Adolescent tobacco smoking and associated psychosocial health risk factors

Prevalence and factors associated with risky sexual behavior among Brazilian school adolescents

This article evaluated the prevalence and factors associated with risky sexual behavior (RSB) among Brazilian school adolescents. This is a cross-sectional study with data collected from the National Survey of School Health, 2019 edition, with a representative sample of 7th grade of elementary school to 3rd year of high school Brazilian school adolescents. This work evaluated sociodemographic, behavioral, sexual and reproductive health, mental health, sociability characteristics, medical advice received at school, and body image. RSB was characterized as the non-use of a condom during sexual intercourse. The data were analyzed using hierarchical Poisson regression modeling. The prevalence of RSB was of 40.3%, with the lowest proportion appearing in the North region (37.4%). The highest prevalence of RSB was found among female adolescents, whose first sexual intercourse occurred at 13 years of age or under, who were victims of sexual violence, who practiced bullying, and who used illicit drugs, cigarettes, and alcohol. Those who used a condom during their first sexual intercourse showed the lowest prevalence of RSB. The high prevalence of RSB among Brazilian school adolescents, together with the knowledge of the associated factors, serves to define strategies to favor improvements in the sexual and reproductive health of these young people.

Tobacco Use and Its Association with Mental Morbidity and Health Compromising Behaviours in Adolescents in Indonesia

Background:

Limited evidence has been established on associations between tobacco use and mental morbidity and health compromising behaviours. The study aimed to investigate the associations between tobacco use, mental problems, and health risk behaviour among adolescents attending school in Indonesia. Methods: Nationally representative data were studied from 11,124 adolescents that took part in the cross-sectional “Indonesia Global School-Based Student Health Survey (GSHS) in 2015”.

Results:

The prevalence of current tobacco use was 12.8%. In adjusted logistic regression analysis, compared to non-current or never tobacco users, current tobacco use was associated with eight of eight mental problem indicators (lonely, anxiety, no close friend, suicidal ideation, suicide plan, suicide attempt and current alcohol use), two of four dietary risk behaviours (soft drink and fast food consumption) and seven of ten other health risk behaviours (in a physical fight, bullied, injury, ever sex, school truancy, and two sub-optimal hand hygiene behaviours).

Conclusion:

Compared to nontobacco users, current tobacco users had significantly higher mental problem indicators and health risk behaviours. Multiple comorbidity with tobacco use should be targeted in interventions.

Smoking Cessation Failure Among Korean Adolescents

The aim of this study was to identify smoking cessation failure subgroups among Korean adolescents. Participants were 379 smoking adolescents who joined a smoking cessation program. A questionnaire and a cotinine urine test were administered before the program began. Three months after the program ended, the cotinine urine test was repeated. A decision-tree model identified seven subgroups with low or high smoking cessation rates. The predictors of smoking cessation were intention to stop smoking, initiation of smoking, amount of cigarette use, self-efficacy, and paternal smoking status. The subgroup with the lowest smoking cessation rate included adolescents who did not have any intention to stop smoking and who had started smoking after eighth grade, and none of the participants in this group stopped smoking. The results of this study provide crucial information for tailored smoking cessation programs.

Lifestyle behaviors and illness-related factors as predictors of recurrent headache in U.S. adolescents

PURPOSE

This study describes a multivariate model showing how lifestyle behaviors (skipping meals, water intake, tobacco use, alcohol use, and physical activity) and illness-related factors (depression, somatic complaints, insomnia, and obesity) work together to predict headache in an adolescent population.

METHOD

A descriptive, cross-sectional, secondary analysis using survey data from the National Longitudinal Study of Adolescent Health (1996) is reported. The National Longitudinal Study of Adolescent Health is a large database providing a nationally representative sample of adolescents (aged 11-17 years, n = 13,570). The database evaluated adolescent headache and is inclusive of all the predictors specific to this study. Frequency analysis and forward logistic regression were performed using each of the lifestyle behaviors and illness-related factors.

RESULTS

Approximately 26% of the adolescents experienced recurrent headache. Recurrent headache was reported by 19% of male adolescents and 26% of female adolescents. A multivariate model was developed that showed how lifestyle behaviors and illness-related factors predict recurrent headache in adolescents. The final model (Wald F = 86.88, p = .00) consisted of the following predictors: chest pain, muscle and joint pain, skip breakfast three or more times a week, skip lunch one or more times a week, and physical activity. The interactions of gender and age group, race and smoking regularly, and depression and insomnia were also included in the final model.

CONCLUSION

Providing evidence to clinicians that lifestyle behaviors and illness-related factors are associated with adolescent headache may improve overall headache assessment and may result in a more comprehensive plan of treatment.

