Stages in the development of adolescent smoking

Smartphone Apps Targeting Youth Tobacco Use Prevention and Cessation: An Assessment of Credibility and Quality

Purpose of Review

The goals of this study were to identify smartphone apps targeting youth tobacco use prevention and/or cessation discussed in the academic literature and/or available in the Apple App Store and to review and rate the credibility of the apps. We took a multiphase approach in a non-systematic review that involved conducting parallel literature and App Store searches, screening the returned literature and apps for inclusion, characterizing the studies and apps, and evaluating app quality using a standardized rating scale.

Recent Findings

The negative consequences of youth tobacco use initiation are profound and far-reaching. Half of the youth who use nicotine want to quit, but quit rates are low. The integration of smartphone apps shows promise in complementing and enhancing evidence-based youth tobacco prevention and treatment methods.

Summary

Consistent with prior reviews, we identified a disconnect between apps that are readily accessible and those that have an evidence base, and many popular apps received low quality scores. Findings suggest a need for better integration between evidence-based and popular, available apps targeting youth tobacco use.

Tobacco retailer density and smoking behaviour: how are exposure and outcome measures classified? A systematic review

INTRODUCTION

To date only a limited number of reviews have focused on how exposure and outcome measures are defined in the existing literature on associations between tobacco retailer density ('density') and smoking behaviour ('smoking'). Therefore this systematic review classified and summarised how both density and smoking variables are operationalised in the existing literature, and provides several methodological recommendations for future density and smoking research.

METHODS

Two literature searches between March and April 2018 and April 2022 were conducted across 10 databases. Inclusion and exclusion criteria were developed and keyword database searches were undertaken. Studies were imported into Covidence. Cross-sectional studies that met the inclusion criteria were extracted and a quality assessment was undertaken. Studies were categorised according to the density measure used, and smoking was re-categorised using a modified classification tool.

RESULTS

Large heterogeneity was found in the operationalisation of both measures in the 47 studies included for analysis. Density was most commonly measured directly from geocoded locations using circular buffers at various distances (n = 14). After smoking was reclassified using a smoking classification tool, past-month smoking was the most common smoking type reported (n = 26).

CONCLUSIONS

It is recommended that density is measured through length-distance and travel time using the street network and weighted (e.g. by the size of an area), or by using Kernel Density Estimates as these methods provide a more accurate measure of geographical to tobacco and e-cigarette retailer density. The consistent application of a smoking measures classification tool, such as the one developed for this systematic review, would enable better comparisons between studies. Future research should measure exposure and outcome measures in a way that makes them comparable with other studies.

IMPLICATIONS

This systematic review provides a strong case for improving data collection and analysis methodologies in studies assessing tobacco retailer density and smoking behaviour to ensure that both exposure and outcome measures are clearly defined and captured. As large heterogeneity was found in the operationalisation of both density and smoking behaviour measures in the studies included for analysis, there is a need for future studies to capture, measure and classify exposure measures accurately, and to define outcome measures in a manner that makes them comparable with other studies.

Multi-trait genome-wide association analyses leveraging alcohol use disorder findings identify novel loci for smoking behaviors in the Million Veteran Program

Smoking behaviors and alcohol use disorder (AUD), both moderately heritable traits, commonly co-occur in the general population. Single-trait genome-wide association studies (GWAS) have identified multiple loci for smoking and AUD. However, GWASs that have aimed to identify loci contributing to co-occurring smoking and AUD have used small samples and thus have not been highly informative. Applying multi-trait analysis of GWASs (MTAG), we conducted a joint GWAS of smoking and AUD with data from the Million Veteran Program (N = 318,694). By leveraging GWAS summary statistics for AUD, MTAG identified 21 genome-wide significant (GWS) loci associated with smoking initiation and 17 loci associated with smoking cessation compared to 16 and 8 loci, respectively, identified by single-trait GWAS. The novel loci for smoking behaviors identified by MTAG included those previously associated with psychiatric or substance use traits. Colocalization analysis identified 10 loci shared by AUD and smoking status traits, all of which achieved GWS in MTAG, including variants on SIX3, NCAM1, and near DRD2. Functional annotation of the MTAG variants highlighted biologically important regions on ZBTB20, DRD2, PPP6C, and GCKR that contribute to smoking behaviors. In contrast, MTAG of smoking behaviors and alcohol consumption (AC) did not enhance discovery compared with single-trait GWAS for smoking behaviors. We conclude that using MTAG to augment the power of GWAS enables the identification of novel genetic variants for commonly co-occuring phenotypes, providing new insights into their pleiotropic effects on smoking behavior and AUD.

Momentary Associations Among Minority Stress, Craving, Affect, and Nicotine Use Among Sexual Minority Youth

OBJECTIVES

Sexual minority youth are more likely to use nicotine relative to heterosexual youth. The minority stress model posits these disparities are partly due to unique stress (i.e., minority stress) specific to their stigmatized identities. However, there is a dearth of research exploring the fine-grained dynamic interplay between minority stressors, mediating processes, and nicotine use in sexual minority youth's daily lives and natural environment. We leveraged ecological momentary assessment over a 30-day monitoring period to test the mediating effects of craving and negative and positive affect on the momentary associations between minority stressors and subsequent nicotine use among sexual minority youth who were active nicotine users and recruited from the community.

METHODS

Participants were 85 nicotine users, ages 15-19 years old (M age = 17.96, SD = 1.10; 56.6% cisgender female; 56.6% bisexual; 73.5% non-Hispanic White) and half (51.8%) were daily nicotine users.

RESULTS

Results indicated that exposure to a minority stressor was associated with momentary elevations in nicotine craving and negative affect and decreases in positive affect. Nicotine craving and positive affect were also associated with greater probability of subsequent nicotine use. The associations between minority stressors and subsequent nicotine use were mediated through craving and positive, but not negative affect.

CONCLUSIONS

Our findings provide the first ecological momentary assessment evidence of these associations among sexual minority youth and help support and advance both addictions and sexual minority-specific models (e.g., minority stress) of nicotine use among youth.

Correlates of tobacco product initiation among youth and young adults between waves 1-4 of the population assessment of tobacco and Health (PATH) study (2013-2018)

INTRODUCTION

While risk factors for cigarette smoking among youth and young adults are well-documented, less is known about the correlates of initiation of other tobacco products. This study aims to provide estimates and correlates of initiation among U.S. youth and young adults.

METHODS

Data on youth aged 12-17 (n = 10,072) and young adults aged 18-24 (N = 5,727) who provided information on cigarettes, electronic nicotine delivery systems (ENDS), cigars, pipe, hookah and smokeless tobacco use in Wave 1 (W1: 2013-2014)-Wave 4 (W4: 2016-2018) of the nationally-representative PATH Study were used to calculate ever use initiation and correlates of initiation by W4.

RESULTS

Nearly 6 million youth and 2.5 million young adults used tobacco for the first time between W1-W4. Approximately one quarter of youth and young adult ENDS never users initiated ENDS between W1-W4 of the PATH Study. Among youth, use of other tobacco products, ever substance use, and high externalizing problems were associated with initiation of most products. Among young adults, use of other tobacco products and ever substance use were associated with initiation of most products. In both youth and young adults, Hispanics were more likely to initiate hookah use than their non-Hispanic White counterparts. While male sex was a risk factor for most tobacco product initiation across both age groups, it was not associated with hookah initiation.

CONCLUSIONS

Cigarette and non-cigarette products shared many correlates of initiation, although there are noteworthy demographic differences. Findings can help tailor product specific interventions to reach populations at risk during preliminary stages of use.

Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study

(1) Background: It is well recognised that a focus on changing behaviour remains a dominant and often appealing approach to develop health policies. This study provides a sociological insight into young adults’ knowledge of the health effects of smoking cigarettes. We also examine the challenges in tobacco control and criticize the implementation policies in Chinese context. (2) Methods: The study applies both a micro-sociological and a macro-sociological approach using semi-structured interviews and documents as the primary research methodology. Fieldwork was conducted from July to September 2016 and December 2016 to March 2017. The qualitative study involved 45 semi-structured interviews with young adults aged 16–24 years (15 females and 30 males) in Tianjin, China. A grounded theory approach was used for a thematic analysis. (3) Results: The participants knew cigarettes are harmful, although they lacked a comprehensive understanding of the health risks of smoking. Because the health consequences usually emerge after a long period of smoking, young smokers decide to take the health risk. All participants have a general understanding of China’s tobacco control policies and think that the implementation is ineffective. (4) Conclusions: Changing in smoking is a process embedded in complex social environments and cultures. Smoking behaviour is not only a personal choice, but also related to personal connections with peers and identity in Chinese society. The Chinese government has made significant achievements in tobacco control since joining the WHO framework convention on tobacco control in 2005. However, implementation needs to be stricter in order to achieve international levels of control, especially in taxes on tobacco product and the price of cigarettes. There is an urgent need for the regulation of e-cigarettes in China.

