Does parental smoking cessation discourage adolescent smoking?

Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience

BACKGROUND

Though the relationship between parental smoking and adolescent smoking has been established, gender differences, and mediation of resilience in this relationship are poorly understood. This research aims to investigate the prevalence of adolescent smoking, and to understand how consequences may differ for boys and girls, as well as to explore what role resilience played in this relationship.

METHODS

Through the school-based cross-sectional survey, a total of 65,898 adolescents were involved in this study, and information were collected by self-reported questionnaire. Participants' smoking status and their parental smoking status were collected by self-made questionnaire, and resilience was assessed by the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The multivariate logistic regression was conducted to explore the relationship between parental smoking and adolescent smoking. After that, the path analysis was applied to explore the mediation of resilience in this relationship.

RESULTS

Of all participants, the rate of self-report current smoking and biologically verified smoking was 1.4% and 2.0%, respectively. Both self-reported and biologically verified prevalence of smoking among boys were higher than that in girls. There were gender differences in the impact of parental smoking on adolescent smoking: mother smoking had a negative effect on adolescent smoking, and resilience could mitigate this negative effect. Father smoking had no association with girl smoking, while father smoking was positively associated with boy smoking, and resilience was mediated in this association.

CONCLUSIONS

Our findings suggested smoking prevention in adolescents can be done differently for different genders. Besides, results indicated resilience was important in preventing adolescent smoking. Furthermore, parents quitting smoking can play an important role in preventing adolescent smoking to a certain extent.

A content analysis of 'junk food' content in children's TV programmes: a comparison of UK broadcast TV and video-on-demand services

OBJECTIVES

Exposure to high in fat, sugar or salt (HFSS) food imagery is associated with unhealthy consumption, and subsequently obesity, among young people. We report and compare the results of two content analyses, one of popular children's television channels in the UK and the other of a selection of children's programmes available on video-on-demand (VOD) services.

METHODS

Content analysis of 3 days' worth of programmes on two popular children's television channels broadcast on UK television (CBeebies and Milkshake as well as a sample of children's programmes available on the VOD platforms (Netflix and Amazon Prime) using 1-min interval coding.

RESULTS

In children's television channels, HFSS content was seen in 181 episodes (36%) and in 417 intervals (13%) on terrestrial television, 'Milkshake' had a significantly higher proportion of broadcasts, which contained HFSS content than 'CBeebies'. In VOD platforms, HFSS content was seen in 82 episodes (72% of the total number of episodes), across 459 intervals (19% of the total number of intervals), with no significant difference in the proportion of programmes containing HFSS content between Netflix and Amazon Prime.

CONCLUSIONS

HFSS content is common in both popular UK children's television channels and children programmes on VOD services and is likely having an effect on HFSS consumption in children. Legislative opportunities to prevent this exposure are being missed.

Profile of Cigarette and Drug Use Status in Population of Tabari Cohort Study

Background

The study of the smoking and drug use profile of the Tabari cohort enrolment phase, the outcomes of which will be evaluated in the coming years, has proper comprehensiveness. Therefore, the present study aimed to determine the cigarette and drug use status in the population of the Tabari cohort study (TCS).

Methods

In this study, the profile of cigarette and drug use in the TCS was evaluated. Data analysis was performed in SPSS version 24 using percentage, mean, and standard deviation, chi-square, and independent t test.

Findings

The frequency of daily smoking in the entire population was 9.1%, and the frequencies in men and women were 21.5% and 0.6%, respectively (P<0.001). The frequency of exposure to smoking in the home, at present or in the past, in the entire population was 30.5%, and in the populations living in urban and mountainous areas were 35.4% and 19.8%, respectively (P<0.001). The mean age at first use of cigarettes in the entire population was 20.50±7.61, whereas the mean age of regular smoking was 23.19±8.02. Furthermore, the frequency of experiencing drug abuse in the total population was 6.1%, and the frequencies in men and women were 14.1% and 0.7%, respectively.

Conclusion

According to the results of this study, cigarette smoking and drug use are significant in men, and overall exposure of the Tabari cohort population to tobacco and drugs in the home is high. If effective prevention is not on the agenda, a significant proportion of the future outcomes in this population may be attributable to these risk factors.

Hard to Reach or Just Not Enough? A Narrative Review of Inpatient Tobacco Cessation Programs in Pediatrics

Caregiver smoking is a significant risk factor for children with acute and chronic diseases. Hospitalization presents an opportunity to explore caregiver smoking as a modifiable risk factor during a time of crisis when the motivation to change could be heightened. To date, there has not been a published review on inpatient smoking cessation interventions in pediatrics that focus on supporting caregivers of hospitalized children. The goals of this review were to identify and assess the reach and efficacy of tobacco cessation strategies implemented across inpatient units in pediatrics and mother-baby units. This review also proposes clinical and research implications along with program-building recommendations that can help inform future practice in tobacco cessation. A narrative review of the literature identified 14 peer-reviewed studies that described smoking cessation interventions between 2002 and 2021. There were five randomized controlled trials, seven prospective studies, and one retrospective study. The primary kinds of interventions were counseling to heighten caregiver contemplation to quit (n = 12), provision of Nicotine Replacement Therapy (NRT) medications (n = 7), and follow-up with the local Quitline (n = 12). A diverse range of deliverers implemented interventions across studies. Variation in defining quit attempts along with tobacco reduction and cessation outcomes contributed to mixed findings across studies.

Smoking Cessation Treatment for Parents Who Dual Use E-Cigarettes and Traditional Cigarettes

INTRODUCTION

An increasing number of parents use both e-cigarettes and cigarettes (dual users). Previous studies have shown that dual users may have higher rates of contemplating smoking cessation than parents who only smoke cigarettes. This study was aimed to assess the delivery of tobacco cessation treatment (prescription for nicotine replacement therapy and referral to the quitline) among parents who report being dual users vs. cigarette-only smokers.

METHODS

A secondary analysis of parent survey data collected between April and October 2017 at 10 pediatric primary care practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was conducted. Parents were considered to be dual users of cigarettes and e-cigarettes if they reported smoking a cigarette, even a puff, in the past seven days and using an e-cigarette within the past 30 days. Parents were asked if they received a prescription for nicotine replacement therapy and referral to the quitline to help them quit from their child's clinician. Multivariable logistic regression examined factors (dual use, insurance status, relationship to the child, race, and education status of the parent) associated with delivery of smoking cessation treatment (receiving prescriptions and/or enrollment in quitline) to smoking parents. Further, we compared the rates of tobacco cessation treatment delivery to dual users in the usual-care control practices vs. intervention practices.