Tobacco, Nicotine, and Headache

BACKGROUND

Migraineurs variably attribute the cause of their headache to tobacco exposure, whereas tobacco is often stated to cause headache-related disability worldwide. Given tobacco's physiological and emotional addictiveness and migraine's substantial economic impact, improved functionality can be difficult for those with migraine exposed to tobacco products. Environmental tobacco exposure in indoor spaces and workplaces is associated with exacerbation of headache. Avoidance of headache triggers is included in most comprehensive migraine treatment programs, yet tobacco awareness, avoidance, or coping is rarely emphasized as part of that regimen.

OBJECTIVE

The aims of this study were to examine the various types of tobacco products to which headache sufferers are exposed and the known basic mechanisms by which tobacco (nicotine) exposure promotes headache pain, and to review the extensive literature on tobacco related to headache with a detailed descriptive narrative providing the basis for conclusions regarding association of noncluster headache-related tobacco exposure. Tobacco-related recommendations are offered.

METHODS

MEDLINE, EMBASE, and Google Scholar databases were searched without yearly restriction through the date of submission (May 2015), using the MeSH terms "tobacco," "tobacco products," "smoking," "tobacco use," "headache," and "headache disorders." The selection of articles was not limited to English studies or to humans. Articles were excluded when "headache" and "tobacco" were not both mentioned with data provided. Case series were included. Bibliographies of all articles were screened for additional relevant articles.

RESULTS

Although migraineurs worldwide report tobacco smoke among triggers, it is rarely among the highest in frequency, and biases abound with predominantly noncontrolled retrospective data. Prospective population-based diary data are extremely limited, and no controlled trials exist to confirm a cause and effect for headache of any type. Although some studies are nonsupportive and even conflicting, headache, pain, and tobacco exposure currently remain associated.

CONCLUSION

Conflicting data support the validity of patient-reported environmental tobacco exposure as a headache trigger. Prospective controlled studies are needed, but unlikely to be performed, to determine the extent that tobacco influences the headache process, in addition to other under-recognized factors. Meanwhile, because of numerous other negative health effects, decreased tobacco exposure should be recommended to headache patients of all ages in hopes of decreasing disability and improving functionality.

The role of diet and lifestyle in adolescents with headache: a review

Several dietary habits and lifestyles can be associated with different headache types or with their progression to chronic forms. Different population-based studies have tried to investigate this relationship with poor or contradictory results. We shortly reported the current knowledges available in literature in this regard, paying particular attention to the role that certain factors play in modifying frequency and intensity of headache in adults and in adolescents. Future studies are necessary to clarify the real weight which the different factors have in natural history and in clinic evolution of headache, especially in adolescence, but the already known data suggest an important modulating action. If they will be confirmed, these results will be likely to influence clinical practice as well to address educational programs in preadolescents and adolescents.

When Life is a Drag: Depressive Symptoms Associated with Early Adolescent Smoking

Adolescent nicotine use continues to be a significant public health problem. We examined the relationship between the age of youth reporting current smoking and concurrent risk and protective factors in a large state-wide sample. We analyzed current smoking, depressive symptoms, and socio-demographic factors among 4,027 adolescents, ages 12-17 years using multivariate logistic regression (see 2005 California Health Interview Survey (CHIS) Public Use File). Consistent with previous work, Latinos, girls, those whose family incomes were below the poverty level, and those with fair-poor health were more likely to display depressive symptoms. Males, whites, older teens and those in fair-poor health were more likely to be current smokers. In a multivariate analysis predicting depressive symptoms, the interaction between age and current smoking was highly significant (Wald Χ²=15.8, p<.01). At ages 12-14 years, the probability of depressive symptoms was estimated to be four times greater among adolescents who currently smoked, compared to those who were not current smokers. The likelihood of depressive symptoms associated with current smoking decreases with age and becomes non-significant by 17 years. Interventions to reduce smoking may be most useful among youth prior to age 12 years and must be targeted at multiple risks (e.g. smoking and depression).

Smoking among adolescents in Northern Greece: a large cross-sectional study about risk and preventive factors

Background

The aim of the present study was to investigate epidemiological data about cigarette smoking in relation with risk and preventive factors among Greek adolescents.

Methods

We randomly selected 10% of the whole number of schools in Northern Greece (133 schools, 18,904 participants were included). Two anonymous questionnaires (smoker's and non-smoker's) were both distributed to all students so they selected and filled in only one. A parental signed informed consent was obtained using an informative leaflet about adolescent smoking.

