Relationships of teenage smoking to educational aspirations and parents' education

Physicians' views on the role of smoking in smoking-related diseases: findings from cross-sectional studies from 1982-2014 in Estonia

Background

Previous reports have shown that physicians who smoke underestimate the effects of smoking on health and this influences their practice. This study was designed to investigate the views of Estonian physicians on the role of smoking in smoking-related diseases.

Methods

Cross-sectional postal surveys were sent to all practising physicians in Estonia in 1982, 2002 and 2014 providing data from 3504, 2694, and 2865 physicians respectively. Data analysis involved calculation of the prevalence of smoking with 95% confidence intervals and calculation of the prevalence of agreement with a causal role of smoking in ischaemic heart disease (IHD), lung cancer and chronic bronchitis. Logistic regression was used to analyse associations between agreement with the statements that smoking is a cause of IHD, lung cancer, chronic bronchitis and study year, smoking status, age group and ethnicity. Fully adjusted odds ratios with 95% confidence intervals were calculated.

Results

The age-standardized prevalence of current smoking among men decreased from 39.6% in 1982 to 14.2% in 2014, and among women from 12.4 to 5.1%, respectively. Compared with 1982, the proportion of physicians agreeing with statements that smoking is a major cause or one of the causes of IHD, lung cancer, or chronic bronchitis was significantly higher in 2002 and 2014. Past and never smokers were more likely to admit a causal role of smoking in lung cancer than smokers. Agreement with a causal role of smoking in IHD and chronic bronchitis was significantly higher among never and past smoking women only. Compared with non-Estonians, the odds ratio indicating agreement with all three statements was significantly higher among Estonians.

Conclusion

From 1982 to 2014, physicians’ attitudes towards the health risks of smoking improved in Estonia. However, their assessment of a causal role of smoking in smoking-related diseases was related to their own smoking habits and ethnicity.

A further decline in smoking among Estonian physicians would require special efforts targeted at physicians. Societal pressure from a national policy could support a further decline in the social acceptability of smoking in Estonia and developments in medical education could provide continuing evidence-based information about the effects of smoking to Estonian physicians.

Smoking and associated factors among adolescents in Tallinn, Helsinki and Moscow: a multilevel analysis

Aims: To investigate variations in smoking and associated factors on individual and aggregate level among adolescents in Tallinn (Estonia), Helsinki (Finland) and Moscow (the Russian Federation). Methods: The data was collected in Tallinn (N=1268 in Estonian and N=901 in Russian schools), in Helsinki (N=1396) and in Moscow (N=618) from pupils aged 13 - 18 by self-administered questionnaire. Multilevel analysis was used to estimate the possible effects of background characteristics, of the proximity of other smokers and the school context on the tobacco use of pupils. Results: The prevalence rate of smoking among girls in Russian schools in Tallinn (34.6%), among girls in Helsinki (39.5%), and in Moscow (32.1%) was higher than that among girls in Estonian schools in Tallinn (17.6%). Smoking was slightly less prevalent among boys in Helsinki (27.5%), compared to boys in Estonian (33.6%) and Russian (35.6%) schools in Tallinn, and to boys in Moscow (32.8%). Smoking increased with age. Multilevel analysis showed that smoking differed by school among pupils. Individual determinants of smoking as study site, grade, friends', siblings' and parental smoking behaved differently depending upon school. Friends and siblings' smoking showed interaction with study site to the smoking among girls. Conclusions: Strategies aimed at influencing smoking behaviour need to be directed not only towards the individual, but also towards the influences within the child's school environment.

What factors influence follow-up in orthopedic trauma surgery?

BACKGROUND

Among surgical patients, follow-up visits are essential for monitoring post-operative recovery and determining ongoing treatment plans. Non-adherence to clinic follow-up appointments has been associated with poorer outcomes in many different patient populations. We sought to identify factors associated with non-attendance at follow-up appointments for orthopedic trauma patients.

