Why children start smoking cigarettes: predictors of onset

The social context of adolescent smoking: a systems perspective

We used a systems science perspective to examine adolescents' personal networks, school networks, and neighborhoods as a system through which emotional support and peer influence flow, and we sought to determine whether these flows affected past-month smoking at 2 time points, 1994-1995 and 1996. To test relationships, we employed structural equation modeling and used public-use data from the National Longitudinal Study of Adolescent Health (n = 6504). Personal network properties affected past-month smoking at both time points via the flow of emotional support. We observed a feedback loop from personal network properties to emotional support and then to past-month smoking. Past-month smoking at time 1 fed back to positively affect in-degree centrality (i.e., popularity). Findings suggest that networks and neighborhoods in this system positively affected past-month smoking via flows of emotional support.

Two-year effects of a school-based prevention programme on adolescent cigarette smoking in Guangzhou, China: a cluster randomized trial

BACKGROUND

The prevalence of adolescent smoking has been increasing rapidly in China. Theory-based smoking prevention programmes in schools may be an effective approach in preventing smoking among Chinese adolescents.

METHODS

A school-level cluster randomized controlled trial was conducted among 7th and 8th grade students (N = 2343) in four junior high schools in southern China during 2004-06. The theory-based, multi-level intervention was compared with the standard health curriculum. Outcome measures comprised changes in students' smoking-related knowledge, attitudes and behaviour.

RESULTS

The mean knowledge scores from baseline to the 1- and 2-year follow-ups increased more in the intervention group than in the control group, whereas there was little change in attitude scores. At the 1-year follow-up (the total sample), the interventions reduced the probability of baseline experimental smokers' escalating to regular smoker [7.9 vs 18.3%; adjusted odds ratio (OR) 0.34, 95% confidence interval (CI) 0.12-0.97, P = 0.043], but did not reduce the probability of baseline non-smokers' initiating smoking (7.9 vs 10.6%; adjusted OR 0.86, 95% CI 0.54-1.38, P = 0.538). At the 2-year follow-up (only 7th grade students), similar proportions of baseline non-smokers initiated smoking in the intervention group and the control group (13.5 vs 13.1%), while a possibly lower proportion of baseline experimental smokers escalated to regular smoking in the intervention group than the control group (22.6 vs 40.0%; adjusted OR 0.43, 95% CI 0.12-1.57, P = 0.199).

CONCLUSIONS

This multi-level intervention programme had a moderate effect on inhibiting the escalation from experimental to regular smoking among Chinese adolescents, but had little effect on the initiation of smoking. The programme improved adolescents' smoking-related knowledge, but did not change their attitudes towards smoking.

Stress and tobacco use among African-American adolescents: the buffering effect of cultural factors

Tobacco is a leading contributor to morbidity and mortality and a primary reason for health disparities among African Americans. In this study we explore the role of stress in smoking and cultural factors that protect against stress among African-American adolescents. Our sample consisted of 239 youth who were recruited into the study while enrolled in 8th and 12th grade. Measures of risk factors (stress, school transition stress, and community disorganization), moderator or protective factors (religious support and intergenerational connections), and 30-day tobacco use were collected. Hierarchical multiple regression analyses were conducted. Intergenerational connections moderated the effect of stress on past 30-day tobacco use. Religious support moderated the effect of neighborhood disorganization on past 30-day tobacco use. Religious support also moderated the effect of stress on past 30-day tobacco use. The findings have implications for prevention efforts to consider religious beliefs and practices and also to link youth with supportive adults in their community.

Correlates of multiple chronic disease behavioral risk factors in Canadian children and adolescents

The authors assessed individual, social, and school correlates of multiple chronic disease behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a representative sample of Canadian youth aged 10-15 years (mean = 12.5 years) attending public schools. Cross-sectional data (n = 1,747) from cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth were used. Ordinal regression models were constructed to investigate associations between selected covariates and multiple behavioral risk-factor levels (0/1, 2, 3, or 4/5 risk factors). Older age (odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.21, 3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09, 2.03), reporting that most/all of one's peers smoked (OR = 7.31, 95% CI: 4.00, 13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18, 6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31, 2.88) increased the likelihood of having multiple behavioral risk factors. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85, 0.99) and youth from families with postsecondary education (OR = 0.58, 95% CI: 0.41, 0.82) were less likely to have a higher number of risk factors. Although several individual and social characteristics were associated with multiple behavioral risk factors, no school-related correlates emerged. These variables should be considered when planning prevention programs.

Smoking determinants in Turkish university students

The aim was to explore the prevalence and the correlates of smoking in a group of Turkish university students. A sample of 1,870 students (21.2 ± 2.0 years old) completed the Beck Depression Inventory, Beck Hopelessness Scale, Anxiety Sensitivity Index, 20-item Toronto Alexithymia Scale. Smoking was highly prevalent (35.9%) in this sample. Male gender (OR = 2.72, CI 2.15–3.44), and parental smoking (OR = 1.41, CI 1.13–1.78) were factors associated with increased likelihood of smoking. Higher depressive symptoms and hopelessness levels were significantly related to smoking behavior. Smoking behavior might initiate as a mild and transient habit and unfortunately could become more serious and lead to an actual dependence. The results of this study show that it is necessary to pay attention to levels of depression and hopelessness, as well as parental influence.

Relative risks of exposure to different smoking models on the development of nicotine dependence during adolescence: a five-wave longitudinal study

PURPOSE

Many studies have focused upon predictors of smoking onset and continuation in adolescents. However, less is known about the development of nicotine dependence (ND) and how smoking in the interpersonal environment relates to this. To examine which smoking models have the largest impact on the development of ND, we examined the relative impact of current smoking from fathers, mothers, siblings, best friends, and friend groups on the development of ND in adolescents.

