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

The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuation

Although the influence of peers on adolescent smoking should vary depending on social dynamics, there is a lack of understanding of which elements are most crucial and how this dynamic unfolds for smoking initiation and continuation across areas of the world. The present meta-analysis included 75 studies yielding 237 effect sizes that examined associations between peers' smoking and adolescents' smoking initiation and continuation with longitudinal designs across 16 countries. Mixed-effects models with robust variance estimates were used to calculate weighted-mean Odds ratios. This work showed that having peers who smoke is associated with about twice the odds of adolescents beginning (OR ¯ = 1.96, 95% confidence interval [CI] [1.76, 2.19]) and continuing to smoke (OR ¯ = 1.78, 95% CI [1.55, 2.05]). Moderator analyses revealed that (a) smoking initiation was more positively correlated with peers' smoking when the interpersonal closeness between adolescents and their peers was higher (vs. lower); and (b) both smoking initiation and continuation were more positively correlated with peers' smoking when samples were from collectivistic (vs. individualistic) cultures. Thus, both individual as well as population level dynamics play a critical role in the strength of peer influence. Accounting for cultural variables may be especially important given effects on both initiation and continuation. Implications for theory, research, and antismoking intervention strategies are discussed. (PsycINFO Database Record

The Impact of Cigarette Plain Packaging on Health Warning Salience and Perceptions: Implications for Public Health Policy

The study employed a mixed methods design using focus group interviews with 6 student groups and self-administered questionnaires with 1239 students. The participants were nonsmoking, current smokers, and quit-smoking teenagers from secondary schools and colleges. Focus group revealed that although nonsmoking teenagers perceived fear appeals to warning messages, current smokers did not perceive fear appeals to health. Black and white backgrounds of the cigarette package were chosen as the best color for plain packaging. However, most participants suggested various pictorials and a bigger size of pictorial warnings for greater and more effective fear appeal. Odds ratio showed that males had 2.43 times the odds to perceive intention not to smoke. Teenagers who had never smoked and those who had quit smoking had 13.27 and 3.61 times the odds, respectively, to perceive intention not to smoke.

Smoking cessation-specific parenting and parental smoking as precursors of adolescent smoking cognitions and quitting

Relatively little is known about if and through which mechanisms parents influence adolescents' smoking cessation. The present study used Social Cognitive Theory as a theoretical framework to test whether parental smoking and smoking cessation-specific parenting (SCSP) predicted readiness to quit smoking and actual smoking cessation one year later. Both direct paths between parent factors and outcomes, and indirect paths via adolescents' smoking-specific cognitions (pros of smoking and quitting, and self-efficacy) were examined in a sample of 530 adolescents in the ages of 13 to 18 who smoked daily and weekly at baseline. The main findings show that although parental smoking and SCSP were significantly associated with cognitions (cross-sectionally), neither the parent factors nor cognitions predicted readiness to quit smoking or actual cessation one year later. Baseline SCSP did predict readiness to quit one year later. Parents may be more influential in shaping adolescents' beliefs and readiness to quit than in facilitating actual cessation.

Secondhand smoke in Geneva, 1996-2006: changes in exposure, opinions, and workplace smoking bans in the absence of national legislation

Postal surveys were conducted in 1996 and 2006 to assess change in duration of exposure to secondhand tobacco smoke (SHS), frequency of smoking bans at the workplace, and opinions on smokefree measures in Geneva, Switzerland in the absence of national smoke-free legislation. A random sample of 742 participants in 1996 and 1487 in 2006 showed length of exposure to SHS decreased from 7 hours/week to 4 hours/week, with the largest decrease among 26-45 year olds. Workplace smoking bans increased from 33.4% to 66.3% (p < 0.001). Agreement that SHS is dangerous to health increased from 77.5% to 86.0% (p = 0.006). Agreement that all restaurant tables should be reserved to nonsmokers also increased, from 14.8% to 41.4% (p < 0.001). Opinions were more favorable to all smoke-free measures in 2006 than in 1996, except, "More information should be given on the health dangers of SHS," suggesting a level of saturation was reached for information on SHS.

