A prospective study of perception in adolescent smoking

Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies

BACKGROUND AND AIMS

Social norms towards smoking are a key concept in tobacco control policy and research. However, the influence and strength of different types of social norms on youth smoking uptake is unclear. This study aimed to examine, quantify and compare evidence of the longitudinal associations between different types of social norms towards smoking and youth smoking uptake (initiation and escalation).

METHODS

Systematic review searching four databases (MEDLINE, EMBASE, PsycInfo, CINAHL) from January 1998 to October 2020. Evidence synthesis via narrative review, meta-analysis pooling unadjusted associations (initiation only, due to heterogeneity in escalation outcomes) and meta-regression comparing effect sizes by norm type and study characteristics. Studies included observational prospective cohort studies using survey methodology with youth aged ≤24 years. Measurements included longitudinal associations between descriptive norms (perceived smoking behaviour) and injunctive norms (perceived approval/disapproval of smoking) among social network(s) and subsequent smoking initiation or escalation.

RESULTS

Thirty articles were identified. In the narrative review, smoking initiation (but not escalation) was consistently predicted by two norms: parental and close friend smoking. Associations between smoking uptake and other descriptive norms (smoking among siblings, family/household, partner, peers, adults) and all injunctive norms (perceived approval of smoking among parents, siblings, close friends/peers, partner, teachers, people important to you, the public) were less consistent or inconclusive. In the meta-analysis pooling unadjusted associations, 17 articles were included (n = 27 767). Smoking initiation was predicted by the following descriptive norms: smoking among parents [Odds Ratio (OR) = 1.88, 95% Confidence Interval (CI) = 1.56-2.28], close friends (OR = 2.53, 95% CI = 1.99-3.23), siblings (OR = 2.44, 95% CI = 1.93-3.08), family/household (OR = 1.55, 95% CI = 1.36-1.76) and adults (OR = 1.34, 95% CI = 1.02-1.75), but not peers (OR = 1.14, 95% CI = 0.92-1.42). Smoking initiation was also predicted by two injunctive norms, perceived approval of smoking among parents (OR = 1.74, 95% CI = 1.27-2.38) and the public (OR = 4.57, 95% CI = 3.21-6.49), but not close friends/peers (OR = 2.36, 95% CI = 0.86-6.53) or people important to the individual (OR = 1.24, 95% CI = 0.98-1.58).

CONCLUSIONS

In this systematic review (narrative and meta-analysis), descriptive norms of parents' and close friends' smoking behaviour appeared to be consistent predictors of youth smoking initiation, more so than the descriptive norms of more distal social networks and injunctive norms.

Adolescent Tobacco Use and Misperceptions of Social Norms Across Schools in the United States

OBJECTIVE

This study assesses tobacco use norm misperceptions by distinguishing between perceived and actual peer norms for both tobacco use attitudes and behavior, and examines the association between perceived norms and personal use among U.S. students in Grades 6-12.

METHOD

Anonymous self-report surveys were conducted with 28,070 students across 64 schools in 11 U.S. states between 1999 and 2017.

RESULTS

Although 77% of students said tobacco use is never good, 64% of students thought that most students in their grade believed that use is acceptable. Similarly, although 79% of students reported never using tobacco, 85% of students perceived that most students in their grade typically use tobacco, with 66% thinking that peers use monthly or more often. Substantial norm misperception existed regardless of student and school factors, increasing by grade. Perceiving that most peers thought tobacco use is acceptable was highly predictive of personal attitude, and perceiving tobacco use as the norm among same-grade peers strongly predicted personal tobacco use, even after we adjusted for actual peer use prevalence and other factors. Males' perception of the male peer norm was a stronger predictor of personal use than was their perception of the female peer norm. Females' perceptions of sex-specific norms were associated with personal use, each at about the same magnitude.

CONCLUSIONS

Norm misperceptions are pervasive across a diversity of students and schools, whereas perceptions of peer norms about tobacco use are highly associated with personal attitude and use. Results suggest that population-wide interventions correcting these misperceptions may help reduce tobacco use broadly among youth.

Observed smoking and tobacco pack display in Australian outdoor cafés 2 years after implementation of plain packaging

Background

Implementation of tobacco plain packaging (PP) in Australia in December 2012 was associated with significant reductions in the percentage of patrons at outdoor cafés observed to be displaying tobacco packs and actively smoking, immediately post-implementation and 1 year later. This study examines whether these positive effects were sustained through to 2 years post-PP.

Methods

An observational study conducted at cafés, restaurants and bars with outdoor seating in Melbourne, Australia documented the number of: patrons; patrons actively smoking; tobacco packs on display; orientation and type of displayed packs and whether or not children were present. Data were collected pre-PP (2012), early post-PP (2013), 1 year post-PP (2014) and 2 years post-PP (2015). Multilevel Poisson regressions analyzed changes in each outcome, adjusting for important covariates.