RESULTS

Of 1007 smokers or recent quitters surveyed in the five intervention practices, 722 parents reported current use of cigarettes-only and 111 used e-cigarettes. Of these 111 parents, 82 (73.9%) reported smoking cigarettes. Parents were more likely to report receiving any treatment if they were dual users vs. cigarette-only smokers (OR 2.43, 95% CI 1.38, 4.29). Child's insurance status, parents' sex, education, and race were not associated with parental receipt of tobacco cessation treatment in the model. No dual users in the usual-care control practices reported receiving treatment. Discussion. Dual users who visited CEASE intervention practices were more likely to receive treatment than cigarette-only smokers when treatments were discussed. An increased uptake of tobacco cessation treatments among dual users reinforces the importance of discussing treatment options with this group, while also recognizing that cigarette-only smokers may require additional intervention to increase the acceptance rate of cessation assistance. This trial is registered with ClinicalTrials.gov, Identifier: NCT01882348.

Tobacco-Related Counseling and Documentation in Adolescent Primary Care Practice: Challenges and Opportunities

INTRODUCTION

Primary care visits present an opportunity to reduce tobacco use and tobacco smoke exposure (TSE) among adolescents. To date, few studies have examined tobacco-related electronic health record (EHR) documentation in adolescent visits. The purpose of this study was to (1) describe tobacco-related EHR documentation practices in adolescent care clinics, including whether alternative tobacco products, parental use, and TSE were addressed; and (2) identify aspects of adolescent tobacco use that may inform EHR updates and counseling and documentation practices.

METHODS

Following a convergent mixed-methods design, we conducted an EHR review of 508 adolescent well-child visits, performed focus groups with pediatric providers and staff, and conducted in-depth interviews with adolescent patients. Record review data and interview transcripts were analyzed and interpreted concurrently.

RESULTS

In the EHR review, cigarette screening was documented in 92.3% of visits, smokeless tobacco screening in 51.4%, parental tobacco use in 23.2%, and home TSE in 33.1% of visits. Smoking status options were not mutually exclusive and did not include noncigarette products. No records documented assessment of e-cigarette use, despite nearly half of adolescent interview respondents citing these as the most popular products among adolescents. In interviews, adolescents discussed their experiences with alternative tobacco/nicotine products more than cigarettes.

CONCLUSIONS

Tobacco use status prompts should be revised for clarity and include noncigarette tobacco products and TSE. Provider education on noncigarette products and TSE assessment is needed. Improvements in EHR systems, resources, and tools can lead to better tobacco screening, prevention, and treatment practices among primary care providers.

IMPLICATIONS

Clinical guidelines call for pediatricians to assess and treat adolescent and parental tobacco use during primary care visits. The use of electronic health records (EHRs) can improve screening and counseling practices; however, few studies have examined tobacco-related EHR documentation practices in adolescent care settings. This mixed-methods study found low rates of EHR documentation related to noncigarette nicotine/tobacco products, parental tobacco use, and tobacco smoke exposure. These results demonstrate the need for increased provider training and EHR modifications to facilitate comprehensive tobacco control efforts in the adolescent population.

Innovations in parental smoking cessation assistance delivered in the child healthcare setting

Addressing parental smoking in the child healthcare setting improves the health of all family members. Innovative approaches, such as mobilizing technology-based platforms, may streamline screening and motivate acceptance of behavioral health services to treat tobacco use and dependence. The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use. Child healthcare practices in five states (IN, NC, OH, TN, and VA) used an electronic tablet screener to identify tobacco use within families and deliver tobacco cessation assistance to smokers. Motivational/educational videos on cessation were displayed via the screener to enhance its utility. Five CEASE intervention practices screened 50,111 family members for tobacco use and identified 6,885 families with children exposed to tobacco smoke. The mean number of screeners per practice per month was 417; the mean number of households with smokers identified per month was 57. Of 2,764 smokers who were at visits and consented, 57% indicated that they wanted a prescription to reduce or quit smoking; 94% of these were given preprinted prescriptions. Of 41% who requested connection to the quitline, 93% were given enrollment forms. Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke. Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice. CLINICAL TRIALS REGISTRATION: Trial Number NCT01882348.

Influence of Family Environment and Tobacco Addiction: A Short Report from a Post-Graduate Teaching Hospital, India

Background: The initiation of tobacco addiction is complex, and several factors contribute to the onset of this behavior. It is presumed that the influence of family environment may pose a key factor in tobacco addiction. Tobacco-use has been highly observed in the Jamnagar district of Saurashtra region of Gujarat, India. No earlier study has focused on determining the pervasiveness of tobacco-use in families of tobacco users and non-users in this geographical area. Thus, this study aimed to assess the practice and pattern of tobacco-use (smoking and/or tobacco-chewing) in the families of tobacco-user patients. Methods: We studied the families of 65 tobacco-user patients (Group 1) who visited an outpatient clinic of an Ayurvedic post-graduate hospital with complaints of cough were studied and compared with age and gender-matched non-tobacco users (Group 2). The prevalence of tobacco use among the parents, siblings, and children of both groups was analyzed and compared. Results: The findings revealed that tobacco use among parents, siblings, and children in Group 1 was higher than Group 2 (p < 0.001). This meant that the problems of tobacco addiction are not always related to the individual, and therefore, tobacco-prevention strategies should focus on the entire family. Conclusions: These findings offer further insight into the promotion of smoking prevention interventions. Nevertheless, further research is warranted.

Treating Parents for Tobacco Use in the Pediatric Setting: The Clinical Effort Against Secondhand Smoke Exposure Cluster Randomized Clinical Trial

IMPORTANCE

Despite the availability of free and effective treatment, few pediatric practices identify and treat parental tobacco use.

OBJECTIVE

To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years.

DESIGN, SETTING, AND PARTICIPANTS

This cluster randomized clinical trial was conducted from April 2015 to October 2017. Ten pediatric practices in 5 states were randomized to either implement the CEASE protocol or maintain usual care (as a control group). All parents who screened positive for tobacco use by exit survey after their child's clinical visit 2 weeks (from April to October 2015) and 2 years after intervention implementation (April to October 2017) were eligible to participate. Data analysis occurred from January 2018 to March 2019.