MATERIALS AND METHODS

A retrospective chart review at a level I trauma center identified 2,165 patients who underwent orthopedic trauma surgery from 2008 to 2009. Demographic data including age, sex, race, tobacco use, American Society of Anesthesiologist (ASA) score, insurance status, distance from the hospital, and follow-up time were collected. Injury characteristics including fracture type, anatomic location of the operation, length of hospital stay, living situation and employment status were recorded. Attendance at the first scheduled follow-up visit was recorded. Multivariable log-binomial regression analyses were used with statistical significance maintained at p < 0.05.

RESULTS

Of the 2,165 patients included in the analysis, 1,449 (66.9 %) attended their first scheduled post-operative clinic visit. 33.1 % (717) were not compliant with keeping their first clinic appointment after surgery. Patients who used tobacco, lived more than 100 miles from the clinic site, did not have private insurance, had an ASA score >2, or had a fracture of the hip or pelvis were significantly less likely to follow-up. Age, sex, and race were not significantly associated with failure to follow-up.

DISCUSSION

Follow-up appointments are essential for preventing complications among orthopedic trauma patients. By identifying patients at risk of failure to follow-up, orthopedic surgeons can appropriately design and implement long-term treatment plans specifically targeted for high-risk patients.

The social network, socioeconomic background, and school type of adolescent smokers

The aim of this study is to examine the role of Dutch second grade (age 13–14) high school peer networks in mediating socioeconomic background and school type effects on smoking behavior. This study is based on a longitudinal design with two measurement waves at five different high schools, of the complete networks of second grader friendships, as well as their smoking behavior, school type, and parents’ educational level. The analysis is done by simulation investigation for empirical network analysis (SIENA) modeling that can control for friendship selection on the basis of smoking similarity when assessing friends’ influence on smoking. The findings show that, when controlling for friendship selection, the influence of friends still plays a significant role in adolescent smoking behavior, and suggests that socioeconomic background and school type effects on smoking are mediated by the friendship networks at school.

The role of family factors and school achievement in the progression of adolescents to regular smoking

This study examines whether parental smoking and single parenting were related to adolescents' school achievement and anti-smoking parental practices as well as how these factors predicted later smoking. The sample comprised 1163 Finnish students in Grades 7 through 9. Results show that at the beginning of the seventh grade, parental smoking and single parenting were related to adolescents' lower levels of school achievement. Moreover, parental smoking had moderate association with lack of house smoking rules. At the beginning of the ninth grade, these associations were strengthened and lack of house smoking rules as well as loosened perceived parental punishment for smoking was related to both parental smoking and single parenting. The likelihood of ninth grade regular smoking was greater among adolescents whose parents smoked, who had no smoking rules in their homes and had substandard school achievement. These results suggest that smoking parents and single parents had similar anti-smoking regulations for their children at the baseline but once children became older smoking parents were not able to maintain these rules as successfully as non-smoking parents and families with two parents. Motivating parents to uphold these anti-smoking regulations offers a prospective intervention opportunity.

The role of family influences on adolescent smoking in different racial/ethnic groups

INTRODUCTION

Although differing levels of family influences may explain some of the varying racial/ethnic trends in adolescent smoking behavior, clarification of which influences are protective against smoking may aid in the development of future ethnic-specific smoking prevention interventions. We sought to identify and compare the association of family influences on adolescent smoking among Black, Hispanic, and White adolescents in a cross-sectional national sample.

METHODS

Data from 6,426 parent-child dyads from Round 1 of the National Survey of Parents and Youth were analyzed. The association of family influences with ever-smokers and recent smokers was evaluated. Multinomial logistic regression using SUDAAN software was used.

RESULTS

While all measures of family influences except for parent-adolescent activities and intention to monitor were significantly protective against recent smoking and ever smoking among Whites, ethnic-specific family influence predictors of smoking were found in Blacks and Hispanics. Higher parental monitoring, higher intention to monitor, and higher connectedness were protective among Hispanics, while higher parental punishment and favorable attitude toward monitoring were protective against smoking among Blacks. For family influences significantly associated with protection against smoking, consistently greater protection was afforded against recent smoking than against ever smoking.

