Family structure and adolescent cigarette smoking in eleven European countries

Parental divorce and nicotine addiction in Lebanese adolescents: the mediating role of child abuse and bullying victimization

BACKGROUND

Lebanon ranks first amongst Middle-Eastern countries in terms of cigarette and waterpipe smoking. Understanding the mediating factors for nicotine addiction in adolescents who have experienced parental divorce is vital to take effective measures that will help in lowering its prevalence in our community. The objective of this study was to investigate the association between the increasingly concerning parental divorce and nicotine addiction in Lebanese adolescents while taking into consideration the plausible mediating effect of abuse and bullying victimization.

METHODS

This was a cross-sectional survey-based study that was conducted between January and May 2019. A total of 1810 adolescents aged between 14 and 17 years was enrolled from 16 Lebanese schools. Linear regressions taking the cigarette and waterpipe dependence scores as dependent variables were conducted respectively, using the SPSS software. PROCESS v3.4 model 4 was used for mediation analysis.

RESULTS

A total of 11.9% of the enrolled participants had divorced parents. Higher cigarette and waterpipe dependence were found in adolescents whose parents were divorced compared to those living together. More child psychological abuse, having divorced parents vs living together, and more child physical abuse were significantly associated with higher cigarette dependence. More child psychological and physical, and having divorced parents vs living together were significantly associated with more waterpipe dependence. In addition, all forms of abuse (except neglect) and bullying victimization had a partially mediating effect in the associations between parental divorce and nicotine dependence (cigarette and waterpipe) in adolescents.

CONCLUSION

This study results may serve as a first step towards enrolling separated parents and their children in special prevention programs to help them create a protective and supportive environment.

Is Adolescent Risk Behavior Associated With Cross-Household Family Complexity? An Analysis of Post-separation Families in 42 Countries

We examine whether complex cross-household structures of post-separation families are associated with higher risk-taking behavior in adolescence (substance use, bullying, early sexual onset) and whether the proportion, and thus statistical normality, of complex family types in a certain country is a potential moderator of this association. Drawing on representative data from 42 countries and regions from the Health Behavior in School-aged Children (HBSC) study in 2001, 2006, and 2010 (N = 506,977), we provide detailed analyses on adolescent risk behavior even for very rare family types, thereby accounting for the complex cross-household structure present in many post-separation families. We combine logistic and count regression models to analyze risk incidence and intensity. Controlling for relevant child and family characteristics, our results reveal a gradient along which adolescent risk-taking increases with family complexity: The incidence and intensity of risk-taking among adolescents is lowest in two-biological-parent and highest in two-household families with stepparents in both households. The association decreases with a higher proportion of the respective family type in a country. However, the differences between family types, other than the two-biological parent family, are not as pronounced as expected.

Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group

BACKGROUND

France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group.

METHODS

The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression.

RESULTS

Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55-1.84), 1.29 (1.14-1.45) and 2.31 (1.95-2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22-1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64-0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use.

CONCLUSION

Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.

A long way to go: 20-year trends from multiple surveillance systems show a still huge use of tobacco in minors in Italy

Background

Main aim was to describe youth smoking prevalence in Italy over the last two decades, and to provide recent trends in knowledge, attitudes towards smoking, awareness of anti-tobacco mass media campaigns, second-hand smoke (SHS) exposure and access to cigarettes.

Methods

Figures from three surveillance systems, with 12 representative cross-sectional surveys (about 43 000 participants): European School Survey Project on Alcohol and Other Drugs, 15-16-year-old students, 1995-2015; Health Behaviour in School-aged Children, 11-, 13-, 15-year-old students, 2002-14 and Global Youth Tobacco Survey, 13-15-year-old students, 2010, 2014.

Results

Among 11- and 13-year-old students, daily and non-daily smokers decreased by 30-50% from 2002 to 2014. Among 15-16-year-old adolescents, ever smokers significantly decreased by 10% in the period 1995-2015, whereas current and daily smokers have been stalling or even increased. Appeal of smoking increased in 2014 compared to 2010, perception of SHS as harmful, and awareness of recent anti-tobacco mass media campaigns decreased. Moreover, a significant 30% reduction in reporting retailers did not refuse to sell cigarettes to adolescents and a decrease in reporting to buy cigarettes were reported.