METHODS

Data were used from five annual waves of the "Family and Health" survey project. At baseline 428 adolescents (mean age=15.2 years; SD=.60), both their parents, and their siblings were participating. In this study we included only smoking adolescents (n=175). To assess the individual development of ND of each adolescent, and whether current smoking exposure affected changes from baseline across time, we used latent growth curve modeling (LGC).

RESULTS

Findings revealed that smoking of sibling and best friend were related to baseline levels of ND, but not to the rates of change over time. Of all models, only having smoking friends in the friend group was related to a faster development of ND.

CONCLUSIONS

The current findings highlight the key role of smoking friends in the development of ND and suggest that interventions targeting at peers are probably effective in reducing the prevalence of ND symptoms among adolescents.

Impact of x chromosome genes in explaining the excess risk of cancer in males

The authors examined cancer incidence sex ratios in Denmark for 1943-2003 by age group. At nongenital/nonbreast sites, incidences were consistently higher in males. While environmental factors dominate cancer risk, the authors hypothesized that the higher risk in males might be explained by unspecified X chromosome genes' protecting female cells from genotoxic damage. If so, cancer susceptibility would be passed from parent to offspring differently by sex. The authors compared relative risks in offspring of parents with and without cancer histories. For all comparisons, relative risks were similar in offspring of fathers with cancer (relative risk (RR) = 1.14, 95% confidence interval: 1.08, 1.20). Risks in offspring were higher for parents diagnosed before age 50 years and for cancers at the same site rather than different sites. Genital cancer risks were increased in same-sex offspring of parents with genital cancers. Breast cancer risks were high in both daughters (RR = 2.37) and sons (RR = 4.63) of mothers with breast cancer and in daughters (RR = 5.96) of fathers with breast cancer. Thus, X chromosome genetic factors were not responsible for the excess risk of cancer in males. Susceptibility to genital cancer was increased in same-sex offspring, and breast cancer risks were increased in both sons and daughters when either parent had had breast cancer.

[Predictors of current smoking among male students in a technical high school: A prospective study]

OBJECTIVES

This study was performed using a longitudinal approach to explore the predictors for current smoking among male high school students.

METHODS

Baseline data was collected in May 2004 through a self-administrated questionnaire completed by 607 male students in a technical high school in Daegu city, Korea. Subsequently, their smoking behaviors were followed one year after. Among the 544 followed participants, data for 439 non-smokers in the first year was used in longitudinal analysis. Current smokers were defined as those respondents who had smoked one or more cigarettes within the 30 days preceding the survey. Several potential predictors for smoking were investigated including smoking history (never, experimental, former smoker), sociodemographic factors, environmental factors, attitudes toward smoking, and behavioral factors. Logistic regression was used to predict smoking with SPSS ver. 12.0.

RESULTS

According to multiple logistic regression analysis, those students who were more likely to smoke after one year were former smokers (OR: 2.12, 95% CI=1.01-4.44), current drinkers (OR: 2.55, 95% CI=1.33-4.89), who had four or five smokers among five best friends (OR: 3.43. 95% CI=1.14-10.30). In addition, those who had smokers among family members besides parents or siblings (OR: 1.66, 95% CI=0.92-2.98), exhibited a high level of subjective stress (OR: 1.77, 95% CI=0.96-3.26), or had a very good relationship with friends (OR: 1.93, 95% CI=0.99-3.75) were also more likely to smoke albeit with marginal statistical significance (p<0.1).

CONCLUSIONS

A smoking prevention program aimed at high school students may be more effective with due consideration of the predictors highlighted in this study. However, further studies with larger sample size and various target populations are necessary to find potential predictors not found in this study but suggested in other longitudinal studies.

Influence of subjective social status on the relationship between positive outcome expectations and experimentation with cigarettes

PURPOSE

In Texas, Mexican American (MA) adolescents, and in particular boys, are at increased risk for experimenting with cigarettes compared with their black or white counterparts. Positive outcome expectations (POE), that is, the functional social significance ascribed to cigarettes, and subjective social status (SSS), that is, the adolescents' subjective views of where they lie in the school-based social hierarchy, are independent predictors of smoking. The goal of this study was to test the hypothesis that SSS moderates the relationship between POE and experimentation with cigarettes.

METHODS

Moderating effects of SSS were examined using a between-subjects, 2 x 2 analysis of variance and unconditional logistic regression analyses. Using a prospective study design, we followed 1142 MA adolescents aged 11-13 years. Participants completed a baseline survey at home, which assessed POE, SSS, and smoking and were followed via telephone at 6-month intervals over a 12-month period to assess changes in smoking behavior.

RESULTS

At follow-up, there were 99 new experimenters. Consistent with our hypothesis, adolescents who reported moderate-low SSS and who held POE at baseline were more likely to have experimented with cigarettes at either follow-up evaluation than their peers with moderate-low SSS who held less POE (odds ratio [OR], 1.92, 95% confidence interval [95% CI], 1.02-3.58). There was no association between outcome expectations and experimenting among adolescents with high SSS (OR, 1.79, CI, .73-4.36). Low SSS boys were more likely to experiment than girls and high SSS boys.

CONCLUSIONS

The results of this study indicate that adolescents with moderate-low SSS hold different outcome expectations about smoking than their higher SSS peers. The results underscore the possibility that moderate-low SSS adolescents view behaviors such as smoking as a way to achieve higher SSS and thereby increase their peer social standing. Our results suggest that, in addition to tailoring intervention efforts by gender, placing adolescents of similar social standing to one another within the school into intervention groups that are led by a peer-nominated peer may increase the overall effectiveness of these peer-led prevention efforts.

Early exposure to movie smoking predicts established smoking by older teens and young adults

OBJECTIVE

Movie smoking exposure is a strong predictor of smoking initiation by adolescents; however, we do not know whether it is a long-term predictor of established smoking. We conducted a prospective study to determine whether movie smoking exposure during early adolescence predicts established smoking in older teens and young adults.