CONCLUSIONS

Higher levels of family influences are protective against smoking among all racial/ethnic groups. There are consistencies in family influences on youth smoking; however, there may be specific family influences that should be differentially emphasized within racial/ethnic groups in order to protect against smoking behavior. Our results offer insight for designing strategies for preventing smoking in youth of different racial/ethnic backgrounds.

Academic achievement and smoking: Is self-efficacy an important factor in understanding social inequalities in Finnish adolescents?

Aims: Poor academic achievement is strongly related to smoking but studies that examine the mechanism between academic achievement and smoking are lacking. The aim of this study, therefore, was to examine the smoking-related cognitions (i.e. attitude, social influence, self-efficacy and intention to smoke) in relation to academic achievement and determine whether these cognitions explain different patterns of smoking. Methods: The study uses the data of a longitudinal study that was carried out in Finland, and the sample comprised 1,096 students in grades seven to nine. Results: During the seventh-grade students with poor academic achievement reported more positive attitudes to smoking and a greater social influence of their peers regarding smoking, weaker self-efficacy to refuse smoking and more intentions to smoke in the future compared to students with high academic achievement. Moreover, the follow-up analyses after a 24-month interval revealed that self-efficacy to refuse smoking of students with poor grades had become weaker compared to students with high grades. Furthermore, the influence of seventh-grade academic achievement predicting ninth-grade weekly smoking was partially mediated through the self-efficacy beliefs and the intention to smoke. Conclusions: Differences in academic achievement may have an impact on adolescents’ self-efficacy beliefs and the intention to smoke in the future. To reduce health inequalities a strong input on continuing research to improve smoking prevention methods, especially for students with low academic achievement, is needed.

Longitudinal study of relations between school achievement and smoking behavior among secondary school students in Finland: results of the ESFA study

The aim of this study was to explore a longitudinal bi-directional relationship between school achievement and smoking behavior. The sample consists of 2,188 Finnish students in grades 7-9. Data were collected at three separate occasions between the years 1998 and 2000. Three hypothesized conceptual models were developed and tested using path analyses by structural equation modeling (SEM). Students that performed poorly at school smoked weekly six times more than those who achieved the highest school grade point averages at the age of 15. Using SEM, the findings suggest that not only does deterioration of school achievement contribute to progression in smoking uptake continuum but also vice versa progression in smoking uptake continuum to deterioration of school achievement over time (CFI = .997). There were no moderating effects of gender or treatment condition in the proposed models. Both deterioration of school achievement and progression in smoking uptake continuum predicted changes in other behavior during the first two years in secondary school in Finland.

Longitudinal precursors of young adult light smoking among African Americans and Puerto Ricans

INTRODUCTION

Studies have consistently documented the importance of examining light smoking among African American and Latino adolescent and adult smokers. Little is known, however, about the psychosocial antecedents of adolescent and young adult light smoking in these racial/ethnic minority groups.

METHODS

This study examined the longitudinal interrelationships and pathways leading to light smoking among African Americans (n = 288) and Puerto Ricans (n = 262). Specifically, we assessed parental factors, perceived discrimination, peer smoking, personality factors, and light smoking in late adolescence as precursors to light smoking among African American and Puerto Rican young adults.

RESULTS

The results of structural equation modeling showed that a history of greater parental smoking, less parental educational attainment, and more perceived discrimination were each mediated by peer smoking and the youth's maladaptive personality and behavior in late adolescence. The youth's maladaptive personality and behavioral characteristics and light smoking in late adolescence, in turn, predicted light smoking in young adulthood. There were no significant racial/ethnic or gender differences in the pathways to light smoking.

