Adolescent smoking. A review of prevalence and prevention

Cigarette smoking among adolescents in Northwest Ohio: correlates of prevalence and age at onset

This study examined the prevalence and correlates of smoking initiation among adolescents. We have used data from adolescents (n=5,392) ages 10-18 who participated in the 2003 Tobacco Survey, a representative sample of adolescents in Northwest Ohio. A self-report of cigarette smoking was obtained using a questionnaire administered in classrooms. Data were analyzed using weighted chi-square and multiple logistic regressions in SAS that accounted for the survey design. The prevalence rates for adolescents that ever tried smoking were 7.4% in elementary (grades 4-5); 17.7% in middle (grades 6-8), and 41.4% in high (grades 9-12) schools, respectively. The highest prevalence rate was among Hispanics. Having a close friend that smoked and a smoker at home correlated significantly with both initiation of smoking and smoking at an earlier age. Smoking was correlated with low academic achievement among adolescents in all grades. Students who reported smoking by parents or siblings were significantly more likely to start smoking at an earlier age, compared to other students living in a non-smoking home environment. Smoking prevention program should include components focused on adolescents' home environment and should start as early as the 4th grade.

Effective practices for school-based tobacco use prevention

BACKGROUND

Research evidence addressing effectiveness of tobacco use prevention interventions has accumulated since the 1970s. Systematic reviews 1985-2006 were considered, building on previous syntheses and spanning tobacco control and prevention efforts to date. Practitioners' experience was drawn upon to supplement research evidence.

METHODS

A systematic, comprehensive approach was used to synthesize published literature evaluating the effectiveness of school-based tobacco use prevention interventions. Systematic reviews conducted on all populations published in English, peer-reviewed journals were included. Reviews were screened for relevance and assessed for methodological quality using pre-tested, standardized tools. The best available evidence was extracted and integrated with experiential evidence from individual interview and focus group results from practitioners involved in tobacco use prevention programming.

RESULTS

Considerable consensus among the three evidence sources indicates that school-based tobacco use prevention interventions are effective in reducing smoking prevalence, reducing smoking initiation and intended smoking intentions in the short term. There is adequate evidence from over three decades of research and years of experience to recommend ongoing implementation of school-based tobacco use prevention interventions.

CONCLUSION

There is strong evidence that school-based tobacco use prevention programs are largely effective for most tobacco use related outcomes, at least in the short term.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high school adolescents in the Pietersburg area of the Northern Province, South Africa

AIM

The aim of this study was to investigate the prevalence of illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high-school adolescents in the Pietersburg area (Central Region) of the Northern Province, South Africa.

PARTICIPANTS

Participants in this study were 435 secondary-school adolescent students around the Pietersburg area (Central Region), in the Northern Province. Two hundred and forty-three (56%) participants were female and 192 (44%) were male. They were aged between 15 and 19 years, with the mean age of 17.25 years (S.D.=1.34). Their educational level ranged between standards 7 and 10 (Grades 9-12).

INSTRUMENTS

Participants' demographic variables were determined by use of a questionnaire which covered participants personal characteristics such as age and gender, as well as educational level. Illicit drug use, cigarette smoking, and alcohol drinking behaviour were also measured using the questionnaire.

RESULTS

Findings of this study indicate the prevalence rate of 19.8% for illicit drug use, 10.6% for cigarette smoking and 39.1% for alcohol consumption among the participants. Both drug use, cigarette smoking and alcohol consumption are associated more with males than with females. The majority of the drug users and cigarette smokers indicated that they do so when they are bored, tired or stressed up, or at parties; and most of those who drink alcohol indicated that they do so at parties, weekends, or any other time. The mean age for first drug use is 14.9 years (S.D.=1.77); 14.54 years (S.D.=1.80) for first cigarette smoking and 15.33 years (S.D.=1.91) for first alcohol consumption. Among those who drink alcohol, 24.1% and 14.1% experience unplanned drunkenness and irritability, respectively. Unplanned drunkenness is associated with males, while unplanned irritability (after drinking alcohol) is not associated with any gender.

CONCLUSION

Mental health workers and the law-enforcement agencies should take note of the above findings while planning preventive and therapeutic strategies for the reduction of drug use, cigarette smoking and alcohol use and abuse among adolescents in the area.

Choosing to remain smoke-free: the experiences of adolescent girls

PURPOSE

To develop an understanding of the experiences of nonsmoking girls and determine how these girls avoid smoking.