School-based smoking prevention programs with the promise of long-term effects

I provide a systematic review of trials of school-based smoking prevention programs that had at least 15 sessions, preferably with some in high school, that reported significant short-term effects, and that included long-term follow-up. This is supplemented with a description of some other programs that produce short-term effects that portend large long-term effects. I conclude that school-based programs can have long-term effects of practical importance it they: include 15 or more sessions over multiple years, including some in high school; use the social influence model and interactive delivery methods; include components on norms, commitment not to use, intentions not to use, and training and practice in the use of refusal and other life skills; and use peer leaders in some role. School-based programs of this type can reduce smoking onset by 25-30%, and school plus community programs can reduce smoking onset by 35-40% by the end of high school. Some early childhood programs that do not have smoking prevention as their main aim, including home nursing, the Good Behavior Game, the Positive Action program and others, seem to change the developmental trajectories of children so that they are less likely to engage in multiple problem behaviors, including smoking, as adolescents. This review makes it clear that effective school-based smoking prevention programs exist and can be adopted, adapted and deployed with success - and should be.

Testing Social Cognitive Theory as a theoretical framework to predict smoking relapse among daily smoking adolescents

Predictors of adolescent smoking relapse are largely unknown, since studies either focus on relapse among adults, or address (long-term) smoking cessation but not relapse. In the present study, Social Cognitive Theory (SCT) was used as a theoretical framework to examine the first and second lapses, as well as mild and heavy relapse into smoking among 135 daily smoking adolescents who embarked on a serious quit attempt. Baseline predictors were pros of smoking, pros of quitting, self-efficacy, and intensity of smoking. Using an ecological momentary assessment (EMA) study design, participants were monitored three times a day during 4 weeks. A follow-up was administered 2 months after the monitoring period. Perceiving many pros of smoking, reporting a low self-efficacy to quit, and high levels of baseline smoking significantly predicted relapse within 3 weeks after quitting. The effects of pros of smoking and self-efficacy on relapse, however, appeared to be accounted for by differences in intensity of smoking. Besides that pros of quitting showed a marginal effect on abstinence at the 2-month follow-up, no long-term effects were detected.

Understanding differences in substance use among bisexual and heterosexual young women

BACKGROUND

Numerous studies have documented higher substance use rates among bisexual than heterosexual young women, although little is known about the developmental factors contributing to these differences. Based on self-reported sexual orientation collected at age 23, this study identified similarities and differences between bisexual and heterosexual women in their substance use at ages 14 and 18, compared these groups at ages 14 and 18 on key psychosocial factors known to predict young adult substance use, and determined whether these psychosocial factors at age 18 could account for sexual orientation differences in substance use at age 23.

METHODS

Longitudinal survey data from a West Coast cohort were used to compare heterosexual (n = 1,479) and bisexual (n = 141) women on their substance use and psychosocial characteristics.

RESULTS

During adolescence, bisexual women were more likely to have been current and solitary substance users; reported stronger pro-drug beliefs and lower resistance self-efficacy; perceived greater parental approval of their substance use; had more exposure to substance-using peers; and reported poorer mental health. By age 23, bisexual women had higher rates of current substance use, greater quantity and frequency of use, and more problematic alcohol and drug use. Differences in problematic use at age 23 could be partially explained by risk factors assessed five years earlier at age 18, particularly pro-drug social influences and beliefs.

CONCLUSIONS

Notwithstanding the lack of longitudinal data on sexual orientation, these results provide important insights regarding the drug prevention needs of bisexual women.

Availability influences initial and continued ingestion of nicotine by adolescent female rats

BACKGROUND

The availability of tobacco products is associated with the likelihood that adolescents will begin using tobacco. Yet the relationship between nicotine availability and voluntary consumption has not been tested experimentally in developing rats.

METHOD

The impact of environmental availability on adolescent female rats' initial reaction to and continued ingestion of a novel solution (nicotine or control) was compared using a standard 2-bottle free-choice method and a multiple-bottle method.

RESULTS

Manipulating the ratio of bottles containing novel solution to water directly influenced the amount of both nicotine and control solutions consumed. Although subtle differences emerged in intake patterns with prolonged exposure, overall intake patterns were remarkably similar for nicotine and control solutions.

CONCLUSION

The intake of oral nicotine was directly influenced by the availability of nicotine solution relative to water. The results indicate that simply providing the right environment is sufficient, and perhaps necessary, to increase rats' voluntary consumption of a nicotine solution without relying on deprivation or sweetening of the solution. That overall intake patterns were comparable for nicotine and control solutions suggests that this may be a general principle of rodent behavior rather than an effect specific to nicotine.

Smoking and adolescence: narratives of identity

The purpose of this study was to understand the identities that youth hold in relation to smoking, as revealed in narrative accounts of their smoking experiences. The analysis was a narrative inquiry, a qualitative approach based on the propensity of people to narrate or tell stories about the experiences in their daily lives. A purposeful sample of 35 youths ages 14-18 years with a variety of smoking histories (all had tried smoking) participated in in-depth interviews. A detailed analysis of the transcripts revealed the key identities communicated by the youths including the confident nonsmoker, the vulnerable nonsmoker, the ardent nonsmoker, the accepting nonsmoker, the in-control smoker, the confirmed smoker, and the contrite smoker. Tobacco control interventions for youth must be designed to respond to and incorporate multiple smoking identities.

The relation of retail tobacco availability to initiation and continued smoking

Used an ecological analysis employing multilevel random-effects regression analyses to model Level 1 (individual and social) and Level 2 (environmental) correlates of smoking initiation and continued smoking among 6th-, 7th-, and 8th-grade students. Data from 5,234 youth in 11 Midwestern communities were examined. Results indicate higher levels of retail tobacco availability (RTA) were associated with increased odds that a youth initiated smoking but not continued smoking. Among the Level 1 factors, youth who were older, male, had an adult tobacco user in the home, and had more peers who use tobacco had increased odds of initiating smoking. In contrast, only the presence of an adult tobacco user in the home and the number of peers who use tobacco were associated with increased odds that a youth continued smoking. Examining individual, social, and environmental factors simultaneously provides a clearer and more accurate model of these complex ecological influences.

Familial influences on adolescent smoking

The family unit is the primary source of transmission of basic social, cultural, genetic, and biological factors that may underlie individual differences in smoking. Existing information on the role of familial factors in tobacco use is characterized by two separate, but somewhat overlapping, lines of research: genetic epidemiological studies and risk-factor research. The present paper summarizes and evaluates studies assessing the association between adolescent smoking and parent and sibling smoking behaviors. A review of 87 studies reveals that methods are limited by a lack of standardized instruments, failure to measure important confounding and mediating factors, reliance on cross-sectional designs and the use of inconsistent definitions of tobacco-related behavior and assessment procedures. Moreover, there are no systematic family studies of the acquisition and continuation of smoking that have employed contemporary methodological standards for examining familial aggregation of tobacco behaviors among adolescents. Findings across studies show weak and inconsistent associations between parent and adolescent smoking; inconsistent findings may be attributed to methodological issues or associated factors that may complicate the relation between parent and adolescent smoking. Sibling and peer smoking show greater associations with adolescent smoking. Suggestions for future research include contemporary family studies that delineate meaningful phenotypes of tobacco use and prospective work on the later stages of tobacco use and the timing of the influence and valence of parent and family factors. Integration of the risk factor approach within the family study design may enrich both approaches to elucidate familial influences on smoking.

Theory, measurement, and methods in the study of family influences on adolescent smoking

This paper discusses three dilemmas faced by researchers interested in family influences in substance use: the transitional nature of adolescent smoking, the complexity and multi-dimensionality of family forms and influences, and the inter-relationship of family influences with other key developmental contexts. Methodological and conceptual issues stemming from these dilemmas are discussed with regard to understanding why previous reviews have found the correlations between family predictors and adolescent smoking to be relatively low. In particular, the importance of understanding time, the transitional nature of the phenomenon, and within- and between- family processes are emphasized. More appropriate conceptual and statistical models for analyzing family influences are suggested, including both mixed models and person-centered approaches.

Relationship between student illicit drug use and school drug-testing policies

This report provides information about drug testing by American secondary schools, based on results from national surveys. The study provides descriptive information on drug-testing practices by schools from 1998 to 2001, and examines the association between drug testing by schools and reported drug use by students. School-level data on drug testing were obtained through the Youth, Education, and Society study, and student-level survey data were obtained from the same schools participating in the Monitoring the Future study. A relatively small percentage of schools (about 18%) reported testing students for drug use, with more high schools than middle schools reporting drug testing. Drug testing was not associated with students' reported illicit drug use, or with rate of use among experienced marijuana users. Drug testing of athletes was not associated with illicit drug use among male high school athletes. Policy implications are discussed.