Results

Overall, positive effects of PP implementation on tobacco pack display and active smoking were not fully sustained through to 2 years post-PP for the total sample. Interactions between phase and the presence of children indicated that pack display and active smoking were lower in all post-implementation phases (compared with pre-PP) at venues where children were present but not at venues where children were not present.

Conclusions

Children at outdoor cafés were still being exposed to less tobacco packaging and active smoking, 2 years after implementation of the packaging changes. More regular refreshment of graphic health warnings is likely to be required to sustain these effects, and to reduce pack display behaviour at venues with no children.

The effect of parental smoking on preadolescents' implicit and explicit perceptions of smoking-related cues

Children of smokers are significantly more likely to experiment with cigarettes and become habitual smokers than children of nonsmokers. The current study examined the effect of parental smoking on children's implicit and explicit responses toward smoking behavior and smoking-related cues with the goal of identifying potential mechanisms for this relationship. A sample of 8-12-year-old children of smokers (n = 57) and children of nonsmokers (n = 86) completed a dot probe task to assess implicit attentional bias toward smoking cues and the Affect Misattribution Procedure (AMP) to assess implicit affective responses to smoking cues. In addition, children indicated their explicit perceptions of smokers and smoking behavior. Results demonstrated that children of smokers showed more sustained implicit attentional bias toward pictures of smoking stimuli presented alone than children of nonsmokers. Overall, participants showed negative implicit affective responses to smoking stimuli regardless of parental smoking. Children of smokers indicated that smokers would experience fewer negative consequences than children of nonsmokers; these relationships were moderated by age. Together, our findings suggest that parental smoking affects the ways that preadolescent children implicitly process smoking cues and their perceptions about smoking and its consequences. These findings help us understand the environmental mechanisms associated with smoking behavior in this vulnerable population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Body image perceptions and symptoms of disturbed eating behavior among children and adolescents in Germany

THEORETICAL BACKGROUND

Body image distortions such as perception biases are assumed to be precursors of eating disorders (ED). This study aims to investigate body image perceptions and symptoms of disturbed eating behavior among a sample of 11-17 year-old students in Germany.

METHODS

A cross-sectional survey study was carried out among 1524 students of twelve secondary schools from all school types in North Rhine-Westphalia (Germany). A naturalistic photograph-rating consisting of photographs of young women's bodies was used to examine children's perceptions of female bodies (i.e., perceived average body size and perceived ideal body size of young women). Also, symptoms of disturbed eating behavior were examined.

RESULTS

Compared to statistical data, children and adolescents underestimated the average body size of young women by more than two BMI-points (estimated average BMI = 20), with no differences between boys and girls. Also, girls and boys generally held a slim female thin-ideal (perceived ideal BMI = 19.5), which is nearly three BMI-points below the average body size in the young female population. Girls showed a slightly stronger female thin-ideal than boys. Among all subgroups, early-adolescent girls (13-14 years) displayed the strongest thin-ideal internalization. Nearly one-third of this group perceived a BMI below 18 as ideal female body size. Symptoms of disturbed eating behavior were common among youth and most frequent among adolescent girls (15-17 years). Girls who displayed a bias towards underestimation of female body size and girls who displayed an underweight female thin-ideal were more likely to report harmful dieting behaviors and psychological distress associated with eating, body, and weight.

CONCLUSIONS

This study found that 11-17 year-old girls and boys do not show accurate judgements regarding the average body size of young women. Instead, there is systematic and significant underestimation, indicating considerable perception biases, which may constitute a risk factor for the development and maintenance of ED. Symptoms of disturbed eating behavior were common, especially among girls, and associated with body-related perceptions. Future research will need to clarify the severity and course of these symptoms.

The Silent Majority? College Students’ Views, Conditions, and Reactions to Drunken Facebook Posts

College students’ definitions of inappropriate drunken posts, their reasoning, and what they do in response are generally absent in the literature. An online survey of 522 college students examined two drunken Facebook posts, one a general statement of drunkenness and a second which specifically mentioned vomiting and being underage. Findings suggest that students’ views of these posts are more complex and less accepting than previously thought. Most students considered both posts “a little” to “very” inappropriate, but the second post was more negatively viewed. A common reason was that the posts were socially unpopular, especially if the individual was underage. Findings also show that overwhelmingly students would ignore an inappropriate post or react in a way that is invisible to the poster. Thus, visible reactions may be falsely biased toward favorable feedback, even if many views are disapproving. Theoretical and practical implications are discussed.

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

What parents can do to keep their children from smoking: A systematic review on smoking-specific parenting strategies and smoking onset

AIM

To provide a systematic overview of longitudinal studies on different smoking-specific parenting practices (i.e., perceived parental norms and influences, smoking-specific monitoring, availability of cigarettes at home, household smoking rules, non-smoking agreements, smoking-specific communication, and parental reactions) as useful tools in the prevention of youth smoking.

METHOD

MEDLINE and PsychINFO search identified 986 studies published from 1990 to December 2016. Two independent researchers identified eligible studies. Study quality was assessed using Newcastle Ottawa Scale (NOS).

