Prevalence of youth cigarette smoking and selected social factors in 25 European countries: findings from the Global Youth Tobacco Survey

Proportions of and trends in exposure to pro-tobacco and anti-tobacco advertisements among young adolescents aged 12-16 years in 142 countries and territories, 1999-2018: an analysis of repeated cross-sectional surveys

BACKGROUND

The proportions and trends in exposure to pro-tobacco and anti-tobacco advertisements among young people remain unknown globally. We determined recent (2010-18) proportions of exposure to pro-tobacco and anti-tobacco advertisements among young adolescents and their secular trends from 1999 to 2018.

METHODS

In this analysis of repeated cross-sectional surveys, we used the most recent data from 142 countries and territories (hereafter referred to as countries) collected between Jan 1, 2010, and Dec 31, 2018, comprising 710 191 participants, to assess the proportions of exposure to pro-tobacco and anti-tobacco advertisements among young adolescents aged 12-16 years. Data from 120 countries that had performed two or more Global Youth Tobacco Surveys between Jan 1, 1999, and Dec 31, 2018, comprising 1 482 031 participants, were used to assess trends in the proportions of exposure to pro-tobacco and anti-tobacco advertisements over time. A χ² test analysis was used for proportion comparisons between subgroups. Exposure to pro-tobacco and anti-tobacco advertisements were calculated as proportions using sampling weights, strata, and primary sampling units.

FINDINGS

The most recent global proportion of past 30-day exposure to tobacco advertisements among young adolescents was 433 585 (64·6%) of 710 191 (95% CI 63·5-65·7; all final percentages were weighted) for messages on electronic media, 206 766 (33·1%) of 710 191 (31·9-34·4) for exposure at the point of sale, and 63 385 (10·2%) of 710 191 (9·7-10·6) for owning something with a tobacco brand logo. The most recent global proportion of exposure to anti-tobacco advertisements was 431 862 (63·6%) of 710 191 (62·3-64·9) for messages on electronic media and 227 658 (34·1%) of 710 191 (32·8-35·3) for exposure to gathering activities. The majority of included countries showed a decreasing trend in exposure to tobacco advertisements (111 [93%] of 120) and anti-tobacco advertisements (110 [92%] of 120) between 1999 and 2018.

INTERPRETATION

Among young adolescents, exposure to tobacco advertisements remains high, and exposure to anti-tobacco advertisements is not high enough. The proportion of young adolescents exposed to pro-tobacco and anti-tobacco advertisements had decreased over time in the majority of included countries. These findings underscore the importance of strict implementation of regulation on tobacco control including strengthening anti-tobacco marketing and prohibiting tobacco marketing.

FUNDING

Youth Team of Humanistic and Social Science of Shandong University.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

Smoking is a Risk Factor for Generation Z, Too: The Evolution of the Attitudes

Objectives: Generation Z, defined as "post-millennial," is considered to be the first generation that could end smoking. The objective is also to take into account the evolutionary aspect of the smoking and attitudes of the Generation Z. The aim of this study was to explore the willingness of Generation Z in Slovakia to comply with the legislation adopted in the field of anti-tobacco policy and to investigate some selected social factors-intention, subjective norm and percevied behavioral control-that contribute to a lower rate of compliance. Methods: Global Youth Tobacco Survey (GYTS) data on cigarette smoking among 3,557 adolescents (age range 13-15) in 2016 as well as on attitudes towards tobacco use and control measures were used to explore the level of compliance of adolescents with anti-tobacco regulations in Slovakia within the Framework Convention of Tobacco Control (FCTC). We used the concept of intention as explained in Ajzen's theory of planned behaviour (1985), focusing on the role of subjective norm and perceived behavioural control. Results: We found a decrease in ever smoking, current smoking and frequent smoking. We found that these adolescents start experimenting with dependence-causing substances, such as tobacco, regardless of existing rules. Conclusion: Adolescents were attracted to smoking, although they were aware of health effects of passive smoking, and a vast majority liked smoke-free places. They are also influenced by their peers and parental models.

E-cigarette use, opinion about harmfulness and addiction among university students in Bratislava, Slovakia

OBJECTIVES

The study aimed to investigate the use of electronic cigarettes (EC) among medical students, their knowledge and beliefs (opinion about harmfulness and addiction potential) on ECs, perceptions of the risk, as well as to assess the type of education and cessation training they received during their study at Faculty of Medicine, Comenius University in Bratislava, Slovakia.

METHODS

This cross-sectional, anonymous online e-mailed survey was conducted among medical students via the Study Department by sending e-mails containing the survey link. Participants completed the online questionnaire adapted from the American Survey on Tobacco and Alternative Tobacco Products. It included questions about the personal use of EC, perceptions about the harms and their role in disease causation, education and cessation training, and practices related to conventional cigarettes (CC), EC, and alternative tobacco products (ATP). The e-mailed questionnaire filled in 577 medical students (71.9% women) from Comenius University in Bratislava, the average age was 23 ± 2 years. The sample comprised 486 (84.2%) Slovak and 91 (15.8%) foreign students. The data were analysed using the Statistical Package for Social Science (SPSS) version 25.

RESULTS

There were 385 (66.7%) non-smokers, 111 (19.3%) ex-smokers and 81 (14%) current smokers in the study sample. EC currently use 13.5% of medical students, with a statistically significant intersexual difference (22.2% males vs. 10.12% females; OR = 2.53, 95% CI: 1.55-4.13), more foreign students than Slovak students (24.2% vs. 11.52%; OR = 2.44, 95% CI: 1.41-4.26), more smokers of conventional cigarettes than non-smokers (46.9% vs. 8.06%; OR = 10.07, 95% CI: 5.85-17.34). EC seems to be less harmful to 59.97% of students, mostly in the age group ≤ 24 (61.76% vs. 51.49%; OR = 1.46, 95% CI: 1.03-2.07), 41.25% of students consider EC to be less addictive, 55.6% think they do not get enough education on EC during their medical study.

