacco advertising (when respondents report to have noticed specified types of tobacco advertising) is associated with a higher probability of smoking initiation among men and women. This is in line with research indicating that pro-tobacco media and advertising increases susceptibility to smoking over time, that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke [18–20], and that a causal relationship exists between tobacco promotion and smoking initiation among adolescents. Our research gives additional arguments to those politicians in Ukraine who propose to ban tobacco advertising in the country, or at the very least, the outdoor advertising.
We found an association only with the outdoor advertising, which may be explained through the high visibility of outdoor advertising compared with other kinds like advertising goods, point of sale advertising etc. It appears that there is a greater heterogeneity in exposure to outdoor tobacco advertising, as it is seen less in the rural areas than in urban ones. Yet, we noted that when the type of settlement was controlled there was still a significant association between outdoor advertising and smoking initiation. We found that other types of advertising like advertising goods and point of sale advertising are more evenly seen throughout the country, and possibly more often viewed where outdoor advertising is less reported.
It is noteworthy that we did not find a dose-and-effect relationship between advertising exposure and the risk of smoking initiation and progression. We only surveyed the extent of contacts with all the types of advertising together, not specifically outdoor advertising.
Our finding that for young women there is a stronger association between the tobacco advertising and smoking initiation than among men is probably explained by the tobacco industry promotional campaigns aimed at young women, [22, 23] and the fact that the tobacco industry may target women in a manner that differs from its targeting of men.
Impact of tobacco-related knowledge
We found that among adolescents and young adults, better knowledge of tobacco-related harm was negatively associated with daily smoking initiation, while impact of tobacco-related knowledge on the age of smoking initiation is negligible. The present study results are in line with the international evidence that the mass-media interventions can be effective in preventing the uptake of smoking in young people,  and supports the need for wide-range media campaigns, which can result both in smoking cessation and prevention of smoking initiation.
The questions regarding sources of tobacco-related information, which was explained as information about tobacco related harm and tobacco control measures, did not reveal any protective influences. The hypothesis of the protective role of school-based information was not supported. Both sources which showed significant associations, if reported, were associated with a higher risk of smoking initiation. While this could be expected with information coming from friends and colleagues who in this case were most likely smokers, the association between a higher risk of smoking initiation and information coming from magazines needs to be further discussed. We suspect that girls noticed direct and indirect tobacco advertising found in female magazines and responded about this rather than health-related information. The revealed association shows the necessity to consider a tobacco advertising ban in printed media as one of the tobacco control priorities in Ukraine.