Why children start smoking cigarettes: predictors of onset

How connectedness contributes to experimental smoking among rural youth: developmental and ecological analyses

The influences of peer, sibling, and parents' smoking on adolescents' initiation of tobacco use have been explained as a function of peer pressure, genetics, and social learning processes, but rarely in combination or with assessments of the quality of these relationships. This study examined the additional contributions of connectedness to friends, siblings, parents, and teachers beyond the effects of friend, sibling, and parental smoking using logistic regression analyses with a cross-sectional middle and high school sample of 303 rural adolescents. Friends' and siblings' smoking, and connectedness to friends, were the strongest predictors of experimental smoking. Parental smoking and connectedness to parents and to teachers were significant predictors of experimental smoking when considered independently, but not after accounting for friend and sibling factors. Connectedness to parents and teachers decreased the odds of experimental smoking, while connectedness to friends increased the odds. EDITORS' STRATEGIC IMPLICATIONS: This strategy of assessing connectedness to-and smoking behaviors of-friends, siblings, teachers, and parents shows promise in predicting teens' cigarette smoking choices. The finding that the negative effects of unconventional connectedness and smoking by friends and siblings outweigh positive effects of connectedness to adults awaits replication with different samples and measures.

Survey of smoking attitudes in grade school children in Greece: a preliminary study

AIMS

Tobacco use among children and adolescents is a major public health concern. Past literature has indicated that smoking attitudes are reliable predictors of teen smoking. The present study explored the smoking attitudes of 4th-6th grade Greek pupils.

METHODS

Data were obtained from 379 Greek elementary school students who completed a smoking attitudes survey, based on the Bogalusa Heart Study.

FINDINGS AND CONCLUSIONS

Analysis of variance indicated that 4th graders expressed significantly more positive attitudes towards tobacco use in three statements related to the psychological consequences of cigarette use, and to peer pressures to smoke. No gender differences were evident. Overall, pupils across grades expressed relatively negative attitudes towards smoking. Differences between school grades in certain statements denoting the psychological properties of tobacco use, and in peer pressures were attributed to 4th graders' lack of knowledge in the particular areas.

Peer influences on adolescent cigarette smoking: a theoretical review of the literature

This article reviews several classes of theories to elucidate the relationship between adolescent cigarette smoking and friends' cigarette smoking. Perceived influence theories hinge upon an adolescent's perception of friends' smoking behavior. External influence theories are those in which friends' smoking behavior overtly influences adolescent smoking. Group level theories examine how differences at the level of subculture, gender, and race/ethnicity influence the relationship under study. Network theories are also discussed. A model integrating relevant theories into a longitudinal model representing friend influences on adolescent smoking is presented, along with implications of the results presented for adolescent tobacco prevention programs.

The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

Correlates of regular cigarette smoking in a population-based sample of Australian twins

AIMS

To investigate the role of measured risk factors and the influence of genetic and environmental factors on regular cigarette smoking. Design Members of monozygotic and dizygotic, including unlike-sex twin pairs (n = 6257) from a young adult cohort from the Australian Twin Registry.

METHODS

Cox proportional hazards models were used to determine whether putative risk factors were significantly associated with regular cigarette smoking. Risk factors were classified into four tiers: tier 1 (parental history, including parental education, alcoholism and cigarette smoking), tier 2 (early home and family influences), tier 3 (early life events, e.g. trauma) and tier 4 (psychiatric symptoms/disorders with onset prior to 14 years), after controlling for gender, zygosity and their interactions. Genetic models were fitted to examine the heritability of smoking behavior before and after controlling for significant covariates from the four tiers.

FINDINGS

Parental history of cigarette smoking and alcoholism, parental closeness and home environment, as well as incidence of childhood sexual abuse or other trauma, a history of early onset panic attacks and conduct problems were associated with regular cigarette smoking. Important age interactions were found, particularly for family background risk factors. Regular cigarette smoking was moderately heritable, even after accounting for significant covariates.

CONCLUSIONS

Several measured risk factors are associated with regular smoking. While some of the genetic influences on regular smoking may be shared with these risk factors, a significant proportion of the genetic vulnerability to regular smoking is phenotype-specific.

The relationship between student smoking in the school environment and smoking onset in elementary school students

This study examined how perceptions of student smoking in the school environment and the actual smoking rate among senior students at a school are related to smoking onset. Multilevel logistic regression analysis was used to examine correlates of ever smoking in a sample of 4,286 grade 6 and 7 students from 57 elementary schools in Ontario, Canada. Students are at increased risk for smoking if they (a) often see students smoking near their school, (b) report that students at their school smoke where they are not allowed, and (c) attend a school with a relatively high senior student smoking rate. Each 1% increase in the smoking rate among grade 8 students increased the odds that a student in grades 6 or 7 was an ever smoker versus never smoker (odds ratio, 1.05; 95% confidence interval, 1.02-1.08). A low-risk student (no family or friends who smoke) was over twice as likely to try smoking if he/she attended a high-risk school. Prevention programs should target both at-risk schools and at-risk students, and strongly enforced policies preventing students from smoking on or near school property should be implemented.

False consensus and adolescent peer contagion: examining discrepancies between perceptions and actual reported levels of friends' deviant and health risk behaviors

Adolescents' perceptions of their friends' behavior strongly predict adolescents' own behavior, however, these perceptions often are erroneous. This study examined correlates of discrepancies between adolescents' perceptions and friends' reports of behavior. A total of 120 11th-grade adolescents provided data regarding their engagement in deviant and health risk behaviors, as well as their perceptions of the behavior of their best friend, as identified through sociometric assessment. Data from friends' own report were used to calculate discrepancy measures of adolescents' overestimations and estimation errors (absolute value of discrepancies) of friends' behavior. Adolescents also completed a measure of friendship quality, and a sociometric assessment yielding measures of peer acceptance/rejection and aggression. Findings revealed that adolescents' peer rejection and aggression were associated with greater overestimations of friends' behavior. This effect was partially mediated by adolescents' own behavior, consistent with a false consensus effect. Low levels of positive friendship quality were significantly associated with estimation errors, but not overestimations specifically.

Knowledge about tobacco and subsequent use of cigarettes and smokeless tobacco among Swedish adolescents

PURPOSE

To investigate whether knowledge of the risks and properties of tobacco among adolescents influences their future use of cigarettes and smokeless tobacco in different directions.