Enhancing the effectiveness of tobacco package warning labels: a social psychological perspective

OBJECTIVE

To outline social psychological principles that could influence the psychosocial and behavioural effects of tobacco warning labels, and to inform the development of more effective tobacco warning labels.

DATA SOURCES

PsycInfo and Medline literature searches and expert guided selection of principles and theories in social psychology and of tobacco warning labels, including articles, books, and reports.

CONCLUSIONS

Tobacco warning labels represent a potentially effective method of influencing attitudes and behaviours. This review describes social psychological principles that could be used to guide the creation of more effective warning labels. The potential value of incorporating warning labels into a broader public health education campaign is discussed, and directions for future research are suggested.

Effectiveness of a school-based intervention at changing preadolescents' tobacco use and attitudes

This study evaluated the effectiveness of a tobacco intervention on preadolescents' tobacco use and attitudes. A tobacco assessment questionnaire was distributed to seventh-grade students in May 1997 (N = 229) and 1999 (N = 230). During the 1998-1999 academic year, sixth-grade students at the intervention school received a tobacco intervention. Though not statistically significant, the number of smokers at the intervention school decreased from 43.2% to 31.1% after the intervention (p = .09). These students predicted less smoking in five years (29.6% to 19.8%, p = .078) and 20 years (28.4% to 13.2%, p = .004). Because of the difficulty in reducing smoking rates at the population level, the nonsignificant results can be viewed as a success rather than a setback. When faced with increasing use trends, an intervention can at least hope to achieve a decrease or slow the rate of growth, and the program succeeded in that respect. School-based interventions can effectively influence preadolescent' attitudes concerning tobacco use. Future programs should begin earlier and be reinforced yearly.

Evaluating the effects of a peer support programme on adolescents' knowledge, attitudes and use of alcohol and tobacco

This study was designed to evaluate the effects of a peer support programme on adolescents' knowledge, attitudes and use of alcohol and tobacco. Year 7 students (average age 12 years) from three schools who offered the programme (n = 169) and from three schools without the programme (n = 157) completed a self-report assessment. Perceptions of their parents' and friends' use of alcohol and tobacco and attitudes towards the participants' use of these substances as well as the participants' own attitudes (preferences and norms) and use of the substances were assessed on three occasions; pre-intervention, post-intervention and at 6 months follow-up. There were no significant effects of the programme on participants' knowledge, attitudes and use of alcohol and tobacco. Over time, participants in both groups reported increased enjoyment of alcohol, increased use of alcohol and tobacco and more lenient attitudes towards these substances. In conclusion, the peer support programme failed to show any positive influence on adolescents' knowledge, attitudes and use of alcohol and tobacco.

Adolescent smoking cessation: how effective have we been?

Adolescent smoking, at its current rate, is considered a pediatric epidemic, with 3,000 youths less than 18 years of age becoming regular smokers each day (Johnson, O'Malley, & Bachman, 1998). The reasons adolescents begin and continue to smoke are multifactorial. There is a paucity of research describing effective adolescent smoking-cessation programs. Much of the research on adolescent tobacco use has focused on correlates and prevention of onset, rather than on intervention with active smokers. Current research indicates that 75% of adolescents who currently smoke want to quit. It is essential that nurses involved with adolescent health promotion become active in smoking-cessation efforts. This article describes the risk factors for adolescent smoking and identifies smoking-cessation strategies, with interventions specific to the adolescent population.

Psychosocial factors related to adolescent smoking: a critical review of the literature

OBJECTIVE

To extend the analysis of psychosocial risk factors for smoking presented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding the development of smoking.

DATA SOURCES

General Science Index, Medline, PsycLIT, Sociofile, Sociological Abstracts, and Smoking and Health. Holdings of the Addiction Research Foundation of Ontario Library as well as the authors' personal files.

STUDY SELECTION

Reviewed literature focused on studies that examined the association of sociodemographic, environmental, behavioural, and personal variables with smoking.

DATA SYNTHESIS

Adolescent smoking was associated with age, ethnicity, family structure, parental socioeconomic status, personal income, parental smoking, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, family environment, attachment to family and friends, school factors, risk behaviours, lifestyle, stress, depression/distress, self-esteem, attitudes, and health concerns. It is unclear whether adolescent smoking is related to other psychosocial variables.

CONCLUSIONS

Attempts should be made to use common definitions of outcome and predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypotheses. Future research should be theory driven and consider the range of possible factors, such as social, personal, economic, environmental, biological, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic status and adolescent disposable income need to be resolved as does the underlying constructs for which socioeconomic status is a proxy.

Antecedents of smoking cessation among adolescents: who is motivated to change?

BACKGROUND

In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation.

METHODS

Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits.

RESULTS

Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting).

CONCLUSIONS

Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.

Stages of acquisition and cessation for adolescent smoking: an empirical integration

Adolescent cigarette smoking acquisition and cessation were integrated into a single nine-stages-of-change continuum using the transtheoretical model of change framework. Findings in a high school student sample (n > 700) showed that a few of the never smokers were planning to try smoking, and half of the current smokers were contemplating quitting. More than half of former smokers were long-term quitters. The high pros of smoking scores assessing coping benefits of cigarettes were related to smoking acquisition and the high con (disadvantages) scores to long-term abstinence. Never smokers were most tempted to try smoking when they anticipated that smoking would help reduce negative and increase positive mood. Current and former smokers were tempted due to peer cigarette offers and negative mood. These temptations were significantly reduced among ex-smokers.

Adolescents' experiences of smoking cessation

Recent prevalence rates show that by Year 10 (ages 14-16 years), 15% of students are smoking each day. As the majority of young people do not smoke, schools have traditionally provided an emphasis on prevention. However, the prevalence of daily smoking increases from 15 to 31% across the last 3 years of secondary school, suggesting a need for cessation programs. Therefore, a study of smoking cessation among students was conducted with 2877 Year 10 students in Queensland, Australia. Results of the survey showed that students (i) moderately under-estimated the number of smoking peers who had tried to stop smoking (perceived as 42%, reported as 55%), and (ii) over-estimated the success their smoking peers have (perceived as 29%, reported as 13.6%). The majority of adolescents (57.5%) reported that they had done something to influence a student not to smoke in the last 12 months, including 29% of the smokers. Among those who were current smokers, 64% wanted to stop smoking and 55% had tried to stop in the past year. Withdrawal symptoms were frequently reported among adolescent smokers and more males than females reported being stressed and depressed as a result of their efforts to quit. Intention to quit in the next year was associated with high confidence in ability to quit. These issues deserve attention in prevention programs and the development of age appropriate cessation material for adolescents should have high priority.

Adolescents' promotion of nonsmoking and smoking

Previous studies of the influence of friends on adolescent smoking have adopted the approach of asking adolescents about their friends. However, studies in which the friends were also approached have shown that adolescents' reports of friends behavior were not accurate (more closely resembled their own behavior). In order to gauge the level of active social influence among adolescents we asked 14-15 year old students what they did to influence others not to smoke or to smoke. Across two surveys, a quarter of the Form 4 students were promoting antismoking messages or activities and 3% were promoting smoking by encouraging or forcing friends, siblings and acquaintances to smoke. Relatively more positive beliefs about smoking identified those students who actively promoted smoking whereas some positive beliefs about the adverse effects of cigarette advertising tended to identify those who were actively antismoking. Use of this approach to examine the issue of social influence provided information about the antismoking activities which students conducted, and could be used to further examine which messages students do not believe or do not use. For example, students believed that smoking reduces fitness but did not promote this message to others, and the reasons for such disparity need to be investigated and should be addressed in the content of prevention programs.

Individual differences in sensitivity to nicotine: implications for genetic research on nicotine dependence

Recent evidence suggests that cigarette smoking has a heritability index around 53%. While related research on underlying mechanisms also supports the idea that genetic factors contribute to nicotine dependence--as well as to cofactors such as substance use and mood disorders--the nature of the behavioral traits and biological capacity for reinforcement that constitutes vulnerability to nicotine dependence is not well understood. The present review explores the problem of why some people become highly nicotine dependent, others develop a pattern of occasional use, and still others avoid the drug entirely despite extensive exposure and widespread experimentation with tobacco in the population. Recent research--both infrahuman and human--suggests that vulnerability to nicotine dependence is related to high initial sensitivity to nicotine and that the development of tolerance is more rapid and self-administration more extensive in such individuals. Relevant findings from neuroscience and biobehavioral research are reviewed in order to identify variables and methodologies that might improve the reliability and validity of behavioral and molecular genetic studies on cigarette smoking. The integration of research in these areas may lead to new insights in the understanding of nicotine dependence as well as to improved techniques for prevention and treatment.