Conclusions

Policies enforced in Italy over the last 20 years slightly reduced ever smokers, but did not decrease current and daily smokers in 15-16-year-old adolescents, and determined an impact among younger adolescents. Stricter rules on youth tobacco access reduced ease of access to cigarettes, but did not affect adolescents' tobacco use. Stronger tobacco control measures are urgently needed in order to determine a steeper decline in smoking prevalence in adolescents.

Health and health risk behaviour of adolescents-Differences according to family structure. Results of the German KiGGS cohort study

Objective

This study’s aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities.

Methods

We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003–2006, follow-up: 2009–2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models.

Results

We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents’ health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower.

Conclusions

Because the direct effects of family structure on adolescents’ health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents’ health, prevention programmes and interventions should be directed towards the parent–adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.

Personal Values as a Mediator of Relations Between Perceived Parental Support and Control and Youth Substance Use

BACKGROUND

Tobacco and marijuana smoking are very popular in adolescence and there is a high rate of comorbidity between them, even in young adulthood. Parental support and control may hinder involvement in the use of these substances by promoting conventional values among adolescents.

OBJECTIVES

The present study investigates the relations between family functioning (parental support and control) and psychoactive substance use (tobacco and marijuana smoking) and determines whether these relationships are mediated by personal values (in terms of disapproval of deviance and beliefs about the importance of school, health and religion).

METHODS

175 Italian late adolescents (17 to 20 years old) participated in this two-wave longitudinal study. Data were collected at school through an anonymous questionnaire.

RESULTS

Greater parental control and support were directly associated with lower adolescent tobacco and marijuana use; adolescent acceptance of conventional values mediated the association between parenting and adolescent marijuana use.

CONCLUSION

Findings emphasize the influence of family relationships throughout adolescence. The transmission of conventional values to adolescents may be a critical mechanism through which parenting protects adolescents from substance use, especially marijuana use.

Adolescents' smoking experiences, family structure, parental smoking and socio-economic status in Ciudad Juárez, Mexico

BACKGROUND

Cigarette smoking is the leading cause of preventable death worldwide. Tobacco use and secondhand-tobacco smoke (SHS) exposure are classified as a pediatric disease. In Mexico, the prevalence of smoking has decreased among adults but paradoxically increased among adolescents, particularly among young females. This study was designed to determine the association between adolescents' smoking experiences (smoking behaviors and second hand smoke [SHS] exposure), family structure, parental smoking and socio-economic status (SES) in Ciudad Juárez, Mexico.

METHODS

This is a cross-sectional, population-based study. Data was collected from sixth-grade students (N = 506) attending school in Ciudad Juárez, Mexico. Descriptive analyses were conducted. The relationship between key outcome variables (adolescents smoking and SHS exposure) and independent variables (family structure, parental smoking, and SES level) were examined. Adjusted odds ratios were calculated. Multiple logistic regression analysis was performed while controlling for possible confounders (i.e. gender and age).

RESULTS

The overall prevalence of ever/lifetime smoking and SHS exposure at home was 29.6 and 41.1 %, respectively. Results of the logistic regression analysis show that being a member of a non-intact family [(OR = 2.20; 95 % CI = 1.21-3.90) and (OR = 2.45; 95 % CI = 1.19-4.10) respectively], having parents who smoke [(OR = 4.41; 95 % CI = 2.15-5.46) and (OR = 4.95; 95 % CI = 2.25-7.12) respectively], and living in low SES setting [(OR = 1.73; 95 % CI = 1.43-3.30) and (OR = 1.99; 95 % CI = 1.16-4.00) respectively] are significantly associated with ever smoking and SHS exposure at home among sixth grade students.

CONCLUSIONS

The findings of our study show that tobacco use and SHS exposure are strongly associated with adolescents living in low SES, non-intact households that have parents that smoke. To be effective, tobacco strategies specifically tailored for this particularly vulnerable group of adolescents would require a comprehensive, multi-faceted approach centered on prevention, cessation and protection.

Self-concept and social comparison and their relation with smoking and alcohol consumption in adolescents

BACKGROUND

Some attitudes that possess certain risks such as smoking and alcohol consumption rate are increasing among the adolescent age group. For this reason it is very important to shape the attitudes of adolescents during their growth period.

OBJECTIVE

The aim of this study is to investigate the association of social comparison and self-concept of adolescents' relation with smoking and alcohol consumption.