Developmental trajectories of tobacco use and risk factors from adolescence to emerging young adulthood: a population-based panel study

BACKGROUND

Adolescence to young adulthood is a critical developmental period that determines lifelong patterns of tobacco use. We examined the longitudinal trajectories of tobacco use, and risk factors for its use, and explored the association between the trajectories of mobile phone dependency and smoking throughout the life-course among adolescents and young adults.

METHODS

Data of 1,723 subjects (853 boys and 870 girls) were obtained from six waves of the Korean Children and Youth Panel Survey (mean age = 13.9-19.9 years). To identify trajectories of smoking and mobile phone dependency, group-based trajectory modelling (GBTM) was conducted. A multinomial logistic regression analysis was performed to identify the characteristics of the trajectory groups.

RESULTS

GBTM identified four distinct smoking trajectories: never smokers (69.1%), persistent light smokers (8.7%), early established smokers (12.0%), and late escalators (10.3%). Successful school adjustment decreased the risk of being an early established smoker (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.27-0.78). The number of days not supervised by a guardian after school was positively associated with the risk of being an early established smoker (OR 1.96, 95% CI 1.23-3.13). Dependency on mobile phones throughout the life-course was positively associated with the risk of being a persistent light smoker (OR 4.04, 95% CI 1.32-12.34) or early established smoker (OR 8.18, 95% CI 4.04-16.56).

CONCLUSIONS

Based on the group-based modeling approach, we identified four distinctive smoking trajectories and highlight the long-term effects of mobile phone dependency, from early adolescence to young adulthood, on smoking patterns.

Price and Income Elasticities of Cigarette Smoking Demand in Bangladesh: Evidence from Urban Adolescents and Young Adults

INTRODUCTION

Understanding the elasticities of cigarette smoking demand among the youth could help improve the effectiveness of tobacco control interventions. The objective of this study is to measure the price and income elasticities of cigarette smoking demand among urban Bangladeshi male adolescents and young adults aged 10-24 years.

METHOD

Using data from a cross-sectional survey conducted in seven urban districts of Bangladesh, we applied probit and ordinary least square (OLS) models to examine the effect of price and income on smoking participation (decision to smoke) and intensity (number of cigarettes smoked).

RESULTS

Our results showed that price was not significantly associated with the decision to smoke, while income was a significant determinant of smoking participation. Both price and income determined the smoking intensity. The positive income elasticity (0.39) indicated that participants with greater access to money were more likely to participate in cigarette smoking and smoked more cigarettes. Negative price elasticity (-0.62) implied that increasing prices could lead to a reduction in smoking intensity among adolescents and young adults in urban Bangladesh.

CONCLUSION

The inelastic price demand for cigarette smoking suggests that there is scope for increasing tax on cigarettes without compromising the tax revenue.

IMPLICATIONS

This is the first study to investigate price and income elasticities among urban adolescents and young adults in Bangladesh. The study found no evidence that increasing the price of cigarettes discourages smoking participation but did show that increasing the price reduces the intensity of smoking among existing smokers. The results also suggest that economic measures such as taxation that increase the price of cigarettes could be a useful policy tool to limit smoking intensity without compromising government tax revenue.

Latent Class Analysis for Repeatedly Measured Multiple Latent Class Variables

Research on stage-sequential shifts across multiple latent classes can be challenging in part because it may not be possible to observe the particular stage-sequential pattern of a single latent class variable directly. In addition, one latent class variable may affect or be affected by other latent class variables and the associations among multiple latent class variables are not likely to be directly observed either. To address this difficulty, we propose a multivariate latent class analysis for longitudinal data, joint latent class profile analysis (JLCPA), which provides a principle for the systematic identification of not only associations among multiple discrete latent variables but sequential patterns of those associations. We also propose the recursive formula to the EM algorithm to overcome the computational burden in estimating the model parameters, and our simulation study shows that the proposed algorithm is much faster in computing estimates than the standard EM method. In this work, we apply a JLCPA using data from the National Longitudinal Survey of Youth 1997 in order to investigate the multiple drug-taking behavior of early-onset drinkers from their adolescence, via young adulthood, to adulthood.

Longitudinal Associations of Substance Use Risk Profiles with the Use of Alternative Tobacco Products and Conventional Smoking among Adolescents

Although personality is associated with the onset of substance use (i.e., conventional smoking, alcohol use, and cannabis use) during adolescence, it is unclear whether personality traits are also associated with the onset of use of alternative tobacco products (ATPs), i.e., electronic cigarettes, shisha-pens, and water pipes. This study examines whether personality traits are associated with the onset of use of both conventional cigarettes and ATPs. Longitudinal data (baseline and 18-month follow-up) were used. The sample consisted of 1114 non-user adolescents (mean age = 13.36, SD = 0.93, 56% female) at baseline. To measure personality traits, the Substance Use Risk Profile Scale was used with four subscales: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Structural equation models were conducted using Mplus 7.3. Results showed that both hopelessness and sensation seeking were associated with the onset of use of e-cigarettes and conventional cigarettes. Further, sensation seeking and impulsivity were associated with the onset of use of shisha-pens and water pipes. In conclusion, to prevent adolescents from using ATPs and/or conventional cigarettes, it is important to take their personality traits into account. More research on other (shared) risk factors and on more advanced stages of ATP use is needed before effective prevention strategies can be developed.

Social competence, leisure time activities, and smoking trajectories among adolescent boys: Data from The Korean Children & Youth Panel Survey

OBJECTIVES

The purpose of this study was to identify the trajectories and potential predictors of tobacco use during adolescence in Korea and to develop appropriate strategies for the implementation of tobacco use prevention programs.

METHODS

The trajectory of tobacco use and associated predictors were analyzed for 1,169 male students from grade 6 (age 11-12) to grade 10 (age 15-16) in the Korean Children & Youth Panel Survey from 2012 to 2016.

RESULTS

Three trajectories of smoking experience were identified: non-smokers (class 1: n=775, 82.3%), temporary users (class 2: n=32, 3.4%), and regular users (class 3: n=135, 14.3%). When compared to non-smokers, temporary users had a higher likelihood of living with a single parent, dissatisfaction with grades, having a girlfriend, having been victimized at least once, and having at least 1 delinquent friend in grade 7 (when smoking experimentation was at its peak). Significant factors associated with regular use included having a girlfriend, committing at least 1 type of delinquent behavior, and being a non-reader. Committing at least 1 type of delinquent behavior and having at least 1 delinquent friend were associated with regular users, distinguishing them from temporary users.

CONCLUSIONS

Understanding why adolescents exhibit different trajectories of tobacco use by identifying the factors associated with each trajectory can contribute to the development of tailored prevention strategies and early cessation programs for adolescents.

Association between sexual orientation acceptance and suicidal ideation, substance use, and internalised homophobia amongst the pink carpet Y cohort study of young gay, bisexual, and queer men in Singapore

Background

Gay, bisexual and queer (GBQ) men are frequently subjected to minority stressors that have negative impacts on their health. Milestones that include the acceptance and disclosure of sexual identity amongst GBQ men are hence key instruments in understanding the prevalence of internalised homophobia and predicting health outcomes. As such, this work takes a novel approach to deduce the correlates of delayed acceptance of sexual orientation in young GBQ men as a measure of internalised homophobia through retrospective self-reporting and age-based analysis.

Methods

Participants were recruited as part of a cohort study exploring the syndemic risks associated with HIV acquisition among young GBQ men in Singapore. We examined their levels of internalised, perceived, experienced homophobia, as well as their health behaviours and suicidal tendencies. Two separate variables were also self-reported by the participants – the age of questioning of sexual orientation and the age of acceptance of sexual orientation. We subsequently recoded a new variable, delayed acceptance of sexual orientation, by taking the difference between these two variables, regressing it as an independent and dependent variable to deduce its psychosocial correlates, as well as its association with other measured instruments of health.