DESIGN

We assessed movie smoking exposure and smoking status through a written school-based survey in 1999, when participants were 10 to 14 years of age. We enrolled 73% (n = 2603) of those who had never tried smoking in a follow-up study. In 2006-2007, we conducted telephone interviews with 69% (n = 1791) of the cohort to ascertain current smoking status. The primary outcome was established smoking, defined as having smoked >100 cigarettes. Mean age at follow-up was 18.7 years.

RESULTS

Thirteen percent (n = 235) progressed from never smoking to established smoking during the follow-up period. Eighty-nine percent (n = 209) of established smokers smoked during the 30 days before the survey. Even after controlling for a wide range of baseline characteristics, the relative risk for established smoking increased by one third with each successive quartile of movie smoking exposure. Those in the highest quartile for baseline movie smoking exposure were twice as likely to be established smokers at follow-up compared with those in the lowest quartile.

CONCLUSIONS

Movie smoking exposure significantly predicted progression to established smoking in long-term follow-up. We estimate that 34.9% of established smoking in this cohort can be attributed to movie smoking exposure.

Where do our children learn to smoke?

BACKGROUND

Primary prevention of smoking in children is mostly carried out through school education schemes organised by trained teachers. The generally accepted notion is that children's opinions and behaviour are influenced by the school, but mainly by the family and their peers, as well as by the broader society. The primary preventive programme aimed at the first three years of primary schools, called "No Smoking is a Norm" strives to encourage parents to take an active part in the education of their children against smoking, as well as about other aspects of a healthy lifestyle. This paper analyses the data documenting the effectiveness of the programme with respect to children's family smoking history.

METHODS

The information about smokers in families was collected during enquiries prior to the initiation of the 1st and 2nd stage (in the 1st and the 2nd class), and again after their conclusion. In the first stage, smoking of mothers, fathers, and grandparents was followed separately. In the second stage, the category of smokers that can influence children, included parents, grandparents, siblings, aunts, and uncles, with whom the children are in contact (the so-called "broader family"). Questionnaires answered by children who did not know whether their parents or grandparents smoked were excluded from the survey The analysis included 1423 (i.e., 76.6%) from the total number of 1857 children from the programme and control groups. The answers were coded and analysed using the chi2 test in EPI INFO software, version 3.3.2.

RESULTS

Approximately 30% of the children's parents are smokers. Almost 60% of the children were exposed to the influence of smoking parents and grandparents, and more than three quarters of the children experienced smoking from the "broader family". The more smokers there are in the family, the more children have the opportunity to handle cigarettes and smoking accessories from an early age: they get, buy, or even light cigarettes. Smoking of parents and other relatives led to a substantial increase in the number of children who were determined to smoke in the future or were considering it. More than half of the eight-year-olds have tasted an alcoholic drink, and significantly more frequently in the families of smokers. 8% of the eight-year-olds have gone through their first smoking attempts and all of them from families with adult smokers. On the other hand, the smoking or non-smoking family environment of the respondents did not influence the knowledge part of the intervention programme. In the study group, in comparison with the control group, there were significantly more children exposed to the influence of smokers in the "broader" family (80.1% vs. 73.0%). This could explain why evaluation of the medium-term efficiency of the programme without consideration of the family environment was highest in the knowledge area, while differences in change of opinions and behaviour were mostly insignificant.

CONCLUSIONS

Smoking of family members significantly reduces the efficiency of school educational anti-smoking activities aimed at children and young people.

The roles of parenting, church attendance, and depression in adolescent smoking

The aim of the present study was to identify contextual factors related to smoking among urban African-American and White adolescents. We administered a survey assessing demographic and psychosocial variables to 299 adolescents in an urban pediatric clinic in the Midwest. Results indicated that being female, older age, lower academic performance, depressive symptoms, less frequent church attendance, parental smoking, and parental attitudes toward smoking were related to adolescent smoking. After controlling for demographics, the multivariate model predicting adolescent smoking included depressive symptoms, less frequent church attendance, and parental disapproval of smoking. Given these findings, efforts to decrease adolescent smoking may be enhanced by attending to depressive symptoms demonstrated by adolescents as well as contextual factors including parental attitudes and church attendance.

The impact of social influence on adolescent intention to smoke: combining types and referents of influence

OBJECTIVES

Theory and research suggest that the intention to smoke is the main determinant of smoking initiation and emphasizes the role of cognitive and social factors on the prediction of the intention to smoke. However, extended models such as the I-Change and results from published studies reveal inconsistencies regarding the impact of social influence on the intention to smoke. Possible explanations for this may be the definition and measurement of the constructs that have been used.

DESIGN AND METHODS

The current study was designed with two main goals: (i) to test a measurement model for social influence, combining different types of social influence (subjective norms, perceived behaviour, and direct pressure) with various referents of influence (parents, siblings, peers, and teachers); (ii) to investigate the impact of social influence on adolescent intention to smoke, controlling for smoking behaviour. LISREL was used to test these models. The sample includes 3,064 Portuguese adolescents, with a mean age of 13.5 years, at the beginning of the seventh school grade.

RESULTS

The hypothesized measurement model of social influence was supported by results and explained 29% of the variance of the intention to smoke. A more extended model, including attitude and self-efficacy, explained 55% of the variance of the intention to smoke. Perceived behaviour of peers, parental norms, and perceived behaviour of parents were the social influence factors with impact on adolescent intention to smoke.

CONCLUSIONS

Results suggest that different referents exert their influence through distinct types of social influence and recommend further work on the definition and measurement of social influence.

Social-cognitive and school factors in initiation of smoking among adolescents: a prospective cohort study

AIMS

The aim of the present study was to examine the association between social-cognitive factors, school factors, and smoking initiation among adolescents who had never smoked.