DISCUSSION

Findings highlight the longitudinal pathways to light smoking among African Americans and Puerto Ricans. The results suggest that effective prevention and cessation programs must address peer and parental social influences, perceived discrimination, and especially, emotional and behavioral problems in late adolescence to reduce light smoking among late adolescents and young adults in these racial/ethnic groups.

Socioeconomic status and health behaviors in adolescence: a review of the literature

OBJECTIVE

The goal of this review was to determine the direction of associations between SES and health behaviors during the period of adolescence.

METHOD

We searched the PsychInfo and Pubmed databases for studies that measured the association between SES and cigarette smoking, alcohol consumption, marijuana use, diet, and physical activity in adolescents between 10- and 21-years old.

RESULTS

Associations between SES and health behaviors conformed to two patterns. First, low SES was associated with poorer diets, less physical activity, and greater cigarette smoking. Second, there was no clear pattern of associations between SES and alcohol consumption or marijuana use.

CONCLUSION

Results from this review indicate that, although some associations between SES and health behaviors exist during adolescence, the associations are not as robust as those in adulthood. Efforts to curb poor diet, inactivity, and smoking behaviors should target low SES adolescents, whereas efforts to curb teen drinking and marijuana use may be useful across the SES spectrum.

Are educational aspirations associated with the risk of alcohol use and alcohol use-related problems among adolescents?

OBJECTIVE

Using prospective data, we hypothesized that public middle school students with high educational aspirations would report less alcohol use, and alcohol use-related problems in the subsequent year.

METHODS

The participants for these analyses included students, ages 11 to 14 years old, participating in a longitudinal study in an urban sample of public schools (n = 1229). As part of the prospective annual assessments of the students, in 1992 (to) and 1993 (t1), data on educational aspirations and on alcohol use, and alcohol use-related problems were gathered. Latent variable modeling was used to assess the relationship between educational aspirations at baseline (to) and subsequent year drinking behavior (t1) in two separate models, one to examine the relationship of educational aspirations with self-reported alcohol use (model 1), and another to examine the association with alcohol use-related problems (model 2). Potential confounding by age, sex, race-ethnicity, alcohol use by peers, self-reported school performance, and neighborhood environment was held constant in each model. In addition, each model took into account the prior year report of alcohol use and alcohol use-related problems, respectively.

RESULTS

The evidence indicated that students with high aspirations were no more nor less likely to report subsequent alcohol use [beta = 0.15, 95% confidence interval (CI) = -0.19, 0.49; p = 0.38] nor alcohol use-related problems (beta = -0.009, CI = -0.07, 0.06; p = 0.80). Other characteristics were associated with alcohol use at follow-up and included race-ethnicity (being non-Black), neighborhood environment, and having friends who drink alcohol. Characteristics associated with alcohol use-related problems at the time of the follow-up interview also included race-ethnicity, peer drinking, neighborhood environment, as well as older age.

CONCLUSIONS

Findings from the current study do not support the hypothesis that educational aspirations have significant influences on alcohol consumption or drinking problems in this study population of urban, predominantly Black students. As such, this work helps to advance our understanding of suspected relationships between educational aspirations, as well as factors associated with resilience to alcohol use and the occurrence of alcohol use-related problems.

Health-compromising behaviors among Vietnamese adolescents: the role of education and extracurricular activities

PURPOSE

To examine the prevalence of unhealthy behaviors among a cohort of Vietnamese adolescents in California; to examine the relationship between these behaviors and school-related variables (school performance, educational risk behaviors, higher-education aspirations, and participation in extracurricular activities); and to assess the differences that may exist between males and females with regard to these factors.

METHODS

We conducted telephone interviews with 783 Vietnamese adolescents, aged 12-17 years, recruited through telephone listings from four California counties where large Vietnamese populations reside: San Francisco, Santa Clara, Los Angeles, and Orange. Of the 783 completed interviews, 60.8% were conducted in English and 39.2% in Vietnamese. The main outcome measure is a health risk behavior scale that includes adolescents' reports of ever smoking a cigarette, sedentary vs. active lifestyle, consumption of fruits and vegetables, consumption of foods high in fat, ever drinking alcohol, and ever engaging in sexual behavior. Multiple regression analyses were employed to estimate the association among the demographic variables, acculturation, school performance, aspirations, extracurricular activities, and the overall health risk.

RESULTS

Females were significantly more sedentary than males. Over one-quarter (29%) of the females reported not having participated in vigorous physical activity on 3 or more days per week, compared with just 18% of the males. Most adolescents reported they had never tried cigarettes (84%), never used alcohol (77%), and never had sex (97%). Males were more likely than females to report a higher frequency of experimentation with smoking and drinking. Overall, school performance and participation in extracurricular activities were significantly related to the health risk behavior scale. Adolescents who demonstrated at least one educational risk (ever skipped school or ever sent out of the classroom) were more likely to engage in other risky behaviors. Also, older and more acculturated adolescents were at increased risk of engaging in health-compromising behaviors. Analysis by gender revealed that the variables age, educational risk, and chance of attending college were all related to health risk behavior for both males and females. Among the boys, those who reported achieving an average grade of B or better had a decreased risk of engaging in health-compromising behaviors; however, neither extracurricular activities nor acculturation was related to health-compromising behaviors in boys. Among the girls, the reverse was true: lack of participation in extracurricular activities was related to health-compromising behaviors, whereas grades were not a significant risk factor.

CONCLUSIONS

Among sampled Vietnamese adolescents in California, health risk behaviors are common and inversely related to some school performance indicators. Using these indicators to identify high-risk groups could allow targeted educational programs or interventions for the mitigation of health-compromising behaviors.

Adolescent stress and future smoking behaviour: a prospective investigation

OBJECTIVE

Adolescent stress has been retrospectively associated with various measures of smoking behaviour in school-aged samples. The present study sought to extend this to a prospective investigation in order to examine the possibly formative influences of stress on the onset of smoking in adolescents.

METHOD

A 12-month follow-up study related sources and degree of adolescent stress measured at study commencement with the onset of smoking behaviour 12 months later in a large cohort of adolescents attending Australian secondary schools.

RESULTS

Adolescent stress was only weakly related to smoking onset in adolescent males and even this could possibly be explained by other factors. In adolescent girls, however, prospective associations were stronger and more broadly represented across the various domains of adolescent stress, suggesting that stress may exert a formative influence on smoking onset for girls.

CONCLUSION

Management strategies for adolescent stress may be an affective target for smoking prevention programs among adolescent girls.

Cognitive adaptation, psychological adjustment, and disease progression among angioplasty patients: 4 years later

The long-term effects of the Cognitive Adaptation Theory Index (CATI) on psychological and physical health outcomes among men (n = 199) and women (n = 99) treated for coronary artery disease with percutaneous transluminal coronary angioplasty were examined. The CATI reflects a positive view of the self, a positive view of one's future, and a sense of personal control over daily life. This index was created from questionnaires administered during hospitalization for the initial angioplasty. Four years later, the CATI predicted positive adjustment to disease, even when initial adjustment was taken into consideration. In addition, the CATI predicted a reduced likelihood of sustaining a subsequent cardiac event over 4 years. This association was more robust for men.

The relationship between socioeconomic status, ethnicity, and cigarette smoking in urban adolescents

BACKGROUND

This study examined the relationship between community-level and school-level socioeconomic status indicators and current cigarette smoking among urban adolescents, and examined whether the socioeconomic status-cigarette smoking relationship was similar for African Americans and Whites.

METHODS

Participants were 3,813 seventh-graders recruited in a large school system in the United States. Independent variables included median income and mean education within zip codes of participants' residence, percentage of participants receiving lunch at reduced or no cost at school level, and ethnicity. The dependent variable was current smoking status (never smoked vs smoking one or more cigarettes per month).