Results

As a dependent variable, delayed acceptance of sexual orientation is positively associated with an increase of age and internalised homophobia, while being negatively associated with reporting as being gay, compared to being bisexual or queer. As an independent variable, delayed acceptance of sexual orientation was associated with a delayed age of coming out to siblings and parents, suicide ideation, historical use of substances including smoking tobacco cigarettes and consuming marijuana, as well as reporting higher levels of experienced, internalised and perceived homophobia.

Conclusion

Greater levels of early intervention and efforts are required to reduce the heightened experience of minority stress resulting from communal and institutional hostilities. Areas of improvement may include community-based counselling and psychological support for GBQ men, while not forsaking greater education of the social and healthcare sectors. Most importantly, disrupting the stigma narrative of a GBQ ‘lifestyle’ is paramount in establishing an accepting social environment that reduces the health disparity faced by GBQ men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10992-6.

Do Parents Still Matter? The Impact of Parents and Peers on Adolescent Electronic Cigarette Use

PURPOSE

Vaping among adolescents has reached epidemic levels. Identifying factors associated with electronic cigarette (e-cigarette) use initiation could inform prevention programming. This study examined whether parental attitudes toward e-cigarettes impacted adolescent e-cigarette use intentions, positive expectancies of use, and actual use when accounting for adolescent attitudes and peer norms. Parents' negative attitudes toward e-cigarettes were expected to reduce teen e-cigarette use intentions. Low e-cigarette use intentions were expected to mediate the association between parental attitudes and teen e-cigarette use. Peer norms were expected to be associated with positive expectancies. Positive expectancies were expected to mediate the association between peer norms and teen e-cigarette use.

METHODS

A sample of e-cigarette naïve adolescents (n = 176, aged 14-17 years, 52% female, 82% Latinx/Hispanic) and their parents were assessed. Parents and adolescents rated harm associated with e-cigarette use. Adolescents reported their perceptions of peer e-cigarette norms, intentions, positive expectancies, and e-cigarette use. Cross-sectional models were estimated for e-cigarette use intentions and positive expectancies. Prospective mediation models (n = 142) characterized pathways to e-cigarette use.

RESULTS

Parents' attitudes toward e-cigarettes were associated with weaker intentions. Intentions mediated the association between parental attitudes and e-cigarette use. Adolescents reporting favorable e-cigarette peer norms endorsed more positive expectancies. Positive expectancies did not mediate the association between peer norms and e-cigarette use.

CONCLUSIONS

Parents actively shape adolescent e-cigarette use even when accounting for peer norms and adolescent attitudes. Involving parents in prevention programming may help reduce vaping among teens. These associations should be examined with a larger and more diverse sample.

[The Effect of Neighborhood Characteristics and Friends' Smoking Status on the Habitual Smoking Onset in Adolescents]

PURPOSE

The aim of this study was threefold, to longitudinally examine the risk of habitual smoking onset in adolescents, to delineate the effects of neighborhood characteristics and friends' smoking status on the habitual smoking onset, and to investigate whether the association between friends' smoking status and habitual smoking onset was moderated by neighborhood characteristics.

METHODS

This study conducted multilevel discrete-time survival analysis, using cohort data from the 3rd to 6th waves of the Korean Child and Youth Panel Survey, which excluded habitual smokers, matched with 2010 census data on respondents' residence.

RESULTS

Habitual smoking onset risk increased from the 8th to the 11th grade, and then slightly decreased from the 11th to the 12th grade. Friends' smoking status (B = 0.60, p < .001), smoking rate (B = 0.06, p = .038), and the number of tobacco outlets in the respondents' neighborhood (B = 0.51, p = .003) were positively associated with habitual smoking onset risk. Furthermore, the association between friends' smoking status and habitual smoking onset risk was moderated by the number of tobacco outlets in the neighborhood. Specifically, the association was stronger in neighborhoods with more tobacco outlets (B = 0.58, p = .048).

CONCLUSION

Friends' smoking status and living in neighborhoods that are more susceptible to smoking increase the risk of habitual smoking. The number of tobacco outlets in the neighborhood enhances the peer effect of adolescent's smoking behavior. Therefore, policies or interventions designed to reduce youth's tobacco use should focus on not only on reducing peer smoking, but also restricting smoking by adults and the number of neighborhood tobacco outlets.

E-cigarette use perceptions that differentiate e-cigarette susceptibility and use among high school students

BACKGROUND

E-cigarette use among adolescents is increasingly popular and a growing public health concern.

OBJECTIVES

To examine how individual e-cigarette use perceptions differ between adolescents based on e-cigarette use status and susceptibility to future use of e-cigarettes.

METHODS

Data were collected using surveys administered across eight Connecticut high schools (grades 9-12), Spring 2015. N = 2592 students (Mage = 16.01, SD = 1.28, Female = 51.7%) reported e-cigarette use and susceptibility and were categorized into non-susceptible never-users (57.8%), susceptible never-users (16.9%) and ever-users (25.4%). Youth also responded to 12 e-cigarette use perceptions describing perceived benefits and risks of e-cigarette use.

RESULTS

A multinomial logistic regression model was used. Eight use perceptions were related to susceptibility or use of e-cigarettes. The benefit-related use perception "feel relaxed" was the only item associated with greater odds of being both susceptible (vs. non-susceptible, p <.001) and an ever-user (vs. susceptible; p <.05). Two other benefit-related use perceptions were related to higher odds of being susceptible to e-cigarette use ("control your weight"; AOR = 1.82, p <.05; "look cool"; AOR = 3.13, p <.05). Results also identified key risk-related use perceptions that related to lower odds of either being susceptible to e-cigarette use ("have a heart attack"; AOR =.43, p <.001) or of ever-use ("have bad breath"; AOR =.28, p <.001; "get lung cancer"; AOR =.58, p <.05).

CONCLUSION

E-cigarette use perceptions among youth differ by e-cigarette use and susceptibility status. Findings could help identify youth who are vulnerable to e-cigarette use and inform prevention, for example by developing counter-messaging for benefit perceptions associated with susceptibility and ever-use.

5-HT2A and 5-HT2C receptors as potential targets for the treatment of nicotine use and dependence

Nicotine use and dependence, typically achieved through cigarette smoking, but increasingly through vape products, is the leading cause of preventable death today. Despite a recognition that many current smokers would like to quit, the success rate at doing so is low and indicative of the persistent nature of nicotine dependence and the high urge to relapse. There are currently three main forms of pharmacotherapy approved as aids to treat nicotine dependence: a variety of nicotine replacement products (NRT's), the mixed NA/DA reuptake inhibitor bupropion (Zyban®), and the preferential nicotinic α4β2 receptor agonist drug, varenicline (Chantix®); the latter being generally recognized to be the most effective. However, each of these approaches afford only limited efficacy, and various other pharmacological approaches are being explored. This chapter focusses on approaches targeted to the serotonin (5-HT) system, namely, selective serotonin reuptake inhibitors (SSRI's) which served a pioneer role in the investigation of serotoninergic modulators in human smoking cessation trials; and secondly drugs selectively interacting with the 5-HT2A and 5-HT2C receptor systems. From an efficacy perspective, measured as smoking abstinence, the 5-HT2A agonist psychedelics, namely psilocybin, seem to show the most promise; although as the article highlights, these findings are both preliminary and there are significant challenges to the route to approval, and therapeutic use of this class should they reach approval status. Additional avenues include 5-HT2C receptor agonists, which until recently was pioneered by lorcaserin, and 5-HT2A receptor antagonists represented by pimavanserin. Each of these approaches has distinct profiles across preclinical tests of nicotine dependence, and may have therapeutic potential. It is anticipated as diagnostic and predictive biomarkers emerge, they may provide opportunities for subject stratification and opportunities for personalizing smoking cessation treatment. The clinical assessment of SSRI, 5-HT2A and/or 5-HT2C receptor-based treatments may be best served by this process.

Separation Individuation and Transitional Object Use in Daily Smoker Adolescents

BACKGROUND

Smoking is an important problem in adolescence. Early developmental trajectories are also associated with cigarette smoking.