METHODS

The study was based on longitudinal data on Danish adolescents attending randomly selected public schools. Adolescents enrolled in grade 7 (mean age, 13 years) who had never smoked (n = 912) were followed up for 6 months after baseline. Those who had still never smoked were followed up again 18 months after baseline, in grade 8 (n = 442). Social-cognitive factors were examined with five measures: self-efficacy, social influence (norms), social influence (behavior), social influence (pressure), and attitude. We used multilevel analyses to estimate the associations between social-cognitive factors at baseline and smoking initiation as well as the random effects of school, school class, and gender group in the school class.

RESULTS

At the first follow-up, we found significant associations between attitude, father's smoking, best friend's smoking, and smoking initiation. At the second follow-up, we found a significant association with pressure to smoke from friends. Of the school factors, gender group in the school class showed an effect at both first and second follow-up.

CONCLUSION

Our results suggest that father's smoking, best friend's smoking, attitude, and pressure to smoke from friends affect smoking initiation. The results for school factors suggest an effect of classmates of the same gender, which has not previously been examined longitudinally.

Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control

OBJECTIVE

Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation.

METHODS

We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation.

RESULTS

Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use.

CONCLUSIONS

Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.

The impact of tobacco promotion at the point of sale: a systematic review

INTRODUCTION

Tobacco promotion increases the likelihood that adolescents will start smoking. Much of the tobacco industry's promotional budget is spent on point of sale (PoS) promotion in many jurisdictions. Consequently, tobacco is an eye-catching feature at the PoS in many places.

METHODS

We reviewed the evidence that PoS tobacco promotion influences key smoking-related behaviors and beliefs, increases susceptibility to smoking in youth, undermines smokers' quit attempts, and promotes relapse among ex-smokers.

RESULTS

We found 12 peer-reviewed studies, 10 of which were focused on children. Seven of 8 observational studies found statistically significant associations between exposure to tobacco promotion at the PoS and smoking initiation or susceptibility to smoking. Two experimental studies of children found statistically significant associations between exposure to PoS tobacco promotions and beliefs about ease of getting tobacco and smoking prevalence among their peers. An experimental study with adults found that a picture of collected tobacco pack elicited cravings for cigarettes among smokers. A cross-sectional study found that 25% of adult smokers reported impulse purchasing and a third of recent ex-smokers reported urges to start smoking after seeing tobacco displayed.

DISCUSSION

More prospective studies are needed to clarify the temporal relationship between exposure to PoS tobacco and outcome. However, given the addictiveness of tobacco, the severity of the health hazards posed by smoking, the evidence that tobacco promotion encourages children to start smoking, and the consistency of the evidence that PoS promotion influences children's smoking, we believe that ample justification exists for banning PoS advertising and displays of smoked tobacco products.

Therapy for specific problems: youth tobacco cessation

Cigarette smoking is the leading cause of premature morbidity and mortality in the United States. The majority of children smoke their first cigarette in early adolescence, and many older teens have well-established dependence on nicotine. Efforts to promote and support smoking cessation among these youth smokers are critical. The available experimental studies of youth cessation interventions find that behavioral interventions increase the chances of youth smokers achieving successful cessation. Currently there is insufficient evidence for the effectiveness of pharmacological treatments with youth smokers. Many innovative studies have been compromised by challenges in recruiting sufficient numbers of youth, obtaining approval for waivers of parental consent, and high attrition in longitudinal studies. Key areas for future work include bridging the fields of adolescent development and treatment design, matching treatments to developmental trajectories of smoking behavior, better understanding treatment processes and treatment moderators, and building demand for evidence-based cessation treatments.

Tobacco and cannabis co-occurrence: does route of administration matter?

BACKGROUND

Qualitative research suggests that a shared route of administration (i.e. via inhalation) for the common forms of both tobacco (i.e. cigarettes) and cannabis (i.e. joints) may contribute to their co-occurring use.

METHODS

We used data on 43,093 U.S. adults who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether cannabis use and abuse/dependence were associated with smoked (cigarettes, cigars, pipes) versus smokeless (snuff, chewed tobacco) forms of tobacco use, even after controlling for socio-demographic, psychiatric and substance-related covariates.

RESULTS

Tobacco smoking was associated with a 3.3-4.5 times increased risk for cannabis use and abuse/dependence respectively. After covariate adjustment, importantly for nicotine dependence, smoking tobacco (but not smokeless tobacco) was still significantly associated with both cannabis use (multinomial odds-ratio (MOR) 1.99) and cannabis dependence (MOR 1.55). In contrast, use of smokeless tobacco was not significantly correlated with elevated rates of cannabis use (MOR 0.96) or abuse/dependence (MOR 1.04).

CONCLUSIONS

Route of administration may play an important role in the observed association between tobacco and cannabis use. This may represent a physiological adaptation of the aero-respiratory system and/or index social and cultural influences surrounding the use of smoked versus smokeless forms of tobacco.

The association between DSM-IV nicotine dependence and stressful life events in the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND OBJECTIVES

Nicotine dependence (ND) is a pervasive public health concern and a leading cause of preventable mortality. Stressful life events (SLEs), which severely disrupt the lives of individuals experiencing such events, have been posited as correlates of persisting ND. While both ND and SLEs have been studied extensively in relation to other variables, there are few instances in which they have been investigated in concert.

METHODS

In this study, we use data on 18,013 smokers from the 2001-2002 data set of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC, N = 43,093) to examine whether experiencing a SLE in the past 12 months was associated with meeting criteria for ND in the same past 12 months. Logistic regression analyses were conducted while accounting for a variety of covariates.