INTERVENTIONS

The CEASE intervention is a practice-change intervention designed to facilitate both routine screening in pediatric settings of families for tobacco use and delivery of tobacco cessation treatment to individuals in screened households who use tobacco.

MAIN OUTCOMES AND MEASURES

The primary outcome was delivery of meaningful tobacco treatment, defined as the prescription of nicotine replacement therapy or quit line enrollment. Furthermore, changes in practice-level smoking prevalence and cotinine-confirmed quit rates over the 2 years of intervention implementation were assessed.

RESULTS

Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-2.7% vs 1.1%; difference -3.7% [95% CI, -6.3% to -1.2%]), as did the cotinine-confirmed quit rate (2.4% vs -3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]).

CONCLUSIONS AND RELEVANCE

In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01882348.

Impact of removing point-of-sale tobacco displays on smoking behaviour among adolescents in Europe: a quasi-experimental study

BACKGROUND

An increasing number of European countries implemented a point-of-sale (PoS) display ban on tobacco products. This study assessed the association between PoS display bans in Europe and adolescent smoking and perceived accessibility of tobacco, 2-6 years after PoS display ban implementation.

METHODS

In a quasi-experimental design, we compared individuals in countries that did and countries that did not implement a PoS display ban, before and after implementation. We used repeated cross-sectional data of 174 878 15-year-old and 16-year-old adolescents from 25 countries from the 2007, 2011 and 2015 European Survey Project on Alcohol and Other Drugs surveys. Multilevel logistic regression models examined smoking behaviour (regular smoking vs other) and perceived access (easy vs difficult) as a function of display ban implementation and controlled for survey year, gender, parental education and implementation of other tobacco control policies. Interaction with gender was tested.

RESULTS

The implementation of a PoS display ban was associated with a 15% larger drop in the odds of regular smoking (OR 0.85, 95% CI 0.79 to 0.91), but was not significantly associated with perceived accessibility of tobacco (OR 0.97, 95% CI 0.892 to 1.03). Associations were similar in males and females (cross-level interactions of gender with display ban were not statistically significant for either outcome).

CONCLUSION

The implementation of PoS display bans in Europe was associated with a stronger decrease in regular smoking among adolescents. This decrease does not appear to be driven by a decreasing accessibility of tobacco, but might be caused by further de-normalisation of tobacco as a result of PoS display bans.

Parental smoking, rejection of parental smoking, and smoking susceptibility and behaviors in Hong Kong adolescents

INTRODUCTION

We explored the role of rejection of parental smoking in the association between parental smoking and smoking in adolescents.

METHODS

In 2010-11 cross-sectional survey, 61,810 Hong Kong secondary school students (mean age 14.6 years, 50.5% boys) reported their smoking (never, not susceptible; never, susceptible; ever, not current; current), paternal and maternal smoking, and whether they accepted paternal and maternal smoking (acceptance/rejection). We used multinomial logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of students' smoking in relation to acceptance and rejection of parental smoking, compared with no parental smoking.

RESULTS

The OR (95% CI) of "never, susceptible", "ever, not current", and "current", compared with "never, not susceptible", in relation to acceptance of paternal smoking was 1.81 (1.67-1.96), 2.46 (2.25-2.69), and 2.79 (2.51-3.10), respectively. The corresponding ORs for rejection were 0.70 (0.64-0.76), 1.23 (1.13-1.35), and 0.47 (0.40-0.56). The OR (95% CI) of "never, susceptible", "ever, not current", and "current", compared with "never, not susceptible", in relation to acceptance of maternal smoking was 2.05 (1.80-2.33), 2.57 (2.29-2.88), and 6.33 (5.39-7.44), respectively. The corresponding ORs for rejection were 0.85 (0.69-1.05), 1.59 (1.39-1.81), and 2.14 (1.71-2.68). No overlapping was observed between the 95% CIs for acceptance and rejection of paternal or maternal smoking.

CONCLUSIONS

While adolescent smoking was associated with parental smoking, especially in those who accepted parental smoking, the association was attenuated or reversed in those who rejected parental smoking.

Adult Attitudes and Practices Regarding Smoking Restrictions and Child Tobacco Smoke Exposure: 2000 to 2015

BACKGROUND AND OBJECTIVES

Since 2000, tobacco control efforts have greatly increased state and local protections from childhood tobacco smoke exposure. The objective of this study is to examine changes in attitudes and practices regarding smoking bans in multiple public and private settings from 2000 to 2015, as well as to examine the changes in pediatrician and family practitioner screening and counseling for tobacco smoke exposure.

METHODS

Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed.

RESULTS

The majority of adults, 69.3%, reported household smoking restrictions in 2000, and these restrictions increased to 79.5% through 2015 (P < .05). Car smoking prohibitions increased from 68.3% to 81.8% (P < .05). A growing majority of adults supports smoke-free policies in public settings, and tobacco counseling by child health care providers also increased. However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and half of the US population is not protected by state or local laws prohibiting smoking inside of hospitality venues.

CONCLUSIONS

Despite dramatic progress since 2000, these trend data reveal potential areas where child health care clinicians might focus effort at the family and community level to accelerate the protection of children from tobacco smoke exposure.

Teens, Tweets, and Tanning Beds: Rethinking the Use of Social Media for Skin Cancer Prevention

The incidence of skin cancer is rising in the U.S., and melanoma, the deadliest form, is increasing disproportionately among young white women. Indoor tanning is a modifiable risk factor for all skin cancers and continues to be used at the highest rates in young white women. Adolescents and young adults report personal appearance-based reasons for using indoor tanning. Previous research has explored the influences on tanning bed use, including individual factors as well as relationships with peers, family, schools, media influences, legislation, and societal beauty norms. Adolescents and young adults also have high rates of social media usage, and research is emerging on how best to utilize these platforms for prevention. Social media has the potential to be a cost-effective way to reach large numbers of young people and target messages at characteristics of specific audiences. Recent prevention efforts have shown that comprehensive prevention campaigns that include technology and social media are promising in reducing rates of indoor tanning among young adults. This review examines the literature on psychosocial influences on indoor tanning among adolescents and young adults, and highlights ways in which technology and social media can be used for prevention efforts.

Tobacco Use Disorder: A Family Disease

This clinical case presentation discusses a family in which 3 generations are affected by tobacco. The discussants discuss approaches to be taken to minimize the exposure of an infant to tobacco smoke from older relatives, behavioral and pharmacological approaches to assist smoking cessation, and concerns regarding electronic cigarettes.