RESULTS

The systematic search resulted in 1 to 14 longitudinal studies per parenting practice. Studies scored between 4 and 9 on the NOS, indicating an overall moderate quality. The results of complete smoking house rules showed a preventive effect on smoking onset. Furthermore, availability of cigarettes, frequency and quality of communication, parental reaction (i.e., conflict engagement) and norms showed significant and non-significant effects. Significant results were in line with expectations: availability of cigarettes and frequent communication about smoking predicted smoking, whereas a high quality of communication, negative reactions or punishments and setting norms by parents showed a preventive effect. No effects were found for non-smoking agreements. The number of studies was too limited to draw conclusions about other parenting strategies. More research on (1) reliable and valid instruments, (2) other stages of smoking in addition to onset, and (3) potential moderators and mediators is warranted.

CONCLUSION

While evidence supports the effectiveness of smoking-specific parenting, further research is required.

Influences of parents, close friends and classmates on four co-existing oral health practices in Saudi male teenagers

OBJECTIVE

The objective of this study is to investigate the association between oral health practices and similar practices adopted by parents, close friends and classmates in a group of Saudi male teenagers.

MATERIAL AND METHODS

A cross-sectional study was conducted in Dammam, Saudi Arabia, in 2016 including 12-14-year-old intermediate school students (n = 478). A questionnaire assessed socioeconomic background, whether participants, their parents, close friends and classmates brushed twice daily, used tobacco, snacked on sugary foods or sugary drinks and perceiving a supportive classroom environment. Univariate and multivariate logistic regression models assessed the association of parents', close friends', classmates' practices and classroom support with participants' four practices, controlling for socioeconomic factors.

RESULTS

The response rate was 93.9%. In multivariate regression, close friends' practices had a strong significant association with teenagers' tooth brushing (OR = 4.45; 95%CI = 1.09, 18.12), tobacco use (OR = 5.63; 95%CI = 3.44, 7.88), snacking on sugary foods (OR = 14.42; 95%CI = 7.89, 21.89) and sugary drinks (OR = 7.05; 95%CI = 5.97, 9.20). The percentages of classmates perceived to brush their teeth and use tobacco were significantly associated with the respective practices in teenagers (OR = 1.03 and 1.02). Fathers' snacking on sugary drinks was significantly associated with that of the teenagers (OR = 4.04; 95%CI= 1.03, 15.85).

CONCLUSIONS

In early adolescence, four oral health practices of Saudi males were associated with those perceived to be adopted by their close friends. Fathers' use of sugary drinks was also significantly associated with that of teenagers.

Parents' and peers' normative influence on adolescents' smoking: results from a Swiss-Italian sample of middle schools students

BACKGROUND AND METHOD

Adolescents observe and imitate people to whom they are associated in their social context, and the normative factors sent out by reference groups are crucial determinants of their decision to smoke. The aim of the study is to investigate how adolescents' smoking changes when they are exposed to factors of pro-smoking normative influence by parents and peers, and how age moderate this relation. A cross sectional survey collected data from 5657 students, aged between 11 and 14, from public and private middle schools in the Italian region of Switzerland (Ticino) on their smoking habits, perceived parents' and peers' approval and smoking.

RESULTS

Multinomial logistic regression show that, as adolescents get older, more of the pro-smoking factors come from peers and parents, the higher the risk gets of being a "heavy smoker" has compared against having no experience with smoking. Living in a context with no factor of normative influence toward smoking play a protective role against smoking, and this effect becomes more important than more harmful the smoking behavior in question is. Furthermore, peers' descriptive norms are more influential for adolescents to become "light" and "heavy smokers", while smoking being approved by peers is important for adolescents to become accustomed to smoking.

CONCLUSIONS

Findings support the different influence of parents' and peers' norms on adolescents' smoking, and highlight the importance of peers' model behavior as the most important factor influencing smoking during adolescence. Such results have implications for programs that aim to prevent or reduce smoking in early adolescence when friendship choice starts to become crucial.

Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities

BACKGROUND

Young people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level.

METHODS

Data of 10,283 14-17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0-10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education.

RESULTS

Determinants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively.

CONCLUSION

Across educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.

Understanding the role of family dynamics, perceived norms, and lung cancer worry in predicting second-hand smoke avoidance among high-risk lung cancer families

Reducing exposure to environmental tobacco smoke significantly reduces lung cancer risk. We used family communication patterns theory and the theory of planned behavior to examine whether perceived norms and lung cancer worry more strongly influenced intentions to avoid environmental tobacco smoke in families higher in conformity and conversation orientations. Results from 52 individuals in 17 high-risk lung cancer families showed injunctive norms were positively related to intentions when families conformed and conversed more. Lung cancer worry was positively related to intentions in high conformity families and negatively related to intentions in low conformity families. Findings can benefit interventions to reduce environmental tobacco smoke exposure.

