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James PB, Bah AJ, Kabba JA, Kassim SA, Dalinjong PA. Prevalence and correlates of current tobacco use and non-user susceptibility to using tobacco products among school-going adolescents in 22 African countries: a secondary analysis of the 2013-2018 global youth tobacco surveys. Arch Public Health 2022; 80:121. [PMID: 35422011 PMCID: PMC9009031 DOI: 10.1186/s13690-022-00881-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Our study examined the prevalence and associated factors of tobacco product use and non-users' susceptibility to using tobacco products among school-going adolescents in 22 African countries. METHODS We analyzed the cross-sectional 2013-2018 Global Youth Tobacco Survey (GYTS) data from 22 African countries. We conducted complex sampling descriptive and logistic regression analyses. RESULTS The overall prevalence of current use of any tobacco product among adolescents was 19.1%, with more males (23.7%) than females (13.7%) being current users. Zimbabwe and Morocco were the highest (47.1%) and least (12.6%) reported prevalence, respectively. Being male (AOR = 1.93;95%CI:1.61-2.32), being 16 and older(AOR = 1.37;95%CI:1.01-1.86), exposure to secondhand smoke within (AOR = 1.98;95%CI:1.69-2.32) and outside (AOR = 1.37;95%CI:1.13-1.65) the home, not knowledgeable about the harmful effect of secondhand smoke (AOR = 1.44;95%CI:1.20-1.74), exposure to tobacco industry promotion (AOR = 3.05;95%CI:2.68-3.47) and not in favour of banning smoking in enclosed places (AOR = 1.32;95%CI:1.08-1.60) were associated with current use of any tobacco product. The prevalence of the susceptibility to using tobacco products among never users of tobacco products was 12.2%, with no significant gender difference. Mozambique (24.6%) and Algeria (4.5%) had the highest and least prevalence of susceptibility to using tobacco products among never users, respectively. Exposure to tobacco industry promotion (AOR = 1.54;95%CI:1.31-1.82), those not in favour of banning smoking in enclosed places (AOR = 1.29;95%CI:1.14-1.45) and those not exposed to anti-smoking school education (AOR = 1.24;95%CI:1.06-1.46) were associated with susceptibility to using any tobacco product among never users of tobacco products. CONCLUSION Our study reports that tobacco use and non-user susceptibility to using tobacco products among school-going adolescents in the 22 African countries is high. As part of public health efforts, governments and other stakeholders need to fully implement anti-tobacco use campaigns, enforce a complete ban on tobacco promotion and advertising, institute educational programs for families, and anti-tobacco use education for the general public and in schools in line with WHO Framework Convention on Tobacco Control guidelines.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, New South Wales, 2480, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China
| | - Said Abasse Kassim
- Département de Management, Centre de Recherche en Gestion des Services de Sante, Faculté des sciences de l'administration (FSA), Université Laval (UL), Centre Hospitalière Universitaire (CHU) de Québec, Québec, CA, G1V 0A6, Canada
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Polanska K, Znyk M, Kaleta D. Susceptibility to tobacco use and associated factors among youth in five central and eastern European countries. BMC Public Health 2022; 22:72. [PMID: 35016662 PMCID: PMC8753878 DOI: 10.1186/s12889-022-12493-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Yang X, Yan Z, Xu G, Tan Y, Zhu J. How secondhand smoke exposure affects tobacco use and smoking susceptibility of adolescents: Sex and school differences. Tob Induc Dis 2021; 19:68. [PMID: 34539307 PMCID: PMC8409096 DOI: 10.18332/tid/140094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure affects tobacco related health behaviors during adolescence and persists into adulthood. This study aimed to investigate the influence of SHS exposure on tobacco use among adolescents stratified by school and gender, and provide recommendations for controlling tobacco use in youth. METHODS Through stratified random cluster sampling, 12278 selected students (aged 13-18 years) from schools in China were administered questionnaires. Multiple logistic regression was used to analyze whether SHS exposure would increase the smoking risk and susceptibility of adolescents. RESULTS The prevalence of SHS exposure among the participating students was 74.8%. Adolescents exposed to SHS were at higher odds of being susceptible and currently smoking. Students with SHS exposure at both home and public places accounted for 36.6%, greatly increasing the current smoking risk and smoking susceptibility. Home SHS exposure had greater impact on the current tobacco use of boys (OR=2.13; 95% CI: 1.50-3.03) and junior school students (OR=4.67; 95% CI: 2.41-9.06). Exposure from public places increased the risk of current smoking in boys (OR=4.20; 95% CI: 2.31-7.65) and smoking susceptibility of vocational school students (OR=1.51; 95% CI: 1.07-2.15). Students with highlevel exposure to SHS had 2.25 times higher odds of e-cigarette use. CONCLUSIONS The prevalence of SHS exposure is still high among adolescents in China and is associated with increased risk for tobacco use regardless of gender and school level. Effective smoke-free strategies should be developed and strictly implemented. Boys and junior school students constitute vulnerable populations exposed to SHS at home.