METHODS

A grounded theory approach was used to direct the discovery of process(es) that nonsmoking females undertake to remain nonsmokers. Seventeen nonsmoking females between the ages of 13 and 17 years were interviewed using open-ended questions designed by the authors. The interviews were tape-recorded and then analyzed using the techniques described by Strauss and Corbin.

RESULTS

The data revealed that the process of remaining a nonsmoker is composed of three phases: making sense of smoking, rejecting smoking, and declaring oneself to be a nonsmoker. The process of remaining a nonsmoker appears to be rooted in developing self-confidence. As girls rejected smoking, self-confidence was boosted because they learned that their choice would be accepted and their strategies were effective in rejecting smoking.

CONCLUSIONS

The findings of this study offer new insights into the experiences of adolescent nonsmokers. Our assumption that there is a process that underlies remaining a nonsmoker was supported. The findings suggest that adolescents use several strategies in this process. These strategies are noteworthy because they offer those who work in the field of health promotion new insights into ways in which they might contribute to increasing the ranks of nonsmokers.

Depression and smoking: examining correlates in a subset of depressed patients

OBJECTIVE

The objective of this study was to examine for associations between depression and cigarette smoking.

METHOD

A sample of 92 depressed smokers was compared with a control sample of depressed non-smokers, matched for age, gender and diagnostic variables. Comparisons were made across a range of demographic, depression, family history, developmental factors, anxiety and personality style variables, as well as use of alcohol and illicit drugs.

RESULTS

We failed to find any difference between smokers and non-smokers in history or severity of depression. Cigarette smokers were distinguished principally by greater exposure to aversive experiences in childhood, disordered personality function, greater use of illicit drugs, anxiolytics and alcohol. Logistic regression identified dysfunctional personality 'domains', physical violence in childhood, long-term anxiolytic use and illicit drug use as the most significant predictor set.

CONCLUSIONS

Results favour a model of cigarette smoking and depression as linked by shared early deprivational variables, rather than cigarette smoking causing depression or the converse.

Consequences of adolescent drug use on psychiatric disorders in early adulthood

This article summarizes the existing literature on the relationship between adolescent drug use and abuse and the development of psychiatric disorders in adulthood. In recent years, there has been increased awareness of the co-occurrence of drug abuse and psychiatric disorders in adolescence and young adulthood. Few longitudinal studies, however, have examined specifically the impact of earlier drug use and abuse on later psychiatric disorders. The literature suggests three possible models to explain the relation between drug use and abuse and psychiatric disorders. According to the first model, adolescent psychiatric disorders precede drug use and abuse. A second model postulates that psychiatric disorders and drug use are correlated because they share one or more common aetiological factor(s). The third model posits that drug use and abuse predict or precede certain psychiatric disorders. We present data from a recent longitudinal study to support this latter model. As drug use and abuse have been shown to increase the likelihood of psychiatric disorders, it is clear that medical attention needs to be given to adolescents who use drugs of abuse. It is expected that a decrease in adolescent drug abuse should lead to an accompanying reduction in later psychiatric disorders.

Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students

We examined the prevalence of smokeless tobacco use, and its relationship to other risky behaviors in Connecticut school children in grades four through 12 (n=31,861). Less than one per cent of students in grades 4-8, and four per cent of those in grades 9-12, used smokeless tobacco. Eighty-two percent of all users were white males. Among high school males, the prevalences of risk-taking behaviors and feelings of stress and depression were significantly higher among users than non-users. Among high school males, the highest prevalences of risky behaviors and stress indicators were reported by joint users of cigarettes and smokeless tobacco.

Tobacco cessation and youth: the feasibility of brief office interventions for adolescents

BACKGROUND

The prevalence of tobacco use among adolescents remains high and the great majority of adult smokers begin smoking prior to the age of 18. While there have been a number of primary prevention projects in communities and schools, less attention has been given to smoking cessation for adolescents. This paper reviews the literature on the theory and practice of cessation as applicable to adolescents.

METHODS

The relevant literature was culled from a MEDLINE search and supplemented with secondary searches from those articles.

RESULTS

There have been few studies on brief interventions for adolescent smoking cessation in health care settings. However, there are several models for smoking cessation that are either applicable to or designed for adolescents. Pharmacologic treatments are also beginning to be used.

CONCLUSIONS

There is a great need for the development and evaluation of models for adolescent smoking cessation in health care settings. Recent developments, however, give cause for optimism in helping adolescent smokers in tobacco cessation.