Parental smoke exposure and the development of nicotine craving in adolescent novice smokers: the roles of DRD2, DRD4, and OPRM1 genotypes

BACKGROUND

Among adolescent novice smokers, craving is often the first, and is the most reported, symptom of nicotine dependence. Until now, little has been known about the development of craving symptoms in novice smokers. The aim of this study was to identify specific genetic (i.e., DRD2 Taq1A, DRD4 48 bp VNTR, and OPRM1 A118G polymorphisms) and environmental mechanisms that underlie the emergence of both cue-induced and cognitive craving among adolescent novice smokers.

METHOD

A five-wave longitudinal, genetically-informed survey study was conducted with intervals of four months. The sample included 376 early adolescent smokers (12-13 years of age at baseline). Self-report questionnaires were completed regarding smoking behavior, observed parental smoking behavior, and both cue-induced and cognitive craving.

RESULTS

Data were analyzed with a latent growth curve approach. For both cue-induced and cognitive craving, significant interaction effects were found for DRD2 Taq1A with parental smoke exposure. A1-allele carriers did not seem to be influenced by the environment with regard to craving development. Adolescents who are homozygous for the A2-allele and who are more exposed to parental smoking experience the highest levels of both types of craving over time. No significant interaction effects were found between parental smoke exposure and DRD4 48 bp VNTR or OPRM1 A118G.

CONCLUSIONS

Previous studies identified DRD2 Taq1A A1-allele carriers as vulnerable to developing nicotine dependence. However, this study showed that parental smoking increased the chances of developing dependence more rapidly for early adolescents who are considered to be less sensitive to the rewarding effects of nicotine according to their DRD2 Taq1A genotype. It is thus especially important that these young people not be exposed to smoking in their social environment.

Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor café strips

AIMS

We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia.

METHODS

Between October and April 2011-12 (pre-plain packaging, pre-PP) and 2012-13 (post-plain packaging, post-PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression.

RESULTS

Pack display declined by 15% [adjusted incident rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.79-0.91, P < 0.001], driven by a 23% decline in active smoking (IRR = 0.77, 95% CI = 0.71-0.84, P < 0.001) between phases. The decline in pack display coincided with the full implementation of plain packaging from December 2012, was stronger in venues with children present and was limited to mid and high socio-economic status (SES) areas. The proportion of packs orientated face-up declined from 85.4% of fully branded packs pre-PP to 73.6% of plain packs post-PP (IRR = 0.87, 95% CI = 0.79-0.95, P = 0.002). Alternatively, the proportions concealed by telephones, wallets or other items (4.4% of fully branded packs pre-PP and 9.5% of plain packs post-PP; IRR = 2.33, 95% CI = 1.72-3.17, P < 0.001) and in an external case (1.5-3.5% of all packs; IRR = 2.79, 95% CI = 1.77-4.40, P < 0.001) increased. Low SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation.

CONCLUSIONS

Following Australia's 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimize exposure to tobacco promotion.

Normative influences on intentions to smoke among Greek adolescents: the moderating role of smoking status

Background

Social norms influence adolescent smoking intentions, but this effect may differentiate depending on current smoking experiences. The presented study assessed the moderation effects of smoking status on the relationship between social norms and smoking intentions among Greek adolescents.

Methods

A cross-section survey-based design was used. Overall, 251 Greek secondary school students (M age = 16.1 years, 61.2% females) completed structured and anonymous questionnaires including demographic characteristics (age, gender), subjective and descriptive social norms towards smoking, self-reported tobacco use, and intentions to smoke in the next 12 months.

Results

Linear regression analysis showed that social norms overall predicted 36.4% (Adjusted R²) of the variance in intentions. Perceived prevalence of smoking in same age peers and adults, having more close friends who smoke and perceived social approval of smoking predicted intentions to smoke in one year. Moderated regression analysis showed that the effects of social norms on smoking intentions were significantly moderated by smoking status.

Conclusions

Social norms predict smoking intentions, but this effect is stronger among ever (than never) smoker adolescents. Adolescents with smoking experiences may selectively attend to pro-smoking social cues and this perpetuates into their motivation to keep up the habit. School-based interventions should target normative beliefs and related cognitive processes, especially among adolescents who have already initiated tobacco use.

Initial responses to the first dose of nicotine in novel smokers: the role of exposure to environmental smoking and genetic predisposition

BACKGROUND

Sensitivity to initial smoking constitutes an early predictor of the risk of dependence. We investigated the role of exposure to smoking (by parents, siblings, and peers) and reward-related candidate gene polymorphisms (OPRM1 A118G, DRD2 TaqlA and DRD4 bp VNTR) in adolescents' responses to initial smoking.

METHODS

We used cross-sectional survey data and saliva samples from 171 Dutch students who had never inhaled on a cigarette (mean age: 13.9 years). The outcome measure was adolescents' self-reported responses to initial smoking.

RESULTS

Exposure to peer smoking was associated with increased liking (OR = 1.74, CI = 1.13-2.70) and more pleasant sensations (β = .21, p = .01). Exposure to maternal smoking was associated with less unpleasant sensations (β = -.20, p = .01). Adolescents carrying the G-variant of the OPRM1 A118G polymorphism were more likely to report liking (OR = 2.50, CI = 1.09-5.73) and adolescents homozygous for the C-variant of the DRD2 TaqlA polymorphism reported less unpleasant sensations (β = .18, p = .04).

CONCLUSION

Although preliminary, these findings suggest that exposure to environmental smoking and polymorphisms in the OPRM1 and DRD2 gene may affect initial sensitivity to nicotine, an early phenotype of the risk of dependence. In the future, collaborative efforts to combine data from multiple studies in meta-analyses are needed to improve accuracy of estimated effects in genetic studies.

Prevalence of tobacco use among adolescents in north Kerala, India

The present study was conducted to assess the prevalence of tobacco use among adolescents and also the reasons for the initiation of tobacco use amongst them. It was conducted in ten randomly selected schools in Kannur district of Kerala state, India. A total of 3,000 school children participated. The study observed an overall prevalence of 5.5% for users. The prevalence observed among boys was 12% and none of the girls were tobacco users. Associations between father's and friend's tobacco habits were observed.

The role of environmental smoking in smoking-related cognitions and susceptibility to smoking in never-smoking 9-12 year-old children

Environmental smoking has numerous adverse effects on child health, and children are frequently exposed to environmental smoking. In the present study, we investigated the role of environmental smoking (parental smoking, sibling smoking, peer smoking) in smoking-related cognitions (pros of smoking, perceived safety of casual smoking, cue-triggered wanting to smoke) and susceptibility to smoking among 9-12 year old never-smoking children (N=778). We collected cross-sectional survey data from children attending 15 Dutch primary schools. Using structural equation modelling, we assessed direct as well as indirect relationships among study variables. The results showed that children who were exposed to more smoking parents, siblings, and peers perceived more pros of smoking. Additionally, parental smoking was associated with higher perceived safety of casual smoking and more cue-triggered wanting to smoke. In turn, perceiving a higher safety of casual smoking and more cue-triggered wanting to smoke were associated with a higher susceptibility to smoking in children. No direct effects of environmental smoking on children's susceptibility to smoking were found. However, parental smoking was associated with children's susceptibility to smoking through children's perceived safety of casual smoking and cue-triggered wanting to smoke. The present study indicates that pre-adolescents may already display favourable smoking-related cognitions and that these cognitions may be an early indicator of a child's vulnerability to smoking. Environmental smoking, particularly parental smoking, is associated with more favourable smoking-related cognitions in never-smoking children. In the intergenerational transmission of smoking from parents to children, children's risk perceptions of smoking and the experience of cue-triggered wanting to smoke may constitute mechanisms of action, which need to be investigated in longitudinal research.

Perceptions of health risk and smoking decisions of young people

Using the Annenberg Perception of Tobacco Risk Survey 2, this paper finds that perceived risk deters smoking among persons aged 14-22 years who think that it is relatively difficult to quit smoking and that onset of deleterious health effects occurs relatively quickly. Perceived health risk, however, does not affect the smoking status of young people who hold the opposite beliefs. These results are consistent with predictions of rational addiction models and suggest that young people, who view smoking as more addictive and health effects as more immediate, may have greater incentive to consider long-term health effects in their decision to smoke.

Smoking-specific communication and children's smoking onset: an extension of the theory of planned behaviour

The aim of this study was to test whether maternal smoking-specific communication and parental smoking related to smoking cognitions (i.e. attitude, self-efficacy and social norm) derived from the Theory of Planned Behaviour in association with smoking onset during preadolescence. A total of 1478 pairs of mothers and children participated (mean age: 10.11; standard deviation = 0.78). Structural equation models in Mplus were used to examine whether smoking-specific communication influences children's smoking cognitions, which in turn, affect smoking onset. A positive association was found between pro-smoking attitudes and smoking onset. Smoking-specific communication and parental smoking were related to smoking cognitions. Specifically, frequency of communication was negatively associated with pro-smoking attitudes, social norms of mother and best friend. Quality of communication related negatively to pro-smoking attitudes and positively to self-efficacy and norms of friends. Parental smoking was positively associated with pro-smoking attitudes and norms of mother and (best) friends. Additionally, more frequent communication and higher levels of parental smoking were associated with higher smoking onset. In conclusion, smoking-specific communication and parental smoking were associated with smoking cognitions and smoking onset. Already during preadolescence, parents contribute to shaping the smoking cognitions of their children, which may be predictive of smoking later in life.

Bidirectional influences between parents and children in smoking behavior: a longitudinal full-family model

BACKGROUND

The present study investigated longitudinal associations and bidirectional influences between family members in smoking behavior using a longitudinal full-family design. Family systems provide a powerful social context in which modeling and imitation take place. In current literature, however, bidirectional associations between parents and children in smoking behavior are seldom considered.