METHODS

A prospective cohort study of 2581 adolescents whose knowledge of tobacco was assessed in the sixth grade by means of a multi-item scale. Tobacco use was assessed by annual surveys up to the ninth grade.

RESULTS

Knowledge level was not associated with future use. Items dealing with addictive properties of nicotine were prospectively associated with smokeless tobacco ("snus") use only.

CONCLUSIONS

A high level of knowledge of the risks associated with tobacco is not a predictor of future nonuse or of a shift to smokeless tobacco rather than cigarettes. Attitudes and expectations may determine knowledge rather than vice versa.

Family influences on the risk of daily smoking initiation

PURPOSE

To examine developmental patterns and family influences on the risk of daily smoking initiation from adolescence to young adulthood.

METHOD

A gender-balanced, ethnically diverse urban sample of 808 children aged 10-11 years was surveyed in 1985 and followed prospectively to age 21 in 1996. Discrete-time survival analysis was used to assess the hazard of initiation of daily smoking during this time period, as well as the effects of family factors on the risk of daily smoking initiation.

RESULTS

Less parental smoking, more strict family monitoring and rules, and stronger family bonding predicted a significantly lower risk of daily smoking initiation controlling for socio-demographic background. The decline in the impact of family bonding over time was marginally significant; however, none of the interactions between family factors and time were significant, indicating generally consistent family influences on daily smoking from age 10 to 21.

CONCLUSIONS

The present findings indicate that parent smoking contributes to the onset of daily smoking in their teenagers even if parents practice good family management, hold norms against teen tobacco use, and do not involve their children in their own tobacco use. Smoking prevention programs should include components focused on parents of adolescents. To reduce risks for daily smoking among adolescents, it is important to encourage parents to stop or reduce their own smoking. In addition, these data indicate that parents can reduce their children's risk of daily smoking initiation by reducing family conflict, by maintaining strong bonds with their children, by setting clear rules, and by closely monitoring their children's behaviors.

Sociometric status as a predictor of onset and progression in adolescent cigarette smoking

The relation between sociometric status and adolescent cigarette smoking was examined in a 1-year longitudinal study. Students in 6th, 7th, and 8th grades (N=1,630) were asked to nominate peers in their grade at school whom they liked and peers whom they disliked. These nominations were used to classify participants into one of five sociometric categories (popular, rejected, controversial, neglected, and average). Participants also reported their lifetime cigarette use at two measurements in consecutive school years. The results indicated that rejected and controversial adolescents were more likely than average adolescents to (a) report lifetime smoking at time 1 (T1) and (b) report onset of smoking at time 2 (T2). However, among adolescents who had already tried cigarettes at T1, rejected and controversial youth were not at increased risk for progression in total lifetime cigarette smoking (i.e., higher levels of total lifetime cigarette use at T2). Thus the results confirm that controversial youth are similar to rejected youth in their risk for onset of cigarette smoking during adolescence.

Role of parents and peers in influencing the smoking status of high school students in Taiwan

OBJECTIVES

To assess parental influence on smoking behaviour by high school students in an Asian culture and to compare the relative importance of parental and peer influence.

METHODS

A 5% nationally representative sample, including 44 976 high school students in 10th to 12th grade (aged 15-18 years) in Taiwan, were surveyed in 1995. Each completed a long self administered questionnaire. Parental influence was measured by examining both parental behaviour (smoking status) and attitudes (perceived "tender loving care" (TLC) by adolescents). Changes in smoking status were used to determine peer influence, defined as the increase in the likelihood of smoking from grade 10 to 12 in a steady state environment. Odds ratios (ORs) were calculated for parental and peer influence, using logistic regression.

RESULTS

Adolescents of smoking parents with low TLC had the highest smoking rates and those of non-smoking parents with high TLC had the lowest. The difference was more than twofold in boys and more than fourfold in girls. When either parental smoking status or TLC alone was considered, parental influence was similar to peer influence in boys, but larger than peer influence in girls. However, when smoking status and TLC were considered jointly, it became larger than peer influence for both groups (OR 2.8 v 1.8 for boys and OR 3.9 v 1.3 for girls).

CONCLUSION

When parental influence is taken as parental behaviour and attitude together, it plays a more important role than peer influence in smoking among high school students in Taiwan. This study, characterising such relationships among Asian populations for the first time, implies that future prevention programmes should direct more efforts toward the parental smoking and parent-child relationships, and not aim exclusively at adolescents in schools.

Soziale und individuelle Determinanten des Tabakkonsums im frühen Jugendalter

Zusammenfassung: Fragestellung: Der Tabakkonsum von Jugendlichen soll hinsichtlich des Wirkungsgefüges individueller und sozialer Einflussfaktoren untersucht werden. Methodik: In einer prospektiven Längsschnittstudie an einer Geburtskohorte von 384 Kindern mit Risiken für die Entwicklung psychischer Auffälligkeiten wurden im Alter von 15 Jahren der jugendliche Tabakkonsum, mit dem Rauchen verbundene Erwartungen bezüglich Instrumentalität und Selbstwirksamkeit sowie der Tabakkonsum im Elternhaus und Freundeskreis erhoben. Ergebnisse: Etwa 60% der 15-Jährigen gaben an, jemals Zigaretten konsumiert zu haben, ca. 16% rauchten täglich. Eine geringe rauchbezogene Selbstwirksamkeit und eine hohe Anzahl tabakkonsumierender Freunde waren bei beiden Geschlechtern am engsten mit dem jugendlichen Zigarettenkonsum verbunden. Besonders gefährdet waren Jugendliche mit einem hohen Tabakkonsum im Freundeskreis, die sich als wenig selbstwirksam beschrieben. Während elterliches Rauchen einen direkten, aber geringen Einfluss auf den Tabakkonsum der Jugendlichen ausübte, erstreckte sich der deutlich stärkere Einfluss der Peers auch auf die individuellen rauchbezogenen Einstellungen. Schlussfolgerungen: Raucherfahrungen und rauchbezogene Einstellungen im frühen Jugendalter stehen in einem engen Zusammenhang mit den Konsumgewohnheiten des Freundeskreises.

Father's occupational group and daily smoking during adolescence: patterns and predictors

OBJECTIVES

We investigated the relationship among father's occupational group, daily smoking, and smoking determinants in a cohort of New Zealand adolescents.