Factors associated with different smoking status in European adolescents: results of the SEYLE study

Early onset and long-term smoking are associated with physical and psychological health problems. The aim of the presented analysis was to investigate risk and influencing factors for different smoking status in a big sample of European adolescents. In the context of the "saving and empowering young lives in Europe" (SEYLE) study we surveyed 12,328 adolescents at the age of 13-17 from 11 countries. The survey took place in a school-based context using a questionnaire. Overall 58% reported the onset of ever-smoking under the age of 14 and 30.9% smoke on a daily basis. Multinomial logistic regression model showed significant positive associations between adolescent smoking and internalizing problems (suicidal behavior, direct self-injurious behavior, anxiety), externalizing problems (conduct problems, hyperactivity, substance consumption) and family problems (parental substance consumption, broken home). Our data show that smoking among adolescents is still a major public health problem and adolescents who smoke are at higher risk for mental problems. Further, adolescent smoking is associated with broken home families and parental behaviors. Therefore, early preventive measures are necessary not only for adolescents, but also for their parents.

Intergenerational Patterns of Smoking and Nicotine Dependence Among US Adolescents

OBJECTIVES

We examined associations between parental and adolescent smoking and nicotine dependence in the United States.

METHODS

We used data from the 2004 to 2012 National Survey on Drug Use and Health, which ascertained smoking behaviors of 1 parent and 1 adolescent aged 12 to 17 years in 35 000 dyads. We estimated associations between parental and adolescent smoking behaviors, adjusted for covariates.

RESULTS

Parental current dependence was strongly associated with adolescents' lifetime smoking (adjusted odds ratio [AOR] = 2.96; 95% confidence interval [CI] = 2.47, 3.55), whereas parental current nondependent smoking (AOR = 2.26; 95% CI = 1.92, 2.67) and former smoking (AOR = 1.51; 95% CI = 1.31, 1.75) were less strongly associated. Only parental nicotine dependence was associated with adolescent nicotine dependence (AOR = 1.66; 95% CI = 1.00, 2.74). Associations between parental and adolescent smoking did not differ by race/ethnicity. Parents' education, marital status, and parenting and adolescents' mental health, beliefs about smoking, perception of schoolmates' smoking, and other substance use predicted adolescent smoking and dependence.

CONCLUSIONS

Reducing parental smoking would reduce adolescent smoking. Prevention efforts should encourage parental smoking cessation, improve parenting, address adolescent mental health, and reinforce adolescents' negative beliefs about smoking.

Parent voices guide smoking intervention development

Purpose

– While parents’ influence on their children’s smoking behaviour is widely recognised, little is known about parents of four to eight year olds’ attitudes and beliefs around smoking cessation and how they communicate with their children about smoking. The purpose of this paper is to explore parents’ perceptions of quitting smoking and their beliefs and actions related to the use of parenting practices to discourage smoking by their children.

Design/methodology/approach

– Four focus groups and 17 interviews were conducted with parents (n=46) of four to eight year old children in Perth, Western Australia.

Findings

– Many parents indicated their children strongly influenced their quitting behaviours, however, some resented being made to feel guilty about their smoking because of their children. Parents were divided in their beliefs about the amount of influence they had on their children’s future smoking. Feelings of hypocrisy appear to influence the extent to which parents who smoked talked with their child about smoking. Parents recommended a variety of resource options to support quitting and talking with their child about smoking.

Practical implications

– Interventions aimed at parents who smoke and have young children should: reinforce parents’ importance as role models; highlight the importance of talking to children about smoking when they are young and provide strategies for maintaining ongoing communication; be supportive and avoid making parents feel guilty; and emphasise that quitting smoking is the best option for their child’s health (and their own), while also providing effective harm minimisation options for parents who have not yet quit.

Originality/value

– Parents of children of lower primary school age can be highly influential on their children’s later smoking behaviours, thus, effective interventions that address the current beliefs and practices of these parents may be particularly advantageous.

Promoting smoking cessation among parents: effects on smoking-related cognitions and smoking initiation in children

BACKGROUND

Parental smoking is associated with an increased risk of smoking among youth. Epidemiological research has shown that parental smoking cessation can attenuate this risk. This study examined whether telephone counselling for parents and subsequent parental smoking cessation affect smoking-related cognitions and smoking initiation among children of smoking parents.

METHODS

Data of a two-arm randomized controlled trial were used in which 512 smoking parents were recruited into cessation support through their children's primary schools. After the baseline assessment, smoking parents were randomly assigned to tailored telephone counselling or a standard self-help brochure. Parental cessation was measured as 6-month prolonged abstinence at the 12-month follow-up. Children's smoking-related cognitions and smoking initiation were examined at 3-month, 12-month, and 30-month follow-up.

RESULTS

No statistical evidence was found that children of parents who received telephone counselling tailored to smoking parents or children of parents who achieved prolonged abstinence differ in smoking-related cognitions (i.e., smoking outcome expectancies, perceived safety of smoking, self-efficacy to refrain from smoking, susceptibility to smoking) or smoking initiation rate on any follow-up assessment.

CONCLUSIONS

This study is the first to examine the effects of an evidence-based smoking cessation treatment for parents and treatment-induced parental smoking cessation on cognitive and behavioural outcomes among children. Although descriptive statistics showed lower smoking initiation rates among children of parents who achieved prolonged abstinence, there was no statistical evidence that telephone counselling tailored to parents or treatment-induced parental smoking cessation affects precursors of smoking or smoking initiation among youth.

Sustainability of a parental tobacco control intervention in pediatric practice

OBJECTIVE

To determine whether an evidence-based pediatric outpatient intervention for parents who smoke persisted after initial implementation.

METHODS

A cluster randomized controlled trial of 20 pediatric practices in 16 states that received either Clinical and Community Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care. The intervention provided practices with training to provide evidence-based assistance to parents who smoke. The primary outcome, assessed by the 12-month follow-up telephone survey with parents, was provision of meaningful tobacco control assistance, defined as discussing various strategies to quit smoking, discussing smoking cessation medication, or recommending the use of the state quitline after initial enrollment visit. We also assessed parental quit rates at 12 months, determined by self-report and biochemical verification.