SUBJECTS

Study was conducted as a prospective study in nine high schools which are located in city of Bursa, Turkey. Nine hundred and fifty-three (n=953) students were included.

METHODS

Data were gathered using a questionnaire form especially developed by researchers for this study according to relevant literature. For social comparison and self-concept evaluation Piers-Harris Self Concept Scale and Social Comparison Scale of Gilbert were used.

RESULTS

The mean age was 15.74±1.27 and 411 of cases (43.1%) were male. It was determined that smoking and alcohol consumption increased as the age of adolescents' age increases. Rate of smoking and alcohol consumption was significantly higher in males compared to females. The mean self-concept scale score of the cases who smoke (52.30±11.01) were found to be lower than the non-smokers (56.07±10.13). The mean social comparison scale score of smoking adolescents' (70.25±23.99) was higher than the non-smokers (69.43±25.47).

CONCLUSION

The social comparison scale scores were found to be higher in adolescents who consume alcohol and smoke tobacco. In contrast to this result self-concept scale scores were low. As a conclusion this study reveals that attitudes such as smoking and alcohol consumption are mostly influenced by self-concept of the adolescents and family attitudes towards adolescents.

The Association between Family Structure and Adolescent Smoking among Multicultural Students in Hawaii

Objective

The purpose of this study was to examine whether the prevalence of smoking was associated with family structure among multicultural adolescents and whether there was gender disparity on the association.

Methods

Data were collected from a sample of 7th graders in Hawaii who completed in-class questionnaires in 2004. The final sample included 821 multicultural students from different family structures. Descriptive analyses, Chi-square tests and logistic regression were performed to examine the prevalence of smoking and the association between family structure and smoking prevalence.

Results

This sample contained students who lived in intact (61.7%), single-parent (16.5%), step-parent (15.6%), and no-parent (6.2%) families. The overall prevalence of ever/lifetime smoking was 24.0%, and was not significantly different between genders in each family structure (P > 0.05). Compared with living in intact families, living in single-parent, step-parent, or no-parent families was significantly associated with higher odds of ever/lifetime smoking among all students (P < 0.05) and living in single-parent and step-parent families was significantly associated with higher odds of ever/lifetime smoking among females (P < 0.05) and among males (P < 0.05) respectively, after adjusting for covariates.

Conclusions

These findings suggest that family structure is a risk factor for smoking among multicultural students. Anti-smoking programs should consider this factor.

•

We examine if family structure is associated with smoking among Hawaii adolescents.

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Adolescents in non-intact families are more likely to smoke than in intact families.

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Males in step-parent families are more likely to smoke than in intact families.

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Females in single-parent families are more likely to smoke than in intact families.

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Family structure is a risk factor of smoking among multicultural adolescents.

Does Parental Divorce Increase Risk Behaviors among 15/16 and 18/19 year-old Adolescents? A Study from Oslo, Norway

BACKGROUND

Several studies have reported an increase in risk behaviors among adolescents after experience of parental divorce. The aim of the study was to investigate whether parental divorce is associated with risk behavior among adolescents independent of mental health problems, first when early divorce was experienced, and second after experience of late parental divorce.

METHOD

One prospective (n=1861) and one cross-sectional study (n=2422) were conducted using data from two Young-HUBRO surveys in Oslo, Norway. All 15/16 year-old 10(th) grade students who participated in the first survey in the school year 2000/01 were followed-up in 2004 when they were 18/19 year-olds. The follow-up rate was 68%. The prospective study investigated the influence of late parental divorce that occurred between the age of 15/16 and 18/19. In the cross-sectional study we focused on early parental divorce that occurred before the participants were 15/16 year-old.

RESULTS

In the prospective study we could not discern a significant association between experiencing late parental divorce and an increase in risk behaviors among 18/19 year-old adolescents. In the cross-sectional study parental divorce was significantly associated with cigarette smoking and using doping agents.

CONCLUSION

Parental divorce that occurs when the children of divorced parents are 15/16 year-old or younger is associated with an increase in cigarette smoking and use of doping agents. However, no evidence of significant association is found between experience of late parental divorce and risk behaviors in late adolescence.