METHODS

The longitudinal Multidisciplinary Health and Development Study provided information on adolescents' self-reported smoking behavior and potential predictors of smoking, such as social and material factors, personality characteristics, educational achievement, and individual attitudes and beliefs regarding smoking. Longitudinal logistic generalized estimating equation analyses were used.

RESULTS

Adolescents whose fathers were classified in the lowest-status occupational group were twice as likely as those whose fathers occupied the highest-status occupational group to be daily smokers. This high risk of daily smoking among the adolescents from the lowest occupational group was largely predicted by their lower intelligence scores and by the higher prevalence of smoking among fathers and friends.

CONCLUSIONS

To prevent socioeconomic differences in smoking, school-based interventions should seek to prevent smoking uptake among adolescents, particularly those of lower socioeconomic status. Programs need to provide positive, nonsmoking role models consonant with the culture and norms of lower-socioeconomic-status groups. Adolescents need to acquire resistance skills and protective behaviors against social pressure and influences.

Parental rules and communication: their association with adolescent smoking

AIMS

To examine the association between parental rules and communication (also referred to as antismoking socialization) and adolescents' smoking.

DESIGN AND PARTICIPANTS

A cross-sectional study including 428 Dutch two-parent families with at least two adolescent children (aged 13-17 years).

MEASUREMENTS

Parents' and adolescents' reports on an agreement regarding smoking by adolescents, smoking house rules, parental confidence in preventing their child from smoking, frequency and quality of communication about smoking, and parent's reactions to smoking experimentation.

FINDINGS

Compared with fathers and adolescents, mothers reported being more involved in antismoking socialization. There were robust differences in antismoking socialization efforts between smoking and non-smoking parents. Perceived parental influence and frequency and quality of communication about smoking were associated with adolescents' smoking. The association between antismoking socialization practices and adolescents' smoking was not moderated by birth order, parents' smoking or gender of the adolescent.

CONCLUSIONS

Encouraging parents, whether or not they themselves smoke, to discuss smoking-related issues with their children in a constructive and respectful manner is worth exploring as an intervention strategy to prevent young people taking up smoking.

Psychosocial predictors of smoking trajectories during middle and high school

AIMS

Little is known about the heterogeneity in and risk factors associated with trajectories of smoking during adolescence. This study aimed to (1) identify smoking trajectories empirically and (2) identify risk factors for trajectory group membership.

DESIGN

Latent growth mixture models were used to identify population smoking trajectories, and logistic regression was used to estimate risk factors for group membership.

SETTING

The participants were drawn from seven middle schools in a Maryland school district.

PARTICIPANTS

Participants consisted of 1320 6th graders who were followed to the 9th grade.

MEASUREMENTS

Measurements of smoking risk factors were made in the fall of 6th grade and smoking stage was assessed on five different occasions between the fall of 6th and 9th grades.

FINDINGS

Five distinct smoking trajectories were identified. Overall, being female, having friends who smoked, deviance acceptance and outcome expectations were associated with an increased likelihood of being an intender, delayed escalator, early experimenter and early user compared to a never smoker. Additionally, comparisons with never smokers revealed unique identifiers for intenders, early experimenters and early users, but not delayed escalators.

CONCLUSIONS

There is much heterogeneity in the manner in which middle-schoolers progress from having no intention of smoking to becoming smokers. Implications for prevention programs are discussed.

Understanding the role of cigarette promotion and youth smoking in a changing marketing environment

In 2001, $11.21 billion was spent on domestic cigarette advertising and promotion, an increase of 16.9% over 2000. This article explains how cigarette industry efforts stimulate demand and encourage smoking within the context of recent changes, including the 1998 Master Settlement Agreement (MSA) and resulting litigation, and variations in tobacco marketing policies. Communication concepts are combined with adolescent development concepts to explain how youth are impacted. Industry documents and current syndicated research data are used to reveal and explain key concepts.

The impact of self-control indices on peer smoking and adolescent smoking progression

OBJECTIVE

To determine the direct impact of self-control variables on baseline smoking and smoking progression and determine whether self-control had indirect effects on smoking practices through effects on peer smoking.

METHODS

Study participants were 918 adolescents who were followed from 9th through the 12th grade and completed self-report measures of peer smoking, self-control, and cigarette smoking. An exploratory factor analysis (EFA) was conducted to assess the factor structure of a 41-item self-control measure. The EFA indicated a six-factor structure comprising of impulsive control, planning, hostile blaming, attentional disregulation, conscientiousness, and physical aggression.

RESULTS

The results of a latent growth model indicated that conscientiousness (OR = 0.81, CI = 0.73-0.90), hostile blaming (OR = 0.89, CI = 0.81-0.99), and physical aggression (OR = 1.16, CI = 1.06-1.27) had direct effects on baseline smoking, whereas planning (OR = 0.90, CI = 0.82-0.99) and impulse control (OR = 1.15, CI = 1.02-1.28) had indirect effects on adolescent smoking at baseline through baseline peer smoking. There were no significant direct or indirect effects of the self-control indices on smoking progression. There was a direct effect of peer smoking progression (number of peers who smoked) on adolescent smoking progression, such that increases in the number of peers who smoked across time increased the odds that an adolescent would progress to a higher level of smoking.

CONCLUSIONS

Youth smoking prevention and intervention program outcomes may potentially improve by addressing self-control behaviors as they appear to have direct effects on smoking and indirect effects through peers who smoke.

Parental occupation, education, and smoking as predictors of offspring tobacco use in adulthood: a longitudinal study

This study examined the interrelation of parental occupational status (blue- versus white-collar), parental education, parental smoking, parent-child relations, late adolescent tobacco use, and adult offspring smoking. A longitudinal data set was employed, composed of 603 participants who were first studied in childhood and then followed to mean age 27 years. Structural Equation Modeling (SEM) showed that the distal factors of parental blue-collar status, low parental educational achievement, and parental smoking were related to adult offspring smoking. Specifically, parental blue-collar status and parental smoking were mediated by the latent construct of the parent-child relationship, which in turn was mediated by smoking in late adolescence with respect to adult offspring smoking. Parental educational level was partially mediated by the parent-adolescent relationship but also had a direct path to adult offspring smoking. The most powerful predictor of offspring smoking in adulthood was smoking in late adolescence. Findings imply areas that may be targeted by intervention programs to decrease offspring tobacco use.