Factors associated with smoking among children and adolescents in Connecticut

INTRODUCTION

The age of smoking initiation has dropped over the past four decades. Since behaviors and attitudes adopted in late childhood or early adolescence predict future smoking, it is important to understand the smoking and other risk-taking behaviors and attitudes of children aged 12 and younger. The goal of the analyses presented here was to describe behavioral and attitudinal factors associated with smoking among elementary school (grades 4-6), middle school (grade 7-8), and high school (grades 9-12) students in Connecticut.

METHODS

We have used data from 8 years (1988-1996) of an anonymous, self-administered health risk appraisal survey given to children and adolescents in self-selected public and private schools. We compared the proportion of smokers and nonsmokers who reported various behaviors and attitudes and compared them with the chi-square test.

RESULTS

Fifteen percent (n = 4,884) of the total population (n = 31, 861) were current smokers. At all grade levels, current smokers were more likely than nonsmokers to engage in risk-taking behaviors, and to report more stress and depression. Indicators of risk-taking and stress were also associated with the intent to smoke among children in grades 4-6.

CONCLUSIONS

Smoking occurs within the context of other risk-taking behavior and psychological distress, among both children and older adolescents. Our data provide support for the idea of early identification and targeting of children at high risk of smoking in elementary school, possibly as early as grade four.

Longitudinal study of co-occurring psychiatric disorders and substance use

OBJECTIVE

To examine temporal priority in the relationship between psychiatric disorders and drug use.

METHOD

Psychiatric assessments and drug use were completed at three different points in time, spanning 9 years. Structured interviews were administered to a cohort of youths and their mothers. Subjects were selected on the basis of their residence in either of two counties in upstate New York. The sample was predominantly white male and female youths, aged 1 through 10 years upon initial collection of data. Psychiatric diagnoses were assessed by a supplemented version of the Diagnostic Interview Schedule for Children Version 1, using computer algorithms designed to match DSM-III-R criteria to combine information from mothers and youths. Substance use information was obtained in the interviews.

RESULTS

A significant relationship was found to exist between earlier adolescent drug use and later depressive and disruptive disorders in young adulthood, controlling for earlier psychiatric disorders. Earlier psychiatric disorders did not predict changes in young adult drug use.

CONCLUSIONS

Implications for policy, prevention, and treatment include (1) more medical attention needs to be given to the use of legal and illegal drugs; and (2) a decrease in drug use may result in a decrease in the incidence of later psychiatric disorders.

Gender differences regarding peer influence and attitude toward substance abuse

Gender role socialization differentially influences attitudes toward substance abuse for boys and girls. Students (n = 968, 456 = males, M age = 16.20, SD = 1.20) were administered a questionnaire to assess their perceptions of attitudes toward substance abuse. Boys' approval was significantly different than the level of approval estimated for girls on teenagers drinking beer or wine coolers chi 2 (4,n = 931) = 418.58, p < .00001, drinking hard liquor chi 2 (4,n = 921) = 432.49, p < .00001, driving after drinking chi 2 (4,n = 924) = 492.32, p < .00001, smoking marijuana chi 2 (4,n = 921) = 609.62, p < .00001, smoking cigarettes chi 2 (4,n = 927) = 480.35, p < .00001, taking diet pills to lose weight chi 2 (4,n = 914) = 185.05, p < .00001, and taking diet pills to get high chi 2 (4,n = 921) = 428.43, p < .00001. Teens viewed getting drunk at a party as more acceptable than driving after drinking 2 (4,n = 921) = 264.10, p < .00001, but gave boys more approval than girls for driving after drinking. Possible implications of these findings are discussed.

Transitions to cigarette smoking during adolescence

The process of transition from nonsmoking to regular weekly smoking during a period from 10 to 16 years was examined using data gathered during the course of a longitudinal study of 957 New Zealand adolescents. These data were analyzed using a latent Markov model to estimate both rates of transition between stages of smoking and errors of measurement in report data. The fitted model suggested that the process of transition to smoking was a progressive and one-way process in which once teenagers had graduated to a given smoking status, return to earlier stages was uncommon. This process also showed a clear tendency to accelerate with age, so that rates of transition to smoking behaviors after the age of 14 years were far higher than rates of transition at age 10 years. The model also made it possible to estimate the accuracy of smoking reports. This suggested that individuals who were nonsmokers or regular smokers were classified with better than 95% accuracy on the basis of report data. However, the reporting accuracy of occasional smoking was poor, with 42% of occasional smokers being falsely classified as nonsmokers. The implications of these findings for the understanding of the processes of transition to smoking behaviors and the effects of measurement errors in report data are discussed.

Trends in cigarette smoking among US adolescents, 1974 through 1991

OBJECTIVES

The purpose of this study was to determine national trends in adolescent cigarette smoking prevalence.

METHODS

We conducted trend analyses based on 1974 through 1991 current smoking prevalence data among persons aged 12 through 19 years from the National Household Surveys on Drug Abuse, High School Seniors Surveys, and National Health Interview Surveys.

RESULTS

Overall smoking prevalence declined much more rapidly from 1974 through 1980 (1.9 percentage points annually among younger adolescents; the range among surveys of older adolescents was 0.2 to 2.0 percentage points annually) than from 1985 through 1991 (0 to 0.5 percentage points annually among all adolescents). Since 1980, smoking has generally declined at a slightly faster rate among older female adolescents than among male adolescents. Smoking among Black adolescents of all ages declined in nearly every survey population during each study period (range among surveys: 1974-1985 = 1.0 to 2.9 percentage points; 1985-1991 = 0.7 to 1.5 percentage points annually); for White adolescents, only minimal declines in smoking have occurred since 1985.

CONCLUSIONS

Since 1974, major changes in adolescent smoking patterns have occurred, especially among Blacks. The overall slowing rate of decline in smoking prevalence since 1985 may indicate success of increased tobacco advertising and promotional activities targeted at adolescents or inadequate antitobacco education efforts.

Social influence predictors of alcohol use among New York Latino youth

We examined demographic and social influence predictors of adolescent drinking among New York City Latino adolescents, including specific Latino subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian). Sixth- and seventh-grade students (N = 3129) who identified themselves as Latino or Hispanic on the survey questionnaire comprised our Latino sample. The survey included self-reported frequency of alcohol use, demographic items, and measures of social influences for drinking. Logistic-regression analyses revealed that social influences (how many friends drink, attitudes of parents and friends toward respondent's drinking) are strong predictors of current drinking (defined as drinking at least once a month) for the overall sample of Latino youth, as well as for Puerto Rican youth and Dominican youth. Findings are discussed in terms of their implications for prevention.

[Efficacy of smoking prevention campaign in adolescents: critical review of the literature]

This review is intended to assist those interested in smoking prevention in young people in choosing the most efficient and cost-effective methods. The importance of a critical analysis of the abundant literature available on the topic before implementing a new programme is stressed. In view of the present knowledge, preventive methods should start at age 12 and extend up to age 18 through actualizing sessions. The most promising programme should include learning to resist to social pressures and a cognitive and developmental approach which anchor smoking prevention in the psychological evolution of the adolescent. Training of peers being disproportionate in regard to what can be expected from their intervention, one key element is the teacher's training in the technique of changing behaviour. Evaluation of methodology and of long term results should belong to any programme.

The context of smoking initiation and maintenance: findings from interviews with youths

The characteristics of initial cigarette-smoking situations and subsequent situations in which adolescents received an offer to smoke were examined by means of interviews with 287 youths in grades 7 through 10. Initiation of smoking generally took place in a social context (89%), with small groups (2.7 people) of same-gender, older (2.1 years), peers (and siblings) who were smokers (60%). In one-third of these onset situations, another novice smoked for the first time. Most subjects (81%) reported that they smoked their first cigarette because they accepted an offer. The characteristics of the onset situation did not significantly differ between regular and experimental smokers. The situations for later offers to smoke were similar: small groups of same-gender, slightly older, cigarette-smoking peers (and siblings). Descriptive and comparative data also are presented on procurement, perceived prevalence, parental influence, cravings, quit attempts, beliefs about ease of quitting, and intention to smoke. These data suggest that school-based interventions may not be sufficient to address the broad social context surrounding adolescent tobacco use. Community-wide interventions are advocated.

Change in children's smoking from age 9 to age 15 years: the Dunedin Study

Studies have shown that the rate at which children take up smoking is still very high, particularly for female adolescents. While some progress has been made in determining the factors related to the initiation of smoking, an issue that still requires investigation is the relationship between early smoking patterns and later smoking behaviour. This paper reports the results of a longitudinal study which examined the continuity between smoking at an early age and later smoking behaviour. The smoking behaviour of a cohort of New Zealand children was followed from age 9 to age 15 years. Results showed that children's smoking pattern at age 9 years was not highly related to their smoking behaviour at age 15. The children most likely to become daily smokers by age 15 were those who had smoked within the last year at ages 11 and 13. It was concluded that the formative period for children's daily smoking at age 15 was from 10 to 13 years of age.