OBJECTIVES

The present study aims to evaluate the separation-individuation process and use of transitional objects in daily smoker adolescents.

METHOD

The research included 97 adolescents who were daily smokers and 210 adolescents who were nonsmokers. Transitional object assessment questionnaire, strength and difficulties questionnaire- adolescent form(SDQ), children's depression inventory(CDI) and state-trait anxiety inventory for children(STAI-C), separation and individuation test of adolescence(SITA) were applied.

RESULTS

SITA subscales scores of engulfment anxiety, need denial, and rejection expectancy was higher and separation anxiety, teacher enmeshment, nurturance seeking scores were statistically significantly lower in smoker adolescents than nonsmokers. In logistic regression analysis, separation anxiety(odds ratio [OR] 0.93; 95% confidence interval[CI] 0.87-0.98), teacher enmeshment(OR 0.93; 95% CI 0.88-0.98), practicing mirroring(OR 1.05; 95% CI 1.02,1.08) and rejection expectancy (OR 1.06 95% CI 1.02,1.11) were found to be predictors of daily smoking. The use of a childhood transitional object for feeling tired and the use of an adolescent transitional object for feeling anxious and tired was found to be significantly higher in smokers.

CONCLUSIONS

There are some differences in the process of separation-individuation and the use of transitional objects in the smoker group. This suggests that early developmental characteristics may be associated with smoking. Further studies are needed to better understand the causal relationship between smoking and the separation-individuation process and transitional object use.

Time-varying effects of family smoking and family management on adolescent daily smoking: The moderating roles of behavioral disinhibition and anxiety

BACKGROUND

Family smoking environment and family management are associated with risk of teen smoking behaviors. However, less is known about whether these associations increase or decrease in strength across adolescence, and whether there are person-environment interactions. The current study examined 1) the age-varying main effects of family smoking and family management on adolescent daily smoking from ages 12-18 and tested 2) whether behavioral disinhibition and anxiety moderated these relationships.

METHODS

Data were drawn from the Seattle Social Development Project (SSDP; N = 808), a longitudinal study examining prosocial and antisocial behavior. Analyses used time-varying effect modeling (TVEM), which tested the stability of the relationship between family smoking and family management and youth daily smoking across adolescence.

RESULTS

Greater family smoking increased the likelihood of adolescent daily smoking, whereas greater family management reduced the likelihood of daily smoking. Significant interactions between family management and youth behavioral disinhibition and anxiety during early and mid-adolescence indicated that family management was more protective for adolescents with low (compared to high) behavioral disinhibition and anxiety. The effect of family smoking was not moderated by behavioral disinhibition or anxiety.

CONCLUSIONS

Family smoking and family management are key risk and protective factors that may be targeted for adolescent smoking prevention. Our interaction results for individual differences in behavioral disinhibition and anxiety suggest that certain types of youth may respond differently to family management practices. Findings also show periods during adolescence where family-centered preventive interventions could be optimally timed to prevent or reduce persistent adolescent smoking.

Intergenerational Transfer of Tobacco Use Behaviour from Parent to Child: A Case Control Study

Background:

Parental influence may be a strong modifiable risk factor in the initiation of Tobacco habits among young adults. Parenting style may modify the risk of initiation of Tobacco use.

Objective:

To examine the intergenerational transfer of Tobacco habits amongst the urban and tribal populations in Kerala.

Methodology:

A hospital based unmatched case control study was undertaken in urban and tribal health centres in Kerala, India. 239 cases (19-30 years of age using any form of Tobacco, 64.10% males) and 256 controls (35.90% males) were enrolled. Parental Tobacco exposure ascertainment was done by conducting in depth interviews using a validated structured questionnaire, parent bonding instrument and life grid technique. Multiple logistic regressions were performed.

Results:

The odds of a case initiating the habit of Tobacco use was nearly four times more when the parent was a Tobacco user [adjusted OR 4.26 (95% CI 2.39 – 7.58)] as opposed to controls. Among other covariates examined, low parental bonding with subject (especially father- warmth/care) was a strong risk factor for Tobacco usage [OR 2.17 (95% 1.11 – 4.23)]. The cases had nearly four times the probability of Tobacco uptake compared to controls if the mothers had no formal schooling [adjusted OR of 3.93 (95% CI, 2.12 – 7.26)].

Conclusion:

Parental use of Tobacco influences the uptake of Tobacco habits in their children, with the father’s parenting (low paternal warmth) being a strong risk factor.

Susceptibility to smoking and determinants among medical students: A representative nationwide study in China

INTRODUCTION

The rationale behind why the majority of medical students are non-smokers, but some initiate smoking after becoming physicians is not fully understood in China. Exploring factors that may increase susceptibility to smoking initiation among medical students is an essential first step in assessing preventative actions.

METHODS

Participants were 11954 students, who were identified through a multistage survey sampling process that included 50 universities in China. Subsequent analysis focused on 8916 non-smokers among medical students. Both unadjusted and adjusted logistic methods were considered in the data analyses.

RESULTS

The prevalence of susceptibility to smoking was 23.0%. Multivariate logistic regression analyses found that exposure to secondhand smoke (SHS) in domestic places (OR= 1.63) and in public places (OR=1.78), cigarette advertising (OR=1.91) and promotional activities on campus (OR=1.90) were positively associated with susceptibility to smoking. In contrast, positive attitudes toward tobacco control on the part of health professionals, HPs, (OR=0.52) were negatively associated with susceptibility to smoking. Those who received information about the dangers of smoking (OR=0.75) and did not agree that light cigarettes are less harmful to health (OR=0.79) were less susceptible to smoke. Caring about exposure to secondhand smoke (OR=0.68 care, and OR=0.33 very) and advising family members to stop smoking (OR=0.81) were negatively associated with susceptibility to smoking.

CONCLUSIONS

These findings underscore the importance of tobacco control training and establishing smoke-free campuses for reducing susceptibility to smoking among medical students.

Smoking Trajectory Classes and Impact of Social Smoking Identity in Two Cohorts of U.S. Young Adults

This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth Initiative Young Adult Cohort Study [YA Cohort], n = 1,491). Using latent class growth analyses and growth mixture models, five smoking trajectories were identified in each sample: in SECAP: nonsmoking (n = 658, 73.7%), declining smoking (n = 20, 2.2%), moderate/stable smoking (n = 114, 12.8%), high/stable smoking (n = 79, 8.9%), and escalating smoking (n = 22, 2.5%); and in YA Cohort: nonsmoking (n = 1,215, 81.5%), slowly declining smoking (n = 52, 3.5%), rapidly declining smoking (n = 50, 3.4%), stable smoking (n = 139, 9%), and escalating smoking (n = 35, 2.4%). SSID was most prevalent in moderate/stable smoking (35.5% SECAP), rapidly declining smoking (25.2% YA Cohort), and nonsmoking. Understanding nuances of how smoking identity is formed and used to limit or facilitate smoking behavior in young adults will allow for more effective interventions to reduce tobacco use.

Nonconformist tendencies related to risky choices in female methamphetamine abstainers

Background: Many experimental studies and theoretical models have tried to explain the multifaceted formation of drug addiction. In most addiction models, social factors are an important component; however, few empirical studies have investigated the social influences on the safe or risky choices of drug-addicted individuals during the abstinence stage. Objectives: To investigate the behavioral patterns of female methamphetamine abstainers under social influence. Methods: Thirty-seven female methamphetamine abstainers (average abstinence time: 8.61 ± 4.75 months) and 40 matched controls performed a gambling task in the presence of peers' choices. We applied both model-free and computational model-based analysis to examine how the decision patterns differed with social influence between the two groups. Results: 1) the choice data from the two groups showed a social influence effect such that participants made more risky choices when others made risky choices; 2) overall, the female methamphetamine abstainers made more risky choices in the social influence task; and 3) in the computational model parameters, the female methamphetamine abstainers exhibited more nonconforming attitudes (with negative other-conferred utility) with respect to peer influence, whereas controls showed higher conformity to peers. Conclusion: Our findings provide the first objective evidence that female methamphetamine abstainers show peer nonconformity. This nonconformist tendency may be a potential behavioral marker to track drug addiction and help to elucidate the mechanisms of decisions made by female methamphetamine abstainers.