Cholecystokinin (CCK) and the CCKA receptor gene polymorphism, and smoking behavior

We analyzed genetic variants of the promoter region of the cholecystokinin (CCK; which modulates the release of dopamine) gene, and intron 1 and exon 5 of the CCKA receptor gene, and performed association analyses of nicotine dependence using an allele-specific amplification (ASA) method and PCR-RFLP methods. There was a significant difference between the current smoking and nonsmoking groups in the allele frequency of the CCK-45C/T polymorphism. However, there was no significant difference in the CCKA PstI polymorphism, and the HincII polymorphism was not detected in our study. Our data suggest that polymorphisms of the CCK gene may be one of the risk factors for smoking behavior.

Latent growth curve analyses of peer and parent influences on smoking progression among early adolescents

Social influences on smoking uptake were examined in latent growth curve analyses of data from 1,320 youths assessed 5 times during 6th to 9th grade. Initial smoking stage predicted increases in number of friends who smoked, indicating selection; however, initial number of friends who smoked did not predict smoking stage progression, indicating no significant effect of socialization. Associations over time among smoking stage progression, affiliation with friends who smoke, and parenting behaviors were significant, suggesting dynamic, reciprocal relationships. Parental involvement, monitoring, and expectations provided direct protective effects against smoking progression as well as indirect effects, by limiting increases in number of friends who smoke. These results are consistent with the peer selection hypothesis, confirm the powerful association over time of social influences with smoking, and provide the first evidence that parenting behavior may protect against smoking progression by limiting increases in number of friends who smoke.

Influence of known psychosocial smoking risk factors on Egyptian adolescents' cigarette smoking behavior

The morbidity and mortality associated with cigarette smoking is shifting from the developed world to developing countries, especially developing Arab countries. One such country is Egypt, which has the highest rate of tobacco consumption in the Arab world. To curb the rising smoking epidemic in Egypt, appropriate adolescent smoking prevention programs need to be developed. Most of the effective adolescent smoking prevention programs are based on the social influence approach, which targets the proximal psychosocial variables believed to promote adolescent smoking. However, most of our understanding of adolescents' psychosocial smoking risk factors is based mainly on Western studies. Whether these factors have the same influence on Egyptian adolescents' smoking behavior has not been investigated to date. An understanding of the psychosocial correlates of smoking behavior among Egyptian adolescents may help in designing the appropriate smoking prevention program aimed at this population. This study reports the results of a cross-sectional survey administered to a random sample of 1930 students in grades 7, 9 and 12 in the city of Alexandria, Egypt, in May 2003. Adolescent smoking behavior was positively associated with positive beliefs about smoking, sibling, parent and peer smoking, and social smoking norms, with sibling smoking and perceived adult smoking norms having a stronger influence on adolescents' smoking behavior than peer smoking and perceived peer smoking norms. Refusal self-efficacy was protective against smoking behavior, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to future smoking among females only. The results suggest that adolescents from collective cultures, like Egypt, are more influenced by their family's smoking behavior and perceived adult smoking norms than their peers' smoking behavior and perceived peer smoking norms. Smoking prevention programs aimed at Egyptian adolescents should be accompanied by smoking cessation programs for the family and adult community members.

Understanding factors that influence smoking uptake

OBJECTIVE

To explore relationships between patterns of smoking uptake and social context and attitudinal variables.

DESIGN

Cross sectional survey.

SETTING

Public schools in Tucson, Arizona and Albuquerque, New Mexico.

PARTICIPANTS

982 children in grades 6-9 (ages 11-15 years).

MAIN OUTCOME MEASURES

Items measuring smoking history, nicotine dependence and quit attempts, susceptibility to smoking in the future, smoking norms, use of other tobacco products, attitudes toward smoking, and demographic characteristics.

RESULTS

Overall, 43% of children had smoked a cigarette and 57% had never used them. Ever smokers lived in social contexts with more smoking and where smoking was normative. Among never users, 25% are susceptible to smoking; these children have positive attitudes toward smoking, do not feel social pressure to stay off cigarettes, and had more friends who smoked. Among ever users, 36% were currently smoking in the past 30 days. Current users also lived in social context with more smoking and had positive attitudes toward smoking. Most users had tried to stop smoking. Only 9% of current users smoked daily; 29% had not smoked a whole cigarette. Greater cigarette consumption was associated with more favourable attitudes toward smoking. Most of past users were in early uptake: 95% had smoked less than 100 cigarettes but 49% were susceptible to smoking again.

CONCLUSIONS

There is promise in differentiating subgroups among the never, past and current use of cigarettes. Susceptibility within each of these groups was associated with similar patterns of attitudes and social context. These patterns in smoking uptake need to be confirmed prospectively.

How have smoking risk factors changed with recent declines in California adolescent smoking?

AIM

To compare predictors of smoking initiation in two longitudinal studies in California conducted during periods when adolescent smoking prevalence was increasing (1993-96) and decreasing (1996-99).

DESIGN, SETTING AND PARTICIPANTS

Cohorts of 12-15-year-old never smokers were identified from the cross-sectional 1993 and 1996 California Tobacco Surveys (large population-based telephone surveys) and followed-up 3 years later (1993-96, n = 1764; 1996-99, n = 2119).

MEASURES

We compared cohort transition rates to any smoking by follow-up in risk groups defined by known predictors of smoking initiation at baseline. Besides examining predictors individually, risk groups were defined using a multivariate analysis.

FINDINGS

Overall, transition to any smoking by follow-up occurred in 38.3 +/- 4.0% (% +/- 95% confidence interval) of never smokers in the 1993-96 cohort and 31.1 +/- 2.6% in the 1996-99 cohort. For most predictors, the transition rate for adolescents with the characteristic was the same or only slightly lower in the 1996-99 cohort compared to the 1993-96 cohort, but the transition rate in those without the characteristic was generally much lower, thus increasing the power of the predictor. The multivariate analysis confirmed that compared to the 1993-96 cohort, transition occurred much less often in the 1996-99 cohort for adolescents at low rather than at medium or high risk of future smoking.