METHODS

Participants were 426 families, including mothers, fathers, and 2 adolescent children. Associations were assessed over 5 waves with yearly intervals using a cross-lagged model in structural equation modeling.

RESULTS

Findings demonstrate that families resemble an interactive system affording smoking contagion across family members. Results suggest that associations between parents and children are bidirectional, that is, parental smoking behavior influences adolescent smoking behavior and adolescent smoking behavior influences parental smoking behavior. There is insufficient evidence to conclude that longitudinal associations between family members are generally bidirectional, as only unidirectional longitudinal associations were found between between siblings and partners.

CONCLUSIONS

The present study extends previous research on the intergenerational transmission of smoking behavior by demonstrating bidirectional influences between parents and children in smoking behavior. Moreover, the present study suggests that family members may be susceptible to adjust their smoking behavior across time in response to smoking behavior within the family.

Associação entre comportamentos de risco à saúde de pais e adolescentes em escolares de zona rural de um município do Sul do Brasil

Objetivou-se avaliar a associação entre comportamentos de risco à saúde dos pais e adolescentes escolares de zona rural. Participaram 377 escolares entre 10 e 18 anos e 338 pais. Foram analisados: nível de atividade física no lazer e deslocamento, hábitos de alimentação inadequados, excesso de peso, uso de cigarros e consumo de bebidas alcoólicas. A prevalência de relato de uso de cigarro e álcool nos últimos 30 dias entre os jovens foi de 6,7% e 27%, respectivamente. Quarenta e cinco por cento dos adolescentes não atingiram o escore de atividade física. A adesão aos passos para uma alimentação saudável foi baixa. A atividade física dos adolescentes esteve relacionada de forma positiva com a dos pais, e o consumo de álcool da mãe se associou de forma positiva com o consumo do adolescente. Para os outros comportamentos, não houve associação significativa. Na análise estratificada por sexo, o nível de atividade física do pai se associou ao nível de atividade física das meninas. O comportamento de risco à saúde dos pais associa-se ao mesmo comportamento dos adolescentes de zona rural.

Driving kids to smoke? Children's reported exposure to smoke in cars and early smoking initiation

The health risks associated with second hand smoke (SHS) are well-known. However, little is known about exposure to SHS in cars and risk of smoking uptake. This paper investigates the association between pre-adolescents reported exposure to smoking in cars and prevalence of early stage smoking activity. Data from Keeping Kids Smokefree baseline surveys of students were used to investigate smoking status and reported exposure to smoking in cars. Log binomial regression analyses were used to investigate if reported exposure to SHS in cars was associated with smoking prevalence. 83% of 5676 students invited took part. After controlling for all variables reported exposure to smoking in cars and homes were significantly associated with increased risk of initiated smoking (RR 1.87, 95% CI 1.43-2.44, and RR 1.5, 95% CI 1.13-1.97, respectively). Exposure to smoking in cars was substantially and significantly associated with risk of current smoking (RR 3.21, 95% CI 1.45-7.08). Early smoking uptake is associated with students' reported exposure to smoking in cars which confirms the importance of protecting children from SHS. Smoking in cars is under parental control and therefore modifiable. Moreover, children's reports of SHlS exposure offer a simple way of identifying families who can be targeted for tobacco control interventions.

Social normative beliefs regarding cigarette smoking in Hungarian adolescents

BACKGROUND

Hungary will continue to experience a high burden of disease and death from lung cancer and other tobacco-induced disease unless there is a significant reduction in youth smoking. Social factors have been found to be among the most important determinants of adolescent smoking, yet few studies have investigated social normative beliefs in Hungarian youth. The purpose of the current study was to investigate three measures of smoking normative beliefs thought to influence adolescent smoking: perceived prevalence of smoking; perceived popularity of smoking among successful/elite elements of society; and perceived disapproval by friends and family.

METHODS

A cross-sectional school-based survey of eighth grade (n = 258) and 12th grade (n = 288) students in Mako, Hungary was conducted to assess social normative beliefs about smoking, current smoking, ever smoking, and susceptibility to smoking. The association of the normative beliefs with the smoking behavior variables was examined through logistic regression analysis, and the underlying factor structure of the normative belief items in the current sample was determined through factor analysis.

RESULTS

The percent of boys reporting current smoking was 40.5% in 12th grade and 27.0% in eighth grade. Among girls, the percent was 44.0% of 12th graders and 29.1% of eighth graders. Parent/peer disapproval was the most consistently associated normative belief with smoking behavior and susceptibility to smoking across both samples.

CONCLUSIONS

Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

Effectiveness of proactive telephone counselling for smoking cessation in parents: study protocol of a randomized controlled trial

Background

Smoking is the world's fourth most common risk factor for disease, the leading preventable cause of death, and it is associated with tremendous social costs. In the Netherlands, the smoking prevalence rate is high. A total of 27.7% of the population over age 15 years smokes. In addition to the direct advantages of smoking cessation for the smoker, parents who quit smoking may also decrease their children's risk of smoking initiation.

Methods/Design

A randomized controlled trial will be conducted to evaluate the effectiveness of proactive telephone counselling to increase smoking cessation rates among smoking parents. A total of 512 smoking parents will be proactively recruited through their children's primary schools and randomly assigned to either proactive telephone counselling or a control condition. Proactive telephone counselling will consist of up to seven counsellor-initiated telephone calls (based on cognitive-behavioural skill building and Motivational Interviewing), distributed over a period of three months. Three supplementary brochures will also be provided. In the control condition, parents will receive a standard brochure to aid smoking cessation. Assessments will take place at baseline, three months after start of the intervention (post-measurement), and twelve months after start of the intervention (follow-up measurement). Primary outcome measures will include sustained abstinence between post-measurement and follow-up measurement and 7-day point prevalence abstinence and 24-hours point prevalence abstinence at both post- and follow-up measurement. Several secondary outcome measures will also be included (e.g., smoking intensity, smoking policies at home). In addition, we will evaluate smoking-related cognitions (e.g., attitudes towards smoking, social norms, self-efficacy, intention to smoke) in 9-12 year old children of smoking parents.

Discussion

This study protocol describes the design of a randomized controlled trial to evaluate the effectiveness of proactive telephone counselling in smoking cessation. It is expected that, in the telephone counseling condition, parental smoking cessation rates will be higher and children's cognitions will be less favorable about smoking compared to the control condition.

Trial registration

The protocol for this study is registered with the Netherlands Trial Register NTR2707.

Overestimation of peer smoking prevalence predicts smoking initiation among primary school students in Hong Kong

PURPOSE

To investigate the relationship between perceived prevalence of smoking and smoking initiation among Hong Kong primary second- to fourth-grade-students.

METHODS

A cohort of 2,171 students was surveyed in 2006 and again in 2008. Students who perceived ever-smoking prevalence in peers as "none" or "some" were considered as correct (reference group), whereas those who perceived it as "half" (overestimation) or "most/all" (gross overestimation) were considered as incorrect.

RESULTS

At baseline, overestimation was found to be cross-sectionally associated with ever-smoking (p < .01). At follow-up, 7.2% of never-smoking students with incorrect estimation at baseline had started smoking, which was 79% (95% confidence interval: 3%-213%), greater than that of 3.7% for those with correct estimation. Among the never-smoking students with incorrect estimation, subsequent correct estimation was associated with 70% (95% confidence interval: 47%-83%) lower risk of smoking initiation compared with persistent incorrect estimation.

CONCLUSION

Overestimation of the prevalence of peer smoking predicted smoking initiation among children. Interventions should be carried out to evaluate whether correcting children's overestimation of peer smoking could reduce smoking initiation.

Elite athletes' estimates of the prevalence of illicit drug use: evidence for the false consensus effect

INTRODUCTION AND AIMS

The false consensus effect (FCE) is the tendency for people to assume that others share their attitudes and behaviours to a greater extent than they actually do. The FCE has been demonstrated for a range of health behaviours, including substance use. The study aimed to explore the relationship between elite athlete's engagement in recreational drug use and their consensus estimates (the FCE) and to determine whether those who engage in the behaviour overestimate the use of others around them.

DESIGN AND METHOD

The FCE was investigated among 974 elite Australian athletes who were classified according to their drug use history.

RESULTS

Participants tended to report that there was a higher prevalence of drug use among athletes in general compared with athletes in their sport, and these estimates appeared to be influenced by participants' drug use history. While overestimation of drug use by participants was not common, this overestimation also appeared to be influenced by athletes' drug use history.

DISCUSSION AND CONCLUSIONS

The results suggest that athletes who have a history of illicit drug use overestimate the prevalence of drug use among athletes. These findings may be helpful in the formulation of normative education initiatives.

Beyond Homophily: A Decade of Advances in Understanding Peer Influence Processes

This article reviews empirical and theoretical contributions to a multidisciplinary understanding of peer influence processes in adolescence over the past decade. Five themes of peer influence research from this decade were identified, including a broadening of the range of behaviors for which peer influence occurs, distinguishing the sources of influence, probing the conditions under which influence is amplified/attenuated (moderators), testing theoretically based models of peer influence processes (mechanisms), and preliminary exploration of behavioral neuroscience perspectives on peer influence. This review highlights advances in each of these areas, underscores gaps in current knowledge of peer influence processes, and outlines important challenges for future research.

Beyond Homophily: A Decade of Advances in Understanding Peer Influence Processes

This article reviews empirical and theoretical contributions to a multidisciplinary understanding of peer influence processes in adolescence over the past decade. Five themes of peer influence research from this decade were identified, including a broadening of the range of behaviors for which peer influence occurs, distinguishing the sources of influence, probing the conditions under which influence is amplified/attenuated (moderators), testing theoretically based models of peer influence processes (mechanisms), and preliminary exploration of behavioral neuroscience perspectives on peer influence. This review highlights advances in each of these areas, underscores gaps in current knowledge of peer influence processes, and outlines important challenges for future research.

Social normative beliefs about smoking among Vietnamese adolescents

Tobacco-related deaths in Vietnam are forecast to climb from 40 000 annually to 70 000 by 2030. Previous research in Western nations has found social factors to be important determinants of adolescent smoking. Because these factors remain unexplored in Vietnamese youth, the purpose of this study was to examine social normative beliefs regarding smoking in a school-based sample of North Vietnamese adolescents and the association of these factors with smoking behavior and susceptibility to smoking. Three measures of normative beliefs regarding smoking were evaluated in cross-sectional surveys of secondary students. Of the 3 measures, parent/peer disapproval was the most consistent normative belief associated with smoking behavior and susceptibility to smoking. Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

Emotional, behavioural problems and cigarette smoking in adolescence: findings of a Greek cross-sectional study

Background

Although several studies have reported findings concerning the association between smoking and emotional/behavioural problems, little research has investigated this association after controlling for confounding factors which have been found to be significantly correlated with both cigarette smoking and emotional/behavioural problems and may have a strong effect on the relationship between adolescents' mental health and smoking. The present study attempted to assess the association between adolescents' smoking status and their emotional/behavioural problems after controlling for a number of possible confounders (i.e. age, gender, parental smoking status, exposure to family smoking, family socioeconomic status, adolescents' leisure time) in a Greek nation-wide school-based sample.

Methods

Participants completed a questionnaire which retrieved information about age, gender, family socioeconomic status, smoking status, parental smoking, adolescents' leisure time and emotional/behavioural problems. Data were modelled using multiple logistic regression analysis with adolescents' smoking status as the dependent variable.

Results

A total of 1194 (i.e. 63% response rate) of self-reported questionnaires (40.1% boys, 59.9% girls; 12-18 years old) were returned. Data from 1030 participants with full data were analyzed. Cigarette smoking was strongly associated with higher levels of emotional/behavioural problems (p < 0.001) and the association was not moderated (OR = 1.13, 95% CI: 1.08-1.18) after controlling for the effects of other covariates. Emotional symptoms, conduct problems and hyperactivity/inattention were all significantly associated with adolescents' current smoking.

Conclusions

This study supports the association between smoking and emotional/behavioural problems among adolescents. Addressing adolescents' needs regarding their emotional/behavioural health could be helpful in the development of effective anti-smoking strategies in school environment and elsewhere.

Predictors of transition in different stages of smoking: a longitudinal study

BACKGROUND

We investigated longitudinally the prevalence of smoking according to three stages of smoking (never smoking, experimenting the smoking, and regular smoking), the rates of transition from one stage to another one, and determinant predictors of transition through these stages of smoking.

METHODS

Of all 10(th) grade students in Tabriz, 1785 students were randomly selected and assessed twice, with a 12-month interval, with respect to the changes of stage. The predictor variables were measured when the students were in the 10(th) grade. Logistic regression and principal component analysis were used to analysis data at grade 11.

FINDINGS

Of 1785 students, 14.3% (CI 95%: 12.3-16.4) and 2.8% (CI 95%: 2.0-4.0) of the never smokers became experimenters and regular smokers, respectively and 16.5% (CI 95%: 12.4-21.7) of the experimenters became regular smokers. Among never smokers, participating in smoker groups (OR=1.24), having smoker friends (OR=1.85) and a positive attitude towards smoking (OR=1.22) predicted experimentation; and participating in smokers groups (OR=1.35) and a lower socioeconomic class (OR=0.36) predicted regular smoking. Among experimenters, students having general high risk behaviors (OR=2.56) and participating in smoker groups (OR=2.58) were distinguished as those who progressed to regular smoking in follow-up.

CONCLUSION

Programs aimed at smoking prevention and intervention should incorporate plans which focus on predictors of transition through smoking stages, and targeting participation in smoker groups.

School smoking policy characteristics and individual perceptions of the school tobacco context: are they linked to students' smoking status?

The purpose of this study was to explore individual- and school-level policy characteristics on student smoking behavior using an ecological perspective. Participants were 24,213 (51% female) Grade 10–11 students from 81 schools in five Canadian provinces. Data were collected using student self-report surveys, written policies collected from schools, interviews with school administrators, and school property observations to assess multiple dimensions of the school tobacco policy. The multi-level modeling results revealed that the school a student attended was associated with his/her smoking behavior. Individual-level variables that were associated with student smoking included lower school connectedness, a greater number of family and friends who smoked, higher perceptions of student smoking prevalence, lower perceptions of student smoking frequency, and stronger perceptions of the school tobacco context. School-level variables associated with student smoking included weaker policy intention indicating prohibition and assistance to overcome tobacco addiction, weaker policy implementation involving strategies for enforcement, and a higher number of students smoking on school property. These findings suggest that the school environment is important to tobacco control strategies, and that various policy dimensions have unique relationships to student smoking. School tobacco policies should be part of a comprehensive approach to adolescent tobacco use.