Results

The main findings of the study were: a) 14.2% of the adolescents (mean age+/−SD: 15.3+/−1.7 years) reported regular smoking (24.1% in the age group 16–18 years), b) 84.2% of the current smokers reported daily use, c) students who live in urban and semirural areas smoke more frequently than those in rural areas, d) students in technically oriented schools smoke twice as frequent compared to those in general education, e) risk factors for smoking: male gender, low educational level of parents, friends who smoke (OR: 10.01, 95%CI: 8.53-11.74, p<0.001), frequent visits to internet cafes (OR:1.53, 95%CI: 1.35-1.74, p<0.001), parents, siblings (OR:2.24, 95%CI: 1.99-2.51, p<0.001) and favorite artist (OR:1.18, 95%CI: 1.04-1.33, p=0.009) who smoke, f) protective factors against smoking: participation in sports (OR:0.59, 95%CI: 0.53-0.67, p<0.001), watching television (OR:0.74, 95%CI 0.66-0.84, p<0.001) and influence by health warning messages on cigarette packets (OR:0.42, 95%CI: 0.37, 0.48, p<0.001).

Conclusions

Even though prevalence of cigarette smoking is not too high among Greek adolescents, frequency of everyday cigarette use is alarming. We identified many social and lifestyle risk and preventive factors that should be incorporated in a national smoking prevention program among Greek adolescents.

Trends in cigarette use behaviors among adolescents by region in Korea

Objectives

Understanding recent trends in cigarette smoking among adolescents is important in order to develop strategies to prevent cigarette smoking. The aim of this study was to compare recent trends in cigarette smoking for adolescents living in rural areas, small towns and metropolitan cities in Korea.

Methods

The raw data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2005 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Logistic regression models were used to evaluate significant linear time trends in cigarette smoking. The indicators of cigarette use behaviors were 'current smoking rate', 'frequent smoking rate', 'heavy smoking rate' and 'smoking experience rate before 13 years of age'. All analyses were conducted according to gender.

Results

Statistically significant increasing trends in current smoking rate and frequent smoking rate were observed and borderline significant increasing trends in heavy smoking rate were shown among rural boys. Among metropolitan city boys, statistically significant increasing trends were also seen for frequent smoking. Statistically significant decreasing trends in current smoking rate were observed among small town and metropolitan city girls. Smoking experience rate before 13 years of age for rural girls decreased significantly.

Conclusions

Cigarette smoking prevalence among adolescents in the rural areas has increased in the last five years especially among boys. Our findings suggest that anti-tobacco program for adolescents should be conducted primarily for those in rural areas.

Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study

BACKGROUND

Diet and lifestyle are seen as factors which influence headache in adults. However, population-based studies on this issue in adolescents are rare.

OBJECTIVE

Aim of the present study was to investigate associations between diet and lifestyle factors and different types of headache, ie, migraine and tension-type headache (TTH) in adolescents.

METHODS

A total of 1260 adolescents from the 10th and 11th grades of high schools filled in questionnaires on intake of meals, coffee, nonalcoholic and alcoholic drinks, smoking, and physical activity. Type of headache was classified according to the International Classification of Headache Disorders - 2nd edition. Multiple logistic regression models, adjusted for sex and grade, were calculated.

RESULTS

High consumption of cocktails (odds ratio = 3.4; 95% confidence interval 1.9-6.0) and coffee (2.4; 1.3-4.7), smoking (2.7; 1.4-5.1), and lack of physical activity (2.2; 1.3-3.7) were significantly associated with migraine plus TTH episodes, consumption of coffee and physical inactivity particularly with migraine (3.4; 1.6-7.0 and 4.2; 2.2-7.9, respectively) and physical inactivity with TTH (1.7; 1.1-2.7). Skipping of meals or insufficient fluid intake were not associated with any type of headache.

CONCLUSIONS

Adolescents with any type of headache might benefit from regular physical activity and low consumption of alcoholic drinks, while for migraine patients a low consumption of coffee should additionally be recommended. Intervention studies are warranted to assess whether psycho-educational programs conferring knowledge of these associations will influence headache-triggering behavior and headache in adolescents.

When do adolescents become smokers? Annual seven-year population-based follow-up of tobacco habits among 2000 Swedish pupils--an open cohort study

OBJECTIVE

To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys.

SETTING

Kronoberg County in southern Sweden.

SUBJECTS

All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18.

DESIGN

Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom.

MAIN OUTCOME MEASURES

Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff.

RESULTS

From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls.

CONCLUSION

Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.

Risk-taking behaviour is more frequent in teenage girls with multiple sexual partners

OBJECTIVE

To investigate associations between sexual behaviour and risk-taking health behaviour among adolescent females in our changing sexual culture.