Offers of Cigarettes and E-Cigarettes Among High School Students: A Population Study from California

Receiving offers of cigarettes or e-cigarettes can contribute to the progression from intention to actual use. However, there is a lack of data about the prevalence or characteristics of youth being offered cigarettes or e-cigarettes. A random sample of 91 high schools in the state of California (with 40,137 students) participated in the 2015–16 California Student Tobacco Survey. Offers of cigarettes and e-cigarettes in the last 30 days were assessed. Separate multilevel logistical regression models identified student characteristics associated with being offered cigarettes and e-cigarettes. On average, 11.1% and 16.1% of all students reported being offered cigarettes and e-cigarettes in the last 30 days, respectively. Among those who received offers of cigarettes, 45.5% were never smokers. Among those who received offers of e-cigarettes, 29.6% were never vapers. Male students were more likely to report being offered an e-cigarette than female students (Adjusted Odds Ratio (AOR) 1.13), as were students with friends that used e-cigarettes (AOR 5.14–23.31) and those with high sensation seeking tendencies (AOR 1.33). Similar characteristics were associated with offers of cigarettes. Including measures of offers of cigarettes and e-cigarettes in surveillance systems could help identify those at risk of future cigarette and e-cigarette use.

Prevalence and perception of cigarette smoking among out of school adolescents in Birnin Kebbi, North-western Nigeria

Introduction

cigarette smoking is on the increase among adolescents' especially in developing countries and is a leading cause of premature morbidity and mortality worldwide. Adolescents incorrectly perceive that cigarette smoking is less risky than other behaviors such as alcohol consumption and drug use. This study assessed the prevalence and perception of out of school adolescents on cigarette smoking in Birnin kebbi metropolis of Kebbi state.

Methods

This is a cross-sectional mixed methods study. For quantitative data, respondents were selected using two-staged sampling technique. Semi structured interviewer-administered questionnaire was used. Univariate and bivariate analysis was done as appropriate using Epi-info software. Focus Group Discussion guide was used for qualitative data collection. Narrative synthesis was used for qualitative data analysis.

Results

The proportion of respondents who had ever smoked cigarettes was 32.2% while 20.8% currently smoke. Most of the respondents (84.1%) perceived that cigarette smoking was harmful and that passive smoking was dangerous to their health (70.8%). Smokers had a significantly lower risk perception about smoking compared to non-smokers (p < 0.005).

Conclusion

The prevalence of cigarette smoking among out of school adolescents is high with smokers having lower risk perception compared to non-smokers. There is an urgent need to create awareness about the specific dangers associated with cigarette smoking, the transient nature of its perceived benefits and the fact that the risks associated with smoking are severe.

Nye bruksmønstre i et tobakksmarked i endring – kombinert bruk av sigaretter, snus og e-sigaretter blant ungdom

Objectives:

There is limited research on combined use of cigarettes, snus and e-cigarettes in the Nordic countries. This study will investigate whether this pattern of use occurs among adolescents in Norway. In addition, we will investigate the association between combined use of several tobacco products, e-cigarettes and socio-demographic and psychosocial factors (SPF).

Method:

A school-based cross-sectional survey of adolescents in the 8th to the 12th grade (N = 875) in 2014. Information on the use of cigarettes, snus, e-cigarettes and SPF was collected using an electronic questionnaire.

Results:

Of the adolescents, 31% reported having tried or used one or more tobacco product and/or e-cigarette. Of these, over half reported having tried or used one product, 1/3 two products and 1/10 three products. There were more boys among poly-users (63%) than among single-users (44%). Compared to single-users, poly-users also reported weaker school performance (30% and 11%, respectively), more often reported drinking alcohol to intoxication (91% and 75%, respectively), and having tried cannabis (28% and 9%, respectively). Poly-users also scored higher on impulsivity, sensation-seeking and depression.

Conclusion:

The study shows that combined use of tobacco products and e-cigarettes occurs among young people in Norway. Such use was associated with psychosocial and socio-demographic risk factors. There is a need to investigate this phenomenon in more details in representative samples.

Youth perspectives on concurrent smoking and vaping: Implications for tobacco control

Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants' narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases.

Child and adolescent predictors of smoking involvement in emerging adulthood

OBJECTIVE

This study examined the differential relationship of externalizing behavior, internalizing behavior, social context, and their interactions to three developmental indicators of smoking involvement: onset (age), amount of smoking, and dependence symptomatology.

METHOD

Participants (n = 504, 73% male) from a high-risk community-based longitudinal study were followed from age 12-14 to young adulthood (18-20). Smoking involvement was conceptualized as a process involving differences in (a) age of onset of smoking, (b) amount of smoking at age 18-20, and (c) level of nicotine dependence symptomatology at age 18-20. Survival analysis was used to predict onset of smoking, regression for smoking level, and zero-inflated Poisson regression for nicotine dependence.

RESULTS

Externalizing (teacher report) and internalizing behavior (youth self-report), prior to the onset of smoking, predicted different components of smoking and nicotine dependence in young adulthood. Parental smoking predicted all levels of smoking involvement. Peer smoking was related to early onset of smoking, but not higher levels of smoking involvement. Externalizing and internalizing behavior interacted to predict nicotine dependence level, with higher levels of internalizing behavior predicting higher levels of dependence symptoms, even at low levels of externalizing behavior.

CONCLUSIONS

Externalizing and internalizing behavior and social context are independent and interacting risk factors that come into play at different points in the developmental process occurring between smoking onset and dependence. This study provides important information for theoretical models of smoking progression and shows that different types of risk should be targeted for prevention at different points in smoking progression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intention to Try Tobacco Among Middle School Students in a Predominantly Rural Environment of Central Appalachia

BACKGROUND

Disparities in tobacco use exist across regions in the United States. The Central Appalachian region carries some of the very high rates of tobacco use prevalence but research on tobacco use initiation is sparse.

OBJECTIVE

To investigate the intention to try tobacco and its associated factors among nonsmoking youth.

METHOD

Data were obtained from school-based tobacco surveys (n = 539) conducted in 11 middle schools (6th-8th grades; aged 10-15 years) in Northeast Tennessee in 2015-2016. Nonsmoking participants without firm commitment to abstain from trying tobacco in the next year were considered to have an intention to try tobacco. The Full Information Maximum Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable logistic regression analysis to delineate correlates of intention to try tobacco.

RESULTS

Overall, 20.0% of participants had intention to try tobacco. Among participants with intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that tobacco users have more friends, and 88.9% lived with tobacco users. In the adjusted logistic model, ever use of tobacco products, home smoking rules, owning tobacco-branded item(s), living with tobacco users, believing that tobacco users have more friends, and perception of easy access to tobacco products were significantly associated with intention to try tobacco (p < .02).

CONCLUSION

This study suggests that individual, interpersonal, and community level factors influence intention to try tobacco in this environment where tobacco pre-emption laws impede development of local tobacco control policies and regulations. Thus, efforts should focus on tobacco use initiation preventive programs, including school-based tobacco control programs.

Knowledge of Alternative Tobacco Products in Unaccompanied Homeless Youth

Objectives

This study examined perceptions of factors that influence use and non-use of Alternative Tobacco Products (ATPs) among unaccompanied youth experiencing homelessness.

Methods

Focus groups were conducted with 30 homeless 18-24 year olds (80% men, 50% Hispanic, 30% Black, 17% White, 20% multi-racial/other) recruited from drop-in centers in Los Angeles. Discussion focused on several ATPs (hookah, electronic cigarettes/vaping devices, cigarillos/little cigars, smokeless tobacco, snus, natural cigarettes, clove cigarettes), soliciting participants' experiences using each ATP and motivations for using or not using each ATP.

Results

Focus group transcripts were subjected to a rigorous coding procedure and 8 themes relating to the reasons that participants may or may not use ATPs emerged. Each ATP was associated with distinctive characteristics that motivated use and non-use. For example, hookah use was viewed positively with positive sensory and social features dominating the discussion, whereas electronic cigarettes were viewed largely negatively (i.e., that they were expensive and harmful to health). Homelessness characterized participants' responses to the extent that cost was a factor in their choice of ATP.

Conclusions

These data provide important, first look insights into factors that may influence the use and non-use of ATPs among unaccompanied youth experiencing homelessness.