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Affiliation(s)
- Xiaochen Yang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zhongheng Yan
- The Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yinliang Tan
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jingfen Zhu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Polańska K, Wojtysiak P, Bąk-Romaniszyn L, Kaleta D. Susceptibility to cigarette smoking among secondary and high school students from a socially disadvantaged rural area in Poland. Tob Induc Dis 2016; 14:28. [PMID: 27531970 PMCID: PMC4986373 DOI: 10.1186/s12971-016-0092-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/05/2016] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Kinga Polańska
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, Zeligowskiego 7/8 Street, 90-752 Lodz, Poland
| | - Piotr Wojtysiak
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, Zeligowskiego 7/8 Street, 90-752 Lodz, Poland
| | - Leokadia Bąk-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Dorota Kaleta
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, Zeligowskiego 7/8 Street, 90-752 Lodz, Poland
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Abstract
BACKGROUND Light smoking, consuming a few cigarettes daily, and intermittent, or nondaily, smoking patterns are increasingly common but carry health risks comparable to heavier smoking patterns. Nearly all smokers begin smoking as adolescents, who are at risk for developing these smoking patterns. Previous research suggests that smokers underestimate the risks associated with smoking. The extent to which adolescents perceive light and intermittent smoking as harmful has not been previously assessed. METHODS Data from 24,658 US adolescents sampled by the 2012 National Youth Tobacco Survey, a national, school-based, cross-sectional survey, were examined. Cross-tabulations and multivariate ordered probit regression models were constructed to describe correlates of US adolescents' perception of light and intermittent smoking. RESULTS Although most adolescents (88.0%; 95% confidence interval [CI], 87.2% to 88.8%) reported beliefs that a heavier smoking pattern is very harmful, only 64.3% (95% CI; 63.2% to 65.3%) and 33.3% (95% CI; 32.0% to 34.6%) reported that light and intermittent smoking, respectively, are very harmful. Conversely, nearly one-quarter of US adolescents believed intermittent smoking causes little or no harm. Males, younger adolescents, Hispanics, and non-Hispanic blacks were more likely than their peers to view light and intermittent smoking patterns as less harmful. Those who were already light or intermittent smokers, those who used other tobacco products, and those who had a family member who used tobacco were also less likely to view their smoking patterns as harmful. CONCLUSIONS Misconceptions about the safety of light and intermittent smoking are widespread among US adolescents. Significant public health attention is needed to redress these misperceptions.
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Affiliation(s)
| | - Michael Weitzman
- Departments of Pediatrics, and,Environmental Medicine, New York University School of Medicine, New York, New York; and,Global Institute of Public Health, New York University, New York, New York
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Treur JL, Boomsma DI, Lubke GH, Bartels M, Vink JM. The predictive value of smoking expectancy and the heritability of its accuracy. Nicotine Tob Res 2014; 16:359-68. [PMID: 24169813 PMCID: PMC3983427 DOI: 10.1093/ntr/ntt155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/31/2013] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Among smokers, former smokers, and never-smokers, this study aimed to (a) determine the predictive value of smoking expectancy on future smoking status, and (b) test the relative contribution of genes and environment to a person's ability to accurately predict future smoking status. For smokers, smoking expectancy reflects the intention to continue smoking; for former smokers, it reflects the intention to take up smoking again; and for never-smokers, it reflects the intention to initiate smoking. METHODS A longitudinal design was employed in which participants of the Netherlands Twin Register completed 2 consecutive surveys 2 years apart between 1993 and 2011 (3,591 adolescents aged 14-18 years), or between 1993 and 2004 (11,568 adults, aged 18+ years). Smoking expectancy was measured by asking, "Do you think you'll smoke in a year's time?", with answer categories ranging from "certainly not" to "absolutely yes" on a 5-point scale. To determine the predictive value of smoking expectancy, analyses were performed in smokers, former smokers, and never-smokers separately. Data of 2,987 adolescents and 4,911 adult twins were analyzed to estimate heritability. A dichotomous variable reflected the ability to predict future smoking status (correct/incorrect). RESULTS Smoking expectancy significantly predicted future smoking status among former smokers and never-smokers. The ability to accurately predict future smoking status was explained by additive genetic factors for 59% of adolescents and 27% of adults, with the remainder being explained by unique environmental factors. CONCLUSIONS A single question on smoking expectancy helps predict future smoking status. Variation in how well subjects predict their future smoking behavior is influenced by genetic factors, especially during adolescence.