CONCLUSION

The results overall show the high consumption of tobacco products and the lack of knowledge and awareness among medical students, future health care providers. In health promotion and disease prevention, they should serve as a model for their patients and for the general public as well. Our study emphasizes the need for intervention in this field at medical faculties and for support of further monitoring in Slovakia and other countries and draws attention to the ongoing lack of EC regulation.

Does tobacco use among adolescents come out of style in Czechia and Slovakia? Findings from the Global Youth Tobacco Survey between 2002 and 2016

OBJECTIVES

The aim of this study is to analyse Global Youth Tobacco Survey (GYTS) data on a prevalence of tobacco use, indicators of tobacco control and pro-tobacco activities in Czechia and Slovakia between 2002 and 2016.

METHODS

GYTS is a school-based survey of students aged 13-15 years carried out in Czechia and Slovakia in 2002/2003, 2007, 2011 and 2016. Standardized uniform questionnaires provided representative data.

RESULTS

Between 2002 and 2016 the current cigarette smoking declined both in Czechia and Slovakia (from 34.6% and 26.4% to 15.2% and 17.1%, respectively). Indicators of tobacco control activities either did not change (access to buy cigarettes by minors) or decreased (school-based and mass media interventions). Indicators of pro-tobacco activities declined (being ever offered by a free tobacco product and having something with a tobacco product brand logo on it).

CONCLUSIONS

Tobacco use is on decline and the situation becomes similar to the most of European countries. Preventive activities are only partially responsible for the process. Rather effect of global trends accelerated by widespread use of social media can play a role.

Susceptibility to tobacco use and associated factors among youth in five central and eastern European countries

Background

Tobacco use among young people still remains a major public health problem. Thus, the aim of this study was to perform a cross-country comparison for the factors associated with susceptibility to tobacco use among youth from five central and eastern European countries.

Methods

The data used in the current analysis, focusing on youth (aged 11–17 years), who have never tried or experimented with cigarette smoking, was available from the recent Global Youth Tobacco Survey (Czech Republic (2016), n = 1997; Slovakia (2016), n = 1998; Slovenia (2017), n = 1765; Romania (2017), n = 3718; Lithuania (2018), n = 1305). Simple, multiple logistic regression analyses and random-effect meta-analysis were conducted to identify factors associated with tobacco use susceptibility as the lack of a firm commitment not to smoke.

Results

Nearly a quarter of the students were susceptible to tobacco use in 4 of 5 countries. The following factors were identified, consistently across countries, as correlates of tobacco use susceptibility: exposure to passive smoking in public places (AOR from 1.3; p = 0.05 in Slovakia to 1.6; p < 0.01 in Czech Republic and Romania), peers smoking status (AOR from 1.8 p < 0.01 in Slovakia to 2.5; p < 0.01 Lithuania), opinion that smoking helped people feel more comfortable at celebrations (AOR from 1.3; p = 0.01 in Czech Republic to 1.9; p < 0.01 in Lithuania), noticing people using tobacco in mass media (AOR 1.5; p < 0.01 in Slovenia and 1.6; p < 0.01 in Lithuania), lack of knowledge on harmful effects of passive smoking (AOR 1.8; p < 0.01 in Slovakia and 2.4; p < 0.01 in Slovenia), lack of antismoking education provided by school (AOR 1.3; p < 0.05 in Czech Republic, Slovakia and Slovenia; 1.9; p < 0.01 in Lithuania), and family (AOR 1.5; p < 0.01 in Slovenia and Romania). Moreover those who believed that smoking makes young people look less attractive (AOR from 0.5; p < 0.01 in Romania to 0.7; p = 0.05 in Lithuania) and that people who smoke have less friends (AOR 0.7; p ≤ 0.06) turned out to be less susceptible to tobacco use initiation. In Czech Republic and Slovenia significantly higher susceptibility to tobacco use was observed among females as compared to males (AOR 1.4; p < 0.01), whereas in Romania opposite pattern, although not significant, was observed (p = 0.3). Having more money available for own expenses, positively correlated with smoking suitability in all countries (AOR > 1.5; p < 0.01) except Lithuania where youth with more money available tend to be less susceptible to tobacco use (p > 0.05). Youth who share the opinion that people who smoke have more friends were more susceptible to smoking in Romania (AOR 1.4; p = 0.04) but tend to be less susceptible in other countries. Exposure to advertisements at points of sale was significant correlate of tobacco use susceptibility in Slovakia and Slovenia (AOR 1.4 and 1.5 respectively; p < 0.05), with moderate heterogeneity between the countries.

Conclusions

A high proportion of youth from central and eastern European countries was susceptible to tobacco use. Social factors, and those related to educational and policy issues as well as to attitudes regarding tobacco use were strongly, and consistently across countries, correlated with tobacco use susceptibility. Slight differences in susceptibility to tobacco use between the countries were related to: sex, money available for own expenses, exposure to advertisements at points of sale and opinion that people who smoke have more friends. These factors should be considered when designing and implementing anti-tobacco activities among young people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12493-6.

Transition in Smoking Stages and Its Relationship with Family Psychological Function and Perceived Social Support in Adolescents of Tabriz, Iran

BACKGROUND

There is limited information on the relationship between family psychological functions and perceived social support with progress in cigarette smoking stages in adolescents. This study was aimed to determine the relationship between family psychological function and perceived social support through a transition in different stages of cigarette smoking in adolescents of Tabriz, Iran.

METHODS

In this study, 4,216 students (14-19 years old) from high schools were selected by multistage cluster sampling method. Initially, we used valid and reliable questionnaires for demographic characteristics, risk factors, Iranian family psychological function, and perceived social support. The smoking status questionnaire was administered twice, with an interval of 6 months. Data were analyzed using univariate and multivariate logistic regression analysis.

RESULTS

Overall, 3,968 students with the mean (standard deviation) age of 15.96 (0.75) years completed the questionnaire in the first phase of the study. The results showed that lower levels of family psychosocial function (P < 0.001) and perceived social support (P < 0.001) in the univariate state were significantly associated with progress in cigarette smoking stages. By controlling the potential confounding factors, the weak and moderate family psychological function compared to the strong function increased the chance of progress in the cigarette smoking stages by almost 11 and 4 times, respectively (P < 0.001). The low and moderate level of perceived social support compared to the high level increased the chance of progress in cigarette smoking stages by almost 7 and 2 times, respectively (P < 0.001).

CONCLUSIONS

It is suggested to perform an organized, precise, and operational planning for strengthening the family psychological functions and providing an appropriate social support condition among adolescents to prevent the tendency toward cigarette smoking and its more advanced phases.

Child and adolescent mental health disorders in the GCC: A systematic review and meta-analysis

Background

The Gulf Cooperation Council (GCC), with a predominant ‘youth bulge’ among its 54 million people, has witnessed an exponential increase in research pertinent to child and adolescent mental health (CAMH). Aside from a few narrative reviews, to date, no critical appraisal examining the magnitude of CAMH has emerged from this region.

Aims

This study aimed to report the prevalence rates of CAMH disorders in the GCC through a systematic review of the existing literature followed by a meta-analysis.

Methods

A systematic review of the literature from the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) was conducted. The databases used included Scopus, ProQuest, Pubmed, and a final check was performed on Google Scholar to account for any remaining studies that may have still been under review. Meta analytic techniques were then used to estimate prevalence rates of each specific mental disorder, i.e. ADHD, depression, anxiety, stress, eating disorders, and tobacco use disorder.

Results

A total of 33 studies from the six countries were included. The pooled prevalence of ADHD as per the Vanderbilt ADHD Diagnostic Rating Scale (VADHDDRS), clinical judgments, Attention Deficit Disorders Evaluation Scale (ADDES), and the Strengths and Difficulties Questionnaire (SDQ) was found to be 13.125%, 13.38%, 26.135%, and 12.83%, respectively. The pooled prevalence of depressive symptoms solicited by the Patient Health Questionnaire (PHQ-9), Depression, Anxiety, and Stress Scale (DASS), and Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) was 44.684%, 45.09%, and 26.12%, respectively. The pooled prevalence of anxiety according to the DASS and the MINI Kid was 57.04% and 17.27%, respectively, while the pooled prevalence of stress as per the DASS was found to be 43.15%. The pooled prevalence of disordered eating solicited by the Eating Attitudes Test (EAT-26) was 31.55%. Lastly, the pooled prevalence of tobacco use disorder per the Global Youth Tobacco Survey was 19.39%.

Discussion

To date, this is the first systematic review and meta-analysis of its kind from the GCC. The prevalence rate of CAMH disorders appears to be in the upper range of international trends. The higher rates could be attributed to the existing studies using suboptimal methodological approaches and instruments to solicit the presence of CAMH.

Smoking in Teenagers from the Social Protection System-What Do We Know about It?

Background and Objectives: The impact of smoking on the young population is an extremely important issue for the public health system. As the prevalence of smoking is considerably increasing amongst the pubescent and adolescent population, the prevention of smoking at this age should be considered of high priority. The primary aim of this observational study was to assess tobacco use in teenagers included in the social protection system. Materials and Methods: 275 foster care teenagers (155 from the Professional Maternal Assistance System (AMP) and 120 from the residential system) from two different counties were enrolled. After a brief interactive session focused on the main consequences of smoking, a self-administered questionnaire was anonymously completed. Results: The mean age of the study group was 14 years, with a significant difference between the residential system and AMP (p = 0.001). Smoking status was significantly higher in participants from family-type houses (36.7%) than in those from the AMP (11.7%) (p < 0.001). The presence of smokers in the family (78.3%) and passive smoking (64.7%) were significantly higher in children from the residential system than in those from the AMP (32.9% and 31.8%, respectively) (p < 0.001). The number of cigarettes consumed daily was associated with the age of the participants (p = 0.01, rho 0.42). In total, 82.3% were cigarette users and 19.4% were e-cigarette users. Smokers bought the majority of their cigarettes from the store (63.2%) or asked a friend (19.3%) or an adult to buy them on their behalf (12.3%). Conclusions: The null hypothesis, according to which children who are abandoned but raised and cared for by professional nursing assistants are predisposed to earlier tobacco activity compared to children raised in a normal familiar environment, is supported. Future education and prevention campaigns conveying the benefits of a healthy long-term lifestyle to this population category are needed.

Hookah Use among Russian adolescents: Prevalence and correlates

Hookah use among adolescents is increasing globally. No prior studies in the published literature have examined hookah use among youth in the Russian Federation. We assessed demographic, psychological and behavioral factors associated with lifetime and past 30-day hookah use among Russian youth. This cross-sectional study was conducted in three areas of Bashkortostan, Russia. In 2015, we surveyed Russian high school students (n = 716) on socio-demographic characteristics, tobacco (cigarettes, e-cigarettes, hookah) and drug use (alcohol, marijuana, and other illicit drugs), coping strategies, and getting in trouble (self and/or family). We estimated hookah use prevalence and performed bivariate analyses prior to fitting two multilevel models evaluating lifetime and past 30-day hookah use. Within this sample, 34.92% and 9.36% were lifetime and last 30-day hookah users, respectively. Lifetime hookah use was associated with older age (OR = 1.29), higher anger coping (OR = 1.41), school troubles (OR = 2.30), lifetime cigarette (OR = 1.59), e-cigarette (OR = 4.62), alcohol (OR = 5.61), and marijuana use (OR = 8.05). Additionally, past 30-day hookah use was associated with older age (OR = 1.71), lifetime use of alcohol (OR = 5.39), school troubles (OR = 5.82), and anger coping strategies (OR = 1.40). Hookah use is currently high among Russian youth in Bashkortostan and is associated with other risky behaviors. Effective interventions targeting multiple substances and coping strategies are needed. Social media campaigns encouraging cessation and advocating against its use at home may be beneficial in curbing hookah use among youth.

Susceptibility to cigarette smoking among secondary and high school students from a socially disadvantaged rural area in Poland

Background

To prevent adolescents from becoming smokers, it is essential to understand factors that cause them to become susceptible to smoking (SS). The aim of this study was to examine association between individual and school characteristics and susceptibility to smoking initiation and experimentation in the youth.

Methods

We collected cross-sectional survey data from students aged 13–19 years attending 21 schools from Piotrkowski district. Of 4050 students, 3552 respondents, including 2508 non-smokers, filled in an anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey. The univariate and multivariate logistic regression analyses were applied to the study factors linked to SS among the never and ever smoking youth.

Results

About 22 % of the never smoking and 57 % of the ever smoking students were found to be vulnerable to smoking. The youth who were males (OR = 1.4; p = 0.001), who were older (OR = 1.1; p = 0.002) and those, whose mothers had medium (OR = 1.8; p < 0.001) and lower (OR = 4.1; p < 0.001) educational levels were more prone regarding future smoking compared to the females, younger ones and those whose mothers were highly educated. The students who lived in households with no smoking ban (OR = 1.4; p = 0.001) and those who had ever tried cigarettes (OR = 3.5; p < 0.001) were more susceptible to smoking comparing to those who indicated smoke-free home and who had never smoked. In addition, having smoking friends (OR = 2.3; p < 0.001), seeing school personnel smoking on the premises of the school (OR = 1.8; p < 0.001) and perceiving smoking girls more attractive than the non-smokers (OR = 3.8; p < 0.001) were the correlates of smoking susceptibility. Finally, the separate analysis among the never smokers indicated that no school training on tobacco harm (OR = 1.3; p = 0.04) is the additional significant factor for susceptibility to smoking initiation.

Conclusions

SS is prevalent in secondary and high school students in Poland. Personal, social and environmental factors are strongly correlated with SS. When addressing the youth, efforts should be focused on the groups at risk, with a comprehensive approach including multiple factors and involving school personnel, parents and the group leaders in tobacco control activities. Projects aimed at changing social norms around smoking and providing the youth with knowledge and skills to resist smoking are also needed. This may help to implement an effective approach to prevent smoking susceptibility and initiation of tobacco use among the youth.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-016-0092-9) contains supplementary material, which is available to authorized users.

Self-report distortions of puffing topography in daily smokers

Under-reporting tobacco consumption is common, although there is lack of evidence whether under-reporting is associated with health risk perception. In this study, smoking topography from 110 smokers was recorded over 24 hours, aiming to capture a representative average of smoking behaviour. Participants significantly under-reported the duration of secondary exposure, and there was a significant interaction between self-report distortion type and risk perception. Analysis showed that smokers under-reporting puff number declared perceiving significantly less susceptibility to acquiring airway diseases, which is correlating significantly with the level of under-reporting. The present findings may suggest that under-reporting smoking behaviour has psychological functions beyond achieving social desirability.

Adolescents' Attitudes on Smoking Are Related to Experimentation with Smoking, Daily Smoking and Best Friends' Smoking in Two Karelias in Finland and in Russia

PURPOSE

Becoming a smoker usually starts during adolescence and is a dynamic process involving experimentation before the establishment of daily smoking. It has been suggested that adolescents who smoke differ from those who do not in their attitudes to smoking. The purpose of this study was to find out whether attitudes related to smoking legislation and restrictions, social pressures in smoking and image of smokers are associated with smoking experimentation, daily smoking and best friends' smoking.

METHOD

The data were gathered with a self-administered questionnaire in North Karelia, Eastern Finland and in the Pitkyaranta district, Republic of Karelia, Russia. The respondents were 15-year-old 9th grade pupils in local schools. In Pitkyaranta, the data analyses covered pupils in all eight schools in the area (n = 179). In North Karelia, the data analyses comprised of selected eight schools (n = 601). Data were analysed with exploratory factor analysis.

RESULTS

The models revealed that attitudes related to restrictions and social pressure were significantly associated with experimenting with smoking [OR (95 % CI) 7.923 (5.787-10.847)], daily smoking [OR (95 % CI) 9.575 (6.727-13.628)] and the likelihood of best friends' smoking [OR (95 % CI) 3.154 (2.579-3.858)]. The stronger the young peoples' attitudes and opinions, for example, towards restrictions and with more difficulties in refusing smoking, the higher the likelihood for smoking experimentations, daily smoking as well as the likelihood for their best friends' smoking. The country and factor interactions were not associated with smoking experimentations, daily smoking or best friends' smoking.

CONCLUSION

Regardless of cultural background, adolescents who smoke have more positive attitudes to smoking, and perceive more social support for smoking, than do adolescents who do not smoke. The study stresses the similarity of the results in both Karelia's despite the enormous differences in culture, economy and public policy.

Tobacco use among children in Romanian foster care homes

BACKGROUND

Children living in facilities under the supervision of child protection authorities are vulnerable to early smoking experimentation. This is the first study to report the prevalence and correlates of smoking behaviour among foster care home residents in Romania.

METHODS

We conducted an in-person, cross-sectional survey of 914 resident children in 148 foster care homes of four Transylvanian counties. We included children <18 and those with complete tobacco use information in the analytical sample (n = 791). Sociodemographic, peer and foster family characteristics were evaluated for their influence on tobacco experimentation and past 30-day use.

RESULTS

Respondents included 50.7% girls of average age 13.6 years (range 8-17). Almost half reported ever experimenting with tobacco (44.6%) and approximately one in four reported past 30-day use (25.9%). Factors significantly associated with an increased odds of smoking experimentation and past 30-day use in the multivariable model included being 13-17 years old (vs. <12 years), having friends who are current smokers, and having a sibling who smokes. Living in a home with a foster mother or foster father who smokes was associated with increased odds of experimentation and past-30 day use, respectively. The longer time living in foster care was associated with decreased odds of experimentation and past 30-day use controlling for all covariates.

CONCLUSION

Anti-tobacco programmes that incorporate the role family and peers to reduce smoking are needed to address the high rates of use among Romanian foster care children.

Smoking Prevalence and Associated Factors as well as Attitudes and Perceptions towards Tobacco Control in Northeast China

Objectives: The present study aimed to investigate the prevalence of smoking and environmental tobacco smoke (ETS), the associated factors of current smoking among adults, and their attitudes and perceptions towards tobacco control. Methods: A population-based cross-sectional survey was conducted in 2012 using a self-reported questionnaire. A representative sample of adults aged 18–79 years was collected in the Jilin Province of Northeast China by a multistage stratified random cluster sampling design. Descriptive data analysis was conducted, and 95% confidence intervals (CI) of prevalence/frequency were calculated to enable comparisons between the alleged differences and similarities. Multivariable logistic regressions were used to examine the risk factors associated with current smoking. Results: 21,435 adults responded to the survey (response rate: 84.9%). The overall prevalence of ever smoking, current smoking, and former smoking or smoking cessation was 39.1% (95% CI: 38.3–39.9), 31.8% (95% CI 31.1–32.6), and 7.3% (95% CI: 6.9–7.7), respectively. The proportion of ETS exposure among adult non-smokers in Jilin Province was 61.1% (95% CI: 60.1–62.1), and 23.1% (95% CI: 22.3–24.0) of the non-smokers reported daily ETS exposure. The proportion of ETS exposure at home was 33.4% (95% CI: 32.5–34.4), but the proportion of ETS exposure at restaurants was lower (6.5%) (95% CI: 6.0–7.1). More than 90% of the participants had positive attitudes and perceptions towards tobacco control, but 23.2% (95% CI: 22.5–24.0) of them did not agree with the perception of “smoking is fully quit in public places”, and almost half of the adults (49.5%) (95% CI: 48.7–50.3) did not agree with the perception of “hazards of low-tar cigarettes are equal to general cigarettes”. Conclusions: Smoking and exposure to ETS are prevalent among adults from the Jilin Province of Northeast China. Our findings suggest that tobacco control should be advocated in Northeast China. Anti-smoking campaigns and legislation should be built into the public health curriculum and government policy.

Changes in smoking among adolescents in the Republic of Karelia, Russia and Eastern Finland from 1995 to 2013

AIMS

The aim of this study was to compare the prevalence of smoking, smoking experimentation and future intention to smoke in the Pitkäranta district, the Republic of Karelia, Russia and Eastern Finland in the years 1995 and 2013.

METHODS

Cross-sectional studies were carried out among 15-year-old ninth grade adolescents in all schools in the Pitkäranta region (1995: n=385, response rate 95%; 2013: 182, response rate 98%) and a sample of schools in Eastern Finland (1995: n=2098, response rate 91%; 2013: 635 response rate 95%).

RESULTS

The daily smoking prevalence among adolescents did not change either in Eastern Finland or in the Pitkäranta district from 1995 to 2013. However, smoking among Finnish adolescents was more common than among Russians (p<0.001) and boys, in general, smoke more commonly than girls (p<0.001). In Finland, early smoking experimentations declined by half among both genders but in Pitkäranta the girls' smoking experimentations tripled (relative risk 3.03, 95% confidence interval 1.76-5.20) from 1995 to 2013. The combined effect of country and gender was significant (p<0.001) for future intention to smoke. In Finland future intentions to smoke were very similar in boys and girls compared with obvious gender differences in Russia.

CONCLUSIONS

These results suggest that more attention should be paid for programmes that consider better gender and culture-specific issues in preventing initiation of smoking and promoting an anti-smoking climate in societies.

Tobacco smoke in infants with bronchopulmonary dysplasia

Exposure to tobacco smoke has been not evaluated in children with bronchopulmonary dysplasia (BPD). We evaluate the association of in utero smoking (IUS) and environmental tobacco smoke (ETS) with the respiratory events of BPD and non-BPD children. Two hundred sixty-two children born before 35 weeks of gestational age (GA) and regularly followed up in our regional network for preterms were enrolled. They were paired according to their BPD status, their gestational age and birth weight (131 children with BPD and 131 without BPD, 28 mean weeks GA; mean weight 1000 g). Respiratory data were obtained prospectively during their first 2 years of life. A complementary questionnaire was completed by the parents about their child's respiratory health at the age of 2, their home environment, and tobacco status. IUS concerned 12.6 %; ETS, 48.8 % (67 % in BPD children treated with oxygen at home). No further influence on respiratory outcome could be found by exposure to intrauterine smoke or extrauterine tobacco smoke in this patient sample.

CONCLUSION

IUS and ETS exposures are as high in preterm children as in a general pediatric population. The highest exposure occurs among BPD infants treated with oxygen at home.

WHAT IS KNOWN

• Environmental tobacco smoke (ETS) and in utero smoking (IUS) are responsible for many morphological, functional, and clinical changes in children. • Children with bronchopulmonary dysplasia (BPD) have more respiratory events in their first years of life than preterm children without BPB, maybe triggered by ETS and IUS. What is New: • The exposition to ETS and IUS is high in preterm children with and without BDP, as high as in a general. • Pedaitric population, particularly in children with BPD and treated with oxygen at home. • No further influence on respiratory outcome could be found by exposure to ETS or IUS in our studied population.

Smoking motivators are different among cigarette and waterpipe smokers: The results of ITUPP

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37 ± 01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% (n = 624) and 20.70% (n = 1,109), respectively; and 5.08% (n = 311), 11.06% (n = 619) for smokers, and 13.30% (n = 711) for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 (95% CI: 1.29–4.39); angriness 2.58 times (95% CI: 1.51–4.43); and distress by 2.49 times (95% CI: 1.42–4.40). Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal (OR = 3.11, 95% CI: 1.67–5.77); and smoking after waking up (OR = 2.56, 95% CI: 1.42–4.40). Comprehensive and multifaceted preventive programs must tailor identified factors and increase family’s awareness.

Practice and attitude of cigarette smoking: a community-based study

Background

In Saudi Arabia many studies have addressed cigarette smoking from various perspectives. Most of these studies, however, were conducted among males and confined to Riyadh, the capital city. Such limitations have enhanced the need for community-based epidemiological studies that include both genders and various age groups and socio-demographic features, as well as different regions.

Objective

This cross-sectional study aims to assess the prevalence of cigarette smoking and to discuss the association between cigarette smoking habits and socio-demographic factors among community members of the Jazan area in southwest Saudi Arabia.

Methods

A pre-coded questionnaire was designed and tested for data consistency. A well-trained health team was assigned to gather the data from the 30 primary healthcare centers distributed across eight provinces. The response rate was 92.8% (4,326 respondents ≥13 years old). The associations among the subjects' socio-demographic characteristics were examined by the chi-square test. A multiple logistic regression and odds ratios were calculated as well.

Results

A total of 1,017 (23.5%), 1,042 (24.1%), and 3,284 (75.9%) respondents were, respectively, current smokers (TCS), ever-smokers (TES), and non-smokers (TNS). Though current smokers seem to be more prevalent in urban populations (13.8%) than in rural populations (9.7%), the association of urbanization with a current smoking habit is insignificant.

Conclusion

Having fun, relieving stress, and the influence of parents, particularly of mothers, were the main motives that encouraged participants' cigarette-smoking habits. This situation was worsened by the fact that accessing cigarettes was either very easy or easy for over 90% of the respondents.

Effectiveness of a school-based multi-component smoking prevention intervention: the LdP cluster randomized controlled trial

OBJECTIVE

We assessed the effectiveness of the Luoghi di Prevenzione-Prevention Grounds school-based smoking prevention programme.

METHODS

We undertook a cluster randomized controlled trial of 989 students aged 14-15 years in 13 secondary schools located in Reggio Emilia, Italy. The intervention consisted of the "Smoking Prevention Tour" (SPT) out-of-school workshop, one in-depth lesson on one Smoking Prevention Tour topic, a life-skills peer-led intervention, and enforcement surveillance of school antismoking policy. Self-reported past 30-day smoking of ≥ 20 or 1-19 days of cigarette smoking (daily or frequent smoking, respectively) was recorded in 2 surveys administered immediately before and 18 months after the beginning of the programme. Analysis was by intention to treat. The effect of the intervention was evaluated using random effects logistic regression and propensity score-matching analyses.

RESULTS

Past 30-day smoking and daily cigarette use at eighteen months follow-up were 31% and 46% lower, respectively, for intervention students compared to control students. Taking into account non-smokers at baseline only, daily smoking at eighteen months follow-up was 59% lower in intervention students than in controls. Past 30-day smoking in school areas was 62% lower in intervention students compared to controls.

CONCLUSIONS

The Luoghi di Prevenzione-Prevention Grounds programme was effective in reducing daily smokers and in reducing smoking in school areas.

Smoking status in Iranian male adolescents: a cross-sectional study and a meta-analysis

The present study aimed to estimate the prevalence of smoking status and its associated factors in Iranian adolescents and a meta-analysis of recent cross-sectional studies in order to estimate the corresponding prevalence for all Iranian adolescents. In a cross-sectional study, 1064 male high school students in Zanjan city (northwest of Iran) were recruited. A self-administered questionnaire was used for smoking status and associated factors. Through the meta-analysis, all relevant published studies were reviewed. Almost one-third of adolescents (34.2%, n=354) have experienced smoking either experimentally (23.4%, n=242), or regularly (10.8%, n=112). Multivariate analysis showed that older age (OR=1.20; 95% CI: 1.05-1.37), risky behaviors (OR=1.83; 1.25-2.68), Tramadol medication (OR=2.19; 1.54-3.11), low self-esteem (OR=1.07; 1.03-1.11), positive attitude toward smoking (OR=1.15; 1.09-1.21), positive thinking about smoking (OR=1.07; 1.01-1.14) and having smoker friends (OR=1.94; 1.36-2.77) were significantly associated with cigarette smoking in adolescents. Meta-analysis results showed that 7% of Iranian adolescents are regular smokers and 27% are experimenters. Increasing prevalence of smoking in Iranian adolescents is a major concern for public health. Controlling risky behaviors and increasing health education are recommended.

Smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness for smoke-free air in the workplace: a study from the Balkans

OBJECTIVE

Identify the psychosocial variables that predict smokers’ compliance with smoke-free policies at work, and non-smokers’ assertiveness for smoke-free rights in Greek and Bulgarian workplaces.

METHODS

Data were collected from employees in Greece and Bulgaria. The main outcome measures were smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness intentions. Demographic variables, tobacco use and dependence, as well as beliefs about second-hand smoke (SHS) exposure and smoking at work were also assessed.

RESULTS

Regression analyses showed that smokers’ compliance with smoke-free policies was predicted by age, perceived health risks of smoking, and beliefs related to the benefits of smoking at work. Non-smokers’ assertiveness was predicted by annoyance from exposure to SHS at work, and assertiveness-related social cognitions (e.g., attitudes, social norms, and self-efficacy).

CONCLUSIONS

Interventions to promote support for tobacco control policies at work in Greece and Bulgaria may benefit from targeting smokers’ beliefs about the actual effects of tobacco use on health and job performance. Accordingly, efforts to promote non-smokers assertiveness should build stronger assertiveness-related attitudes, convey anti-smoking normative messages, and strengthen self-efficacy skills.

Degree of urbanization and gender differences in substance use among Slovak adolescents

OBJECTIVES

Substance use among adolescents varies with gender and between countries. Urbanization may contribute to this. The aim of our study is to explore the association between the degree of urbanization and gender differences in adolescent smoking, binge drinking, and cannabis use.

METHODS

A cross-sectional questionnaire survey of Slovak adolescents was used (N = 3,493; mean age = 14.33), stratified by degree of urbanization. The effects of gender and urbanization of the area and their interaction on substance use (smoking, binge drinking, and cannabis) were analyzed using a logistic regression model adjusted for age.

RESULTS

Gender and area and their interaction had statistically significant (p < 0.01) associations with substance use. The lower the urbanization of the area, the less riskily females behaved. An exception was found in the case of binge drinking where the results of the interaction of gender and degree of urbanization were not significant for the second least urbanized area.

CONCLUSIONS

Prevalence rate of substance use among girls increased along with an increasing degree of urbanization, while the prevalence rate of substance use among boys remained constant.

Global teens and tobacco: a review of the globalization of the tobacco epidemic

Worldwide, the burden of suffering to children caused by tobacco does not just originate from exposure to tobacco smoke or smoking, but includes exposure to tobacco-friendly media, poverty associated with money spent on tobacco, increased incidence of tobacco-related fires, and the harms related to child labor in tobacco cultivation. Despite global efforts through human rights acts, the Framework Convention on Tobacco Control, and the MPOWER report, tobacco use continues to accelerate in most countries. While the efforts that have been taken, such as smoking bans in public, are worthy actions, not enough is being done to protect children and teens. More can be done at the policy level, by individuals, and by health care providers.

What impact have tobacco control policies, cigarette price and tobacco control programme funding had on Australian adolescents' smoking? Findings over a 15-year period

AIMS

To assess the impact of tobacco control policies relating to youth access, clean indoor air and tobacco advertising at point-of-sale and outdoors, in addition to cigarette price and per capita tobacco control spending, on adolescent smoking prevalence.

DESIGN

Repeated cross-sectional surveys. Logistic regression analyses examined association between policies and smoking prevalence.

SETTING

Australia, 1990-2005.

PARTICIPANTS

A nationally representative sample of secondary students (aged 12-17 years) participating in a triennial survey (sample size per survey range: 20 560 to 27 480).

MEASUREMENTS

Students' report of past-month smoking. In each jurisdiction, extent of implementation of the three policies for the year of the survey was determined. For each survey year, national per capita tobacco control spending was determined and jurisdiction-specific 12-month change in cigarette price obtained.

FINDINGS

Extent of implementation of the three policy areas varied between states and over the survey years. Multivariate analyses that adjusted for demographic factors, year and all tobacco control variables showed that 12-month cigarette price increases [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99], greater per capita tobacco control spending (OR: 0.99, 95% CI: 0.98-0.99) and stronger implementation of clean indoor air policies (OR: 0.93, 95% CI: 0.92-0.94) were associated with reduced smoking prevalence.

CONCLUSIONS

Adult-directed, population-based tobacco control policies such as clean indoor air laws and increased prices of cigarettes, implemented as part of a well-funded comprehensive tobacco control programme are associated with lower adolescent smoking.

Multi-country, cross-national comparison of youth tobacco use: findings from global school-based health surveys

OBJECTIVE

Describe the prevalence of current cigarette smoking and other tobacco use among 13-15year olds across 44 countries and 110 sites participating in the Global School-based Health Survey (GSHS), and compare these results with previous findings from the Global Youth Tobacco Survey.

METHODS

The GSHS is conducted in countries using standardized sampling and survey methodology procedures. Smoking and other tobacco use prevalence was compiled from fact sheets available on the GSHS web site from the available 110 sites where the survey has been conducted and resulting data processed. Tobacco use prevalence rates are weighted to adjust for the probabilities of nonresponse and varying probabilities of selection. Boy to girl ratios were calculated to examine gender differences in tobacco use prevalence.