RESULTS

Practices' rates of providing any meaningful tobacco control assistance (55% vs 19%), discussing various strategies to quit smoking (25% vs 10%), discussing cessation medication (41% vs 11%), and recommending the use of the quitline (37% vs 9%) were all significantly higher in the intervention than in the control groups, respectively (P < .0001 for each), during the 12-month postintervention implementation. Receiving any assistance was associated with a cotinine-confirmed quitting adjusted odds ratio of 1.89 (95% confidence interval: 1.13-3.19). After controlling for demographic and behavioral factors, the adjusted odds ratio for cotinine-confirmed quitting in intervention versus control practices was 1.07 (95% confidence interval: 0.64-1.78).

CONCLUSIONS

Intervention practices had higher rates of delivering tobacco control assistance than usual care practices over the 1-year follow-up period. Parents who received any assistance were more likely to quit smoking; however, parents' likelihood of quitting smoking was not statistically different between the intervention and control groups. Maximizing parental quit rates will require more complete systems-level integration and adjunctive cessation strategies.

Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke

OBJECTIVE

To assess the impact of an electronic health record (EHR) modification and brief clinician training on tobacco smoke exposure (TSE) management in pediatric primary care.

METHODS

Within a teaching hospital-based, urban primary care setting, we modified the EHR to include TSE screening prompts, decision support, educational literature, and simplified referral to the state quit line (QuitWorks). A brief training was conducted for the 48 clinic physicians (34 residents and 14 attendings). We collected cross-sectional, independent, random samples of EHR data from well-child visits for children ≤12 years old seen 3 months before (2024 visits) and 3 months after (1895 visits) the intervention and pooled client data from QuitWorks to evaluate TSE screening, counseling, and quit-line referrals. A needs assessment questionnaire examined preintervention attitudes and practice around TSE management; follow-up questionnaires explored satisfaction and subjective changes in skills.

RESULTS

The baseline needs assessment revealed that although most clinicians agreed that it is appropriate for pediatricians to conduct TSE screening, counseling, and referral during well-child visits, only about half screened, 42% counseled, and 28% routinely offered to refer smoking parents. In pre-post analyses of 117 and 112 EHR-documented positive screens, the intervention was associated with a 16-fold greater likelihood of counseling among positive screens (adjusted odds ratio 16.12; 95% confidence interval 7.28, 35.68). Referrals to QuitWorks increased from 1 before to 31 after the intervention.

CONCLUSIONS

Implementation of EHR modifications and a brief training to support TSE management was associated with higher rates of counseling and quit-line referrals for parents who smoke.

Household and school-level influences on smoking behavior among Korean adolescents: a multilevel analysis

BACKGROUND

Trends in adolescent smoking rates in South Korea have not shown substantial progress due to a lack of effective anti-smoking interventions and policies in school settings.

METHODS AND FINDINGS

We examined individual- and school-level determinants of adolescent smoking behavior (ever smoking, current smoking, and daily smoking) using the nationally representative fifth Korean Youth Risk Behavior Web-based Survey conducted in 2009. We found that students in coeducation schools or vocational high schools had greater risks of smoking for each type of smoking behavior than those in single-sex schools or general high schools, respectively even after controlling for individual-level factors. Higher family affluence and higher weekly allowances were associated with greater risks of ever smoking, current smoking and daily smoking even after controlling for parental education and other confounders.

CONCLUSIONS

Whilst caution is required in interpreting results given the cross-sectional nature of the study, our findings suggest that in addition to raising the price of cigarettes, youth anti-smoking interventions in South Korea may benefit from focusing on coeducation schools and vocational high schools.

Protecting children from taking up smoking: parents' views on what would help

ISSUE ADDRESSED

The present study investigated what factors the parents of children in low-income areas of Auckland, New Zealand, thought could help protect their children from smoking initiation.

METHODS

Participants in a large quasi-experimental trial that tested a community-, school- and family-based smoking-initiation intervention were asked in a questionnaire 'What could we do to help you protect your children from smoke and taking up smoking?' Free-text responses were divided into distinct meaning units and categorised independently by two of the researchers.

RESULTS

1806 participants (70% of parents who returned the questionnaire) completed the question. The majority of respondents (80%) were either Pacific Island or Māori mothers and 25% were current smokers. Five main categories of suggested strategies for preventing smoking initiation were identified: building children's knowledge of the ill-effects of smoking; denormalising smoking; reducing access to tobacco; building children's resilience; and health promotion activities. The most common suggestion was to educate children about smoking.

CONCLUSION

Building children's knowledge of smoking risks was the main strategy parents proposed. There was some support for banning smoking in most public areas and for tougher moves to stop tobacco sales to minors. Few parents suggested innovative or radical strategies, such as banning the sale of tobacco, fining children for smoking or use of competitions. So what? To ensure reductions in smoking initiation for lower socioeconomic and Māori and Pacific Island people, further research should engage Māori, Pacific Island and lower socioeconomic parents in a process that elicits innovative thinking about culturally acceptable strategies.

Children with asthma versus healthy children: differences in secondhand smoke exposure and caregiver perceived risk

INTRODUCTION

Secondhand smoke (SHS) exposure remains a public health problem. Few, if any, studies include both children with and without asthma to assess differences in caregiver smoking behavior, risk perception, and SHS.

METHODS

Participants were 738 daily U.S. smokers (443 caregivers of children with asthma [CG-AC] and 295 caregivers of healthy children [CG-HC]; 50.9% White, 25% Black, 15% Latino). Data are cross-sectional; SHS was measured through self-report and passive dosimetry.

RESULTS

Compared with CG-HC, CG-AC had fewer risk factors for exposing children to SHS (lower nicotine dependence, higher motivation to quit, greater perceived benefits of cessation on child's health, and lower optimistic bias; all p values < .05). Specifically, 60.6% of CG-AC reported a household smoking ban versus 40.1% of CG-HC (p < .05), though >95% of both groups had detectable levels of SHS in their home. CG-AC self-reported lower SHS than CG-HC, but both groups had nearly equivalent SHS when measured objectively. CG-AC were almost twice as likely as CG-HC to report a home smoking ban when they had detectable levels of household SHS as measured by passive dosimetry (OR = 1.71; 95% CI = 1.2, 2.4; p = .003).

CONCLUSIONS

Caregivers of children with chronic health conditions, such as asthma, may be motivated to self-report lower levels of SHS. Child health status (e.g., asthma) may cue practitioners to inquire about SHS, but given the low proportion of household bans and high levels of actual exposure among both groups, SHS exposure assessment and reduction/elimination counseling should be prompted to occur for all children.

Family smoking history moderates the effect of expectancies on smoking initiation in college students

AIMS

This report was designed to test the hypothesis that family history of smoking (FH) would moderate the effects of positive and negative smoking expectancies on initiation in a college sample.

DESIGN

Secondary analysis of a study of college freshmen never-smokers (n=196; 46% male) who completed a baseline interview and quarterly online follow-up assessments for 15 months.

FINDINGS

Analyses indicated that FH moderated the effect of negative outcome expectancies (p=.003) but not the effects of expectancies for positive or negative reinforcement on the probability of smoking initiation. Stronger negative expectancies were associated with a decreased risk of initiation for family history positive but not family history negative participants.

CONCLUSIONS

Findings are consistent with previous tobacco research indicating that FH+adolescents have more negative expectancies about cigarette smoking. This suggests that adolescents observing negative consequences or receiving negative messages from their parents about cigarettes may be less likely to experiment with smoking.

Implementation of a parental tobacco control intervention in pediatric practice

OBJECTIVE

To test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking.

METHODS

Cluster RCT of 20 pediatric practices in 16 states that received either CEASE intervention or usual care. The intervention gave practices training and materials to change their care delivery systems to provide evidence-based assistance to parents who smoke. This assistance included motivational messaging; proactive referral to quitlines; and pharmacologic treatment of tobacco dependence. The primary outcome, assessed at an exit interview after an office visit,was provision of meaningful tobacco control assistance, defined as counseling beyond simple advice (discussing various strategies to quit smoking), prescription of medication, or referral to the state quitline, at that office visit.

RESULTS

Among 18 607 parents screened after their child’s office visit between June 2009 and March 2011, 3228 were eligible smokers and 1980 enrolled (999 in 10 intervention practices and 981 in 10 control practices). Practices’ mean rate of delivering meaningful assistance for parental cigarette smoking was 42.5% (range 34%–66%) in the intervention group and 3.5% (range 0%–8%) in the control group (P < .0001).Rates of enrollment in the quitline (10% vs 0%); provision of smoking cessation medication (12% vs 0%); and counseling for smoking cessation(24% vs 2%) were all higher in the intervention group compared with the control group (P < .0001 for each).

CONCLUSIONS

A system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit.

HIV-infected adolescent, young adult and pregnant smokers: important targets for effective tobacco control programs

Tobacco use is inextricably linked to a number of health risks both in the general and HIV-infected populations. There is, however, a dearth of research on effective tobacco control programs among people living with HIV, and especially among adolescents, young adults and pregnant women, groups with heightened or increased vulnerability secondary to tobacco use. Adolescents and young adults constitute a growing population of persons living with HIV infection. Early and continued tobacco use in this population living with a disease characterized by premature onset multimorbidity and chronic inflammation is of concern. Additionally, there is an increased acuity for tobacco control among HIV-infected pregnant women to reduce pregnancy morbidity and improve fetal outcome. This review will provide an important summary of current knowledge of tobacco use among HIV-infected adolescents, young adults and pregnant women. The effects of tobacco use in these specific populations will be presented and the current state of tobacco control within these populations, assessed.

Evaluation of factors influencing intention to quit smokeless and cigarette tobacco use among Nigerian adolescents

Background:

Smokeless and cigarette tobacco use is becoming increasingly popular among Nigerian adolescents. This study aimed to evaluate predictors of intention to quit tobacco use among adolescents that currently use tobacco products in Nigeria.

Materials and Methods:

A total of 536 male and female high school students in senior classes in Benue State, Nigeria were enrolled into the cross-sectional study. The survey instrument was adapted from the Global Youth Tobacco Survey (GYTS) questionnaire.

Results:

Among adolescents with tobacco habits, 80.5% of smokeless tobacco users and 82.8% of cigarette smokers intended to quit tobacco use within 12 months. After adjustment, significant predictors of intention to quit cigarette smoking were parents’ smoking status (P<0.01), peers’ smokeless use status (P<0.01) and perception that smoking made one comfortable at social events (P<0.01). For intention to quit smokeless tobacco use, significant predictors after adjustment were parents’ smokeless use status, (P=0.03) perception that smokeless tobacco use made one more comfortable at social events (P=0.04) and perception of harm from smokeless use (P=0.02).

Conclusion:

This study demonstrates that the intention to quit smokeless and cigarette tobacco use is significantly predicted by perception about the societal acceptance of tobacco use at social events, parents and peers’ tobacco use status as well as the perception of harm from use of tobacco products. Providing social support may increase quit attempts among youth smokers.

Parental psychosocial predictors of secondhand smoke exposure (SHSe) for children with cancer

Children with cancer are at greater risk for the negative consequences of secondhand smoke exposure, making the identification of predictors of exposure critical. The current study investigated the impact of parents' psychosocial variables (perceived stress and vulnerability, self-efficacy), as well as health-related and demographic variables, on children's current exposure levels. Data were from 135 families whose children (M = 8.6 years old) lived with a smoker and were being treated for cancer. Self-efficacy was the consistent significant psychosocial predictor of exposure and the time since a child's diagnosis was indicative of lower exposure when limiting the sample to only smoking parents (n = 95). Both predictors of exposure have implications on motivation for behavioral change and may be suggestive of a teachable moment. Interventions may profit from tailoring programs to families based on these predictors of exposure, in particular for tobacco-based interventions for parents of medically compromised children, such as children with cancer.

Pathways to children's externalizing behavior: a three-generation study

In this study, based on Family Interactional Theory (FIT), the authors tested a longitudinal model of the intergenerational effects of the grandmothers' parent-child relationships and the grandparents' smoking on the grandchildren's externalizing behavior via parents' psychological symptoms, tobacco use, and child rearing. Using Mplus, the authors obtained a structural equation model that demonstrated generational associations from grandmothers (G1) to parents (G2) to their oldest children (G3) and thus was in accord with FIT. They identified a pathway from the grandmothers' parenting to the grandchildren's externalizing behavior via the parents' psychological symptoms, their smoking, and their child rearing. Parents' psychological symptoms in adolescence were associated with their tobacco use in their late twenties, controlling for the continuity of their psychological symptoms and their tobacco use. This 3-generational model adds to the literature on parent-child relationships (G1), smoking from adolescence to early adulthood (G2), and externalizing behavior in the G3 child.

Does smoking affect schooling? Evidence from teenagers in rural China

Youth smoking can biologically reduce learning productivity. It can also reduce youths' expected returns to education and lower their motivation to go to school, where smoking is forbidden. Using rich household survey data from rural China, this study investigates the effect of youth smoking on educational outcomes. Youth smoking is clearly an endogenous variable; to obtain consistent estimates of its impact, we use counts of registered alcohol vendors and a food price index as instrumental variables. Since the variable that measures smoking behavior is censored for non-smoking adolescents, we implement a two-step estimation strategy to account for the censored nature of this endogenous regressor. The estimates indicate that smoking one cigarette per day during adolescence can lower students' scores on mathematics tests by about 0.08 standard deviations. However, we find no significant effect of youth smoking on either Chinese test scores or total years of schooling.

State and self investments in health

In this paper we consider how State investments can crowd out or reinforce self-investments in health using a theoretical model of insurance and protection. We apply this model to the smoking cessation decision made by individuals diagnosed with a cardiovascular disease using data from the 1998, 2003 and 2006 waves of the Health Survey of England. Prescription of lipid-lowering drugs, which increased substantially over this period, is used as the measure of State investment. Using bivariate and trivariate probit models, we allow for the endogeneity of the doctor's decision to prescribe and offer smoking cessation advice. We find that unobservable characteristics affecting the prescription of drugs are positively correlated with those affecting smoking advice and negatively correlated with those affecting the propensity to quit. Our results indicate that prescription of lipid-lowering drugs to individuals with cardiovascular disease increases the probability of smoking cessation by 20-28 percentage points.

Parental smoking cessation and child daily smoking: A 9-year longitudinal study of mediation by child cognitions about smoking

OBJECTIVE

This study investigated to what extent the prospective relationship between parental smoking cessation and child daily smoking is mediated by child cognitions about smoking.

DESIGN

The study drew its sample from the 40 Washington State school districts involved in the Hutchinson Smoking Prevention Project. The predictor variable of parental smoking cessation was measured during third grade. The mediator measures, consistent with the Theory of Planned Behavior and Social Cognitive Theory, were measured during ninth grade, and the smoking status outcome was measured during twelfth grade.

MAIN OUTCOME MEASURES

Smoking status at twelfth grade.

RESULTS

Negative general attitudes toward smoking, attitude that cigarette smoke is bothersome, and tobacco refusal self-efficacy together significantly mediated 49% of the prospective relationship between parental smoking cessation and child daily smoking.

CONCLUSION

Parental smoking cessation before children reach third grade may lead children to develop more negative cognitions about smoking, and, in turn, reduce their risk of smoking.

Disentangling two underlying processes in the initial phase of substance use: Onset and frequency of use in adolescent smoking

PURPOSE

Most studies on adolescent smoking focus either on the probability of smoking onset or frequency of smoking. We assume the existence of two different qualitatively distinct processes in smoking acquisition. Therefore our objective was to test a two-part latent growth model, which assumes that psychosocial variables associated with the probability of smoking onset are different from, or differently related to variables associated with frequency of smoking given smoking onset.

METHODS

The predictive associations of blocks of variables of (1) intrapersonal factors, (2) cognitions, (3) role models, and (4) family variables, on both smoking onset, and frequency of smoking given smoking onset, were tested in a nationwide sample of Dutch adolescents by using a two-part model.

SUMMARY

Smoking onset was instigated by a variety of factors, while similar and other factors predicted frequency of smoking given smoking onset itself. Self-esteem, attitudes, and proportion of friends smoking, were identified as factors that affected both absolute smoking and frequency of smoking.

OVERALL CONCLUSIONS

This study illustrates that it makes sense to differentiate between smoking onset and frequency of smoking and that few factors are active in both processes.

The relation between smoking-specific parenting and smoking trajectories of adolescents: how are changes in parenting related to changes in smoking?

In this study, we tested to what extent smoking-specific parenting and changes in parenting are related to adolescents' smoking trajectories. Data were used from a four-wave prospective study including 428 adolescents (aged M = 15.2; SD = 0.60). Latent Class Growth Analyses were conducted to identify trajectories. Multinomial Logistic Regression Analyses were executed to examine the relations between parenting and class membership. Longitudinal cross-lagged models were tested to examine causal predominance between parenting and smoking. Four trajectories were found, consisting of Non-smokers, Increasers, Stable smokers and Decreasers. Quality of parental smoking-specific communication was strongly related to the membership in different trajectories. Along with the cross-lagged associations demonstrating that the quality of communication was predominantly related to future smoking rather than vice versa, these findings indicate that parents who talked about smoking in a constructive and respectful manner were more likely to have non-smoking children. In contrast, parents who talked often about smoking-related issues and increased these discussions over time were more likely to have smoking children; cross-lagged associations indicated that these findings could be best explained by children changing their parents. Having a non-smoking agreement was related to a lower risk in becoming a regular smoker.

Keeping Kids Smokefree: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to smoking among Māori and Pacific Island children in New Zealand

Despite a concerted, sustained and comprehensive tobacco control effort, smoking is prevalent among young people in New Zealand, particularly for Māori and Pacific Island teenagers. Many took up smoking in their pre-teen years. New Zealand research has shown that daily smoking by children aged 14-15 years is strongly influenced by parental smoking. The Keeping Kids Smokefree study is investigating whether changing parental smoking behavior and attitudes via a community-partnership approach with parents, schools, and local health providers can reduce smoking initiation by 11-12 year olds. It is a quasi-experimental trial involving four schools in an urban area of high social deprivation with large numbers of Māori and Pacific Islands families. Schools were allocated to intervention or control and the intervention was developed through a process of engagement with the schools, parents of children and local healthcare organizations. This article describes the rationale, context, methodology and methods involved in establishing the study. Building Māori and Pacific Islander research capacity was a secondary objective of the study.

Adolescent attributes and young adult smoking cessation behavior

This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally supported the hypothesized model. The results indicated that having parents who smoked and having low educational aspirations and expectations were associated with being unconventional, which, in turn, was related to having low emotional control and reporting more internalizing behaviors. Internalizing behaviors were directly associated with a lower likelihood of smoking cessation, as was parental smoking. Research and clinical implications are discussed and the limitations noted.