A human immunodeficiency virus peer education program for adolescent females

Black adolescent females living in urban environments are at high risk for human immunodeficiency virus (HIV) infection. Our objectives were to develop an HIV peer education program and to pilot-test its effect on knowledge and sexual behavior. Between September 1989 and March 1990, all females aged 12-19 years attending an inner-city, hospital-based adolescent clinic were invited to meet individually with trained peer educators (10 females aged 16-19 years) to discuss acquired immunodeficiency syndrome (AIDS) and its prevention. Each participant completed a modified version of the AIDS Knowledge and Attitudes Survey immediately before and 2-6 weeks after the counseling session. Of the 283 counseled patients, 241 (85%) completed the follow-up questionnaire and comprised the study sample. Mean age was 15.6 years, mean Hollingshead (parental occupational) score was 3.4, and 216 (90%) patients were black. Baseline knowledge about routes of transmission was high and did not improve on follow-up. Comparison of individual baseline and follow-up responses revealed improvements (p less than 0.05) in routes by which HIV is not transmitted, methods of prevention, individuals at risk, and general information about AIDS. The improvement in total score between baseline and follow-up was 38% for patients with low baseline scores, 13% for middle scores, and 3% for high scores (p less than 0.05). At baseline, 50 (21%) patients reported sexual intercourse within the preceding 2 weeks, compared to 33 (14%) at follow-up (p less than 0.05). Of the sexually active patients, 22 (44%) reported no condom use at baseline, compared to 11 (33%) at follow-up (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent smoking

Most smokers start experimenting with cigarettes in early adolescence. This paper describes the factors which influence the development of the smoking habit. Methods of intervention, both in and out of the classroom, are discussed. Recommendations for further legislation and increased taxation on tobacco are supported.

Depressive mood, the single-parent home, and adolescent cigarette smoking

The association between depressive mood and cigarette smoking among adolescents was examined within a multivariate model. Subjects were 205 eleventh graders (123 boys and 82 girls) enrolled in a Northeast metropolitan public high school for science-oriented students. Logistic regression analysis showed an independent relation of depressive mood, friends' smoking behavior, and living in a single-parent home with cigarette smoking. Depression scores correlated with the number of cigarettes smoked. These associations suggest that depressive mood and stress may contribute to the onset of smoking.

Adolescent wellness. Facilitating compliance in social morbidities

The establishment of a well adolescent schedule needs to be developed similar to the scheduled clinical visits in pediatric care. However, providing adolescent wellness visits without appropriate financial reimbursement for time expended and without increased provider training may make "well" adolescent visits an unrealistic expectation. However, two major trends will significantly impact on the future of adolescent health care. These include a sharp increase in numbers of adolescents beginning in 1990 and the poverty within the adolescent population. These data suggest that obstacles, whether personal, financial, or educational, need to be addressed quickly in order to resolve these problems because of increasing numbers of adolescents and related morbidities through the year 2000. The increasing trend of juvenile poverty in this population has been significantly associated with a number of the new morbidities such as substance abuse, STD, pregnancy, and the latest morbidity, AIDS. Without a wellness schedule, it is likely that adolescents will continue to represent an underserved population; as a consequence, mortalities and morbidities will increase through the year 2000. The issue of adherence to prescribed medical regimens in the adolescent population is an interesting, complex, and especially challenging one when faced with the social morbidities. Although preliminary work in this area has progressed in the last 15 years, greater attention must be paid to the needs of adolescents in order to determine effective strategies that can minimize the effects of the current morbidities. It is important for the primary care physician not to become overwhelmed with the scope of problems that adolescents have or become discouraged because anticipatory guidance seems ineffective. Repeated dosages of anticipatory guidance should not be viewed as limitations or failures but rather as necessary and standard care. One should consider such interventions as similar to immunizations, in which certain vaccines result in life-long immunity. One would not eliminate the tetanus vaccine because the patient must receive periodic boosters. Similarly, as health care professionals, we should not consider interventions designed to preclude behavior or mental health problems as failures if periodic and developmentally appropriate relevant "boosters" are necessary. Anticipatory guidance is an extremely effective tool that every primary care physician has at his or her disposal to assist in the diagnosis of problematic behavior in adolescents and to preclude problems. Future research needs to focus on documenting strategies that can be utilized by physicians on a daily basis without excessive time or financial constraints.(ABSTRACT TRUNCATED AT 400 WORDS)