RESULTS

Whites were significantly more likely than African Americans to smoke cigarettes. There was a main effect of education and lunch at reduced or no cost on cigarette smoking. Mean education by zip code was inversely associated with cigarette smoking, and lunch at reduced or no cost was directly associated with cigarette smoking. There was a significant interaction between income and ethnicity. Median income by zip code was directly associated with cigarette smoking among African Americans.

CONCLUSIONS

Our findings suggest that smoking prevention efforts in this population should take both socioeconomic status and ethnicity into account.

Characterization of the smoking habit among high school students in Syria

OBJECTIVES

To establish an accurate estimate of the prevalence of smoking among high school students in Aleppo-Syria and to characterize the smoking habit in this age group.

DESIGN

A cross-sectional survey was performed, in which a self-administered questionnaire was distributed to 10th, 11th and 12th graders.

SUBJECTS

A sample of 1587 students (784 males; mean age 16 years, and 803 females; mean age 15.9 years) was studied. This sample was drawn from 16 schools randomly selected from a total of 73 schools in the city.

RESULTS

The prevalence of current smoking was 15.9% for males and 6.6% for females. The prevalence of daily smoking was 2.4% for males and 0.5% for females. Almost all smoking categories increased with age and grade. Forty seven percent of male daily smokers were heavy smokers. Peer influence was evident in all stages of the smoking process, especially for males. Parental smoking was also an important associated factor. The combination of parental and siblings smoking was the strongest predictor of the smoking status of the surveyed (OR: 4.4; 95% CI: 2.7-7). Thirty eight percent of male smokers and 47.2% of female smokers smoke out of boredom. Fifty one percent of male smokers were introduced to smoking by a friend. Forty percent of male smokers buy their cigarettes, while 56.6% of female smokers obtain their cigarettes from home. Logistic regression analyses showed that parental and siblings smoking were the most important predictors of ever trying to smoke or current smoking among male and female students.

CONCLUSIONS

Our study shows that smoking is more frequent in male than female students. Parental and sibling smoking are the most important factors associated with smoking in this population, and peer influence is important particularly in the smoking-initiation stage. Pattern of smoking and associated factors differed substantially between males and females in this study.

Juvenile and early adulthood smoking and adult educational achievements--a 31-year follow-up of the Northern Finland 1966 Birth Cohort

AIMS

To investigate the association between juvenile and early adult cigarette smoking and educational achievements up to the age of 31 years.

METHODS

As a part of the follow-up of the North Finland 1966 Birth Cohort (n = 10542) from 1966 to 1997, smoking was assessed at the ages of 14 and 31 by postal questionnaires. The highest level of educational attainment was obtained from the National Education Registry of Statistics Finland up to the age of 31 years.

RESULTS

Adult smoking (at age 31) and prolonged smoking (at ages 14 and 31) were both associated with an approximately two- to sixfold, adjusted odds for educational underachievement. Smoking only at age 14 showed none of these associations.

CONCLUSION

These results are unlikely to be causal, but may be explained by other characteristics associated with smoking such as personality or lifestyle factors, as well as the effect of knowledge related to smoking gained during higher education.

Occupational attainment, smoking, alcohol intake, and marijuana use: ethnic-gender differences in the CARDIA study

OBJECTIVES

To evaluate the prospective interrelationship of smoking, alcohol intake, marijuana use, and educational and occupational attainment of Black and White young adults.

METHODS

Logistic or mixed model linear regression were used to evaluate relationships between self-reported substance use, ethnicity, gender, college graduation, and four measures of occupational attainment.

RESULTS

College graduation in the next 10 years was negatively associated with smoking and marijuana use, but not daily alcohol consumption in all ethnic and gender groups. In Whites, marijuana use was associated with less prestigious occupations and lower family income, while smoking was unrelated and moderate daily drinking was positively associated. In Blacks, marijuana use was generally unrelated to occupational measures, while smoking and daily alcohol consumption were negatively associated.

CONCLUSIONS

Relationships between smoking, marijuana use, daily drinking, and occupational attainment were not universally negative in this age group. Substance use, particularly smoking, is associated with reduced occupational attainment in Blacks compared with Whites after considering sociodemographic factors potentially limiting educational progression and occupational attainment.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA SYNTHESIS

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

CONCLUSIONS

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

Psychosocial predictors of cigarette smoking among adolescents living in public housing developments

BACKGROUND

Adolescents residing in low-income public housing developments in inner-city regions may be particularly vulnerable to a variety of risk factors associated with cigarette smoking.

OBJECTIVE

To elucidate the aetiology of cigarette smoking among adolescents living in public housing developments.

DESIGN, SETTING, AND SUBJECTS

We examined predictors of smoking from four domains: background characteristics, social influences, behavioural control, and psychosocial characteristics using a sample of seventh graders (mean age 12.9 years) who reside in public housing developments in New York City (n = 624). The addresses of participants in a larger investigation of the aetiology and prevention of smoking were checked to determine if they lived in one of 335 public housing developments in New York City. All participants living in public housing developments were included in the current study.

MAIN OUTCOME MEASURES

African-American and Hispanic students completed questionnaires about their cigarette use, social pressures to smoke, smoking attitudes, smoking knowledge, and smoking resistance skills. Students also provided information on demographic and behavioural control (such as church and school attendance).

RESULTS

Logistic regression analyses indicated that social influences from friends and family members predicted smoking. Psychosocial characteristics such as advertising resistance skills, anti-smoking attitudes, and refusal skills lowered the odds of smoking.

CONCLUSIONS

These findings suggest that smoking prevention approaches targeted at these young people should increase their awareness of social pressures to smoke, correct misperceptions about the prevalence of smoking among friends, and teach relevant psychosocial skills.

Sociocultural and physiological correlates of cigarette smoking in women

Cigarette smoking is a major modifiable risk factor for cancer and coronary heart disease and the chief avoidable cause of death in the United States. Over the past few decades, the prevalence of cigarette smoking among males has significantly decreased. However, the same significant decrease has not been seen among women. Researchers have identified sociocultural factors and physiological correlates associated with women's cigarette smoking. It is essential that health care professionals understand the findings of research on women's smoking if they wish to identify and counsel women at risk and to define directions for future research.

Characteristics of young female smokers in a Swedish primary health care area

OBJECTIVE

To analyse the correlation between smoking, socioeconomic characteristics, and sexual and contraceptive patterns in young women.

DESIGN

Cross-sectional population study, smokers compared with non-smokers.

SETTING

Nättraby-Hasslö, a rural area in southern Sweden.

PARTICIPANTS

All women between 15-34 years of age (n = 541).

RESULTS

26% smoked daily. Smokers on average had less schooling, lower 9th grade results, less satisfaction in school, and more unskilled professions than non-smokers. Apart from a higher parental divorce rate among smokers, no correlation between parental factors and smoking was found. Smokers on average reported an earlier sexual debut, more unprotected first intercourse, more life-time sexual partners, and more legal abortions.

CONCLUSION

Smoking is associated with sexual habits, which may reflect a higher tendency to take personal risks among smokers.

Parent educational attainment and adolescent cigarette smoking

In a longitudinal design, this study examined psychosocial mediators of the effects of parental educational attainment on adolescent smoking acquisition and also examined whether smoking transition had different antecedents among adolescents from families of varying educational backgrounds. Parents' low educational attainment acted as a moderate to strong risk factor for the initial onset of smoking among middle school girls. Some of this effect was mediated by the higher smoking prevalence among both parents and friends of these adolescent girls, as well as by their lowered expectations for academic success. However, these variables only partially mediated the effect of parent education. There were few indications of differential antecedents of smoking acquisition among adolescents from less and more highly educated families. Implications for public health antismoking campaigns are discussed.