RESULTS

Current smoking rates ranged widely from a low of approximately 1 in 100 students in Tajikistan and India to a high of more than 1 in 4 students in certain sites in Chile and Colombia, and more than 1 in 5 in other sites in Chile, Ecuador, Argentina, and Colombia. Other tobacco use prevalence ranged from a low of 1.0% in Hangzhou, China to a high of 43.7% in Northwest Namibia.

CONCLUSION

This is the first multi-country, cross-national study of tobacco use involving GSHS data. Results provide an opportunity to examine youth tobacco use in several countries and compare results with the Global Youth Tobacco Survey (GYTS) which is a more extensive global surveillance of youth tobacco use.

Self-efficacy, affectivity and smoking behavior in adolescence

BACKGROUND

Research on health-related behaviors confirms the contribution of self-efficacy and affective factors to the initiation and continuation of smoking behavior. The aim was to assess the degree to which affectivity contributes to the association between self-efficacy and smoking behavior in adolescence.

METHODS

A sample of 501 elementary school students (mean age 14.7 ± 0.9 years, 48.5% males) from the Slovak and Czech Republics filled out the Self-Efficacy Scale, the Positive and Negative Affect Schedule and answered questions about smoking behavior.

RESULTS

Logistic regression showed that social self-efficacy increased the likelihood of smoking behavior but only after adding positive and negative affectivity to the model. Adjustment for age and gender as covariates did not change these findings.

CONCLUSION

Results show the need to prepare programs aimed at enhancing appropriate social self-efficacy and especially improving skills to resist the pressures emerging from peers. Adolescents should also learn to handle their negative emotions differently, instead of through smoking behavior.

The social determinants of adolescent smoking in Russia in 2004

OBJECTIVES

To determine the prevalence of adolescent smoking in the Russian Federation and examine what factors are associated with it.

METHODS

Data were drawn from Round 13 of the Russia Longitudinal Monitoring Survey (RLMS) carried out in 2004. The sample consists of 815 adolescents (430 boys, 385 girls) aged 14-17 years who answered questions about their health behaviours.

RESULTS

Smoking was more prevalent among boys than girls (26.1 vs. 5.7%). Maternal smoking and adolescent alcohol use were associated with smoking among both sexes. The self-assessment of one's socioeconomic position as unfavourable was associated with girls' smoking, while living in a disrupted family, physical inactivity and having a low level of self-esteem were predictive of boys' smoking.

CONCLUSIONS

The family environment appears to be an important determinant of adolescent smoking in Russia. In particular, boys and girls may be modelling the negative health behaviour lifestyles of their parents, with unhealthy behaviours clustering. Efforts to reduce adolescent smoking in Russia must address the negative effects emanating from the parental home whilst also addressing associated behaviours such as alcohol use.

Cigarette smoking among school-going adolescents in Lithuania: Results from the 2005 Global Youth Tobacco Survey

Background

The majority of people who suffer morbidity due to smoking may have initiated smoking during adolescent period. The aim of this study is to determine the prevalence and associated factors for cigarette smoking among school-going adolescents in Lithuania.

Findings

Data from the Global Youth Tobacco Survey (GYTS) 2005 were used to conduct this study. Data were analyzed using SUDAAN software 9.03. Comparisons for categorical variables were done using the Pearson's Chi-square test. The cut of point for statistical significance was set at 5% level. Logistic regression analyses were conducted to determine factors associated with the outcome. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95% confidence intervals (CI) are reported.

Of the 1822 respondents, 35.8% males and 27.1% females reported being current cigarette smokers (p < 0.001). Having friends who smoke cigarettes was associated with smoking after controlling for age, gender, parental smoking status, and perception of risks of smoking (AOR = 3.76; 95% CI [2.33, 6.90] for some friends using tobacco; and AOR = 17.18; 95% CI [10.46, 28.21] for most or all friends using tobacco). Male gender and having one or both parents who smoke cigarettes were associated with smoking (AOR = 1.31; 95% CI [1.03, 1.66]) and AOR = 1.76; 95% CI [1.37, 2.27]) respectively).

Conclusions

There is a high prevalence of cigarette smoking among Lithuanian adolescents. Male adolescents and adolescents who have friends or parents who smoke should be the main target for tobacco control in Lithuania.

Perceived factors related to cigarette and waterpipe (ghelyan) initiation and maintenance in university students of Iran

OBJECTIVES

To investigate the perceived factors leading to cigarette and waterpipe (ghelyan) smoking initiation and maintenance in Iranian university students.

METHOD

A cross-sectional study was conducted on 233 students aged 20-25 enrolled in Isfahan University and Kashan University in 2007. Demographic factors as well as cigarette and ghelyan status, and perceived factors related to cigarette or ghelyan smoking initiation and maintenance were recorded. Principal component analysis was carried out to cluster perceived smoking initiation and maintenance factors.

RESULT

In a multiple logistic regression model, perceived psychological factors were more significant to cigarette smoking initiation and maintenance than ghelyan smoking among girls (odds ratio, OR = 1.90; P < 0.04) although perceived psychological factors (OR = 2.20; P < 0.001) and social factors (OR = 2.42; P < 0.001) were more significant in cigarette smoking initiation than ghelyan smoking initiation among boys (OR = 2.42; P < 0.001). Moreover, study appears that in boys, perceived entertainment factors could play more significant role in ghelyan smoking initiation compared with cigarette smoking initiation (OR = 0.42; P < 0.001).

CONCLUSION

Whereas the factors related to smoking initiation and maintenance are different in both genders and in both tobacco products, identification of cigarette and ghelyan smoking may guide policy makers to develop comprehensive interventions.