CONCLUSIONS

The turnaround in California adolescent smoking in the mid-1990s, when smoking began to decline, appears to come primarily from adolescents already at low risk of future smoking (as defined by a variety of predictors), who transitioned to smoking at much lower rates than previously.

Changes in reasons given for adolescent smoking, 1984-1999

Adolescent smoking has been widely studied, but surprisingly little research has been done about the reasons given for smoking by adolescents themselves. This study examines the reasons given by Finnish adolescents for their own smoking and the reasons that they perceive for smoking by others. It reports on how these reasons have changed over a period of 15 years. In 1984, a questionnaire about reasons for smoking was administered to a sample of adolescents aged 14-16 (N = 396). The questionnaire was administered again to a similar sample (N = 488) in 1999, when Finland adopted strict new tobacco legislation. It was found that the reasons given (i.e., attributions) had changed considerably, and that the attributions for the adolescents' own behavior were quite different from the attributions for smoking by others. The attributions were only weakly influenced by the participants' gender or by their smoking habits, either in 1984 or 1999. In relation to participants' own smoking, the later questionnaire elicited inner subjective experiences involving "good feelings." In relation to the perceived reasons for other people's smoking, it elicited more responses connected with the notion of "belonging." The limitations of the study and suggestions for further research are discussed.

Smoking as a weight-control strategy among adolescent girls and young women: a reconsideration

Many studies have reported that adolescent girls and young women smoke to control their weight. The majority of these studies are cross-sectional and report on correlational data from quantitative surveys. This article presents data from ethnographic interviews with 60 smokers, interviewed in high school and in follow-up interviews at age 21. Contrary to previous research, this study found little evidence for the sustained use of smoking as a weight-control strategy. In high school, smokers were no more likely than nonsmokers to be trying to lose weight. In the follow-up study, 85 percent of informants replied that they had never smoked as a way to control their weight. One-half of informants at age 21 believed that smoking as a weight-control strategy would be ineffective, while the other one-half had no idea whether it would work or not. Researchers need to exert caution in propagating the idea that smoking is commonly used as a conscious and sustained weight-control strategy among adolescent females and young women.

Smoking among parents of pediatric cancer patients and children's exposure to environmental tobacco smoke

For 303 children newly diagnosed with cancer, we investigated the prevalence of parental smoking and examined patients' respiratory or pulmonary symptoms according to household smoking status. Results indicated that approximately 45 percent of patients came from households with at least one current parent smoker and 20 percent of current non-smoking parents reported past tobacco use. There was a trend for more patients from smoking households to experience respiratory problems than patients from non-smoking households (p = .068). In conclusion, many patients are at risk for parental smoke exposure and associated health problems if they are continually exposed during therapy. Clinician-delivered interventions to reduce environmental smoke exposure are clearly warranted.

Unplanned smoking initiation: new insights and implications for interventions

Despite intensive efforts, most smoking prevention interventions have had disappointing results. In the present paper, the assumption underlying these efforts that smoking initiation is the result of a rational decision or plan, is questioned. The process of adolescent smoking initiation is described, based on a recently conducted series of studies. It is argued that smoking initiation among adolescents is unplanned behaviour. Therefore, interventions regarding smoking initiation should not only include a focus on smoking-specific cognitions. Models that incorporate both conscious and unconscious processes need to be used in mapping smoking prevention efforts. Further, programmes that help adolescents to quit smoking need more attention. Finally, it is argued that smoking prevention interventions should aim at influencing the image of nonsmoking by using mass media interventions and restrictive policies.

Socioeconomic status and health in adolescents: the role of stress interpretations

The role of psychological interpretations in the relationship between low socioeconomic status (SES) and physiological responses was tested. One hundred high school students (ages 15-19) watched videos of ambiguous and negative life situations, and were interviewed about their interpretations. Lower SES was associated with greater threat interpretations during ambiguous (but not negative) situations and with greater diastolic blood pressure and heart rate reactivity. Threat interpretations partially mediated relationships between SES and reactivity. General life events (e.g., lack of positive life events), rather than specific life events (e.g., exposure to violence), partially explained the relationship between low SES and threat interpretations. Results suggest that the larger social environment helps explain how adolescents approach new social situations, which in turn has implications for adolescent physical health.

Factors Associated With Smoking Onset: 3-Year Cohort Study of Schoolchildren

OBJECTIVE

To analyze the predictors of smoking onset among schoolchildren.

METHODS

A cohort study of 1056 children starting in first year secondary school at 44 schools in Barcelona was carried out. Participating children were invited to answer a lifestyle questionnaire every year for 4 years. Each questionnaire carried a personal code to allow the 4 questionnaires to be matched. Matching questionnaires were found for 729 children, 70% of the initial sample.

RESULTS

Over the study period, the prevalence of regular smokers increased from 1.7% to 22% among boys and from 1.6% to 38.2% among girls. The predictors of smoking onset among boys were scoring high on the pro-smoking attitudes index (odds ratio [OR]=1.2; 95% confidence interval [CI], 1.1-1.3), intention to smoke in the future (OR=2.2; 95% CI, 1.0-4.9), low self-efficacy in resisting pressures to smoke (OR=0.98; 95% CI, 0.96-0.99), having siblings that smoke (OR=2.5; 95% CI, 1.2-5.4), and spending some free time in bars (OR=2.4; CI, 1.1-4.9). Among girls, the predictors were having low self-esteem (OR=0.94; 95% CI, 0.88-0.99), scoring low on the anti-tobacco attitudes index (OR=0.92; 95% CI, 0.88-0.97), having siblings who smoke (OR=2.5; 95% CI, 1.2-5.5), spending some free time in discotheques (OR=4.5; 95% CI, 1.9-11.8), and living in high socioeconomic-status neighborhoods (OR=3.1; 95% CI, 1.4-10.9).

CONCLUSIONS

The results show the importance of cognitive variables as well as a variety of environmental variables, particularly the pattern of free time use and the influence of sibling models. Prevention programs must take into account smoking onset risk factors as a whole.

Defining subgroups of adolescents at risk for experimental and regular smoking

If multiple etiologies of substance use are truly at work in the population, then further strides in the accurate prediction of smoking and the use of other substances will likely be built on diverse pattern-centered approaches that explore the presence of multiple population subgroups across various substance use stages. The present study aimed to identify population subgroups defined by individual risk factors or risk factor constellations that prospectively predict specific smoking stages. Using data from the National Longitudinal Study of Adolescent Health (Add Health), analyses were conducted on the sample that took part in the baseline and 1 year follow-up assessment between 1994 and 1996. Classification and regression tree procedures were used to investigate the structure of individual risk factors, or constellations of risk, that define population subgroups with high rates of both experimental and established smoking. For each level of smoking, a relatively simple model including two subgroups predicted over half of the smoking cases. Findings also indicated that the two group models identified higher rates of regular smokers compared to experimental smokers. Deviant behaviors and alcohol use without permission independently predicted movement to experimentation at follow-up. Progression to regular smoking from both a nonsmoking and experimental smoking status at baseline were each predicted by smoking friends. Additionally, baseline levels of experimental use predicted movement from experimental to regular smoking, while a relatively low grade point average predicted rapid progression from baseline nonuse to regular use at follow-up. By identifying first approximations of patterns, these analyses may lead to clues regarding the major multiple mechanisms at work for the progression of smoking among adolescents.

Influence and selection processes in friendships and adolescent smoking behaviour: the role of parental smoking

Concerning the role of parental smoking on development of adolescent smoking, most studies have exclusively focused on the direct effects of parents' smoking on youths' smoking. However, parental smoking may also play an indirect role by affecting youths' susceptibility to peer influences and by affecting friendship selection. Data were from a three-wave short-term longitudinal study of 1595 adolescents. Findings showed high similarities in smoking between reciprocal friends. Additionally, friend's smoking and parents' smoking were moderately related to adolescent smoking onset, but parents' smoking did not moderate the prospective association between best friend's smoking and adolescent smoking. Finally, parental smoking seemed to affect the selection of new friends: In particular, adolescents with smoking parents were most likely to become affiliated with smoking friends. There was no evidence that parental smoking affected termination of friendships.

Smoking as a symbol of friendship: Qualitative study of smoking behavior and initiation of a group of male nurse students in Iran

The study of smoking initiation and behavior of nurses and nurse students is important when considering their professional health promotion roles. In the present qualitative study, 26 nursing students of all grades from two nursing schools in the capital city of Iran were surveyed to explore their reasons for smoking. Through in-depth and semistructured interviews, participants were encouraged to talk about their smoking behavior and explain initiating reasons freely. Majority of the participants began smoking before commencing nursing, while only a few initiated smoking after entering into nursing school. Reasons for smoking included belonging to a group and as a symbol of friendship and mutual trust. Indeed, peer group behaviors influenced most participates to commence smoking and social influences also emerged as a theme in this study.

Perceived peer smoking prevalence and its association with smoking behaviours and intentions in Hong Kong Chinese adolescents

BACKGROUND

Among the many personal, social and environmental risk factors of adolescence smoking, normative beliefs stand out for their potential to be modified with factual information on smoking prevalence.

AIMS

To study the perceived peer smoking prevalence and its association with smoking behaviours in Hong Kong Chinese adolescents.

DESIGN AND SETTING

Cross-sectional territorial-wide school-based survey conducted in 64 randomly selected secondary schools in Hong Kong.

PARTICIPANTS

A total of 13,280 forms 1-3 students (equivalent to grades 7-9 in the United States) aged 12-16 years.

MEASUREMENTS

Perceived peer smoking prevalence, smoking status, intention to smoke in future, other smoking-related factors and demographic information.

FINDINGS

Overestimation of peer smoking prevalence was observed regardless of gender and smoking status, and was more common in girls (69.4%) than boys (61.0%), and in experimental (74.3%) and current smokers (85.4%) than in never smokers (60.7%). Boys who overestimated and grossly overestimated (over two times) peer smoking were more likely to be current smokers, with adjusted odds ratios and 95% confidence intervals (95% CI) of 1.95 (1.24-3.07) and 3.52 (2.37-5.24) (P for trend <0.001). Similarly, boys who grossly overestimated peer smoking were 76% (95% CI: 41-120%) more likely to have ever smoked.

CONCLUSION

Overestimation of peer smoking prevalence was common in Hong Kong Chinese boys and girls, and was associated with current and ever smoking in boys. These findings have important implications on normative education in adolescence smoking prevention programmes.

Social imagery, tobacco independence, and the truthsm campaign

OBJECTIVES

This study investigated relationships among exposure to the truthsm campaign, differences in social imagery about not smoking and related measures, and smoking behavior. We asked, "How does truthsm work? Through what psychological mechanisms does it affect smoking behavior?" We developed a framework to explain how receptivity to truthsm ads might influence youth cognitive states and subsequent effects on progression to established smoking. The main hypotheses were that social imagery about not smoking and related beliefs and attitudes about tobacco use mediate the relationship between truthsm exposure and smoking status.

METHODS

The study was based on data from the Legacy Media Tracking Survey (LMTS), waves I-III, which were conducted at three time points from 1999 through 2001. A nationally representative sample of 20,058 respondents aged 12-24 from the three time points was used in the analysis. We developed a structural equation model (SEM) based on constructs drawn from the LMTS. We investigated the model and tested our hypotheses about the psychological and behavioral effects of campaign exposure.

RESULTS

We tested our constructs and model using a two-stage structural equation modeling approach. We first conducted a confirmatory factor analysis (CFA) to test the measurement model. Our model achieved satisfactory fit, and we conducted the SEM to test our hypotheses. We found that social imagery and perceived tobacco independence mediate the relationship between truthsm exposure and smoking status. We found meaningful differences between paths for segmented samples based on age, gender, and race/ethnicity subgroups and over time.

CONCLUSIONS

The truthsm campaign operates through individuals'sense of tobacco independence and social imagery about not smoking. This study indicates that the campaign's strategy has worked as predicted and represents an effective model for social marketing to change youth risk behaviors. Future studies should further investigate subgroup differences in campaign reactions and utilize contextual information about the truthsm campaign's evolution to explain changes in reactions over time.

Predictors of smoking intentions and smoking status among nonsmoking and smoking adolescents

PURPOSE

To examine predictors of smoking intentions among current adolescent nonsmokers and smokers as well as risk factors associated with smoking status.

METHODS

Adolescents (N=237), ages 12 through 18 years, were asked to complete a questionnaire that assessed smoking behavior and variables thought to be related to smoking. Cognitive-motivational variables including perceived vulnerability and optimism, not previously examined in adolescent smoking studies, were also included.