The association of lone-motherhood with smoking cessation and relapse: prospective results from an Australian national study

The aims were to examine the association of lone-motherhood with smoking cessation and relapse, and to investigate the extent to which this association was accounted for by socioeconomic status (education, occupation, and income), social support, and mental health. We used data from 10 yearly waves (2001 to 2010) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Response rate in the first wave was 66%. Logistic regression was used to examine the effect of lone-motherhood and other covariates on smoking cessation (n = 2,878) and relapse (n = 3,242). Results showed that the age-adjusted odds of smoking cessation were 32% smaller among lone mothers than partnered mothers (p = 0.004). The age-adjusted odds of relapse was 172% greater among lone mothers than partnered mothers (p < 0.001). We found that socioeconomic status, social support, and mental health account for some of the association of lone motherhood and cessation and relapse. While efforts to reduce the smoking prevalence among lone mothers should focus on their material deprivation, availability of social support, and addressing mental health issues, other factors unique to the lives of lone mothers also need to be taken into account. More research is needed to discover other factors that can explain the association of lone-motherhood and smoking behavior.

Substance use by adolescents in special education and residential youth care institutions

This study examined substance use rates and related background factors among adolescents in special education (SE) and in residential youth care institutions (RYC). Information on substance use from 531 adolescents in RYC, 603 adolescents in SE for students with behavioral problems (SEB) and 1,905 adolescents in SE for students with learning disabilities (SEL) was compared with information from 7,041 adolescents who attended mainstream education. Results show that substance use rates are particularly high among adolescents in RYC and in SEB. For example, 22% of the 12-13 years old in RYC and 16% in SEB was a daily smoker compared with 1% of their counterparts in mainstream education. Background factors, including age, ethnic background and family situation, partly explained the differences in substance use between mainstream education on the one hand and SE and RYC on the other hand, but differences between the groups remained substantial and significant. Several interaction effects were found in the relation between SE/RYC and substance use that were all in line with the risk paradox: some subgroups that are normally at lower risk for problem behavior are at higher risk when they are subjected to high-risk indicators. The elevated risk of substance use among adolescents in RYC/SE was in some cases particularly marked for those who would normally be at lower risk for substance use (girls in SEB for heavy alcohol drinking and cannabis use, ethnic minority adolescents and adolescents with a stable family situation in RYC for respectively heavy weekly alcohol drinking and daily use of tobacco). Results of this study have important implications for health education and intervention programs for adolescents in RYC and SE.

Adolescent gender differences in the determinants of tobacco smoking: a cross sectional survey among high school students in São Paulo

BACKGROUND

Diverse psychosocial factors have been associated with the use of cigarettes by adolescents. We investigated gender differences in tobacco smoking, and factors correlated with smoking among boys and girls.

METHODS

Data was collected on recent cigarette smoking (CS) and related factors, with a focus on religious beliefs, leisure activities, family structure, relationships and parental monitoring from 2,691 private school-attending youths from 28 schools in São Paulo, Brazil, selected via probability sampling. Estimates were derived via weighted hierarchical logistic regression models.

RESULTS

There was no difference in the prevalence of recent cigarette smoking between boys and girls (14.2%). Older age (aORboys = 1.71[1.33-2.21]; aORgirls = 1.73[1.35-2.23]), second-hand smoke exposure at home (aORboys = 1.52[1.00-2.29]; aORgirls = 1.74[1.13-2.68]) and not having a religion (aORboys = 1.99[1.41-2.81]; aORgirls = 1.78[1.14-2.78]) were associated with CS in boys and girls. Adolescents who went out often at night were more likely to be tobacco smokers (aORboys = 8.82[3.96-19.67]; aORgirls = 14.20[6.64-30.37]). For girls, data suggest that CS was also associated with a lack of parental attention and care (aORgirls = 4.37[1.19-16.04]) and no participation in youth religious activities (aORgirls = 2.76[1.49-5.12]). For boys, CS was additionally associated with the loss of one or both parents (aORboys = 3.75[1.78-7.85]).

CONCLUSIONS

Although older age, living with smokers at home and lack of religion were common contributing factors to cigarette smoking among all adolescents, girls were influenced to a greater degree by family relationships and religiosity than boys. The study results may be materially important to the development of prevention programs that influence determinants connected to gender and the implementation of single-core models of prevention; gender differences must be considered in order to reduce adolescent CS.

The effect of lone motherhood on the smoking behavior of young adults

We provide evidence that living with an unmarried mother during childhood raises smoking propensities for young adults in Germany.

Family structure, parent-child conversation time and substance use among Chinese adolescents

BACKGROUND

The family plays a vital role in shaping adolescent behaviours. The present study investigated the associations between family structure and substance use among Hong Kong Chinese adolescents.