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Affiliation(s)
- Jorien L. Treur
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
| | - Dorret I. Boomsma
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
| | - Gitta H. Lubke
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
- Department of Psychology, University of Notre Dame, Notre Dame, IN
| | - Meike Bartels
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
| | - Jacqueline M. Vink
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands
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Worldwide never-smoking youth susceptibility to smoking. J Adolesc Health 2014; 54:144-50. [PMID: 24060576 DOI: 10.1016/j.jadohealth.2013.07.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate susceptibility to smoking among never-smoking youth globally and identify factors associated with such behavior. METHODS Cross-sectional data for 168 countries were obtained from the Global Youth Tobacco Survey. Simple and multiple logistic regression analyses were conducted. Frequencies and proportions for descriptive statistics, and adjusted odds ratios with 95% confidence intervals for logistic regression models were reported. RESULTS Approximately 12.5% of never-smoking youth worldwide were susceptible to smoking worldwide, of which 7.2% were males and 5.3% were females. Compared with youth in the Americas, those in other WHO regions were associated with decreased susceptibility to smoking. Regardless of gender, exposure to parental or peer smoking, secondhand smoke inside or outside home, and tobacco industry promotion was associated with increased smoking susceptibility. In contrast, support for smoke-free policies and school antismoking education was associated with decreased susceptibility to smoking among females. Moreover, exposure to antismoking media messages was associated with increased susceptibility to smoking among never-smoking youth. CONCLUSIONS Approximately 1 in 8 never-smoking youth worldwide was found to be susceptible to smoking. A comprehensive approach involving parental and peer education, smoke-free policies, ban on tobacco advertising and promotions, and antismoking education in schools should be developed by policy makers and public health professionals to protect never-smoking youth from being susceptible to smoking and transforming into future regular smokers.
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Azagba S, Asbridge M. School connectedness and susceptibility to smoking among adolescents in Canada. Nicotine Tob Res 2013; 15:1458-63. [PMID: 23322767 DOI: 10.1093/ntr/nts340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Smoking susceptibility in early adolescence is strongly predictive of subsequent smoking behavior in youth. As such, smoking susceptibility represents a key modifiable factor in reducing the onset of smoking in young people. A growing literature has documented a number of factors that influence susceptibility to smoking; however, there is limited amount of research examining associations of susceptibility to smoking and school connectedness. The current study examines whether school connectedness has an independent protective effect on smoking susceptibility among younger adolescents. METHODS A nationally representative sample of 12,894 Canadian students in grades 6-8 (11-14 years old), surveyed as part of the 2010-2011 Youth Smoking Survey, was analyzed. Multilevel logistic regression models examined unadjusted and adjusted associations between school connectedness and smoking susceptibility. The impacts of other covariates on smoking susceptibility were also explored. RESULTS Approximately 29% of never-smokers students in grades 6-8 in Canada were susceptible to future smoking. Logistic regression analysis, controlling for standard covariates, found that school connectedness had strong protective effects on smoking susceptibility (odds ratio [OR] 0.91, 95% CI 0.89-0.94). CONCLUSIONS The finding that school connectedness is protective of smoking susceptibility, together with previous research, provides further evidence that improving school conditions that promote school connectedness could reduce risky behavior in adolescents. While prevention efforts should be directed at youth of all ages, particular attention must be paid to younger adolescents in the formative period of 11-14 years of age.
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Affiliation(s)
- Sunday Azagba
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Gabrhelik R, Duncan A, Lee MH, Stastna L, Furr-Holden CDM, Miovsky M. Sex specific trajectories in cigarette smoking behaviors among students participating in the unplugged school-based randomized control trial for substance use prevention. Addict Behav 2012; 37:1145-50. [PMID: 22717195 DOI: 10.1016/j.addbeh.2012.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 05/02/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Understanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic. METHODS Growth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N=1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention. RESULTS A two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR=1.17, p=0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR=1.22, p<0.01 slow escalators; OR=1.54, p=0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR=1.02, p=0.98). CONCLUSIONS This study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.
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Pabayo R, O'Loughlin J, Barnett TA, Cohen JE, Gauvin L. Does Intolerance of Smoking at School or in Restaurants or Corner Stores Decrease Cigarette Use Initiation in Adolescents? Nicotine Tob Res 2012; 14:1154-60. [DOI: 10.1093/ntr/ntr326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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