RESULTS

Parental smoking, higher perceived instrumental value, higher risk taking/rebelliousness, higher perceived vulnerability, and older age increased the odds of an adolescent being a smoker. Greater intentions to smoke among nonsmokers was best predicted by peer influences, less knowledge, and higher perceived instrumental value. Smokers with lower intentions to quit perceived greater instrumental value of smoking.

CONCLUSIONS

There are important distinctions between the factors that prompt intentions to smoke and to quit smoking. Smoking prevention/cessation programs will need to address specific factors that distinguish adolescents at varying stages of risk.

Effect of parental R-rated movie restriction on adolescent smoking initiation: a prospective study

OBJECTIVE

To determine if young adolescents who report that their parents restrict viewing R-rated movies have a lower risk of trying smoking in the future.

DESIGN

Prospective observational study. Students from 15 schools in New Hampshire and Vermont, randomly selected from all middle schools with >150 students, were surveyed in 1999. Baseline never-smokers were surveyed again by telephone 13 to 26 months later to determine smoking status.

OUTCOME MEASURE

Trying smoking during the follow-up period.

RESULTS

The majority of the 2596 students were white, with ages ranging from 10 to 14 years. Nineteen percent reported that their parents never allowed them to view R-rated movies, 29% were allowed once in a while, and 52% were allowed sometimes or all the time. Ten percent of students tried smoking during the follow-up period. Smoking-initiation rates increased as parental restriction of R-rated movies decreased (2.9% for adolescents reporting that their parents never allowed them to view R-rated movies, 7.0% for those allowed to view them once in a while, and 14.3% for those allowed to view them sometimes or all the time). There was a strong and statistically significant effect of parental R-rated movie restriction on adolescent smoking even after controlling for sociodemographics, social influences (friend smoking, receptivity to tobacco promotions), parenting style (maternal support and control, parental disapproval of smoking), and characteristics of the adolescent (school performance, sensation seeking, rebelliousness, self-esteem). Compared with adolescents whose parents never allowed them to view R-rated movies, the adjusted relative risk for trying smoking was 1.8 (95% confidence interval [CI]: 1.1, 3.1) for those allowed to watch them once in a while and 2.8 (95% CI: 1.6, 4.7) for those allowed to watch them sometimes or all the time. The effect was especially strong among adolescents not exposed to family (parent or sibling) smoking, among whom the adjusted relative risk for smoking was 4.3 (95% CI: 1.4, 13) for those allowed to view R-rated movies once in a while and 10.0 (95% CI: 3.6, 31) for those allowed to view them sometimes or all the time.

CONCLUSIONS

Parental restriction from watching R-rated movies strongly predicts a lower risk of trying smoking in the future. The effect is largest among adolescents not exposed to family smoking. By exerting control over media choices and by not smoking themselves, parents may be able to prevent or delay smoking in their children.

A methodological and substantive review of the evidence that schools cause pupils to smoke

The objectives of this review were to examine whether smoking prevalence varies between schools independently of health promotion programmes and pupil composition, to show which school characteristics are responsible for this variation, and to examine the methodological adequacy of such studies. Searches for published studies were performed on medical, educational and social science databases, relevant articles' reference lists, and citation searches. Any study was included that described inter-school variation in smoking prevalence, or related such variation to school characteristics. A model relating pupil smoking to school, neighbourhood, and pupil characteristics unlikely and likely to be influenced by school was used to examine the adequacy of control of confounding by pupil composition. Data from studies were combined qualitatively considering methodological adequacy to examine the relation of smoking prevalence to school characteristics. Theoretical frameworks underpinning the choice of school characteristics and postulated relationships between these characteristics and smoking prevalence were described. There were large variations in smoking prevalence between ostensibly similar schools. Evidence that pupil composition did not cause this was weak, because all studies had methodological problems, including under control of relevant pupil compositional factors and over control of factors likely to represent the mechanism through which schools influence pupils' smoking. There was little evidence that elements of tobacco control policy other than bans and enforcement deterred smoking. Academic practice and school ethos were related to smoking. Academically selective schools did not influence smoking, once pupil composition was controlled. There was one study on neighbourhood influences, which were unrelated to smoking. Studies frequently offered little or no theoretical justification for associating school characteristics with smoking. Some aspects of school influence pupils' smoking, probably independently of pupil composition. However, under-control and over-control of confounding and lack of theoretical underpinning precludes definitive conclusions on how particular school characteristics influence pupils' smoking.

Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool, and to identify the predictors of experimentation with cigarettes during pre-adolescence. A cohort of children (n = 270) completed questionnaires that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socio-economic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender 9P = 0.041) paternal smoking (P = 0.001) fraternal smoking (P = 0.017) a best friend who smoked (P = 0.026) and knowing someone with a smoking-related disease (P = 0.006) Intentions to smoke at age 9 did not predict smoking at age 11 (P < 0.001). In univariate analyses, child smoking was also associated with maternal smoking (P = 0.002 at age 11), living in a low-income household (P < 0.001 at age 10) and living in a deprived area ( P = 0.025 at age 11). Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood.

Cognitive and social learning models of drug dependence: implications for the assessment of tobacco dependence in adolescents

This paper is part of a series that has the goal of identifying potential approaches toward developing new instruments for assessing tobacco dependence among adolescents. The fundamental assumption underlying the series is that contemporary theories of drug dependence offer a rich source of opportunities for the development of theoretically based assessment tools. The present paper focuses on cognitive and social-learning models of drug dependence and the implications of these models for novel assessment instruments. In particular, the paper focuses on Mark Goldman's model of drug expectancies, Albert Bandura's model of self-efficacy, Thomas Wills's model of stress and coping and Stephen Tiffany's cognitive-processing model of drug urges and cravings. In addition to traditional self-report measures, naturalistic and laboratory-based assessments are identified that may yield information relevant to multi-dimensional measurement of tobacco dependence.