RESULTS

A majority of the SLEs were associated with past 12 month ND, even after controlling for poverty, psychiatric and substance use disorders, and a prior history of ND (odds-ratios 1.35-2.20). The rates of past 12 month ND were considerably greater in those experiencing more than one SLE.

CONCLUSIONS

While these data do not allow us to make causal interpretations, our results suggest an association between SLE and ND. Potentially, individuals experiencing SLEs may find it difficult to quit smoking; alternatively, directly or via correlated risks (e.g., living in a high risk neighborhood), smoking may increase the likelihood of exposure to SLEs.

Mechanisms of adolescent smoking cessation: roles of readiness to quit, nicotine dependence, and smoking of parents and peers

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.

Smoking behavior and ethnicity in Jujuy, Argentina: evidence from a low-income youth sample

Latin America is the world region with the highest rates of youth tobacco use and widest socioeconomic gaps, yet no data are available on smoking among Indigenous people, the largest disadvantaged group in the region. A self-administered survey of 3,131 8th grade youth enrolled in a random sample of 27 urban and rural schools was administered in 2004 in Jujuy, Argentina. Standard questions adapted from global surveys were used. Compared with youth of European background (11.4%; 95% CI 6.7-15.1), Indigenous (23.0%; 95% CI 21.0-25.0), and Mixed ethnicity (23%; 95% CI 18.9-27.1) youth had higher prevalence of current smoking. The odds of current smoking remained significantly elevated for Indigenous (OR 1.9; 95% CI = 1.1-3.3) and Mixed youth (OR 2.0; 95% CI 1.2-3.4) after controlling for confounders. Other risk factors that were associated with current smoking included: having any friends who smoke, repeating a grade in school, depressive symptoms in previous year, drinking any alcohol in the previous week and thrill seeking orientation. These results underscore the importance of social and cultural diversity aspects of the global tobacco epidemic.

Social contexts in adolescent smoking: does school policy matter?

According to an ecological perspective in psychology and in line with social cognitive theory, smoking behaviour is determined by different social contexts (for example, peers, family and school) providing adolescents with important role models. This paper investigates the effects of personal characteristics as well as family, peer and school context variables on youth smoking behaviour. We hypothesize that school smoking policy variables predict adolescents' smoking in addition to other context variables. Data were obtained from a self-report survey administered to 3364 students in 40 secondary schools in Bavaria, Germany. For both younger (10-15 years) and older (16-21 years) students, strong associations were found between smoking behaviour and (i) smoking best friends and friends in general, (ii) other substance use and (iii) school performance. In the younger age group, the non-existence of smoking bans for students was associated with an increased risk of being smoker. For the older students, a positive association was found between the presence of smoking teachers on school grounds and smoking behaviour. Results are discussed considering methodological aspects and public health concerns.

Fatores associados à experimentação do cigarro em adolescentes

OBJETIVO: Analisar a prevalência e os fatores associados à experimentação do cigarro em adolescentes. MÉTODOS: Estudo transversal, utilizando-se questionário específico, onde foram entrevistados 2.883 estudantes do ensino fundamental e do 1º ano do ensino médio, de escolas localizadas na zona urbana da cidade de Cuiabá (MT). Estimou-se a prevalência e foram analisados os principais fatores relacionados à experimentação do cigarro. Após isso, obteve-se um modelo logístico hierarquizado descrevendo as chances da experimentação do cigarro relacionada com as variáveis investigadas. RESULTADOS: A prevalência da experimentação do cigarro foi de 30,2%. No modelo final de análise, as principais variáveis relacionadas com a experimentação do cigarro foram menor nível de escolaridade da mãe (OR = 2,44; IC95%: 1,72-3,47); menor nível socioeconômico (OR = 1,39; IC95%: 1,01-1,93); estudar na escola pública (OR = 1,56; IC95%: 1,22-2,00); estar no 1º ano do ensino médio (OR = 3,45; IC95%: 2,63-4,54); estudar no período noturno (OR = 2,44; 1,85-3,22); ter pais separados (OR = 1,23; IC95%: 1,02-1,49); já ter sido reprovado na escola (OR = 2,17; IC95%: 1,78-2,70); ter amigos fumantes (OR = 3,75; IC95%: 2,99-4,70); ter irmãos fumantes (OR = 2,44; IC95%: 1,82-3,27); e ser mais velho (17-19 anos) (OR = 2,44; IC95%: 1,39-4,17). CONCLUSÕES: Foi alta proporção de adolescentes que experimentaram o cigarro. Após ajuste para variáveis de confusão os fatores mais fortemente associados à experimentação do cigarro foram nível de escolaridade da mãe, idade do adolescente, estudar no período noturno, já ter sido reprovado na escola e ter amigos e irmãos fumantes. Medidas preventivas devem ser direcionadas aos adolescentes, dentro das instituições escolares, como forma de controle do tabagismo.

An ecological system approach to adolescent smoking behavior

The aim of the present study was to simultaneously examine the effect of factors related to school, leisure, family and the individual on adolescent smoking. These determining factors occupy the micro- and mesosystems of Bronfenbrenner's Ecological Theory. Data were collected using questionnaires from a nationally representative sample of 15-year-olds (1404 pupils) and 73 staff members from 73 schools in Norway. Males formed 51% of the sample size. Consistent with previous studies, the various factors were linked to adolescent smoking when examined separately. However, in an ecological setting, factors related to the individual and leisure (i.e., attitudes towards smoking, perceived behavioural control and evenings with friends) emerged as the strongest predictors. School and family factors were completely mediated by individual and leisure factors, although when examined alone, they explained quite a substantial amount of the variance and a considerable amount of school difference in adolescent smoking. The implications are discussed.