Adolescent Tobacco Uptake and Other Substance Use: A Latent Class Analysis

Objective: The purpose of this study was to identify patterns of tobacco uptake and other substance use, from early to late adolescence. Methods: We used weighted latent class analysis, conducted separately for 7^th, 9^th, and 11^th graders, to assess patterns of susceptibility, ever and current use of combustible tobacco and e-cigarettes, and other substance use (ie, current alcohol, binge drinking, and marijuana). Data were from Wave 3 of the Texas Adolescent Tobacco and Marketing Surveillance System (n = 2733; N = 461,069), collected in fall 2015. Multinomial regression was used to examine differences in class membership by demographic factors. Results: Two latent classes were identified in 7^th grade, 3 classes in 9^th grade, and 4 classes in 11^th grade models. In each grade, classes included both a "no risk" and a "tobacco susceptible" class. For 9^th grade, there was an additional "tobacco ever use" class, and 11^th grade had the same additional class as well as an "all products use" class. Conclusion: Distinct patterns of polysubstance use emerged as grade level increased, supporting a stage-sequential model of onset and progression across developmental age groups. Future research can examine other factors affecting transitions across these stages.

Nicotinic acetylcholine receptor gene polymorphism is not associated with tobacco-related oral squamous cell carcinoma

BACKGROUND

Nicotinic acetylcholine receptor is implicated in carcinogenesis indirectly through increasing nicotine dependence and directly through its impact on cell-cycle regulation. Functional polymorphism in nicotinic acetylcholine receptor alpha-5 subunit gene (CHRNA5 c.1192G>A; rs16969968) is associated with nicotine dependence and risk of lung cancer.

AIM

The aim of this study was to evaluate the association of CHRNA5 c.1192G>A polymorphism with the risk of oral squamous cell carcinoma (OSCC).

SETTINGS AND DESIGN

This was a rural teaching hospital-based case-control study.

MATERIALS AND METHODS

A total of 100 histopathologically confirmed cases of OSCC patients and 100 age- and gender-matched healthy individuals were genotyped for CHRNA5 c.1192G>A polymorphism by polymerase chain reaction-restriction fragment length polymorphism method. Allele and genotype frequencies among case and control groups were compared by Chi-squared test (Fisher's exact).

RESULTS

The frequency of CHRNA5 c.1192A allele was 22% in OSCC patients and 26% in control individuals. The difference in the distribution of alleles and genotypes between case and control groups was not significant (P > 0.05).

CONCLUSIONS

CHRNA5 c.1192G>A polymorphism is not associated with the risk of developing OSCC.

A neurobiological pathway to smoking in adolescence: TTC12-ANKK1-DRD2 variants and reward response

The TTC12-ANKK1-DRD2 gene-cluster has been implicated in adult smoking. Here, we investigated the contribution of individual genes in the TTC12-ANKK1-DRD2 cluster in smoking and their association with smoking-associated reward processing in adolescence. A meta-analysis of TTC12-ANKK1-DRD2 variants and self-reported smoking behaviours was performed in four European adolescent cohorts (N = 14,084). The minor G-allele of rs2236709, mapping TTC12, was associated with self-reported smoking (p = 5.0 × 10^-4) and higher plasma cotinine levels (p = 7.0 × 10^-5). This risk allele was linked to an increased ventral-striatal blood-oxygen level-dependent (BOLD) response during reward anticipation (n = 1,263) and with higher DRD2 gene expression in the striatum (p = 0.013), but not with TTC12 or ANKK gene expression. These data suggest a role for the TTC12-ANKK1-DRD2 gene-cluster in adolescent smoking behaviours, provide evidence for the involvement of DRD2 in the early stages of addiction and support the notion that genetically-driven inter-individual differences in dopaminergic transmission mediate reward sensitivity and risk to smoking.

Cigarette and hookah smoking and their relationship with self-esteem and communication skills among high school students

Background: Tobacco smoking is one of the most important public health problems that may be prevented. There is limited information about its relationship with communication skills. Findings on the relationships between self-esteem and cigarette/hookah smoking are inconsistent. The aim of this study was to investigate the relationships between cigarette and hookah smoking,self-esteem and communication skills among a representative sample of high school students.

Methods: In this cross-sectional study, a sample of 1321 tenth-grade students (14-17 years) was selected through multi-stage proportionally cluster sampling in Tabriz, 2017. The participants completed a self–administered multiple choice questionnaire including questions about cigarette smoking, hookah smoking, self-esteem, and communication skills.

Results: After controlling for potential confounders, the results demonstrated that higher score of self-esteem protects students against being in advanced stages of cigarette smoking (odds ratio [OR] = 0.95, 95% CI: 0.92-0.99, P=0.012). However, there was no significant association between self-esteem score and the hookah smoking. Also, there was no significant association between communication skills score and cigarette and hookah smoking.

Conclusion: According to our findings, self-esteem was associated with cigarette smoking, but not with hookah smoking. Furthermore, there was no statistically significant association between communication skills score and cigarette and hookah smoking.

Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults

BACKGROUND

We assessed whether receipt of coupons-via direct mail or e-mail-was prospectively related to trajectories of smoking behaviours.

METHODS

Data were from a cohort of US adults (n=26 447) who participated in wave 1 (2013-2014) and wave 2 (2014-2015) of the Population Assessment of Tobacco and Health Study. Participants reported receipt of tobacco direct mail/email coupons in the past 6 months in wave 1 and their smoking status in both waves. Weighted multiple logistic regressions were used to examine demographic correlates of receiving tobacco direct mail/email coupons at wave 1 and to examine the prospective effect of receiving tobacco coupons on trajectories of smoking behaviours.

FINDINGS

At wave 1, 10.7% of never smokers, 13.9% of experimental smokers, 37.1% of current smokers and 16.5% of former smokers reported receiving tobacco direct mail/email coupons. Lower education and higher poverty adults and non-Hispanic white current smokers were more likely to have received these coupons (p<0.05). Receiving tobacco direct mail/email coupons at wave 1 was associated with increased odds of smoking initiation among never smokers (adjusted odds ratio (AOR)=2.28, 95% CI 1.36 to 3.83), becoming established smokers among experimenters (AOR=1.62, 95% CI 1.29 to 2.04), becoming daily smokers among non-daily smokers (AOR=1.56, 95% CI 1.23 to 1.99) and smoking relapse among former smokers between waves (AOR=1.91, 95% CI 1.39 to 2.65). Receiving these coupons at wave 1 was associated with reduced odds of smoking cessation ≥6 months among current smokers (AOR=0.71, 95% CI 0.58 to 0.88).

CONCLUSIONS

Tobacco direct mail/email coupons encourage and sustain smoking and disproportionately affect lower socioeconomic populations.

The "here and now" of youth: the meanings of smoking for sexual and gender minority youth

BACKGROUND

The mainstream tobacco field in the USA tends to situate youth as passive, particularly in terms of their susceptibility to industry manipulation and peer pressure. However, failing to acknowledge youths' agency overlooks important meanings youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives.

METHODS

This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area in California. Topics covered in interviews focused on meanings of tobacco in the lives of youth. Interviews lasted approximately 2.5 h and were transcribed verbatim and linked with ATLAS.ti, a qualitative data analysis software. Following qualitative coding, narrative segments were sorted into piles of similarity identified according to principles of pattern-level analysis to interpret to what extent meanings of smoking for young people may operate as forms of resistance, survival, and defense.

RESULTS

Analysis of our participants' narratives highlights how smoking is connected to what Bucholtz calls the "'here-and-now' of young people's experience, the social and cultural practices through which they shape their worlds" as active agents (Bucholtz, Annu Rev Anthropol31:525-52, 2003.). Specifically, narratives illustrate how smoking signifies "control" in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one's mental health.

CONCLUSIONS

These findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation. Implications of these findings for research, prevention, and policy are discussed, emphasizing the risk of furthering health inequities should we fail to acknowledge the "here and now" of youth.

Health Warnings, Smoking Rules, and Smoking Status: A Cross-National Comparison of Turkey and the United States

OBJECTIVES

This study aimed to compare the prevalence of smoking status (i.e., current, former and never) between the United States and Turkey in terms of age and gender, and examine how smoking rules and health warnings are associated with smoking status within and between the two countries.