DESIGN

A questionnaire study. Girls who had had multiple sexual partners (at least five in their lifetime or four during the last six months) were compared with those with fewer partners. Logistic regression was applied.

SETTING

The Adolescent Clinic, a primary healthcare unit in the city of Tampere, Finland.

SUBJECTS

A sample of 247 female clients aged 15-18 years who had experienced sexual intercourse.

MAIN OUTCOME MEASURES

Contraceptive practices, substance use, and sexual attitudes.

RESULTS

Girls with multiple sexual partners (n = 69) and the reference group (n = 178) did not differ from each other significantly by age, age at menarche, or educational status. In univariate analysis, age at sexual debut, contraceptive practices, and various substance uses were strongly associated with having multiple sexual partners. Ever-use of emergency contraception was marginally associated, while ever-use of conventional hormonal contraception or condoms was not. In multivariate analysis, low age at sexual debut (OR 8.75 for age 11-13), omitting contraception at the most recent intercourse (OR 3.48), ever-use of withdrawal as a contraceptive method (OR 2.34), and repeated use of drugs (OR 4.10) were associated with having multiple sexual partners.

CONCLUSION

Different types of risk-taking behaviour are still interlinked. In discussions with adolescents showing one type of risk behaviour health service providers should make an effort to identify other modes of risk-taking.

Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK women

The world age-standardised prevalence of high-risk HPV (hrHPV) infection among 5038 UK women aged 20–59 years, with a low-grade smear during 1999–2002, assessed for eligibility for TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) was 34.2%. High-risk HPV prevalence decreased with increasing age, from 61% at ages 20–24 years to 14–15% in those over 50 years. The age-standardised prevalence was 15.1, 30.7 and 52.7%, respectively, in women with a current normal, borderline nuclear abnormalities (BNA) and mild smear. In overall multivariate analyses, tertiary education, previous pregnancy and childbirth were associated with reduced hrHPV infection risk. Risk of infection was increased in non-white women, women not married/cohabiting, hormonal contraceptives users and current smokers. In stratified analyses, current smear status and age remained associated with hrHPV infection. Data of this type are relevant to the debate on human papillomavirus (HPV) testing in screening and development of HPV vaccination programmes.

Nicotine dependence and self-esteem in adolescents with mental disorders

Recent studies in adolescents have found a weak association between lower self-esteem and smoking. However, this association has not been investigated in a psychiatric setting. In 223 inpatient adolescents [140 girls (16.5 years) and 83 boys (16.4 years)], self-esteem was measured with Coopersmith's self-esteem inventory (SEI), and smoking dependence with the Fagerström Test for Nicotine Dependence (FTND). DSM-IV categories included major depression (n=35), anxiety disorders (n=35), psychotic disorders (n=31), eating disorders (n=9), and conduct disorders (n=113). There were 101 smokers and 122 nonsmokers. Self-esteem scores were lower in smokers than in nonsmokers (p=0.039). Self-esteem scores were very significantly lower in smokers showing moderate or high nicotine dependence (i.e., FTND score>or=4) when compared with nonsmokers (p=0.002). Smoking with moderate or high nicotine dependence was associated with lower self-esteem in both girls and boys, whereas smoking with no or low nicotine dependence was associated with lower self-esteem only in girls. Smoking was associated with lower self-esteem in all diagnostic categories, except in eating disorders. Interventions targeted on self-esteem might be used to prevent smoking in adolescents with mental disorders.

Epidemiology and etiology of adolescent smoking

PURPOSE OF REVIEW

Despite the socioeconomic and personal health costs directly attributed to smoking, over one-half of high school seniors have used cigarettes, and over 15% of seniors are daily smokers. This review summarizes the recent research concerning the psychosocial and physiologic risk and protective factors associated with adolescent smoking.

RECENT FINDINGS

Studies of the psychosocial risk factors have added to the evidence that stress, peers and family influences, ethnicity, and depression all serve as risk factors for the development and maintenance of smoking in adolescents. Protective factors include parental expectations and monitoring, religious activity, and sociopolitical factors, such as tobacco-related marketing bans and higher cigarette taxes. Adolescent smoking trajectories have been further defined and can be used to classify smokers in terms of dependence symptoms. Finally, neurobiological research has focused to a large extent on the concept of disinhibition as a risk factor for smoking in adolescents.

SUMMARY

While rates of smoking in adolescents have declined since 1997, millions of adolescents initiate or continue smoking each year, with deleterious health and psychosocial consequences. Research into the risk and protective factors for adolescent smoking, particularly that which ties psychosocial and neurobiological factors together, is necessary to inform the development of tailored and maximally efficacious treatments for this population.