General parenting, anti-smoking socialization and smoking onset

A theoretical model was tested in which general parenting and parental smoking predicted anti-smoking socialization, which in turn predicted adolescent smoking onset. Participants were 4351 Dutch adolescents between 13 and 15 years of age. In the model, strictness and psychological autonomy granting were related to lower likelihood of smoking onset, and parental smoking was positively related to smoking onset. Involvement and strictness were positively related to anti-smoking socialization, whereas parents who smoke where less likely to be engaged in anti-smoking socialization. In turn, anti-smoking socialization was negatively related to adolescent smoking. To test mediation, an asymptotic resampling method was used (bootstrapping); anti-smoking socialization appeared to mediate the links between involvement and smoking onset, strictness and smoking onset and parental smoking and smoking onset. In addition, parental smoking appeared to moderate the link between anti-smoking socialization and smoking onset. Implications for prevention were addressed.

Do smoking attitudes predict behaviour? A longitudinal study on the bi-directional relations between adolescents' smoking attitudes and behaviours

AIMS

Prevention and intervention programmes focus frequently upon retaining or creating negative attitudes towards smoking in an effort to prevent adolescents from smoking. As the focus upon attitudes is central in these programmes it is essential to know whether smoking attitudes actually precede smoking behaviour or, conversely, are affected by it. Therefore, in the present study we examined to what extent bi-directional relations existed between smoking attitudes and behaviour.

DESIGN

Data were used from the three annual waves of the 'Family and Health' project.

SETTING

Participants were asked to complete questionnaires individually at their homes.

PARTICIPANTS

Addresses of families consisting of two parents and two adolescents were obtained from the records of 22 municipalities in the Netherlands. At baseline, 428 families participated with a response rate of 94% at the third measurement.

MEASUREMENTS

Self-reports were used to assess adolescents' smoking attitudes and behaviour. Associations between smoking attitudes and behaviour were tested using structural equation modelling.

FINDINGS

Findings revealed that smoking attitudes did not predict smoking consistently over time. However, past smoking affected subsequent attitudes moderately, suggesting that adolescents who started to smoke developed less negative attitudes towards smoking.

CONCLUSIONS

The current findings imply that smoking behaviour predominantly shapes smoking-related attitudes, rather than vice versa. Focusing merely on smoking attitudes is probably not enough to prevent adolescents from smoking.

Trajectories of peer social influences as long-term predictors of drug use from early through late adolescence

The present study analyzed the long-term effects of perceived friend use and perceived peer use on adolescents' own cigarette, alcohol and marijuana use as a series of parallel growth curves that were estimated in two developmental pieces, representing middle and high school (N = 1,040). Data were drawn from a large drug abuse prevention trial, the Midwestern Prevention Project (MPP). Results showed that both perceived peer and friend cigarette use predicted own cigarette use within and across the adolescent years. For own alcohol and marijuana use, peer and friend influences were limited primarily to middle school. The findings suggest that strategies for counteracting peer and friend influences should receive early emphasis in prevention programs that are targeted to middle school. The findings also raise the question of whether cigarette use may represent a symbol of peer group identity that is unlike other drug use, and once formed, may have lasting adverse effects through the adolescent years.

Substance use, resistance skills, decision making, and refusal efficacy among Mexican and Mexican American preadolescents

This article examines the relationships among resistance skills, refusal efficacy, decision-making skills, and substance use for a sample of Mexican and Mexican American 5th grade students who were attending public schools in Phoenix, Arizona. An analysis of self-report questionnaire data indicated that the likelihood that male students reported ever having used one or more substances increased as they reported a greater willingness to use passive decision-making (e.g., going along) and decreased as they reported greater refusal efficacy and a greater willingness to utilize active decision making (e.g., thoughtful processing). No significant relationships emerged between the 4 predictors and lifetime substance use among the girls. These findings support the role of social skills in substance use prevention, shed light on an understudied group, and suggest the importance of continuing to examine gender differences in skills-based interventions.

Asthma-specific predictors of smoking onset in adolescents with asthma: a longitudinal study

OBJECTIVE

Despite even occasional smoking being more risky for adolescents with asthma, the smoking rate in this vulnerable population remains high. This is the first longitudinal study investigating asthma-specific predictors of smoking initiation.

METHODS

A three-wave longitudinal survey study (22 months) among 257 adolescents with asthma was conducted. The effects of asthma-specific factors [symptom severity, medication adherence, coping, attitude towards asthma, and quality of life (QOL)] on smoking onset were tested with logistic regression models.

RESULTS

Poorer self-reported adherence and the maladaptive coping strategy of hiding asthma predicted smoking onset. Poorer QOL predicted smoking in boys only.

CONCLUSIONS

Our findings underscore the importance of recognizing and addressing adherence problems during adolescence as low adherence is a risk factor for smoking initiation. Moreover, psychosocial factors, such as coping and QOL for boys, were associated with smoking initiation. This highlights the importance of attending to the psychosocial needs of youth with asthma.

Adolescents' perceptions of smoking and stress reduction

The present study examined how adolescents perceive the relationship between smoking and stress and where they learn that smoking cigarettes may be an effective stress-reduction mechanism. Eight focus groups were conducted with low-income African American and European American 14- to 16-year-olds in urban and rural locations, in which they suggested that the primary reasons why they smoked-namely, as a coping mechanism (to calm nerves), for social acceptance, and because of environmental influences. Family issues, boyfriend/girlfriend problems, and school were common stressors. Although participants overwhelmingly believed that people smoke to reduce their stress, a few believed that cigarettes do not actually reduce stress. When asked for examples of smoking in popular media, teens predominantly generated examples of individuals smoking to reduce stress. Ethnic and gender differences were found among the types of media in which they had seen smoking, their opinions of anti-smoking messages, and the media's perceived influence.

Local restaurant smoking regulations and the adolescent smoking initiation process: results of a multilevel contextual analysis among Massachusetts youth

OBJECTIVE

To assess whether smoke-free restaurant laws influence the progression from (1) never smoking to early experimentation and (2) early experimentation to established smoking.

DESIGN

A longitudinal, 4-year, 3-wave study of a representative sample of Massachusetts youth.

SETTING

A total of 301 Massachusetts communities.

PARTICIPANTS

Study participants were 3834 Massachusetts youths aged 12 to 17 years at baseline, from January 2, 2001, to June 18, 2002, of whom 2791 (72.8%) were reinterviewed after 2 years (from January 30, 2003, to July 31, 2004) and 2217 (57.8%) were reinterviewed after 4 years (from February 16, 2005, to March 26, 2006). Wave 3 respondents were recruited from both those who responded at wave 2 and those who did not.

MAIN EXPOSURE

The primary predictor of interest is the strength of the local restaurant smoking regulation in the respondents' town of residence at the baseline of each transition period.

MAIN OUTCOME MEASURES

(1) Overall progression to established smoking (having smoked > or =100 cigarettes in one's lifetime), (2) transition from nonsmoking (never having puffed a cigarette) to experimentation, and (3) transition from experimentation to established smoking.

RESULTS

Youths living in towns with a strong restaurant smoking regulation at baseline had significantly lower odds of progressing to established smoking (odds ratio, 0.60; 95% confidence interval, 0.42-0.85) compared with those living in towns with weak regulations. The observed association between strong restaurant smoking regulations and impeded progression to established smoking was entirely due to an effect on the transition from experimentation to established smoking (odds ratio, 0.53; 95% confidence interval, 0.33-0.86).

CONCLUSION

Local smoke-free restaurant laws may significantly lower youth smoking initiation by impeding the progression from cigarette experimentation to established smoking.

Effect of a pediatric practice-based smoking prevention and cessation intervention for adolescents: a randomized, controlled trial

OBJECTIVE

The purpose of this work was to determine whether a pediatric practice-based smoking prevention and cessation intervention increases abstinence rates among adolescents.

METHODS

Eight pediatric primary care clinics were randomly assigned to either intervention or usual care control condition. The provider- and peer-delivered intervention tested was based on the 5A model recommended by the US Public Health Service clinical practice guidelines and the American Academy of Pediatrics and consisted of brief counseling by the pediatric provider followed by 1 visit and 4 telephone calls by older peer counselors aged 21 to 25 years. A consecutive sample of patients aged 13 to 17 years scheduled for an office visit was eligible regardless of smoking status. Of 2711 patients who agreed to participate, 2709 completed baseline assessments, and 2700 (99.6%) and 2690 (99.2%) completed 6- and 12-month assessments, respectively.

RESULTS

Compared with the usual care condition, nonsmokers who received the provider- and peer-delivered intervention were significantly more likely to self-report having remained abstinent at 6-month and 12-month follow-up; smokers who received the provider- and peer-delivered intervention were more likely to report having quit at the 6-month but not the 12-month follow-up. A number of adolescent characteristics (eg, age, peer smoking, tobacco dependence, and susceptibility) were found to be predictive of abstinence at follow-up.

CONCLUSIONS

A pediatric practice-based intervention delivered by pediatric providers and older peer counselors proved feasible and effective in discouraging the initiation of smoking among nonsmoking adolescents for 1 year and in increasing abstinence rates among smokers for 6 months.

Social learning of novel route preferences in adult humans

Non-human animals can acquire novel route preferences by following knowledgeable individuals. Such socially learned route preferences can be stably maintained over multiple transmission episodes, sometimes forming long-lived traditions. In humans, preferences for familiar routes or heavily used worn trails over unfamiliar ones have been described in various contexts. However, social learning of route preferences has not been experimentally demonstrated in humans. Here, we demonstrate that social learning and tradition influence route choice. We led adult male and female participants into a room by one of two routes. Participants followed the demonstrated route choices, and later remembered and preferred this choice even when determinably suboptimal (i.e. longer and not preferred by control participants) or when the choice was indicated as arbitrary (the demonstrator took one route to retrieve a poster that had ostensibly fallen). Moreover, route preferences were stably maintained over multiple transmission episodes. We suggest that simple social learning processes, often neglected in human and primate research, can result in long-lived route preferences that may influence a range of additional behaviour patterns.

Does smoking among friends explain apparent genetic effects on current smoking in adolescence and young adulthood?

We used data from a prospective cohort study of twins to investigate the influence of unmeasured genetic and measured and unmeasured environmental factors on the smoking behaviour of adolescents and young adults. Twins were surveyed in 1988 (aged 11-18 years), 1991, 1996 and 2004 with data from 1409, 1121, 732 and 758 pairs analysed from each survey wave, respectively. Questionnaires assessed the smoking behaviour of twins and the perceived smoking behaviour of friends and parents. Using a novel logistic regression analysis, we simultaneously modelled individual risk and excess concordance for current smoking as a function of zygosity, survey wave, parental smoking and peer smoking. Being concordant for having peers who smoked was a predictor of concordance for current smoking (P<0.001). After adjusting for peer smoking, monozygotic (MZ) pairs were no more alike than dizygotic pairs for current smoking at waves 2, 3 and 4. Genetic explanations are not needed to explain the greater concordance for current smoking among adult MZ pairs. However, if they are invoked, the role of genes may be due to indirect effects acting through the social environment. Smoking prevention efforts may benefit more by targeting social factors than attempting to identify genetic factors associated with smoking.

The effects of second-hand and direct exposure to tobacco smoke on asthma and lung function in adolescence

Cigarette smoking still is quite common in many parts of the world. In parallel, exposure to second-hand smoke continues to be common despite declines in smoking in developed countries and despite evidence of serious health effects in infants and children. This paper focuses on the effects of second-hand and direct exposure (personal smoking) on the respiratory health of adolescents, in particular effects on the occurrence of asthma and on lung function. Published data indicate that, in addition to whatever effects direct and postnatal second-hand tobacco smoke exposure have on the occurrence of asthma and impaired levels and growth of lung function in adolescents, there is an underlying alteration in the prenatal and early postnatal development of the structural and mechanical characteristics of the lung that contribute substantially to these deficits. These developmental effects may be important contributors to the future risks for impaired pulmonary function.

Smoking status of step-parents as a risk factor for smoking in adolescence

AIM

To examine the extent to which smoking by step-parents and biological parents predicts adolescent smoking. DESIGN Five-year cohort study. SETTING Thirty-six schools in South London, England. Participants A subset of 650 students participating in the Health and Behaviour In Teenagers Study (HABITS), who reported living in step-families, were assessed annually from age 11-12 to age 15-16 years.

MEASUREMENTS

Students reported their smoking status, which was cotinine-verified, as well as whether their parents smoked and, if they lived with a step-parent, whether that step-parent smoked. Analyses also controlled for gender, ethnicity and deprivation.

FINDINGS

Students who reported that just their step-parent smoked at age 11-12 were significantly more likely to report current smoking at any time-point from age 11-16 than those who reported having neither biological parents nor a step-parent who smoked [odds ratio (OR) 2.72, 95% confidence interval (CI) = 1.36-5.47], as were those with both a parent and a step-parent who smoked (OR 2.23, 95% CI = 1.46-3.41). While the association between smoking in students and smoking in biological parents in this subsample did not reach statistical significance (OR 1.39, 95% CI = 0.88-2.19), these students were no more or less likely to smoke than those with just a step-parent who smoked.

CONCLUSION

Smoking by a non-biological parent appears at least as influential as smoking by biological parents. This confirms the importance of social influence on smoking initiation and suggests that attempts to work with parents in smoking prevention should involve, and perhaps pay particular attention to, step-parents who smoke.

Social inequalities in changes in health-related behaviour among Slovak adolescents aged between 15 and 19: a longitudinal study

Background

Lower socioeconomic position is generally associated with higher rates of smoking and alcohol consumption and lower levels of physical activity. Health-related behaviour is usually established during late childhood and adolescence. The aim of this study is to explore changes in health-related behaviour in a cohort of adolescents aged between 15 and 19, overall and by socioeconomic position.

Methods

The sample consisted of 844 first-year students (42.8% males, baseline in 1998 – mean age 14.9, follow-up in 2002 – mean age 18.8) from 31 secondary schools located in Kosice, Slovakia. This study focuses on changes in adolescents' smoking, alcohol use, experience with marijuana and lack of physical exercise with regard to their socioeconomic position. Four indicators of socioeconomic position were used – adolescents' current education level and employment status, and the highest education level and highest occupational status of their parents. We first made cross tabulations of HRB with these four indicators, using McNemar's test to assess differences. Next, we used logistic regression to assess adjusted associations, using likelihood ratio tests to assess statistical significance.

Results

Statistically significant increases were found in all health-related behaviours. Among males, the most obvious socioeconomic gradient was found in smoking, both at age 15 and at 19. Variations in socioeconomic differences in health-related behaviour were more apparent among females. Although at age 15, almost no socioeconomic differences in health-related behaviour were found, at age 19 differences were found for almost all socioeconomic indicators. Among males, only traditional socioeconomic gradients were found (the lower the socioeconomic position, the higher the prevalence of potentially harmful health-related behaviour), while among females reverse socioeconomic gradients were also found.

Conclusion

We confirmed an increase in unhealthy health-related behaviour during adolescence. This increase was related to socioeconomic position, and was more apparent in females.

Modèles socio-écologiques : renforcement de la recherche interventionnelle dans le contrôle du tabac

Quelques aspects dans le domaine du contrôle du tabac ont été marqués par une conceptualisation plus large des facteurs complexes qui déterminent la santé de la population. Les programmes de santé publique de contrôle du tabac accordent une part de plus en plus grande à des interventions à plusieurs niveaux et à des changements de politiques pour influencer le contexte. De plus, des concepts socio-écologiques (par exemple, stratégies visant des interactions intrapersonnelles, interpersonnelles et socio-environnementales) sont implicites à de nombreuses politiques exhaustives de réduction du tabac. Par contraste, la recherche interventionnelle sur le tabac est à la traîne par rapport à cette progression, avec des stratégies au niveau individuel qui continuent à dominer le programme de recherche. De nouvelles méthodes de recherche sont suggérées pour renforcer la recherche interventionnelle dans la prévention et l’arrêt du tabagisme. En utilisant l’exemple des adolescents et des transitions développementales, nous illustrerons comment la réflexion entourant les modèles socio-écologiques offre de nouvelles possibilités pour la recherche interventionnelle sur le contrôle du tabac.

Smoking behavior in asthmatic and non-asthmatic adolescents: the role of smoking models and personality

Despite the particular health risks for asthmatics, recent international studies have reported that tobacco use among asthmatics is similar to, or even higher than, non-asthmatics. This study examined the role of personality and environment in smoking among asthmatic and non-asthmatic adolescents. In 2003 a random sample of 33 schools (first and second class of secondary education) was obtained in The Netherlands (N = 4,951). The mean age of the participants was 12.83 (SD = .75), and 52.8% were females. Information about asthma, smoking, personality, and environmental smoking was assessed via self-reports on standard epidemiology survey items (asthma, smoking) and the Quick Big Five (personality). Both personality and environmental smoking were associated with smoking. Asthmatics were similarly or even more exposed to environmental smoke than non-asthmatic adolescents and asthmatic adolescents were less emotionally stable and extravert. Associations between personality and own smoking behavior, as well as between smoking models and own smoking behavior were similar for asthmatic and non-asthmatics. Limitations of the study are taken notice of, and implications of the results are briefly discussed.