METHODS

The study used data from the 2012-2013 National Adult Tobacco Survey (U.S. sample, N = 60,196) and the 2012 Global Adult Tobacco Survey (Turkey sample, N = 9,581). SAS PROC SURVEYLOGISTIC with a weighted variable was used to examine the associations between demographics (age, gender and education), smoking rules, health warnings, and smoking status within and between the two countries.

RESULTS

There was an 18% current smoking prevalence among U.S. sample, compared to 27% of the Turkey sample. The U.S. sample had a higher rate of former smoking compared to the Turkey sample (25% vs. 22%). In both countries, being older and male gender predicted former smoking while being younger and female gender predicted never smoking. Having seen a health warning, and not allowing smoking in the vehicle and home positively predicted former and never smoking status. Higher education predicted both smoking statuses in the U.S. only.

CONCLUSIONS

It is important to work with partners particularly in low- and middle-income countries (e.g., Turkey) to combat the global tobacco epidemic. In both counties, cessation endeavors should emphasize a comprehensive understanding of smoking status in terms of smoking rules in personal spaces and health warnings.

The role of parental smoking on adolescent smoking and its social patterning: a cross-sectional survey in six European cities

Background

Several studies have observed socio-economic (SE) inequalities in smoking among adolescents, but its causes are not fully understood. This study investigates the association between parental and adolescent smoking, and whether this association is socially patterned.

Methods

We used data from a survey administered in 2013 to students aged 14-17 years old of six European cities (n = 10 526). Using multilevel mixed-effects logistic regression, we modelled the probability of being a daily smoker as a function of parental smoking and SE status. We tested whether the smoking association differed across social strata.

Results

The prevalence of parental smoking was higher in low SE status adolescents. Boys and girls were more likely to smoke if they have a father [boys: adjusted odds ratio (AOR) = 1.90, 95% CI = 1.47-2.46; girls: AOR = 1.42, 95% CI = 1.09-1.86] and mother (boys: AOR = 1.77, 95% CI = 1.35-2.31; girls: AOR = 3.36, 95% CI = 2.56-4.40) who smoked. Among boys, the odds of smoking when having a smoking parent were higher in lower SE classes. However, this was not statistically significant, nor was it observed among girls.

Conclusions

Adolescents are more likely to smoke when their father and mother smoke. Although the susceptibility to parental smoking was similar across social classes, SE differences in parental smoking contribute to the transmission of SE inequalities in smoking.

A fMRI study on the impact of advertising for flavored e-cigarettes on susceptible young adults

BACKGROUND

E-cigarettes are sold in flavors such as "skittles," "strawberrylicious," and "juicy fruit," and no restrictions are in place on marketing e-cigarettes to youth. Sweets/fruits depicted in e-cigarette advertisements may increase their appeal to youth and interfere with health warnings. This study tested a brain biomarker of product preference for sweet/fruit versus tobacco flavor e-cigarettes, and whether advertising for flavors interfered with warning labels.

METHODS

Participants (N = 26) were college-age young adults who had tried an e-cigarette and were susceptible to future e-cigarette use. They viewed advertisements in fMRI for sweet/fruit and tobacco flavor e-cigarettes, menthol and regular cigarettes, and control images of sweets/fruits/mints with no tobacco product. Cue-reactivity was measured in the nucleus accumbens, a brain biomarker of product preference. Advertisements randomly contained warning labels, and recognition of health warnings was tested post-scan. Visual attention was measured using eye-tracking.

RESULTS

There was a significant effect of e-cigarette condition (sweet/tobacco/control) on nucleus accumbens activity, that was not found for cigarette condition (menthol/regular/control). Nucleus accumbens activity was greater for sweet/fruit versus tobacco flavor e-cigarette advertisements and did not differ compared with control images of sweets and fruits. Greater nucleus accumbens activity was correlated with poorer memory for health warnings.

CONCLUSIONS

These and exploratory eye-tracking findings suggest that advertising for sweet/fruit flavors may increase positive associations with e-cigarettes and/or override negative associations with tobacco, and interfere with health warnings, suggesting that one way to reduce the appeal of e-cigarettes to youth and educate youth about e-cigarette health risks is to regulate advertising for flavors.

Examining the Validity of Self-reported Primary and Secondary Exposure to Cigarette Smoke in Adolescent Girls: The Utility of Salivary Cotinine as a Biomarker

BACKGROUND

Studies of cigarette use and exposure often rely on either self-report or cotinine assay. In adolescence it is not clear how well assays and self-report correspond, or what effect estrogen exposure has on cotinine.

OBJECTIVES

This study sought to identify optimal cut-points for salivary cotinine thresholds for girls with primary, secondary, and no smoke exposure, and whether menarche and hormone contraceptive use are important for interpreting salivary cotinine.

METHODS

This longitudinal prospective study recruited 262 healthy adolescent girls who participated in three annual interviews across 24 months. Salivary cotinine assays and self-report of primary and secondary smoke exposure, menarcheal status, and hormone contraceptive use were collected.

RESULTS

No adolescents reported primary smoke exposure without secondary exposure. Optimal cut-points for distinguishing primary smoke exposure from secondary-only and no smoke exposure were 1.05 and 3.01 ng/ml, respectively based on receiver operator curves (ROC); no reliable cut-point for secondary-only versus no smoke exposure was identified. The ideal salivary cotinine cut-point to distinguish primary smoke exposure varied by hormone contraceptive use and was 2.14 ng/ml for those using progesterone contraceptives, higher than that of girls using estrogen contraceptives and those not using hormone contraceptives.

CONCLUSIONS

This study is the first to examine variance in salivary cotinine cut-points based on hormone exposure for adolescent girls, with findings indicating that hormone contraceptive use in particular may be a key consideration when identifying adolescent smoking. The use of previously recommended salivary cotinine cut-points of 3.85 ng/ml or higher may overestimate nonsmokers.

Dynamic transitions between marijuana use and cigarette smoking among US adolescents and emerging adults

BACKGROUND

Marijuana and tobacco are considered two closely related substances. It is of great significance to understand the mutual impact of marijuana and cigarette use when more states in the US have legalized marijuana use.

OBJECTIVE

This study aims to investigate the transitions between marijuana and cigarette use among adolescents and emerging adults.

METHOD

Guided by the probabilistic discrete events systems (PDES) theory, a five-stage model with 21 transition paths was constructed to quantify dynamic transitions between marijuana and cigarette use. The five stages were NU: Never-user, MU: Current marijuana user, CU: Current cigarette user, MCU: Current marijuana-cigarette user, and FU: Former-user. The proposed five-stage PDES model was tested using the 2013 National Survey on Drug Use and Health data (N = 26,665, 50.45% male). Transition probabilities were estimated using the Moore-Penrose generalized inverse matrix method.

RESULT

Among the adolescents, 51.14% of the CUs transited to use marijuana (MCU/MU), higher than the proportion of those who first used marijuana and then transferred to cigarettes (MCU/CU) (41.66%). The quitting rates for MUs, CUs and MCUs were 29.38%, 25.93% and 27.76%, respectively. Of the total FUs, 31.90% transited to MUs, 17.06% to CUs, and 17.39% to MCUs. Among the young adults, more people progressed from MUs to CUs. Transition probabilities by single year of age were also estimated.

CONCLUSION

This is the first study to quantify marijuana-cigarette transitions. Study findings indicate more cigarette-to-marijuana transitions for adolescents and more marijuana-to-cigarette transitions for emerging adults. Future intervention programs should consider this age-related difference in marijuana-cigarette use transitions.

Evidence of sexual dimorphism of HTR1B gene on major adult ADHD comorbidities

Attention-deficit/hyperactivity disorder (ADHD) is a very common psychiatric disorder across the life cycle and frequently presents comorbidities. Since ADHD is highly heritable, several studies have focused in the underlying genetic factors involved in its etiology. One of the major challenges in this search is the phenotypic heterogeneity, which could be partly attributable to the sexual dimorphism frequently seen in psychiatric disorders. Taking into account the well-known sexual dimorphic effect observed in serotonergic system characteristics, we differentially tested the influence of HTR1B SNPs (rs11568817, rs130058, rs6296 and rs13212041) on ADHD susceptibility and on its major comorbidities according to sex. The sample comprised 564 adults with ADHD diagnosed according to DSM-IV criteria and 635 controls. There was no association of any HTR1B SNPs tested in relation to ADHD susceptibility. As for the comorbidities evaluated, after correction for multiple tests, significant associations were observed for both rs11568817 and rs130058 with substance use disorders (P_corr = 0.009 and P_corr = 0.018, respectively) and for rs11568817 with nicotine dependence (P_corr = 0.025) in men with ADHD. In women with ADHD, the same rs11568817 was associated with generalized anxiety disorder (P_corr = 0.031). The observed effects of rs11568817 G allele presence conferring risk to either substance use disorders or generalized anxiety disorder according to sex, suggest an overall scenario where a higher transcriptional activity of HTR1B, resulting from the presence of this allele, is related to externalizing behaviors in men and internalizing behaviors in women. These results are consistent with and expand previous evidence of sexual dimorphism of the serotoninergic system.