Individual and Contextual Influences on Adolescent Smoking

Cigarette smoking among adolescents remains one of the most important public health challenges. Despite much attention to research on the etiology of smoking, notably the examination of factors that differentiate adolescent smokers from never smokers, much less is known about factors that predict the development of dependence once an adolescent tries smoking. This paper reviews individual and contextual influences on the progression of smoking among adolescents. Highlights include a consideration of multiple levels of influence, from intra-individual factors, such as genetics, demographics, temperament and comorbidities, to social influences, such as families and peers, to the more macro, societal/cultural levels of influence, including advertising and tobacco-related policies. More recent work examining microcontextual influences through the use of Ecological Momentary Assessments is also discussed. Finally, the need to consider both developmental and transdisciplinary approaches to understanding the development of nicotine dependence in adolescents is emphasized.

The influence of school culture on smoking among pupils

School factors and not solely pupil composition probably cause variation in smoking prevalence amongst schools, but there are no theoretical models to explain why. In this paper we propose a hypothesis to explain schools' influence on pupils' smoking and test this using an existing cross-sectional survey of 23,282 pupils from 166 secondary schools in the West Midlands, UK. We hypothesise that school-level educational achievement scores would not be associated with smoking prevalence, but schools providing value-added education given the social background of pupils (authoritative schools) would provide effective support and control, have a relatively strong influence on pupils' lives and be associated with lower than average smoking prevalence. Schools providing value-denuded education (laissez-faire schools) would have a relatively weak influence on pupils' lives and be associated with higher than average smoking prevalence. The school achievement measures were the proportion of pupils achieving 5A-C General Certificates of Secondary Education (5A-Cs) grades and the proportion of half days lost to truancy. Value-added/denuded terms were created by regressing 5A-Cs and truancy on five markers of the social profile of pupils at the school. Authoritative schools achieved better than expected rates on both measures. Laissez-faire schools achieved worse than expected rates on both measures. All other schools were classed as indeterminate. Multilevel logistic regression was used to relate the risk of regular smoking to school culture in both achievement and authoritative/laissez-faire terms, both with and without adjustment for pupil-level risk factors for smoking. As predicted, schools' achievement measures were unrelated to pupils' smoking. The odds ratios (95% confidence intervals) for smoking in authoritative and laissez-faire schools relative to indeterminate schools were 0.80 (0.70-0.91) and 1.16 (1.07-1.27), respectively. Adjustment for pupil-level smoking risk factors had little effect. School culture is an independent risk factor for adolescent smoking. Schools providing effective support and control might protect pupils from smoking.

Applying a behavioral economic framework to understanding adolescent smoking

Adolescents' choice to smoke may depend on substitute reinforcers for smoking, complementary activities to smoking, and individual differences in reinforcer value. The influence of these variables on smoking was determined among 983 adolescents. Substitutes were school involvement, academic performance, physical activity, and sports team participation: complements were peer smoking and substance use; delay discounting assessed individual differences in reinforcer value. Latent growth modeling indicated that substitute reinforcers reduced the odds of smoking progression almost two-fold, complementary reinforcers increased the odds by 1.14. and delay discounting indirectly influenced the odds of smoking progression through complementary reinforcers. Adolescents who smoke may have fewer reinforcers that protect against smoking and more reinforcers that promote smoking. Discounting of future rewards affects smoking through reinforcer type.

Does adolescent perception of difficulty in getting cigarettes deter experimentation?

BACKGROUND

Considerable controversy surrounds tobacco control emphasis on youth-access-to-tobacco laws, as there is limited evidence that such enforcement reduces youth smoking. In California, access-law enforcement increased substantially in 1996 compared to earlier in the decade.

METHODS

Two longitudinal cohorts of adolescent never smokers from the large, population-based California Tobacco Surveys of 1993 and 1996 were followed-up 3 years later (1993-1996 [n = 1764] and 1996-1999 [n = 2119]). We examined transition to any smoking by follow-up with adolescent perception that cigarettes are easy or hard to get, during periods with less and more access law enforcement.

RESULTS

Transition to any smoking by follow-up among 12- to 15-year-old never smokers was identical in the 1993-1996 cohort, regardless of whether they perceived cigarettes as hard or easy to get (about 38%), but was lower in the 1996-1999 cohort for those who perceived that cigarettes were hard (25.9%) vs. easy (36.1%) to get. This differential effect was confirmed in multivariate analyses that adjusted for demographics, cohort, and other known predictors of adolescent smoking.

CONCLUSIONS

Increased enforcement of access laws may help protect young adolescents from experimenting with cigarettes by strengthening societal anti-tobacco norms. Such enforcement appears warranted as part of a comprehensive tobacco control program.

From adolescence to young adulthood: racial/ethnic disparities in smoking

OBJECTIVES

We used data gathered from 6259 youths between the ages of 13 and 23 years to compare trends in smoking among 4 racial/ethnic groups.

METHODS

We weighted trend data to represent baseline respondent characteristics and evaluated these data with linear contrasts derived from multiple regression analyses.

RESULTS

Although African Americans exhibited higher initiation rates than Whites, they exhibited consistently lower rates of regular smoking than both Whites and Hispanics. This seeming anomaly was explained by African Americans' lower rates of transition to regular smoking and greater tendency to quit. Racial/ethnic disparities were accounted for by differences in pro-smoking influences.

CONCLUSIONS

Reducing racial/ethnic disparities in smoking may require reducing differences in the psychosocial factors that encourage smoking.

Lifetime parental smoking history and cessation and early adolescent smoking behavior

BACKGROUND

Associations are examined between parental smoking and smoking onset by their children. Smoking parents are more likely to have children who start smoking in their teenage years; however, less is known about whether parental quitting is related to adolescent smoking.

METHODS

A cross-sectional national sample of 2,206 adolescents, ages 10-14 years, living in two-parent households were interviewed for the DEFACTO annual report on Dutch youth smoking behavior. Adolescent smokers reported that they have tried smoking, even one puff. Respondents indicated whether their parents were never, former, or current smokers, and provided, in the case a parent had quit, their age at that time.

RESULTS

Logistic regression analyses revealed that likelihood increased gradually: adolescents with both parents being current smokers were four times more likely to be a smoker compared to adolescents with parents who had never smoked. Additionally, within the group of adolescents whose parents quit smoking, the findings demonstrated that the earlier the parents stopped smoking in the life of their offspring, the less likely their children were to start smoking in adolescence.

CONCLUSIONS

Parental smoking history is associated with smoking initiation in early adolescence. Parental cessation at an early age of their offspring reduces the likelihood of adolescent smoking initiation. Preventive efforts, therefore, should focus on the benefits of parental cessation as early as possible.