Public policy to maximize tobacco cessation

Tobacco use kills more than 400,000 Americans every year. For smokers, quitting is the biggest step they can take to improve their health, but it is a difficult step. Fortunately, policy-based interventions can both encourage smokers to quit and help them succeed. Evidence shows that tobacco tax increases encourage smokers to quit-recent state and federal increases have created dramatic surges in calls to quitlines. Similarly, smokefree workplace laws not only protect workers and patrons from secondhand smoke but also encourage smokers to quit, help them succeed, and create a social environment less conducive to smoking. The impact of policy changes can be amplified by promoting quitting around the date they are implemented. Outreach to health practitioners can alert them to encourage their patients to quit. Earned and paid media can also be used to motivate smokers to quit when policy changes are put into effect. Although these policies and efforts regarding them can generate great demand for evidence-based cessation services such as counseling and medication, it is important to make these resources available for those wanting to quit. Public and private health insurance plans should provide coverage for cessation services, and states should invest tobacco tax and/or tobacco settlement dollars in smoking-cessation programs as recommended by the CDC. Finally, the Family Smoking Prevention and Tobacco Control Act has given the U.S. Food and Drug Administration new authority to regulate tobacco products and marketing, and to prevent tobacco companies from deceptively marketing new products that discourage smokers from quitting and keep them addicted.

From the American Academy of Pediatrics: Technical report--Tobacco as a substance of abuse

Tobacco use is the leading preventable cause of morbidity and death in the United States. Because 80% to 90% of adult smokers began during adolescence, and two thirds became regular, daily smokers before they reached 19 years of age, tobacco use may be viewed as a pediatric disease. Every year in the United States, approximately 1.4 million children younger than 18 years start smoking, and many of them will die prematurely from a smoking-related disease. Moreover, there is recent evidence that adolescents report symptoms of tobacco dependence early in the smoking process, even before becoming daily smokers. The prevalence of tobacco use is higher among teenagers and young adults than among older adult populations. The critical role of pediatricians in helping to reduce tobacco use and addiction and secondhand tobacco-smoke exposure in the pediatric population includes education and prevention, screening and detection, and treatment and referral.

A prospective study of perception in adolescent smoking

PURPOSE

This prospective study examined how environmental smoking affects the perception of lifetime smoking prevalence and thereby the likelihood of subsequent regular smoking.

METHODS

A longitudinal design (N = 6769) with three waves was used to test our research questions. Exposure to smoking by peers, best friends, and parents were assessed at T1. Perception of lifetime smoking prevalence was calculated at T2. Adolescent smoking was assessed at three waves.

RESULTS

Overestimation of lifetime smoking prevalence was predicted by having a predominantly smoking peer group, having a best friend who smokes, and by having at least one parent who smokes. In consistency with a false consensus effect, smokers were more susceptible to overestimate lifetime smoking prevalence than nonsmokers. Subsequently, while controlling for smoking at T2, overestimating lifetime smoking prevalence was predictive of regular smoking at T3 (in accordance with the conformity hypothesis). Specifically, overestimation of lifetime smoking appeared to mediate the effects of environmental smoking (peers, best friends, and parents) on adolescent smoking. No support was found for a moderation effect of exposure to environmental smoking on the link between misperception of lifetime smoking prevalence and regular smoking.

CONCLUSIONS

The study offers a rare and needed theoretical and empirical research examining environmental and individual predictors of regular smoking. Besides direct prevention of exposure to smoking, cognitions that are a product of exposure to smoking need to be addressed in prevention campaigns.

"I would do anything for my child, even quit tobacco": bonus effects from an intervention that targets adolescent tobacco use

This paper aims to assess program bonus effects on adult tobacco use from a long-term intervention that targeted adolescent tobacco use. The school-based community intervention started in Västerbotten County in Sweden in 1993 and adults were invited to support adolescents to stay tobacco-free. It was combined with repeated cross-sectional surveys in schools annually 1994-99 among grades 7-9 and after 1999 every second year. Participating schools were randomly selected before the first survey representing both rural and urban settings. Out of 4,055 students, 1,008 (24.8%) reported that their supporting adult had been a tobacco user who quit tobacco in order to be allowed to participate. Out of these, 13.2% used tobacco daily before joining. The remaining 2,997 students' adult partners were not tobacco users. Engaging tobacco using adults as partners in interventions targeting adolescent tobacco use seem to have a considerable tobacco-reducing bonus effect in the adults.

Family composition and children's exposure to adult smokers in their homes

OBJECTIVE

Smoking behavior is strongly influenced by the social environment. More information is needed about how the composition of households with children is associated with adult smoking behavior so that more effective interventions to reduce children's secondhand smoke exposure can be devised and implemented.

METHODS

Using data from the Medical Expenditure Panel Survey 2000-2004, we conducted cross-sectional analyses to assess how adult smoking behavior is associated with household characteristics, including the number of adults and smokers present, the relationship of the child to the head of household, and relationships between adult members of the household.

RESULTS

More than one third (34.4%) of children lived with > or =1 adult smoker. Almost half (49.4%) of poor children lived with a smoker, and they were more likely to live with multiple smokers compared with those who lived at >400% of the federal poverty level (21.2% vs 7.8%). Approximately 5 million children lived in households headed by an adult other than their parent, and they were significantly more likely to live with smokers: 53.4% of children who lived in their grandparents' homes and 46.2% of children in homes of other adults lived with at least 1 adult smoker, compared with 33.3% who lived in their parents' home. A total of 59.4% of all children who lived with a smoker had a smoking mother, and 56.7% of those children lived with > or =2 smokers, whereas only 17.0% of children whose mother did not smoke had smoking adults in the home.

CONCLUSIONS

These findings demonstrate the significant influence of household composition on children's likelihood to live in homes with adult smokers.

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.

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.

Smoking cessation in England: intentionality, anticipated ease of quitting and advice provision

Smoking prevalence in England continues to reduce but further reduction is increasingly difficult. Cessation policy has successfully targeted those who want to quit but further reduction will need to shift attention to more difficult 'core smoker' populations. Following the established 'stages of change' perspective, this paper considers the characteristics of people who do not intend to quit smoking, anticipate difficulties in quitting and have not received advice about quitting. We deploy multilevel models of data drawn from the Health Survey for England years 2002-2004, and the NHS Primary Care Trust Patient Surveys for 2004 and 2005. It was found that variations in intentionality and anticipated ease of quitting are associated with individual factors such as smoking intensity, parental smoking, age/length of time as a smoker and the nature of the advice-giving consultation. Household composition and household income are also implicated in the intention to quit and anticipated difficulties in quitting. Once individual and household factors are taken into account the only identifiable area-level variation is reduced intentionality towards quitting in rural areas. We conclude by arguing that further gains in smoking cessation must focus on understanding the characteristics of 'hard-to-engage' populations.