METHODS

A total of 32,961 Form 1 to 5 (grade 7-12 in the US) Hong Kong students participated in the Youth Smoking Survey in 2003-4. An anonymous questionnaire was used to obtain information about family structure, daily duration of parent-child conversation, smoking, alcohol drinking and drug use. Logistic regression was used to calculate the adjusted odds ratios (OR) for each substance use by family structure.

RESULTS

Adjusting for sex, age, type of housing, parental smoking and school, adolescents from non-intact families were significantly more likely to be current smokers (OR = 1.62), weekly drinkers (OR = 1.72) and ever drug users (OR = 1.72), with significant linear increases in ORs from maternal, paternal to no-parent families compared with intact families. Furthermore, current smoking (OR = 1.41) and weekly drinking (OR = 1.46) were significantly more common among adolescents from paternal than maternal families. After adjusting for parent-child conversation time, the ORs for non-intact families remained significant compared with intact families, but the paternal-maternal differences were no longer significant.

CONCLUSIONS

Non-intact families were associated with substance use among Hong Kong Chinese adolescents. The apparently stronger associations with substance use in paternal than maternal families were probably mediated by the poorer communication with the father.

Family structure and adolescent drug use: an exploration of single-parent families

Data from the 2004 Monitoring the Future survey examined a nationally representative cross-sectional sample of 8th to 12th grade adolescents in rural and urban schools from across the United States (N = 37,507). Results found that drug use among daughters living with single fathers significantly exceeded that of daughters living with single mothers, while gender of parent was not associated with sons' usage. This distinction in adolescent drug use between mother-only versus father-only households is largely overlooked in contemporary studies. Factors responsible for variations in sons' and daughters' usage in single-parent families have important implications for future drug prevention efforts.

Social contexts of regular smoking in adolescence: towards a multidimensional ecological model

Using data from the Add Health, this study examined multilevel factors of adolescent smoking after controlling for the baseline smoking behavior and individual characteristics. Results showed that peer, family and school were all important life domains contextually influencing subsequent smoking behavior among adolescents. Time spent with peers, best friend smoking and household member smoking were associated with higher risk. Parent-child closeness, parental control, attending a private school and having a higher percentage of Hispanic students at school were protective factors. Significant interaction effects were found between parental control and household member smoking and between parent-child closeness and communication. None of the neighborhood- and state-level factors were significant in the final full model but they were significant in reduced models. More proximate social contexts appear to play a more direct and immediate role in adolescent smoking than macro-level factors. An ecological model incorporating multiple social systems seems more fruitful than single-system models to reveal etiology of adolescent smoking.

Smoking status of step-parents as a risk factor for smoking in adolescence

AIM

To examine the extent to which smoking by step-parents and biological parents predicts adolescent smoking. DESIGN Five-year cohort study. SETTING Thirty-six schools in South London, England. Participants A subset of 650 students participating in the Health and Behaviour In Teenagers Study (HABITS), who reported living in step-families, were assessed annually from age 11-12 to age 15-16 years.

MEASUREMENTS

Students reported their smoking status, which was cotinine-verified, as well as whether their parents smoked and, if they lived with a step-parent, whether that step-parent smoked. Analyses also controlled for gender, ethnicity and deprivation.

FINDINGS

Students who reported that just their step-parent smoked at age 11-12 were significantly more likely to report current smoking at any time-point from age 11-16 than those who reported having neither biological parents nor a step-parent who smoked [odds ratio (OR) 2.72, 95% confidence interval (CI) = 1.36-5.47], as were those with both a parent and a step-parent who smoked (OR 2.23, 95% CI = 1.46-3.41). While the association between smoking in students and smoking in biological parents in this subsample did not reach statistical significance (OR 1.39, 95% CI = 0.88-2.19), these students were no more or less likely to smoke than those with just a step-parent who smoked.

CONCLUSION

Smoking by a non-biological parent appears at least as influential as smoking by biological parents. This confirms the importance of social influence on smoking initiation and suggests that attempts to work with parents in smoking prevention should involve, and perhaps pay particular attention to, step-parents who smoke.

Family structure and health, how companionship acts as a buffer against ill health

Background

Health and well-being are the result of synergistic interactions among a variety of determinants. Family structure and composition are social determinants that may also affect health behaviours and outcomes. This study was performed to examine the associations between family structure and health and to determine the protective effects of support mechanisms to improve quality of health outcome.

Methods

Six hundred people, selected by multistage sampling to obtain a representative population of men and women aged 20–60 living in communities in Japan, were included in this study. Data regarding subjective views of one's own health, family structure, lifestyle and social support were collected through structured face-to-face interviews on home visits. Systolic and diastolic blood pressures, height and weight were measured by trained examiners. The associations between family structure and health after controlling for demographics, lifestyle and social support were examined using logistic and linear regression analyses.

Results

Subjects living alone were significantly more likely to be in ill health, as determined using the General Health Questionnaire, in comparison to those in extended families (OR = 3.14). Subjects living alone or as couples were significantly more likely to suffer from severe hypertension in comparison to those living in extended families (OR = 8.25, OR = 4.90). These associations remained after controlling for the influence of lifestyle. Subjects living only with spouse or in nuclear family had higher probabilities of mental ill health in the absence than in the presence of people showing concern for their well-being.

Conclusion

The results of this study infers that a support mechanism consisting of companionship and the presence of family or other people concerned for one's well being acts as a buffer against deleterious influence of living in small family that will lead to improved quality of health outcome.

Prevalencia del consumo de tabaco en adolescentes. Influencia del entorno familiar

OBJECTIVE

To determine the prevalence of tobacco use among 12-18 year-olds in Biscay (Spain) and its relation with the family environment.

SUBJECTS AND METHOD

We performed a cross-sectional study in 12-18 year-olds. A self-administered, anonymous questionnaire was distributed in different schools of the region selected by stratified sampling, based on the type of school (public school or subsidized private school) and on the linguistic model. The final study sample comprised 1921 students. Information was obtained on tobacco, alcohol and other drug use, as well as on family and sociodemographic characteristics.

RESULTS

A total of 51.8 % of the students had used tobacco. One-third (29.9%) of the teenagers were current smokers and 50.4% were daily smokers. The mean age of first tobacco use was 13.1 +/- 1.85 years. The prevalence of tobacco use was higher in girls and increased with age until the age of 15-16 years. More than 90 % of smokers had experimented with alcohol, 86.3 % had used cannabis at some time and 11 % had used other illegal drugs. In multivariate analysis, the variables associated with a higher odds of smoking were age, female sex, available money, use of other drugs, and smoking by siblings in front of the adolescent.

CONCLUSIONS

The prevalence of tobacco use among 12-18 year-olds increased in relation to female gender, age, having siblings who smoked in their presence, available money, and the use of alcohol, cannabis and other illicit drugs. Maternal and sibling disapproval of smoking may be associated with lower tobacco use among adolescents.

Parental Smoking and Adolescent Smoking Stages: The Role of Parents’ Current and Former Smoking, and Family Structure

This study examined the role of parents' current and former smoking in predicting adolescent smoking acquisition stages. Participants were 7,426 students from 33 schools in the Netherlands. Participants' survey data were gathered at baseline and at two-year follow-up. Logistic regression models showed that parental smoking status was not only predictive of transitions from never smoking to trying smoking, monthly smoking, or daily smoking, but also of the progression from trying smoking to daily smoking. Further, although parental former smoking was weaker associated with progressive adolescent smoking transitions than current parental smoking, however absence of parental smoking history was most preventive. Compared to the situation in which both parents had never smoked, cessation of parental smoking after the child was born was associated with an increased risk for children to smoke. Adolescents living in a single-parent family were at greater risk of smoking than adolescents living in an intact family with both mother and father. In sum, the role of parental smoking is not restricted to smoking onset and is present throughout different phases of the acquisition process. Results support the delayed modeling hypothesis that parental smoking affects the likelihood for children to smoke even when parents quit many years before. Children living in single-parent families are only exposed to the behaviour of one parent; in two-parent families the behaviour from one parent may magnify or buffer the behaviour of the other parent.

Psychosocial correlates of substance use in adolescence: a cross-national study in six European countries

AIMS

To examine the psychosocial correlates of substance use among adolescents in six European countries.

DESIGN

Cross-sectional school population survey (ESPAD) based on standardized methodological procedures.

SETTING

High schools in six European countries: Bulgaria, Croatia, Greece, Romania, Slovenia and UK.

PARTICIPANTS

Representative samples of a total sample of 16,445 high school students whose 16th birthday fell in the year of data collection.

MEASUREMENTS

Anonymous self-administered questionnaire. Self-reported substance use was measured by core items on tobacco, alcohol, marijuana and any illegal drug use. Psychosocial correlates included scales of self-esteem, depression, anomie and antisocial behavior, and items pertaining to family, school and peers.

FINDINGS

Logistic regression analyses for each potential correlate adjusted for country, taking into account the clustered sample, showed statistically significant associations with each substance use variable separately, in almost every case. Particularly strong associations were found between smoking and going out most evenings and having many friends who smoke, while cannabis and illegal drugs were strongly correlated with having friends or older siblings who used these substances. The self-esteem scale score was not correlated with substance use. Anomie and antisocial behavior were more strongly associated than depression with substance use. In the case of depression, anomie and most of the other items examined, associations were stronger for girls than for boys.

CONCLUSION

The present cross-national study identified correlates of legal and illegal substance use which extend outside specific countries, providing grounds to believe that they can be generalized. They provide evidence for the need to address both the use of the gateway drugs and deviant behavior in conjunction with environmental risk factors when designing and implementing preventive interventions in schools.

[Smoking among adolescents: population study on parental and school influences]

OBJECTIVE

Smoking represents a public health problem, one which begins during adolescence. The main objective of this study was to analyze the association between smoking and parental and school factors.

SUBJECTS AND METHODS

The study sample consisted of the students from the 20 secondary schools in the region of Osona, Barcelona, Spain. A self-report questionnaire was used to obtain information on the following variables: smoking habit, age of initiation, frequency, type of school (state school or private-subsidized), sex, age, persons living in the home, town, whether the student had lunch at school, whether the student often had lunch or dinner alone at home.

RESULTS

A total of 2280 students participated in the study (91%). Mean age was 15.5 years. Of the participants, 20% said they were smokers; 5%, ex-smokers; 34% had tried smoking at least once, and 41% had never smoked. Factors significantly associated with smoking in the multivariate analysis were age, rural town, state school, single parent family, eating alone, and not lunching at school.

CONCLUSIONS

Smoking prevalence is high among adolescents in our society and there is no gender difference. Our results show that family structure and dynamics can influence smoking in adolescents. Smoking is less prevalent among adolescents who have lunch at school.

[Snoring as an sign of sleep disorders in 11- to 15-year-old school children--initial results of a Vienna epidemiologic study]

INTRODUCTION

The prevalence of snoring was evaluated in school children between 11 and 15 years of age. In addition to items reported by parents, children were asked to answer a questionnaire in order to receive information about the children's potential complaints, life style and school performance.

METHOD

The study was performed in 21 randomly selected schools in the Vienna area. 1434 school children were interviewed by a questionnaire (mean age 12.5 years, median 13 years, 676 girls vs. 699 boys). The questionnaire consisted of 45 multiple-choice questions about the socioeconomic status, possible sleep disorders and signs or symptoms of obstructive sleep apneas (OSA). The questionnaire completed by parents was also used to calculate the Brouillette-Score from the items snoring, obstructed breaths and apneas.

RESULTS

5.2% (74/1434) of children and 6.9% (86/1259) of parents or caregivers reported about snoring (frequently or very frequently). There were no sex differences for the children's and the parents' questionnaire. None of the children had a clearly positive result (hint of OSA) from the Brouillette-Score whereas "suspicious OSA" was observed in 3.2% (40/1259). When frequent and very frequent snorers were compared with the other children, more mouth breathing during sleep (p < 0.00001), mouth dryness (p < 0.00005), headache (p < 0.0005), cigarette exposition at home (p < 0.001), smoking (p < 0.005), daytime naps (p < 0.005), crying out of sleep (p < 0.01), daytime tiredness (p < 0.05) und a higher body mass index (p < 0.05) could be observed in this group, in addition to the items reported by the parents.

CONCLUSION

The prevalence of snoring is lower in our study than in other studies. No statistically significant sex differences were observed, both in the parents' and the children's questionnaire. In our study snoring seems to be a sign or symptom of different sleep disorders, and not only of OSA. A statistically significant correlation between snoring and anamnestic hints of sleep disorders underlines the need to ask concerned children themselves for observations potentially associated with sleep disorders. Results of the Brouillette-Score could not be used to identify sleep disorders in our study.