The association between personal income and smoking among adolescents: a study in six European cities

AIMS

This study investigates the link between personal income and smoking among adolescents, and aims to answer the following questions: (i) to what extent is personal income related to smoking, independent of family socio-economic status (SES) and (ii) does the association between personal income and smoking apply to different subpopulations?

DESIGN

Cross-sectional study.

SETTING

Six cities from European countries (Amersfoort, the Netherlands; Coimbra, Portugal; Hannover, Germany; Latina, Italy; Namur, Belgium; Tampere, Finland) in 2013.

PARTICIPANTS

A school-based sample of 10 794 adolescents aged 14-17 years.

MEASUREMENTS

We modelled smoking experimentation, weekly smoking, daily smoking and (among daily smokers) smoking intensity as function of personal income, adjusting for age, sex, family SES, parental smoking and country. We tested interactions between personal income and covariates. Stratification analyses were performed for the variables for which interactions were significant.

FINDINGS

Adolescents in the highest income quintile were more likely to be smoking experimenters [odds ratio (OR) = 1.87; P < 0.01], weekly smokers (OR = 3.51; P < 0.01) and daily smokers (OR = 4.55; P < 0.01) than those in the lowest quintile. They also consumed more cigarettes per month (β = 0.79; P < 0.01). Adjusting for family SES did not modify the significance of relationships, and increased the magnitude of the association for daily smoking. None of the interactions between covariates and personal income was significant for smoking measures. For the intensity of smoking, the interaction was significant for SES. The stratified analysis showed a non-significant association between smoking intensity and personal income among the oldest adolescents and those with the lowest SES background, while significant among younger and higher SES backgrounds.

CONCLUSION

In the Netherlands, Portugal, Germany, Italy, Belgium and Finland, adolescents' personal income is related positively to smoking behaviours independent of family socio-economic status (SES). However, among low socio-economic status adolescent daily smokers, the association between the intensity of smoking and personal income is weaker.

Susceptibility to cigarette smoking among middle and high school e-cigarette users in Canada

There is a growing concern that the historic reductions in tobacco consumption witnessed in the past decades may be undermined by the rapid increase in e-cigarette use. This study examined the association between e-cigarette use and future intention to smoke cigarettes among middle and high school students who had never smoked cigarettes. Data were drawn from the 2014-2015 Canadian Student Tobacco, Alcohol and Drugs Survey (n=25,637). A multivariable logistic regression model was used to examine the association between e-cigarette use and susceptibility to cigarette smoking. In addition, an inverse probability of treatment weighted regression adjustment method (doubly robust estimator), which models both the susceptibility to smoking and the probability of e-cigarette use, was conducted. About 10% of the students had ever tried an e-cigarette. There were higher rates of ever e-cigarette use among students in grades 10-12 (12.5%) than those in grades 7-9 (7.3%). Students who had ever tried an e-cigarette had higher odds of susceptibility to cigarette smoking (adjusted odds ratio=2.16, 95% confidence interval=1.80-2.58) compared to those that had never tried an e-cigarette. Current use of an e-cigarette was associated with higher odds of smoking susceptibility (adjusted odds ratio=2.02, 95% confidence interval=1.43-2.84). Similar results were obtained from the doubly robust estimation. Among students who had never smoked cigarettes, e-cigarette use was associated with a higher susceptibility to cigarette smoking.

Relationship between trying an electronic cigarette and subsequent cigarette experimentation in Scottish adolescents: a cohort study

BACKGROUND

This study examines whether young never smokers in Scotland, UK, who have tried an e-cigarette are more likely than those who have not, to try a cigarette during the following year.

METHODS

Prospective cohort survey conducted in four high schools in Scotland, UK during February/March 2015 (n=3807) with follow-up 1 year later. All pupils (age 11-18) were surveyed. Response rates were high in both years (87% in 2015) and 2680/3807 (70.4%) of the original cohort completed the follow-up survey. Analysis was restricted to baseline 'never smokers' (n=3001/3807), 2125 of whom were available to follow-up (70.8%).

RESULTS

At baseline, 183 of 2125 (8.6%) never smokers had tried an e-cigarette and 1942 had not. Of the young people who had not tried an e-cigarette at baseline, 249 (12.8%) went on to try smoking a cigarette by follow-up. This compares with 74 (40.4%) of those who had tried an e-cigarette at baseline. This effect remained significant in a logistic regression model adjusted for smoking susceptibility, having friends who smoke, family members' smoking status, age, sex, family affluence score, ethnic group and school (adjusted OR 2.42 (95% CI 1.63 to 3.60)). There was a significant interaction between e-cigarette use and smoking susceptibility and between e-cigarette use and smoking within the friendship group.

CONCLUSIONS

Young never smokers are more likely to experiment with cigarettes if they have tried an e-cigarette. Causality cannot be inferred, but continued close monitoring of e-cigarette use in young people is warranted.

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.

Incentives for preventing smoking in children and adolescents

BACKGROUND

Adult smoking usually has its roots in adolescence. If individuals do not take up smoking during this period it is unlikely that they ever will. Further, once smoking becomes established, cessation is challenging; the probability of subsequently quitting is inversely proportional to the age of initiation. One novel approach to reducing the prevalence of youth smoking is the use of incentives.

OBJECTIVES

To assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It was also our intention to assess, where possible, the dose-response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives.

SEARCH METHODS

For the original review (published 2012) we searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, Embase, CINAHL, CSA databases and PsycINFO for terms relating to incentives, in combination with terms for smoking and tobacco use, and children and adolescents. The most recent searches were of the Cochrane Tobacco Addiction Group Specialized Register, and were carried out in December 2016.

SELECTION CRITERIA

We considered randomized controlled trials (RCTs) allocating children and adolescents (aged 5 to 18 years) as individuals, groups or communities to intervention or control conditions, where the intervention included an incentive aimed at preventing smoking uptake. We also considered controlled trials (CTs) with baseline measures and post-intervention outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors extracted and independently assessed the data. The primary outcome was the smoking status of children or adolescents at follow-up who reported no smoking at baseline. We required a minimum follow-up of six months from baseline and assessed each included study for risks of bias. We used the most rigorous definition of abstinence in each trial; we did not require biochemical validation of self-reported tobacco use for study inclusion. Where possible we combined eligible studies to calculate pooled estimates at the longest follow-up, using the Mantel-Haenszel fixed-effect method, grouping studies by study design.

MAIN RESULTS

We identified three eligible RCTs and five CTs, including participants aged 11 to 14 years, who were non-smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta-analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke-free for a six-month period, and report their smoking status regularly. If 90% or more of the class are non-smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.Most studies resulted in statistically non-significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow-up. However, this study was at risk of multiple biases, and when we calculated the adjusted risk ratio (RR) we no longer detected a statistically significant difference. The pooled RR for the more robust RCTs (3 studies, n = 3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% confidence interval (CI) 0.84 to 1.19). Pooled results from the non-randomized trials also did not detect a significant effect of the SFC, and we were unable to extract data on our outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose-response relationship or to report costs of incentives for preventing smoking uptake.We judged the included RCTs to be at unclear risk of bias, and the non-RCTs to be at high risk of bias. Using GRADE, we rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non-RCTs), because of imprecision (all studies had wide confidence intervals), and for the risks of bias identified. We further downgraded the non-RCT evidence, due to issues with the non-RCT study design, likely to introduce further bias.

AUTHORS' CONCLUSIONS

The very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality. In addition, trials included in the meta-analyses were all studies of the SFC, which distributed small to moderately-sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people.Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail.