Patterns of smoking among inner-city teenagers: smoking has a pediatric age of onset

Evaluation of a school-based, experiential-learning smoking prevention program in promoting attitude change in adolescents

INTRODUCTION

School-based tobacco control programs exhibit great variety. Our study aimed to evaluate the effectiveness of an experiential learning smoking prevention program in facilitating knowledge acquisition, forging healthy attitudes, and decreasing intention to smoke.

METHODS

A school-based intervention-control study was implemented during the 2016–2017 academic year among middle-school students in Athens, Greece. The experiential learning intervention was delivered using an interdisciplinary approach, bridging excerpts from ancient classical Greek myths, Aesop fables and ancient classical literature (Aristotle, Herodotus, Plutarch, Xenophon, Homer’s Epics), with their decoded archetypal symbols applied in a smoking and tobacco control paradigm. An anonymous self-administered questionnaire was used at baseline and at follow-up at 3 months to evaluate program effectiveness.

RESULTS

A total of 351 students participated in our study; 181 (51.6%) in the intervention group and 170 (48.4%) in the control group. The mean age of student participants was 13 years (SD=0.96). Students in the intervention group were more likely to improve their knowledge of the adverse effects of smoking, develop attitudes against smoking and report a negative intention to smoke in the first year following the intervention, compared to the control group.

CONCLUSIONS

This study provides evidence that school-based experiential learning smoking prevention programs improve smoking-related knowledge, enhance anti-smoking attitudes and reinforce negative intentions toward tobacco products.

Smoking beliefs across genders, a comparative analysis of seven European countries

BACKGROUND

Most European countries have seen a decrease in the prevalence of adolescent smoking. This decrease has, however, been patterned by gender. Girls' smoking rates have now overtaken boys' in many European countries. The two genders may not, however, share the same smoking beliefs and this could explain differences between the genders in smoking prevalence. We describe gender differences in smoking beliefs and investigate variations between countries, along with their gender context.

METHODS

In 2016, we conducted the SILNE R study (Smoking Inequalities Learning from Natural Experiments - Renew) in 55 schools located in seven European countries: Belgium, Italy, The Netherlands, Portugal, Finland, Ireland, and Germany. We surveyed 12,979 students aged 14-16 years (50% were girls). We classified smoking beliefs into four categories: positive individual, positive social, negative individual, and negative social beliefs. We expected girls to score higher on the last three of those categories and we hypothesized that countries with a more gender-equal culture would have less gender difference in beliefs about smoking.

RESULTS

One out of two smoking beliefs differed significantly between genders. Negative social beliefs were more common in girls, while beliefs about the dating-related aspects of smoking were more common in boys. We identified Germany and Belgium as the only countries with no gender differences in any of the belief scales. No correlation was found, however, between these scales and the Gender Inequality Index.

CONCLUSIONS

In some countries, gender-specific interventions might be implemented; however, two opposing strategies might be used, depending on whether such programs are aimed at boys or girls.

Prevalence and predictors of tobacco use among Bhutanese adolescents

Purpose

The purpose of this paper is to examine the prevalence of tobacco use and associated factors influencing the use of tobacco among adolescents in a school setting.

Design/methodology/approach

A cross-sectional descriptive study was conducted amongst Bhutanese adolescents studying at high schools in the district of Wangdue Phodrang in May 2016. A total of 378 eighth-grade students from four schools participated in the study. A self-administered questionnaire was used to collect data. Bivariate and multivariate logistic regressions were carried out to describe the predictors of tobacco use.

Findings

Of the 378 student participants, 52.90 percent were girls and 47.10 percent boys. The age ranged from 11 to 19 years, and the majority lived in school hostels (82 percent). The prevalence of smoking was 10.80 percent while smokeless tobacco users constituted 11.10 percent in the month preceding the study. Gender, tobacco use by siblings and friends, ever having tried alcohol, consumption of alcohol in the last 30 days, previous experimentation with cigarettes/bidi and smokeless tobacco/baba (p-value <0.05) were significantly related to the use of tobacco among students. In multivariate analysis, tobacco use by friends (AdjOR=1.09; 95%CI=0.01–2.48), ever having tried alcohol (AdjOR=2.24; 95%CI=1.75–3.72), current alcohol use (AdjOR=2.63; 95%CI=1.52–4.31), experimentation with cigarettes/bidi (AdjOR =39.46; 95%CI=11.91–90.63) or with smokeless tobacco/baba (AdjOR=32.61; 95%CI=11.78–90.30) were observed as the strong predictors of current tobacco use among adolescents.

Originality/value

These study results re-emphasized the rising public health concern of tobacco use among younger boys and girls. The findings may help the Bhutanese policy makers and managers to better understand the present situation of adolescent tobacco use and its associated determinants, and formulate appropriate tobacco control strategies for adolescents.

[Do smokers know the harmful effects of tobacco?]

Le tabagisme est une des principales causes de morbidité et de mortalité évitable. Le but de ce travail est d’évaluer les connaissances du fumeur vis-à-vis les risques du tabac et son motivation pour cesser de fumer. Nous avons réalisé une enquête transversale chez les malades tabagiques hospitalisés au service en répondant à un questionnaire précisant leur niveau socio-économique et culturel, l'histoire du tabagisme, les méfaits connus du tabac, la dépendance pharmacologique à la nicotine et leur motivation pour cesser de fumer. Il s'agit de 120 patients, l’âge moyen était de 45 ans±15. Les principaux motifs d'hospitalisation étaient: pathologie tumorale (54%), pathologie infectieuse (35%) BPCO (9%). 85% des patients étaient scolarisés jusqu'au cycle secondaire. Pour l'ensemble des patients, l’âge moyen de la première cigarette était précoce (avant de 20 ans) et la dépendance pharmacologique à la nicotine était légère (82% avaient un score de Fagerström < 8). Plus d'un tiers des patients (38%) avaient au moins fait une tentative d'arrêt. La connaissance des effets néfastes du tabac était variable: les pathologies cancéreuses (88%), les maladies cardiovasculaires (65%) et la BPCO (31%). La majorité des patients (78%) avaient cessé de fumer depuis l'hospitalisation. Notre enquête met en évidence l'intérêt de la médiatisation dans l'information de la population sur les risques du tabac. Les pneumologues, qui prennent en charge la grande majorité de ces patients, doivent donc s'impliquer activement dans ce domaine.

Pathways to smoking cessation among African American and Puerto Rican young adults

OBJECTIVES

We examined the pathways to smoking cessation between late adolescence and young adulthood.

METHODS

We obtained data from a sample of urban African American and Puerto Rican young adults (N=242), mean age 19 years, who reported tobacco use and determined cessation rates between late adolescence and young adulthood. We used structural equation modeling to examine the pathways of positive family relations, family smoking, maladaptive personality attributes, and substance use to smoking cessation.

RESULTS

A mediational pathway linked the absence of positive family relations with maladaptive personality attributes, both of which were related to substance use and ultimately smoking cessation. Substance use mediated the path between family smoking and smoking cessation.

CONCLUSIONS

The results suggest that a positive relationship with one's parents, less smoking in the family, conventional personality attributes, and little or no other substance use facilitate smoking cessation among young adults.

Personality risk factors associated with trajectories of tobacco use

The purpose of this longitudinal, prospective study was to evaluate trajectories of smoking in a cohort of African-American and Puerto Rican young adults and describe personality and behavioral factors associated with specific smoking trajectory group membership. Participants consisted of African-American and Puerto Rican male and female young adults (N = 451, mean age 26) from an inner-city community. Data were collected at four time points over a period of 13 years using structured interviews. Interviews took place within the schools and the participants' homes. Scales with adequate psychometric properties were adapted from previously validated measures. Variables that were examined for this study came from the domains of internalizing behaviors, externalizing behaviors, drug use, and demographic information. Data were analyzed using latent growth mixture modeling to explore discrete smoking trajectories. Logistic regression analyses were then used to examine the risk factors associated with the various smoking trajectory groups. Four trajectory groups were determined to best fit the data: nonsmokers, maturing-out smokers, late-starting smokers, and early-starting continuous smokers. Subjects who were unconventional, experienced intrapersonal distress, and used alcohol and illegal drugs were more likely to belong to one of the smoking trajectory groups than to the nonsmoking group. The early-starting continuous group scored highest on these personal risk attributes. The long-term impact of unconventional behavior, intrapersonal distress, and drug use on developmental trajectories of smoking support the importance of early intervention and prevention.

Peer and parental influences on longitudinal trajectories of smoking among African Americans and Puerto Ricans

The purpose of this study was to identify distinct trajectories of smoking behavior during a period extending from adolescence (mean age = 14 years) to young adulthood (mean age = 26 years) among African American and Puerto Rican adolescents/young adults, to examine ethnic and gender differences in group membership, and to assess the ability of peer and parental smoking to distinguish among trajectory groups. A community-based sample of 451 African American and Puerto Rican adolescents was interviewed four times during adolescence and in early adulthood, covering a span of 12 years. For both ethnic/racial groups, four distinct trajectories were identified: Nonsmokers, maturing-out smokers, late-starting smokers, and early-starting continuous smokers. Compared with Puerto Ricans, African Americans were over-represented in the nonsmoking group, whereas Puerto Ricans were over-represented in the early-starting continuous group. Females were more likely than males to be early-starting continuous smokers than late starters. Adolescents who were exposed to peer and parental smoking in early adolescence were more likely to belong to trajectory groups characterized by higher levels of smoking. These findings show that exposure to peer and parental smoking in early adolescence constitutes a risk factor for engaging in elevated levels of smoking behavior at an early age and for continued smoking into adulthood for urban African Americans and Puerto Ricans. To be most effective, smoking prevention programs should address peer group and family influences on adolescent smoking.

Development and validation of transtheoretical model measures for Bulgarian adolescent non-smokers

The goal of this study was to develop, translate, and evaluate measures for decisional balance and situational temptations for Bulgarian adolescent nonsmokers and to test the predicted relationships with stages of change. Students in the last grades of high school (15-19 years old) recruited in 12 randomly selected schools participated in the study. Data from the 369 nonsmokers (61.8% female, mean age 16.4 years, 97.1% Bulgarian) were used in the measurement development. A two-factor model for decisional balance (CFI=.94) and a hierarchical three-factor model for temptations (CFI=.90) demonstrated the best fit. The predicted crossover pattern for decisional balance and decreasing trend for temptations across the stages of change was verified. Both measures demonstrated tau-equivalent invariance across gender, in addition to good psychometric properties. These results, with the caveat of the noted limitations, support the cross-cultural validity of these transtheoretical model (TTM) constructs and indicate that they can be used as a basis for development of smoking prevention interventions.

UK health policy and ‘underage’ smokers: The case for smoking cessation services

The UK government's White Paper titled 'Smoking Kills' set explicit targets for reductions in the prevalence of smoking. As well as targets for the population as a whole, specific targets were set for sub-groups in the population: children were identified as one such sub-group. Following the publication of the White Paper, smoking cessation services were established nationwide as part of the strategy to meet the targets. Considerable resources have been put into these smoking cessation services and evaluations of the service tend to conclude that they are relatively successful and cost effective in terms of getting people to quit smoking. However, this article argues that one group of smokers has been marginalised in terms of access to the service. The evidence indicates that 'underage' smokers - those aged less than 16 years - have not had the level of access to smoking cessation services that is warranted in terms of the prevalence of smoking among children, in terms of their apparent willingness to use such services and in terms of the particular value of quitting smoking while still so young. This article explores the potential for underage smokers to benefit from smoking cessation services and considers the possibilities for widening access to the cessation services to 11-15 years old.

The application of household expenditure data in the development of anti‐smoking campaigns

Purpose

Despite widespread anti‐smoking campaigns, prevalence and the consequent damage to the community remains high and are therefore of concern to health educators. Several studies have identified a clear socio‐economic status gradient in smoking prevalence. One purpose of this paper is to re‐examine this gradient to assist in the more accurate targeting of anti‐smoking campaigns. Another purpose of this paper is to examine the financial cost of smoking from a household perspective and also to compare survey data with data compiled by other means to test whether smokers are accurately reporting their smoking behaviour. This can assist in the refining of anti‐smoking message strategies.

Design/methodology/approach

Data from a large‐scale survey of Australian households – the Household Expenditure Survey – was analysed and compared with data from other sources to examine demographic correlates and self‐reported estimates of smoking behaviour.

Findings

Approximately one third of households reported expenditure on tobacco. Expenditure is more prevalent among households with a female head and among lower status occupations. Young people are continuing to take up smoking. Smoking households appear to underestimate their expenditure on tobacco by more than 40 percent.

Research limitations/implications

Data are drawn from households, not individuals; therefore exact estimations of smoking prevalence and individual smoking behaviour are not possible.

Originality/value

The findings provide important guidance for health educators developing anti‐smoking campaigns. The findings provide assistance in the development of targeting and message strategy guidelines.

[Risk factors in experimenting with and consumption of tobacco by 12-14 year-old school students. Attitudes to tobacco in pressure groups]

INTRODUCTION

Tobacco is the first addictive substance that adolescents and school-children have contact with. The presence of family members and friends as smokers in their environment is related to tobacco experimentation.

OBJECTIVES

To describe experimentation and consumption of tobacco in secondary school students (ESO); to identify the attitudes related to smoking; and to study the relationship between smoking by family members, friends and teachers and students' own experimentation and consumption.

METHODS

Observational, prospective study at the "Los Cantos" secondary school, Bullas, Murcia, Spain.

POPULATION

students from the first, second and third years of ESO, analysed in December 2000 and 2001. The variables studied were collected with the FRISC questionnaire.

RESULTS

The population had 529 students, 293 of them boys, with average age 13.2. A total of 328 had smoked sometime (62%) and 19.1% smoked habitually. Attitudes related with smoking were: "smoking makes you feel better" (P<.001), "smoking is fun" (P<.001), "smoking helps to make friends" (P<.001) and "I'd accept a cigarette from a friend" (P<.001). Tobacco experimentation was related to friends/companions smoking (OR=2.402; 95% CI, 1.591-3.628), to the presence of a mother and older siblings smoking (OR=2.703; 95% CI, 1.574-4.642), and to the presence of friends/companions smoking (OR=6.342; 95% CI, 3.102-12.964).

CONCLUSION

Experimentation and consumption of tobacco in the population studied is very high. The most important risk factors for students smoking are the conduct of friends and of older siblings.

Approval procedures and passive consent considerations in research among young people

Purpose

The intention of this paper is to encourage debate among ethical researchers on this very important issue. Research necessary to underpin health education and health promotion is often controversial and often involves vulnerable populations such as young people and children. It is essential that the rights of these respondents are protected in every research project. Current research ethical approval processes aim to protect these rights but have the potential to undermine the viability of research projects in this area. This paper addresses two ethical issues associated with this research: the approval process and respondent consent.

Design/methodology/approach

The paper looks at the codified antecedents of common ethical guidelines and discusses their application in a particular but not unusual health education research project.

Findings

The paper recommends the adoption of a simplified approval process and greater appreciation of the merits of researching among students in a classroom setting, when these students are an appropriate target market.

Research limitations/implications

Much health education research falls between medical research and marketing research. Guidelines for this sort of research need to be developed through discussion among practitioners and academics in the field.

Originality/value

Adoption of this simplified approach will facilitate more important research being undertaken without jeopardizing the rights or the welfare of the vulnerable respondents involved.

Factors Associated With Smoking Onset: 3-Year Cohort Study of Schoolchildren

OBJECTIVE

To analyze the predictors of smoking onset among schoolchildren.

METHODS

A cohort study of 1056 children starting in first year secondary school at 44 schools in Barcelona was carried out. Participating children were invited to answer a lifestyle questionnaire every year for 4 years. Each questionnaire carried a personal code to allow the 4 questionnaires to be matched. Matching questionnaires were found for 729 children, 70% of the initial sample.

RESULTS

Over the study period, the prevalence of regular smokers increased from 1.7% to 22% among boys and from 1.6% to 38.2% among girls. The predictors of smoking onset among boys were scoring high on the pro-smoking attitudes index (odds ratio [OR]=1.2; 95% confidence interval [CI], 1.1-1.3), intention to smoke in the future (OR=2.2; 95% CI, 1.0-4.9), low self-efficacy in resisting pressures to smoke (OR=0.98; 95% CI, 0.96-0.99), having siblings that smoke (OR=2.5; 95% CI, 1.2-5.4), and spending some free time in bars (OR=2.4; CI, 1.1-4.9). Among girls, the predictors were having low self-esteem (OR=0.94; 95% CI, 0.88-0.99), scoring low on the anti-tobacco attitudes index (OR=0.92; 95% CI, 0.88-0.97), having siblings who smoke (OR=2.5; 95% CI, 1.2-5.5), spending some free time in discotheques (OR=4.5; 95% CI, 1.9-11.8), and living in high socioeconomic-status neighborhoods (OR=3.1; 95% CI, 1.4-10.9).

CONCLUSIONS

The results show the importance of cognitive variables as well as a variety of environmental variables, particularly the pattern of free time use and the influence of sibling models. Prevention programs must take into account smoking onset risk factors as a whole.

Measuring the emergence of tobacco dependence: the contribution of negative reinforcement models

This review of negative reinforcement models of drug dependence is part of a series that takes the position that a complete understanding of current concepts of dependence will facilitate the development of reliable and valid measures of the emergence of tobacco dependence. Other reviews within the series consider models that emphasize positive reinforcement and social learning/cognitive models. This review summarizes negative reinforcement in general and then presents four current negative reinforcement models that emphasize withdrawal, classical conditioning, self-medication and opponent-processes. For each model, the paper outlines central aspects of dependence, conceptualization of dependence development and influences that the model might have on current and future measures of dependence. Understanding how drug dependence develops will be an important part of future successful tobacco dependence measurement, prevention and treatment strategies.

Public education campaign heightens awareness that youth model authorities' tobacco use

To evaluate whether people changed their views about acceptability of authority figures smoking after an anti-tobacco initiative, randomly selected southeastern U.S. voters (801 in 2001; 806 in 2002) responded to a 20-minute telephone interview. Acceptability attitudes held steady: most (80.8%) said that any authority figures' smoking in front of youth is unacceptable, with women, minorities, and never-smokers even surer than their counterparts. However, there was a change in 2002, with respondents more strongly recognizing that youth model adults' tobacco behaviors and attitudes. An implication is that media campaigns may benefit from emphasizing that youth model adults' tobacco use.

Bone mass of asian adolescents in China: influence of physical activity and smoking

INTRODUCTION/PURPOSE

Research addressing the role of biology and behavior on bone development during times of peak bone acquisition in adolescence is limited. The present investigation was conducted to address the influence of body composition (lean body mass, fat mass), menarche, leisure physical activity, sports team participation, smoking, and second-hand smoke on skeletal mass of a unique sample of Asian adolescents in China.

METHODS

A total of 166 girls and 300 boys (ages 12-16 yr) participated in this study. Bone mineral density (BMD) and content (bone mineral content (BMC)) of the forearm and the os calcis were measured using dual energy x-ray absorptiometry (DXA); lean body mass (LBM) and fat mass were estimated by bioelectrical impedance analysis (BIA); grip strength was measured by isometric dynamometry. Menarche, leisure physical activity, sports team participation, and active and passive smoking were determined using questionnaire.

RESULTS

In girls, a total of 44% of the variance in forearm BMC was attributed to a model which included LBM (32%), time since menarche (10%), and age (2%); heel BMC was best predicted by LBM alone (42%), with no significant contribution by other variables. In boys, a total of 39% of the variance in forearm BMC was attributed to a model which included LBM (28%), age (5%), sports team participation (4%), height (1%), and fat mass (1%); heel BMC was best predicted by LBM (50%) and height (3%), accounting for 53% of the variance.

CONCLUSION

The findings of this study suggest that lean body mass is the primary determinant of bone mass in Chinese adolescents. Menarche is also an important contributor in girls, whereas age and sports team participation are secondary predictors of bone mass in boys.

Rapid progression to regular cigarette smoking among nonsmoking adolescents: interactions with gender and ethnicity

BACKGROUND

While the correlates and predictors associated with transition through the stages of smoking acquisition have received substantial attention, the identification of factors associated with the time course of progression remain generally unexplored.

METHODS

We identified adolescents escalating from nonsmoking to regular smoking in 1 year as rapid progressors (n = 98) and those escalating from nonsmoking to experimental smoking in 1 year as slow progressors (n = 555). We entered demographic and psychosocial variables, initial reactions to smoking variables, and their interactions with gender and ethnicity into a logistic regression analysis comparing rapid progressors to slow progressors.

RESULTS

At baseline, rapid progressors reported more friends who smoked regularly. Girls who reported more concern with dieting and less social success were more likely to progress to regular smoking within 1 year; these variables did not influence progression in boys. Those who associated positive feelings with their initial smoking experience were more likely to progress to regular smoking. Differences between white and African American youth emphasize the importance of physiological interpretations of initial smoking experiences.

CONCLUSIONS

Our findings suggest that even as nonsmokers, adolescents likely to progress quickly to regular smoking can be identified. Researchers designing prevention programs should take these factors into account.

Research on tobacco use among teenagers: ethical challenges

Recent increases in adolescent smoking portend upcoming public health challenges as the majority of smokers initiate long-term addiction during youth, but experience major health consequences later in life. To effectively address this important teenage and adult health issue, critical research information and early interventions are needed, yet conducting tobacco research with teen smokers poses substantial challenges, including several ethical dilemmas. This paper reviews some of the ethical issues presented in etiologic and clinical treatment research addressing adolescent smoking. Common problems and possible solutions are presented. Issues of parent/guardian involvement, decision-making ability of teens, the need to maintain confidentiality are discussed, along with the specific problems of recruitment, compensation, and ethical challenges that arise in group treatment settings. Context-specific ethical adjustments and alternative perspectives are likely to be needed if we are to overcome procedural difficulties in conducting teen smoking studies.

Determinants of youth smoking--evidence from Turkey

This paper investigates the determinants of smoking among middle- and high-school students in Ankara, Turkey. Data were collected from 4800 students in the second semester of the 1997-98 academic year to investigate substance use prevalence among young people. In addition to classical independent variables, factors which are not frequently used in the literature--such as school type, neighborhood, family religiosity, and factors reflecting the cultural background of the students--are included in the analysis. The results of binomial logistic regression offer evidence for the effects of school type, a smoking-related attitude, presence of a stepmother, father's use of alcohol, sister and brother who smoke, student's alcohol use, and participation in art activities.

Smoking and its correlates among preadolescent children in France

BACKGROUND

Smoking often begins in early adolescence, and addiction can occur rapidly. For effective smoking prevention efforts with younger children, knowledge of their early smoking experience is needed. The purpose of this paper was to report the smoking experience of French elementary school children and to describe their lifestyle habits and health knowledge.

METHODS

A cross-sectional study of 913 children age 9-11 years in 31 randomly selected schools of the Loire administrative department in France was conducted, using anonymous previously validated questionnaires. Correlates of smoking initiation and intention to smoke in the future were assessed by unconditional logistic regression analysis.

RESULTS

A total of 12.3% of the children had smoked at least one cigarette, 5.1% within the previous 30 days. Correlates of ever smoking were male sex, older age, engaging in physical activity, reporting not following safety-related recommendations, or drinking alcohol. Of the 112 children who reported ever smoking, 45.5% stated that they did not want to remain smokers in the future and an additional 26.8% were not sure.

CONCLUSIONS

Information on the smoking experience of preadolescents should help in designing effective prevention programs, which are essential for reinforcing abstinence in nonsmokers and preventing others from progressing to addiction.

Initial tobacco use episodes in children and adolescents: current knowledge, future directions

Approximately three-quarters of adult tobacco users report that their first tobacco use occurred between ages 11 and 17, while many adults who do not regularly use tobacco report that they experimented with it as adolescents. Surprisingly little is known about the effects of these initial tobacco use episodes and their influence on adult tobacco use patterns. In particular, understanding the role that nicotine plays in these early tobacco use experiences may be important in understanding the development of regular tobacco use and concomitant nicotine dependence. One goal of this review is to summarize current knowledge regarding the effects of initial tobacco use episodes in adolescents and to discuss nicotine exposure in initial tobacco use episodes. Another goal is to outline a research agenda designed to learn more about initial tobacco use episodes and the effects of nicotine in children. An ethical rationale and some potential methods for this research agenda are presented.

Context Dissonance in Tobacco Education Literature

Tobacco education has gained widespread popular and political support and Is incorporated into many public schools' curricula. However, evaluation studies indicate that such programs do not decrease adolescents' smoking rates because program content is often dissonant with adolescents' interpretations of smoking. This study uses social constructionism and content analysis to explore tobacco education literature used in an alternative high school for at-risk youths. Findings indicate that the content's construction of smoking and cessation is dissonant with adolescents' subcultural social contexts. Dissonance-generating elements include decontextualization of smoking; suggested alternatives that are Improbable in adolescents' social contexts; and image biases that reflect stereotypes of age, class, and gender. The conclusion suggests ways to eliminate context dissonance in order to increase adolescents' receptivity to intervention efforts.

Initiation of cigarette smoking and subsequent smoking behavior among U.S. high school students

BACKGROUND

Most adult smokers report trying their first cigarette before age 18 years. Understanding the impact of smoking initiation at young ages may help public health policy makers and practitioners improve strategies to prevent or delay adolescent cigarette smoking.

METHODS

This paper examined age of initiation of cigarette smoking and subsequent patterns of smoking among U.S. high school students 16 years of age and older (N = 13,858). We used data from the 1991-1997 national Youth Risk Behavior Surveys, conducted by the Centers for Disease Control and Prevention.

RESULTS

The majority of students 16 years of age and older (60.4%) reported ever having smoked a whole cigarette, and 11.1% initiated smoking at age 10 years or younger. Age of smoking initiation was significantly related to current frequent smoking, daily smoking, and whether students had ever smoked daily. A younger age of smoking initiation was associated with smoking more cigarettes per day than was initiating at an older age.

CONCLUSIONS

Delaying the onset of smoking may affect the likelihood of becoming addicted to nicotine and smoking heavily. For students who are already addicted to nicotine, smoking cessation programs are needed.

Adolescent tobacco use and cessation

Over one third of high school students in the United States smoke cigarettes, and close to 10% use spit tobacco. Tobacco use clusters with alcohol use, other substance abuse, and other health risk behaviors among teenagers. Public health and law enforcement policy changes, combined with effective substance use prevention programs in both elementary and middle school, are needed to prevent the early age of onset of tobacco use by youth. Primary care providers can play a key role in identifying children and adolescents who smoke or use spit tobacco and helping them discontinue their tobacco use.

Hazards of smoking initiation among Asian American and non-Asian adolescents in California: a survival model analysis

BACKGROUND

Information about the risk of smoking initiation among whites, African Americans, and Latino Americans has provided an important information base for smoking prevention programs among adolescents from these ethnic backgrounds. Unfortunately, there is a lack of such information for Asian Americans, a fast-growing ethnic minority group with much internal diversity.

METHOD

This study used cross-sectional data from 20,482 subjects 12-17 years of age, randomly sampled in California, to describe and compare the risk of smoking initiation for adolescents by age among Asian American and other non-Asian ethnic groups, using survival analysis. Computer-aided telephone interview techniques were used in data collection.

RESULT

The risk of early smoking initiation among Asian American adolescents is about a third of that of Caucasians. However, the risk among Asian Americans continues to increase throughout adolescence, while the same risk among Caucasians and African Americans plateaus around 14-15 years of age. Significant differences in the levels and patterns of smoking initiation among Asian American subgroups were observed, with Chinese Americans showing the lowest risk of smoking initiation and Filipino Americans the highest, Japanese and Korean Americans being in-between.

CONCLUSION

Asian American adolescents may be especially at risk of smoking initiation later in adolescence, even though they are at lower risk early in adolescence. Smoking prevention programs for Asian Americans should continue throughout adolescence and early adulthood.

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.

Nicotine dependency of a girl at the age of 18 months

This case report describes severe nicotine dependency developing at the age of 18 months. Familial, genetic, biological aspects of the case and the therapeutic strategy are discussed.

Accessibility of cigarettes to minors in suburban Cook County, Illinois

This study assessed the problem of under age sale of cigarettes, educated vendors about the law restricting the sale of tobacco to minors, and determined the effectiveness of a vendor education intervention. Twenty-one teen volunteers, 14 to 17 years in age, attempted to purchase cigarettes in suburban Cook County from over-the-counter merchants and vending machines. Of the 347 vendors that were checked, the minors were successful in 37.2% of their attempts to purchase cigarettes. After information was sent to each vendor about the State of Illinois law, follow up visits were made to all the vendors who were willing to sell cigarettes to the minors during the first visits. Approximately 50% of the vendors were again willing to sell cigarettes to minors. This study's findings suggest that minors can easily purchase cigarettes in suburban Cook County. The education intervention component of the study had a limited but promising effect on compliance rates of the vendors.